At a glance
Charlotte hospital prices span $25 to $276,348 across 4897 shoppable procedures, drawn from 58 reporting hospitals across the metro area. Every price comes directly from federally mandated Machine-Readable Files under 45 CFR Part 180. ProcedureRadar last refreshed Charlotte data in Sep 2026, with monthly updates ongoing.
By Kevin Monangai, Founder, ProcedureRadar.
City pages are how we answer what does healthcare actually cost where I live. We aggregate every procedure we cover, across every hospital in that metro, into one place. About 140 shoppable procedures, all sourced from federally mandated transparency files, all refreshed monthly. If you live there, this is the page we built for you.
Every shoppable procedure in Charlotte, plotted by median price against how much prices vary across hospitals. Hover any point to see the procedure, median, and hospital spread. Click to view hospitals.
| Procedure | Category | Median Price | Low | High | Hospitals |
|---|---|---|---|---|---|
| Aminocaproic Acid 500 Mg Tab | other | $25 | $25 | $25 | 1 |
| Cervical, Semi-rigid, Adjustable | other | $25 | $25 | $25 | 1 |
| Foley Urinary Catheter 18fr 5ml Silicone Council Tip #0196si18 12ea/cs | cardiac | $25 | $25 | $25 | 1 |
| Dermatac Drape W/granufoam Dressing Small10pk | other | $25 | $25 | $25 | 1 |
| Drop Foot Splint Standard Lg Lt #pls-ff-300l | other | $25 | $25 | $25 | 1 |
| Drop Foot Splint Standard Lg Rt #pls-ff-300r | other | $25 | $25 | $25 | 1 |
| Drop Foot Splint Standard Med Rt #pls-ff-200r | other | $25 | $25 | $25 | 1 |
| Drop Foot Splint Standard Sm Rt #pls-ff-100r | other | $25 | $25 | $25 | 1 |
| Trach Tube 6dct #6cn75h | other | $25 | $25 | $25 | 1 |
| Clobetasol 0.05% Solution | other | $25 | $25 | $25 | 1 |
| Trach Sz 8 Shiley Cuffed Trach Cann 8.5mm #8cn85h | other | $25 | $25 | $25 | 1 |
| Trach Tube 4dct #4cn65h | other | $25 | $25 | $25 | 1 |
| Drain Hemovac Replacement 5ea/1bx #00-2555-050 | surgery | $25 | $25 | $25 | 1 |
| Splint Denver Nasal Thermoplastic Sm #10-4021-05ks 5/bx | other | $25 | $25 | $25 | 1 |
| Pediatric Tracheostomy Tube Shiley Cuffless 4.0mm Id 6.0mm Od Medtronic 4.0pe... | other | $25 | $25 | $25 | 1 |
| Butrans 5 Mcg/hr Patch | other | $25 | $25 | $25 | 1 |
| Injection, Heparin Sodium (pfizer), Not Therapeutically Equivalent to J1644, ... | other | $25 | $25 | $25 | 1 |
| Nasal 7.5 Epistaxis Ant/posterior 10ea/1bx | other | $26 | $26 | $26 | 1 |
| Immobilizer Shoulder Lg W/block Deroyal | other | $26 | $26 | $26 | 1 |
| Immobilizer Shoulder Med W/block Deroyal | other | $26 | $26 | $26 | 1 |
| Immobilizer Shoulder Small W/block Deroyal | other | $26 | $26 | $26 | 1 |
| Tube Trach Cuff Size 8 Low Pressure | other | $26 | $26 | $26 | 1 |
| Tube Trach Cuff Sz-6 Low Pressure | other | $26 | $26 | $26 | 1 |
| Tube Trach Cuffless Sz 4 W/cannula #4cfs | other | $26 | $26 | $26 | 1 |
| Laser Trach Tube 3.0 #86400 Uncuffed | other | $26 | $26 | $26 | 1 |
| Laser Trach Tube 3.5 #86401 Uncuffed | other | $26 | $26 | $26 | 1 |
| Laser Trach Tube 4.0 #86402 Uncuffed | other | $26 | $26 | $26 | 1 |
| Pin Guide 2.8 #ar | other | $26 | $26 | $26 | 1 |
| Provisc #8065-18 | other | $26 | $26 | $26 | 1 |
| Trach Sz 10 Shiley Cuffed Trach Cann 10.0mm 10cn10h | other | $26 | $26 | $26 | 1 |
| Prosthetic Sock, Multiple Ply, Below Knee, Each | other | $26 | $26 | $26 | 1 |
| Ultrasound Mak Kit #k12t-05493a **must Order Increments of 10 Each** | imaging | $26 | $26 | $26 | 1 |
| Cath Cholangiogram Orc-b | other | $26 | $26 | $26 | 1 |
| Clindamycin Ph 1% Gel | other | $26 | $26 | $26 | 1 |
| Single Action Pumping Sys #m0067201001 | other | $26 | $26 | $26 | 1 |
| Prednisolone Oral, Per 5 Mg | other | $26 | $26 | $26 | 1 |
| Splint Nasal Intranasal 15-24050 5ea/1bx | other | $26 | $26 | $26 | 1 |
| Pulmonary Biopsy Forcep Rj4 #m0515181 | lab | $26 | $26 | $26 | 1 |
| Laser Flex Trach Tube 4.5mm #86397 Cuffed | other | $26 | $26 | $26 | 1 |
| Laser Flex Trach Tube 5.5 #86395 Cuffed | other | $26 | $26 | $26 | 1 |
| Laser Flex Tracheal Tube 6.0 Cuffed | other | $26 | $26 | $26 | 1 |
| Injection, Lincomycin Hcl, Up to 300 Mg | other | $26 | $26 | $26 | 1 |
| Urethral Needle for Macroplastique | other | $26 | $26 | $26 | 1 |
| Vac Soft White Foam Sys Sm 10"x 7.5" M8275068 | other | $26 | $26 | $26 | 1 |
| Pleuravac - Infant #a-8020-08lf | other | $27 | $27 | $27 | 1 |
| Cannula Aortic Ez Glide 21fr X 35cm Ezs21ta | other | $27 | $27 | $27 | 1 |
| Betamethasone Dp 0.05% Oint | other | $27 | $27 | $27 | 1 |
| Cement Mix Bowl Quick Vac Vacuum | other | $27 | $27 | $27 | 1 |
| Immobilizer Shoulder Xlg W/block Deroyal | other | $27 | $27 | $27 | 1 |
| Cannula Endo 5fr Biliary ERCP 5-4-3 M00530880 | other | $27 | $27 | $27 | 1 |
| Cor-knot Quick Load Singles #030850 | other | $27 | $27 | $27 | 1 |
| Foot, Arch Support, Removable, Premolded, Metatarsal, Each | other | $27 | $27 | $27 | 1 |
| Introducer Peritoneal Taut #pi | other | $27 | $27 | $27 | 1 |
| Presto Inflation High Pressure Device with 30cc Barrel 5ea/ca Id4030 | other | $27 | $27 | $27 | 1 |
| Semen Analysis; Presence And/or Motility of Sperm Excluding Huhner | other | $27 | $27 | $27 | 1 |
| Splint, Prefabricated, Elbow | other | $27 | $27 | $27 | 1 |
| Tray Epidural #182221 Ballard | other | $27 | $27 | $27 | 1 |
| Pentam 300 Mg Vial | other | $27 | $27 | $27 | 1 |
| Brexpiprazole 2 Mg Po Tabs | other | $27 | $27 | $27 | 1 |
| Rexulti 1 Mg Tablet | other | $27 | $27 | $27 | 1 |
| Rexulti 2 Mg Tablet | other | $27 | $27 | $27 | 1 |
| Marker Scar Spee-d-line 3d Digital Breast | other | $27 | $27 | $27 | 1 |
| Shiley Pediatric Tracheostomy Tube Cuffless 3.0mm Id 4.8mm Od 39mm 3.0 Pef #3... | other | $27 | $27 | $27 | 1 |
| Shiley Pediatric Tracheostomy Tube Cuffless 4.5mm Id 6.7mm Od 42mm 4.5 Pef #4... | other | $27 | $27 | $27 | 1 |
| Infusion Set Rapid #d-60hl Smith Med.10ea/1cs | surgery | $27 | $27 | $27 | 1 |
| Catheter Duplocath Application 35cm #1506166 Be-10-01-106 for Billing Reference | cardiac | $27 | $27 | $27 | 1 |
| Automated Platelet Count | other | $27 | $27 | $27 | 1 |
| Blood,occult By Peroxidase Act | other | $27 | $27 | $27 | 1 |
| Assay of Blood/uric Acid | other | $27 | $27 | $27 | 1 |
| Shiley Tracheostomy Tube Twist Lock Ic Size 10.0 Adult #10fen | other | $28 | $28 | $28 | 1 |
| Tube Trach Cuff Size 6fen 1ea | other | $28 | $28 | $28 | 1 |
| Tube Trach Cuff Size 8fen 1ea | other | $28 | $28 | $28 | 1 |
| Administration of Hepatitis B Vaccine | preventive | $28 | $28 | $28 | 1 |
| Administration of Influenza Virus Vaccine | preventive | $28 | $28 | $28 | 1 |
| Administration of Pneumococcal Vaccine | preventive | $28 | $28 | $28 | 1 |
| Trocar 15mm X 100 6/bx #c0r37 | other | $28 | $28 | $28 | 1 |
| Cannula 15fr Coronary Ostial Perfusion | surgery | $28 | $28 | $28 | 1 |
| Cannula 17fr Coronary Ostial Perfusion | surgery | $28 | $28 | $28 | 1 |
| Cannula 20fr Coronary Ostial Perfusion | surgery | $28 | $28 | $28 | 1 |
| Sheath Storz/xomed 4mm/30" #1912010 Sc | other | $28 | $28 | $28 | 1 |
| Sheath Storz/xomed 4mm/45" #1912013 Sc | other | $28 | $28 | $28 | 1 |
| Lumbar Support Basic Xlrg #10155 | other | $28 | $28 | $28 | 1 |
| Stylet S 53-j | other | $28 | $28 | $28 | 1 |
| Stylet S 53-jl | other | $28 | $28 | $28 | 1 |
| Stylet S 53-s | other | $28 | $28 | $28 | 1 |
| Stylet S53-k | other | $28 | $28 | $28 | 1 |
| Torque Wrench | other | $28 | $28 | $28 | 1 |
| Tobramycin-dexameth Ophth Susp | imaging | $28 | $28 | $28 | 1 |
| Tobramycin-dexamethasone 0.3-0.1 % Op Susp | imaging | $28 | $28 | $28 | 1 |
| Deluxe Paring Board 1ea | other | $28 | $28 | $28 | 1 |
| Neomyc-polym-gramicid Eye Drop | other | $28 | $28 | $28 | 1 |
| Cath Word Bartholin Gland 10fr 6ea/1bx | other | $28 | $28 | $28 | 1 |
| Cannula Arterial 18fr Eopa Elongated One Piec | other | $28 | $28 | $28 | 1 |
| Cannula Arterial 20fr Eopa Elongated One Piec | other | $28 | $28 | $28 | 1 |
| Cannula Arterial 22fr Eopa Elongated One Piec | other | $28 | $28 | $28 | 1 |
| Injection, Ampicillin Sodium, 500 Mg | other | $28 | $26 | $30 | 2 |
| Decalcification of Tissue | other | $28 | $28 | $28 | 1 |
| Urine Pregnancy Test | other | $28 | $28 | $28 | 1 |
| Assay of Phosphorus | other | $28 | $28 | $28 | 1 |
| Boot Prevalon Iii W/wedge #7355 8ea/cs | other | $29 | $29 | $29 | 1 |
| Prosthetic Sock, Multiple Ply, Above Knee, Each | other | $29 | $29 | $29 | 1 |
| Insulin for Administration Through DME (i.e., Insulin Pump) Per 50 Units | other | $29 | $29 | $29 | 1 |
| Muscle Biopsy Clamp Rayport 12mm #su130 | lab | $29 | $29 | $29 | 1 |
| Iodosorb Gel | other | $29 | $29 | $29 | 1 |
| Tube Endobronchial 35fr Left #125035 | other | $29 | $29 | $29 | 1 |
| Tube Endobronchial 37fr Left #125037 | other | $29 | $29 | $29 | 1 |
| Tube Endobronchial 39fr Left #125039 | other | $29 | $29 | $29 | 1 |
| Tube Endobronchial 41fr Left #125041 | other | $29 | $29 | $29 | 1 |
| Surgiclip Lrg 13.0 #134048 | other | $29 | $29 | $29 | 1 |
| Surgiclip Sm 9.0 #133650 | other | $29 | $29 | $29 | 1 |
| Tube Trach Metal Jackson Sz 7 #pm1034317 | other | $29 | $29 | $29 | 1 |
| Ligaclip Medium 11.5 6/bx #134053 | other | $29 | $29 | $29 | 1 |
| Sensor Rectal Pressure #pg | other | $29 | $29 | $29 | 1 |
| Sensor Vaginal Emg #pg | other | $29 | $29 | $29 | 1 |
| Surgiclip Med 9.75 6 Ea/bx #134051 | other | $29 | $29 | $29 | 1 |
| Vac Pad Large Black 10ea/1ca | other | $29 | $29 | $29 | 1 |
| Irrigation Sys Bard Assist #160130 | other | $29 | $29 | $29 | 1 |
| Catheter Kit 5.0" Pain On Q Silversoaker 5/bx | cardiac | $29 | $29 | $29 | 1 |
| Avitene Ultrafoam Collagen Sponge 100 SQ Cm 8cm X 12.5cm 3-1/18" X 5" 1050040 | other | $29 | $29 | $29 | 1 |
| Tube Trach Metal Jackson Sz 5 #pm1034915 | other | $29 | $29 | $29 | 1 |
| Rbn-114 Bone Marrow Biopsy Needle 11 Gauge X 4" Snarecoil Box/10each | lab | $29 | $29 | $29 | 1 |
| Rbn-116 Bone Marrow Biopsy Needle 11 Gauge X 6" Snarecoil Box/10each | lab | $29 | $29 | $29 | 1 |
| Immobilizer Arm/shoulder Atlas#00052 Breg | other | $29 | $29 | $29 | 1 |
| Hydro-surg Plus Laparoscopic Irrigator with Nezhat-dorsey Smokevac Trumpet Va... | surgery | $29 | $29 | $29 | 1 |
| Safety Amniocentesis 20gx3.5 29-am1sfa 10ea/case | other | $29 | $29 | $29 | 1 |
| Buprenorphine 10 Mcg/hr Patch | other | $29 | $29 | $29 | 1 |
| Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm | other | $29 | $27 | $30 | 2 |
| Tubersol 5t Unit/0.1 Ml Vial | other | $29 | $29 | $29 | 1 |
| Assay of Serum Sodium | other | $29 | $29 | $29 | 1 |
| Immobilizer Sling Shot Sz Large Breg | other | $30 | $30 | $30 | 1 |
| Immobilizer Sling Shot Sz Medium | other | $30 | $30 | $30 | 1 |
| Immobilizer Sling Shot Sz Small | other | $30 | $30 | $30 | 1 |
| Immobilizer Sling Shot Sz Xlarge Breg | other | $30 | $30 | $30 | 1 |
| Lap Probe Monopolar J Hook Tip | other | $30 | $30 | $30 | 1 |
| Viscera Retainer-medium Hs3204-1 Bx/10 | other | $30 | $30 | $30 | 1 |
| Tube Ear Ventilation Richards T 1.14mm 240071 | other | $30 | $30 | $30 | 1 |
| Nasal 4.5 Epistaxis Anterior 10ea/1bx | other | $30 | $30 | $30 | 1 |
| Nasal 5.5 Epistaxis Anterior 10ea/1bx | other | $30 | $30 | $30 | 1 |
| Cannula Endo 1.83mm X 210cm Tandem M00545820 | other | $30 | $30 | $30 | 1 |
| Nystatin-triamcinolone 100000-0.1 Unit/gm-% Ex Oint | other | $30 | $30 | $30 | 1 |
| Nystatin-triamcinolone Ointm | other | $30 | $30 | $30 | 1 |
| Guardian Ii Hemostasis Valve #8211 | other | $30 | $30 | $30 | 1 |
| Polymyxin B-trimethoprim 10000-0.1 Unit/ml-% Op Soln | other | $30 | $30 | $30 | 1 |
| 5% Dextrose in Lactated Ringers Infusion, Up to 1000 Cc | surgery | $30 | $30 | $30 | 1 |
| 5% Dextrose/normal Saline | other | $30 | $30 | $30 | 1 |
| 5% Dextrose/water | other | $30 | $30 | $30 | 1 |
| Bacteriostatic Saline Vial | other | $30 | $30 | $30 | 1 |
| Bupivacaine-epinephrine (pf) 0.5% -1:200000 Ij Soln | other | $30 | $30 | $30 | 1 |
| Caffeine Cit 60 Mg/3 Ml Vial | other | $30 | $30 | $30 | 1 |
| Cefazolin 5 Mg/ml + Heparin 2500 Units/ml Antibiotic Catheter Mixture - Compo... | cardiac | $30 | $30 | $30 | 1 |
| Dextrose 2.5%-0.45% Nacl IV | other | $30 | $30 | $30 | 1 |
| Dextrose 5%-0.2% Nacl IV Soln | other | $30 | $30 | $30 | 1 |
| Diltiazem 25 Mg/5 Ml Vial | other | $30 | $30 | $30 | 1 |
| Encore 40 Inflation Device M001394472540 | other | $30 | $30 | $30 | 1 |
| Etomidate 2 Mg/ml IV Soln | other | $30 | $30 | $30 | 1 |
| Evoke Epidural Needle 6.5' #3014 | other | $30 | $30 | $30 | 1 |
| Hc Dress Duoderm 5.5 X 5.5 Signal | other | $30 | $30 | $30 | 1 |
| Infusion, Normal Saline Solution, 250 Cc | surgery | $30 | $30 | $30 | 1 |
| Injection, Acetaminophen (fresenius Kabi), Not Therapeutically Equivalent to ... | other | $30 | $30 | $30 | 1 |
| Injection, Acetylcysteine, 100 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Amiodarone Hydrochloride, 30 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Bumetanide, 0.5 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Calcium Gluconate, Not Otherwise Specified, 10 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Ciprofloxacin for Intravenous Infusion, 200 Mg | surgery | $30 | $30 | $30 | 1 |
| Injection, Dicyclomine Hcl, Up to 20 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Digoxin, Up to 0.5 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Diphenhydramine Hcl, Up to 50 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Famotidine, 0.25 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Fluphenazine Decanoate, Up to 25 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Folic Acid, 0.1 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Furosemide, 1 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Granisetron Hydrochloride, 100 Mcg | other | $30 | $30 | $30 | 1 |
| Injection, Haloperidol, Up to 5 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Heparin Sodium, (heparin Lock Flush), Per 10 Units | other | $30 | $30 | $30 | 1 |
| Injection, Ketorolac Tromethamine, Per 15 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Levofloxacin, 250 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Lidocaine Hydrochloride, 1 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Lorazepam, 2 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Meperidine Hydrochloride, Per 100 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Metoclopramide Hcl, Up to 10 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Midazolam Hydrochloride, Per 1 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Milrinone Lactate, 5 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Nalbuphine Hydrochloride, Per 10 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Paricalcitol, 1 Mcg | other | $30 | $30 | $30 | 1 |
| Injection, Phenylephrine Hydrochloride (biorphen), 20 Micrograms | other | $30 | $30 | $30 | 1 |
| Injection, Phenytoin Sodium, Per 50 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Sterile Cefuroxime Sodium, Per 750 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Terbutaline Sulfate, Up to 1 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Triamcinolone Acetonide, Not Otherwise Specified, 10 Mg | other | $30 | $30 | $30 | 1 |
| Injection, Vitamin B-12 Cyanocobalamin, Up to 1000 Mcg | other | $30 | $30 | $30 | 1 |
| Intraocular Vancomycin 10 Mg/ Ml- 3 Ml (for Dr. Ouano) - Compounded | other | $30 | $30 | $30 | 1 |
| Kcl 20 Meq/l-d5w-0.45% Nacl | other | $30 | $30 | $30 | 1 |
| Lactated Ringers Injection | other | $30 | $30 | $30 | 1 |
| Lidocaine / Bicarb 1 Ml Syringe - Compounded | other | $30 | $30 | $30 | 1 |
| Lidocaine / Sodium Bicarb 0.09 Meq/ Ml Vial - Compounded | other | $30 | $30 | $30 | 1 |
| Lidocaine 0.5%-epi 1:200,000 | other | $30 | $30 | $30 | 1 |
| Lidocaine-epinephrine 2 %-1:100000 Ij Soln | other | $30 | $30 | $30 | 1 |
| Metoprolol Tartrate 5 Mg/5ml IV Soln | other | $30 | $30 | $30 | 1 |
| Morphine 0.1 Mg/ml Peds Oral Solution - Compounded | other | $30 | $30 | $30 | 1 |
| Moxifloxacin Intracameral 600 Mcg / 0.4 Ml Syringe-surgery Center - Compounded | surgery | $30 | $30 | $30 | 1 |
| Neostigmine 10 Mg/10 Ml Vial | other | $30 | $30 | $30 | 1 |
| Norepinephrine Bitartrate 1 Mg/ml IV Soln | other | $30 | $30 | $30 | 1 |
| Removal of Sutures; By a Physician Other Than the Physician Who Originally Cl... | surgery | $30 | $30 | $30 | 1 |
| Ringers Lactate Infusion, Up to 1000 Cc | surgery | $30 | $30 | $30 | 1 |
| Rocuronium Bromide 50 Mg/5ml IV Soln | other | $30 | $30 | $30 | 1 |
| Slitter Catheter for Agilis Hispro Steerable Catheter#ds3a001 | cardiac | $30 | $30 | $30 | 1 |
| Sodium Acetate 40 Meq/20 Ml Vl | other | $30 | $30 | $30 | 1 |
| Sodium Chloride 0.45% Soln | other | $30 | $30 | $30 | 1 |
| Sterile Water for Irrigation | other | $30 | $30 | $30 | 1 |
| Sterile Water, Saline And/or Dextrose, Diluent/flush, 10 Ml | other | $30 | $30 | $30 | 1 |
| Tool Locking Helix for Tendril Sts Pacing Lead#a001helx | other | $30 | $30 | $30 | 1 |
| Tranexamic Acid 1000 Mg/10ml IV Soln | other | $30 | $30 | $30 | 1 |
| Valproate Sod 500 Mg/5 Ml Vl | other | $30 | $30 | $30 | 1 |
| Vancomycin 2.5 Mg/ml + Heparin 2500 Units/ml Antibiotic Catheter Mixture - Co... | cardiac | $30 | $30 | $30 | 1 |
| Vancomycin Retention Enema 500 Mg/ns 100 Ml - Compounded | other | $30 | $30 | $30 | 1 |
| Verapamil 2.5 Mg/5 Ml Syringe (for Radial Cocktail) - Compounded | other | $30 | $30 | $30 | 1 |
| Xylocaine 1%-epi 1:100,000 | other | $30 | $30 | $30 | 1 |
| Ultrasharp Scleral Knife | other | $30 | $30 | $30 | 1 |
| Xifaxan 550 Mg Tablet | other | $30 | $30 | $30 | 1 |
| Hydrocolloid Dressing, Wound Cover, Sterile, Pad Size More Than 48 Sq. In., w... | other | $30 | $30 | $30 | 1 |
| Geo Matt Chair 6ea/1cs | other | $30 | $30 | $30 | 1 |
| Needle Angiody. Ministick Max 5f 10cm #h965457561 | other | $30 | $30 | $30 | 1 |
| Assay of Serum Albumin | other | $30 | $30 | $30 | 1 |
| Bilirubin Direct | other | $30 | $30 | $30 | 1 |
| Bilirubin Total | other | $30 | $30 | $30 | 1 |
| Smear Fluorescent/acid Stai | other | $30 | $30 | $30 | 1 |
| Injection, Piperacillin Sodium/tazobactam Sodium, 1 Gram/0.125 Grams | other | $31 | $30 | $31 | 2 |
| Vac Soft White Foam Sys Lrg 10"x 15" M8275067 | other | $31 | $31 | $31 | 1 |
| Fosfomycin 3 Gm Sachet | other | $31 | $31 | $31 | 1 |
| Caplyta 42 Mg Capsule | other | $31 | $31 | $31 | 1 |
| Injection, Methotrexate Sodium, 50 Mg | other | $31 | $31 | $31 | 1 |
| Benzoyl Peroxide-erythromycin 5-3 % Ex Gel | other | $31 | $31 | $31 | 1 |
| Boot Prevalon Heel Protector Petite #7310 | other | $31 | $31 | $31 | 1 |
| Sheath Storz/xomed 4mm/0" #1912000 Sc | other | $31 | $31 | $31 | 1 |
| Surgiflo Endo Applicator 34cm #ms1995 | other | $31 | $31 | $31 | 1 |
| Tube Endobronchial 35fr Left #116100350 | other | $31 | $31 | $31 | 1 |
| Tube Endobronchial 37fr Left #5 | other | $31 | $31 | $31 | 1 |
| Tube Endobronchial 39fr Left #116100390 | other | $31 | $31 | $31 | 1 |
| Tube Endobronchial 41fr Left #5 | other | $31 | $31 | $31 | 1 |
| Tube Gastrostomy Kangaroo 16fr #8884720163e 5ea/case | other | $31 | $31 | $31 | 1 |
| Cialis 10 Mg Tablet | other | $31 | $31 | $31 | 1 |
| Cialis 20 Mg Tablet | other | $31 | $31 | $31 | 1 |
| Healon5 Pro 0.60 Ml 10340015 Dr. Ouano | other | $31 | $31 | $31 | 1 |
| Irrigator Lap Suction W/pistol Grip/conmed | other | $31 | $31 | $31 | 1 |
| Physostigmine 1 Mg/ml Ampul | other | $31 | $31 | $31 | 1 |
| Splint System Bsn Dynacast Fiberglass Padded Roll Form 4inx15ft #7449804 1ea/... | other | $31 | $31 | $31 | 1 |
| Non-covered Item OR Service | other | $31 | $31 | $31 | 1 |
| Injection, Epinephrine (international Medication Systems), Not Therapeuticall... | other | $31 | $31 | $31 | 1 |
| Aspartate Aminotransferase | other | $31 | $31 | $31 | 1 |
| Assay Alkaline Phosphatase | other | $31 | $31 | $31 | 1 |
| Assay of Urine Creatinine | other | $31 | $31 | $31 | 1 |
| C-reactive Protein | other | $31 | $31 | $31 | 1 |
| Fibrinogen | other | $31 | $31 | $31 | 1 |
| Dextrose 5%-0.45% Nacl IV Soln | other | $32 | $30 | $34 | 2 |
| Injection, Butorphanol Tartrate, 1 Mg | other | $32 | $30 | $33 | 2 |
| Injection, Potassium Chloride, Per 2 Meq | other | $32 | $30 | $34 | 2 |
| Injection, Thiamine Hcl, 100 Mg | other | $32 | $30 | $34 | 2 |
| Dermatac Drape W/granufoam Dressing Med 10pk | other | $32 | $32 | $32 | 1 |
| Kyphon Cement Mixer Only #a07a | other | $32 | $32 | $32 | 1 |
| Coagulator Bipolar .5mm Tip Non-insul#20 | other | $32 | $32 | $32 | 1 |
| Pushr Stent for 4/5fr Pancreatic Rx M00535010 | cardiac | $32 | $32 | $32 | 1 |
| Addition to Lower Extremity Orthosis, Drop Lock Retainer, Each | other | $32 | $32 | $32 | 1 |
| Ephedrine Sulfate (pressors) 50 Mg/ml Soln Wrapper | other | $32 | $32 | $32 | 1 |
| Ortho Glass 3" X 15 #og-3l22 Rolls/case | other | $32 | $32 | $32 | 1 |
| Sole Wedge, Outside Sole | other | $32 | $32 | $32 | 1 |
| Irrigation Tubeset for Bone Scalpel Mxb-t 5/b | other | $32 | $32 | $32 | 1 |
| Neomycin-polymyxin-hc Ear Soln | other | $32 | $32 | $32 | 1 |
| Vac Veraflo Veralink Cassette #ultlnk0500 | other | $32 | $32 | $32 | 1 |
| Hydrocortisone 2.5 % Ex Crea | other | $32 | $32 | $32 | 1 |
| Hydrocortisone 2.5% Cream | other | $32 | $32 | $32 | 1 |
| Trocar Cannula Alcon 25g #8065751448 | other | $32 | $32 | $32 | 1 |
| Bowl Cement Smart Mix #5401-76 | other | $32 | $32 | $32 | 1 |
| Nipple Prosthesis, Prefabricated, Reusable, Any Type, Each | other | $32 | $32 | $32 | 1 |
| Pin Fixation Pk #07.00656.002 | other | $32 | $32 | $32 | 1 |
| Special Casting Material | other | $32 | $32 | $32 | 1 |
| Benzocaine 20% 60 Ml Spray | other | $32 | $32 | $32 | 1 |
| Rbc Pretreatment with Enzymes | other | $32 | $32 | $32 | 1 |
| Alanine Amino | other | $32 | $32 | $32 | 1 |
| Rheumatoid Factor Quant | other | $32 | $32 | $32 | 1 |
| Cortisol, Serum | other | $32 | $32 | $32 | 1 |
| Injection, Ceftazidime, Per 500 Mg | other | $33 | $30 | $35 | 2 |
| Injection, Cytarabine, 100 Mg | other | $33 | $33 | $33 | 1 |
| Mask CPAP O2-resq Sys Sz Adult Med | other | $33 | $33 | $33 | 1 |
| Mammary Support Medium W/cups | other | $33 | $33 | $33 | 1 |
| Addition to Upper Extremity Orthosis, Sock, Fracture OR Equal, Each | other | $33 | $33 | $33 | 1 |
| Levalbuterol Tar Hfa 45mcg Inh | other | $33 | $33 | $33 | 1 |
| Geo Matt-foam Pressure Air 34x72x3.5 4ea/1cs | other | $33 | $33 | $33 | 1 |
| Carbamazepine 100 Mg/5ml Po Susp | other | $33 | $33 | $33 | 1 |
| 4fr Pigtail | other | $33 | $33 | $33 | 1 |
| Blower Mister Kit Clearview #22150 | other | $33 | $33 | $33 | 1 |
| Crutches Underarm, Other Than Wood, Adjustable OR Fixed, Pair, with Pads, Tip... | other | $33 | $33 | $33 | 1 |
| Inflation Device Sphere 20cc #g31027 | other | $33 | $33 | $33 | 1 |
| Plate Tack Acumed #pl-ptack | other | $33 | $33 | $33 | 1 |
| Hydrocortisone 2.5% Ointment | other | $33 | $33 | $33 | 1 |
| Tolvaptan 15 Mg Tablet | other | $33 | $33 | $33 | 1 |
| Coag Bipolar Bayonet Non-insulated Tip1.5mm | other | $33 | $33 | $33 | 1 |
| Desmopressin 10 Mcg/0.1 Ml Spr | other | $33 | $33 | $33 | 1 |
| Tall Air Walker Lg #b | other | $33 | $33 | $33 | 1 |
| Tall Air Walker Med #b | other | $33 | $33 | $33 | 1 |
| Tall Air Walker Sm #b | other | $33 | $33 | $33 | 1 |
| Tall Air Walker Xs #b | other | $33 | $33 | $33 | 1 |
| Platelet Storage Process Fee | other | $33 | $33 | $33 | 1 |
| Platelets, Pheresis, Irradiated, Each Unit | other | $33 | $33 | $33 | 1 |
| Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit | other | $33 | $33 | $33 | 1 |
| Assay of Triglycerides | other | $33 | $33 | $33 | 1 |
| Deb Bone Add-on | other | $33 | $33 | $33 | 1 |
| Coombs Test Direct | other | $33 | $33 | $33 | 1 |
| Tru-pull Lite Left Knee Adult 15.5-18.5" Small #11-0261 | other | $34 | $34 | $34 | 1 |
| Tru-pull Lite Left Knee Adult 18.5-21" Medium #11-0261 | other | $34 | $34 | $34 | 1 |
| Tru-pull Lite Left Knee Adult 21-23.5" Large #11-0261 | other | $34 | $34 | $34 | 1 |
| Tru-pull Lite Left Knee Adult 23.5-26.5" X-large #11-0261 | other | $34 | $34 | $34 | 1 |
| Tru-pull Lite Right Knee Adult 18.5-21" Medium #11-0260 | other | $34 | $34 | $34 | 1 |
| Tru-pull Lite Right Knee Adult 21-23.5" Large #11-0260 | other | $34 | $34 | $34 | 1 |
| Tru-pull Lite Right Knee Adult 23.5-26.5" X-large #11-0260 | other | $34 | $34 | $34 | 1 |
| Drill Solid Side Cutting 2x40 Drll-ssc | other | $34 | $34 | $34 | 1 |
| Pressure Guard 12cm #82050 10ea/1bx | other | $34 | $34 | $34 | 1 |
| Grasper Babcock 533-005-925 8ea/1bx | other | $34 | $34 | $34 | 1 |
| Tube Endobronchial 35fr Right #126035 | other | $34 | $34 | $34 | 1 |
| Tube Endobronchial 37fr Right #126037 | other | $34 | $34 | $34 | 1 |
| Tube Endobroncial 39fr Right #126039 | other | $34 | $34 | $34 | 1 |
| Temno Evolution Biopsy Needles Ctt1811 | lab | $34 | $34 | $34 | 1 |
| Temno Evolution Biopsy Needles Ctt1815 | lab | $34 | $34 | $34 | 1 |
| Temno Evolution Biopsy Needles Ctt1820 | lab | $34 | $34 | $34 | 1 |
| Lantus 100 Unit/ml Vial | other | $34 | $34 | $34 | 1 |
| For Diabetics Only, Multiple Density Insert, Made By Direct Carving with Cam ... | other | $34 | $34 | $34 | 1 |
| Ethyl Chloride Spray | other | $34 | $34 | $34 | 1 |
| Drill Solid Side Cuttin 2.5x40 Drll-ssc | other | $34 | $34 | $34 | 1 |
| Inflation Device Stonemaster V #maj | other | $34 | $34 | $34 | 1 |
| Stylet Kit 58cm Ds06003/58 Ds06003 | other | $34 | $34 | $34 | 1 |
| Lidocaine Hcl 2% Syringe | other | $34 | $34 | $34 | 1 |
| Pin Skull Disp | other | $34 | $34 | $34 | 1 |
| Obs ICU Nonpaid Cc 44 | other | $34 | $34 | $34 | 1 |
| Obs OB Nonpaid Cc 44 | other | $34 | $34 | $34 | 1 |
| Sterile Water for Injection | other | $34 | $34 | $34 | 1 |
| Cholangiogram Catheter | cardiac | $34 | $34 | $34 | 1 |
| Injection, Vancomycin Hcl (mylan), Not Therapeutically Equivalent to J3370, 5... | other | $34 | $34 | $34 | 1 |
| Deb Subq Tissue Add-on | other | $34 | $34 | $34 | 1 |
| Gradient Compression Gauntlet, Each | other | $35 | $35 | $35 | 1 |
| Tray Umbilical Vessel Insertion #43201 | other | $35 | $35 | $35 | 1 |
| Diag Catheter 4fr Vert #srd6108 | cardiac | $35 | $35 | $35 | 1 |
| Radial Cocktail 10 Ml Kit (2-5 Ml Syringes)-compounded | other | $35 | $35 | $35 | 1 |
| Shoulder Suspension Kit 72200195 | other | $35 | $35 | $35 | 1 |
| Sodium Chloride 3% IV Soln | other | $35 | $35 | $35 | 1 |
| Marcaine 0.25%-epi 1:200,000 | other | $35 | $35 | $35 | 1 |
| Resting Hand Orthosis Large Left 29rho-l-l | other | $35 | $35 | $35 | 1 |
| Resting Hand Orthosis Large Right 29rho-l-r | other | $35 | $35 | $35 | 1 |
| Resting Hand Orthosis Medium Right 29rho-m-r | other | $35 | $35 | $35 | 1 |
| Resting Hand Orthosis Small Left 29rho-s-l | other | $35 | $35 | $35 | 1 |
| Resting Hand Orthosis Small Right 29rho-s-r | other | $35 | $35 | $35 | 1 |
| Resting Hand Orthosis X-large Left 29rho-xl-l | other | $35 | $35 | $35 | 1 |
| Resting Hand Orthosis X-large Right 29rho-xl-r | other | $35 | $35 | $35 | 1 |
| Resting Hand Othosis Medium Left 29rho-m-l | other | $35 | $35 | $35 | 1 |
| Brachytherapy Source, Non-stranded, Iodine-125, Per Source | other | $35 | $35 | $35 | 1 |
| Hc Epidural Anesthesia Time - Each Incremental 15 Minute | other | $35 | $35 | $35 | 1 |
| Hc Spinal Anes Ea Addl 15 Min | other | $35 | $35 | $35 | 1 |
| Stylet Kit 52cm Ds06001-52 Ds06001/52 | other | $35 | $35 | $35 | 1 |
| Tall Air Walker Xl #b | other | $35 | $35 | $35 | 1 |
| Pleur-evac Sahara Chest Drain #s-1100-08lf 6ea/case | other | $35 | $35 | $35 | 1 |
| Brachytherapy Needle | other | $35 | $35 | $35 | 1 |
| Monoka Mini #s1-1500u | other | $35 | $35 | $35 | 1 |
| Vascular Sheath A/v Small Yellow | other | $35 | $35 | $35 | 1 |
| Needle/sheath Injector #nm-221c-0427 1ea/1bx | other | $35 | $35 | $35 | 1 |
| Picc Introducer 6.0fr Micro Bard | other | $35 | $35 | $35 | 1 |
| Ped Trach Tapershape Cuff 5.0mm Id 7.3mm Od 5.0pcf 1ea | other | $35 | $35 | $35 | 1 |
| Ped Trach Tapershape Cuff 5.5mm Id 7.9mm Od 5.5pcf 1ea | other | $35 | $35 | $35 | 1 |
| Shiley Pediatric Tracheostomy Tubes with Taperguard Cuff 3.5pcf | other | $35 | $35 | $35 | 1 |
| Shiley Pediatric Tracheostomy Tubes with Taperguard Cuff 4.0pcf | other | $35 | $35 | $35 | 1 |
| Tube Trach Pediatric 4.5 Cuff Medtronic #4.5pcf | other | $35 | $35 | $35 | 1 |
| Kcl 40 Meq/l-d5w-0.9% Nacl | other | $35 | $35 | $35 | 1 |
| Potassium Cl 20 Meq-0.45% Nacl | other | $35 | $35 | $35 | 1 |
| Cannula Tandem Xl Triple Lumen ERCP M00535700 | other | $35 | $35 | $35 | 1 |
| Cannula Eopa Arterial 22fr 77622 10ea/1pk | other | $35 | $35 | $35 | 1 |
| Loop Cutting 24fr #m0068802611 | other | $35 | $35 | $35 | 1 |
| Urinalysis | lab | $35 | $25 | $773 | 19 |
| Injection, Cefepime Hydrochloride, 500 Mg | other | $35 | $35 | $35 | 1 |
| Low Osmolar Contrast Material, 300-399 Mg/ml Iodine Concentration, Per Ml | other | $35 | $35 | $35 | 1 |
| Microalbumin, Urine | other | $35 | $35 | $35 | 1 |
| Antibody Id/eash Sel Reagent C | other | $35 | $35 | $35 | 1 |
| Gait Training Therapy | other | $35 | $35 | $35 | 1 |
| Physical Therapy Session | therapy | $35 | $35 | $35 | 1 |
| Self Care Mngment Training | other | $35 | $35 | $35 | 1 |
| Therapeutic Activities | therapy | $35 | $35 | $35 | 1 |
| Repair Prosthetic Device, Labor Component, Per 15 Minutes | surgery | $36 | $36 | $36 | 1 |
| Gabapentin 250 Mg/5 Ml Soln | other | $36 | $36 | $36 | 1 |
| 10.0mm Shiley Flex Cuffless Reus Trach 10un10r | other | $36 | $36 | $36 | 1 |
| Orthopedic Footwear, Ladies Shoe, Depth Inlay, Each | other | $36 | $36 | $36 | 1 |
| Trach 4cfs 6.5mm Adt Flex Trach Cuffless 4un65r | other | $36 | $36 | $36 | 1 |
| Trach Tube 6cfs #6un75r | other | $36 | $36 | $36 | 1 |
| Trach Tube 8cfs #8un85r | other | $36 | $36 | $36 | 1 |
