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IBRC1410B.TXT
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IBRC1410B.TXT
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Version 3.15 Update - Outpatient Facility,,,,,,,,,,,,,
,,,,,,,,,,,,,
Item Code,Code Type,Description,Modifier,Service Category Code,Multiple Surgery Indicator,Primary/Pass-Through Indicator,Unit Charge,Base Charge,Unit Type,Inpatient Indicator,Skilled Nursing Facility Indicator,Start Date,End Date
10021,CPT,FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE,,30,,,$534.52 ,$0.00 ,1,0,1,20141001,
10022,CPT,FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE,,30,,,"$2,339.13 ",$0.00 ,1,0,1,20141001,
10030,CPT,IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE,,30,,,$874.39 ,$0.00 ,1,0,1,20141001,
10040,CPT,ACNE SURGERY,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
10060,CPT,INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,,30,,,$880.36 ,$0.00 ,1,0,1,20141001,
10061,CPT,INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE,,30,,,$880.36 ,$0.00 ,1,0,1,20141001,
10080,CPT,INCISION & DRAINAGE PILONIDAL CYST SIMPLE,,30,,,$880.36 ,$0.00 ,1,0,1,20141001,
10081,CPT,INCISION & DRAINAGE PILONIDAL CYST COMPLICATED,,30,,,"$4,924.22 ",$0.00 ,1,0,1,20141001,
10120,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
10121,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
10140,CPT,I&D HEMATOMA SEROMA/FLUID COLLECTION,,30,,,"$4,924.22 ",$0.00 ,1,0,1,20141001,
10160,CPT,PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,,30,,,$880.36 ,$0.00 ,1,0,1,20141001,
10180,CPT,INCISION & DRAINAGE COMPLEX PO WOUND INFECTION,,30,,,"$8,819.75 ",$0.00 ,1,0,1,20141001,
11000,CPT,DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
11001,CPT,DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF,,30,,,$350.70 ,$0.00 ,1,0,1,20141001,
11010,CPT,DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11011,CPT,DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11012,CPT,DBRDMT FX&/DISLC SUBQ T/M/F BONE,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11042,CPT,DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
11043,CPT,DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
11044,CPT,DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11045,CPT,DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM,,30,,,"$1,039.81 ",$0.00 ,1,0,1,20141001,
11046,CPT,DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM,,30,,,"$1,663.70 ",$0.00 ,1,0,1,20141001,
11047,CPT,DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,,30,,,"$2,495.54 ",$0.00 ,1,0,1,20141001,
11055,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11056,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11057,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
11100,CPT,BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
11101,CPT,BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN,,30,,,$291.15 ,$0.00 ,1,0,1,20141001,
11200,CPT,REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11201,CPT,REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10,,30,,,$350.70 ,$0.00 ,1,0,1,20141001,
11300,CPT,SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/<,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11301,CPT,SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11302,CPT,SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11303,CPT,SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
11305,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11306,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11307,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11308,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
11310,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11311,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11312,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
11313,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
11400,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11401,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11402,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 1.1-2.0 CM,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11403,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 2.1-3.0 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11404,CPT,EXC B9 LES MRGN XCP SK TG T/A/L 3.1-4.0 CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
11406,CPT,EXC B9 LES MRGN XCP SK TG T/A/L >4.0 CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
11420,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11421,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11422,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11423,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
11424,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
11426,CPT,EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11440,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11441,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11442,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11443,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11444,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11446,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11450,CPT,EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11451,CPT,EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11462,CPT,EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11463,CPT,EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11470,CPT,EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11471,CPT,EXCISION H/P/P/U COMPLEX REPAIR,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11600,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11601,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11602,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11603,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11604,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11606,CPT,EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
11620,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11621,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11622,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11623,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11624,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
11626,CPT,EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11640,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11641,CPT,EXCISION MALIGNANT LES F/E/E/N/L 0.6-1.0 CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11642,CPT,EXCISION MALIGNANT LES F/E/E/N/L 1.1-2.0 CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11643,CPT,EXCISION MALIGNANT LES F/E/E/N/L 2.1-3.0 CM/<,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
11644,CPT,EXCISION MALIGNANT LES F/E/E/N/L 3.1-4.0 CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
11646,CPT,EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11719,CPT,TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,,30,,,$175.13 ,$0.00 ,1,0,1,20141001,
11720,CPT,DEBRIDEMENT NAIL ANY METHOD 1-5,,30,,,$175.13 ,$0.00 ,1,0,1,20141001,
11721,CPT,DEBRIDEMENT NAIL ANY METHOD 6/>,,30,,,$175.13 ,$0.00 ,1,0,1,20141001,
11730,CPT,AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
11732,CPT,AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,,30,,,$350.70 ,$0.00 ,1,0,1,20141001,
11740,CPT,EVACUATION SUBUNGUAL HEMATOMA,,30,,,$175.13 ,$0.00 ,1,0,1,20141001,
11750,CPT,EXCISION NAIL MATRIX PERMANENT REMOVAL,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11752,CPT,EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11755,CPT,BIOPSY NAIL UNIT SEPARATE PROCEDURE,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11760,CPT,REPAIR NAIL BED,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
11762,CPT,RECONSTRUCTION NAIL BED W/GRAFT,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
11765,CPT,WEDGE EXCISION SKIN NAIL FOLD,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11770,CPT,EXCISION PILONIDAL CYST/SINUS SIMPLE,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11771,CPT,EXCISION PILONIDAL CYST/SINUS EXTENSIVE,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11772,CPT,EXCISION PILONIDAL CYST/SINUS COMPLICATED,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11900,CPT,INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11901,CPT,INJECTION INTRALESIONAL >7 LESIONS,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
11920,CPT,TATTOOING INCL MICROPIGMENTATION 6.0 CM/<,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
11921,CPT,TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
11922,CPT,TATTOOING INCL MICROPIGMENTATION EA 20.0 CM,,30,,,"$1,798.29 ",$0.00 ,1,0,1,20141001,
11950,CPT,SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
11951,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
11952,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
11954,CPT,SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
11960,CPT,INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
11970,CPT,REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
11971,CPT,REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
11976,CPT,REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
11980,CPT,SUBCUTANEOUS HORMONE PELLET IMPLANTATION,,30,,,$451.36 ,$0.00 ,1,0,1,20141001,
11981,CPT,INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,30,,,$451.36 ,$0.00 ,1,0,1,20141001,
11982,CPT,REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,30,,,$451.36 ,$0.00 ,1,0,1,20141001,
11983,CPT,RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,,30,,,$451.36 ,$0.00 ,1,0,1,20141001,