| Verapamil 10 Mg/4 Ml Vial | other | $36 | $36 | $36 | 1 |
| Viscoat #8065-18 | other | $36 | $36 | $36 | 1 |
| Shiley Xlt Extended -length Tracheostomy Tube Distal Extension Size 6 Uncuffe... | other | $36 | $36 | $36 | 1 |
| Trach Cuff Xlt 7.0mm #70xltcp | other | $36 | $36 | $36 | 1 |
| Tracheostomy Tube Shiley Uncuffed Id 8.0mm 105mm #80xltud | other | $36 | $36 | $36 | 1 |
| Tracheostomy Tube Shiley Uncuffed Size 6 Id 6mm 95mm 60xltup | other | $36 | $36 | $36 | 1 |
| Tube Trach Cuff 6.0mm Xlt Prox | other | $36 | $36 | $36 | 1 |
| Tube Trach Xlt 6.0 Distal Ext Cuffed | other | $36 | $36 | $36 | 1 |
| Tube Trach Xlt 7.0 Distal Ext Cuffed | other | $36 | $36 | $36 | 1 |
| Tube Trach Xlt 7.0 Uncuffed Proximal #70xltup | other | $36 | $36 | $36 | 1 |
| Tube Trach Xlt 8.0 Distal Ext Cuffed | other | $36 | $36 | $36 | 1 |
| Tube Trach Xlt 8.0 Proximal Ext Cuffed | other | $36 | $36 | $36 | 1 |
| Tube Trach Xlt 8.0 Uncuff Proximal #80xltup | other | $36 | $36 | $36 | 1 |
| 20fr Standard Peg Kit Push Box of 2 #m00568211 | other | $36 | $36 | $36 | 1 |
| 24fr Standard Peg Kit Pull with Enfit M00509061 | other | $36 | $36 | $36 | 1 |
| Aveta Waste Management Accessory 3.0 #205-2036 6ea/ct | other | $36 | $36 | $36 | 1 |
| Breast Prosthesis, Mastectomy Bra, without Integrated Breast Prosthesis Form,... | other | $36 | $36 | $36 | 1 |
| Cast Supplies, Long Leg Cast, Pediatric (0-10 Years), Fiberglass | other | $36 | $36 | $36 | 1 |
| Gastrostomy 24fr Peg Kit/gastrodome #6824 | other | $36 | $36 | $36 | 1 |
| Lap Gas Conditioning Device Vessel Guardian | other | $36 | $36 | $36 | 1 |
| Passport 12 X 3 #ar-6592-12 | other | $36 | $36 | $36 | 1 |
| Pessary, Reusable, Rubber, Any Type | other | $36 | $36 | $36 | 1 |
| Trimming of Dystrophic Nails, Any Number | other | $36 | $36 | $36 | 1 |
| Visit Complexity Inherent to Evaluation and Management Associated with Medica... | other | $36 | $36 | $36 | 1 |
| Vecuronium 10 Mg Vial | other | $36 | $36 | $36 | 1 |
| Vecuronium Bromide 10 Mg IV Solr | other | $36 | $36 | $36 | 1 |
| Injection, Phenylephrine Hydrochloride, 20 Micrograms | other | $36 | $31 | $40 | 2 |
| Complete Blood Count (CBC) | lab | $36 | $28 | $138 | 8 |
| Partial Thromboplastin Time | lab | $36 | $36 | $36 | 1 |
| Lactate (ld) (ldh) Enzyme | other | $36 | $36 | $36 | 1 |
| Injection, Amikacin Sulfate, 100 Mg | other | $37 | $30 | $43 | 2 |
| Injection, Atropine Sulfate, 0.01 Mg | other | $37 | $30 | $44 | 2 |
| Injection, Magnesium Sulfate, Per 500 Mg | other | $37 | $30 | $44 | 2 |
| Injection, Succinylcholine Chloride, Up to 20 Mg | other | $37 | $32 | $41 | 2 |
| Catheter Endo 5.5fr Ercp-1-cramer #g21765 | cardiac | $37 | $37 | $37 | 1 |
| Metatarsal Bar Wedge, Rocker | other | $37 | $37 | $37 | 1 |
| Tube Endobronchial 37fr Right #116200370 | other | $37 | $37 | $37 | 1 |
| Purstring 65 Instrument Medtronic #020242 Case/3ea | other | $37 | $37 | $37 | 1 |
| Splint Nasal Denver Aluminum Sm/md #10-1500-05ks | other | $37 | $37 | $37 | 1 |
| Temno Evolution Biopsy Needle Ctt2011 | lab | $37 | $37 | $37 | 1 |
| Temno Evolution Biopsy Needles Ctt2015 | lab | $37 | $37 | $37 | 1 |
| Catheter, Guiding | cardiac | $37 | $37 | $37 | 1 |
| Dermagraft, Per Square Centimeter | other | $37 | $37 | $37 | 1 |
| Hc Regional Anesthesia Time - Each Incremental 15 Minutes | other | $37 | $37 | $37 | 1 |
| Safeguard 24cm #82000 10ea/1bx | other | $37 | $37 | $37 | 1 |
| Injection, Pantoprazole Sodium, 40 Mg | other | $37 | $37 | $37 | 1 |
| Assay of Iron | other | $37 | $37 | $37 | 1 |
| Addition to Lower Extremity, Below Knee, Fork Strap | other | $38 | $38 | $38 | 1 |
| Cns Monitor Icp Drain Bag 1ea | other | $38 | $38 | $38 | 1 |
| Catheter Jet Ventilation Adult 30-02-013 | cardiac | $38 | $38 | $38 | 1 |
| Catheter Jet Ventilation Child 30-02-014 | cardiac | $38 | $38 | $38 | 1 |
| Catheter Jet Ventilation Infant 30-02-018 | cardiac | $38 | $38 | $38 | 1 |
| Starchmark Ultracore Marker Ss 14g #stmk14gss | other | $38 | $38 | $38 | 1 |
| Ultra Clip Dual Trigger Marker #862017d | other | $38 | $38 | $38 | 1 |
| Ultra Clip Dual Trigger Marker Ribb #863017d | other | $38 | $38 | $38 | 1 |
| Ultraclip Dual Trigger Marker 108 Coil | other | $38 | $38 | $38 | 1 |
| Ultraclip Dual Trigger Marker 108 Venus | other | $38 | $38 | $38 | 1 |
| Ultraclip Dual Trigger Marker Titanium Heart | cardiac | $38 | $38 | $38 | 1 |
| Injection, Testosterone Cypionate, 1 Mg | other | $38 | $38 | $38 | 1 |
| Aprepitant, Oral, 5 Mg | other | $38 | $38 | $38 | 1 |
| Pump Cold Therapy Polar Care Cube | other | $38 | $38 | $38 | 1 |
| Smark Atec-2s-13 | other | $38 | $38 | $38 | 1 |
| Catheter Ph Internal 10cm Disp Dual Versaflex | cardiac | $38 | $38 | $38 | 1 |
| Restraint Vest Xxlrg #m227b-xl | other | $38 | $38 | $38 | 1 |
| Splint Ortho-glass 4"x15' 2rl/cs #og-4l2 | other | $38 | $38 | $38 | 1 |
| Flector Patch | other | $38 | $38 | $38 | 1 |
| Diclofenac Sodium 1% Gel | other | $38 | $38 | $38 | 1 |
| Vascular Sheath Blue #9009 | other | $39 | $39 | $39 | 1 |
| Miami Slim Lumbar 2xl #lmbsl | other | $39 | $39 | $39 | 1 |
| Injection, Pyridoxine Hcl, 100 Mg | other | $39 | $39 | $39 | 1 |
| Potassium Alum Powder | other | $39 | $39 | $39 | 1 |
| Crown Fistula Wound 00860013000301 | other | $39 | $39 | $39 | 1 |
| Balloon Armada 35 Wh 12x80x135cm #b2120 | other | $39 | $39 | $39 | 1 |
| Bellaire Comfort Lso Universal Fits Waist Circumference: 25-60inch (64-152cm)... | other | $39 | $39 | $39 | 1 |
| Wound Retractor/protector Medium | other | $39 | $39 | $39 | 1 |
| Wound Retractor/protector Small 5 Ea/bx #c8401 | other | $39 | $39 | $39 | 1 |
| Trimark Eviva 2s | other | $39 | $39 | $39 | 1 |
| Trimark Td 1309 | other | $39 | $39 | $39 | 1 |
| Infusion Supplies for External Drug Infusion Pump, Per Cassette OR Bag | surgery | $39 | $39 | $39 | 1 |
| Surgicel 1/2 X 2 #1955s 12ea/cs | other | $39 | $39 | $39 | 1 |
| Electrode-bugbee Fulgurating 5frx58cm #be | other | $39 | $39 | $39 | 1 |
| Valved Entry System 23ga 4mm #8065751585 | other | $39 | $39 | $39 | 1 |
| Miami Slim Lumbar 6xl #lmbsl | other | $39 | $39 | $39 | 1 |
| Tcc-ez Regular Boot Tcc21100 1 Each | other | $39 | $39 | $39 | 1 |
| Dermatac Drape W/granufoam Dressing Lg 10pk | other | $39 | $39 | $39 | 1 |
| Injection, Sumatriptan Succinate, 6 Mg | other | $39 | $39 | $39 | 1 |
| Assay of Thyroid | other | $39 | $39 | $39 | 1 |
| Ccp Antibodies | other | $39 | $39 | $39 | 1 |
| Assay of Amylase | other | $39 | $39 | $39 | 1 |
| Assay of Ck | other | $39 | $39 | $39 | 1 |
| Injection, Hydralazine Hcl, Up to 20 Mg | other | $40 | $30 | $50 | 2 |
| Amox-clav 600-42.9 Mg/5 Ml Sus | other | $40 | $40 | $40 | 1 |
| Amoxicillin-pot Clavulanate 600-42.9 Mg/5ml Po Susr | other | $40 | $40 | $40 | 1 |
| Cast Supplies, Long Arm Cast, Pediatric (0-10 Years), Plaster | other | $40 | $40 | $40 | 1 |
| Rom Elbow Orthosis Right #w | other | $40 | $40 | $40 | 1 |
| 10.0mm Shiley Flex Cuffed Reus Trach 10cn10r | other | $40 | $40 | $40 | 1 |
| 6.5mm Shiley Flex Cuffed Reus Trach 4cn65r | other | $40 | $40 | $40 | 1 |
| 8.5mm S Shiley Flex Cuffed Reus Trach 8cn85r | other | $40 | $40 | $40 | 1 |
| Trach Tube Shiley Cuffed 7mm Id 10.1mm Od 68mm Reusable 5cn70r 1ea | other | $40 | $40 | $40 | 1 |
| Packing Silverstein #14 | other | $40 | $40 | $40 | 1 |
| Fogarty Insert Safe Jaw 33mm Safehy33 | other | $40 | $40 | $40 | 1 |
| Tray Snarecoil Bone Marrow 11x4 W/rbn-114 Needle No Aspiration Needle Include... | other | $40 | $40 | $40 | 1 |
| Vascular Sheath Large Orange #9009 | other | $40 | $40 | $40 | 1 |
| Cement Mixer Smart Mix Mini #5401-39 | other | $40 | $40 | $40 | 1 |
| Marker Biopsy Site Stainless Steel Stoplight Shape for Securmark MRI #smark-m... | imaging | $40 | $40 | $40 | 1 |
| Marker Breast Biopsy Clip 9 Gauge Stainless Steel Securmark Atec #smark-m-ss2... | lab | $40 | $40 | $40 | 1 |
| Marker Breast Biopsy Clip Stainless Steel Securmark Atec #smark-m-ss1 10ea/box | lab | $40 | $40 | $40 | 1 |
| Cold Therapy Unit Donjoy Iceman Clear 11 | other | $40 | $40 | $40 | 1 |
| Injection, Lidocaine Hcl in 5% Dextrose, 1 Mg | other | $40 | $40 | $40 | 1 |
| Kcl 10 Meq/l-d5w-0.45% Nacl | other | $40 | $40 | $40 | 1 |
| Kcl 20 Meq/l-d5w-0.9% Nacl | other | $40 | $40 | $40 | 1 |
| Kcl 40 Meq/l-d5w-0.45% Nacl | other | $40 | $40 | $40 | 1 |
| Sacubitril/valsartan 97/103 Mg | other | $40 | $40 | $40 | 1 |
| Assay of Magnesium | other | $40 | $40 | $40 | 1 |
| Injection, Clindamycin Phosphate, 300 Mg | other | $41 | $30 | $51 | 2 |
| Loop Cutting 24fr .012 #g46209 | other | $41 | $41 | $41 | 1 |
| Compass Lumbar Puncture #clph2o001-5 5ea/case | other | $41 | $41 | $41 | 1 |
| Aztreonam 2 Gm/ Ns 50 Ml Mini Bag Plus - Compounded | other | $41 | $41 | $41 | 1 |
| Cefdinir 250 Mg/5 Ml Susp | other | $41 | $41 | $41 | 1 |
| Cefdinir 250 Mg/5ml Po Susr | other | $41 | $41 | $41 | 1 |
| 14fr Entuit Gastrostomy Tube #g35615 | other | $41 | $41 | $41 | 1 |
| Entuit Gastrostomy Tube | other | $41 | $41 | $41 | 1 |
| Gastrostomy/jejunostomy Tube, Low-profile, Any Material, Any Type, Each | other | $41 | $41 | $41 | 1 |
| Physician OR Allowed Practitioner Re-certification for Medicare-covered Home ... | other | $41 | $41 | $41 | 1 |
| Rom Elbow Orthosis Left #w | other | $41 | $41 | $41 | 1 |
| Cystotome Kelman Sharp 22g #e01412s | other | $41 | $41 | $41 | 1 |
| Auto Effluent Set #115370 Ca/ 8ea | other | $41 | $41 | $41 | 1 |
| Vascular Sheath Sm Green | other | $41 | $41 | $41 | 1 |
| 7.5mm Shiley Flex Cuffed Reus Trach 6cn75r | other | $41 | $41 | $41 | 1 |
| Cefpodoxime Proxetil 100 Mg/5ml Po Susr | other | $41 | $41 | $41 | 1 |
| Injection, Methylprednisolone Acetate, 1 Mg | other | $41 | $40 | $42 | 2 |
| Sacubitril/valsartan 24/26mg | other | $41 | $41 | $41 | 1 |
| Assay of Total Thyroxine | other | $41 | $41 | $41 | 1 |
| Assay of Lipase | other | $41 | $41 | $41 | 1 |
| For Diabetics Only, Multiple Density Insert, Custom Molded From Model of Pati... | other | $42 | $42 | $42 | 1 |
| Soft-flow Angled Tip Arterial Cannula with Suture Bulb 21fr X 14" ( 7.0mm ) 5761 | other | $42 | $42 | $42 | 1 |
| Tray Paracentesis Quick Tap 15x3-1/4 4ea/1cs | other | $42 | $42 | $42 | 1 |
| Tumark Pro X for Brevara Std Tumark-brev-s-x | other | $42 | $42 | $42 | 1 |
| Tumark Profess Q for Eviva Std Tumark-e13-s-q | other | $42 | $42 | $42 | 1 |
| Tumark Professional Q Shape 10cm 351220 Bx/10ea | other | $42 | $42 | $42 | 1 |
| Tumark Professional X Shape 10cm 351210 Bx/10ea | other | $42 | $42 | $42 | 1 |
| Tumark Vq for Brevera Standard 127.5mm 18g Tumark-brev-s-q-02 10/bx | other | $42 | $42 | $42 | 1 |
| Endoclip Ii Ml 10mm #176657 | other | $42 | $42 | $42 | 1 |
| Eric Arch Bar/6" Per Chrge | other | $42 | $42 | $42 | 1 |
| Exofin Fusion Skin Closure 22cm #ef70401 | surgery | $42 | $42 | $42 | 1 |
| Manta 14f Depth Locator 5 Ea/bx 114f | other | $42 | $42 | $42 | 1 |
| Shoulder Orthosis, Figure of Eight Design Abduction Restrainer, Prefabricated... | other | $42 | $42 | $42 | 1 |
| Stylet for Peritoneal Cath #sst | other | $42 | $42 | $42 | 1 |
| Wrist Hand Orthosis, Wrist Extension Control Cock-up, Non Molded, Prefabricat... | other | $42 | $42 | $42 | 1 |
| 4fr Pedal Access Set Micropuncture Transitionless #g02972 | other | $42 | $42 | $42 | 1 |
| 5fr Pedal Access Set Micropuncture Transitionless #g02988 | other | $42 | $42 | $42 | 1 |
| Bivona Uncuffed Tracheostomy Tube Flextend Size 8.0 Pediatric #60pfs55 | other | $42 | $42 | $42 | 1 |
| Tretinoin 0.025 % Ex Gel | other | $42 | $42 | $42 | 1 |
| Electrolyte Panel | lab | $42 | $42 | $42 | 1 |
| Swan Ganz Catheter #131f7p 5/cs | cardiac | $43 | $43 | $43 | 1 |
| Duovisc Viscoelastic System | other | $43 | $43 | $43 | 1 |
| Hydromorphone 6 Mg/30 Ml-ns | other | $43 | $43 | $43 | 1 |
| Injection, Procainamide Hcl, Up to 1 Gm | other | $43 | $43 | $43 | 1 |
| Sodium Chloride 120 Meq/30 Ml | other | $43 | $43 | $43 | 1 |
| Fluorometholone 0.1% Eye Drop | other | $43 | $43 | $43 | 1 |
| Foot, Molded Shoe Plastazote (or Similar) Custom Fitted, Each | other | $43 | $43 | $43 | 1 |
| Orthopedic Footwear, Custom Shoe, Depth Inlay, Each | other | $43 | $43 | $43 | 1 |
| Orthopedic Footwear, Mens Shoe, Depth Inlay, Each | other | $43 | $43 | $43 | 1 |
| Vascular Occluder 30mm 1.50 5ea/bx | other | $43 | $43 | $43 | 1 |
| Vascular Occluders 1.25mm | other | $43 | $43 | $43 | 1 |
| Drill Flexible 25mm 71362925 S&n | other | $43 | $43 | $43 | 1 |
| Retrograde Cardioplegia Cannula Self Inflating Balloon 18mm and Sure Touch Ha... | other | $43 | $43 | $43 | 1 |
| Barron Vacuum Punch 9.0mm | other | $43 | $43 | $43 | 1 |
| Healon Gv Pro 0.85ml 10340014 | other | $43 | $43 | $43 | 1 |
| Elite Irrigation Sleeve 7cm #5407-010 | other | $43 | $43 | $43 | 1 |
| Guide Wire | other | $43 | $29 | $56 | 2 |
| Complete Blood Count (CBC) | lab | $43 | $31 | $47 | 4 |
| Microbe Susceptible Disk | other | $43 | $43 | $43 | 1 |
| Exam Synovial Fluid Crystals | other | $43 | $43 | $43 | 1 |
| Pap Smear | preventive | $44 | $30 | $6,857 | 17 |
| Obgyn Vacuum Palm Delivery Pump Mini Vac-6000m 5ea/1bx | obstetric | $44 | $44 | $44 | 1 |
| Obgyn Vacuum Palm Delivery Small Pump Vac-6000s 5ea/1bx | obstetric | $44 | $44 | $44 | 1 |
| Tip Wet-field Bipolar Hemostatic Eraser 25g | other | $44 | $44 | $44 | 1 |
| Speed Pins 3.2x110 #74013401 3ea/bx | other | $44 | $44 | $44 | 1 |
| Valve Speaking Passy-muir Trach #pmv | other | $44 | $44 | $44 | 1 |
| Anesthesia for Electroshock Therapy | other | $44 | $44 | $44 | 1 |
| Vascular Occluders 1.75mm | other | $44 | $44 | $44 | 1 |
| Vessel Occluder Coronary 12mm 2.50 | cardiac | $44 | $44 | $44 | 1 |
| Vessel Occluders 1.50mm | other | $44 | $44 | $44 | 1 |
| Vessel Occuluder 2.0mm #50200 | other | $44 | $44 | $44 | 1 |
| Blake Drain 19fr R/f #2230 Case/10ea | other | $44 | $44 | $44 | 1 |
| Bowl and Spatula Bone Cement Mixing Universal System Vacuum Rotor without Noz... | other | $44 | $44 | $44 | 1 |
| Shunt Javid Carotid 10frx27cm #007714 | other | $44 | $44 | $44 | 1 |
| Injection, Labetalol Hydrochloride, 5 Mg | other | $44 | $44 | $44 | 1 |
| Drug Test Prsmv Dir Opt Obs | other | $44 | $44 | $44 | 1 |
| Istat Chem 8-clia Waived | other | $44 | $44 | $44 | 1 |
| Lap Sac Tissue Pouch 4" X 6" #g16495 | other | $45 | $45 | $45 | 1 |
| Lap Sac Tissue Pouch 8" X 10" #g16497 | other | $45 | $45 | $45 | 1 |
| Electrode Pacing Bipolar 4fr 5ea/1bx | other | $45 | $45 | $45 | 1 |
| Electrode Pacing Bipolar 5fr 5ea/1bx | other | $45 | $45 | $45 | 1 |
| Electrode Pacing Bipolar 6fr - 5ea/1bx | other | $45 | $45 | $45 | 1 |
| Injection, Nafcillin Sodium, 20 Mg | other | $45 | $45 | $45 | 1 |
| Outflare Wedge | other | $45 | $45 | $45 | 1 |
| Relpax 20 Mg Tablet | other | $45 | $45 | $45 | 1 |
| Relpax 40 Mg Tablet | other | $45 | $45 | $45 | 1 |
| Bone Hemostasis 2.5gm #bw012 Ostene | other | $45 | $45 | $45 | 1 |
| Ketamine 500 Mg/5 Ml Vial | other | $45 | $45 | $45 | 1 |
| Aerotech I Aerosol Unit Ca-1124 | other | $45 | $45 | $45 | 1 |
| Inserter Tip for Tibial Tray #00584305201 | other | $45 | $45 | $45 | 1 |
| Insertion Needle 6" #acck1015 | other | $45 | $45 | $45 | 1 |
| Interrogation Device Evaluation(s), (remote) Up to 30 Days; Implantable Cardi... | surgery | $45 | $45 | $45 | 1 |
| Needle Epimed 4" #epmd1040 | other | $45 | $45 | $45 | 1 |
| Omo Neurexa Plus Left Small 5065n=l-s | other | $45 | $45 | $45 | 1 |
| Omo Neurexa Plus Right Small 5065n=r-s | other | $45 | $45 | $45 | 1 |
| Omo Neurexa Plus Right Xlarge 5065n=r-xl | other | $45 | $45 | $45 | 1 |
| Optetrak (4) Holding Pins Mni Head Sharp Point Mini Length Diameter 3.2mm #20... | other | $45 | $45 | $45 | 1 |
| Optetrak (4) Short Head Pins 1.125in (28.575mm) Diameter 3.175mm Item # 201-78 | other | $45 | $45 | $45 | 1 |
| Optetrak Quick Release Pins with Collar 40mm #201-78 | other | $45 | $45 | $45 | 1 |
| Orthopedic Shoe, Oxford with Supinator OR Pronator, Infant | other | $45 | $45 | $45 | 1 |
| Pin Fixation 2.3in Threaded Collared #521-78 | other | $45 | $45 | $45 | 1 |
| Screening Papanicolaou Smear; Obtaining, Preparing and Conveyance of Cervical... | preventive | $45 | $45 | $45 | 1 |
| Sensa Ii Ipg Template #acck7200 | other | $45 | $45 | $45 | 1 |
| Torque Wrench Kit #acck6006 | other | $45 | $45 | $45 | 1 |
| Hook Blunt 5mm #3316-8g 8ea/pk | other | $45 | $45 | $45 | 1 |
| Retractor Ring Plastic Single Use #3304-g | other | $45 | $45 | $45 | 1 |
| Marker Breast MRI Compatible Senomark#smuc13c | imaging | $45 | $45 | $45 | 1 |
| Potassium Cl 40 Meq/1,000ml-ns | other | $45 | $45 | $45 | 1 |
| Brace Knee Post Op Warrior Kb9000 | other | $45 | $45 | $45 | 1 |
| Tube Inner Ear Myringotomy Ventilation Reuter Bobbin without Flange Holes 1 M... | other | $45 | $45 | $45 | 1 |
| Breathing Bag OR Tube | other | $45 | $45 | $45 | 1 |
| Drill for Bi-cortical Post #ar-1365d | other | $46 | $46 | $46 | 1 |
| Post Op Knee Brace Regular #423100 | other | $46 | $46 | $46 | 1 |
| Vessel Occluder 1.75mm #50175 | other | $46 | $46 | $46 | 1 |
| Orthopedic Shoe Addition, Sole, Full | other | $46 | $46 | $46 | 1 |
| Methacholine Chloride Administered As Inhalation Solution Through a Nebulizer... | other | $46 | $46 | $46 | 1 |
| Provocholine (methacholine) Dilutions (vials a -e) - Compounded | other | $46 | $46 | $46 | 1 |
| Midline Indicator Pdl | other | $46 | $46 | $46 | 1 |
| Globo Ped Mobil Gr Lg #36628000030000eu | other | $46 | $46 | $46 | 1 |
| Globo Ped Mobil Gr Shoe Med 36628000020000 | other | $46 | $46 | $46 | 1 |
| Cath Airway Exchange Cook 14fr Dbl #g57628 | other | $46 | $46 | $46 | 1 |
| Mupirocin Calcium 2 % Ex Crea | other | $46 | $46 | $46 | 1 |
| Transfer Set 6" Mini Cap 6ea/cs | other | $46 | $46 | $46 | 1 |
| Addition to Lower Extremity, Limited Ankle Motion, Each Joint | other | $46 | $46 | $46 | 1 |
| C-reamer 9mm #8772a 4/bx | other | $46 | $46 | $46 | 1 |
| Gelfoam Powder | other | $46 | $46 | $46 | 1 |
| Injection, Cefazolin Sodium, 500 Mg | other | $46 | $46 | $46 | 1 |
| Compatibility Test Spin | other | $46 | $46 | $46 | 1 |
| Fungal Culture Hair,skin,nails | lab | $46 | $46 | $46 | 1 |
| Injection, Dopamine Hcl, 40 Mg | other | $47 | $30 | $64 | 2 |
| Lap Sac Tissue Pouch 5" X 8" #g16496 | other | $47 | $47 | $47 | 1 |
| 45 Degree Kelman Mini-flare Tip | other | $47 | $47 | $47 | 1 |
| Marker Breast Stereotactic Senomark #smev9c | other | $47 | $47 | $47 | 1 |
| Tcc-ez Large Boot Tcc21114 1 Each | other | $47 | $47 | $47 | 1 |
| Omo Neurexa Plus Left Xlarge 5065n=l-xl | other | $47 | $47 | $47 | 1 |
| Lift, Elevation, Heel, Tapered to Metatarsals, Per Inch | other | $47 | $47 | $47 | 1 |
| Acclarent Balloon Inflation Device 5 Ea/bxdib30 | other | $47 | $47 | $47 | 1 |
| Inflation Device Acclarent Se #seid Order By Bx/5ea | other | $47 | $47 | $47 | 1 |
| Funnel Fistula 00860013000325 | other | $47 | $47 | $47 | 1 |
| Xomed Nasal Postpac #15-26800 5/pk | other | $47 | $47 | $47 | 1 |
| Uterine Manipulator Dx Vcare | other | $47 | $47 | $47 | 1 |
| Flumazenil 0.5 Mg/5ml IV Soln | other | $47 | $47 | $47 | 1 |
| Brace Rcai Contour Fit Lso Med 451-cf-lso-m | other | $47 | $47 | $47 | 1 |
| Brace Rcai Control Fit Lso Large 451-cf-lso-l | other | $47 | $47 | $47 | 1 |
| Water for Injection Vial | other | $47 | $47 | $47 | 1 |
| Activated Charcoal 25gm Oral | other | $47 | $47 | $47 | 1 |
| Activated Charcoal; 25gm Water | other | $47 | $47 | $47 | 1 |
| Rbc Pretreatment | other | $47 | $47 | $47 | 1 |
| Injection Fluconazole, 200 Mg | other | $48 | $30 | $65 | 2 |
| Bio-medicus Venous Insertion Kit 5 Ea/pk 96551 | other | $48 | $48 | $48 | 1 |
| Addition to Lower Extremity, Below Knee, Waist Belt, Webbing | other | $48 | $48 | $48 | 1 |
| Interstim Therapy Antenna #3709 | other | $48 | $48 | $48 | 1 |
| Injection, Vancomycin Hcl, 500 Mg | other | $48 | $48 | $48 | 1 |
| Tranexamic 1,000 Mg/100ml-nacl | other | $48 | $48 | $48 | 1 |
| Ephedrine Sulfate (pressors) 5 Mg/ml IV Soln | other | $48 | $48 | $48 | 1 |
| Anesthesia for Access to Central Vein | other | $48 | $48 | $48 | 1 |
| Cath Cholangiogram #lap-13 6each/1box | other | $48 | $48 | $48 | 1 |
| Drill 3.0mm Step #ar-1250lt | other | $48 | $48 | $48 | 1 |
| Tissue Orientation Correct Clip #lcc6 | other | $48 | $48 | $48 | 1 |
| Cyclogyl 0.5% Eye Drops | other | $48 | $48 | $48 | 1 |
| Viagra 100 Mg Tablet | other | $48 | $48 | $48 | 1 |
| Viagra 50 Mg Tablet | other | $48 | $48 | $48 | 1 |
| Shunt Coronary Coil 1.5mm X 18mm Cts Flo | cardiac | $48 | $48 | $48 | 1 |
| Shunt Coronary Coil 2.5mm X 18mm #ft | cardiac | $48 | $48 | $48 | 1 |
| Bld Typing Serologic Rh Phnt | other | $48 | $48 | $48 | 1 |
| Blood Typing Rbc Antigens | other | $48 | $48 | $48 | 1 |
| Ag Detect Nos Ia Mult | other | $48 | $48 | $48 | 1 |
| Clostridium Ag Ia | other | $48 | $48 | $48 | 1 |
| Small Parts Kit 23g Cannl&plugset #8065752149 | other | $49 | $49 | $49 | 1 |
| Tube Trach Hyperflex Sz 7 Cuffed #67fhxl70 | other | $49 | $49 | $49 | 1 |
| Wellbutrin Xl 300 Mg Tablet | other | $49 | $49 | $49 | 1 |
| Cath 7fr Navilflex Rx Delivery Sys M00533560 | obstetric | $49 | $49 | $49 | 1 |
| Delivery System Rx 10fr Biliary M00533580 | obstetric | $49 | $49 | $49 | 1 |
| Delivery System Rx 7fr Biliary M00533560 | obstetric | $49 | $49 | $49 | 1 |
| Tcc-ez Extra Large Boot Tcc21124 1 Each | other | $49 | $49 | $49 | 1 |
| Full Sole and Heel Wedge, Between Sole | other | $49 | $49 | $49 | 1 |
| Nacl 0.45 500 | other | $49 | $49 | $49 | 1 |
| Injection, Heparin Sodium, Per 1000 Units | other | $49 | $49 | $49 | 1 |
| Hepatic Function Panel | lab | $49 | $43 | $197 | 3 |
| Iron Binding Test | other | $49 | $49 | $49 | 1 |
| Injection, Methocarbamol, Up to 10 Ml | other | $50 | $30 | $69 | 2 |
| Cath Fogarty Biliary 5fr 23cm 410235fp 5ea/case | other | $50 | $50 | $50 | 1 |
| Cath Fogarty Biliary 6fr 23cm 410236fp 5ea/case | other | $50 | $50 | $50 | 1 |
| External Breast Prosthesis Garment, with Mastectomy Form, Post Mastectomy | other | $50 | $50 | $50 | 1 |
| 4.2mm Trocar 210mm 03.010.070 | other | $50 | $50 | $50 | 1 |
| Strip Fistula Isolator 00860013000318 | other | $50 | $50 | $50 | 1 |
| Eleview Submucosal Injectable Composition 10ml Ampoule 5ea/bx #9000020 | other | $50 | $50 | $50 | 1 |
| Addition to Lower Extremity, Extended Steel Shank | other | $50 | $50 | $50 | 1 |
| Needle Transbronchial 19ga Aspiration W/syr | other | $50 | $50 | $50 | 1 |
| Needle Transbronchial 20ga Aspiration W/syr | other | $50 | $50 | $50 | 1 |
| Needle Transbronchial 21ga Aspiration W/syr | other | $50 | $50 | $50 | 1 |
| Dental Cleaning | other | $50 | $50 | $50 | 1 |
| Drug Screen Quantalcohols | other | $50 | $50 | $50 | 1 |
| Urine Bacteria Culture | lab | $50 | $50 | $50 | 1 |
| Endopath Electrosurgery Probe Plus Ii 5mm Hook 34cm Length Eps01 | surgery | $51 | $51 | $51 | 1 |
| Endopath Electrosurgery Probe Plus Ii 5mm Hook 29cm Length Eps05 | surgery | $51 | $51 | $51 | 1 |
| Shunt Coronary Coil 2.0mm X 18mm Cts Flo | cardiac | $51 | $51 | $51 | 1 |
| Barron Vacuum Punch 7.5mm | other | $51 | $51 | $51 | 1 |
| Barron Vacuum Punch 8.0mm | other | $51 | $51 | $51 | 1 |
| Counseling Visit to Discuss Need for Lung Cancer Screening Using Low Dose CT ... | preventive | $51 | $51 | $51 | 1 |
| Endoscopic Clip Applier 5mm M/l Port Universal Epix #ca500 3ea/box | other | $51 | $51 | $51 | 1 |
| Punch Barron Donor 7.75 K20 | other | $51 | $51 | $51 | 1 |
| Rd Rainbow Set 2 Adult Adhesive Sensor 4026 Box/10ea | other | $51 | $51 | $51 | 1 |
| Rd Rainbow Set 2 Neo Adhesive Sensor 4029 Box/10ea | other | $51 | $51 | $51 | 1 |
| Sensor Large Foresight Elite #fsesl Bx/20 | other | $51 | $51 | $51 | 1 |
| Stylet Faller for Pd Cath #fs | other | $51 | $51 | $51 | 1 |
| Tube Fastrach Combo Sz 3 #135130 5ea/1case | other | $51 | $51 | $51 | 1 |
| Tube Fastrach Combo Sz 4 | other | $51 | $51 | $51 | 1 |
| Tube Fastrach Combo Sz 5 | other | $51 | $51 | $51 | 1 |
| Brush Biopsy Deflection 3.2frx115cm #g15045 | lab | $51 | $51 | $51 | 1 |
| Injection, Aminocaproic Acid, 1 Gram | other | $51 | $51 | $51 | 1 |
| Reaming Rod 3.0 W/offset Ball Tip 950mm Nonst | other | $51 | $51 | $51 | 1 |
| Reaming Rod 3.0mm X 950mm #351.76 | other | $51 | $51 | $51 | 1 |
| Centurion 45 Fms Cassette Only | other | $51 | $51 | $51 | 1 |
| Cook Chest Drain Valve #g36370 | other | $51 | $51 | $51 | 1 |
| Hemoglobin A1C | lab | $51 | $37 | $134 | 12 |
| Fogarty Insert Dbl Hydrajaw 33mm | other | $52 | $52 | $52 | 1 |
| Closure Surgical Skin 16cm Zip16 Ps1160 10/pk | surgery | $52 | $52 | $52 | 1 |
| Gradient Compression Glove, Each | other | $52 | $52 | $52 | 1 |
| Retractor Ring Lone Star Disposable 3307g | other | $52 | $52 | $52 | 1 |
| Grasping Forceps Rescue Combo #m00538351 | other | $52 | $52 | $52 | 1 |
| Retrieval Net 30mm Rescue Net #dgn-538 | other | $52 | $52 | $52 | 1 |
| Sodium Bicarbonate 8.4 % IV Soln | other | $52 | $52 | $52 | 1 |
| Globo Ped Mobil Gr Small #36628000010000eu | other | $52 | $52 | $52 | 1 |
| Globo Ped Mobil Gr X-large #36628000040000 | other | $52 | $52 | $52 | 1 |
| Micro Nester .018 3mm X 14cm | other | $52 | $52 | $52 | 1 |
| Micro Nester .018 4mm X 14cm | other | $52 | $52 | $52 | 1 |
| Micro Nester .018 6mm X 14cn | other | $52 | $52 | $52 | 1 |
| Micro Nester .018 8mm X 7cm | other | $52 | $52 | $52 | 1 |
| Nester .035 16mm X 14cm | other | $52 | $52 | $52 | 1 |
| Nester .035 20mm X 14cm | other | $52 | $52 | $52 | 1 |
| Nester .035 3mm X 7cm | other | $52 | $52 | $52 | 1 |
| Nester .035 4mm X 14cm | other | $52 | $52 | $52 | 1 |
| Nester .035 6mm X 14cm | other | $52 | $52 | $52 | 1 |
| Injection, Mesna, 200 Mg | other | $52 | $52 | $52 | 1 |
| Addition to Lower Extremity, Varus/valgus Correction ('t') Strap, Padded/line... | other | $52 | $52 | $52 | 1 |
| Tcc-ez Transmet Boot Tcc21131 1 Each | other | $52 | $52 | $52 | 1 |
| Electrode Hf Needle 45deg 24-28fr #a22255c | other | $52 | $52 | $52 | 1 |
| Electrode Monopolar Roller Ball24-28f A22251c | other | $52 | $52 | $52 | 1 |
| Single Sensor W/lumen 7fr Catheter | cardiac | $52 | $52 | $52 | 1 |
| Cannula Grundy Retrograde 15fr #94115t | other | $52 | $52 | $52 | 1 |
| Cannula Perfusion Retrograde 15 Fr 32 Cm Length Stopcock Wirewound Body #9462... | surgery | $52 | $52 | $52 | 1 |
| Levemir 100 Unit/ml Vial | other | $52 | $52 | $52 | 1 |
| Brace Knee T-scope Post Op #08814 | other | $52 | $52 | $52 | 1 |
| Neomycin-polymyxin-hc Ear Susp | other | $52 | $52 | $52 | 1 |
| Uterine Manipulator Lrge Vcare | other | $52 | $52 | $52 | 1 |
| Uterine Manipulator Medium Vcare | other | $52 | $52 | $52 | 1 |
| Uterine Manipulator Small Vcare | other | $52 | $52 | $52 | 1 |
| Cement Mixer Sys Acm Stryker(used for Hip Rar | other | $52 | $52 | $52 | 1 |
| Ringers Injection-500cc | other | $52 | $52 | $52 | 1 |
| Fungus Isolation Culture | lab | $52 | $52 | $52 | 1 |
| Electrode Monopolar Loop A22205c | other | $53 | $53 | $53 | 1 |
| Alcohol And/or Substance (other Than Tobacco) Misuse Structured Assessment (e... | other | $53 | $53 | $53 | 1 |
| Barron Vacuum Punch 8.25mm | other | $53 | $53 | $53 | 1 |
| Catheter Dilation Soehendra Biliary G21571 | cardiac | $53 | $53 | $53 | 1 |
| Punch Cornea 8.5mm Barron Vacuum | other | $53 | $53 | $53 | 1 |
| Pigazzi Pad Pink Xl #40583 4ea/1cs | other | $53 | $53 | $53 | 1 |
| Snare System Lariat 30mm10mm6mm Port 2.5mm | other | $53 | $53 | $53 | 1 |
| Injection, Irinotecan, 20 Mg | other | $53 | $53 | $53 | 1 |
| Pessary, Reusable, Non Rubber, Any Type | other | $53 | $53 | $53 | 1 |
| Physician OR Allowed Practitioner Certification for Medicare-covered Home Hea... | other | $53 | $53 | $53 | 1 |
| Sulfacetamide 10% Eye Drops | other | $53 | $53 | $53 | 1 |
| Sulfacetamide Sodium 10 % Op Soln | other | $53 | $53 | $53 | 1 |
| Injection, Neostigmine Methylsulfate, Up to 0.5 Mg | other | $53 | $53 | $53 | 1 |
| Bacterial Culture | lab | $53 | $53 | $53 | 1 |
| Injection, Aminophyllin, Up to 250 Mg | other | $54 | $51 | $57 | 2 |
| Tcc-ez Large Charcot Boot Tcc21116 1 Each | other | $54 | $54 | $54 | 1 |
| Endovive Soft Peg Pull 20f 2/bx M00509001 | other | $54 | $54 | $54 | 1 |
| Gastrostomy Safety Peg 24fr Kit Pull | other | $54 | $54 | $54 | 1 |
| Gastrostomy Safety Peg Set 20fr W/xylocaine | other | $54 | $54 | $54 | 1 |
| Olumiant 1 Mg Tablet | other | $54 | $54 | $54 | 1 |
| Bra Cardiac Surgery Sz-40b-52dd 1ea | surgery | $54 | $54 | $54 | 1 |
| Cath Cholangiogram Aerostat Rigid Tip #c1002 | other | $54 | $54 | $54 | 1 |
| Prolonged Office OR Other Outpatient Evaluation and Management Service(s) Bey... | other | $54 | $54 | $54 | 1 |
| Retractor Alexis O Lg C-section 9-14cm #g6313 | obstetric | $54 | $54 | $54 | 1 |
| Wound Retractor/protector Large #c8403 | other | $54 | $54 | $54 | 1 |
| 9986-21-20 Flexible Osteotome Short 8 Mm | other | $54 | $54 | $54 | 1 |
| 9986-21-21 Flexible Osteotome Short 10 Mm | other | $54 | $54 | $54 | 1 |
| 9986-21-22 Flexible Osteotome Short 12 Mm | other | $54 | $54 | $54 | 1 |
| 9986-21-24 Flexible Osteotome Short Curved | other | $54 | $54 | $54 | 1 |
| 9986-21-26 Flexible Osteotome Long 10 Mm | other | $54 | $54 | $54 | 1 |
| 9986-21-27 Flexible Osteotome Long 8 Mm | other | $54 | $54 | $54 | 1 |
| Injection, Morphine Sulfate (fresenius Kabi), Not Therapeutically Equivalent ... | other | $54 | $54 | $54 | 1 |
| Zomig 5 Mg Nasal Spray | other | $54 | $54 | $54 | 1 |
| Omo Neurexa Plus Left Medium 5065n=l-m | other | $54 | $54 | $54 | 1 |
| Addition to Lower Extremity, Below Knee, Cuff Suspension | other | $54 | $54 | $54 | 1 |
| Influenza Rapid Test | lab | $54 | $54 | $54 | 1 |
| Assay of Free Thyroxine | other | $54 | $54 | $54 | 1 |
| Injection, Esmolol Hydrochloride, 10 Mg | other | $55 | $34 | $75 | 2 |