12001,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12002,CPT,SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12004,CPT,SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12005,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12006,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12007,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12011,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12013,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12014,CPT,SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12015,CPT,SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12016,CPT,SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12017,CPT,SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12018,CPT,SIMPLE REPAIR F/E/E/N/L/M >30.0 CM,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
12020,CPT,TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
12021,CPT,TX SUPERFICIAL WOUND DEHISCENCE W/PACKING,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12031,CPT,REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12032,CPT,REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12034,CPT,REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12035,CPT,REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
12036,CPT,REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
12037,CPT,REPAIR INTERMEDIATE S/A/T/E >30.0 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
12041,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12042,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12044,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12045,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12046,CPT,RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12047,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
12051,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12052,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12053,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12054,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12055,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12056,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
12057,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
13100,CPT,REPAIR COMPLEX TRUNK 1.1-2.5 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
13101,CPT,REPAIR COMPLEX TRUNK 2.6-7.5 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
13102,CPT,REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<,,30,,,"$1,477.60 ",$0.00 ,1,0,1,20141001,
13120,CPT,REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
13121,CPT,REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
13122,CPT,REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<,,30,,,$755.39 ,$0.00 ,1,0,1,20141001,
13131,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
13132,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
13133,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
13151,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
13152,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
13153,CPT,REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
13160,CPT,SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14000,CPT,ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14001,CPT,ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14020,CPT,ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14021,CPT,ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14040,CPT,ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14041,CPT,ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14060,CPT,ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14061,CPT,ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
14301,CPT,ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
14302,CPT,ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<,,30,,,"$6,114.22 ",$0.00 ,1,0,1,20141001,
14350,CPT,FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15002,CPT,PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
15003,CPT,PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT,,30,,,"$3,001.82 ",$0.00 ,1,0,1,20141001,
15004,CPT,PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
15005,CPT,PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT,,30,,,"$3,001.82 ",$0.00 ,1,0,1,20141001,
15040,CPT,HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
15050,CPT,PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
15100,CPT,SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15101,CPT,SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,30,,,"$6,210.68 ",$0.00 ,1,0,1,20141001,
15110,CPT,EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHL,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15111,CPT,EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,30,,,"$3,001.82 ",$0.00 ,1,0,1,20141001,
15115,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15116,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/<,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
15120,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15121,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %,,30,,,"$6,210.68 ",$0.00 ,1,0,1,20141001,
15130,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15131,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA,,30,,,"$4,531.10 ",$0.00 ,1,0,1,20141001,
15135,CPT,DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15136,CPT,DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA,,30,,,"$5,706.61 ",$0.00 ,1,0,1,20141001,
15150,CPT,CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15151,CPT,CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
15152,CPT,CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
15155,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15156,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
15157,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
15200,CPT,FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15201,CPT,FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CM/<,,30,,,"$4,891.38 ",$0.00 ,1,0,1,20141001,
15220,CPT,FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15221,CPT,FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<,,30,,,"$3,001.82 ",$0.00 ,1,0,1,20141001,
15240,CPT,FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15241,CPT,FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<,,30,,,"$1,553.63 ",$0.00 ,1,0,1,20141001,
15260,CPT,FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15261,CPT,FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/<,,30,,,"$4,891.38 ",$0.00 ,1,0,1,20141001,
15271,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM /<1ST 25,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15272,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM EA ADL 25SC,,30,,,$406.75 ,$0.00 ,1,0,1,20141001,
15273,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM 1ST 100SCM,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15274,CPT,APP SKN SUB GRFT T/A/L AREA/100SCM ADL 100SCM,,30,,,$836.57 ,$0.00 ,1,0,1,20141001,
15275,CPT,SUB GRFT F/S/N/H/F/G/M/D <100SCM 1ST 25 SCM,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15276,CPT,SUB GRFT F/S/N/H/F/G/M/D <100SCM EA ADDL 25 SCM,,30,,,$406.75 ,$0.00 ,1,0,1,20141001,
15277,CPT,SUB GRFT F/S/N/H/F/G/M/D </= 100SCM 1ST 100SCM,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15278,CPT,SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SCM,,30,,,$836.57 ,$0.00 ,1,0,1,20141001,
15570,CPT,FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15572,CPT,FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15574,CPT,FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15576,CPT,FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15600,CPT,DELAY FLAP/SECTIONING FLAP TRUNK,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15610,CPT,DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15620,CPT,DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15630,CPT,DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15650,CPT,TRANSFER ANY PEDICLE FLAP ANY LOCATION,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15731,CPT,FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15732,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NC,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15734,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15736,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15738,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15740,CPT,FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15750,CPT,FLAP NEUROVASCULAR PEDICLE,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15760,CPT,GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15770,CPT,GRAFT DERMA-FAT-FASCIA,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15775,CPT,PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
15776,CPT,PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS,,30,,,"$1,231.71 ",$0.00 ,1,0,1,20141001,
15777,CPT,IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,,30,,,"$4,531.10 ",$0.00 ,1,0,1,20141001,
15780,CPT,DERMABRASION TOTAL FACE,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15781,CPT,DERMABRASION SEGMENTAL FACE,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
15782,CPT,DERMABRASION REGIONAL OTHER THAN FACE,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
15783,CPT,DERMABRASION SUPERFICIAL ANY SITE,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
15786,CPT,ABRASION 1 LESION,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
15787,CPT,ABRASION EACH ADDITIONAL 4 LESIONS OR LESS,,30,,,$269.77 ,$0.00 ,1,0,1,20141001,
15788,CPT,CHEMICAL PEEL FACIAL EPIDERMAL,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
15789,CPT,CHEMICAL PEEL FACIAL DERMAL,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
15792,CPT,CHEMICAL PEEL NONFACIAL EPIDERMAL,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
15793,CPT,CHEMICAL PEEL NONFACIAL DERMAL,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