| Humeral Splint Ext Length Medium 37-2162 | other | $55 | $55 | $55 | 1 |
| Humeral Splint Ext. Length Lg | other | $55 | $55 | $55 | 1 |
| Humeral Splint Ext. Length Xlg | other | $55 | $55 | $55 | 1 |
| Humeral Splint Mid Length Lg | other | $55 | $55 | $55 | 1 |
| Humeral Splint Mid Length Med. | other | $55 | $55 | $55 | 1 |
| Humeral Splint Mid Length Small | other | $55 | $55 | $55 | 1 |
| Rally Vacuum Mixing Bowl7127 | other | $55 | $55 | $55 | 1 |
| Bard Single Lumen Picc 5fr #3195335 | other | $55 | $55 | $55 | 1 |
| Loop 3mm 12 Deg for Small Tur Set #wa47050c | other | $55 | $55 | $55 | 1 |
| 16fr Entuit Gastrostomy Tube #g35616 | other | $55 | $55 | $55 | 1 |
| Dressing Nasal Foam Stammberger Sinus #rr650 | other | $55 | $55 | $55 | 1 |
| G Tube Entuit #g35618 | other | $55 | $55 | $55 | 1 |
| 1.5mm Quick Release Drill Msdc15 Ms-dc15 | other | $55 | $55 | $55 | 1 |
| Compass Compartment #cmps001 | other | $55 | $55 | $55 | 1 |
| Nasal Packing Epostat 1ea | other | $55 | $55 | $55 | 1 |
| Nitroglycerin 400 Mcg Spray | other | $55 | $55 | $55 | 1 |
| L.e.t. (lido-epineph-tetra) Ge | other | $55 | $55 | $55 | 1 |
| Assay of Calcium | other | $55 | $55 | $55 | 1 |
| Antibody; HIV 1&2 Single Assay | other | $55 | $55 | $55 | 1 |
| Cath Nasal Posterior Epistaxis Rapid Rhino | other | $56 | $56 | $56 | 1 |
| Removal of Impacted Cerumen (one OR Both Ears) By Physician On Same Date of S... | surgery | $56 | $56 | $56 | 1 |
| Nasogastric/nasointestinal Feeding Tube Retention System 12fr White Corgrip S... | other | $56 | $56 | $56 | 1 |
| Nasogastric/nasointestinal Feeding Tube Retention System 14fr Yellow Corgrip ... | other | $56 | $56 | $56 | 1 |
| Nasogastric/nasointestinal Feeding Tube Retention System Corgrip Sr 10fr Pink... | other | $56 | $56 | $56 | 1 |
| Nasogastric/nasointestinal Feeding Tube Retention System Corgrip Sr 16fr Oran... | other | $56 | $56 | $56 | 1 |
| Nasogastric/nasointestinal Feeding Tube Retention System Corgrip Sr 18fr Tan ... | other | $56 | $56 | $56 | 1 |
| Omo Neurexa Plus Left Large 5065n=l-l | other | $56 | $56 | $56 | 1 |
| Omo Neurexa Plus Right Large 5065n=r-l | other | $56 | $56 | $56 | 1 |
| Omo Neurexa Plus Right Medium 5065n=r-m | other | $56 | $56 | $56 | 1 |
| Basket Retrieval 2.5x230cm Disp Roth 00711050 | other | $56 | $56 | $56 | 1 |
| Gradient Compression Arm Sleeve, Each | other | $56 | $56 | $56 | 1 |
| Roth Net Retrieval Basket #bx00711150 | other | $56 | $56 | $56 | 1 |
| Adapter/extension, Pacing Lead OR Neurostimulator Lead | other | $56 | $56 | $56 | 1 |
| Tcc-ez Extra Large Charcot Boot Tcc21126 1 Each | other | $57 | $57 | $57 | 1 |
| Hc Medihoney Alginate Dressing | other | $57 | $57 | $57 | 1 |
| Aplisol 5t Unit/0.1 Ml Vial | other | $57 | $57 | $57 | 1 |
| Duovisc Large #8065183150 | other | $57 | $57 | $57 | 1 |
| 5.5x85mm Rod Ti Alloy Curved Vitality #07.02015.014 | other | $57 | $57 | $57 | 1 |
| Cast Supplies | other | $57 | $57 | $57 | 1 |
| Home Sleep Test (hst) with Type IV Portable Monitor, Unattended; Minimum of 3... | other | $57 | $57 | $57 | 1 |
| Lineum 3.5mm X 80mm Ti Rod #14 | other | $57 | $57 | $57 | 1 |
| Presbyopia Correcting Function of Intraocular Lens | other | $57 | $57 | $57 | 1 |
| Tornado .018 8mm X 4mm | other | $57 | $57 | $57 | 1 |
| Tornado .035 10mm X 5mm | other | $57 | $57 | $57 | 1 |
| Tornado Coil .035 10mm X 4mm | other | $57 | $57 | $57 | 1 |
| Vitality 5.5x300mm Rod Ti Alloy Straight #07.02013.001 | other | $57 | $57 | $57 | 1 |
| Foot Drop Splint, Recumbent Positioning Device, Prefabricated, Off-the-shelf | other | $57 | $57 | $57 | 1 |
| Orthopedic Footwear, Woman's Shoe, Oxford, Used As an Integral Part of a Brace | other | $57 | $57 | $57 | 1 |
| Hc Dress Aquacl Ag Xtr | other | $57 | $57 | $57 | 1 |
| Instrument Tracker 9733533xom ENT | other | $57 | $57 | $57 | 1 |
| Rbc Pretreatment Serum | other | $57 | $57 | $57 | 1 |
| Compatibility Test Antiglob | other | $57 | $57 | $57 | 1 |
| Oxcarbazepine 300 Mg/5 Ml Susp | other | $58 | $58 | $58 | 1 |
| Kit Mickey Gastrostomy Feeding Tube 14fr2.3cm | other | $58 | $58 | $58 | 1 |
| Kit Mickey Gastrostomy Feeding Tube 16fr2.3cm | other | $58 | $58 | $58 | 1 |
| Tube Inner Ear Myringotomy Ventilation Notched Flange with Tab 1.14 Mm Id Sof... | other | $58 | $58 | $58 | 1 |
| Pillow Intubating Positioner Including Disposable Head Cradle #10-910-00 3/bx | other | $58 | $58 | $58 | 1 |
| Tri-lumen Filtered Tube Set 6ea/cs | other | $58 | $58 | $58 | 1 |
| Foot, Arch Support, Removable, Premolded, Longitudinal/ Metatarsal, Each | other | $58 | $58 | $58 | 1 |
| Cement Mixer Optivac Triple Mi | other | $58 | $58 | $58 | 1 |
| Flu Vaccination | preventive | $59 | $30 | $114 | 21 |
| Humeral Splint Mid Length 2xl #37-2185 | other | $59 | $59 | $59 | 1 |
| Adhesion Barrier | other | $59 | $59 | $59 | 1 |
| Smart Ablate Irrigation Tubing #sat001 | other | $59 | $59 | $59 | 1 |
| Injection, Gemcitabine Hydrochloride (accord), Not Therapeutically Equivalent... | other | $59 | $59 | $59 | 1 |
| Catheter, Occlusion | cardiac | $59 | $59 | $59 | 1 |
| Cement Mixer Smart Mix Tower #5401-98 | other | $59 | $59 | $59 | 1 |
| Addition to Lower Extremity Orthosis, Knee Control, Full Kneecap | other | $59 | $59 | $59 | 1 |
| C-reamer 10mm Linvatec #8773a 4/bx | other | $59 | $59 | $59 | 1 |
| Sternal Zipfix with Needle Pk/20ea #08.501.001.20s | other | $59 | $59 | $59 | 1 |
| Diabetes Outpatient Self-management Training Services, Individual, Per 30 Min... | other | $59 | $59 | $59 | 1 |
| Kyphon Bone Biopsy Device #3 #f05a | lab | $59 | $59 | $59 | 1 |
| Transfer of an Orthosis From One Shoe to Another, Caliper Plate, Existing | other | $59 | $59 | $59 | 1 |
| Bone Marrow Asp Sys Dstl Hole 11g 710.150.97s | other | $59 | $59 | $59 | 1 |
| Cultr Bacteria Except Blood | other | $59 | $59 | $59 | 1 |
| Assay of Troponin Quant | other | $59 | $59 | $59 | 1 |
| Hearing Service, Miscellaneous | other | $60 | $60 | $60 | 1 |
| Indocin 50 Mg Suppository | other | $60 | $60 | $60 | 1 |
| Balloon Wedge Pressure Catheter 5fr 110cm | cardiac | $60 | $60 | $60 | 1 |
| Entrada Needle 11cm $sc-4220 | other | $60 | $60 | $60 | 1 |
| Entrada Needle 15cm #sc-4220 | other | $60 | $60 | $60 | 1 |
| Hand Finger Orthosis, without Joints, May Include Soft Interface, Straps, Pre... | other | $60 | $60 | $60 | 1 |
| Irrigation Tubing #rob10031 | other | $60 | $60 | $60 | 1 |
| Pin Plug #6725 Medtronic | other | $60 | $60 | $60 | 1 |
| Stent Introducer Set G22684 | cardiac | $60 | $60 | $60 | 1 |
| Sheath Uropass 11/13 Fr X 38cm #61138bx | other | $60 | $60 | $60 | 1 |
| Addition to Lower Extremity Orthosis, Femoral Length Sock, Fracture OR Equal,... | other | $60 | $60 | $60 | 1 |
| Needle Ebus 22g #na-201sx-4022-a | other | $60 | $60 | $60 | 1 |
| Nasal Tube Bridal Pro System 12-14 Fr Dark Blue5ea/box #4 | other | $60 | $60 | $60 | 1 |
| Nasal Tube Bridle Pro System 16-18fr Yellow 5ea/box #4 | other | $60 | $60 | $60 | 1 |
| Nasal Tube Bridle Pro System 5-6 Fr Purple 5ea/box#4 | other | $60 | $60 | $60 | 1 |
| Nasal Tube Bridle Pro System 8-10 Fr Teal 5ea/box# 4 | other | $60 | $60 | $60 | 1 |
| Coil Embolization Nester 8mmx7cm #g52744 | other | $60 | $60 | $60 | 1 |
| Cook Catheter Willis Oglesby Tube #g09892 | cardiac | $60 | $60 | $60 | 1 |
| Catheter, Intradiscal | cardiac | $60 | $60 | $60 | 1 |
| D-5 Lr 500 Cc | other | $60 | $60 | $60 | 1 |
| D-5- 1/2 500cc | other | $60 | $60 | $60 | 1 |
| D-5- 1/4 500 Cc | other | $60 | $60 | $60 | 1 |
| D-5- Lr 1000 Cc | other | $60 | $60 | $60 | 1 |
| D-5-1/2 Ns 1000 Cc | other | $60 | $60 | $60 | 1 |
| D-5-1/4 1000 Cc | other | $60 | $60 | $60 | 1 |
| D-5-s 100o Cc | other | $60 | $60 | $60 | 1 |
| D-5-s 500 Cc | other | $60 | $60 | $60 | 1 |
| D-5-w 1000 Cc | other | $60 | $60 | $60 | 1 |
| D-5-w 500 Cc | other | $60 | $60 | $60 | 1 |
| Lactated Ringers 500 Cc | other | $60 | $60 | $60 | 1 |
| Lactated Ringers-1000cc | other | $60 | $60 | $60 | 1 |
| Nacl 0.45 1000 Cc | other | $60 | $60 | $60 | 1 |
| Sodium Chlor(nacl)1000cc C\20m | other | $60 | $60 | $60 | 1 |
| Sodium Chloride 500 Cc | other | $60 | $60 | $60 | 1 |
| Calcium Chloride 10 % IV Soln | other | $61 | $61 | $61 | 1 |
| Albendazole 200 Mg Po Tabs | other | $61 | $61 | $61 | 1 |
| Guide Pin D1.5 Lg 300mm Gleno #230796000 | other | $61 | $61 | $61 | 1 |
| Guide Pin Metaglene 2.5 #2307-87 | other | $61 | $61 | $61 | 1 |
| Technetium Tc 99m Pentetate Diagnostic 25 Mci | other | $61 | $61 | $61 | 1 |
| Injection, Glycopyrrolate, 0.1 Mg | other | $61 | $61 | $61 | 1 |
| Belt, Strap, Sleeve, Garment, OR Covering, Any Type | other | $62 | $62 | $62 | 1 |
| Cath Cholangiogram/taut 4fr X 18in | other | $62 | $62 | $62 | 1 |
| Fulgurating Endo Electrode 2fr 105cm #be | other | $62 | $62 | $62 | 1 |
| 3.0mm Round Diamond 5820-012-030d | other | $62 | $62 | $62 | 1 |
| 4.0mm Round Diamond 5820-012-040d | other | $62 | $62 | $62 | 1 |
| Cement Bone Mixing System #414702 1pk/10ea | other | $62 | $62 | $62 | 1 |
| Knee Brace Recover Neo Long Large #00364 | other | $62 | $62 | $62 | 1 |
| Knee Brace Recover Neo Long Medium #00363 | other | $62 | $62 | $62 | 1 |
| Knee Brace Recover Neo Long Small #00362 | other | $62 | $62 | $62 | 1 |
| Knee Brace Recover Neo Long Xlarge #00365 | other | $62 | $62 | $62 | 1 |
| Knee Brace Recover Neo Long Xxl #00366 | other | $62 | $62 | $62 | 1 |
| Endostitch Device 10mm #173016 | other | $62 | $62 | $62 | 1 |
| I&a Tip Straight | other | $62 | $62 | $62 | 1 |
| Diltiazem 100 Mg/100 Ml - Compounded | other | $62 | $62 | $62 | 1 |
| Potassium Acet 100 Meq/50 Ml | other | $62 | $62 | $62 | 1 |
| Diltiazem 100 Mg Add-van Vial | other | $62 | $62 | $62 | 1 |
| Sterile Water,irregation 250cc | other | $62 | $62 | $62 | 1 |
| Technetium Tc-99m Exametazime, Diagnostic, Per Study Dose, Up to 25 Millicuries | other | $62 | $62 | $62 | 1 |
| Abreva 2 Gm Tube | other | $62 | $62 | $62 | 1 |
| Glycine Sol.1.5%-3000cc | other | $62 | $62 | $62 | 1 |
| Plasmalyte-m | other | $62 | $62 | $62 | 1 |
| Sodium Chloride 1000 Cc | other | $62 | $62 | $62 | 1 |
| Hepatitis B Surface Ag Ia | other | $62 | $62 | $62 | 1 |
| 2.2mm Match Head 5820-107 | other | $63 | $63 | $63 | 1 |
| Hydrocort-pramoxine 1%-1% Crm | other | $63 | $63 | $63 | 1 |
| Food Bolus 4cmx2.5mmx160cm Rothnet Bx00711155 | other | $63 | $63 | $63 | 1 |
| Coil Vascular Loop Shape Standard Stretch 8 Mm Dia 10 Cm Length Pushable 0.03... | other | $63 | $63 | $63 | 1 |
| Mreye .035 10mm X 10cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 10mm X 15cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 10mm X 8cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 15mm X 15cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 20mm X 15cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 4mm X 4cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 5mm X 3cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 5mm X 5cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 5mm X 8cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 6mm X 5cm | other | $63 | $63 | $63 | 1 |
| Mreye .035 8mm X 8cm | other | $63 | $63 | $63 | 1 |
| Lumbar Orthosis, Sagittal Control, with Rigid Posterior Panel(s), Posterior E... | lab | $63 | $63 | $63 | 1 |
| Assay Triiodothyronine | other | $63 | $63 | $63 | 1 |
| Rasp #5100-037-114 Stryker (bone Shaver | other | $64 | $64 | $64 | 1 |
| Rasp Large Tear #5100-037 | other | $64 | $64 | $64 | 1 |
| Rasp Small Tear #5100-37 | other | $64 | $64 | $64 | 1 |
| Probe Vascular 2.0-2.5mm 45cm 5/bx | other | $64 | $64 | $64 | 1 |
| Introducer/sheath, Guiding, Intracardiac Electrophysiological, Fixed-curve, O... | cardiac | $64 | $64 | $64 | 1 |
| Introducer/sheath, Guiding, Intracardiac Electrophysiological, Steerable, Oth... | cardiac | $64 | $64 | $64 | 1 |
| Injection, Leucovorin Calcium, Per 50 Mg | other | $64 | $64 | $64 | 1 |
| Cannula I&a Simcoe | other | $64 | $64 | $64 | 1 |
| Vincristine Sulfate, 1 Mg | other | $64 | $64 | $64 | 1 |
| Addition to Lower Extremity Fracture Orthosis, Drop Lock Knee Joint | other | $64 | $64 | $64 | 1 |
| Reaming Rod 2.5mm X 850mm Ti Cannulated | other | $64 | $64 | $64 | 1 |
| Gastrointestinal Suture Anchor Kit #g04474 | other | $64 | $64 | $64 | 1 |
| Injection, Levetiracetam, 10 Mg | other | $64 | $64 | $64 | 1 |
| Ringers Injection-1000cc | other | $64 | $64 | $64 | 1 |
| Sterile Water,irrigation 3000c | other | $64 | $64 | $64 | 1 |
| Blood Culture | lab | $64 | $64 | $64 | 1 |
| Assay of Lactic Acid | other | $64 | $64 | $64 | 1 |
| Detractor Guhl Ankle 6ea/bx | other | $65 | $65 | $65 | 1 |
| Injection, Adrenalin, Epinephrine, 0.1 Mg | other | $65 | $65 | $65 | 1 |
| Tretinoin 0.05 % Ex Crea | other | $65 | $65 | $65 | 1 |
| Precedex 200 Mcg/50 Ml Bottle | other | $65 | $65 | $65 | 1 |
| Probe Bio Vascular 1.0-1.5mm 5/bx | other | $65 | $65 | $65 | 1 |
| Sodium Bicarbonate 8.4% IV | other | $65 | $65 | $65 | 1 |
| Assay of Vitamin B | other | $65 | $65 | $65 | 1 |
| Cuffed Tracheostomy Tube Bivona Fome-cuf Disposable Ic Size 6.0 Adult 850160 | other | $66 | $66 | $66 | 1 |
| Cuffed Tracheostomy Tube Bivona Fome-cuf Disposable Ic Size 7.0 Adult 850170 | other | $66 | $66 | $66 | 1 |
| Tray Pneumothorax Infant 5ea/1cs | other | $66 | $66 | $66 | 1 |
| Centurion 30 Fms Cassette Only #8065000138 6ea/bx | other | $66 | $66 | $66 | 1 |
| Orthopedic Footwear, Man's Shoe, Oxford, Used As an Integral Part of a Brace | other | $66 | $66 | $66 | 1 |
| Nail Nippers 4" #881302 | other | $66 | $66 | $66 | 1 |
| Tretinoin 0.1 % Ex Crea | other | $66 | $66 | $66 | 1 |
| Cement Mixer 00-4501-090-00 00450109000 | other | $66 | $66 | $66 | 1 |
| Clip Avalon Filshie #avm-851j | other | $66 | $66 | $66 | 1 |
| Resure Sealant Ocular #rs-1004-us-10 10/bx | other | $66 | $66 | $66 | 1 |
| 7fr Single Sensor W/lumen/coude Tip | other | $66 | $66 | $66 | 1 |
| Hc Dress Aquacl Ag Hydrofiber | other | $66 | $66 | $66 | 1 |
| Lift, Elevation, Inside Shoe, Tapered, Up to One-half Inch | other | $66 | $66 | $66 | 1 |
| Closure Pilot Guides 5mm & 10/12mm Set | other | $66 | $66 | $66 | 1 |
| 2.3mm Tapered Router5407-fa2 | other | $67 | $67 | $67 | 1 |
| 3.0mm Tapered Router5407-fa3 | other | $67 | $67 | $67 | 1 |
| Electrode Emg 18mm Needle 2 Channel 1m Cable Muscle Specific Prass Paired Ins... | other | $67 | $67 | $67 | 1 |
| Development of Cognitive Skills to Improve Attention, Memory, Problem Solving... | other | $67 | $67 | $67 | 1 |
| Nester .035 4mm X 7cm #g47372 | other | $67 | $67 | $67 | 1 |
| Dexmedetomidine Hcl in Nacl 80 Mcg/20ml IV Soln | other | $67 | $67 | $67 | 1 |
| Therapeutic Procedures to Improve Respiratory Function, Other Than Described ... | other | $67 | $67 | $67 | 1 |
| Zimmer Compact Vacuum Cement Mixing System #00-5049-035 | other | $67 | $67 | $67 | 1 |
| Side-by-side Bipolar Stimulating Probe 5ea/pk #8225401 | other | $67 | $67 | $67 | 1 |
| Diagnostic Digital Breast Tomosynthesis, Unilateral OR Bilateral | other | $67 | $67 | $67 | 1 |
| Mycobacteria Culture | lab | $67 | $67 | $67 | 1 |
| Injection, Nitroglycerin, 5 Mg | other | $68 | $64 | $72 | 2 |
| Handle Sizer for Inhance Shoulder System #720530301 #7205-30 | other | $68 | $68 | $68 | 1 |
| Repair/modification of a Hearing Aid | surgery | $68 | $68 | $68 | 1 |
| Dificid 200 Mg Tablet | other | $68 | $68 | $68 | 1 |
| Vac Veraflo Dress Sys-medium #ultvfl05md | other | $68 | $68 | $68 | 1 |
| Ankle Orthosis, Ankle Gauntlet OR Similar, with OR without Joints, Prefabrica... | other | $68 | $68 | $68 | 1 |
| Digoxin 0.05 Mg/ml Solution | other | $68 | $68 | $68 | 1 |
| Injection, Cilastatin Sodium; Imipenem, Per 250 Mg | other | $68 | $68 | $68 | 1 |
| Cryoprecipitate, Each Unit | other | $68 | $43 | $151 | 3 |
| Alcohol 5%&dextr.5%in Water 10 | other | $68 | $68 | $68 | 1 |
| D-10-w 500ml | other | $68 | $68 | $68 | 1 |
| D-5-0.2% Sodium Chloride(250cc | other | $68 | $68 | $68 | 1 |
| D-5-r 1000 Cc | other | $68 | $68 | $68 | 1 |
| Dextrose 10%in Saline(d-10-s)1 | other | $68 | $68 | $68 | 1 |
| Dextrose 2.5% Strength Saline | other | $68 | $68 | $68 | 1 |
| Dextrose 5.5%in Salinec\20meq5 | other | $68 | $68 | $68 | 1 |
| Dextrose 5.5%in Salinec\meq 10 | other | $68 | $68 | $68 | 1 |
| Dextrose 5%inh2o(d5w)1000cc | other | $68 | $68 | $68 | 1 |
| Dextrose 5%inwatr(d5w)500cc | other | $68 | $68 | $68 | 1 |
| Dextrose 5%ring.inj.500cc | other | $68 | $68 | $68 | 1 |
| Sodium Bicarbonate Sol.5%500cc | other | $68 | $68 | $68 | 1 |
| Sodium Chloride 3% in Water | other | $68 | $68 | $68 | 1 |
| Sodium Lactate1/6molar 500cc | other | $68 | $68 | $68 | 1 |
| Sodium Lactate1/6molar1000cc | other | $68 | $68 | $68 | 1 |
| Sterile Water,irrigation 1000c | other | $68 | $68 | $68 | 1 |
| Free Assay | other | $68 | $68 | $68 | 1 |
| Antinuclear Antibodies | imaging | $68 | $68 | $68 | 1 |
| Injection, Triamcinolone Acetonide, Preservative Free, 1 Mg | other | $69 | $69 | $69 | 1 |
| Surgicel Original Hemostat 2in X 3in 1953s | other | $69 | $69 | $69 | 1 |
| Ear Mold/insert, Not Disposable, Any Type | other | $69 | $69 | $69 | 1 |
| Nanoneedle Diagnostic Sheath Kit 125 Mm #ar-3210 | other | $69 | $69 | $69 | 1 |
| Needle Osteo-site Bn Bx M2 #g36211 Dbbn-11-10.0-m2s | other | $69 | $69 | $69 | 1 |
| Needle Osteo-site Long #g36406 | other | $69 | $69 | $69 | 1 |
| Polyloop Ligating Device #hx-400u | other | $69 | $69 | $69 | 1 |
| Testosterone Pellet, 75 Mg | other | $69 | $69 | $69 | 1 |
| Endoclip 5mm #176630 | other | $69 | $69 | $69 | 1 |
| Reaming Rod 3.0mm X 950mm W/balltip Sterile | other | $69 | $69 | $69 | 1 |
| Reaming Rod 3.0mm X950mm W/offset Tip | other | $69 | $69 | $69 | 1 |
| Patient Tracker Noninvasive #9734887xom | other | $69 | $69 | $69 | 1 |
| Liver Function Panel | lab | $69 | $31 | $227 | 8 |
| Clot Factor Viii Vw Ristoctn | other | $69 | $69 | $69 | 1 |
| Sars Antigen Fia | other | $69 | $69 | $69 | 1 |
| Creatine Mb Fraction | other | $69 | $69 | $69 | 1 |
| Wound Retractor/protector Xlrg #c8404 | other | $70 | $70 | $70 | 1 |
| Injection, Protamine Sulfate, Per 10 Mg | other | $70 | $70 | $70 | 1 |
| Tornade Embolization Coil 10 X 4 #g09217 | other | $70 | $70 | $70 | 1 |
| Addition to Lower Extremity Orthosis, Non-corrosive Finish, Per Bar | other | $70 | $70 | $70 | 1 |
| 12.6mm X 10.4mm Boring Toolstryker #5130-123 | other | $70 | $70 | $70 | 1 |
| 9.5mm X 10.4mm Boring Tool 5130-123 | other | $70 | $70 | $70 | 1 |
| Astelin | other | $70 | $70 | $70 | 1 |
| Infectious Agent Detection By Nucleic Acid (dna OR Rna); Human Papillomavirus... | other | $70 | $70 | $70 | 1 |
| Injection, Fentanyl Citrate, 0.1 Mg | other | $70 | $70 | $70 | 1 |
| Plasma-lyte a Ph 7.4 Soln. | other | $71 | $71 | $71 | 1 |
| Pin Steinmann 3.2mm 9" #110003484 | other | $71 | $71 | $71 | 1 |
| Sheath Navigator 11/13frx36cm #250-222 Bossci | other | $71 | $71 | $71 | 1 |
| Gastro Anchor Set Saf-t-pexy T-fastener | other | $71 | $71 | $71 | 1 |
| Commode Patient Bariatric (800lbs) Cpat0008d | other | $71 | $71 | $71 | 1 |
| Meniscal Knot Pusher/cutter #72201537 | other | $71 | $71 | $71 | 1 |
| Codman Disposable Catheter Passer #82 | cardiac | $72 | $72 | $72 | 1 |
| Avitene Microfibril Collagen Hemostat 1010020 | other | $72 | $72 | $72 | 1 |
| Resolution Clips 2.8mmx235cm 20ea/1bx | other | $72 | $72 | $72 | 1 |
| Occluder Colpo Pneumo Occluder | other | $72 | $72 | $72 | 1 |
| Dornase Alfa, Inhalation Solution, Fda-approved Final Product, Non-compounded... | other | $72 | $72 | $72 | 1 |
| Button Replacement 24fr X 2.4cm Low Profile | surgery | $72 | $72 | $72 | 1 |
| Gastrostomy Tube 24fr 3.4cm Kit Replacement | surgery | $72 | $72 | $72 | 1 |
| Hard-bone Drill 1.5 Mm Ar-9938 | other | $72 | $72 | $72 | 1 |
| Hard-bone Drill 1.7 Mm Ar-9938 | other | $72 | $72 | $72 | 1 |
| Inner Vision Fiber Optic Tip 56fr 1465 | other | $72 | $72 | $72 | 1 |
| Tip Detachable 40fr Transillumination #1465 | other | $72 | $72 | $72 | 1 |
| Fluticasone Furoate 27.5 Mcg/spray Na Susp | other | $72 | $72 | $72 | 1 |
| Pigazzi Pad #40595 3/cs | other | $72 | $72 | $72 | 1 |
| Neomy-polymyxin B 40 Mg/ml Amp | other | $72 | $72 | $72 | 1 |
| Gross Exam Only By Pathologist | other | $72 | $72 | $72 | 1 |
| Basket Roth Net Pedia Foreign Body Bx00711057 | other | $73 | $73 | $73 | 1 |
| Potassium Phosph 15 Mmol/5 Ml | other | $73 | $73 | $73 | 1 |
| Hetastarch 6%-0.9% Nacl Bag | other | $73 | $73 | $73 | 1 |
| Catheter Kit 7.5" Pain On Q Silversoaker 5/bx | cardiac | $73 | $73 | $73 | 1 |
| Lift, Elevation, Heel and Sole, Neoprene, Per Inch | other | $73 | $73 | $73 | 1 |
| Ofloxacin 0.3% Ear Drops | other | $73 | $73 | $73 | 1 |
| Blood Draw (Venipuncture) | lab | $73 | $46 | $275 | 7 |
| Muri-lube Mineral Oil Vial | other | $73 | $73 | $73 | 1 |
| Injection, Garamycin, Gentamicin, Up to 80 Mg | other | $74 | $30 | $117 | 2 |
| Steinmann Pin 9" Shoulder #405800 | other | $74 | $74 | $74 | 1 |
| Common Carotid Intima-media Thickness (imt) Study for Evaluation of Atheroscl... | other | $74 | $74 | $74 | 1 |
| Sensor Arterial Cdi #cdi510h | other | $74 | $74 | $74 | 1 |
| Dextrose 50%-water Abboject | other | $74 | $74 | $74 | 1 |
| Addition to Lower Extremity Orthosis, Rocker Bottom for Total Contact Ankle F... | other | $74 | $74 | $74 | 1 |
| Abo & Rh Blood Type | other | $74 | $74 | $74 | 1 |
| Addition to Lower Extremity, Split Flat Caliper Stirrups and Plate Attachment | other | $75 | $75 | $75 | 1 |
| 2.0mm Round Diamond 5820-012-020d | other | $75 | $75 | $75 | 1 |
| Ligator Band 7 Speedband 4ea/1bx M00542253 | other | $75 | $75 | $75 | 1 |
| Addition to Lower Extremity, Dorsiflexion Assist (plantar Flexion Resist), Ea... | other | $75 | $75 | $75 | 1 |
| Hydrocortisone-acetic Ear Drop | other | $75 | $75 | $75 | 1 |
| Ankle Control Orthosis, Stirrup Style, Rigid, Includes Any Type Interface (e.... | other | $75 | $75 | $75 | 1 |
| Catheter Venogram Balloon #6215 Mdt | cardiac | $75 | $75 | $75 | 1 |
| Corneal Vacuum Punch 8.00mm #17200d800 | other | $75 | $75 | $75 | 1 |
| Extension Titanium for Pd Catheter #ta | cardiac | $75 | $75 | $75 | 1 |
| Hc Monitored Anesthesia Care Anesthesia Time - Each Incremental 15 Minutes | other | $75 | $75 | $75 | 1 |
| Punch Cornea Vacuum 7.75mm #17200d775 | other | $75 | $75 | $75 | 1 |
| Punch Corneal Vacuum 7.50mm #17200d750 | other | $75 | $75 | $75 | 1 |
| Injection, Octreotide, Non-depot Form for Subcutaneous OR Intravenous Injecti... | other | $75 | $75 | $75 | 1 |
| Loop 12 Degree for Long Tur Set #wa22037c | other | $75 | $75 | $75 | 1 |
| Neomycin-poly-hc Eye Drops | other | $75 | $75 | $75 | 1 |
| Screw Hex Female 2.5mm #42-5099-025 | other | $75 | $75 | $75 | 1 |
| Prosthetic Shrinker, Above Knee, Each | other | $75 | $75 | $75 | 1 |
| Dacarbazine, 100 Mg | other | $75 | $75 | $75 | 1 |
| Injection, Insulin, Per 5 Units | other | $76 | $29 | $123 | 2 |
| Hc Coban 2 #2094 1bx=1kit | other | $76 | $76 | $76 | 1 |
| Hc Coban 2 Lite #2794 1bx=1kit | other | $76 | $76 | $76 | 1 |
| Needle Ebus 21g #na-201sx | other | $76 | $76 | $76 | 1 |
| Super-dimension Premarked Biopsy Forceps #sdbf1000 5/ct | lab | $76 | $76 | $76 | 1 |
| Sizing Catheter Sf #g47308 5ea/1bx | cardiac | $76 | $76 | $76 | 1 |
| Cannula Retrograde 14fr Research Med | other | $76 | $76 | $76 | 1 |
| Post Op Knee Brace Xlg #423101 | other | $76 | $76 | $76 | 1 |
| Addition to Knee Joint, Lift Loop for Drop Lock Ring | other | $77 | $77 | $77 | 1 |
| Surgical Supplies | surgery | $77 | $77 | $77 | 1 |
| Hemoglobin & Hematocrit | other | $77 | $77 | $77 | 1 |
| Injection, Hydrocortisone Sodium Succinate, Up to 100 Mg | other | $77 | $77 | $77 | 1 |
| Assay of Ferritin | other | $77 | $77 | $77 | 1 |
| Culture Screen Only | lab | $77 | $77 | $77 | 1 |
| Rubeola Antibody | other | $77 | $77 | $77 | 1 |
| Vac Veraflo Cleanse Dress Sys Med #ultvcl05md | other | $78 | $78 | $78 | 1 |
| Biktarvy 50-200-25 Mg Tablet | other | $78 | $78 | $78 | 1 |
| Stone Extractor Perc Ncircle #g32862 | other | $78 | $78 | $78 | 1 |
| Pad Electrode Adult One Piece for Auto External Defibrillator Cpr-d-padz 8900... | other | $78 | $78 | $78 | 1 |
| Electrode Barrie Bar 3mm Storz #27050nx-s | other | $78 | $78 | $78 | 1 |
| Chest Tube Tray #cht2085 20ea/case6-8 Week Lead Time | other | $78 | $78 | $78 | 1 |
| Aveta Fluid Management Accessory #205-212 3/ctn | other | $78 | $78 | $78 | 1 |
| Endo Clip Applier 5mm #ae05ml 3 Ea/1bx | other | $78 | $78 | $78 | 1 |
| Fecal Collector Flexi Seal Sys #418000 1ea/bx | other | $78 | $78 | $78 | 1 |
| Knee Orthosis, Immobilizer, Canvas Longitudinal, Prefabricated, Off-the-shelf | other | $78 | $78 | $78 | 1 |
| Alvimopan 12 Mg Capsule | other | $78 | $78 | $78 | 1 |
| Stopcock Universal #75u | other | $78 | $78 | $78 | 1 |
| Opticath High Flow Cath Lfr 8fr 110cm 6/cs | other | $78 | $78 | $78 | 1 |
| Pneumothorax Cath Tray Disp Arrow 5ea/1bx | other | $79 | $79 | $79 | 1 |
| Injection, Tobramycin Sulfate, Up to 80 Mg | other | $79 | $79 | $79 | 1 |
| Addition to Lower Extremity, Torsion Control, Ankle Joint and Half Solid Stirrup | other | $79 | $79 | $79 | 1 |
| Knot Pusher/suture Cutter and Slotted Cannula Set 72202674 | other | $79 | $79 | $79 | 1 |
| Closure Surgical Skin 24cm Zip24 Ps1240 5/pk | surgery | $79 | $79 | $79 | 1 |
| Grasping Device-endo Raptor Disp #bx00711177 | other | $79 | $79 | $79 | 1 |
| Norepinephrine 4 Mg / 250 Ml Ns Bag - Compounded | other | $79 | $79 | $79 | 1 |
| Pressure Monitor Set/stryker Quick | other | $80 | $80 | $80 | 1 |
| Hemostatic Sealant Floseal Matrix Recothrom 5ml 6/cs | other | $80 | $80 | $80 | 1 |
| Injection, Ziprasidone Mesylate, 10 Mg | other | $80 | $80 | $80 | 1 |
| Mammogram | preventive | $80 | $27 | $2,424 | 23 |
| Assay of Digoxin | other | $80 | $80 | $80 | 1 |
| Electrodes-4 Channel Paired Subdermal Ea=set | other | $81 | $81 | $81 | 1 |
| Oxytocin 20 Unit/1,000 Ml-ns | other | $81 | $81 | $81 | 1 |
| Bonopty Biopsy Set 16cm #10 | lab | $81 | $81 | $81 | 1 |
| Bonopty Penetration Set 9.5cms #10 | other | $81 | $81 | $81 | 1 |
| Drill Twist Trimed #drill-2.30l | other | $81 | $81 | $81 | 1 |
| Laser Fiber 200 Rnd Tip #dfs-200-rtsb | other | $81 | $81 | $81 | 1 |
| Laser Fiber 272mic #dfs-272sb | other | $81 | $81 | $81 | 1 |
| Shoulder Gps Threaded Pin Kit(1) Shoulder Gps Coracoid Pin Long(1) Shoulder G... | other | $81 | $81 | $81 | 1 |
| Vac Veraflo Cleanse Choice Medium Ultvcc05md | other | $81 | $81 | $81 | 1 |
| Conformity Evaluation | other | $81 | $81 | $81 | 1 |
| Loop 24fr Monopolar Angled 27050g-s Cysview | other | $81 | $81 | $81 | 1 |
| Technetium Tc 99m Pyrophosphate | other | $81 | $81 | $81 | 1 |
| Feeding Tube Mic Jejunal #0200-12lv | other | $81 | $81 | $81 | 1 |
| Assay of Vancomycin | other | $81 | $81 | $81 | 1 |
| Scraper Membrane Stiff 25g | other | $82 | $82 | $82 | 1 |
| Replace Leather Cuff Kafo-afo, Calf OR Distal Thigh | other | $82 | $82 | $82 | 1 |
| Lyme Disease Antibody | other | $82 | $82 | $82 | 1 |
| Ball 24fr Monopolar Coag 3mm 27050n-s Cysview | other | $83 | $83 | $83 | 1 |
| Cath Laparoscopic Chole Arrow | surgery | $83 | $83 | $83 | 1 |
| Feeding Tube Endovive Jejunal 12fr #m00566340 | other | $83 | $83 | $83 | 1 |
| Stone Extractor Tipless 4.5frx65cm #g17520 | other | $83 | $83 | $83 | 1 |
| Cement Mixer | other | $83 | $83 | $83 | 1 |
| Injection, Fosphenytoin, 50 Mg Phenytoin Equivalent | other | $83 | $83 | $83 | 1 |
| Injection, Calcium Gluconate (wg Critical Care), Not Therapeutically Equivale... | other | $83 | $83 | $83 | 1 |
| Injection, Vancomycin Hydrochloride, 10 Mg | other | $83 | $83 | $83 | 1 |
| Icd-s/d/m In/cl-chec | other | $83 | $83 | $83 | 1 |
| Assay of Folic Acid Serum | other | $83 | $83 | $83 | 1 |
| Transfer of an Orthosis From One Shoe to Another, Solid Stirrup, New | other | $84 | $84 | $84 | 1 |
| Uterine Manipulator X-large Vcare | other | $84 | $84 | $84 | 1 |
| Nevirapine 50 Mg/5 Ml Susp | other | $84 | $84 | $84 | 1 |
| Kit Fecal Management Flexi-seal Protect Plus Enfit Connection Bag Nonsterile ... | other | $84 | $84 | $84 | 1 |
| Drain Ethicon Blake Silicon Surg 15fr #2229 | other | $84 | $84 | $84 | 1 |
| Addition to Lower Extremity Orthosis, Soft Interface for Molded Plastic, Belo... | other | $84 | $84 | $84 | 1 |
| Flu Vaccine Administration | preventive | $84 | $84 | $84 | 1 |
| Needle Ez Io Ld 15ga 45mm #9079 | other | $85 | $85 | $85 | 1 |
| Needle-ez Io Ld 15g Io Set 25mm #9001 Vidacre | other | $85 | $85 | $85 | 1 |
| Needle-ez Io Pd 15g Io Set 15mm #9018 Vidacre | other | $85 | $85 | $85 | 1 |
| Maxgrip Revolution Disp Forceps 23g #706.13 | other | $85 | $85 | $85 | 1 |
| Cath Single Lumen 6.6fr | other | $85 | $85 | $85 | 1 |
| Elbow Orthosis, Rigid, without Joints, Includes Soft Interface Material, Pref... | other | $85 | $85 | $85 | 1 |
| Obs W/tel ICU Nonpaid Cc 44 | other | $85 | $85 | $85 | 1 |
| Obs W/tel OB Nonpaid Cc 44 | other | $85 | $85 | $85 | 1 |
| Vitamin B | other | $85 | $85 | $85 | 1 |
| Tube Inner Ear Myringotomy Ventilation Flange 4.8 Mm Length 1.32 Mm Id Silico... | other | $86 | $86 | $86 | 1 |
| 1203105 9.0 Uniblocker 1/ea | other | $86 | $86 | $86 | 1 |
| Therapeutic Procedures to Increase Strength OR Endurance of Respiratory Muscl... | other | $86 | $86 | $86 | 1 |
| Smog Enema - Compounded | other | $86 | $86 | $86 | 1 |
| Addition to Lower Extremity, Dorsiflexion and Plantar Flexion Assist/resist, ... | other | $86 | $86 | $86 | 1 |
| Addition to Lower Extremity, Torsion Control, Straight Knee Joint, Each Joint | other | $86 | $86 | $86 | 1 |
| Curved Knot Pusher/suture Cutter #72202675 | other | $86 | $86 | $86 | 1 |
| Timolol 0.5% Gfs Gel-solution | other | $86 | $86 | $86 | 1 |
| Thyroid Panel (TSH) | lab | $86 | $70 | $101 | 3 |
| Hepatitis C Ab Test | other | $86 | $86 | $86 | 1 |
| Forcep Micro Holding 23g #dfh | other | $87 | $87 | $87 | 1 |
| Tube Blakemore Ng 20fr | other | $87 | $87 | $87 | 1 |
| Extractor Balloon 15-18mm Rx Pro #4702 | other | $87 | $87 | $87 | 1 |
| Extractor Pro Rx Below Injection 12-15 M00547040 | other | $87 | $87 | $87 | 1 |
| Extractor Pro Rx Below Injection 15-18 M00547050 | other | $87 | $87 | $87 | 1 |
| Extractor Pro Rx Below Injection 9-12 M00547030 | other | $87 | $87 | $87 | 1 |
| Extractor Retrieval Balloon 12.0-15mm Rx Pro | other | $87 | $87 | $87 | 1 |
| Extractor Retrieval Balloon 9-12mm Rx Pro | other | $87 | $87 | $87 | 1 |
| Injection, Sulfamethoxazole 5 Mg and Trimethoprim 1 Mg | other | $87 | $87 | $87 | 1 |
| Olopatadine Hcl 0.1 % Op Soln | other | $87 | $87 | $87 | 1 |
| Sodium Ferric Gluconate (ferrlecit) 125 Mg/ Ns 100 Mls - Compounded | other | $87 | $87 | $87 | 1 |
| Injection, Enoxaparin Sodium, 10 Mg | other | $87 | $87 | $87 | 1 |
| Carcinoembryonic Antigen | other | $87 | $87 | $87 | 1 |
| Catheter, Suprapubic/cystoscopic | cardiac | $88 | $84 | $91 | 2 |
| Malyugin Ring 6.25mm Disp #mal-0001-d | other | $88 | $88 | $88 | 1 |
| Malyugin Ring 7.00mm Disp #mal-0002-d | other | $88 | $88 | $88 | 1 |
| D Stat Flowable #4000 | other | $88 | $88 | $88 | 1 |
| Gia Endo 30 2.5 Roticular Load #030451 | other | $88 | $88 | $88 | 1 |
| Gia Endo 30 3.5 Roticular Load #030452 | other | $88 | $88 | $88 | 1 |
| Gradient Compression Stocking, Below Knee, 30-40 Mmhg, Used As a Surgical Dre... | surgery | $88 | $88 | $88 | 1 |
| Mannitol 20% | other | $88 | $88 | $88 | 1 |
| Catheter Passer Disposable 38cm #8591 | cardiac | $88 | $88 | $88 | 1 |
| Catheter Passer Disposable 4.8mm X 3.3mm X 38cm #48407 | cardiac | $88 | $88 | $88 | 1 |
| IV Hydration | therapy | $88 | $31 | $503 | 12 |
| Technetium Tc-99m Mebrofenin, Diagnostic, Per Study Dose, Up to 15 Millicuries | other | $88 | $88 | $88 | 1 |
| Assay of Prealbumin | other | $88 | $88 | $88 | 1 |
| Nail Nippers 6" #881862 | other | $89 | $89 | $89 | 1 |
| Budesonide 32 Mcg/act Na Susp | other | $89 | $89 | $89 | 1 |
| Feces Culture Aerobic Bact | lab | $89 | $89 | $89 | 1 |
| Laser Fiber 365mic #dfs-365sb | other | $90 | $90 | $90 | 1 |
| Guide Sheath Kit Endo Sz 2mm 105cm #k | other | $90 | $90 | $90 | 1 |
| Needle Entrada #sc-4200 | other | $90 | $90 | $90 | 1 |
| Profile Drill 3.5mm Beveled Ft #ar-8741 | other | $90 | $90 | $90 | 1 |
| Profile Drill for Micro Compression Ft #ar-8737 | other | $90 | $90 | $90 | 1 |
| Knee Orthosis, Elastic with Joints, Prefabricated, Off-the-shelf | other | $90 | $90 | $90 | 1 |
| Transfer of an Orthosis From One Shoe to Another, Caliper Plate, New | other | $90 | $90 | $90 | 1 |
| Diag Catheter 6fr Langston #5540 5/pk | cardiac | $91 | $91 | $91 | 1 |
| Dextrose 70%-water IV Soln | other | $91 | $91 | $91 | 1 |
| Injection, Chloramphenicol Sodium Succinate, Up to 1 Gm | other | $91 | $91 | $91 | 1 |
| Addition to Knee Joint, Drop Lock, Each | other | $91 | $91 | $91 | 1 |
| Catheter Bernstein 4fr 140cm #h787107227085 | cardiac | $91 | $91 | $91 | 1 |
| Injection, Acyclovir, 5 Mg | other | $91 | $37 | $144 | 2 |
| Injection, Haloperidol Decanoate, Per 50 Mg | other | $91 | $91 | $91 | 1 |
| Iodine I-123 Sodium Iodide, Diagnostic, Per Millicurie | other | $91 | $91 | $91 | 1 |
| Dissecting Tool Disp #14mh30 Midas | other | $92 | $92 | $92 | 1 |
| Femoral Bone Cementing Prep Kit W/o Cement 00-5049-055-00 00504905500 | other | $92 | $92 | $92 | 1 |
| Intralipid 20% IV Fat Emul | lab | $92 | $92 | $92 | 1 |
| Ibandronate Sodium 150 Mg Po Tabs | other | $92 | $92 | $92 | 1 |
| Injection, Voriconazole, 10 Mg | other | $92 | $92 | $92 | 1 |
| Injection, Oxytocin, Up to 10 Units | other | $93 | $81 | $104 | 2 |
| Coil Pusher 16 | other | $93 | $93 | $93 | 1 |
| Drill Cann Plyaxial Lck Screw 2mm Drll-pls | other | $93 | $93 | $93 | 1 |
| Knee Orthosis, Elastic with Condylar Pads and Joints, with OR without Patella... | other | $93 | $93 | $93 | 1 |
| Fresh Frozen Plasma (single Donor), Frozen Within 8 Hours of Collection, Each... | other | $94 | $50 | $138 | 2 |
| Pack Robotic Rf | other | $94 | $94 | $94 | 1 |
| Sodium Citrate 4% Soln | other | $94 | $94 | $94 | 1 |
| Addition to Lower Extremity, Straight Knee Joint, Heavy Duty, Each Joint | other | $94 | $94 | $94 | 1 |
| Sumatriptan 6 Mg/0.5ml Autoinj | other | $94 | $94 | $94 | 1 |
| Seprafilm #508602 6ea/pk & 5pk/bx | other | $94 | $94 | $94 | 1 |
| Probe Incrementing Nerve Stim W/std Prasstip #8225825x | other | $94 | $94 | $94 | 1 |
| Cyclosporine, Oral, 100 Mg | other | $94 | $94 | $94 | 1 |
| Grasping Device/endo Talon #00711175 | other | $94 | $94 | $94 | 1 |
| Parenteral Nutrition Solution, Not Otherwise Specified, 10 Grams Lipids | lab | $94 | $94 | $94 | 1 |
| Prep Kit W/restrictors #5461-01 | other | $95 | $95 | $95 | 1 |
| Addition to Lower Extremity Orthosis, Soft Interface for Molded Plastic, Abov... | other | $95 | $95 | $95 | 1 |
| Oats 70 Degree Measure Probe #ar-4070-70s | other | $95 | $95 | $95 | 1 |
| Intubation Set Cook Retrograde | other | $95 | $95 | $95 | 1 |
| Mometasone Furoate 50 Mcg/act Na Susp | other | $95 | $95 | $95 | 1 |
| Initial Oxygen 30 Min | other | $95 | $95 | $95 | 1 |
| Injection, Medroxyprogesterone Acetate, 1 Mg | other | $95 | $95 | $95 | 1 |
| Flulaval Trivalent 2024-25 Syr | other | $96 | $96 | $96 | 1 |
| Injection, Pemetrexed, Not Otherwise Specified, 10 Mg | other | $96 | $96 | $96 | 1 |
| 25 Left Quick Pass Lasso #ar-6068-25tl | other | $96 | $96 | $96 | 1 |
| 25 Right Quick Pass Lasso #ar-6068-25tr | other | $96 | $96 | $96 | 1 |
| 45 Left Quick Pass Lasso #ar-6068-45l | other | $96 | $96 | $96 | 1 |
| 45 Right Quick Pass Lasso #ar-6068-45r | other | $96 | $96 | $96 | 1 |
| 90 Degree Curve Left Quick Pass Lasso #ar-6068-90l | other | $96 | $96 | $96 | 1 |
| 90 Degree Curve Right Quick Pass Lasso #ar-6068-90r | other | $96 | $96 | $96 | 1 |
| 90 Degree Curve Straight Quick Pass Lasso #ar-6068 | other | $96 | $96 | $96 | 1 |
| Ankle Foot Orthosis, Multiligamentous Ankle Support, Prefabricated, Off-the-s... | other | $96 | $96 | $96 | 1 |
| Bonopty Biopsy Set 16.5cm #12 | lab | $96 | $96 | $96 | 1 |
| Bonopty Penetration Set 10cm #12 | other | $96 | $96 | $96 | 1 |
| Crescent Quick Pass Lasso #ar-6068c | other | $96 | $96 | $96 | 1 |
| Initial Preventive Physical Examination; Face-to-face Visit, Services Limited... | preventive | $96 | $96 | $96 | 1 |
| Injection, Oxaliplatin, 0.5 Mg | other | $96 | $96 | $96 | 1 |
| Cholesterol Management | cardiac | $96 | $36 | $162 | 23 |
| Lipid Panel | lab | $96 | $76 | $125 | 7 |
| Alfuria 60 Mcg/0.5 Ml Flu Vacc | other | $96 | $96 | $96 | 1 |
| Endopath Electrosurgery Probe Plus Ii Pistol Hand Control Eph02 | surgery | $97 | $97 | $97 | 1 |
| Inflator Kit Balloon ENT #18infkit | other | $97 | $97 | $97 | 1 |
| Rod Carbon Fiber 11.0mm X 200mm External | other | $97 | $97 | $97 | 1 |
| Extractor Foreign Body 5/cs #fb 5000 5ea/1cs | other | $97 | $97 | $97 | 1 |
| Injection, Phenobarbital Sodium, Up to 120 Mg | other | $97 | $92 | $102 | 2 |
| Skin Tag Removal | other | $97 | $53 | $2,530 | 6 |
| Tray Disp Exchange Transfusion 1ea #275.00 | surgery | $98 | $98 | $98 | 1 |
| Progel Extended Applicator Spray Tip 16cm | other | $98 | $98 | $98 | 1 |
| Injection, Propofol, 10 Mg | other | $98 | $98 | $98 | 1 |
| Hc 2019 Novel Coronavirus Naa | other | $98 | $41 | $154 | 2 |
| Pericardiocentesis Kit Latex Free 3ea/1bx#m00443151 | other | $99 | $99 | $99 | 1 |
| Reaming Rod/3.8mm Ball Tip 950mm Sterile #03.233.010s | other | $99 | $99 | $99 | 1 |
| Addition to Knee Lock with Integrated Release Mechanism (bail, Cable, OR Equa... | other | $99 | $99 | $99 | 1 |
| Cervical, Collar, Semi-rigid Thermoplastic Foam, Two-piece, Prefabricated, Of... | other | $99 | $99 | $99 | 1 |
| Moderate Sedation Services Provided By the Same Physician OR Other Qualified ... | other | $99 | $99 | $99 | 1 |
| Needle Transeptal Adult #tsnc-18-71.0 | other | $99 | $99 | $99 | 1 |
| Needle Transseptal Brk 18ga 71cm #407200 | other | $99 | $99 | $99 | 1 |
| Shoulder Orthosis, Acromio/clavicular (canvas and Webbing Type), Prefabricate... | other | $99 | $99 | $99 | 1 |
| Sheath Access 12/14fr X38cm #61238bx | other | $99 | $99 | $99 | 1 |
| Lokelma 10 Gm Powder Packet | other | $99 | $99 | $99 | 1 |
| Impersol 1.5% 2000cc | other | $99 | $99 | $99 | 1 |
| Impersol 4.25% 2000 Cc | other | $99 | $99 | $99 | 1 |
| Wand 3.0mm 45 Degree Turbo | other | $100 | $100 | $100 | 1 |
| Wand Arthro 2.5mm 60deg Dome #ac3525 | other | $100 | $100 | $100 | 1 |
| Wand Arthro 3.5mm 90deg Rt Angle #ac1340 | other | $100 | $100 | $100 | 1 |
| Wand Ortho Super Multivac 50 | other | $100 | $100 | $100 | 1 |
| Wand Saber 30 W/cable Arthrocare #ac4330 | other | $100 | $100 | $100 | 1 |
| Gradient Compression Wrap, Non-elastic, Below Knee, 30-50 Mmhg, Used As a Sur... | other | $100 | $100 | $100 | 1 |
| Kit Carotid Rf 2ea/1cs #dynj906961f | other | $100 | $100 | $100 | 1 |
| Hip Orthosis, Abduction Control of Hip Joints, Flexible, (pavlik Harness), Pr... | other | $101 | $101 | $101 | 1 |
| Epidisc Patch Kit #1417151 Xomed | other | $101 | $101 | $101 | 1 |
| Alpena Contour Lso Universal Fits Waist Circumference: 25-60inch (64-152cm) #... | other | $101 | $101 | $101 | 1 |
| Aspiration Tubing Kit #72-00114 | other | $101 | $101 | $101 | 1 |
| Postpartum Care | obstetric | $101 | $101 | $101 | 3 |
| Wand Arthro 3.5x90deg Suc Foot #asc4250 | other | $102 | $102 | $102 | 1 |
| Wand Arthrocare 90deg W/suct & Finger Switch | other | $102 | $102 | $102 | 1 |
| Contact Layer, Sterile, More Than 48 Sq. In., Each Dressing | other | $102 | $102 | $102 | 1 |
| Stone Extractor Basket 3.0frx120cm #390 | other | $102 | $102 | $102 | 1 |
| Tisseel Vhsd 2 Ml Kit | other | $102 | $102 | $102 | 1 |
| Injection, Zidovudine, 10 Mg | other | $102 | $102 | $102 | 1 |
| Sodium Phosphate P-32, Therapeutic, Per Millicurie | other | $102 | $102 | $102 | 1 |
| Skin Lesion Destruction | other | $102 | $66 | $195 | 5 |
| Injection, Mannitol, 25% in 50 Ml | other | $103 | $30 | $176 | 2 |
| Insulin (novolin) R 100 Units / 100 Ml Ns - Compounded | other | $103 | $103 | $103 | 1 |
| Myxredlin 100 Unit/100 Ml Bag | other | $103 | $103 | $103 | 1 |
| Tissue Marker, Implantable, Any Type, Each | surgery | $103 | $103 | $103 | 1 |
| Annual Wellness Visit (Established) | preventive | $103 | $55 | $151 | 2 |
| Tvt70100as - Tube Endotracheal L312mm Od10mm Id7mm Pvc Single Lumen Visualize... | other | $104 | $104 | $104 | 1 |
| Tvt75105as - Tube Endotracheal L323mm Od10.5mm Id7.5mm Pvc Single Lumen Visua... | other | $104 | $104 | $104 | 1 |
| Tvt80110as - Tube Endotracheal L323mm Od11mm Id8mm Pvc Single Lumen Visualize... | other | $104 | $104 | $104 | 1 |
| Dextrose 25%-water Syringe | other | $104 | $104 | $104 | 1 |
| Breast Prosthesis, Mastectomy Bra, with Integrated Breast Prosthesis Form, Un... | other | $104 | $104 | $104 | 1 |
| Rod Carbon Fiber 11.0mm X 250mm External | other | $104 | $104 | $104 | 1 |
| Rod Carbon Fiber 11.0mm X 300mm External | other | $104 | $104 | $104 | 1 |
| Rod Carbon Fiber 11.0mm X 350mm External | other | $104 | $104 | $104 | 1 |
| Flovent Hfa 44 Mcg Inhaler | other | $104 | $104 | $104 | 1 |
| Injection, Cefepime Hydrochloride (b Braun), Not Therapeutically Equivalent t... | other | $104 | $104 | $104 | 1 |
| Hydromorphone Pca 1 Mg/ml *high Concentration* Cemc Batched Compounded | other | $105 | $105 | $105 | 1 |
| Carbojet Co2 Tube Set #25-100 | other | $105 | $105 | $105 | 1 |
| Mini Bio-anchor Disp Kit | other | $105 | $105 | $105 | 1 |
| Pushlock Kit for 2.9mm Shrt Pshlck #ar-2923ds | other | $105 | $105 | $105 | 1 |
| Sheath Access 12/14fr X24cm #61224bx | other | $105 | $105 | $105 | 1 |
| Sheath Access 12/14fr X54cm #61254bx | other | $105 | $105 | $105 | 1 |
| Dissecting Tool 3.0 Matchstick Long #10mh30l | other | $105 | $105 | $105 | 1 |
| Gallium Citrate Ga 67 | other | $105 | $105 | $105 | 1 |
| Wand Artho 3.0mm 50deg Suction #asc2530 | other | $105 | $105 | $105 | 1 |
| Doxycycline 100 Mg/100 Ml Ns Mini-bag Plus - Compounded | other | $105 | $105 | $105 | 1 |
| Injection, Daptomycin, 1 Mg | other | $105 | $105 | $105 | 1 |
| Unclassified Drugs | other | $105 | $105 | $105 | 1 |
| Doxy 100 Mg Vial | other | $106 | $106 | $106 | 1 |
| Cath Reddick Cystic Duct 2401-52 *min Order 5 | other | $106 | $106 | $106 | 1 |
| Papaverine 60 Mg/2 Ml Vial | other | $106 | $106 | $106 | 1 |
| Barone Jejunostomy Set | other | $107 | $107 | $107 | 1 |
| Injection, Methylergonovine Maleate, Up to 0.2 Mg | other | $107 | $107 | $107 | 1 |
| IV Infusion, Ea Add Hr | surgery | $107 | $107 | $107 | 1 |
| Velys Array Drill Pin 125mm X 4mm 4515-70-005 Minimum Order 10 Each | other | $108 | $108 | $108 | 1 |
| Velys Array Drill Pin 175mm X 4mm 4515-70-006 Minimum Order 10 Each | other | $108 | $108 | $108 | 1 |
| 2.5mm Mtch Hd 16cm Stryker #8470-107 | other | $108 | $108 | $108 | 1 |
| Rasp Small Riordan #5100-037 | other | $109 | $109 | $109 | 1 |
| Dilator Healicoil Rg 4.75mm #72203951 | other | $109 | $109 | $109 | 1 |
| Dilator Healicoil Rg 5.5mm #72203952 | other | $109 | $109 | $109 | 1 |
| Injection, Ibuprofen, 100 Mg | other | $109 | $109 | $109 | 1 |
| Flovent Hfa 110 Mcg Inhaler | other | $109 | $109 | $109 | 1 |
| Clinolipid 20% | lab | $109 | $109 | $109 | 1 |
| Kyphon Bone Biopsy Device #2 #f07a | lab | $109 | $109 | $109 | 1 |
| Wound Retractor/protector Xxlrg #c8405 | other | $109 | $109 | $109 | 1 |
| Injection, Meropenem (b. Braun), Not Therapeutically Equivalent to J2185, 100 Mg | other | $109 | $102 | $116 | 2 |
| Cxi .014 X 90cm | other | $110 | $110 | $110 | 1 |
| Margin Marker #mms6 | other | $110 | $110 | $110 | 1 |
| Overtube Guardus Endo 3/bx #bx00711147 | other | $112 | $112 | $112 | 1 |
| Grieshaber Revolution Dsp Ilm Forceps 25g | other | $112 | $112 | $112 | 1 |
| Injection, Bortezomib, 0.1 Mg | other | $112 | $112 | $112 | 1 |
| Injection, Fluorouracil, 500 Mg | other | $112 | $112 | $112 | 1 |
| IV Push Inj Each New Drug | other | $112 | $100 | $133 | 4 |
| Surgical Pathology | lab | $112 | $112 | $112 | 1 |
| Scissors Ophthalmic 23ga Vertical Grieshaber | other | $113 | $113 | $113 | 1 |
| Symbicort 80-4.5 Mcg Inhaler | other | $113 | $113 | $113 | 1 |
| Anesthesia for Procedure to Drain Brain and Spinal Cord Fluid | other | $113 | $113 | $113 | 1 |
| Kit for 1.8mm Q-fix Implant #25 | surgery | $113 | $113 | $113 | 1 |
| Addition to Lower Extremity Fracture Orthosis, Plastic Shoe Insert with Ankle... | other | $114 | $114 | $114 | 1 |
| Addition to Lower Extremity, Long Tongue Stirrup | other | $114 | $114 | $114 | 1 |
| Dexmedetomidin 400mcg/100ml-ns | other | $114 | $114 | $114 | 1 |
| Probe Laser Illuminated Directional 55.47.25p | other | $114 | $114 | $114 | 1 |
| Rod Carbon Fiber 11.0mm X 400mm External | other | $115 | $115 | $115 | 1 |
| Vital-vue Urol/gen #8280-06 Extended Yank | other | $115 | $115 | $115 | 1 |
| Prostate Cancer Screening | other | $115 | $42 | $223 | 25 |
| Addition to Lower Extremity Prosthesis, Below Knee, Suspension/sealing Sleeve... | other | $116 | $116 | $116 | 1 |
| Wrist Hand Finger Orthosis, without Joint(s), Prefabricated Item That Has Bee... | other | $116 | $116 | $116 | 1 |
| Falope-ring Band Disp 8ea/bx | other | $116 | $116 | $116 | 1 |
| Super Multivac 50 Wand-amblient | other | $116 | $116 | $116 | 1 |
| Wand 90 Degree Superturbovac Amb Fingerswitch | other | $116 | $116 | $116 | 1 |
| Injection, Hydroxyzine Hcl, Up to 25 Mg | other | $116 | $98 | $134 | 2 |
| Newborn Metabolic Screening Panel, Includes Test Kit, Postage and the Laborat... | lab | $116 | $116 | $116 | 1 |
| Blood Gases Any Combination | other | $116 | $116 | $116 | 1 |
| Addition to Lower Extremity, Below Knee, Molded Distal Cushion | other | $117 | $117 | $117 | 1 |
| Sodium Bicarb 4.2% Abboject | other | $117 | $117 | $117 | 1 |
| Syringe Orise Twnpk23g Intej Needle M00519211 | other | $117 | $117 | $117 | 1 |
| Raltegravir Potassium 400 Mg Po Tabs #6 Dispense Pack | other | $117 | $117 | $117 | 1 |
| Sodium Phosphate 45 Mmol/15 Ml | other | $117 | $117 | $117 | 1 |
| Basket Nitinol 1.9 #390 | other | $117 | $117 | $117 | 1 |
| Decompression Set 14fr #cdsg-14 | other | $117 | $117 | $117 | 1 |
| Needle Scorpion W/megaloader #ar-13999hdn 5ea/bx | other | $117 | $117 | $117 | 1 |
| Injection, Alprostadil, 1.25 Mcg | other | $117 | $117 | $117 | 1 |
| Arc Smart Argon Probe 2.3/220 G1140001 | other | $117 | $117 | $117 | 1 |
| Retractor Dexterity 9-14cm #100301 | other | $118 | $118 | $118 | 1 |
| Injection, Diazepam, Up to 5 Mg | other | $118 | $118 | $118 | 1 |
| Weight Management Program | preventive | $118 | $118 | $118 | 1 |
| Apligraf | other | $118 | $118 | $118 | 1 |
| Tx/pro/dx Inj Same Drug Add On | other | $118 | $118 | $118 | 1 |
| Knee Orthosis, Elastic with Joints, Prefabricated Item That Has Been Trimmed,... | other | $119 | $119 | $119 | 1 |
| Ligasure Xtd Disp #ls3112 | other | $119 | $119 | $119 | 1 |
| Dilator Urethral Set 14f to 26f #g14893 | other | $119 | $119 | $119 | 1 |
| Urethral S-curve Dilator Set 8fr-20fr #g32789 | other | $119 | $119 | $119 | 1 |
| Injection, Midazolam in 0.9% Sodium Chloride, Intravenous, Not Therapeuticall... | other | $119 | $119 | $119 | 1 |
| Stent, Non-coronary, Temporary, without Delivery System | cardiac | $119 | $119 | $119 | 1 |
| 3d/4d Prenatal Ultrasound | imaging | $119 | $119 | $119 | 1 |
| Injection, Caffeine Citrate, 5 Mg | other | $119 | $119 | $119 | 1 |
| Cannulated Hex Driver 3.5 Ar-8967d | other | $120 | $120 | $120 | 1 |
| Carbonaid C02 Diffuser #carbonaid | other | $120 | $120 | $120 | 1 |
| Ear Impression, Each | other | $120 | $120 | $120 | 1 |
| Equinoxe Torque Defining Square Drive Screw Kit #300-20 | other | $120 | $120 | $120 | 1 |
| Hex Driver 2.0 70mm Ao Marked Cannulated #dvhx-2.0/070mc Ao | other | $120 | $120 | $120 | 1 |
| Laser Fiber 200micron Disp #clt1020fl | other | $120 | $120 | $120 | 1 |
| Shoulder Gps Reverse Shoulder Drill Kit (1) 2mm Drill (1) 3.2mm Drill #531-20 | other | $120 | $120 | $120 | 1 |
| Shoulder Orthosis, Vest Type Abduction Restrainer, Canvas Webbing Type OR Equ... | other | $120 | $120 | $120 | 1 |
| Spacer 36+6mm #ar-9555 | other | $120 | $120 | $120 | 1 |
| Fentanyl 2 Mcg/ml, Bupivacaine 0.125% Epidural | other | $120 | $120 | $120 | 1 |
| Fentanyl 2 Mcg/ml, Bupivacaine 0.125% Epidural Pca - Compounded | other | $120 | $120 | $120 | 1 |
| Wand Arthro 3.0mm Capsure Low Temperature | other | $120 | $120 | $120 | 1 |
| Thyroid Test (TSH) | lab | $120 | $55 | $289 | 7 |
| Cold Agglutinin Screen | other | $120 | $120 | $120 | 1 |
| Hyaluronan OR Derivative, Euflexxa, for Intra-articular Injection, Per Dose | other | $122 | $122 | $122 | 1 |
| Resolution 360 Clip 235cm X 2.8mm #m00521232 | other | $123 | $123 | $123 | 1 |
| Arista Surgical Hemostatic Powder 5 Gm Polysaccharide Hemospheres Absorbable ... | surgery | $123 | $123 | $123 | 1 |
| Electrode Pacing Bipolar 5fr-usci 5ea/1ca | other | $123 | $123 | $123 | 1 |
| Reamer Coring 10mm #ar-1224s W/collared Pin | other | $123 | $123 | $123 | 1 |
| Reamer Coring 11mm #ar-1226s | other | $123 | $123 | $123 | 1 |
| Reamer Coring 12mm Cannulated | other | $123 | $123 | $123 | 1 |
| Reamer Coring 8mm Cannulated W/collared Pin | other | $123 | $123 | $123 | 1 |
| Reamer Coring 9mm #ar-1223s W/collarded Pin | other | $123 | $123 | $123 | 1 |
| PSA (Prostate-Specific Antigen) | lab | $123 | $42 | $170 | 10 |
| Introducer/sheath, Other Than Guiding, Other Than Intracardiac Electrophysiol... | cardiac | $123 | $123 | $123 | 1 |
| Sodium Phosphate 15 Mmol/5 Ml | other | $124 | $124 | $124 | 1 |
| Paragon T2 Wand | other | $124 | $124 | $124 | 1 |
| Initial Aerosol O2 - 30 Min | other | $124 | $124 | $124 | 1 |
| Injection, Acetaminophen, Not Otherwise Specified,10 Mg | other | $124 | $124 | $124 | 1 |
| Sodium Chloride 0.9% Irrig. | other | $125 | $125 | $125 | 1 |
| Hip Knee Ankle Foot Orthosis, Torsion Control, Bilateral Rotation Straps, Pel... | other | $126 | $126 | $126 | 1 |
| Eviva Trocar 9g 10cm Length 12mm Aperture | other | $126 | $126 | $126 | 1 |
| Eviva_0913-20 9ga 13cm Length 20mm Aperture | other | $126 | $126 | $126 | 1 |
| Expect Slimline 25g Eus Needle #m00555521 Bx/5ea | other | $126 | $126 | $126 | 1 |
| Needle Eus 19ga Expect Slimline #m00555501 | other | $126 | $126 | $126 | 1 |
| Needle Eus 22ga Expect Slimline #m00555511 | other | $126 | $126 | $126 | 1 |
| Surgicel 4 X 8 #1952s 12ea/case | other | $126 | $126 | $126 | 1 |
| Pin Threaded Tip 1/8 X 2.5in #406669 | other | $126 | $126 | $126 | 1 |
| Annual Wellness Visit; Includes a Personalized Prevention Plan of Service (pp... | preventive | $126 | $126 | $126 | 1 |
| Hydrocodone-chlorphen ER Susp | other | $126 | $126 | $126 | 1 |
| Therapeutic Injection | preventive | $126 | $35 | $438 | 13 |
| Acu-dispo-cautery2 Fine Tip-s #dcft2 | other | $127 | $127 | $127 | 1 |
| Carbojet Xf Handpiece Set with 40" Nozzle (10-unit Multi-pack) #27-100 | other | $127 | $127 | $127 | 1 |
| Stone Extractor Tipless 2.2frx115cm Ncircle | other | $127 | $127 | $127 | 1 |
| Stone Extractor Tipless 3.0frx115cm Ncircle | other | $127 | $127 | $127 | 1 |
| Addition to Lower Extremity, Varus/valgus Correction, Plastic Modification, P... | other | $127 | $127 | $127 | 1 |
| Injection, Iron Dextran, 50 Mg | other | $127 | $127 | $127 | 1 |
| Inhalational Anesth Ea 30min | other | $127 | $127 | $127 | 1 |
| Septal Button Nasal 2 Part #1524110 | other | $128 | $128 | $128 | 1 |
| Atropine Sulf Opth Sol | other | $128 | $128 | $128 | 1 |
| Hospital Discharge | other | $128 | $128 | $128 | 1 |
| Hospital Follow-up Care | other | $128 | $128 | $128 | 1 |
| Gold Probe Injection 10fr #6016 | other | $129 | $129 | $129 | 1 |
| Gold Probe W/injector 7fr/210cm #6015 | other | $129 | $129 | $129 | 1 |
| M00521231 - Clip Internal L235cm Channel 2.8mm with Ergonomic Handle Braided ... | other | $129 | $129 | $129 | 1 |
| Reamer Cann Head 6.5mm #ar-1406.5 | other | $129 | $129 | $129 | 1 |
| Reamer Cann Head 6mm #ar | other | $129 | $129 | $129 | 1 |
| Reamer Cann Head 7.5mm #ar-1407.5 | other | $129 | $129 | $129 | 1 |
| Reamer Cann Head 7mm #ar | other | $129 | $129 | $129 | 1 |
| Reamer Cann Head 8mm #ar | other | $129 | $129 | $129 | 1 |
| Symbicort 160-4.5 Mcg Inhaler | other | $130 | $130 | $130 | 1 |
| Amplatz Grad Renal Dilation Set | other | $130 | $130 | $130 | 1 |
| Blade Shave Biopsy Flex Dermablade 8ea/1cs | lab | $130 | $130 | $130 | 1 |
| Vitamin D Test | lab | $130 | $67 | $383 | 7 |
| Occupational Therapy Evaluation | therapy | $130 | $111 | $168 | 3 |
| Needle Eus 22g Expect Slimline #m00555510 | other | $131 | $131 | $131 | 1 |
| Injection, Epoprostenol, 0.5 Mg | other | $131 | $131 | $131 | 1 |
| Arc Smart Argon Probe 2.3/330 G1140002 | other | $131 | $131 | $131 | 1 |
| Picc Cath 4fr Single Lumen Sapiens | other | $131 | $131 | $131 | 1 |
| 17 Ketogenicsteroids | other | $131 | $131 | $131 | 1 |
| Initial Oxy Hood 30 Min | other | $131 | $131 | $131 | 1 |
| Technetium Tc-99m Pyrophosphate, Diagnostic, Per Study Dose, Up to 25 Millicu... | other | $131 | $131 | $131 | 1 |
| Catheter Oximetry Nonheparin Swan-ganz782f75m | cardiac | $132 | $132 | $132 | 1 |
| A-scope 4 Rhinolaryngo Slim 510001000 5ea/1bx | other | $132 | $132 | $132 | 1 |
| Helmet, Protective, Hard, Prefabricated, Includes All Components and Accessories | other | $132 | $132 | $132 | 1 |
| Knot Pusher Suture Cutter #ar | other | $132 | $132 | $132 | 1 |
| Microspheres 700-900 S820gh 5ea/box | other | $132 | $132 | $132 | 1 |
| Robotic Suction Irrigator #410299 | other | $132 | $132 | $132 | 1 |
| Addition, Endoskeletal System, Above Knee OR Hip Disarticulation, Knee Extens... | other | $132 | $132 | $132 | 1 |
| Injection, Chlorpromazine Hcl, Up to 50 Mg | other | $132 | $116 | $148 | 2 |
| Carbojet Xf Handpiece Set with 40" Nozzle Individual Handpiece #27-100 | other | $133 | $133 | $133 | 1 |
| Cannula Simcoe | other | $134 | $134 | $134 | 1 |
| 2.5mm Prcsn Mtch Hd 13cm8450-107 | other | $134 | $134 | $134 | 1 |
| Tretinoin 0.01 % Ex Gel | other | $135 | $135 | $135 | 1 |
| Lap Grasper 5mm 6ea/bx #5dsg | other | $135 | $135 | $135 | 1 |
| Urethral Dilator Set 8fr-24fr #g14185 | other | $135 | $135 | $135 | 1 |
| 2.0 Mm Drive Shaft for Quickfix Screw System Ar-8930d | other | $135 | $135 | $135 | 1 |
| 3.0 Drive Shft for Quickfix Screw System Ar-8930d | other | $135 | $135 | $135 | 1 |
| Clip Resolution 360 Ultra17mm M00521402 20/bx | other | $135 | $135 | $135 | 1 |
| Erythromycin 200 Mg/5 Ml Susp | other | $135 | $135 | $135 | 1 |
| Pinning System #2544-00 | other | $135 | $135 | $135 | 1 |
| Ruby Coil Detachment Handle | other | $135 | $135 | $135 | 1 |
| Tube Nasal Moss Feed 18fr 44" Min Order of 2 | other | $135 | $135 | $135 | 1 |
| 2.0mm Carbide Round 5820-110-020c | other | $135 | $135 | $135 | 1 |
| 3.0mm Carbide Round5820-110-030c | other | $135 | $135 | $135 | 1 |
| 4.0mm Carbide Round 5820-110-040c | other | $135 | $135 | $135 | 1 |
| Injection, Gadolinium-based Magnetic Resonance Contrast Agent, Not Otherwise ... | other | $135 | $135 | $135 | 1 |
| Technetium Tc-99m Sulfur Colloid, Diagnostic, Per Study Dose, Up to 20 Millic... | other | $135 | $135 | $135 | 1 |
| Addition to Lower Extremity Orthosis, High Strength, Lightweight Material, Al... | other | $137 | $137 | $137 | 1 |
| Static OR Dynamic Ankle Foot Orthosis, Including Soft Interface Material, Adj... | other | $137 | $137 | $137 | 1 |
| Breast Prosthesis, Mastectomy Bra, with Integrated Breast Prosthesis Form, Bi... | other | $137 | $137 | $137 | 1 |
| Power Picc Solo Catheter 4f Sl 3cg #ck001030 3kits/1 Case | cardiac | $137 | $137 | $137 | 1 |
| Electrical Stimulation (unattended), to One OR More Areas for Indication(s) O... | other | $137 | $137 | $137 | 1 |
| Epinephrine Hcl (nasal) 0.1 % Na Soln | other | $138 | $138 | $138 | 1 |
| Gradient Compression Arm Sleeve, Custom, Medium Weight, Each | other | $138 | $138 | $138 | 1 |
| Injection, Ropivacaine Hydrochloride, 1 Mg | other | $138 | $76 | $200 | 2 |
| Injection, Betamethasone Acetate 3 Mg and Betamethasone Sodium Phosphate 3 Mg | other | $138 | $39 | $237 | 2 |
| Fresh Frozen Plasma Between 8-24 Hours of Collection, Each Unit | other | $138 | $138 | $138 | 1 |
| Xenon Xe-133 Gas, Diagnostic, Per 10 Millicuries | other | $138 | $138 | $138 | 1 |
| Type & Screen | other | $139 | $139 | $139 | 1 |
| Mic Tube Feeding Jejunal 18fr 30cm #0250-18 | other | $140 | $140 | $140 | 1 |
| Electrode Pacing Non-heparin 5frx110cm 5ea/ca | other | $140 | $140 | $140 | 1 |
| 2.0 Cann Driver Tip Ht | other | $140 | $140 | $140 | 1 |
| Walking Boot, Non-pneumatic, with OR without Joints, with OR without Interfac... | other | $140 | $140 | $140 | 1 |
| Arndt Endobronchial Blocker Set 7fr G44114 | other | $141 | $141 | $141 | 1 |
| Tobrex 0.3% Eye Ointment | other | $141 | $141 | $141 | 1 |
| Optisphere 700-1000 #osl271 5ea/1bx | other | $141 | $141 | $141 | 1 |
| Medtronic Percutaneous Extention Kit 3560022 | other | $141 | $141 | $141 | 1 |
| 3.0 Precision Round 2flute5820-009 | other | $142 | $142 | $142 | 1 |
| 4.0 Precision Round 2flute5820-009 | other | $142 | $142 | $142 | 1 |
| 5.0 Precision Round 2flute5820-009 | other | $142 | $142 | $142 | 1 |
| 6.0 Precision Round 2flute5820-009 | other | $142 | $142 | $142 | 1 |
| Desonide 0.05 % Ex Lotn | other | $142 | $142 | $142 | 1 |
| Hc General Anesthesia Time - Each Incremental 15 Minutes | other | $143 | $143 | $143 | 1 |
| Pulmonary Needle Arcpoint 21g #ils-2100-pn 5/pk | other | $143 | $143 | $143 | 1 |
| Pneumothorax Cath Set 10.2fr #c-tpt-200 1ea | other | $143 | $143 | $143 | 1 |
| Coblator Evac 70 Xtra W/cable | other | $144 | $144 | $144 | 1 |
| Hc Epidural Anesthesia Time - Initial Base Charge | other | $144 | $144 | $144 | 1 |
| Hc Spinal Anes 1st 30 | other | $144 | $144 | $144 | 1 |
| Silvasorb Gel | other | $144 | $144 | $144 | 1 |
| Fiapc Probe W/ Filter 2200 a Od 2.3 Mm / 6.9 Fr; L 2.2 M / 7.2 Ft - #20132-21... | other | $146 | $146 | $146 | 1 |
| Fiapc Probe W/ Filter 2200 Cod 2.3 Mm / 6.9 Fr; L 2.2 M / 7.2 Ftno. #20132-21... | other | $146 | $146 | $146 | 1 |
| Embospheres 500-700 #s620gh 5ea/bx | other | $146 | $146 | $146 | 1 |
| Microspheres 300-500 #s420gh 5ea/box | other | $146 | $146 | $146 | 1 |
| Lacosamide 200 Mg/20 Ml Vial | other | $146 | $146 | $146 | 1 |
| Forcep Long Kleppinger 45cm 5mm #910010pk | other | $146 | $146 | $146 | 1 |
| Hemostatic Sealant Floseal Matrix 10ml 6/ca | other | $146 | $146 | $146 | 1 |
| Vision Exam | other | $146 | $146 | $146 | 1 |
| Ergo Gps Drill 3.2mm #531-55 | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.0mm X 20mm L76mm Ao Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.0mm X 20mml82mm Dental Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.0mm X 20mml82mm Stryker Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.2mm X 10mm L66mm Ao Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.2mm X 10mm L72mm Dental Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.2mm X 10mm L72mm Stryker Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.2mm X 25mm L81mm Ao Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.2mm X 25mm L87mm Dental Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.2mm X 25mm L87mm Stryker Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.6mm X 10mm L66mm Ao Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.6mm X 10mm L72mm Dental Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.6mm X 10mm L72mm Stryker Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.6mm X 25mm L81mm Ao Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.6mm X 25mm L87mm Dental Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.6mm X 25mm L87mm Stryker Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.9mm X 35mm L91mm Ao Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.9mm X 35mm L97mm Dental Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 1.9mm X 35mm L97mm Stryker Fixation #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 2.1mm X 10mm L66mm Ao Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 2.1mm X 10mm L72 Stryker Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 2.1mm X 10mm L72mm Dental Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 2.35mm X 10mm L66mm Ao Lag #a | other | $147 | $147 | $147 | 1 |