15819,CPT,CERVICOPLASTY,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15820,CPT,BLEPHAROPLASTY LOWER EYELID,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15821,CPT,BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15822,CPT,BLEPHAROPLASTY UPPER EYELID,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15823,CPT,BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15824,CPT,RHYTIDECTOMY FOREHEAD,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15825,CPT,RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15826,CPT,RHYTIDECTOMY GLABELLAR FROWN LINES,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15828,CPT,RHYTIDECTOMY CHEEK CHIN & NECK,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15829,CPT,RHYTIDECTOMY SMAS FLAP,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15830,CPT,EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY,,30,,,"$18,896.92 ",$0.00 ,1,0,1,20141001,
15832,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15833,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15834,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15835,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15836,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
15837,CPT,EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
15838,CPT,EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
15839,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
15840,CPT,GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15841,CPT,GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15842,CPT,GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15845,CPT,GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15847,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN,,30,,,"$6,814.76 ",$0.00 ,1,0,1,20141001,
15850,CPT,REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
15851,CPT,REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
15852,CPT,DRESSING CHANGE UNDER ANESTHESIA,,30,,,$451.36 ,$0.00 ,1,0,1,20141001,
15860,CPT,IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT,,30,,,$451.36 ,$0.00 ,1,0,1,20141001,
15876,CPT,SUCTION ASSISTED LIPECTOMY HEAD & NECK,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15877,CPT,SUCTION ASSISTED LIPECTOMY TRUNK,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15878,CPT,SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15879,CPT,SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15920,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
15922,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15931,CPT,EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15933,CPT,EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15934,CPT,EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15935,CPT,EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15936,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15937,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15940,CPT,EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15941,CPT,EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15944,CPT,EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15945,CPT,EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
15946,CPT,EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15950,CPT,EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15951,CPT,EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
15952,CPT,EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15953,CPT,EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15956,CPT,EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
15958,CPT,EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
15999,CPT,UNLISTED PROCEDURE EXCISION PRESSURE ULCER,,30,,,"$1,776.44 ",$0.00 ,1,0,1,20141001,
16000,CPT,INITIAL TX 1ST DEGREE BURN LOCAL TX,,30,,,$175.13 ,$0.00 ,1,0,1,20141001,
16020,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
16025,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
16030,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
16035,CPT,ESCHAROTOMY FIRST INCISION,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17000,CPT,DESTRUCTION PREMALIGNANT LESION 1ST,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
17003,CPT,DESTRUCTION PREMALIGNANT LESION 2-14 EA,,30,,,$110.67 ,$0.00 ,1,0,1,20141001,
17004,CPT,DESTRUCTION PREMALIGNANT LESION 15/>,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17106,CPT,DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17107,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17108,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17110,CPT,DESTRUCTION BENIGN LESIONS UP TO 14,,30,,,$514.85 ,$0.00 ,1,0,1,20141001,
17111,CPT,DESTRUCTION BENIGN LESIONS 15/>,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17250,CPT,CHEMICAL CAUTERIZATION GRANULATION TISSUE,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17260,CPT,DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17261,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17262,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17263,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17264,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17266,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG < 4.0 CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17270,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/>,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17271,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17272,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17273,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17274,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17276,CPT,DSTRJ MAL LES S/N/H/F/G LES DIAM > 4.0 CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17280,CPT,DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17281,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17282,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17283,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17284,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17286,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM,,30,,,"$1,539.42 ",$0.00 ,1,0,1,20141001,
17311,CPT,MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS,,30,,,"$2,334.29 ",$0.00 ,1,0,1,20141001,
17312,CPT,MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE,,30,,,"$1,501.45 ",$0.00 ,1,0,1,20141001,
17313,CPT,MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS,,30,,,"$2,334.29 ",$0.00 ,1,0,1,20141001,
17314,CPT,MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE,,30,,,"$1,501.45 ",$0.00 ,1,0,1,20141001,
17315,CPT,MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE,,30,,,"$1,501.45 ",$0.00 ,1,0,1,20141001,
17340,CPT,CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE,,30,,,$175.13 ,$0.00 ,1,0,1,20141001,
17360,CPT,CHEMICAL EXFOLIATION ACNE,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17380,CPT,ELECTROLYSIS EPILATION EACH 30 MINUTES,,30,,,$530.00 ,$0.00 ,1,0,1,20141001,
17999,CPT,UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE,,30,,,$175.13 ,$0.00 ,1,0,1,20141001,
19000,CPT,PUNCTURE ASPIRATION CYST BREAST,,30,,,"$2,339.13 ",$0.00 ,1,0,1,20141001,
19001,CPT,PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST,,30,,,$605.95 ,$0.00 ,1,0,1,20141001,
19020,CPT,MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP,,30,,,"$8,819.75 ",$0.00 ,1,0,1,20141001,
19030,CPT,INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM,,30,,,$717.70 ,$0.00 ,1,0,1,20141001,
19081,CPT,BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE,,30,,,"$4,058.34 ",$0.00 ,1,0,1,20141001,
19083,CPT,BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE,,30,,,"$4,058.34 ",$0.00 ,1,0,1,20141001,
19085,CPT,BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE,,30,,,"$4,058.34 ",$0.00 ,1,0,1,20141001,
19100,CPT,BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX,,30,,,"$2,339.13 ",$0.00 ,1,0,1,20141001,
19101,CPT,BIOPSY BREAST OPEN INCISIONAL,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19105,CPT,ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19110,CPT,NIPPLE EXPLORATION,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19112,CPT,EXCISION LACTIFEROUS DUCT FISTULA,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19120,CPT,EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19125,CPT,EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19126,CPT,EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL,,30,,,"$7,427.85 ",$0.00 ,1,0,1,20141001,
19260,CPT,EXCISION CHEST WALL TUMOR INCLUDING RIBS,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
19281,CPT,PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE,,30,,,$460.61 ,$0.00 ,1,0,1,20141001,
19283,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID,,30,,,$460.61 ,$0.00 ,1,0,1,20141001,
19285,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,,30,,,$460.61 ,$0.00 ,1,0,1,20141001,
19287,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID,,30,,,$460.61 ,$0.00 ,1,0,1,20141001,
19296,CPT,PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST,,30,,,"$20,961.01 ",$0.00 ,1,0,1,20141001,
19297,CPT,PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST,,30,,,"$20,961.01 ",$0.00 ,1,0,1,20141001,
19298,CPT,PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST,,30,,,"$20,961.01 ",$0.00 ,1,0,1,20141001,
19300,CPT,MASTECTOMY GYNECOMASTIA,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19301,CPT,MASTECTOMY PARTIAL,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19302,CPT,MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY,,30,,,"$18,896.92 ",$0.00 ,1,0,1,20141001,
19303,CPT,MASTECTOMY SIMPLE COMPLETE,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19304,CPT,MASTECTOMY SUBCUTANEOUS,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19307,CPT,MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN,,30,,,"$18,896.92 ",$0.00 ,1,0,1,20141001,