| Twist Drill 2.35mm X 10mm L72mm Dental Lag #a | other | $147 | $147 | $147 | 1 |
| Balloon Oval Kidney Shape Str #omspdbs2 | other | $147 | $147 | $147 | 1 |
| Blood Test | lab | $147 | $33 | $2,735 | 18 |
| Hc Regional Anesthesia Time - Initial Base Charge | other | $148 | $148 | $148 | 1 |
| Tralement Vial | other | $148 | $148 | $148 | 1 |
| Adapalene 0.3% Gel | other | $149 | $149 | $149 | 1 |
| Sensors Starling W/leadwires 25pk/1bx #cms25 | other | $149 | $149 | $149 | 1 |
| Injection, Erythromycin Lactobionate, Per 500 Mg | other | $149 | $149 | $149 | 1 |
| Reaming Rod Push Rod with Ball Handle 03.010.093 | other | $149 | $149 | $149 | 1 |
| Centurion Anterior Vitrectomy Probe | other | $149 | $149 | $149 | 1 |
| Assistive Listening Device, Television Amplifier, Any Type | other | $150 | $150 | $150 | 1 |
| Aveta Coral Disposable Hysteroscope 4.6mm #214 | other | $150 | $150 | $150 | 1 |
| Aveta Pearl Disposable Hysteroscope 5.7mm #214 | other | $150 | $150 | $150 | 1 |
| Cables Ensite X Extension for Magnet #a-ens-magext-cbl | other | $150 | $150 | $150 | 1 |
| Custom Peg Board Kit #1 #pbk10001 | other | $150 | $150 | $150 | 1 |
| Ensnare 18-30mm #en2007030 Elgx | other | $150 | $150 | $150 | 1 |
| Hearing Aid OR Assistive Listening Device/supplies/accessories, Not Otherwise... | other | $150 | $150 | $150 | 1 |
| Pins 4x127 #rob10010 4ea/bx | other | $150 | $150 | $150 | 1 |
| Pins 4x152 #rob10011 2ea/bx | other | $150 | $150 | $150 | 1 |
| Screwdriver Bit Headless 3.0mm 212-40 | other | $150 | $150 | $150 | 1 |
| Ingrezza 40 Mg Capsule | other | $150 | $150 | $150 | 1 |
| Powerpicc Solo Provena Catheter 4f Dl 3cg #ck001031 3kt/cs | cardiac | $150 | $150 | $150 | 1 |
| Phytonadione Inj 1 Mg/0.5 Ml C | other | $150 | $150 | $150 | 1 |
| Catheter Angiographic Coronary OR Peripheral Guiding W/o Sideholes Right C315... | imaging | $151 | $151 | $151 | 1 |
| Alvarado Traction Boot #00132021000 | other | $151 | $151 | $151 | 1 |
| Prevena Dressing 13cm #pre1155us 5/cs | other | $152 | $152 | $152 | 1 |
| Prevena Dressing 20cm #pre1055us 5/cs | other | $152 | $152 | $152 | 1 |
| Dressing Neg Press Veraflo Lg 5pk Ultvcc05lg | other | $152 | $152 | $152 | 1 |
| Drill Tip Set-acl Patella Tendon Reusable | other | $153 | $153 | $153 | 1 |
| Back Brace Aspen Summit 637 X-large 992380 | other | $153 | $153 | $153 | 1 |
| Ligator Six Bander #mbl-6-ov Implant | surgery | $153 | $153 | $153 | 1 |
| 8813e Suture Kit Dr Dumicz Oh Only 5kt/bx | other | $154 | $154 | $154 | 1 |
| Amnioexcel, Amnioexcel Plus OR Biodexcel, Per Square Centimeter | other | $154 | $154 | $154 | 1 |
| Absorb.gelantin Sponge | other | $154 | $154 | $154 | 1 |
| Parenteral Nutrition Solution; Compounded Amino Acid and Carbohydrates with E... | other | $154 | $154 | $154 | 1 |
| 2019-ncovid Any Technq-non-cdc | other | $154 | $154 | $154 | 1 |
| Injection, Levocarnitine, Per 1 Gm | other | $155 | $155 | $155 | 1 |
| Candin Skin Test | other | $155 | $155 | $155 | 1 |
| Basket Trapezoid 3cm #m00510890 | other | $155 | $155 | $155 | 1 |
| Basket Wireguided Retrieval 2.0 X .035 | other | $155 | $155 | $155 | 1 |
| Basket Wireguided Retrieval 2.5 X .035 | other | $155 | $155 | $155 | 1 |
| **discontinued 2/19/2021** Percut Kit 19fr X 18cm Femoral Arterial | other | $155 | $155 | $155 | 1 |
| Percut Kit 21fr X 18cm Femoral Arterial | other | $155 | $155 | $155 | 1 |
| 8815e Suture Dr Halligan CABG 1ea=1kt 5kt/1bx | other | $155 | $155 | $155 | 1 |
| Cvvh Prisma Dilution Set #106697 4ea/cs | other | $156 | $156 | $156 | 1 |
| Hti Regulator Kit H80215901011 15901 | other | $156 | $156 | $156 | 1 |
| Tube Endobronchial 35 Vivasight-dl #dlvt35las | other | $156 | $156 | $156 | 1 |
| Tube Endobronchial 37 Vivasight-dl #dlvt37las | other | $156 | $156 | $156 | 1 |
| Tube Endobronchial 39 Vivasight-dl #dlvt39las | other | $156 | $156 | $156 | 1 |
| Tube Endobronchial 41 Vivasight-dl #dlvt41las | other | $156 | $156 | $156 | 1 |
| Santyl Ointment | other | $156 | $156 | $156 | 1 |
| Fitting/orientation/checking of Hearing Aid | other | $156 | $156 | $156 | 1 |
| Hemostat Surgicel Snow 2x4 Absrb Ster #2082 | other | $156 | $156 | $156 | 1 |
| Laser Probe 25g Vekt Illum Directl8065 | other | $157 | $157 | $157 | 1 |
| Percut Kit 15fr X 18cm Femoral Arterial | other | $157 | $157 | $157 | 1 |
| Ligator Band 7 Band Speed | other | $157 | $157 | $157 | 1 |
| Injection, Acetazolamide Sodium, Up to 500 Mg | other | $157 | $154 | $160 | 2 |
| Unlisted Reference Lab | other | $157 | $157 | $157 | 1 |
| Retrieval Device, Insertable | other | $158 | $158 | $158 | 1 |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 9/27 Inner Diameter 10.... | other | $158 | $158 | $158 | 1 |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 9/36 Inner Diameter 13.... | other | $158 | $158 | $158 | 1 |
| Vitamin D Level | lab | $158 | $67 | $178 | 3 |
| Laproscopic Alligator Grasper | other | $159 | $159 | $159 | 1 |
| Waveguide 12fr #1911273 | other | $159 | $159 | $159 | 1 |
| Injection, Bleomycin Sulfate, 15 Units | other | $159 | $159 | $159 | 1 |
| Physical Therapy Evaluation | therapy | $159 | $144 | $306 | 10 |
| Disposable Distal Attachment D-201 | other | $160 | $160 | $160 | 1 |
| Silicone Elastomer T-tube 10fr Su130 | other | $161 | $161 | $161 | 1 |
| Silicone Elastomer T-tube 12fr Su130 | other | $161 | $161 | $161 | 1 |
| Silicone Elastomer T-tube 14fr Su130 | other | $161 | $161 | $161 | 1 |
| Silicone Elastomer T-tube 16fr Su130 | other | $161 | $161 | $161 | 1 |
| Stonetome 5.5fr 20mm #3511 | other | $161 | $161 | $161 | 1 |
| Bflex 2 Slim 3.8 Single-use Bronchoscope 0570-0448 Bx=pk/5ea | other | $161 | $161 | $161 | 1 |
| Non-canulated Non-sterile Torque Driver #00-8401-080 | other | $161 | $161 | $161 | 1 |
| Injection, Cisplatin, Powder OR Solution, 10 Mg | other | $161 | $161 | $161 | 1 |
| Injection, Penicillin G Potassium, Up to 600,000 Units | other | $161 | $161 | $161 | 1 |
| Electrode Hf Loop 24fr .2 Wire #a22201d | other | $162 | $162 | $162 | 1 |
| Addition to Knee Joint, Disc OR Dial Lock for Adjustable Knee Flexion, Each J... | other | $162 | $162 | $162 | 1 |
| Wand Arthro 2.3mm 35 Deg Short Bevel Sm Joint | other | $162 | $162 | $162 | 1 |
| 3 Hour Gtt | other | $162 | $162 | $162 | 1 |
| Fdp,fibrinogen Degradation Pro | other | $162 | $162 | $162 | 1 |
| Irrig Drug Delivery Device | obstetric | $162 | $162 | $162 | 1 |
| Meas Post-voiding Residl Urine | other | $162 | $162 | $162 | 1 |
| Overtube Guardus Endo 50cm 3ea/bx #bx00711149 | other | $163 | $163 | $163 | 1 |
| Guidepin Resection 3mm X 100mm for Inhance Shoulder System #700030100 #7000-30 | other | $164 | $164 | $164 | 1 |
| Technetium Tc 99m Labeled Red Blood Cell Diagnostic 30 Mci | other | $164 | $164 | $164 | 1 |
| Injection, Vancomycin Hydrochloride (mylan) Not Therapeutically Equivalent to... | other | $164 | $164 | $164 | 1 |
| Percut Kit 23fr X 18cm Femoral Venous | other | $165 | $165 | $165 | 1 |
| Acp Max Prp System W/acda Abs | other | $165 | $165 | $165 | 1 |
| Driver Surgical T8 Solid Ao for Colink Screw P04s0051 #p04 S0051 | surgery | $165 | $165 | $165 | 1 |
| Knot Pusher #kp1 Cardiac Surg Only | cardiac | $165 | $165 | $165 | 1 |
| Lag Screw Driver T8 Cannulated Sterile Single Use #p06 S0411 | other | $165 | $165 | $165 | 1 |
| Tube Feed Gastrostomy 18fr Moss | other | $165 | $165 | $165 | 1 |
| Clevercut Tome 7mm Tip 20mm Wire | other | $165 | $165 | $165 | 1 |
| Kyphon Bevel Osteo Introducer #t15k | other | $166 | $166 | $166 | 1 |
| Injection, Sodium Ferric Gluconate Complex in Sucrose Injection, 12.5 Mg | other | $166 | $111 | $220 | 2 |
| Endowrist Suction Irrigator #480299 6ea/1bx | other | $167 | $167 | $167 | 1 |
| Injection, Topotecan, 0.1 Mg | other | $167 | $167 | $167 | 1 |
| Prosthesis, Penile, Non-inflatable | other | $167 | $167 | $167 | 1 |
| Injection, Carboplatin, 50 Mg | other | $168 | $168 | $168 | 1 |
| Ibs 2in1 Drill 2.2 Diam / Lg22mm Ao Sterile Cannulated Lg65mm G01 00721 | other | $168 | $168 | $168 | 1 |
| Tool Delivery Large Cps Locator 3d#ds2c300 | obstetric | $168 | $168 | $168 | 1 |
| Tool Delivery Large Xlong Cps Locator 3d#ds2c300 | obstetric | $168 | $168 | $168 | 1 |
| Tool Delivery Medium Cps Locator 3d#ds2c200 | obstetric | $168 | $168 | $168 | 1 |
| Tool Delivery Medium Xlong Cps Locator 3d#ds2c200 | obstetric | $168 | $168 | $168 | 1 |
| Tool Delivery Small Cps Locator 3d#ds2c100 | obstetric | $168 | $168 | $168 | 1 |
| Hc Dressing Aquacel Ag 3.5x6 | other | $168 | $168 | $168 | 1 |
| Occupational Therapy | therapy | $168 | $60 | $450 | 29 |
| Gentran 10%-5% Dextrose | other | $168 | $168 | $168 | 1 |
| Gentran 10%-saline 0.9% | other | $168 | $168 | $168 | 1 |
| Flovent Hfa 220 Mcg Inhaler | other | $169 | $169 | $169 | 1 |
| Pathology (Surgical Specimen) | lab | $169 | $43 | $2,185 | 12 |
| Special Stains Group 1 | other | $169 | $169 | $169 | 1 |
| Foot, Insert, Removable, Molded to Patient Model, Longitudinal Arch Support, ... | other | $170 | $170 | $170 | 1 |
| Physical Therapy | therapy | $170 | $94 | $398 | 29 |
| 11mm Mcglamry Metatarsal Elevator Ar-8930m | other | $171 | $171 | $171 | 1 |
| Connecting Tube #maj | other | $171 | $171 | $171 | 1 |
| Injection, Phytonadione (vitamin K), Per 1 Mg | other | $171 | $171 | $171 | 1 |
| Splinting Tube 11mm X 13.2mm for Enteroscopy | other | $172 | $172 | $172 | 1 |
| Injection, Amiodarone Hydrochloride (nexterone), 30 Mg | other | $172 | $121 | $222 | 2 |
| Needle Ultrafast Fix Straight | other | $173 | $173 | $173 | 1 |
| Pack Arthroscopic 1.2 Disposable Rap-pac B #72202797 | surgery | $173 | $173 | $173 | 1 |
| For Diabetics Only, Fitting (including Follow-up), Custom Preparation and Sup... | other | $173 | $173 | $173 | 1 |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 8/27 Standard Inner Dia... | other | $173 | $173 | $173 | 1 |
| Bone Mill #bm210 Fine | other | $174 | $174 | $174 | 1 |
| All Lower Extremity Prosthesis, Solid Ankle Cushion Heel (sach) Foot, Replace... | other | $174 | $174 | $174 | 1 |
| Basic Metabolic Panel (BMP) | lab | $174 | $31 | $11,362 | 24 |
| S1294108d5 - Power Picc 4fr Dual 3ea/case | other | $175 | $175 | $175 | 1 |
| Powerpicc Solo Catheter 5f Tl Hf 3cg #ck001032 3kt/1cs | cardiac | $175 | $175 | $175 | 1 |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 8/36 Nonsterile Single-... | other | $175 | $175 | $175 | 1 |
| Gore Smoother 7.9mm Disp | other | $176 | $176 | $176 | 1 |
| Gore Smoother 9.5mm Disp | other | $176 | $176 | $176 | 1 |
| EKG (Electrocardiogram) | cardiac | $176 | $27 | $1,303 | 28 |
| Balloon Cre Rx Biliary 10-11-12mm #m00558930 | other | $177 | $177 | $177 | 1 |
| Balloon Cre Rx Biliary 6-7-8mmx5.5 #m00558860 | other | $177 | $177 | $177 | 1 |
| Balloon Cre Rx Biliary 8-9-10mm #m00558920 | other | $177 | $177 | $177 | 1 |
| Balloon Cre Rx Biliary12-13.5-15mm #m00558940 | other | $177 | $177 | $177 | 1 |
| Bio-tenodesis Disp Kit #ar-1530ds | other | $177 | $177 | $177 | 1 |
| Hypertension Management | cardiac | $177 | $90 | $542 | 24 |
| Pt Re-eval Est Plan Care | other | $177 | $177 | $177 | 1 |
| Addition to Lower Extremity Fracture Orthosis, Adjustable Motion Knee Joint, ... | other | $178 | $178 | $178 | 1 |
| Tx/proph/dg Addl Seq IV Inf | other | $178 | $178 | $178 | 1 |
| Cns Drainage System /latex Free #10-110 1ea | other | $179 | $179 | $179 | 1 |
| Injection, Olanzapine, 0.5 Mg | other | $179 | $179 | $179 | 1 |
| Anterior Chamber Intraocular Lens | other | $179 | $179 | $179 | 1 |
| Cables Ensite X Inquiry Quad #d-ens-inq-q-cbl | other | $180 | $180 | $180 | 1 |
| Cables Ensite X Supreme Quad #d-ens-sup-q-cbl | other | $180 | $180 | $180 | 1 |
| Heel, New Rubber, Standard | other | $180 | $180 | $180 | 1 |
| Ocular Implant | surgery | $180 | $180 | $180 | 1 |
| Nim Trivantage Emg Endotracheal Tube 5.0 #8229705 | other | $180 | $180 | $180 | 1 |
| Tube Emg Trivantage 6mm #8229706 | other | $180 | $180 | $180 | 1 |
| Tube Emg Trivantage 7mm #8229707 | other | $180 | $180 | $180 | 1 |
| Tube Emg Trivantage 8mm #8229708 | other | $180 | $180 | $180 | 1 |
| Balloon Seeker 6x17mm Em Sphn #1830617sph | other | $180 | $180 | $180 | 1 |
| Destination Slender Seath Guide 6fr 85cm Gs-r6st1c85w | other | $181 | $181 | $181 | 1 |
| Pedvaxhib Vaccine Vial | preventive | $181 | $181 | $181 | 1 |
| Electrode Hf Roller Lg 24-28fr 12/30deg | other | $182 | $182 | $182 | 1 |
| Rod Attacment for Lrg Multi-pin Clamp Externa | other | $182 | $182 | $182 | 1 |
| Reflex Ultra 45 Coblator Ii #eica4845 | other | $182 | $182 | $182 | 1 |
| Extracorp Shock Wv Tx Ms Nos | other | $183 | $183 | $183 | 1 |
| Mtp Cup Reamer 22mm Gen #58890122 | other | $184 | $184 | $184 | 1 |
| Vital-vue/ob Gyn #8281-06 Slender Tip | other | $184 | $184 | $184 | 1 |
| Td Vacc No Presv 7 Yrs+ IM | other | $184 | $184 | $184 | 1 |
| Special Stains Group 2 | other | $184 | $184 | $184 | 1 |
| Injection, Benztropine Mesylate, Per 1 Mg | other | $185 | $160 | $210 | 2 |
| Forceps Biopsy Piranha #m0065051600 | lab | $185 | $185 | $185 | 1 |
| Wrist Hand Finger Orthosis, without Joint(s), Prefabricated, Off-the-shelf, A... | other | $185 | $185 | $185 | 1 |
| Temno Biopsy Needle 20x20 Ctt2020 | lab | $185 | $185 | $185 | 1 |
| Comprehensive Metabolic Panel | lab | $185 | $63 | $2,642 | 11 |
| Vasectomy | surgery | $186 | $96 | $9,256 | 18 |
| Tb Test Cell Immun Measure | other | $186 | $186 | $186 | 1 |
| Breast Prosthesis, Mastectomy Form | other | $187 | $187 | $187 | 1 |
| Methohexital 10 Mg/ml Injection - Compounded | other | $187 | $187 | $187 | 1 |
| Photon Guide #104015 | other | $188 | $188 | $188 | 1 |
| Diffcult Airway-video-larygeo | other | $188 | $188 | $188 | 1 |
| Drug Test(s), Definitive, Utilizing (1) Drug Identification Methods Able to I... | other | $188 | $188 | $188 | 1 |
| Firstpass Mini Suture Passer - Left Curved 72290129 | other | $189 | $189 | $189 | 1 |
| Firstpass Mini Suture Passer - Right Curved 72290130 | other | $189 | $189 | $189 | 1 |
| Firstpass Mini Suture Passer - Straight 72290128 | other | $189 | $189 | $189 | 1 |
| C-reamer 11mm Linvatec #8774a 4/bx | other | $189 | $189 | $189 | 1 |
| Prismaflex St150 Set Us #107640us | other | $190 | $190 | $190 | 1 |
| Wand Turbinator Arthrocare #eica6895 | other | $190 | $190 | $190 | 1 |
| Toenail Removal | surgery | $190 | $78 | $749 | 9 |
| Estradiol 0.01% Cream | other | $191 | $191 | $191 | 1 |
| Bcg Live Intravesical Instillation, 1 Mg | other | $191 | $191 | $191 | 1 |
| Vaccine Administration | preventive | $191 | $191 | $191 | 1 |
| Photonblade Rf Cautery #pb1 | other | $192 | $192 | $192 | 1 |
| Coblator Probe ENT Reflex #eica4835 | other | $192 | $192 | $192 | 1 |
| Brav0 Cf Capsule Delivery Dev 5-pk #fgs | obstetric | $192 | $192 | $192 | 1 |
| Drill Staple Comp Charlotte #43112032 | other | $193 | $193 | $193 | 1 |
| Bflex 2 Ultraslim 2.8 Single-use Bronchoscope 0570-0447 Bx=pk/5ea | other | $193 | $193 | $193 | 1 |
| Foot, Insert, Removable, Molded to Patient Model, Longitudinal/ Metatarsal Su... | other | $194 | $194 | $194 | 1 |
| Foot X-Ray | imaging | $194 | $194 | $194 | 1 |
| Forearm X-Ray | imaging | $194 | $194 | $194 | 1 |
| Humerus X-Ray | imaging | $194 | $194 | $194 | 1 |
| Wrist X-Ray | imaging | $194 | $194 | $194 | 1 |
| X-ray Exam of Ankle | imaging | $194 | $194 | $194 | 1 |
| X-ray Exam of Clavicle Left | imaging | $194 | $194 | $194 | 1 |
| X-ray Exam of Femur 1 | imaging | $194 | $194 | $194 | 1 |
| X-ray Exam of Femur 2/> | imaging | $194 | $194 | $194 | 1 |
| X-ray Exam of Finger | imaging | $194 | $194 | $194 | 1 |
| X-ray Exam of Lower Leg | imaging | $194 | $194 | $194 | 1 |
| X-ray Exam of Toe | imaging | $194 | $194 | $194 | 1 |
| X-Ray of the Hand | imaging | $194 | $194 | $194 | 1 |
| 10.5mm Short Flipcutter #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flipcutter Ii Short 8.5mm #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flipcutter Ii Short 8mm #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flipcutter Ii Short 9.5mm #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flipcutter Ii Short 9mm #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flipcutter Short 10mm #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flipcutter Short 7.5mm #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flipcutter Short 7mm #ar-1204as | other | $195 | $195 | $195 | 1 |
| Flat Markers #pfsdv0016 18ea/bx | other | $195 | $195 | $195 | 1 |
| Iodine I-131 Sodium Iodide Capsule(s), Therapeutic, Per Millicurie | other | $195 | $195 | $195 | 1 |
| Prevena Plus Dressing #pre4055us 5/cs | other | $196 | $196 | $196 | 1 |
| Caffeine-sod Benzoat 250 Mg/ml | other | $196 | $196 | $196 | 1 |
| Home Sleep Test (hst) with Type Iii Portable Monitor, Unattended; Minimum of ... | other | $196 | $196 | $196 | 1 |
| Micro Acutrak 2 Extended Long Drill Acumed #80 | other | $197 | $197 | $197 | 1 |
| Hand Orthosis, without Joints, May Include Soft Interface, Straps, Custom Fab... | other | $197 | $197 | $197 | 1 |
| Patch Vascular 1cm X 10cm Xenosure E1p10 | other | $197 | $197 | $197 | 1 |
| Captivator Emr Large Scope Single #m00561610 | other | $198 | $198 | $198 | 1 |
| Captivator Emr Standard Scope Single #m00561600 | other | $198 | $198 | $198 | 1 |
| Norepinephrine 16 Mg/250ml-d5w | other | $198 | $198 | $198 | 1 |
| Percut Kit 17fr X 18cm Femoral Arterial | other | $198 | $198 | $198 | 1 |
| Ensnare 7fr 45mm #en2007045 | other | $199 | $199 | $199 | 1 |
| Acyclovir 200 Mg/5 Ml Susp | other | $199 | $199 | $199 | 1 |
| Dressing Dermabond Prineo (2/bx) #clr222us | other | $199 | $199 | $199 | 1 |
| Mitomycin 1.5 Ml (0.4 Mg/ Ml) - for Ophthalmic Use Only - Compounded | other | $200 | $200 | $200 | 1 |
| Hip X-Ray | imaging | $200 | $200 | $200 | 1 |
| X-ray Exam of Elbow | imaging | $200 | $200 | $200 | 1 |
| X-ray Exam of Shoulder | imaging | $200 | $200 | $200 | 1 |
| Mtp Cone Reamer 22mm Gen #58890222 | other | $201 | $201 | $201 | 1 |
| Arthrex Acl Fibertag Tightrope Abs Implant #ar-1588tnt | surgery | $201 | $201 | $201 | 1 |
| Forcep Biopsy Oval Cup 3.3frx15cm #g15054 | lab | $201 | $201 | $201 | 1 |
| COVID-19 Vaccination | preventive | $201 | $29 | $426 | 3 |
| Anesthesia for Tying OR Incision of Fallopian Tubes Using an Endoscope | other | $202 | $202 | $202 | 1 |
| Injection, Ganciclovir Sodium, 500 Mg | other | $202 | $202 | $202 | 1 |
| Injection, Chlorothiazide Sodium, Per 500 Mg | other | $202 | $202 | $202 | 1 |
| Dissector Ultrasonic 13cm #scd13 Sonicision | other | $204 | $204 | $204 | 1 |
| Dissector Ultrasonic 26cm #scd26 Sonicision | other | $204 | $204 | $204 | 1 |
| Injection, Adenosine, 1 Mg | other | $204 | $204 | $204 | 1 |
| Wand ENT Procise Max W/cable #eica8898 | other | $204 | $204 | $204 | 1 |
| Chest X-Ray 1 View | imaging | $204 | $189 | $838 | 11 |
| Catheter, Balloon Dilatation, Non-vascular | cardiac | $205 | $180 | $229 | 2 |
| 2.3mm X 30.0mm Tapered Routerstryker# 5130-071-223s1 | other | $205 | $205 | $205 | 1 |
| Injection, Moxifloxacin, 100 Mg | other | $205 | $205 | $205 | 1 |
| Revision OR Removal of Sacral Integrated Nerve Stimulating System with Electr... | surgery | $206 | $206 | $206 | 1 |
| OB Cath System Bakri Balloon #g24237 | other | $206 | $206 | $206 | 1 |
| Annual Wellness Visit (New) | preventive | $206 | $206 | $206 | 1 |
| X-ray Exam Abdomen 1 View | imaging | $206 | $206 | $206 | 1 |
| X-ray Exam Neck Spine 2-3 Vw | imaging | $206 | $206 | $206 | 1 |
| Cervical, Collar, Semi-rigid, Thermoplastic Foam, Two Piece with Thoracic Ext... | other | $208 | $208 | $208 | 1 |
| Hemostat Surgicel Snow 4x4 Absrb Ster #2083 | other | $208 | $208 | $208 | 1 |
| Moderate Sedation | other | $208 | $87 | $1,512 | 13 |
| Technetium Tc-99m Labeled Red Blood Cells, Diagnostic, Per Study Dose, Up to ... | other | $208 | $208 | $208 | 1 |
| Atb45mm Standard Artic Cutter | other | $209 | $209 | $209 | 1 |
| 4 Hour Gtt | other | $209 | $209 | $209 | 1 |
| Cables Ensite X Livewire Deca #d-ens-l/r-hod-cbl | other | $210 | $210 | $210 | 1 |
| Concave Cone Reamer 21mm P04 N0033 | other | $210 | $210 | $210 | 1 |
| Cone Reamer 23mm Non-sterile P04 N0034 | other | $210 | $210 | $210 | 1 |
| Convex Cup Reamer 21mm P04 N0023 | other | $210 | $210 | $210 | 1 |
| Cup Reamer 23mm Non-sterile P04 N0024 | other | $210 | $210 | $210 | 1 |
| Mental Health Evaluation | therapy | $211 | $65 | $424 | 12 |
| Mic-key Gastric Jejunal Feeding Tube K 1 Ea/ca 0270-18-2.3 | other | $211 | $211 | $211 | 1 |
| Intermediate Joint Injection | surgery | $211 | $143 | $969 | 7 |
| Immunihistology-additional Sli | other | $211 | $211 | $211 | 1 |
| Injection, Desmopressin Acetate, Per 1 Mcg | other | $212 | $140 | $284 | 2 |
| Ipol Vial | other | $212 | $212 | $212 | 1 |
| Angiojet Power Pulse Kit #104834 | other | $212 | $212 | $212 | 1 |
| Needle Biopsy Fine Endobronchial Ultrasound Acquire Pulmonary M00552350 | imaging | $212 | $212 | $212 | 1 |
| Forcep Bipolar Non Stick with Stop Insulated 0.5mm Tip 8 1/2in Buzz Hardy #nh05 | other | $213 | $213 | $213 | 1 |
| Biocomposite Corkscrew Ft Suture Anchor 4.75 Mm X 14 Mm W/two 1.3 Mm Sutureta... | other | $213 | $213 | $213 | 1 |
| Kit-interstim Neurostimulator Extern #353101 | other | $213 | $213 | $213 | 1 |
| Upper Extremity Fracture Orthosis, Humeral, Prefabricated, Includes Fitting a... | other | $213 | $213 | $213 | 1 |
| Brachytherapy Source, Non-stranded, Non-high Dose Rate Iridium-192, Per Source | other | $215 | $215 | $215 | 1 |
| Psychotherapy Session (45 min) | therapy | $216 | $216 | $424 | 3 |
| Anesthesia Facility Charge | other | $216 | $216 | $216 | 1 |
| Nitirol Tipped Stone Extractor G36250 | other | $217 | $217 | $217 | 1 |
| Injection, Nicardipine, 0.1 Mg | other | $218 | $80 | $356 | 2 |
| Sodium Floride F 18 Diagnostic 30 Mci | other | $218 | $218 | $218 | 1 |
| Gradient Compression Garment, Arm, Padded, for Nighttime Use, Each | other | $218 | $218 | $218 | 1 |
| Osteocool Bone Access Kit 10g | other | $218 | $218 | $218 | 1 |
| Dissector Ultrasonic 39cm #scd396 Sonicision | other | $219 | $219 | $219 | 1 |
| Penumbra Max Canister | other | $219 | $219 | $219 | 1 |
| Laser Fiber 150 Micron Tfl Single Use Tfl-fbx150s 5/box | other | $220 | $220 | $220 | 1 |
| Laser Fiber 200 Micron Tfl Single Use Tfl-fbx200s 5/box | other | $220 | $220 | $220 | 1 |
| Laser Fiber 365 Micron Tfl Single Use Tfl-fbx365s 5/box | other | $220 | $220 | $220 | 1 |
| Arterial Cannula 19fr 96530 | other | $220 | $220 | $220 | 1 |
| Injection, Vinorelbine Tartrate, 10 Mg | other | $221 | $221 | $221 | 1 |
| Staple Boyd Fixation Medium Short #128724 | other | $221 | $221 | $221 | 1 |
| Diabetes Management | other | $221 | $91 | $956 | 20 |
| Tc99m Sulfur Colloid | other | $221 | $221 | $221 | 1 |
| Clinimix 8%-10% Solution | other | $222 | $222 | $222 | 1 |
| Hc Monitored Anesthesia Care Anesthesia Time - Initial Base Charge | other | $223 | $223 | $223 | 1 |
| Blood Pressure Monitoring | other | $223 | $99 | $733 | 18 |
| Hla B27 | other | $223 | $223 | $223 | 1 |
| Ligasure 5mm #ls1500 | other | $224 | $224 | $224 | 1 |
| Basket Memory 2x4cm Eight Wire ERCP G21538 | other | $224 | $224 | $224 | 1 |
| Fresh Frozen Plasma | other | $224 | $224 | $224 | 1 |
| Knife Bayonet Disc Non Pt Charge | other | $226 | $226 | $226 | 1 |
| Balloon Seeker 6x7mm Em Maxl #1830607max | other | $227 | $227 | $227 | 1 |
| Injection, Dihydroergotamine Mesylate, Per 1 Mg | other | $227 | $227 | $227 | 1 |
| 6' Dx Cable 10 Pin #c6tmrmst10sa | other | $227 | $227 | $227 | 1 |
| Low Osmolar Contrast Material, 200-299 Mg/ml Iodine Concentration, Per Ml | other | $228 | $224 | $231 | 2 |
| Ligasure Small Jaw Open #lf1212a | other | $229 | $229 | $229 | 1 |
| Blind Obt 22.5fr for A20914a #a20906a | other | $229 | $229 | $229 | 1 |
| Blind Obturator for A20931a 17fr #a20909a | other | $229 | $229 | $229 | 1 |
| Methohexital 100 Mg/10ml-water | other | $229 | $229 | $229 | 1 |
| Injection, Lacosamide, 1 Mg | other | $229 | $229 | $229 | 1 |
| Potassium Phosp 45 Mmol/15 Ml | other | $230 | $230 | $230 | 1 |
| Ankle Foot Orthosis, Plastic OR Other Material, Prefabricated, Includes Fitti... | other | $230 | $230 | $230 | 1 |
| Tisseel Vhsd Frozen Prima 10ml #1506080 | other | $230 | $230 | $230 | 1 |
| Injection, Azacitidine, 1 Mg | other | $230 | $230 | $230 | 1 |
| Combivent Respimat 20-100 Mcg | other | $230 | $230 | $230 | 1 |
| Shingrix Vial Kit | other | $230 | $230 | $230 | 1 |
| Catheter, Electrophysiology, Diagnostic, Other Than 3d Mapping | cardiac | $230 | $230 | $230 | 1 |
| Immediate Post Surgical OR Early Fitting, Application of Non-weight Bearing R... | surgery | $231 | $231 | $231 | 1 |
| Aztreonam 1 G/3ml Ij | other | $231 | $231 | $231 | 1 |
| Aztreonam 1 Gm Vial | other | $231 | $231 | $231 | 1 |
| Alexis Extraction System #gtk17 | other | $231 | $231 | $231 | 1 |
| IV Drug Infusion | therapy | $231 | $72 | $449 | 12 |
| Hospital Admission | other | $231 | $231 | $231 | 1 |
| Fiber Laser 365um 6j 80hz 120w D/f/l for Lithotripsy Moses Ac | other | $232 | $232 | $232 | 1 |
| Topaz Ifs Microdebrider Wand Ez #ach4041 | other | $232 | $232 | $232 | 1 |
| Forcep Bipolar Non Stick Insulated 1.2mm Tip 7 1/2in Buzz Cushing #n19c12 | other | $232 | $232 | $232 | 1 |
| Tumor Markers 1 Inteliq 6x2ml #12008289 | other | $233 | $233 | $233 | 1 |
| Tumor Markers 2 Inteliq 6x2ml #12008290 | other | $233 | $233 | $233 | 1 |
| Urgent Care Visit | other | $233 | $91 | $563 | 18 |
| Loop Cysview Bipolar 24/26fr Longitudinal | other | $234 | $234 | $234 | 1 |
| Ambulatory Infusion Pump, Single OR Multiple Channels, Electric OR Battery Op... | surgery | $235 | $235 | $235 | 1 |
| Laser Fiber 1000mic #dfs-1000sb | other | $235 | $235 | $235 | 1 |
| Electrode Hf Band 30deg #wa22623s | other | $235 | $235 | $235 | 1 |
| Electrode Hf Loop Med 30deg #wa22606s | other | $235 | $235 | $235 | 1 |
| Ankle X-Ray | imaging | $235 | $103 | $530 | 14 |
| X-ray Ac Joints Bi W/wo Weight | imaging | $235 | $235 | $235 | 1 |
| Lumbar Drainage Kit #10 | other | $236 | $236 | $236 | 1 |
| Removal of Bone, Each Additional 20.0 SQ Cm OR Less | surgery | $236 | $236 | $236 | 1 |
| Clamp Lrg Open Adjustable External Mr Safe | other | $236 | $236 | $236 | 1 |
| Needle Acquire Fnb 22 Ga #m00555540 1ea/1bx | other | $236 | $236 | $236 | 1 |
| Injection, Glucagon Hydrochloride (fresenius Kabi), Not Therapeutically Equiv... | other | $238 | $238 | $238 | 1 |
| High Osmolar Contrast Material, 350-399 Mg/ml Iodine Concentration, Per Ml | other | $238 | $238 | $238 | 1 |
| Fibrin Degradation Quant | other | $238 | $238 | $238 | 1 |
| Graft Hemashield 15cm 18mm #m00202175118p0 | other | $239 | $239 | $239 | 1 |
| Graft Oh Hemashield 15cm 24mm #175124p | other | $239 | $239 | $239 | 1 |
| Norepinephrine 16 Mg / 250 Ml Ns Bag (quad Concentrate) - Compounded | other | $239 | $239 | $239 | 1 |
| DEXA Bone Density Scan | imaging | $239 | $161 | $502 | 11 |
| Bone Density Scan | imaging | $240 | $103 | $657 | 30 |
| Cables Ensite X Inquiry Deca #d-ens-inq-od-cbl | other | $240 | $240 | $240 | 1 |
| Ensite X Duo Deca X Cable #d-ens-l/r-ddy-cbl | other | $240 | $240 | $240 | 1 |
| Vitality Polyaxial 7.0x55mm #701m7055 | other | $240 | $240 | $240 | 1 |
| All Lower Extremity Prostheses, Foot, Single Axis Ankle/foot | other | $241 | $241 | $241 | 1 |
| Needle Del Sys 360 Curved 72202468 | other | $242 | $242 | $242 | 1 |
| Needle Del Sys 360 Reverse Curved #72202469 | other | $242 | $242 | $242 | 1 |
| Spirometry (Pulmonary Function) | diagnostic | $242 | $185 | $907 | 9 |
| Injection, Linezolid, 200 Mg | other | $243 | $206 | $280 | 2 |
| Port, Indwelling | other | $243 | $240 | $245 | 2 |
| Monurol 3 Gm Sacet | other | $244 | $244 | $244 | 1 |
| Red Blood Cells, Leukocytes Reduced, Each Unit | other | $245 | $227 | $263 | 2 |
| Hydratome Rx44 450cm X .035" 20mm Cut Wire | other | $245 | $245 | $245 | 1 |
| Electrode Plasmabutton 12/30deg #wa22657s | other | $245 | $245 | $245 | 1 |
| Cellutome Harvester 5cm X 5cm #ct-h50 | other | $246 | $246 | $246 | 1 |
| Graft Oh Hemashield 15cm 22mm #m00202175122p0 | other | $246 | $246 | $246 | 1 |
| Albuterol Inhaler | other | $246 | $246 | $246 | 1 |
| Catheter, Drainage | cardiac | $247 | $76 | $417 | 2 |
| Foot, Insert, Removable, Molded to Patient Model, 'ucb' Type, Berkeley Shell,... | other | $247 | $247 | $247 | 1 |
| Adult Venous Cannula 25fr 96600 | other | $247 | $247 | $247 | 1 |
| Adult Venous Cannula 96600 | other | $247 | $247 | $247 | 1 |
| Percut Kit 21fr X 60cm Femoral Venous | other | $247 | $247 | $247 | 1 |
| Percut Kit 25fr X 60cm Femoral Venous | other | $247 | $247 | $247 | 1 |
| Loop Cysview 24/26 Fr Bipolar Std27040gp130-s | other | $248 | $248 | $248 | 1 |
| Walking Boot, Pneumatic And/or Vacuum, with OR without Joints, with OR withou... | other | $248 | $248 | $248 | 1 |
| Assay of Parathormone | other | $248 | $248 | $248 | 1 |
| Adapalene 0.1 % Ex Gel | other | $250 | $250 | $250 | 1 |
| Injection, Cosyntropin, 0.25 Mg | other | $251 | $128 | $373 | 2 |
| Guide Precision Bipolar Clear 6ea/bx | other | $252 | $252 | $252 | 1 |
| Addition to Lower Extremity Fracture Orthosis, Hip Joint, Pelvic Band, Thigh ... | other | $252 | $252 | $252 | 1 |
| Injection, Vasopressin, 1 Unit | other | $253 | $216 | $289 | 2 |
| Assistant W/stable Soft 3l #401-209s | other | $253 | $253 | $253 | 1 |
| Injection, Aztreonam, 100 Mg | other | $253 | $126 | $380 | 2 |
| Intermediate Repair of Wound of Face, Ears, Eyelids, Nose, Lips, OR Mouth, 20... | surgery | $254 | $254 | $254 | 1 |
| Intermediate Repair of Wound of Face, Ears, Eyelids, Nose, Lips, OR Mouth, Mo... | surgery | $254 | $254 | $254 | 1 |
| Skin Biopsy | other | $254 | $34 | $787 | 12 |
| Graft Hemashield 15cm 28mm #175128p | other | $255 | $255 | $255 | 1 |
| Graft Hemashield 15cm 30mm #175130p | other | $255 | $255 | $255 | 1 |
| Graft Hemashield 15cm 32mm #175132p | other | $255 | $255 | $255 | 1 |
| Graft Hemashield 15cmx38mm #175138p | other | $255 | $255 | $255 | 1 |
| Blood Gases W/o2 Saturation | other | $255 | $255 | $255 | 1 |
| Ahmed Valve | other | $255 | $255 | $255 | 1 |
| Pad Temp Arctic Sun Universal #317-00 | other | $256 | $256 | $256 | 1 |
| Tetracaine 1% (20 Mg/2 Ml) Vl | other | $256 | $256 | $256 | 1 |
| Electrode Electrosurgical 24fr Angled Needle 12-30deg Hf Resection Plasma Nee... | surgery | $257 | $257 | $257 | 1 |
| Electrode Electrosurgical 24fr Standard Band 12-30deg Hf Resection Plasma Ban... | surgery | $257 | $257 | $257 | 1 |
| Esg Plasmaloop - Long Medium Wa22737s Bx/5ea | other | $257 | $257 | $257 | 1 |
| Generator Electrosurgical M Plasmaloop #wa22706s | surgery | $257 | $257 | $257 | 1 |
| Loop TURP Plasmakinetic Superpuls #784415 | other | $258 | $258 | $258 | 1 |
| Levalbuterol, Inhalation Solution, Compounded Product, Administered Through D... | other | $258 | $258 | $258 | 1 |
| Proximal Reamer Headless 2.0mm Non-sterile #cd-fx | other | $259 | $259 | $259 | 1 |
| Proximal Reamer Headless 2.0mm Sterile #cd-fx-2520-s | other | $259 | $259 | $259 | 1 |
| Proximal Reamer Headless 3.0mm #cd-fx | other | $259 | $259 | $259 | 1 |
| Prenatal Care | obstetric | $259 | $259 | $259 | 3 |
| 5 Hour Gtt | other | $259 | $259 | $259 | 1 |
| Technetium Tc-99m Macroaggregated Albumin, Diagnostic, Per Study Dose, Up to ... | other | $259 | $259 | $259 | 1 |
| Red Blood Cells, Each Unit | other | $260 | $260 | $260 | 1 |
| Ligasure Maryland Short Jaw #lf1923 | other | $261 | $261 | $261 | 1 |
| Upper Extremity Fracture Orthosis, Radius/ulnar, Prefabricated, Includes Fitt... | other | $261 | $261 | $261 | 1 |
| Atrovent 17 Mcg Hfa Inhaler | other | $261 | $261 | $261 | 1 |
| Hyaluronan OR Derivative, Hyalgan, Supartz OR Visco-3, for Intra-articular In... | other | $263 | $263 | $263 | 1 |
| **discontinued**laser Fiber 200 Ball Tip #m0068403961 | other | $263 | $263 | $263 | 1 |
| Blood (whole), for Transfusion, Per Unit | surgery | $263 | $263 | $263 | 1 |
| Red Blood Cells, Irradiated, Each Unit | other | $263 | $263 | $263 | 1 |
| Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit | other | $263 | $263 | $263 | 1 |
| Red Cells Process/store/handle | other | $263 | $263 | $263 | 1 |
| Blood Platelet Aggregation | other | $264 | $264 | $264 | 1 |
| Pronto Lp #5010 | other | $265 | $265 | $265 | 1 |
| Centered Nano Alto Partial #651 1/bx | other | $266 | $266 | $266 | 1 |
| Centered Nano Alton Total #611 1/bx | other | $266 | $266 | $266 | 1 |
| Bss Plus Eye Irrig Solution | other | $267 | $267 | $267 | 1 |
| Snare Kit 18-30mm #382007030 | other | $268 | $268 | $268 | 1 |
| Flexiva Pulse Id Tractip M006l8406960 | other | $268 | $268 | $268 | 1 |
| Graft Applic<100cm,add-on 25cm | other | $268 | $268 | $268 | 1 |
| Electrode Plasma Button Front Loading | other | $269 | $269 | $269 | 1 |
| Allograft Mis Dispenser Bl-1900-gun | other | $270 | $270 | $270 | 1 |
| Cables Ensite X Advisor/grid #d-ens-avse-6-cbl | other | $270 | $270 | $270 | 1 |
| Ligasure Maryland Jaw #lf1937 6/cs | other | $270 | $270 | $270 | 1 |
| Metatarsal Reamer 16 Mm #ar-8944mr | other | $270 | $270 | $270 | 1 |
| Metatarsal Reamer 18 Mm #ar-8944mr | other | $270 | $270 | $270 | 1 |
| Metatarsal Reamer 20 Mm #ar-8944mr | other | $270 | $270 | $270 | 1 |
| Metatarsal Reamer 22 Mm #ar-8944mr | other | $270 | $270 | $270 | 1 |
| Phalangeal Reamer 14 Mm #ar-8944pr | other | $270 | $270 | $270 | 1 |
| Phalangeal Reamer 16 Mm #ar-8944pr | other | $270 | $270 | $270 | 1 |
| Phalangeal Reamer 18 Mm #ar-8944pr | other | $270 | $270 | $270 | 1 |
| Phalangeal Reamer 20 Mm #ar-8944pr | other | $270 | $270 | $270 | 1 |
| Phalangeal Reamer 22 Mm #ar-8944pr | other | $270 | $270 | $270 | 1 |
| Breast Prosthesis, Silicone OR Equal, with Integral Adhesive | other | $270 | $270 | $270 | 1 |
| Breast Prosthesis, Silicone OR Equal, without Integral Adhesive | other | $270 | $270 | $270 | 1 |
| Children's Tylenol 160 Mg/5 Ml | other | $272 | $272 | $272 | 1 |
| Graft Hemashield 15cm 34mm #175134p M00202175134po | other | $273 | $273 | $273 | 1 |
| X-Ray of the Knee | imaging | $274 | $103 | $584 | 13 |
| Infusion, Albumin (human), 25%, 50 Ml | surgery | $275 | $147 | $403 | 2 |
| Tlso Flexible, Provides Trunk Support, Extends From Sacrococcygeal Junction t... | other | $275 | $275 | $275 | 1 |
| Retinal Tamponade Device, Silicone Oil | other | $276 | $276 | $276 | 1 |
| Wrist Hand Finger Orthosis, Rigid without Joints, May Include Soft Interface ... | other | $276 | $276 | $276 | 1 |
| Wilson Retractor System Tlc-5042-m | other | $277 | $277 | $277 | 1 |
| Shoulder X-Ray | imaging | $278 | $196 | $511 | 4 |
| Knee X-Ray | imaging | $278 | $196 | $698 | 4 |
| Liver Access/ Biopsy Needle Set | lab | $280 | $280 | $280 | 1 |
| Porous Purified Collagen Matrix Bone Void Filler (integra Mozaik Osteoconduct... | other | $280 | $280 | $280 | 1 |
| Tunneler #402 Vns Cyberonics | other | $281 | $281 | $281 | 1 |
| All Lower Extremity Prostheses, Foot, Flexible Keel | other | $281 | $281 | $281 | 1 |
| Dressing Ab Thera Sensa Trac #m8275026/5 | other | $281 | $281 | $281 | 1 |
| Loop TURP Plasmakinetic Supersect #784515 | other | $283 | $283 | $283 | 1 |
| Gastrografin 66-10 Sol 120 Ml | other | $283 | $283 | $283 | 1 |
| Hand/Wrist X-Ray | imaging | $286 | $64 | $530 | 14 |
| Clamp Lrg Combination #390.005 External | other | $287 | $287 | $287 | 1 |
| Foot X-Ray | imaging | $287 | $81 | $435 | 14 |
| Addition to Lower Extremity, Test Socket, Below Knee | other | $288 | $288 | $288 | 1 |
| Nipride Rtu 50 Mg/100 Ml Vial | other | $288 | $288 | $288 | 1 |
| Addition to Lower Extremity, Socket Insert, Below Knee | other | $291 | $291 | $291 | 1 |
| Lead, Neurostimulator Test Kit | other | $291 | $291 | $291 | 1 |
| Patch Pericardial W/encap 9x14cm #c0914 | other | $291 | $291 | $291 | 1 |
| Snare Kit 27-45mm #382007045 | other | $291 | $291 | $291 | 1 |
| Wrist Hand Finger Orthosis, Includes One OR More Nontorsion Joint(s), Turnbuc... | other | $291 | $291 | $291 | 1 |
| Cardene-nacl 40 Mg/200 Ml IV | other | $292 | $292 | $292 | 1 |
| Clinimix 4.25%-10% Solution | other | $292 | $292 | $292 | 1 |
| Clinimix 4.25%-5% Solution | other | $292 | $292 | $292 | 1 |
| Fiber Laser 200um 2j 80hz 60w D/f/l for Lithotripsy Moses Ac | other | $293 | $293 | $293 | 1 |
| Differin 0.1% Cream | other | $293 | $293 | $293 | 1 |
| Hydrate IV Infusion Add-on | surgery | $293 | $125 | $1,147 | 4 |
| Bone Dowel Revision Kit 10 Mm #abs-2850 | other | $294 | $294 | $294 | 1 |
| Mantis 235cm Closure Clip #m00521422 Bx/20 | other | $294 | $294 | $294 | 1 |
| Asthma Management | other | $294 | $90 | $984 | 25 |
| X-Ray of the Chest | imaging | $295 | $204 | $838 | 4 |
| Forcep Spybite Biopsy #moo546270 | lab | $296 | $296 | $296 | 1 |
| Spybite Max Biopsy Forceps #m00546470 | lab | $296 | $296 | $296 | 1 |
| Application of Paste Boot | other | $296 | $296 | $296 | 1 |
| Addition to Lower Extremity, Lacer Molded to Patient Model, for Custom Fabric... | other | $297 | $297 | $297 | 1 |
| Blade Kahook Dual#kdb Glide | other | $297 | $297 | $297 | 1 |
| Injection, Ertapenem Sodium, 500 Mg | other | $298 | $145 | $450 | 2 |
| Ligasure Exact Dissector Lf2019 6ea/1cs | other | $298 | $298 | $298 | 1 |
| Addition to Lower Extremity, Below Knee, Total Contact | other | $299 | $299 | $299 | 1 |
| 12x11x14mm 7 Degree Vista-s Dev #06-401 | other | $300 | $300 | $300 | 1 |
| 5x11x14mm Vista-s Dev #06-401 | other | $300 | $300 | $300 | 1 |
| Harvest and Injections of Platelet Rich Plasma Using Imaging Guidance | other | $300 | $300 | $300 | 1 |
| Lead, Pacemaker, Other Than Transvenous Vdd Single Pass | cardiac | $300 | $300 | $300 | 1 |
| Cardiac Stress Test | cardiac | $300 | $168 | $1,205 | 8 |
| Hith Kit #inshith | other | $301 | $301 | $301 | 1 |
| Platelets, Pheresis, Leukocytes Reduced, Each Unit | other | $302 | $33 | $570 | 2 |
| Shoulder X-Ray | imaging | $303 | $103 | $511 | 12 |
| 6 Hour Gtt | other | $304 | $304 | $304 | 1 |
| Bear Claw Otsc Sys Set 11/6t 165cm #100.10 | other | $305 | $305 | $305 | 1 |
| Bear Claw Otsc Sys Set 12/6t 220cm #100.31 | other | $305 | $305 | $305 | 1 |
| Otsc 11/6a Bear Claw System Set #100.09 | other | $305 | $305 | $305 | 1 |
| Apply Multlay Comprs Lwr Leg | other | $305 | $305 | $305 | 1 |
| Dissector Spacemaker Pro 10mm-12mm #smsbtovlx | cardiac | $306 | $306 | $306 | 1 |
| Prog Eval Inper Leadls Pm | other | $307 | $307 | $307 | 1 |
| Spy Bite Basket Retrieval Working L286cm Channel 1.2mm Cable Dia 1mm for Dire... | other | $309 | $309 | $309 | 1 |
| Sonicone OR Sharpvac Mxc-c2-vac 5ea/1bx | other | $310 | $310 | $310 | 1 |
| Sonicvac Kit Mxc-x2-vac 5ea/bx | other | $310 | $310 | $310 | 1 |
| Graft Hemashield 30cm X 6mm #175206p | other | $311 | $311 | $311 | 1 |
| Graft Hemashield 30cm X 8mm #175208p | other | $311 | $311 | $311 | 1 |
| Allopatch Human Dermis 5x5 Cm | other | $311 | $311 | $311 | 1 |
| Stapler Hemorrhoid Ph #ppho3 3/bx | other | $312 | $312 | $312 | 1 |
| Hernia Tacker #abstack30 | other | $312 | $312 | $312 | 1 |
| Assay of Natriuretic Peptide | other | $312 | $312 | $312 | 1 |
| Electrode Electrosurgical Resection with Hf Cable Plasma Oval Button | surgery | $313 | $313 | $313 | 1 |
| Tlso, Triplanar Control, Hyperextension, Rigid Anterior and Lateral Frame Ext... | other | $313 | $313 | $313 | 1 |
| Arexvy Vial Kit | other | $314 | $314 | $314 | 1 |
| Injection, Methylnaltrexone, 0.1 Mg | other | $315 | $59 | $570 | 2 |
| Fiber Laser 550um 6j 80hz 120w D/f/l for Lithotripsy Moses Ac | other | $315 | $315 | $315 | 1 |
| 3.0 Knotless Suture Tak Anchor #ar-8934bck | other | $315 | $315 | $315 | 1 |
| Arthrex Acl Fibertag Tightrope Implant #ar-1588rtt | surgery | $315 | $315 | $315 | 1 |
| Nano Swivelock Suture Anchor #ar-8998t | other | $315 | $315 | $315 | 1 |
| Nanoneedle Scope 125 Mm #ar-3210 | other | $315 | $315 | $315 | 1 |
| Clamp Large Multi-pin 4position External | other | $317 | $317 | $317 | 1 |
| Mantis Closure Clip Box 10 #m00521421 | other | $317 | $317 | $317 | 1 |
| Versajet Ii Plus Handset 45deg/14mm #66800044 | other | $317 | $317 | $317 | 1 |
| Versajet Ii Plus Handset 45deg/8mm #66800045 | other | $317 | $317 | $317 | 1 |
| Autoinjector Endologix #tv-a101-n | other | $318 | $318 | $318 | 1 |
| Computer-assisted, Fluoroscopic Image-guided Musculoskeletal Surgical Navigat... | surgery | $318 | $318 | $318 | 1 |
| External Counterpulsation, Per Treatment Session | other | $318 | $318 | $318 | 1 |
| Catheter, Intraspinal | cardiac | $320 | $320 | $320 | 1 |
| X-ray Exam Entire Spi 2/3 Vw | imaging | $320 | $320 | $320 | 1 |
| Ventriculostomy Kit - Ghajar Guide | other | $323 | $323 | $323 | 1 |
| Puraply Am 1 SQ Cm | other | $323 | $323 | $323 | 1 |
| Injection, Dobutamine Hydrochloride, Per 250 Mg | other | $324 | $324 | $324 | 1 |
| Clamp Large Multi-pin External Fix 6 Position | other | $326 | $326 | $326 | 1 |
| Injection, Naloxone Hydrochloride, Not Otherwise Specified, 0.01 Mg | other | $326 | $326 | $326 | 1 |
| Primatrix, Per Square Centimeter | other | $327 | $327 | $327 | 1 |
| Epifix OR Epicord | other | $327 | $327 | $327 | 1 |
| Mesh Fixation Device 5mm W/25 Absorb Straps | other | $327 | $327 | $327 | 1 |
| Laser Fiber 150 Micron Tfl Ball Tip Single Use Tfl-fbx150bs 5/box | other | $328 | $328 | $328 | 1 |
| Laser Fiber 200 Micron Tfl Ball Tip Single Use Tfl-fbx200bs 5/box | other | $328 | $328 | $328 | 1 |
| Injection, Hyaluronidase, Recombinant, 1 Usp Unit | other | $328 | $328 | $328 | 1 |
| Addition to Lower Extremity, Below Knee, Acrylic Socket | other | $329 | $329 | $329 | 1 |
| Needle Acquire Fnb 19 Ga #m00555580 1ea/1bx | other | $329 | $329 | $329 | 1 |
| Endoclip Cartridge M/l-#1112 Microline Clip Titanium K2 Single Use 19/clip 10/bx | other | $329 | $329 | $329 | 1 |
| Obturator 24 Fr #a22081a | other | $329 | $329 | $329 | 1 |
| Drg Tunneling Tool #mn15000 | other | $330 | $330 | $330 | 1 |
| Flexcath Cross Ag 61cm # 900300 | other | $330 | $330 | $330 | 1 |
| Flexcath Cross Ag 71cm# 900301 | other | $330 | $330 | $330 | 1 |
| Flexcath Cross Fc 65cm# 900304 | other | $330 | $330 | $330 | 1 |
| Flexcath Cross Sl 63cm# 900302 | other | $330 | $330 | $330 | 1 |
| Flexcath Cross Sl 81cm# 900309 | other | $330 | $330 | $330 | 1 |
| Flexcath Cross Vz 71cm# 900303 | other | $330 | $330 | $330 | 1 |
| Flexcath Cross Wt 75cm# 900308 | other | $330 | $330 | $330 | 1 |
| Jeti Non-sterile Cannister Set Wv1500a | other | $330 | $330 | $330 | 1 |
| Reference Patch Carto 3 (6pack) #crefp6 | other | $330 | $330 | $330 | 1 |
| Cisatracurium 200 Mg/20 Ml Vl | other | $330 | $330 | $330 | 1 |
| Repair of Prosthetic Device, Repair OR Replace Minor Parts | surgery | $331 | $331 | $331 | 1 |
| Small Joint Injection | surgery | $331 | $158 | $856 | 7 |
| Atrial Depressor W/quick Connect Clearview Mv | other | $334 | $334 | $334 | 1 |
| Laceration Repair | emergency | $334 | $94 | $576 | 9 |
| Thyroid Ultrasound | imaging | $334 | $334 | $334 | 1 |
| Dress/debrid P-thick Burn S | other | $334 | $334 | $334 | 1 |
| Neg Press Wound Tx <=50 Cm | other | $334 | $334 | $334 | 1 |
| Hip Knee Ankle Foot Orthosis, Torsion Control, Bilateral Torsion Cables, Hip ... | other | $335 | $335 | $335 | 1 |
| Acutrak 2 Drill Acumed #at2-m1813 | other | $335 | $335 | $335 | 1 |
| Prevena Plus System Kit #pre4001us | other | $335 | $335 | $335 | 1 |
| Sensor Persona Cr Zimmer Bio Cd39-l Zbh-psncr | other | $335 | $335 | $335 | 1 |
| Sensor Persona Cr Zimmer Bio Cd39-r Zbh-psncr | other | $335 | $335 | $335 | 1 |
| Sensor Persona Cr Zimmer Bio Ef311l Zbh-psncr | other | $335 | $335 | $335 | 1 |
| Sensor Persona Cr Zimmer Bio Ef311r Zbh-psncr | other | $335 | $335 | $335 | 1 |
| Sensor Persona Cr Zimmer Bio Gh712l Zbh-psncr | other | $335 | $335 | $335 | 1 |
| Sensor Persona Cr Zimmer Bio Gh712r Zbh-psncr | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 1-2 Lt #snn-jrnybcs12-l | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 1-2 Rt #snn-jrnybcs12-r | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 3-4 Lt #snn-jrnybcs34-l | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 3-4 Rt #snn-jrnybcs34-r | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 5-6 Lt #snn-jrnybcs56-l | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 5-6 Rt #snn-jrnybcs56-r | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 7-8 Lt #snn-jrnybcs78-l | other | $335 | $335 | $335 | 1 |
| Verasense Journey Bcs 7-8 Rt #snn-jrnybcs78-r | other | $335 | $335 | $335 | 1 |
| Verasense Legion Ps 1-2 #snn-lgnps12 | other | $335 | $335 | $335 | 1 |
| Verasense Legion Ps 3-4 #snn-lgnps34 | other | $335 | $335 | $335 | 1 |
| Verasense Legion Ps 5-6 #snn-lgnps56 | other | $335 | $335 | $335 | 1 |
| Verasense Legion Ps 7-8 #snn-lgnps78 | other | $335 | $335 | $335 | 1 |
| Graft Accessory Component Kit #hero 1003 | other | $336 | $336 | $336 | 1 |
| Progreat 2.8fr Microcatheter Mc*pe28151yv 1ea/1box | cardiac | $336 | $336 | $336 | 1 |
| Scrotal Retraction System Skw Deep #72403867 | other | $336 | $336 | $336 | 1 |
| Laser Fiber 550 Micron Tfl Single Use Tfl-fbx550s 5/box | other | $337 | $337 | $337 | 1 |
| Bipolar Sealer 2.3 Neuro Aquamantys | other | $338 | $338 | $338 | 1 |
| Surgical Supply; Miscellaneous | surgery | $339 | $339 | $339 | 1 |
| Retractor-reddick Saye Screw #e2504 | other | $339 | $339 | $339 | 1 |
| Chord-x Pre-measured Loops for Mitral Chordal Replacement 2-0 U.s.p 16mm Cxl-... | surgery | $340 | $340 | $340 | 1 |
| Mantis Clip L235cm 2.8mm Minimum Working Channel #m00521420 | other | $340 | $340 | $340 | 1 |
| Injection, Vinblastine Sulfate, 1 Mg | other | $340 | $340 | $340 | 1 |
| Elbow Orthosis (eo), with Adjustable Position Locking Joint(s), Prefabricated... | other | $342 | $342 | $342 | 1 |
| Insert Temp Bladder Cath | other | $342 | $342 | $342 | 1 |
| Dispensing Fee, Monaural Hearing Aid, Any Type | other | $343 | $343 | $343 | 1 |
| Laser Fiber Sidefire 600 #ftir600 | other | $343 | $343 | $343 | 1 |
| Harmonic Ace Curved Shears Xi #480275 6ea/1bx | other | $343 | $343 | $343 | 1 |
| Clamp 4.0 Adj for Distal Radius Fixatr Extern | other | $344 | $344 | $344 | 1 |
| Regional Block | other | $344 | $344 | $344 | 1 |
| Gps User Kit for Gps Station V2 Ref# A10012 | other | $345 | $345 | $345 | 1 |
| Active Wound Care/20 Cm OR < | other | $345 | $345 | $345 | 1 |
| Chem Caut of Granltj Tissue | other | $345 | $345 | $345 | 1 |
| Intraocular Vancomycin 10 Mg/ Ml- **10ml** (for Dr. Ouano) - Compounded | other | $347 | $347 | $347 | 1 |
| 8mm Blunt Xi #470008 | other | $347 | $347 | $347 | 1 |
| Addition to Lower Extremity, Suction Suspension, Above Knee OR Knee Disarticu... | other | $351 | $351 | $351 | 1 |
| Ligasure Impact #lf4418 | other | $352 | $352 | $352 | 1 |
| Cannula 8mm #420002 | other | $353 | $353 | $353 | 1 |
| Clinimix 5%-15% Solution | other | $353 | $353 | $353 | 1 |
| Fluzone High-dose Triv 2024 | other | $354 | $354 | $354 | 1 |
| Lumbar Spine X-Ray | imaging | $354 | $139 | $842 | 13 |
| Injection, Epoetin Alfa, (for Non-esrd Use), 1000 Units | other | $356 | $338 | $374 | 2 |
| Gradient Compression Garment, Glove, Padded, for Nighttime Use, Custom, Each | other | $356 | $356 | $356 | 1 |
| Astigmatism Correcting Function of Intraocular Lens | other | $357 | $357 | $357 | 1 |
| Vessel Sealer (6/bx) #410322 | other | $357 | $357 | $357 | 1 |
| Vessel Sealer # 480322 Intuitive Surgical | surgery | $357 | $357 | $357 | 1 |
| Obturator Deflecting Tip 24 Fr #a22085 | other | $358 | $358 | $358 | 1 |
| Proximal Reamer Cannulated 3.0mm #cd-fx | other | $359 | $359 | $359 | 1 |
| Aveta Smol Disposable Resecting Device 2.9mm #210-100 3/ctn | other | $360 | $360 | $360 | 1 |
| Dispensing Fee, Binaural | other | $360 | $360 | $360 | 1 |
| Laser Fiber Sidefire 550 | other | $360 | $360 | $360 | 1 |
| Auto-id Quad Cable; Vizigo Cable #cy1212ct | other | $362 | $362 | $362 | 1 |
| Carto 3 Ablation Cable Irrigated #cr3434ct | other | $362 | $362 | $362 | 1 |
| Carto 3 Dx Cable Vizigo #cb3412ct | other | $362 | $362 | $362 | 1 |
| Decanav Cable #cb3434ct | other | $362 | $362 | $362 | 1 |
| Pentaray and Lasso Cable #d134401 | other | $362 | $362 | $362 | 1 |
| Ligasure Retractable L-hook 37cm Lf5637 6/cs | other | $363 | $363 | $363 | 1 |
| Hbo Therapy Per 30 Min Session | other | $364 | $364 | $364 | 1 |
| Dressing Kit Open Abdomen Abthera Advance | other | $365 | $365 | $365 | 1 |
| Us Exam Abdo Back Wall Lim | other | $365 | $365 | $365 | 1 |
| Us Extremity Non Vascular Lt | other | $365 | $365 | $365 | 1 |
| Breast Ultrasound Complete | imaging | $365 | $365 | $365 | 1 |
| CT Lower Extremity | imaging | $365 | $365 | $365 | 1 |
| Hip Bilateral 2 V | other | $365 | $365 | $365 | 1 |
| Lower Extremity Study | other | $365 | $365 | $365 | 1 |
| Thoracic Spine X-Ray | imaging | $365 | $365 | $365 | 1 |
| Ultrasound Breast Limited | imaging | $365 | $365 | $365 | 1 |
| Us Compl Joint R-t W/img | other | $365 | $365 | $365 | 1 |
| Us Exam Scrotum | other | $365 | $365 | $365 | 1 |
| X-ray Exam of Jaw 4/> Views | imaging | $365 | $365 | $365 | 1 |
| Viscoat Syringe | other | $366 | $366 | $366 | 1 |
| Emergency Surgery Fee | surgery | $367 | $367 | $367 | 1 |
| CT Chest without Contrast | imaging | $368 | $368 | $368 | 1 |
| Obturator Optical 24 Fr #a22071a | other | $370 | $370 | $370 | 1 |
| Repair Device, Urinary, Incontinence, without Sling Graft | surgery | $372 | $372 | $372 | 1 |
| Pelvic Ultrasound Complete | imaging | $372 | $372 | $372 | 1 |
| X-ray Exam Abdomen 3+ Views | imaging | $372 | $372 | $372 | 1 |
| Er-o.v.-established Level 3 | other | $374 | $374 | $374 | 1 |
| Addition, Endoskeletal System, Below Knee, Alignable System | other | $375 | $375 | $375 | 1 |
| Injection, Decitabine, 1 Mg | other | $376 | $376 | $376 | 1 |
| Addition to Lower Extremity, Test Socket, Above Knee | other | $376 | $376 | $376 | 1 |
| Extremity Study | other | $376 | $376 | $376 | 1 |
| Retroperitoneal Ultrasound | imaging | $376 | $376 | $376 | 1 |
| X-ray Exam Abdomen 2 Views | imaging | $376 | $376 | $376 | 1 |
| CT Upper Ext Left W/o Contrast | other | $376 | $376 | $376 | 1 |
| X-ray Exam of Pelvis | imaging | $376 | $376 | $376 | 1 |
| Cervical, Multiple Post Collar, Occipital/mandibular Supports, Adjustable Cer... | other | $377 | $377 | $377 | 1 |
| Cannula 8 Mm Size Reusable for Da Vinci X/xi Endoscopic System #470002 | other | $378 | $378 | $378 | 1 |
| Injection, Paclitaxel, 1 Mg | other | $378 | $378 | $378 | 1 |
| Injection, Epinephrine (adrenalin), Not Therapeutically Equivalent to J0165, ... | other | $378 | $378 | $378 | 1 |
| Azactam 2 Gm Vial | other | $380 | $380 | $380 | 1 |
| Chemotherapy Administration | other | $380 | $153 | $823 | 20 |
| Injection, Methylprednisolone Sodium Succinate, 5 Mg | other | $381 | $381 | $381 | 1 |
| CT Orbit/ear/fossa W/o Dye | other | $381 | $381 | $381 | 1 |
| Cup Removal System 52mm #00705305220 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Full 48mm #00705304820 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Full 50mm #00705305020 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Full 54mm #00705305420 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Full 56mm #00705305620 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Full 58mm #00705305820 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Full 60mm #00705306020 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Truncatd 50mm #00705305010 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Truncatd 52mm #00705305210 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Truncatd 54mm #00705305410 | surgery | $384 | $384 | $384 | 1 |
| Cup Removal System Truncatd 58mm #00705305810 | surgery | $384 | $384 | $384 | 1 |
| Injection, Degarelix, 1 Mg | other | $386 | $386 | $386 | 1 |
| Nicardipin 40mg/200ml-0.9%nacl | other | $389 | $389 | $389 | 1 |
| Ankle Foot Orthosis, Plastic OR Other Material with Ankle Joint, Prefabricate... | other | $390 | $390 | $390 | 1 |
| Catheter Angiographic Coronary OR Peripheral Delivery 45 Degree Angled Tip 15... | imaging | $390 | $390 | $390 | 1 |
| Cyberwand Probe Set #cw-rbpbx | other | $390 | $390 | $390 | 1 |
| Injection, Methylprednisolone Sodium Succinate, Up to 125 Mg | other | $391 | $391 | $391 | 1 |
| Newborn Care | obstetric | $391 | $151 | $630 | 2 |
| Injection, Iron Sucrose, 1 Mg | other | $393 | $393 | $393 | 1 |
| CT Abdomen without Contrast | imaging | $393 | $393 | $393 | 1 |
| Vessel Xi Sealer Extnd #480422 Intuitive Surg | other | $394 | $394 | $394 | 1 |
| Injection, Aprepitant, (aponvie), 1 Mg | other | $394 | $394 | $394 | 1 |
| Forcep Flexo Grasping #fg53s-x | other | $394 | $394 | $394 | 1 |
| Unclassified Biologics | other | $395 | $395 | $395 | 1 |
| Nanoscope Handpiece #ar-3210 | other | $395 | $395 | $395 | 1 |
| CT Contrast Low Osmolar 200-299ml | imaging | $397 | $397 | $397 | 1 |
| Visual Obturator 22.5 Fr #a20924a | other | $398 | $398 | $398 | 1 |
| Laser Fiber 940 Micron Tfl Single Use Tfl-fbx940s 5/box | other | $399 | $399 | $399 | 1 |
| Graft Jacket | other | $399 | $399 | $399 | 1 |
| Wrist Hand Orthosis, without Joints, May Include Soft Interface, Straps, Cust... | other | $401 | $401 | $401 | 1 |
| Drainage of Skin Abscess | other | $404 | $404 | $404 | 1 |
| Addition to Lower Extremity, Pelvic Control, Hip Joint, Adjustable Flexion, E... | other | $405 | $405 | $405 | 1 |
| Hospital Observation | other | $405 | $38 | $1,413 | 12 |
| Technetium Tc-99m Sestamibi, Diagnostic, Per Study Dose | other | $406 | $406 | $406 | 1 |
| Red Blood Cells, Washed, Each Unit | other | $407 | $407 | $407 | 1 |
| Trimark Td 13mr Breast Biopsy Site Marker MRI | imaging | $408 | $408 | $408 | 1 |
| Biomed Fiber Optic Probe Assembly Pteye | other | $410 | $410 | $410 | 1 |
| Cannula Long 8mm #470004 | other | $410 | $410 | $410 | 1 |
| Pre Sympt Study<30 Days Hookup | other | $410 | $410 | $410 | 1 |
| All Lower Extremity Prostheses, Energy Storing Foot | other | $415 | $415 | $415 | 1 |
| Pr Rom Rad Therapy Bone Mets, Pc | other | $416 | $416 | $416 | 1 |
| Fetal Pillow #fp-010 6ea/bx | other | $417 | $417 | $417 | 1 |
| Stabilizer Enclose #en240 | other | $417 | $417 | $417 | 1 |
| Injection, Esmolol Hydrochloride (wg Critical Care), Not Therapeutically Equi... | other | $418 | $418 | $418 | 1 |
| Hyperbaric Oxygen Under Pressure, Full Body Chamber, Per 30 Minute Interval | other | $419 | $419 | $419 | 1 |
| Cortisone Shot (Joint Injection) | surgery | $419 | $126 | $4,007 | 22 |
| Intracept Access Instruments Additional Level #rlv 0075 | other | $420 | $420 | $420 | 1 |
| Placement of Occlusive Device Into Either a Venous OR Arterial Access Site, P... | other | $420 | $420 | $420 | 1 |
| Stress Test | cardiac | $423 | $168 | $2,030 | 27 |
| Path Consult Intraop Frozen Se | other | $425 | $425 | $425 | 1 |
| Harmonic Lap Dissector 9cm #har9f 6ea/bx | other | $426 | $426 | $426 | 1 |
| Room & Board - Private (one Bed) - Pediatric | other | $426 | $426 | $426 | 1 |
| Anchor/screw for Opposing Bone-to-bone OR Soft Tissue-to-bone | other | $428 | $318 | $537 | 2 |
| Lumbar Spine X-Ray | imaging | $428 | $318 | $486 | 4 |
| Gelport Laparoscopic Colectomy 120mm | surgery | $429 | $429 | $429 | 1 |
| Nervous System Surgery | surgery | $432 | $432 | $432 | 1 |
| Injection, Micafungin Sodium, 1 Mg | other | $436 | $217 | $655 | 2 |
| Room & Board - Private (one Bed) - General Classification | other | $440 | $440 | $440 | 1 |
| Material for Vocal Cord Medialization, Synthetic | other | $441 | $441 | $441 | 1 |
| Ankle Orthosis, Supramalleolar with Straps, with OR without Interface/pads, C... | other | $443 | $443 | $443 | 1 |
| Twin Grasper Otsc 220cm #200.45 | other | $443 | $443 | $443 | 1 |
| Trigger Point Injection | therapy | $444 | $158 | $628 | 6 |
| Fluciclovine F-18, Diagnostic, 1 Millicurie | other | $448 | $448 | $448 | 1 |
| Chest X-Ray | imaging | $449 | $189 | $20,404 | 23 |
| Bactisure Wound Lavage #00888700200(qtys of 6 | other | $450 | $450 | $450 | 1 |
| Coil Vascular 2mm X 1cm Ruby #rby4c0201 | other | $450 | $450 | $450 | 1 |
| Coil Vascular 2mm X 2cm Ruby #rby4c0202 | other | $450 | $450 | $450 | 1 |
| Coil Vascular 2mm X 4cm Ruby #rby4c0204 | other | $450 | $450 | $450 | 1 |
| Coil Vascular 3mm X 5cm Ruby #rby4c0305 | other | $450 | $450 | $450 | 1 |
| Cooled Radiofrequency Kit #crk-17-75 | other | $450 | $450 | $450 | 1 |
| Cooled Rf Probe Kit #crk-17-50 | other | $450 | $450 | $450 | 1 |
| Gelpoint Mini Advanced Access Platform | other | $450 | $450 | $450 | 1 |
| Hemostatic Agent, Gastrointestinal, Topical | other | $450 | $450 | $450 | 1 |
| Pars Suture Implant Ar-8860ds | surgery | $450 | $450 | $450 | 1 |
| Ruby Complex Soft 3 Mm X 15 Cm | other | $450 | $450 | $450 | 1 |
| Ruby Complex Soft 4 Mm X 6 Cm | other | $450 | $450 | $450 | 1 |
| Ruby Complex Standard 3mm X 5cm | other | $450 | $450 | $450 | 1 |
| Vas-q-clip Applier 10mm - 45cm #an1462-l | other | $450 | $450 | $450 | 1 |
| All Endoskeletal Lower Extremity Prosthesis, Axial Rotation Unit, with OR wit... | other | $451 | $451 | $451 | 1 |
| Anti-xa | other | $454 | $454 | $454 | 1 |
| Addition to Lower Extremity, Above Knee OR Knee Disarticulation, Acrylic Socket | other | $455 | $455 | $455 | 1 |
| Reamer 40/44 Depuy Low Profile #2230-00 | other | $456 | $456 | $456 | 1 |
| Reamer 48/52/56 Depuy #2230-00-031 Low Profil | other | $456 | $456 | $456 | 1 |
| Reamer Shoulder 40mm Depuy #223600008 | other | $456 | $456 | $456 | 1 |
| Reamer Shoulder 48mm #223000010 Depuy | other | $456 | $456 | $456 | 1 |
| Ankle Foot Orthosis, Double Upright Free Plantar Dorsiflexion, Solid Stirrup,... | other | $458 | $458 | $458 | 1 |
| Aspiration And/or Injection of Fluid From Medium Joint Using Ultrasound Guidance | imaging | $459 | $459 | $459 | 1 |
| Cor-knot Mini Device Kit W/ Loads #031350 | other | $459 | $459 | $459 | 1 |
| Allergy Testing Panel | diagnostic | $459 | $304 | $614 | 2 |
| Carboprost 250 Mcg/ml Vial | other | $460 | $460 | $460 | 1 |
| Aortic Balloon Pump Cath 7.5fr 34cc 0684-00-0479-01u | other | $463 | $463 | $463 | 1 |
| Nursery - Newborn - Level I | obstetric | $465 | $465 | $465 | 1 |
| Pretreatment of Rbc By Density | other | $465 | $465 | $465 | 1 |
| Fibrin Sealant Patch Large Tachosil #1144922 | other | $466 | $466 | $466 | 1 |
| Balloon Seeker 70dg Frt 6x17 #1830617frt0 | other | $467 | $467 | $467 | 1 |