19316,CPT,MASTOPEXY,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19318,CPT,REDUCTION MAMMAPLASTY,,30,,,"$18,896.92 ",$0.00 ,1,0,1,20141001,
19324,CPT,MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT,,30,,,"$18,896.92 ",$0.00 ,1,0,1,20141001,
19325,CPT,MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT,,30,,,"$20,961.01 ",$0.00 ,1,0,1,20141001,
19328,CPT,REMOVAL INTACT MAMMARY IMPLANT,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19330,CPT,REMOVAL MAMMARY IMPLANT MATERIAL,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19340,CPT,IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,30,,,"$18,896.92 ",$0.00 ,1,0,1,20141001,
19342,CPT,DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,30,,,"$20,961.01 ",$0.00 ,1,0,1,20141001,
19350,CPT,NIPPLE/AREOLA RECONSTRUCTION,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
19355,CPT,CORRECTION INVERTED NIPPLES,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19357,CPT,BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ,,30,,,"$20,961.01 ",$0.00 ,1,0,1,20141001,
19366,CPT,BREAST RECONSTRUCTION OTHER TECHNIQUE,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19370,CPT,OPEN PERIPROSTHETIC CAPSULOTOMY BREAST,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19371,CPT,PERIPROSTHETIC CAPSULECTOMY BREAST,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19380,CPT,REVISION RECONSTRUCTED BREAST,,30,,,"$18,896.92 ",$0.00 ,1,0,1,20141001,
19396,CPT,PREPARATION MOULAGE CUSTOM BREAST IMPLANT,,30,,,"$15,243.64 ",$0.00 ,1,0,1,20141001,
19499,CPT,UNLISTED PROCEDURE BREAST,,30,,,"$11,351.65 ",$0.00 ,1,0,1,20141001,
20005,CPT,I&D SOFT TISSUE ABSCESS SUBFASC,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
20100,CPT,EXPLORATION PENETRATING WOUND SPX NECK,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
20101,CPT,EXPLORATION PENETRATING WOUND SPX CHEST,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
20102,CPT,EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
20103,CPT,EXPLORATION PENETRATING WOUND SPX EXTREMITY,,30,,,"$4,924.22 ",$0.00 ,1,0,1,20141001,
20150,CPT,EXCISION EPIPHYSEAL BAR,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
20200,CPT,BIOPSY MUSCLE SUPERFICIAL,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
20205,CPT,BIOPSY MUSCLE DEEP,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
20206,CPT,BIOPSY MUSCLE PERCUTANEOUS NEEDLE,,30,,,"$4,713.32 ",$0.00 ,1,0,1,20141001,
20220,CPT,BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
20225,CPT,BIOPSY BONE TROCAR/NEEDLE DEEP,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
20240,CPT,BIOPSY BONE OPEN SUPERFICIAL,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
20245,CPT,BIOPSY BONE OPEN DEEP,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
20250,CPT,BIOPSY VERTEBRAL BODY OPEN THORACIC,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20251,CPT,BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20500,CPT,INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
20501,CPT,INJECTION SINUS TRACT DIAGNOSTIC,,30,,,"$1,180.26 ",$0.00 ,1,0,1,20141001,
20520,CPT,REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
20525,CPT,RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
20526,CPT,INJECTION THERAPEUTIC CARPAL TUNNEL,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20527,CPT,INJECTION ENZYME PALMAR FASCIAL CORD,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20550,CPT,INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20551,CPT,INJECTION SINGLE TENDON ORIGIN/INSERTION,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20552,CPT,INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20553,CPT,INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20555,CPT,PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20600,CPT,ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20605,CPT,ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURS,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20610,CPT,ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20612,CPT,ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ,,30,,,$914.18 ,$0.00 ,1,0,1,20141001,
20615,CPT,ASPIRATION & INJECTION TREATMENT BONE CYST,,30,,,"$2,339.13 ",$0.00 ,1,0,1,20141001,
20650,CPT,INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20660,CPT,APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX,,30,,,"$2,594.96 ",$0.00 ,1,0,1,20141001,
20662,CPT,APPLICATION HALO PELVIC INCLUDING REMOVAL,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
20663,CPT,APPLICATION HALO FEMORAL INCLUDING REMOVAL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20665,CPT,REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL,,30,,,$451.36 ,$0.00 ,1,0,1,20141001,
20670,CPT,REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
20680,CPT,REMOVAL IMPLANT DEEP,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
20690,CPT,APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20692,CPT,APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20693,CPT,ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20694,CPT,REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
20696,CPT,XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20697,CPT,XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT,,30,,,"$2,594.96 ",$0.00 ,1,0,1,20141001,
20822,CPT,RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP,,30,,,"$12,276.96 ",$0.00 ,1,0,1,20141001,
20900,CPT,BONE GRAFT ANY DONOR AREA MINOR/SMALL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20902,CPT,BONE GRAFT ANY DONOR AREA MAJOR/LARGE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20910,CPT,CARTILAGE GRAFT COSTOCHONDRAL,,30,,,"$2,366.57 ",$0.00 ,1,0,1,20141001,
20912,CPT,CARTILAGE GRAFT NASAL SEPTUM,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
20920,CPT,FASCIA LATA GRAFT BY STRIPPER,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
20922,CPT,FASCIA LATA GRAFT INCISION & AREA EXPOSURE,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
20924,CPT,TENDON GRAFT FROM A DISTANCE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
20926,CPT,TISSUE GRAFTS OTHER,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
20930,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED,,30,,,"$4,186.68 ",$0.00 ,1,0,1,20141001,
20931,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL,,30,,,"$4,557.69 ",$0.00 ,1,0,1,20141001,
20950,CPT,MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME,,30,,,$880.36 ,$0.00 ,1,0,1,20141001,
20972,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL,,30,,,"$20,968.71 ",$0.00 ,1,0,1,20141001,
20973,CPT,FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE,,30,,,"$20,968.71 ",$0.00 ,1,0,1,20141001,
20979,CPT,LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE,,30,,,$308.18 ,$0.00 ,1,0,1,20141001,
20982,CPT,ABLATION BONE TUMOR RF PERCUTANEOUS CT GUIDANCE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
20985,CPT,CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,,30,,,"$1,915.25 ",$0.00 ,1,0,1,20141001,
20999,CPT,UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
21010,CPT,ARTHROTOMY TEMPOROMANDIBULAR JOINT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21011,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
21012,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
21013,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
21014,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
21015,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
21016,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/<,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21025,CPT,EXCISION BONE MANDIBLE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21026,CPT,EXCISION FACIAL BONE,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21029,CPT,REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21030,CPT,EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21031,CPT,EXCISION TORUS MANDIBULARIS,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21032,CPT,EXCISION MAXILLARY TORUS PALATINUS,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21034,CPT,EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21040,CPT,EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21044,CPT,EXCISION MALIGNANT TUMOR MANDIBLE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21046,CPT,EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21047,CPT,EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21048,CPT,EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21049,CPT,EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21050,CPT,CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21060,CPT,MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21070,CPT,CORONOIDECTOMY SEPARATE PROCEDURE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21073,CPT,MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21076,CPT,IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21077,CPT,IMPRESSION & PREPARATION ORBITAL PROSTHESIS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21079,CPT,IMPRESSION & PREPARATION INTERIM OBTURATOR PROST,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21080,CPT,IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21081,CPT,IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21082,CPT,IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21083,CPT,IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21084,CPT,IMPRESSION & PREPARATION SPEECH AID PROSTHESIS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21085,CPT,IMPRESSION & PREPARATION ORAL SURGICAL SPLINT,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
21086,CPT,IMPRESSION & PREPARATION AURICULAR PROSTHESIS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21087,CPT,IMPRESSION & PREPARATION NASAL PROSTHESIS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21088,CPT,IMPRESSION & PREPARATION FACIAL PROSTHESIS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21089,CPT,UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE,,30,,,$541.32 ,$0.00 ,1,0,1,20141001,
21100,CPT,APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21110,CPT,APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
21116,CPT,INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY,,30,,,$979.50 ,$0.00 ,1,0,1,20141001,
21120,CPT,GENIOPLASTY AUGMENTATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21121,CPT,GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21122,CPT,GENIOPLASTY 2/> SLIDING OSTEOTOMIES,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21123,CPT,GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21125,CPT,AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21127,CPT,AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21137,CPT,REDUCTION FOREHEAD CONTOURING ONLY,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21138,CPT,RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21139,CPT,RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21150,CPT,RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21172,CPT,RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21175,CPT,RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21181,CPT,RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21193,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21195,CPT,RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21198,CPT,OSTEOTOMY MANDIBLE SEGMENTAL,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21199,CPT,OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21206,CPT,OSTEOTOMY MAXILLA SEGMENTAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21208,CPT,OSTEOPLASTY FACIAL BONES AUGMENTATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21209,CPT,OSTEOPLASTY FACIAL BONES REDUCTION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21210,CPT,GRAFT BONE NASAL/MAXILLARY/MALAR AREAS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21215,CPT,GRAFT BONE MANDIBLE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21230,CPT,GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21235,CPT,GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR,,30,,,"$6,986.31 ",$0.00 ,1,0,1,20141001,
21240,CPT,ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21242,CPT,ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21243,CPT,ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21244,CPT,RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21245,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21246,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21248,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21249,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21256,CPT,RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21260,CPT,PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21261,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21263,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21267,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21270,CPT,MALAR AUGMENTATION PROSTHETIC MATERIAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21275,CPT,SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21280,CPT,MEDIAL CANTHOPEXY SEPARATE PROCEDURE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21282,CPT,LATERAL CANTHOPEXY,,30,,,"$6,986.31 ",$0.00 ,1,0,1,20141001,
21295,CPT,REDUCTION MASSETER MUSCLE & BONE EXTRAORAL,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
21296,CPT,REDUCTION MASSETER MUSCLE & BONE INTRAORAL,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21299,CPT,UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE,,30,,,$541.32 ,$0.00 ,1,0,1,20141001,
21310,CPT,CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION,,30,,,$541.32 ,$0.00 ,1,0,1,20141001,
21315,CPT,CLOSED TX NASAL FRACTURE W/O STABILIZATION,,30,,,"$3,151.15 ",$0.00 ,1,0,1,20141001,
21320,CPT,CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,,30,,,"$6,986.31 ",$0.00 ,1,0,1,20141001,
21325,CPT,OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21330,CPT,OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21335,CPT,OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21336,CPT,OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
21337,CPT,CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION,,30,,,"$6,986.31 ",$0.00 ,1,0,1,20141001,
21338,CPT,OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21339,CPT,OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21340,CPT,PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21345,CPT,CLOSED TX NASOMAXILLARY COMPLEX FRACTURE,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21346,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21355,CPT,PERCUTANEOUS TX MALAR AREA FRACTURE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21356,CPT,OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21360,CPT,OPEN TX DEPRESSED MALAR FRACTURE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21365,CPT,OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21385,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21386,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21387,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21390,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21395,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21400,CPT,CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
21401,CPT,CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
21406,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21407,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21408,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21421,CPT,CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21440,CPT,CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21445,CPT,OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21450,CPT,CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION,,30,,,"$1,714.28 ",$0.00 ,1,0,1,20141001,
21451,CPT,CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION,,30,,,"$6,986.31 ",$0.00 ,1,0,1,20141001,
21452,CPT,PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ,,30,,,"$6,986.31 ",$0.00 ,1,0,1,20141001,
21453,CPT,CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21454,CPT,OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21461,CPT,OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21462,CPT,OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21465,CPT,OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21470,CPT,OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21480,CPT,CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,,30,,,$541.32 ,$0.00 ,1,0,1,20141001,
21485,CPT,CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21490,CPT,OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION,,30,,,"$17,657.96 ",$0.00 ,1,0,1,20141001,
21495,CPT,OPEN TREATMENT HYOID FRACTURE,,30,,,"$6,986.31 ",$0.00 ,1,0,1,20141001,
21497,CPT,INTERDENTAL WIRING OTHER THAN FRACTURE,,30,,,"$3,070.54 ",$0.00 ,1,0,1,20141001,
21499,CPT,UNLISTED MUSCULOSKELETAL PROCEDURE HEAD,,30,,,$541.32 ,$0.00 ,1,0,1,20141001,
21501,CPT,I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX,,30,,,"$8,819.75 ",$0.00 ,1,0,1,20141001,
21502,CPT,I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
21550,CPT,BIOPSY SOFT TISSUE NECK/THORAX,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
21552,CPT,EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21554,CPT,EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21555,CPT,EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
21556,CPT,EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21557,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
21558,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21600,CPT,EXCISION RIB PARTIAL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
21610,CPT,COSTOTRANSVERSECTOMY SEPARATE PROCEDURE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
21685,CPT,HYOID MYOTOMY & SUSPENSION,,30,,,"$10,725.09 ",$0.00 ,1,0,1,20141001,
21700,CPT,DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
21720,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
21725,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/CAST,,30,,,$880.36 ,$0.00 ,1,0,1,20141001,
21742,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
21743,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
21800,CPT,CLOSED TX RIB FRACTURE UNCOMPLICATED EACH,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
21805,CPT,OPEN TX RIB FRACTURE W/O FIXATION EACH,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
21820,CPT,CLOSED TREATMENT STERNUM FRACTURE,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
21899,CPT,UNLISTED PROCEDURE NECK/THORAX,,30,,,$541.32 ,$0.00 ,1,0,1,20141001,
21920,CPT,BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
21925,CPT,BIOPSY SOFT TISSUE BACK/FLANK DEEP,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21930,CPT,EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
21931,CPT,EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21932,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
21933,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
21935,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
21936,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
22100,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22101,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22102,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22103,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA,,30,,,"$24,646.61 ",$0.00 ,1,0,1,20141001,