| Positioner Heart Urchin Evo #hp3500 | cardiac | $467 | $467 | $467 | 1 |
| Albumin (human) 5% Glass Bottl | other | $472 | $472 | $472 | 1 |
| Reamer / + 5.5mm 03.045.029 | other | $473 | $473 | $473 | 1 |
| Lap Harmonic Shear Curved 36cm 6/bx #har36 | other | $473 | $473 | $473 | 1 |
| X-ray Exam Hip Uni 1 View | imaging | $473 | $200 | $1,110 | 4 |
| Room & Board - Private (one Bed) - Rehabilitation | therapy | $474 | $474 | $474 | 1 |
| Room & Board - Semi-private (two Beds) - General Classification | other | $474 | $474 | $474 | 1 |
| Pr Rom Rad Therapy Brain Mets, Pc | other | $475 | $475 | $475 | 1 |
| Kyphon Osteo Introducer Size 2 #t34a | other | $475 | $475 | $475 | 1 |
| Kyphon Osteo Introducer Size 3 #t15j | other | $475 | $475 | $475 | 1 |
| Prosthesis, Breast | other | $477 | $477 | $477 | 1 |
| Rts Instruments Size 1-2 M03 S0002 | other | $477 | $477 | $477 | 1 |
| Olm Intracranial Pressure Monitor Kit 1ea | other | $479 | $479 | $479 | 1 |
| Aveta Flex Disposable Resecting Device 2.9mm #210-080 3/ctn | other | $480 | $480 | $480 | 1 |
| Fixate Suture Device Band Pk=2ea Fb-201-01 Sc | other | $480 | $480 | $480 | 1 |
| Orthoalign Plus Unit #403001 | other | $480 | $480 | $480 | 1 |
| Placement of Locating Device in Breast Using Imaging Guidance, Each Additiona... | other | $480 | $480 | $480 | 1 |
| Echelon Contour Curved Cutter Stapler Blue 2.0 Gcs40g Bx/3ea | other | $485 | $485 | $485 | 1 |
| Amniotic Membrane for Surgical Reconstruction, Per Procedure | surgery | $486 | $486 | $486 | 1 |
| Waterjet Destruction of Prostrate Accessed Through the Urethra | other | $486 | $486 | $486 | 1 |
| Hyaluronan OR Derivative, Synvisc OR Synvisc-one, for Intra-articular Injecti... | other | $487 | $487 | $487 | 1 |
| Abscess Drainage (I&D) | emergency | $489 | $151 | $7,701 | 13 |
| Hip/Pelvis X-Ray | imaging | $491 | $121 | $1,110 | 13 |
| Rom Rad Therapy Lymphoma, Pc | other | $497 | $497 | $497 | 1 |
| Hc an Epidural Block Charge | other | $497 | $497 | $497 | 1 |
| Dmsa Injection Kit | other | $501 | $501 | $501 | 1 |
| Addition, Endoskeletal System, Below Knee, Flexible Protective Outer Surface ... | other | $502 | $502 | $502 | 1 |
| Additions to Lower Extremity, Total Contact, Above Knee OR Knee Disarticulati... | other | $505 | $505 | $505 | 1 |
| Inceptiv Programming Handset and Communicator #th91scsr | other | $505 | $505 | $505 | 1 |
| Spinal Pt Programmer #97740 Restoresensor | other | $505 | $505 | $505 | 1 |
| Mesh | other | $509 | $376 | $641 | 2 |
| Injection, Rho(d) Immune Globulin (human), (rhophylac), Intramuscular OR Intr... | other | $511 | $439 | $583 | 2 |
| Nursery - General Classification | other | $514 | $514 | $514 | 1 |
| Punch Bx Skin Single Lesion | other | $515 | $515 | $515 | 1 |
| Tubal Ligation | surgery | $516 | $272 | $2,886 | 3 |
| Gradient Compression Garment, Arm, Padded, for Nighttime Use, Custom, Each | other | $517 | $517 | $517 | 1 |
| IV Infusion, 1st Hr | surgery | $518 | $90 | $568 | 4 |
| Addition, Endoskeletal System, Below Knee, Ultra-light Material | other | $519 | $519 | $519 | 1 |
| Ankle Foot Orthosis, Plastic OR Other Material, Custom Fabricated | other | $519 | $519 | $519 | 1 |
| Room & Board - Private | other | $525 | $525 | $525 | 1 |
| Technetium Tc-99m Mertiatide, Diagnostic, Per Study Dose, Up to 15 Millicuries | other | $526 | $526 | $526 | 1 |
| Addition to Lower Extremity, Pre-tibial Shell, Molded to Patient Model | other | $529 | $529 | $529 | 1 |
| Hyaluronan OR Derivative, Orthovisc, for Intra-articular Injection, Per Dose | other | $529 | $529 | $529 | 1 |
| Coring Reamer Cannulated 6 Mm #ar-8900cr | other | $537 | $537 | $537 | 1 |
| Coring Reamer Cannulated 8 Mm #ar-8901cr | other | $537 | $537 | $537 | 1 |
| Endoblade Plantar Fascia Release Ar-8856ds | other | $537 | $537 | $537 | 1 |
| Ankle Foot Orthosis, Posterior Solid Ankle, Plastic, Custom Fabricated | other | $538 | $538 | $538 | 1 |
| Leadless C Pm Ins/rpl Ventr | other | $538 | $538 | $538 | 1 |
| Airway Inhalation Treatment | other | $542 | $542 | $542 | 1 |
| Pos Airway Pressure CPAP | other | $542 | $542 | $542 | 1 |
| Magnetic Resonance Angiography without Contrast, Chest | imaging | $543 | $543 | $543 | 1 |
| Wand Laryngeal Procise Mlw #eica7071 | other | $545 | $545 | $545 | 1 |
| Wand Procise Lw Arthrocare #eica7070 | other | $545 | $545 | $545 | 1 |
| Partial Foot, Shoe Insert with Longitudinal Arch, Toe Filler | other | $547 | $547 | $547 | 1 |
| Gradient Compression Garment, Lower Leg and Foot, Padded, for Nighttime Use, ... | other | $549 | $549 | $549 | 1 |
| Addition, Endoskeletal System, Above Knee OR Hip Disarticulation, Alignable S... | other | $549 | $549 | $549 | 1 |
| Grafix Prime, Grafixpl Prime, Stravix and Stravixpl, Per Square Centimeter | other | $549 | $549 | $549 | 1 |
| Epifix 1 SQ Cm | other | $549 | $549 | $549 | 1 |
| Tobradex Eye Ointment | other | $550 | $150 | $949 | 2 |
| Periprosthetic Wire Guide 03.233.000 | other | $551 | $551 | $551 | 1 |
| IOL Akreos Lens B&l | other | $551 | $551 | $551 | 1 |
| Microcatheter Canaloplasty Itrack 250a | cardiac | $553 | $553 | $553 | 1 |
| Protopam Chloride 1 Gm Vial | other | $554 | $554 | $554 | 1 |
| Custom Shaped Protective Cover, Below Knee | other | $554 | $554 | $554 | 1 |
| Radiation Therapy | other | $556 | $309 | $2,099 | 11 |
| Neg Press Wnd Tx <=50 SQ Cm | other | $558 | $558 | $558 | 1 |
| CT Pelvis W/o Dye | other | $562 | $562 | $562 | 1 |
| CT Soft Tissue Neck W/o Dye | other | $562 | $562 | $562 | 1 |
| ERCP (Gallstone Removal) | other | $563 | $224 | $9,018 | 26 |
| Closed Treatment of Broken Wrist Bone Near Base of Thumb | other | $563 | $563 | $563 | 1 |
| CT Sinus without Contrast | imaging | $563 | $563 | $563 | 1 |
| Vena Cava Filter | other | $564 | $564 | $564 | 1 |
| Shoulder Elbow Wrist Hand Orthosis, Abduction Positioning, Airplane Design, P... | other | $565 | $565 | $565 | 1 |
| Ruby Complex Soft 4 Mm X 15 Cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Soft 6 Mm X 20 Cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 3mm X 12cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 3mm X 20cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 4mm X 10cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 4mm X 15cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 4mm X 20cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 5mm X 12cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 6mm X 20cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 7mm X 25cm | other | $570 | $570 | $570 | 1 |
| Ruby Complex Standard 8mm X 25cm | other | $570 | $570 | $570 | 1 |
| Injection, Ibutilide Fumarate, 1 Mg | other | $572 | $572 | $572 | 1 |
| Injection, Infliximab-axxq, Biosimilar, (avsola), 10 Mg | other | $573 | $573 | $573 | 1 |
| Hydration IV Infusion Init | surgery | $573 | $573 | $573 | 1 |
| Bupivacaine, Collagen-matrix Implant, 1 Mg | surgery | $575 | $575 | $575 | 1 |
| Implantation of Biologic Implant to Soft Tissue | surgery | $578 | $578 | $578 | 1 |
| CT Cervical Spine without Contrast | imaging | $579 | $579 | $579 | 1 |
| Abdominal Ultrasound | imaging | $580 | $45 | $1,946 | 29 |
| Ultrasound of the Abdomen | imaging | $580 | $368 | $1,946 | 11 |
| CT Lumbar Spine without Contrast | imaging | $580 | $580 | $580 | 1 |
| Injection, Non-radioactive, Non-contrast, Visualization Adjunct (e.g., Methyl... | other | $581 | $522 | $639 | 2 |
| Stent, Non-coronary, Temporary, with Delivery System | cardiac | $584 | $584 | $584 | 1 |
| Addition, Endoskeletal Knee-shin System, Single Axis, Friction Swing and Stan... | other | $585 | $585 | $585 | 1 |
| Implant System Achillies Midsubstance Speedbridge Ar-8929bc-cp | surgery | $585 | $585 | $585 | 1 |
| Vein Harvest Dumicz Endovascular #vsp550ex | other | $589 | $589 | $589 | 1 |
| Closed Treatment of Broken Kneecap | other | $592 | $592 | $592 | 1 |
| Pr Rom Rad Therapy Breast, Pc | other | $593 | $593 | $593 | 1 |
| Hc General Anesthesia Time - Initial Base Charge | other | $593 | $593 | $593 | 1 |
| Aveta Wave+ Disposable Resecting Device 3.9mm #210-2005 3/ctn | other | $594 | $594 | $594 | 1 |
| Ruby Complex Standard 5mm X 20cm | other | $594 | $594 | $594 | 1 |
| Ruby Complex Standard 6mm X 12cm | other | $594 | $594 | $594 | 1 |
| Addition to Lower Extremity, Below Knee / Above Knee Suspension Locking Mecha... | other | $595 | $595 | $595 | 1 |
| Scleral Tutoplast Processed | other | $595 | $595 | $595 | 1 |
| Brevital Sodium 500 Mg Vial | other | $597 | $597 | $597 | 1 |
| Spiration Deployment Catheter and Loader Hudhus-c26n | cardiac | $600 | $600 | $600 | 1 |
| Watchman Fxd Access System Double Curve Tu8002 | other | $600 | $600 | $600 | 1 |
| Watchman Trueseal Access System Anterior Curve Tu7004 | other | $600 | $600 | $600 | 1 |
| Removal of Infected Artificial Material OR Mesh From Abdomen | surgery | $601 | $601 | $601 | 1 |
| Apply Rigid Leg Cast | other | $609 | $609 | $609 | 1 |
| Injectable Bulking Agent, Collagen Implant, Urinary Tract, 2.5 Ml Syringe, In... | surgery | $611 | $611 | $611 | 1 |
| Addition to Lower Extremity, Below Knee/above Knee, Custom Fabricated From Ex... | other | $613 | $613 | $613 | 1 |
| Graft, Vascular | other | $617 | $617 | $617 | 1 |
| All Lower Extremity Prostheses, Multi-axial Rotation Unit | other | $618 | $618 | $618 | 1 |
| Cranial Neurostim Complex | other | $622 | $622 | $622 | 1 |
| Closed Treatment of Dislocated Finger Joint with Manipulation Under Anesthesia | other | $623 | $623 | $623 | 1 |
| Obstetric Ultrasound | imaging | $623 | $141 | $1,335 | 16 |
| Repair of Wound By Transferring Skin, Each Additional 30.0 SQ Cm | surgery | $625 | $625 | $625 | 1 |
| Pr Renal Angio, Cardiac Cath | cardiac | $627 | $627 | $627 | 1 |
| Removal of Nasal Air Passage | surgery | $627 | $627 | $627 | 1 |
| Ther/proph/diag Inj IV Push | other | $628 | $628 | $628 | 1 |
| Ensite X Surface Electrodes #ensite-sek-5-01 5ea/bx | other | $630 | $630 | $630 | 1 |
| Ankle Foot Orthosis, Spiral, (institute of Rehabilitative Medicine Type), Pla... | other | $630 | $630 | $630 | 1 |
| 000-030 Min - Anesthesia | other | $630 | $630 | $630 | 1 |
| Add'l 30 Min Anesthesia | other | $630 | $630 | $630 | 1 |
| Injection, Zoledronic Acid, 1 Mg | other | $630 | $630 | $630 | 1 |
| Convalescent Plasma | other | $631 | $631 | $631 | 1 |
| Custom Seal Kit Endologix #tv-cs14-g | other | $636 | $636 | $636 | 1 |
| Application of Walking Cast Covering Foot, Ankle, and Lower Leg | other | $638 | $638 | $638 | 1 |
| Addition to Lower Extremity, Below Knee Suction Socket | other | $641 | $641 | $641 | 1 |
| Injection, Imipenem 4 Mg, Cilastatin 4 Mg and Relebactam 2 Mg | other | $642 | $642 | $642 | 1 |
| Rom Rad Therapy Lung, Pc | other | $643 | $643 | $643 | 1 |
| Glucagon Kit - Compounded | other | $645 | $645 | $645 | 1 |
| Hem-o-lok Medium/large 5mm Endo Applier # 544965 | other | $647 | $647 | $647 | 1 |
| Progel Pleural Air Leak Sealant 4ml 4ea/capgps002 | other | $651 | $651 | $651 | 1 |
| Pegasys 180 Mcg/ml Vial | other | $651 | $651 | $651 | 1 |
| Anjeso (meloxicam) Inj 30 Mg | other | $652 | $652 | $652 | 1 |
| Injection, Triamcinolone Acetonide, Preservative-free, Extended-release, Micr... | other | $653 | $653 | $653 | 1 |
| Emergency Room Visit (Level 3) | emergency | $653 | $389 | $916 | 2 |
| Implantable Breast Prosthesis, Silicone OR Equal | surgery | $657 | $657 | $657 | 1 |
| Removal of Growth Under Skin of Face OR Scalp, Less Than 2.0 Cm | surgery | $658 | $658 | $658 | 1 |
| Resecting Device Symphion #fg | other | $659 | $659 | $659 | 1 |
| Rbc Leukocytes Reduced | other | $659 | $659 | $659 | 1 |
| Afo, Rigid Anterior Tibial Section, Total Carbon Fiber OR Equal Material, Pre... | other | $660 | $660 | $660 | 1 |
| Injection, Amphotericin B Liposome, 10 Mg | other | $661 | $661 | $661 | 1 |
| Release of Tissue of Palm | other | $663 | $663 | $663 | 1 |
| Injection, Etoposide, 10 Mg | other | $667 | $667 | $667 | 1 |
| Knee Orthosis, Adjustable Knee Joints (unicentric OR Polycentric), Positional... | other | $669 | $669 | $669 | 1 |
| Alexis Ces W/gel Point Mini #gtm14 | other | $669 | $669 | $669 | 1 |
| Destino Catheter (steerable Sheath 55cm 7mm Curve) #dst0655507d2 | cardiac | $669 | $669 | $669 | 1 |
| Removal of Growth Under Skin of Face OR Scalp, 2.0 Cm OR More | surgery | $670 | $670 | $670 | 1 |
| Knee Orthosis (ko), Single Upright, Thigh and Calf, with Adjustable Flexion a... | other | $671 | $671 | $671 | 1 |
| Sodium Nitrite 300 Mg/10 Ml Vl | other | $672 | $672 | $672 | 1 |
| Sodium Thiosulfat 12.5 G/50 Ml | other | $672 | $672 | $672 | 1 |
| Accessory Kit Ams 700 #72401850 | other | $675 | $675 | $675 | 1 |
| Knee Orthosis, Single Upright, Thigh and Calf, with Adjustable Flexion and Ex... | other | $675 | $675 | $675 | 1 |
| Deb Subq Tissue 20 SQ Cm/< | other | $675 | $675 | $675 | 1 |
| Signature One Alliance Glenoid Shoulder Guide and Bone Model Left 20-8090-008 | other | $677 | $677 | $677 | 1 |
| Bridion 200 Mg/2 Ml Vial | other | $678 | $678 | $678 | 1 |
| Pelvic Ultrasound | imaging | $678 | $221 | $1,210 | 15 |
| Ultraflex Intra-aortic Ballon 7.5fr 40cc Iab-06840-u | other | $684 | $684 | $684 | 1 |
| Endobronchial Us Add-on | other | $685 | $685 | $685 | 1 |
| Hosp Obs Direct Referral | other | $685 | $685 | $685 | 1 |
| Tumor Immunohistochem/comput | other | $687 | $687 | $687 | 1 |
| Prostin Vr Pedi 500 Mcg/ml Amp | other | $688 | $688 | $688 | 1 |
| Shunt Carotid Pruitt W/t-port(outlying)*min 3 | other | $689 | $689 | $689 | 1 |
| Injectable Bulking Agent, Synthetic Implant, Urinary Tract, 1 Ml Syringe, Inc... | surgery | $690 | $690 | $690 | 1 |
| Speed Compression Implant Kit #se | surgery | $691 | $691 | $691 | 1 |
| Biopsy of Voice Box Using an Endoscope with Operating Microscope OR Telescope | lab | $693 | $693 | $693 | 1 |
| Tactiflex Radiofrequency Cable #tsq-rf-tfse-cbl | other | $693 | $693 | $693 | 1 |
| Nursery - Newborn - Level Ii | obstetric | $696 | $696 | $696 | 1 |
| Injection, Doxorubicin Hydrochloride, 10 Mg | other | $697 | $697 | $697 | 1 |
| Knee Orthosis (ko), Double Upright, Thigh and Calf, with Adjustable Flexion a... | other | $700 | $700 | $700 | 1 |
| Dialysis | other | $702 | $91 | $114,715 | 20 |
| Cardioplegia Del Nido Formula | other | $706 | $706 | $706 | 1 |
| Repair Device, Urinary, Incontinence, with Sling Graft | surgery | $706 | $706 | $706 | 1 |
| Immunohisto Antb 1st Stain | other | $708 | $708 | $708 | 1 |
| Flowcytometry/ Tc 1 Marker | other | $709 | $709 | $709 | 1 |
| Rbc Antibody Identification | other | $709 | $709 | $709 | 1 |
| Drainage of Fluid From Chest Cavity with Insertion of Indwelling Tube | other | $710 | $710 | $710 | 1 |
| Injection, Regadenoson, 0.1 Mg | other | $710 | $70 | $1,349 | 2 |
| Removal of Foreign Body in Voice Box Using an Endoscope with Operating Micros... | surgery | $712 | $712 | $712 | 1 |
| Patient Programmer, Neurostimulator | other | $714 | $714 | $714 | 1 |
| Rom Rad Therapy Pancreas, Pc | other | $714 | $714 | $714 | 1 |
| Incision of Achilles Tendon Using Local Anesthetic | other | $717 | $717 | $717 | 1 |
| Room & Board - Private (one Bed) - Psychiatric | therapy | $720 | $720 | $720 | 1 |
| Right Angled Slimline Cryoprobe #pcs | other | $720 | $720 | $720 | 1 |
| Closed Treatment of Broken Shin Bone | other | $722 | $722 | $722 | 1 |
| Pr Rom Rad Therapy Colorectal, Pc | other | $722 | $722 | $722 | 1 |
| Removal of Blood Flow Assist Device in Left Lower Heart Chamber Through the Skin | surgery | $724 | $724 | $724 | 1 |
| Removal of Growth of Throat And/or Stripping of Vocal Cords Using an Endoscope | surgery | $725 | $725 | $725 | 1 |
| Removal of Growth of Voice Box Using an Endoscope | surgery | $730 | $730 | $730 | 1 |
| Duraseal Exact 5ml Spine Sealant Sys #206520 | other | $732 | $732 | $732 | 1 |
| Fine Needle Aspiration Biopsy Using Fluoroscopic Guidance, First Growth | lab | $732 | $732 | $732 | 1 |
| Intravenous Infusion OR Subcutaneous Injection, Casirivimab and Imdevimab Inc... | surgery | $732 | $732 | $732 | 1 |
| Intravenous Infusion, Bamlanivimab and Etesevimab, Includes Infusion and Post... | surgery | $732 | $732 | $732 | 1 |
| Biopsy of Fluid Collection of Lung Using an Endoscope | lab | $736 | $736 | $736 | 1 |
| Incision of Nasal Sinus Through Nose | other | $736 | $736 | $736 | 1 |
| Pr Rom Rad Therapy Cns, Pc | other | $737 | $737 | $737 | 1 |
| Catheter Frontrunner Xp Ctd #fbp39140 | cardiac | $740 | $740 | $740 | 1 |
| Upper Extremity Study | other | $740 | $740 | $740 | 1 |
| Tlso, Flexible, Provides Trunk Support, Thoracic Region, Rigid Posterior Pane... | other | $744 | $744 | $744 | 1 |
| Extensive Removal of Nasal Polyp | surgery | $744 | $744 | $744 | 1 |
| Carotid Duplex Ultrasound | imaging | $746 | $498 | $2,091 | 4 |
| Injection Into Vocal Cords Using an Endoscope | other | $749 | $749 | $749 | 1 |
| Other Procedure On Voice Box | other | $749 | $749 | $749 | 1 |
| Jada System 2.0 Vacuum Induced Hemorrhage Control System Blue Seal Valve Gree... | other | $750 | $750 | $750 | 1 |
| Packing Coil 45cm Rbypodj45 | other | $750 | $750 | $750 | 1 |
| Pod J-soft Packing Coil 60cm Rbypodj60 | other | $750 | $750 | $750 | 1 |
| Removal of Growth of Soft Tissue of Abdominal Wall, Less Than 3.0 Cm | surgery | $750 | $750 | $750 | 1 |
| Ruby Coil Standard 10 Mm X 35 Cm Rby2c1035 | other | $750 | $750 | $750 | 1 |
| Ruby Coil Standard 12 Mm X 60 Cm Rby2c1260 | other | $750 | $750 | $750 | 1 |
| Ruby Complex Soft 16 Mm X 50 Cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Soft 20 Mm X 60 Cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Soft 6 Mm X 30 Cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Soft 8 Mm X 35 Cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Soft 8 Mm X 60 Cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 14mm X 60cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 16mm X 60cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 18mm X 57cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 20mm X 60cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 24mm X 57cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 28mm X 60cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 32mm X 60cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 4mm X 35cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 5mm X 30cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 6mm X 30cm | other | $750 | $750 | $750 | 1 |
| Ruby Complex Standard 8mm X 40cm | other | $750 | $750 | $750 | 1 |
| Echo Limit | imaging | $750 | $750 | $750 | 1 |
| Insertion of Temporary Pacemaker Lead in Upper and Lower Heart Chambers | cardiac | $751 | $751 | $751 | 1 |
| Grafix Core and Grafixpl Core, Per Square Centimeter | other | $753 | $753 | $753 | 1 |
| Matristem Micromatrix, 1 Mg | other | $755 | $755 | $755 | 1 |
| Joint Device | other | $759 | $660 | $858 | 2 |
| Graft Hemashield 28x10x50 | other | $760 | $760 | $760 | 1 |
| Graft Hemashield 30x10x50 | other | $760 | $760 | $760 | 1 |
| Insertion of Device to Block Groin Artery | other | $763 | $763 | $763 | 1 |
| Emergent Incision of Windpipe for Insertion of Breathing Tube | other | $767 | $767 | $767 | 1 |
| Accessory Kit Ams 800 #720066 | other | $768 | $768 | $768 | 1 |
| Rom Rad Therapy Gi, Pc | other | $768 | $768 | $768 | 1 |
| Spacemaker Pro Trocar Endoscoic Blunt Tip W/oval Dissection Balloon #smbttovlx | cardiac | $771 | $771 | $771 | 1 |
| Lumbar Puncture (Spinal Tap) | other | $771 | $80 | $5,567 | 17 |
| Harvest of Artery From Arm for Heart Bypass Graft Using an Endoscope | cardiac | $773 | $773 | $773 | 1 |
| Ruby Complex Soft 10 Mm X 35 Cm | other | $774 | $774 | $774 | 1 |
| Ruby Complex Soft 12 Mm X 40 Cm | other | $774 | $774 | $774 | 1 |
| Ruby Complex Standard 12mm X 40cm | other | $774 | $774 | $774 | 1 |
| Ruby Complex Standard 14mm X 40cm | other | $774 | $774 | $774 | 1 |
| Ruby Complex Standard 4mm X 30cm | other | $774 | $774 | $774 | 1 |
| Ruby Complex Standard 7mm X 40cm | other | $774 | $774 | $774 | 1 |
| Ruby Complex Standard 9mm X 30cm | other | $774 | $774 | $774 | 1 |
| Amputation of Toe At Toe Joint | other | $777 | $777 | $777 | 1 |
| Shunt Carotid Flexcel Inlying #2020 | other | $777 | $777 | $777 | 1 |
| Shunt Carotid Pruitt F3 T-port 8f #e2013 | other | $779 | $779 | $779 | 1 |
| Shunt Carotid Pruitt Inahara 2012-11 Min. 3 | other | $779 | $779 | $779 | 1 |
| Skin Substitute, Not Otherwise Specified | other | $779 | $779 | $779 | 1 |
| Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Cast Orthosis, Custom... | other | $781 | $781 | $781 | 1 |
| Removal of Growth Under Skin of Leg OR Ankle, Less Than 3.0 Cm | surgery | $781 | $781 | $781 | 1 |
| Insertion of Vein Patch At Lowest Portion of Bypass Graft | other | $784 | $784 | $784 | 1 |
| Removal of Connective Tissue of Palm and Release of Finger, Each Additional D... | surgery | $784 | $784 | $784 | 1 |
| Removal of Growth Under Skin of Leg OR Ankle, 3.0 Cm OR More | surgery | $788 | $788 | $788 | 1 |
| Revision of Permanent Windpipe Opening Scar | other | $788 | $788 | $788 | 1 |
| Graft Hemashield 32x10x50 | other | $789 | $789 | $789 | 1 |
| Rom Rad Therapy Uterus, Pc | other | $789 | $789 | $789 | 1 |
| Exam of Windpipe and Lung Airways Through Permanent Windpipe Opening Using an... | other | $789 | $789 | $789 | 1 |
| Removal of Growth Under Skin of Upper Arm OR Elbow, 3.0 Cm OR More | surgery | $791 | $791 | $791 | 1 |
| Injection, Baclofen, 10 Mg | other | $792 | $792 | $792 | 1 |
| Twist Drill U44-645 | other | $795 | $795 | $795 | 1 |
| Drain/inj Joint/bursa W/us | other | $795 | $795 | $795 | 1 |
| Ankle Foot Orthosis, Plastic with Ankle Joint, Custom Fabricated | other | $796 | $796 | $796 | 1 |
| Platelets, Pheresis, Each Unit | other | $799 | $799 | $799 | 1 |
| Vh-4000 - System Vein Harvest Connical Dissector Tip with Insulated Jaw Short... | other | $800 | $800 | $800 | 1 |
| Closure of Permanent Windpipe Opening OR Abnormal Drainage Tract | other | $800 | $800 | $800 | 1 |
| Removal of Growth Under Skin of Thigh OR Knee, Less Than 3.0 Cm | surgery | $802 | $802 | $802 | 1 |
| Pr Rom Rad Therapy Bladder, Pc | other | $803 | $803 | $803 | 1 |
| Nursery - Newborn - Level Iii | obstetric | $803 | $803 | $803 | 1 |
| Removal of Growth of Muscle of Foot OR Toe, 1.5 Cm OR More | surgery | $806 | $806 | $806 | 1 |
| Magnetic Resonance Angiography with Contrast, Chest | imaging | $807 | $807 | $807 | 1 |
| Incision of Lower Finger Joint for Exploration, Fluid Drainage, OR Removal of... | surgery | $808 | $808 | $808 | 1 |
| Biopsy OR Removal of Deep Lymph Nodes of Underarm | surgery | $810 | $810 | $810 | 1 |
| Fuzeright Peg and Hole Reaming Kit Sterile #ht-60-8000-s | other | $810 | $810 | $810 | 1 |
| Graft Applic <100cm, 1st 25 Cm | other | $810 | $810 | $810 | 1 |
| Graft Applic <100cm, 1st 25cm | other | $810 | $810 | $810 | 1 |
| Addition, Endoskeletal System, Above Knee, Ultra-light Material | other | $811 | $811 | $811 | 1 |
| Cath Intra-aortic Balloon 30cc #iab-05830-lws | other | $813 | $813 | $813 | 1 |
| Cath Intra-aortic Balloon 40cc #iab-05840-lws | other | $813 | $813 | $813 | 1 |
| Menquadfi Vial | other | $813 | $813 | $813 | 1 |
| Removal of Growth of Soft Tissue Under Skin of Neck OR Front of Chest, 3.0 Cm... | surgery | $815 | $815 | $815 | 1 |
| Fusion of Big Toe Between Toe Joints | surgery | $817 | $817 | $817 | 1 |
| Removal of Growth Under Skin of Shoulder Area, 3.0 Cm OR More | surgery | $817 | $817 | $817 | 1 |
| Stabilizer Tissue Octopus 4.3 #ts2000 | other | $820 | $820 | $820 | 1 |
| Rotalink Plus Burr 1.25mm #23631 | other | $825 | $825 | $825 | 1 |
| Removal of Growth of Mouth with Complicated Repair | surgery | $825 | $825 | $825 | 1 |
| Low Osmolar Contrast Material, 100-199 Mg/ml Iodine Concentration, Per Ml | other | $825 | $825 | $825 | 1 |
| Kafo, Fracture Orthosis, Femoral Fracture Cast Orthosis, Rigid, Prefabricated... | other | $826 | $826 | $826 | 1 |
| Removal of Growth of Soft Tissue of Abdominal Wall, 3.0 Cm OR More | surgery | $826 | $826 | $826 | 1 |
| Removal (1.5 Centimeters OR Greater) Tissue Growth Beneath the Skin of Foot O... | surgery | $832 | $832 | $832 | 1 |
| Incision of Artery for Creation of Channel for Ecmo External Blood Circulatio... | other | $836 | $836 | $836 | 1 |
| Infusion, Albumin (human), 5%, 50 Ml | surgery | $839 | $630 | $1,048 | 2 |
| Inceptiv Recharger #rs7230 | other | $842 | $842 | $842 | 1 |
| Recharger 97755 Intellis Rtm #97755 | other | $842 | $842 | $842 | 1 |
| Removal of Growth Under Skin of Forearm OR Wrist, 3.0 Cm OR More | surgery | $844 | $844 | $844 | 1 |
| Repositioning of Blood Flow Assist Device in Lower Heart Chamber Using Imagin... | cardiac | $844 | $844 | $844 | 1 |
| Pad Temp Arctic Sun Large Kit #317-09 | other | $845 | $845 | $845 | 1 |
| Pad Temp Arctic Sun Sml Kit #3170502 2ea/1cs | other | $845 | $845 | $845 | 1 |
| Injection Into Vocal Cords Using an Endoscope with Operating Microscope OR Te... | other | $850 | $850 | $850 | 1 |
| Removal of Growth of Lung Airways Using an Endoscope | surgery | $852 | $852 | $852 | 1 |
| Amputation of Toe and Midfoot Bone | other | $854 | $854 | $854 | 1 |
| CT Lower Ext Left W/wo Contras | other | $859 | $859 | $859 | 1 |
| CT Upper Ext Left W/contrast | other | $859 | $859 | $859 | 1 |
| CT Upper Ext Left W/wo Contras | other | $859 | $859 | $859 | 1 |
| Platelet Pheres Leuko-storage& | other | $859 | $859 | $859 | 1 |
| Octaray Mapping Cable #d-1344 | other | $860 | $860 | $860 | 1 |
| Emergency Room Visit | emergency | $863 | $97 | $7,317 | 15 |
| Insertion of Tube Into Artery OR Vein for Drug Infusion for Blood Clot with R... | surgery | $865 | $865 | $865 | 1 |
| N Block, Other Peripheral | other | $866 | $866 | $866 | 1 |
| Primary Repair of Tendon OR Muscle of Palm Side of Forearm OR Wrist | surgery | $868 | $868 | $868 | 1 |
| Removal of Nasal Air Passage Under Lining Tissue | surgery | $870 | $870 | $870 | 1 |
| Inner 24 Fr for 26 Fr Outer #a22040a | other | $872 | $872 | $872 | 1 |
| Preparation of Skin Graft Site of Face, Scalp, Eyelids, Mouth, Neck, Ears, Ar... | other | $872 | $872 | $872 | 1 |
| Placement of Stabilizing Device for Broken End of Finger OR Thumb | other | $872 | $872 | $872 | 1 |
| Rom Rad Therapy Cervical, Pc | other | $875 | $875 | $875 | 1 |
| Removal of Growth Under Skin of Back OR Lower Sides, 3.0 Cm OR More | surgery | $878 | $878 | $878 | 1 |
| ICU Nursing Increment | other | $878 | $878 | $878 | 1 |
| Paracentesis | diagnostic | $880 | $213 | $1,835 | 14 |
| Incision of Windpipe for Insertion of Breathing Tube | other | $881 | $881 | $881 | 1 |
| Large Clip Applier #470230 | other | $882 | $882 | $882 | 1 |
| Injection, Mycophenolate Mofetil, 10 Mg | other | $884 | $884 | $884 | 1 |
| Fine Needle Aspiration Biopsy Using Ultrasound Guidance, First Growth | imaging | $884 | $884 | $884 | 1 |
| CT Lower Ext Left W/contrast | other | $884 | $884 | $884 | 1 |
| Addition, Endoskeletal Knee-shin System, Polycentric, Mechanical Stance Phase... | other | $885 | $885 | $885 | 1 |
| Amputation of Toe At Joint Between Forefoot and Toes | other | $885 | $885 | $885 | 1 |
| Injection, Aprepitant, 1 Mg | other | $885 | $885 | $885 | 1 |
| Destruction of Growth OR Narrowing of Lung Airway Using an Endoscope | other | $886 | $886 | $886 | 1 |
| Elastomeric Pump Reservoir 8 Ml/hr | other | $891 | $891 | $891 | 1 |
| Tissueblue 0.025% Syringe | other | $892 | $892 | $892 | 1 |
| Repair of Abdominal OR Groin Artery with Prosthesis with Review By Radiologist | surgery | $893 | $893 | $893 | 1 |
| Rom Rad Therapy Anal, Pc | other | $894 | $894 | $894 | 1 |
| Rom Rad Ther Head/neck, Pc | other | $895 | $895 | $895 | 1 |
| Epifix, Per Square Centimeter | other | $897 | $897 | $897 | 1 |
| Removal of Growth Under Skin of Pelvis and Hip, Less Than 3.0 Cm | surgery | $898 | $898 | $898 | 1 |
| Injection, Ceftolozane 50 Mg and Tazobactam 25 Mg | other | $900 | $900 | $900 | 1 |
| Bypass of Upper OR Lower Leg Artery Reoperation More Than 1 Month After Origi... | other | $900 | $900 | $900 | 1 |
| Clip Flex 35mm Atriclip #ach235 | other | $900 | $900 | $900 | 1 |
| Clip Flex 40mm Atriclip #ach240 | other | $900 | $900 | $900 | 1 |
| Clip Flex 45mm Atriclip #ach245 | other | $900 | $900 | $900 | 1 |
| Endoscope, Single-use | other | $900 | $900 | $900 | 1 |
| Laa Exclusion Sys Flex 50mm Clip #a000919 | other | $900 | $900 | $900 | 1 |
| Stent, Non-coated/non-covered, with Delivery System | cardiac | $900 | $900 | $900 | 1 |
| Gradient Compression Garment, Full Leg and Foot, Padded, for Nighttime Use, C... | other | $904 | $904 | $904 | 1 |
| Bexsero Prefilled Syringe | other | $905 | $905 | $905 | 1 |
| Removal of Growth Under Skin of Pelvis and Hip, 3.0 Cm OR More | surgery | $905 | $905 | $905 | 1 |
| Programmer Kit Interstim Smart #th90q01 | other | $906 | $906 | $906 | 1 |
| Removal of Growth of Leg And/or Ankle Tendon Lining OR Capsule | surgery | $906 | $906 | $906 | 1 |
| Argatroban Non-esrd 1mg | other | $906 | $906 | $906 | 1 |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Chest | imaging | $911 | $911 | $911 | 1 |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Sp... | imaging | $911 | $911 | $911 | 1 |
| Intravitreal Injection | surgery | $912 | $912 | $912 | 1 |
| Removal of Fluid-filled Sac (bursa) OR Calcium Deposit of Pelvis | surgery | $913 | $913 | $913 | 1 |
| Balloon Dilation of Large Bowel Using a Flexible Endoscope | other | $914 | $914 | $914 | 1 |
| Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 Mg | other | $916 | $916 | $916 | 1 |