22222,CPT,OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM THRC,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22305,CPT,CLOSED TX VERTEBRAL PROCESS FRACTURE,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
22310,CPT,CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
22315,CPT,CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ,,30,,,"$7,237.99 ",$0.00 ,1,0,1,20141001,
22505,CPT,MANIPULATION SPINE REQUIRING ANESTHESIA,,30,,,"$6,580.91 ",$0.00 ,1,0,1,20141001,
22520,CPT,PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
22521,CPT,PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
22522,CPT,PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR,,30,,,"$17,122.74 ",$0.00 ,1,0,1,20141001,
22523,CPT,PERCUTANEOUS VERTEBRAL AUGMENTATION THORACIC,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
22524,CPT,PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
22525,CPT,PERQ VERTEBRAL AUGMENTATION EA ADDL THRC/LMBR,,30,,,"$24,729.70 ",$0.00 ,1,0,1,20141001,
22526,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL,,30,,,"$2,367.67 ",$0.00 ,1,0,1,20141001,
22527,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL,,30,,,"$2,367.67 ",$0.00 ,1,0,1,20141001,
22551,CPT,ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22554,CPT,ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22612,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22614,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL,,30,,,"$24,646.61 ",$0.00 ,1,0,1,20141001,
22851,CPT,APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE,,30,,,"$17,122.74 ",$0.00 ,1,0,1,20141001,
22856,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV,,30,,,"$19,137.94 ",$0.00 ,1,0,1,20141001,
22899,CPT,UNLISTED PROCEDURE SPINE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
22900,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
22901,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
22902,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
22903,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
22904,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
22905,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
22999,CPT,UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
23000,CPT,REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
23020,CPT,CAPSULAR CONTRACTURE RELEASE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23030,CPT,I&D SHOULDER DEEP ABSCESS/HEMATOMA,,30,,,"$8,819.75 ",$0.00 ,1,0,1,20141001,
23031,CPT,I&D SHOULDER INFECTED BURSA,,30,,,"$8,819.75 ",$0.00 ,1,0,1,20141001,
23035,CPT,INCISION BONE CORTEX SHOULDER AREA,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
23040,CPT,ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23044,CPT,ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23065,CPT,BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
23066,CPT,BIOPSY SOFT TISSUE SHOULDER DEEP,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
23071,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
23073,CPT,EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
23075,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
23076,CPT,EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
23077,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
23078,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
23100,CPT,ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
23101,CPT,ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23105,CPT,ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23106,CPT,ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23107,CPT,ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23120,CPT,CLAVICULECTOMY PARTIAL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23125,CPT,CLAVICULECTOMY TOTAL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23130,CPT,PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23140,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
23145,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23146,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23150,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23155,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23156,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23170,CPT,SEQUESTRECTOMY CLAVICLE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23172,CPT,SEQUESTRECTOMY SCAPULA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23174,CPT,SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23180,CPT,PARTIAL EXCISION BONE CLAVICLE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23182,CPT,PARTIAL EXCISION BONE SCAPULA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23184,CPT,PARTIAL EXCISION BONE PROXIMAL HUMERUS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23190,CPT,OSTECTOMY SCAPULA PARTIAL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23195,CPT,RESECTION HUMERAL HEAD,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23330,CPT,REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
23333,CPT,REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM,,30,,,"$3,250.23 ",$0.00 ,1,0,1,20141001,
23334,CPT,PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT,,30,,,"$9,946.64 ",$0.00 ,1,0,1,20141001,
23350,CPT,INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG,,30,,,$728.97 ,$0.00 ,1,0,1,20141001,
23395,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23397,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23400,CPT,SCAPULOPEXY,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23405,CPT,TENOTOMY SHOULDER AREA 1 TENDON,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23406,CPT,TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23410,CPT,OPEN REPAIR OF ROTATOR CUFF ACUTE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23412,CPT,OPEN REPAIR OF ROTATOR CUFF CHRONIC,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23415,CPT,CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23420,CPT,RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23430,CPT,TENODESIS LONG TENDON BICEPS,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23440,CPT,RESECTION/TRANSPLANTATION LONG TENDON BICEPS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
23450,CPT,CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23455,CPT,CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23460,CPT,CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23462,CPT,CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23465,CPT,CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23466,CPT,CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23470,CPT,ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
23473,CPT,REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
23480,CPT,OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
23485,CPT,OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23490,CPT,PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23491,CPT,PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23500,CPT,CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
23505,CPT,CLSD TX CLAVICULAR FRACTURE W/MANIPULATION,,30,,,"$2,594.96 ",$0.00 ,1,0,1,20141001,
23515,CPT,OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
23520,CPT,CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION,,30,,,"$7,237.99 ",$0.00 ,1,0,1,20141001,
23525,CPT,CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
23530,CPT,OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
23532,CPT,OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
23540,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
23545,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
23550,CPT,OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
23552,CPT,OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
23570,CPT,CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
23575,CPT,CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
23585,CPT,OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
23600,CPT,CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
23605,CPT,CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ,,30,,,"$7,237.99 ",$0.00 ,1,0,1,20141001,
23615,CPT,OPEN TREATMENT PROXIMAL HUMERAL FRACTURE,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
23616,CPT,OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
23620,CPT,CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
23625,CPT,CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION,,30,,,"$7,237.99 ",$0.00 ,1,0,1,20141001,
23630,CPT,OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
23650,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
23655,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES,,30,,,"$6,580.91 ",$0.00 ,1,0,1,20141001,
23660,CPT,OPEN TX ACUTE SHOULDER DISLOCATION,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
23665,CPT,CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ,,30,,,"$2,594.96 ",$0.00 ,1,0,1,20141001,
23670,CPT,OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
23675,CPT,CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
23680,CPT,OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
23700,CPT,MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS,,30,,,"$6,580.91 ",$0.00 ,1,0,1,20141001,
23800,CPT,ARTHRODESIS GLENOHUMERAL JOINT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23802,CPT,ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
23921,CPT,DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION,,30,,,"$12,413.37 ",$0.00 ,1,0,1,20141001,
23929,CPT,UNLISTED PROCEDURE SHOULDER,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
23930,CPT,I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA,,30,,,"$8,819.75 ",$0.00 ,1,0,1,20141001,
23931,CPT,INCISION&DRAINAGE UPPER ARM/ELBOW BURSA,,30,,,"$4,924.22 ",$0.00 ,1,0,1,20141001,
23935,CPT,INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
24000,CPT,ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24006,CPT,ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24065,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
24066,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
24071,CPT,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
24073,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
24075,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
24076,CPT,EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
24077,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
24079,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
24100,CPT,ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
24101,CPT,ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24102,CPT,ARTHROTOMY ELBOW W/SYNOVECTOMY,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24105,CPT,EXCISION OLECRANON BURSA,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
24110,CPT,EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
24115,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24116,CPT,EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24120,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
24125,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24126,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24130,CPT,EXCISION RADIAL HEAD,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24134,CPT,SEQUESTRECTOMY SHAFT/DISTAL HUMERUS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24136,CPT,SEQUESTRECTOMY RADIAL HEAD OR NECK,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24138,CPT,SEQUESTRECTOMY OLECRANON PROCESS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24140,CPT,PARTIAL EXCISION BONE HUMERUS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24145,CPT,PARTIAL EXCISION BONE RADIAL HEAD/NECK,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24147,CPT,PARTIAL EXCISION BONE OLECRANON PROCESS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24149,CPT,RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24150,CPT,RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24152,CPT,RADICAL RESECTION TUMOR RADIAL HEAD/NECK,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24155,CPT,RESECTION ELBOW JOINT ARTHRECTOMY,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24160,CPT,IMPLANT REMOVAL ELBOW JOINT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24164,CPT,IMPLANT REMOVAL RADIAL HEAD,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24200,CPT,RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
24201,CPT,REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
24220,CPT,INJECTION ELBOW ARTHROGRAPHY,,30,,,$765.42 ,$0.00 ,1,0,1,20141001,
24300,CPT,MANIPULATION ELBOW UNDER ANESTHESIA,,30,,,"$6,580.91 ",$0.00 ,1,0,1,20141001,
24301,CPT,MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24305,CPT,TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24310,CPT,TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
24320,CPT,TENOPLASTY ELBOW TO SHOULDER SINGLE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24330,CPT,FLEXOR-PLASTY ELBOW,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
24331,CPT,FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24332,CPT,TENOLYSIS TRICEPS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24340,CPT,TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24341,CPT,REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24342,CPT,RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24343,CPT,REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24344,CPT,RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24345,CPT,REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24346,CPT,RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24357,CPT,TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24358,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24359,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24360,CPT,ARTHROPLASTY ELBOW W/MEMBRANE,,30,,,"$15,904.79 ",$0.00 ,1,0,1,20141001,
24361,CPT,ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
24362,CPT,ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ,,30,,,"$20,380.23 ",$0.00 ,1,0,1,20141001,
24363,CPT,ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
24365,CPT,ARTHROPLASTY RADIAL HEAD,,30,,,"$15,904.79 ",$0.00 ,1,0,1,20141001,
24366,CPT,ARTHROPLASTY RADIAL HEAD W/IMPLANT,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
24370,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
24371,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
24400,CPT,OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24410,CPT,MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24420,CPT,OSTEOPLASTY HUMERUS,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24430,CPT,REPAIR NON/MALUNION HUMERUS W/O GRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
24435,CPT,REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
24470,CPT,HEMIEPIPHYSEAL ARREST,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24495,CPT,DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
24498,CPT,PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
24500,CPT,CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24505,CPT,CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24515,CPT,OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24516,CPT,TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24530,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24535,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24538,CPT,PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
24545,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24546,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24560,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
24565,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24566,CPT,PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
24575,CPT,OPEN TX HUMERAL EPICONDYLAR FRACTURE,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24576,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24577,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24579,CPT,OPEN TREATMENT HUMERAL CONDYLAR FRACTURE,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24582,CPT,PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
24586,CPT,OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24587,CPT,OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24600,CPT,TREATMENT CLOSED ELBOW DISLOCATION W/O ANES,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24605,CPT,TREATMENT CLOSED ELBOW DISLOCATION REQ ANES,,30,,,"$6,580.91 ",$0.00 ,1,0,1,20141001,
24615,CPT,OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24620,CPT,CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ,,30,,,"$7,237.99 ",$0.00 ,1,0,1,20141001,
24635,CPT,OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24640,CPT,CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24650,CPT,CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24655,CPT,CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24665,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
24666,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
24670,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
24675,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
24685,CPT,OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
24800,CPT,ARTHRODESIS ELBOW JOINT LOCAL,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
24802,CPT,ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
24925,CPT,AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
24935,CPT,STUMP ELONGATION UPPER EXTREMITY,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
24999,CPT,UNLISTED PROCEDURE HUMERUS/ELBOW,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
25000,CPT,INCISION EXTENSOR TENDON SHEATH WRIST,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25001,CPT,INCISION FLEXOR TENDON SHEATH WRIST,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25020,CPT,DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25023,CPT,DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25024,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25025,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25028,CPT,I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25031,CPT,INCISION & DRAINAGE FOREARM&/WRIST BURSA,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25035,CPT,INCISION DEEP BONE CORTEX FOREARM&/WRIST,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25040,CPT,ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25065,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL,,30,,,"$3,670.92 ",$0.00 ,1,0,1,20141001,
25066,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
25071,CPT,EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
25073,CPT,EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
25075,CPT,EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
25076,CPT,EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
25077,CPT,RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM,,30,,,"$6,504.69 ",$0.00 ,1,0,1,20141001,
25078,CPT,RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>,,30,,,"$9,950.82 ",$0.00 ,1,0,1,20141001,
25085,CPT,CAPSULOTOMY WRIST,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25100,CPT,ARTHROTOMY WRIST JOINT WITH BIOPSY,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25101,CPT,ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25105,CPT,ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25107,CPT,ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25109,CPT,EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25110,CPT,EXCISION LESION TENDON SHEATH FOREARM&/WRIST,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25111,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25112,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25115,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25116,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25118,CPT,SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25119,CPT,SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25120,CPT,EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25125,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25126,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25130,CPT,EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25135,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25136,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25145,CPT,SEQUESTRECTOMY FOREARM &/WRIST,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25150,CPT,PARTIAL EXCISION BONE ULNA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25151,CPT,PARTIAL EXCISION BONE RADIUS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25170,CPT,RADICAL RESECTION TUMOR RADIUS OR ULNA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25210,CPT,CARPECTOMY 1 BONE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25215,CPT,CARPECTOMY ALL BONES PROXIMAL ROW,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25230,CPT,RADICAL STYLOIDECTOMY SEPARATE PROCEDURE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25240,CPT,EXCISION DISTAL ULNA PARTIAL/COMPLETE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25246,CPT,INJECTION WRIST ARTHROGRAPHY,,30,,,$896.82 ,$0.00 ,1,0,1,20141001,
25248,CPT,EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25250,CPT,REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25251,CPT,REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25259,CPT,MANIPULATION WRIST UNDER ANESTHESIA,,30,,,"$7,237.99 ",$0.00 ,1,0,1,20141001,
25260,CPT,RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25263,CPT,RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25265,CPT,RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25270,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25272,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25274,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25275,CPT,RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25280,CPT,LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25290,CPT,TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25295,CPT,TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25300,CPT,TENODESIS WRIST FLEXORS FINGERS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25301,CPT,TENODESIS WRIST EXTENSORS FINGERS,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25310,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25312,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25315,CPT,FLEXOR ORIGIN SLIDE FOREARM &/WRIST,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25316,CPT,FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25320,CPT,CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25332,CPT,ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ,,30,,,"$15,904.79 ",$0.00 ,1,0,1,20141001,
25335,CPT,CENTRALIZATION WRST ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25337,CPT,RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25350,CPT,OSTEOTOMY RADIUS DISTAL THIRD,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25355,CPT,OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25360,CPT,OSTEOTOMY ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25365,CPT,OSTEOTOMY RADIUS & ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25370,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25375,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25390,CPT,OSTEOPLASTY RADIUS/ULNA SHORTENING,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25391,CPT,OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25392,CPT,OSTEOPLASTY RADIUS & ULNA SHORTENING,,30,,,"$13,709.59 ",$0.00 ,1,0,1,20141001,
25393,CPT,OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25394,CPT,OSTEOPLASTY CARPAL BONE SHORTENING,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25400,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25405,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25415,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25420,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25425,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25426,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25430,CPT,INSERTION VASCULAR PEDICLE CARPAL BONE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25431,CPT,REPAIR NONUNION CARPAL BONE EACH BONE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25440,CPT,RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25441,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
25442,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
25443,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL,,30,,,"$20,380.23 ",$0.00 ,1,0,1,20141001,
25444,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE,,30,,,"$20,380.23 ",$0.00 ,1,0,1,20141001,
25445,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM,,30,,,"$20,380.23 ",$0.00 ,1,0,1,20141001,
25446,CPT,ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS,,30,,,"$20,640.46 ",$0.00 ,1,0,1,20141001,
25447,CPT,ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS,,30,,,"$15,904.79 ",$0.00 ,1,0,1,20141001,
25449,CPT,REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT,,30,,,"$15,904.79 ",$0.00 ,1,0,1,20141001,
25450,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25455,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25490,CPT,PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25491,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25492,CPT,PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25500,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
25505,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION,,30,,,"$2,594.96 ",$0.00 ,1,0,1,20141001,
25515,CPT,OPEN TREATMENT RADIAL SHAFT FRACTURE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
25520,CPT,CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25525,CPT,OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
25526,CPT,OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
25530,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
25535,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25545,CPT,OPEN TREATMENT OF ULNAR SHAFT FRACTURE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
25560,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
25565,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25574,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
25575,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
25600,CPT,CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25605,CPT,CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,,30,,,"$2,594.96 ",$0.00 ,1,0,1,20141001,
25606,CPT,PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
25607,CPT,OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
25608,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
25609,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG,,30,,,"$22,010.55 ",$0.00 ,1,0,1,20141001,
25622,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25624,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ,,30,,,"$2,594.96 ",$0.00 ,1,0,1,20141001,
25628,CPT,OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
25630,CPT,CLTX CARPAL BONE FX W/O MANJ EACH BONE,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25635,CPT,CLTX CARPAL BONE FX W/MANJ EACH BONE,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25645,CPT,OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
25650,CPT,CLOSED TREATMENT ULNAR STYLOID FRACTURE,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25651,CPT,PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
25652,CPT,OPEN TREATMENT ULNAR STYLOID FRACTURE,,30,,,"$19,204.17 ",$0.00 ,1,0,1,20141001,
25660,CPT,CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25670,CPT,OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
25671,CPT,PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
25675,CPT,CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ,,30,,,"$1,002.68 ",$0.00 ,1,0,1,20141001,
25676,CPT,OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
25680,CPT,CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
25685,CPT,OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
25690,CPT,CLOSED TX LUNATE DISLOCATION W/MANIPULATION,,30,,,"$7,237.99 ",$0.00 ,1,0,1,20141001,
25695,CPT,OPEN TREATMENT LUNATE DISLOCATION,,30,,,"$11,251.44 ",$0.00 ,1,0,1,20141001,
25800,CPT,ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25805,CPT,ARTHRODESIS WRIST W/SLIDING GRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25810,CPT,ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25820,CPT,ARTHRODESIS WRIST LIMITED W/O BONE GRAFT,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25825,CPT,ARTHRODESIS WRIST LIMITED W/AUTOGRAFT,,30,,,"$23,288.42 ",$0.00 ,1,0,1,20141001,
25830,CPT,ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE,,30,,,"$18,179.63 ",$0.00 ,1,0,1,20141001,
25907,CPT,AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25909,CPT,AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25922,CPT,DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25929,CPT,TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ,,30,,,"$7,543.18 ",$0.00 ,1,0,1,20141001,
25931,CPT,TRANSMETACARPAL AMPUTATION RE-AMPUTATION,,30,,,"$9,206.64 ",$0.00 ,1,0,1,20141001,
25999,CPT,UNLISTED PROCEDURE FOREARM/WRIST,,30,,,$625.27 ,$0.00 ,1,0,1,20141001,
26010,CPT,DRAINAGE FINGER ABSCESS SIMPLE,,30,,,$880.36 ,$0.00 ,1,0,1,20141001,
26011,CPT,DRAINAGE FINGER ABSCESS COMPLICATED,,30,,,"$4,924.22 ",$0.00 ,1,0,1,20141001,