| Biopsy OR Removal of Lymph Nodes of Neck with Removal of Fat Pad | surgery | $916 | $916 | $916 | 1 |
| Ultrasound Guided Needle Aspiration OR Biopsy of Esophagus, Stomach, And/or U... | imaging | $916 | $916 | $916 | 1 |
| Biopsy OR Removal of Deep Lymph Nodes of Neck | surgery | $919 | $919 | $919 | 1 |
| Incision of Connective Tissue of Front OR Side of Lower Leg to Relieve Pressure | other | $920 | $920 | $920 | 1 |
| Removal of Growth of Tongue And/or Stripping of Vocal Cord Using an Endoscope... | surgery | $920 | $920 | $920 | 1 |
| Primary Repair of Tendon On Front of Leg | surgery | $923 | $923 | $923 | 1 |
| Knee Orthosis, without Knee Joint, Rigid, Custom Fabricated | other | $926 | $926 | $926 | 1 |
| Lumbar-sacral Orthosis, Sagittal-coronal Control, Rigid Shell(s)/panel(s), Po... | lab | $926 | $926 | $926 | 1 |
| Removal (1.5 Centimeters OR Greater) Tissue Beneath the Skin Growth of Hand O... | surgery | $927 | $927 | $927 | 1 |
| Insertion of Tube Into Vena Cava | other | $932 | $932 | $932 | 1 |
| Closed Treatment of Back Portion of Shin Bone At Ankle with Manipulation | other | $940 | $940 | $940 | 1 |
| Complicated Control of Bleeding of Throat | other | $940 | $940 | $940 | 1 |
| Complicated Drainage of Abscess of Saliva Gland | other | $940 | $940 | $940 | 1 |
| Control of Bleeding of Upper Large Bowel Using a Flexible Endoscope | other | $942 | $942 | $942 | 1 |
| Incision of Tendon Covering of Finger | other | $942 | $942 | $942 | 1 |
| Injection, Epinephrine, Not Otherwise Specified, 0.1 Mg | other | $945 | $945 | $945 | 1 |
| Simple Revision of Permanent Opening of Windpipe for Breathing | other | $948 | $948 | $948 | 1 |
| LASIK Eye Surgery | other | $949 | $949 | $949 | 1 |
| Removal of Salivary Cyst Under Tongue | surgery | $950 | $950 | $950 | 1 |
| Partial Removal of Breast | surgery | $954 | $954 | $954 | 1 |
| Strapping, Unna Boot | other | $955 | $955 | $955 | 1 |
| Microporous Collagen Implantable Tube (neuragen Nerve Guide), Per Centimeter ... | surgery | $960 | $960 | $960 | 1 |
| Bronchospam Complete | other | $960 | $960 | $960 | 1 |
| Emergent Incision of Windpipe Through Neck for Insertion of Breathing Tube | other | $962 | $962 | $962 | 1 |
| CT Lumbar Spine W/dye | other | $962 | $962 | $962 | 1 |
| CT Abdomen with Contrast | imaging | $963 | $963 | $963 | 1 |
| CT Pelvis W/dye | other | $963 | $963 | $963 | 1 |
| Hip Orthosis, Abduction Control of Hip Joint, Postoperative Hip Abduction Typ... | other | $967 | $967 | $967 | 1 |
| Exposure of Arm Artery for Insertion of Prosthesis | other | $969 | $969 | $969 | 1 |
| Carotid Ultrasound | imaging | $972 | $306 | $2,091 | 13 |
| Rom Rad Therapy Prostate, Pc | other | $974 | $974 | $974 | 1 |
| Removal of Lining of Large Bowel Using an Endoscope Inserted Through Surgical... | surgery | $979 | $979 | $979 | 1 |
| Removal of Multiple Hemorrhoid Groups and Chronic Tear in Anus | surgery | $985 | $985 | $985 | 1 |
| Placement of Locating Device in Breast Using X-ray with Needle Guidance, Firs... | imaging | $986 | $986 | $986 | 1 |
| Mometasone Furoate Sinus Implant, 370 Micrograms | surgery | $987 | $987 | $987 | 1 |
| Injection, Glucagon Hydrochloride, Per 1 Mg | other | $988 | $988 | $988 | 1 |
| Closed Treatment of Broken Hand Bone with Manipulation and Placement of Exter... | other | $989 | $989 | $989 | 1 |
| Custom Shaped Protective Cover, Above Knee | other | $991 | $991 | $991 | 1 |
| Removal of Growth of Muscle of Face OR Scalp, Less Than 2.0 Cm | surgery | $991 | $991 | $991 | 1 |
| Diagnostic Exam of Lungs, Heart Sac, Chest Cavity, OR Lung Lining Using an En... | cardiac | $992 | $992 | $992 | 1 |
| CT Neck with Contrast | imaging | $992 | $992 | $992 | 1 |
| Biopsy of Abdomen Using an Endoscope | lab | $993 | $993 | $993 | 1 |
| Exam of Chest with Biopsy of Lymph Node Using an Endoscope | lab | $994 | $994 | $994 | 1 |
| Repair of Abnormal Drainage Tract in Anal Sphincter | surgery | $994 | $994 | $994 | 1 |
| Repair of Fibrous Tissue of Arch of Foot Using an Endoscope | surgery | $994 | $994 | $994 | 1 |
| Placement of Stabilizing Device for Broken Finger OR Thumb At Midportion OR P... | other | $997 | $997 | $997 | 1 |
| Stent, Non-coated/non-covered, without Delivery System | cardiac | $997 | $997 | $997 | 1 |
| Control of Bleeding of Small Bowel Using an Endoscope | other | $998 | $998 | $998 | 1 |
| Harvest of Arm Artery Segment for Heart Byplass Procedure | cardiac | $1,000 | $1,000 | $1,000 | 1 |
| Incision of Finger Joint for Exploration, Fluid Drainage, OR Removal of Forei... | surgery | $1,001 | $1,001 | $1,001 | 1 |
| Removal of Polyps OR Growths of Large Bowel Using a Flexible Endoscope with E... | surgery | $1,001 | $1,001 | $1,001 | 1 |
| Graft Hemashield 30x10x8x8x10mm #175930p | other | $1,002 | $1,002 | $1,002 | 1 |
| Removal of Growth of Tendon Finger OR Hand | surgery | $1,002 | $1,002 | $1,002 | 1 |
| Insertion of Abdominal Cavity Tube Using an Endoscope | other | $1,005 | $1,005 | $1,005 | 1 |
| Repair of Abnormal Drainage Tract Between Nasal Sinuses | surgery | $1,009 | $1,009 | $1,009 | 1 |
| Removal (less Than 1.5 Centimeters) Tissue Beneath the Skin Growth of Hand OR... | surgery | $1,010 | $1,010 | $1,010 | 1 |
| Repair Umbilical Hernia, Age 5 Years OR Older; Reducible | surgery | $1,013 | $1,013 | $1,013 | 1 |
| Injection, Ceftaroline Fosamil, 10 Mg | other | $1,013 | $1,013 | $1,013 | 1 |
| Pod 12mm X 60cm Coil Rbypod12 | other | $1,014 | $1,014 | $1,014 | 1 |
| Exploration, Drainage, Biopsy, OR Removal of Foreign Body in Chest Cavity Thr... | surgery | $1,016 | $1,016 | $1,016 | 1 |
| Treatment of Broken Midportion of Foot | other | $1,019 | $1,019 | $1,019 | 1 |
| Coronary Artery Bypass Using Vein OR Artery Graft, 1 Graft | cardiac | $1,021 | $1,021 | $1,021 | 1 |
| Removal OR Scraping of Skin On Nose | surgery | $1,025 | $1,025 | $1,025 | 1 |
| Echocardiogram | imaging | $1,027 | $71 | $42,762 | 31 |
| Bydureon Bcise 2 Mg Autoinject | other | $1,028 | $1,028 | $1,028 | 1 |
| Exposure of Major Groin Artery with Creation of Conduit | other | $1,029 | $1,029 | $1,029 | 1 |
| Cranial Access W/subdural Port Medtronic | other | $1,030 | $1,030 | $1,030 | 1 |
| Intensive Care Unit - Intermediate ICU | other | $1,032 | $1,032 | $1,032 | 1 |
| Repair of Abdomen Using Abdominal Lining Graft | surgery | $1,033 | $1,033 | $1,033 | 1 |
| Procedure Kit Illumisite 180 #ils-1800-kt | other | $1,034 | $1,034 | $1,034 | 1 |
| Repair of Groin Hernia Using an Endoscope | surgery | $1,036 | $1,036 | $1,036 | 1 |
| Removal of Growth of Muscle of Face OR Scalp, 2.0 Cm OR More | surgery | $1,037 | $1,037 | $1,037 | 1 |
| Repair of Abnormal Drainage Tract Around Anal Sphincter | surgery | $1,037 | $1,037 | $1,037 | 1 |
| Tissue Exam By Pathologist | other | $1,039 | $1,039 | $1,039 | 1 |
| Biopsy of Esophagus Using a Flexible Endoscope Through Mouth | lab | $1,040 | $1,040 | $1,040 | 1 |
| Injection Into Esophagus Using a Flexible Endoscope | other | $1,040 | $1,040 | $1,040 | 1 |
| Inj Paravert F Jnt L/s 2 Lev | other | $1,041 | $1,041 | $1,041 | 1 |
| Inj Paravert F Jnt L/s 3 Lev | other | $1,041 | $1,041 | $1,041 | 1 |
| Drainage of Tendon of Finger And/or Palm | other | $1,042 | $1,042 | $1,042 | 1 |
| Diagnostic Exam of Esophagus Using a Flexible Endoscope Through Mouth | other | $1,045 | $1,045 | $1,045 | 1 |
| Balloon Dilation of Esophagus Using a Flexible Endoscope, Less Than 3.0 Cm | other | $1,046 | $1,046 | $1,046 | 1 |
| Dilation of Esophagus with Insertion of Guide Wire Using a Flexible Endoscope | other | $1,046 | $1,046 | $1,046 | 1 |
| Needle Biopsy OR Removal of Surface Lymph Nodes | surgery | $1,046 | $1,046 | $1,046 | 1 |
| Removal of Foreign Bodies in Esophagus Using a Flexible Endoscope | surgery | $1,046 | $1,046 | $1,046 | 1 |
| Removal of Polyps OR Growths of Large Bowel Using an Endoscope with Mechanica... | surgery | $1,047 | $1,047 | $1,047 | 1 |
| Creation of Window Into Nasal Sinus | other | $1,054 | $1,054 | $1,054 | 1 |
| Daily Management of Ecmo External Vein to Artery Blood Circulation in Heart a... | cardiac | $1,055 | $1,055 | $1,055 | 1 |
| Biopsy of Growth of Lung Using an Endoscope | lab | $1,057 | $1,057 | $1,057 | 1 |
| Biopsy of Lung Lining Using an Endoscope | lab | $1,057 | $1,057 | $1,057 | 1 |
| Removal of Infected Skin, Tissue OR Muscle of Genitals | surgery | $1,061 | $1,061 | $1,061 | 1 |
| Inj Paravert F Jnt C/t 2 Lev | other | $1,061 | $1,061 | $1,061 | 1 |
| CT Abdomen with and without Contrast | imaging | $1,067 | $1,067 | $1,067 | 1 |
| Biopsy of Lung Airway Using an Endoscope | lab | $1,068 | $1,068 | $1,068 | 1 |
| Diagnostic Exam of Lung Airway Using an Endoscope | other | $1,068 | $1,068 | $1,068 | 1 |
| Exam of Lung Airways Using an Endoscope | other | $1,068 | $1,068 | $1,068 | 1 |
| Irrigation and Suction of Lung Airways to Obtain Cells Using an Endoscope | other | $1,068 | $1,068 | $1,068 | 1 |
| Needle Biopsy of Lobe of Lung Using an Endoscope, Each Additional Lobe | lab | $1,068 | $1,068 | $1,068 | 1 |
| Needle Biopsy of Windpipe Cartilage, Airway, And/or Lung Using an Endoscope | lab | $1,068 | $1,068 | $1,068 | 1 |
| Removal of Foreign Body in Lung Airways Using an Endoscope | surgery | $1,068 | $1,068 | $1,068 | 1 |
| Addition to Lower Extremity, Below Knee/above Knee, Custom Fabricated Socket ... | other | $1,072 | $1,072 | $1,072 | 1 |
| Incision of Bladder with Removal of Bladder Stone | surgery | $1,073 | $1,073 | $1,073 | 1 |
| Vivigen Mis Delivery System Bl-1900 | obstetric | $1,075 | $1,075 | $1,075 | 1 |
| Amniomatrix OR Biodmatrix, Injectable, 1 Cc | other | $1,079 | $1,079 | $1,079 | 1 |
| Hip Extraction System S9-hip S9hip | other | $1,080 | $1,080 | $1,080 | 1 |
| Universal Knee Implant Extraction System #s9kne #s9knee | surgery | $1,080 | $1,080 | $1,080 | 1 |
| Removal of Vocal Cord Growths and Reconstruction with Local Tissue Flap Using... | surgery | $1,082 | $1,082 | $1,082 | 1 |
| Diagnostic Exam of Small Bowel Using an Endoscope Inserted Through Surgically... | surgery | $1,085 | $1,085 | $1,085 | 1 |
| Replacement of Peripherally Inserted Central Venous Tube (picc) with Review B... | surgery | $1,085 | $1,085 | $1,085 | 1 |
| Repair of Abnormal Anal Drainage Tract with Rectal Tissue Flap | surgery | $1,091 | $1,091 | $1,091 | 1 |
| Injection, Infliximab-abda, Biosimilar, (renflexis), 10 Mg | other | $1,092 | $75 | $2,109 | 2 |
| Removal of Saliva Gland Under Floor of Mouth | surgery | $1,096 | $1,096 | $1,096 | 1 |
| Needle Biopsy of Pancreas | lab | $1,099 | $1,099 | $1,099 | 1 |
| Secondary Closure OR Revision of Scar At Previous Thigh Amputation | other | $1,099 | $1,099 | $1,099 | 1 |
| CT Angiography Neck | imaging | $1,099 | $1,099 | $1,099 | 1 |
| CT Angio Abdom W/o & W/dye | other | $1,099 | $1,099 | $1,099 | 1 |
| CT Angiography Head | imaging | $1,099 | $1,099 | $1,099 | 1 |
| Treatment of Broken Finger Bone with Stabilizing Device Accessed Through Skin | other | $1,100 | $1,100 | $1,100 | 1 |
| Removal and Replacement of Single Lead Permanent Pacemaker | surgery | $1,100 | $1,100 | $1,100 | 1 |
| Graft Hemashield 32x12x10x10x10mm #175732p | other | $1,101 | $1,101 | $1,101 | 1 |
| Repair of Groin Hernia | surgery | $1,106 | $1,106 | $1,106 | 1 |
| Lumbar-sacral Orthosis, Sagittal-coronal Control, with Rigid Anterior and Pos... | other | $1,107 | $1,107 | $1,107 | 1 |
| Removal of Multiple Hemorrhoid Groups | surgery | $1,108 | $1,108 | $1,108 | 1 |
| Exploration (not Followed By Surgical Repair), with OR without Lysis of Arter... | surgery | $1,108 | $1,108 | $1,108 | 1 |
| Clip Flexv Dvice W/vclp 50mm Atriclip Achv50 | other | $1,110 | $1,110 | $1,110 | 1 |
| Dissector Articlating Instrument #mid1 | other | $1,110 | $1,110 | $1,110 | 1 |
| Digital Nerve Block | other | $1,110 | $1,110 | $1,110 | 1 |
| Tlso, Triplanar Control, Modular Segmented Spinal System, Four Rigid Plastic ... | other | $1,111 | $1,111 | $1,111 | 1 |
| Complications of Treatment without Cc/mcc | other | $1,111 | $1,111 | $1,111 | 1 |
| Cable Torch Grip 5 X 115mm 71340004 | other | $1,113 | $1,113 | $1,113 | 1 |
| Injection, Amphotericin B, 50 Mg | other | $1,114 | $1,114 | $1,114 | 1 |
| Incision of Connective Tissue of Back of Lower Leg to Relieve Pressure | other | $1,115 | $1,115 | $1,115 | 1 |
| Injection, Etanercept, 25 Mg | other | $1,115 | $1,115 | $1,115 | 1 |
| Hemabate 250 Mcg IM | other | $1,116 | $1,116 | $1,116 | 1 |
| Injection of Implant Material Beneath Lining of Bladder And/or Urethra Using ... | surgery | $1,117 | $1,117 | $1,117 | 1 |
| Removal of Cyst OR Growth of Wrist Bone | surgery | $1,122 | $1,122 | $1,122 | 1 |
| Delayed Insertion of Prosthesis for Repair of Abdominal OR Groin Artery with ... | surgery | $1,124 | $1,124 | $1,124 | 1 |
| Removal of Growth of Rectum Through Anus | surgery | $1,126 | $1,126 | $1,126 | 1 |
| Platelets, Pheresis, Pathogen-reduced, Each Unit | other | $1,126 | $1,126 | $1,126 | 1 |
| Intracept Access Instruments #rlv 0045 | other | $1,128 | $1,128 | $1,128 | 1 |
| Repair of Femoral Groin Hernia | surgery | $1,128 | $1,128 | $1,128 | 1 |
| Diagnostic Exam of Shoulder Using an Endoscope | other | $1,129 | $1,129 | $1,129 | 1 |
| Removal of Extra Breast Tissue in Male | surgery | $1,129 | $1,129 | $1,129 | 1 |
| Ocular Implant, Aqueous Drainage Assist Device | surgery | $1,132 | $1,132 | $1,132 | 1 |
| Closure of Permanent Windpipe Opening OR Abnormal Drainage Tract with Plastic... | other | $1,133 | $1,133 | $1,133 | 1 |
| Removal of Growth of Muscle of Hand OR Finger, Less Than 1.5 Cm | surgery | $1,133 | $1,133 | $1,133 | 1 |
| Knee Ankle Foot Orthosis, Double Upright, Free Ankle, Solid Stirrup, Thigh an... | other | $1,134 | $1,134 | $1,134 | 1 |
| Exposure of Underarm OR Upper Chest Artery for Delivery of Prosthesis | obstetric | $1,135 | $1,135 | $1,135 | 1 |
| Diagnostic Exam of Knee Using an Endoscope | other | $1,136 | $1,136 | $1,136 | 1 |
| Spinal Cs Charging Sys Restoresensor #97754 | other | $1,137 | $1,137 | $1,137 | 1 |
| V-shaped Removal of Lip Tissue | surgery | $1,138 | $1,138 | $1,138 | 1 |
| Placement of Stabilizing Device for Dislocated Hand Bone At Wrist Joint with ... | other | $1,139 | $1,139 | $1,139 | 1 |
| 23x11x14mm Vbr-s Dev #06-115 | other | $1,140 | $1,140 | $1,140 | 1 |
| 41x11x14mm Vbr-s Dev #06-115 | other | $1,140 | $1,140 | $1,140 | 1 |
| Connective Tissue, Human | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 4x100mm #lx1813041004f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 4x40mm #lx181304404f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 4x60mm #lx181304604f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 4x80mm #lx181304804f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 5x100mm #lx1813051005f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 5x40mm #lx181305405f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 5x60mm #lx181305605f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 5x80mm #lx181305805f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 6x100mm #lx1813061005f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 6x40mm #lx181306405f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 6x60mm #lx181306605f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 7x100mm #lx1813071005f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 7x40mm #lx181307405f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 7x60mm #lx181307605f | other | $1,140 | $1,140 | $1,140 | 1 |
| Lutonix .018" Dcb 130cm 7x80mm #lx181307805f | other | $1,140 | $1,140 | $1,140 | 1 |
| Removal of Growth of Soft Tissue of Pelvis and Hip, Less Than 5.0 Cm | surgery | $1,140 | $1,140 | $1,140 | 1 |
| Revision of Abdominal Cavity Tube Using an Endoscope | other | $1,140 | $1,140 | $1,140 | 1 |
| Vbr-s Dev 26mm X 11mm X 14mm #06-115 | other | $1,140 | $1,140 | $1,140 | 1 |
| Vbr-s Dev 29mm X 11mm X 14mm #06-115 | other | $1,140 | $1,140 | $1,140 | 1 |
| Removal of Saliva Gland Under Tongue | surgery | $1,147 | $1,147 | $1,147 | 1 |
| Removal and Replacement of Dual Lead Permanent Pacemaker | surgery | $1,148 | $1,148 | $1,148 | 1 |
| Circumcision | surgery | $1,151 | $47 | $16,397 | 7 |
| Removal OR Partial Removal of Lower End of Forearm Bone On Small Finger Side ... | surgery | $1,152 | $1,152 | $1,152 | 1 |
| Epidural Steroid Injection | other | $1,153 | $256 | $2,233 | 9 |
| Diagnostic Exam of Wrist Using an Endoscope | other | $1,154 | $1,154 | $1,154 | 1 |
| Treatment of Broken Finger At Midportion OR Part Near Hand | other | $1,157 | $1,157 | $1,157 | 1 |
| Diagnostic Exam of Jaw Joint Using an Endoscope | other | $1,159 | $1,159 | $1,159 | 1 |
| Removal of Tube for Ecmo External Blood Circulation in Heart and Lungs Using ... | surgery | $1,159 | $1,159 | $1,159 | 1 |
| Destr L/s Facet Jnt Addtl | other | $1,160 | $1,160 | $1,160 | 1 |
| Inj Foramen Epidural Add-on | other | $1,160 | $1,160 | $1,160 | 1 |
| Inj Foramen Epidural L/s | other | $1,160 | $1,160 | $1,160 | 1 |
| Inj Paravert F Jnt C/t 1 Lev | other | $1,160 | $1,160 | $1,160 | 1 |
| Inj Paravert F Jnt L/s 1 Lev | other | $1,160 | $1,160 | $1,160 | 1 |
| N Block Stellate Ganglion | other | $1,160 | $1,160 | $1,160 | 1 |
| Destr Paravertebrl N Add-on | other | $1,160 | $1,160 | $1,160 | 1 |
| Immediate Post Surgical OR Early Fitting, Application of Initial Rigid Dressi... | surgery | $1,167 | $1,167 | $1,167 | 1 |
| Partial Removal of Wrist Bone Near Thumb | surgery | $1,168 | $1,168 | $1,168 | 1 |
| Insertion of Blood Flow Assist Device in Aorta Through Upper Leg Artery | other | $1,169 | $1,169 | $1,169 | 1 |
| Removal of Wrist Bone | surgery | $1,171 | $1,171 | $1,171 | 1 |
| Removal of Voice Box Cartilage Using an Endoscope with Operating Microscope O... | surgery | $1,172 | $1,172 | $1,172 | 1 |
| Removal of Growth of Muscle of Leg OR Ankle, Less Than 5.0 Cm | surgery | $1,173 | $1,173 | $1,173 | 1 |
| Treatment of Broken Midhand Bone | other | $1,175 | $1,175 | $1,175 | 1 |
| Removal of Growth of Muscle of Forearm OR Wrist, 3.0 Cm OR More | surgery | $1,177 | $1,177 | $1,177 | 1 |
| Injection, Cyclophosphamide (dr. Reddy's), 5 Mg | other | $1,177 | $1,177 | $1,177 | 1 |
| Repair of Bulging of Rectum Into Vagina | surgery | $1,177 | $1,177 | $1,177 | 1 |
| Mole Removal | other | $1,177 | $300 | $4,101 | 10 |
| Aspiration And/or Injection of Cyst of Kidney | other | $1,179 | $1,013 | $1,345 | 2 |
| CT Scan of the Head | imaging | $1,180 | $579 | $4,273 | 12 |
| Biopsy of Tissue of Chest Using an Endoscope | lab | $1,181 | $1,181 | $1,181 | 1 |
| Removal of Cyst OR Growth of Wrist Bone with Self Bone Graft | surgery | $1,183 | $1,183 | $1,183 | 1 |
| Insertion of Small Bowel Tube Using Fluoroscopic Guidance with Contrast | other | $1,186 | $1,186 | $1,186 | 1 |
| Harvest of Upper Leg to Thigh Vein Segment | other | $1,187 | $1,187 | $1,187 | 1 |
| Tying of Sphenopalatine Artery Using an Endoscope | other | $1,187 | $1,187 | $1,187 | 1 |
| Removal of Tendon of Forearm And/or Wrist | surgery | $1,187 | $1,187 | $1,187 | 1 |
| Incision of Elbow Tendon with Removal of Tissue | surgery | $1,189 | $1,189 | $1,189 | 1 |
| Hyaluronan OR Derivative, Durolane, for Intra-articular Injection, 1 Mg | other | $1,190 | $1,190 | $1,190 | 1 |
| Drainage of Abscess of Throat From Outside Mouth | other | $1,192 | $1,192 | $1,192 | 1 |
| Removal of Growth of Muscle of Abdomen, 5.0 Cm OR More | surgery | $1,192 | $1,192 | $1,192 | 1 |
| Implantable Surgical Supplies | surgery | $1,192 | $1,192 | $1,192 | 1 |
| Tlso, Triplanar Control, One Piece Rigid Plastic Shell with Interface Liner, ... | other | $1,193 | $1,193 | $1,193 | 1 |
| Addition to Lower Extremity, Endoskeletal System, Above Knee - Knee Disarticu... | other | $1,193 | $1,193 | $1,193 | 1 |
| Intensive Care Unit - General Classification | other | $1,194 | $687 | $1,701 | 2 |
| Removal and Replacement of Multiple Lead Permanent Pacemaker | surgery | $1,195 | $1,195 | $1,195 | 1 |
| Removal of Deep Lymph Nodes of Neck | surgery | $1,201 | $1,201 | $1,201 | 1 |
| Incision of Connective Tissue of Front And/or Side and Back of Lower Leg to R... | other | $1,201 | $1,201 | $1,201 | 1 |
| Insertion of Defibrillator with Existing Dual Leads | other | $1,205 | $1,205 | $1,205 | 1 |
| Removal of Large Bowel Tissue Using a Flexible Endoscope | surgery | $1,209 | $1,209 | $1,209 | 1 |
| Release of Ligaments of Knee Joint | other | $1,211 | $1,211 | $1,211 | 1 |
| Critical Care | emergency | $1,211 | $119 | $2,866 | 13 |
| Ankle Foot Orthosis, Walking Boot Type, Varus/valgus Correction, Rocker Botto... | other | $1,214 | $1,214 | $1,214 | 1 |
| Bronchoscopy | diagnostic | $1,214 | $594 | $5,098 | 12 |
| Biopsy and Removal of Lymph Nodes of Abdominal Cavity Using an Endoscope | surgery | $1,216 | $1,216 | $1,216 | 1 |
| Needle Biopsy of Lining of Lung | lab | $1,222 | $1,099 | $1,345 | 2 |
| Knee Orthosis, Double Upright, Thigh and Calf, with Adjustable Flexion and Ex... | other | $1,226 | $1,226 | $1,226 | 1 |
| Insertion of Tube Into Vein for Drug Infusion for Blood Clot with Review By R... | surgery | $1,227 | $1,227 | $1,227 | 1 |
| Removal of Joint Lining and Repair of Tendon On the Topside of Finger | surgery | $1,228 | $1,228 | $1,228 | 1 |
| Exposure of Thigh Artery for Insertion of Prosthesis | other | $1,228 | $1,228 | $1,228 | 1 |
| CT Head | imaging | $1,229 | $579 | $4,273 | 30 |
| Njx Interlaminar Lmbr/sac | other | $1,231 | $844 | $2,233 | 5 |
| Tying of Ethmoidal Artery Ethmoidal for Control of Nose Bleed | other | $1,232 | $1,232 | $1,232 | 1 |
| Blood Transfusion Service | surgery | $1,233 | $1,233 | $1,233 | 1 |
| Removal of Foreign Body OR Stone in Kidney Using an Endoscope Inserted Throug... | surgery | $1,236 | $1,236 | $1,236 | 1 |
| Removal of Growth of Saliva Gland OR Saliva Gland, Lateral Lobe | surgery | $1,239 | $1,239 | $1,239 | 1 |
| Repair Recurrent Incisional OR Ventral Hernia; Reducible | surgery | $1,240 | $1,240 | $1,240 | 1 |
| Addition to Lower Extremity, Above Knee, Flexible Inner Socket, External Frame | other | $1,242 | $1,242 | $1,242 | 1 |
| Addition to Lower Extremity, Below Knee, Flexible Inner Socket, External Frame | other | $1,242 | $1,242 | $1,242 | 1 |
| Secondary Closure OR Revision of Scar of Lower Leg Bone Amputation | other | $1,243 | $1,243 | $1,243 | 1 |
| Removal of Plaque From Heart Artery At Time of Coronary Artery Bypass | surgery | $1,244 | $1,244 | $1,244 | 1 |
| Removal of Growth of Muscle of Back OR Lower Sides, Less Than 5.0 Cm | surgery | $1,248 | $1,248 | $1,248 | 1 |
| Removal of Growth of Muscle of Hand OR Finger, 1.5 Cm OR More | surgery | $1,248 | $1,248 | $1,248 | 1 |
| Partial Removal of Lymph Nodes of Underarm | surgery | $1,251 | $1,251 | $1,251 | 1 |
| Interfyl, 1 Mg | other | $1,254 | $1,254 | $1,254 | 1 |
| Insertion of Pacemaker Pulse Generator with Existing Multiple Leads | cardiac | $1,256 | $1,256 | $1,256 | 1 |
| Fusion of Finger Joint, Initial Joint | surgery | $1,256 | $1,256 | $1,256 | 1 |
| Repair of Recurrent Groin Hernia Using an Endoscope | surgery | $1,258 | $1,258 | $1,258 | 1 |
| Drainage of Fluid From Chest Cavity with Insertion of Indwelling Tube Using I... | other | $1,259 | $1,259 | $1,259 | 1 |
| Repair of Tendon, Finger, And/or Palm of Hand | surgery | $1,260 | $1,260 | $1,260 | 1 |
| Reshaping of Nasal Cartilage | other | $1,260 | $1,260 | $1,260 | 1 |
| Repair Initial Incisional OR Ventral Hernia; Reducible | surgery | $1,261 | $1,261 | $1,261 | 1 |
| Repair of Recurrent Femoral Groin Hernia | surgery | $1,261 | $1,261 | $1,261 | 1 |
| Repair of Trapped Femoral Groin Hernia | surgery | $1,261 | $1,261 | $1,261 | 1 |
| Diagnostic Exam of Small Bowel (excluding Lower Small Intestine) Using an End... | other | $1,262 | $1,262 | $1,262 | 1 |
| Biopsy of Small Bowel (except Ileum) Using an Endoscope | lab | $1,266 | $1,266 | $1,266 | 1 |
| Injection, Penicillin G Benzathine and Penicillin G Procaine, 100,000 Units | other | $1,272 | $1,272 | $1,272 | 1 |
| Removal of Appendix | surgery | $1,277 | $1,277 | $1,277 | 1 |
| Injection, Tbo-filgrastim, 1 Microgram | other | $1,278 | $875 | $1,680 | 2 |
| Connective Tissue, Non-human | other | $1,284 | $1,284 | $1,284 | 1 |
| Repair of Sliding Groin Hernia | surgery | $1,286 | $1,286 | $1,286 | 1 |
| 8x21x32mm 7 Degree Tm-400 Dev #06-131 | other | $1,290 | $1,290 | $1,290 | 1 |
| Aspiration of Initial Secretion of Lung Airway Using an Endoscope | other | $1,291 | $919 | $1,662 | 2 |
| Velys Puresight Array Set Knee 4515-70-011 Minimum Order 5 Each | other | $1,293 | $1,293 | $1,293 | 1 |
| Biopsy of Lobe of Lung Using an Endoscope, Each Additional Lobe | lab | $1,294 | $1,294 | $1,294 | 1 |
| Amputation of Foot Across Instep | other | $1,295 | $1,295 | $1,295 | 1 |
| Removal of Congenital Cyst OR Abnormal Drainage Tract of Neck And/or Throat | surgery | $1,303 | $1,303 | $1,303 | 1 |
| Biopsy of Large Bowel Using an Endoscope Inserted Through Surgically Created ... | surgery | $1,303 | $1,303 | $1,303 | 1 |
| Other Procedure On Appendix Using an Endoscope | other | $1,308 | $1,308 | $1,308 | 1 |
| Removal of Appendix Using an Endoscope | surgery | $1,308 | $1,308 | $1,308 | 1 |
| Tying of Dilated Veins of Stomach And/or Esophagus Using a Flexible Endoscope | other | $1,308 | $1,308 | $1,308 | 1 |
| Removal of Border of Lip | surgery | $1,316 | $1,316 | $1,316 | 1 |
| Closure Device, Vascular | other | $1,320 | $1,320 | $1,320 | 1 |
| Lutonix .018" Dcb 130cm 5x150mm #lx1813051505f | other | $1,320 | $1,320 | $1,320 | 1 |
| Lutonix .018" Dcb 130cm 6x150mm #lx1813061505f | other | $1,320 | $1,320 | $1,320 | 1 |
| Lutonix .018" Dcb 130cm 7x150mm #lx1813071505f | other | $1,320 | $1,320 | $1,320 | 1 |
| Microporous Collagen Implantable Slit Tube (neurawrap Nerve Protector), Per C... | surgery | $1,320 | $1,320 | $1,320 | 1 |
| Injection of Esophagus, Stomach, And/or Upper Small Bowel Using a Flexible En... | other | $1,326 | $1,326 | $1,326 | 1 |
| Drainage of Lymph Fluid to Abdominal Cavity Using an Endoscope | other | $1,330 | $1,330 | $1,330 | 1 |
| Dilation of Stomach Outlet Using a Flexible Endoscope | other | $1,331 | $1,331 | $1,331 | 1 |
| Repair of Trapped Groin Hernia | surgery | $1,336 | $1,336 | $1,336 | 1 |
| Exploration of Stomach OR Removal of Foreign Body in Stomach | surgery | $1,337 | $1,337 | $1,337 | 1 |
| Repair of Groin Hernia That Is Not Trapped | surgery | $1,339 | $1,339 | $1,339 | 1 |
| Placement of Stabilizing Device for Broken Forearm Bone On Thumb Side At Wrist | other | $1,341 | $1,341 | $1,341 | 1 |
| Lengthening OR Shortening of Tendon of Leg OR Ankle | other | $1,342 | $1,342 | $1,342 | 1 |
| Initiation of Ecmo External Vein to Artery Blood Circulation in Heart and Lun... | cardiac | $1,343 | $1,343 | $1,343 | 1 |
| Removal OR Destruction of Growth of Nose Through Nose | surgery | $1,349 | $1,349 | $1,349 | 1 |
| Removal and Replacement of Single Lead Defibrillator | surgery | $1,354 | $1,354 | $1,354 | 1 |
| Release of Hand Muscle | other | $1,367 | $1,367 | $1,367 | 1 |
| Removal of Growth of Muscle of Neck OR Front of Chest, 5.0 Cm OR More | surgery | $1,367 | $1,367 | $1,367 | 1 |
| Revision of Permanent Opening of Windpipe for Breathing with Flap Rotation | other | $1,372 | $1,372 | $1,372 | 1 |
| Removal of Defect in Wall of Esophagus Using a Rigid Endoscope | surgery | $1,374 | $1,374 | $1,374 | 1 |
| Removal of Growth of Muscle of Upper Arm OR Elbow, 5.0 Cm OR More | surgery | $1,374 | $1,374 | $1,374 | 1 |
| Removal of Wedge of Lip Tissue with Closure | surgery | $1,375 | $1,375 | $1,375 | 1 |
| Needle Biopsy of Kidney | lab | $1,376 | $1,376 | $1,376 | 1 |
| Exposure of Underarm OR Upper Chest Artery with Creation of Conduit | other | $1,378 | $1,378 | $1,378 | 1 |
| Insertion of Implant in Urethra Within Prostate Gland Using an Endoscope, Eac... | surgery | $1,379 | $1,379 | $1,379 | 1 |
| Other Procedure On Stomach Using an Endoscope | other | $1,380 | $1,380 | $1,380 | 1 |
| Shaving of Part of Shoulder Bone and Repair of Ligament Using an Endoscope | surgery | $1,380 | $1,380 | $1,380 | 1 |
| Incision of Hand OR Finger Bone | other | $1,382 | $1,382 | $1,382 | 1 |
| Prostate Biopsy | other | $1,384 | $261 | $12,364 | 11 |
| Forcep - Prograsp | other | $1,386 | $1,386 | $1,386 | 1 |
| Forceps Tenaculum for Davinci Xi/x 8mm Instrument #470207 | other | $1,386 | $1,386 | $1,386 | 1 |
| Repair of Openings of Nasal Cartilage | surgery | $1,386 | $1,386 | $1,386 | 1 |
| Technetium Tc 99m Exametazime Diagnostic 25 Mci | other | $1,386 | $1,386 | $1,386 | 1 |
| Placement of Locating Device in Breast Using Imaging Guidance, First Growth | other | $1,388 | $1,029 | $1,747 | 2 |
| Removal of Growth of Muscle of Shoulder, 5.0 Cm OR More | surgery | $1,388 | $1,388 | $1,388 | 1 |
| Insertion of Defibrillator with Existing Multiple Leads | other | $1,392 | $1,392 | $1,392 | 1 |
| Repair of Defect OR Tear of Eardrum | surgery | $1,393 | $1,393 | $1,393 | 1 |
| Treatment of Ligament Tear At Ankle Joint | other | $1,393 | $1,393 | $1,393 | 1 |
| Removal of Lining Covering Abdominal Organs | surgery | $1,397 | $1,397 | $1,397 | 1 |
| Amputation of Finger OR Thumb with Direct Closure | other | $1,398 | $1,398 | $1,398 | 1 |
| Partial Removal of Collar Bone At Shoulder Using an Endoscope | surgery | $1,398 | $1,398 | $1,398 | 1 |
| Primary Repair of Tendon OR Muscle of Top Side of Forearm OR Wrist | surgery | $1,398 | $1,398 | $1,398 | 1 |
| Drainage of Fluid Collection By Tube Through Skin Using Imaging Guidance | other | $1,411 | $1,411 | $1,411 | 1 |
| Removal and Replacement of Dual Lead Defibrillator | surgery | $1,417 | $1,417 | $1,417 | 1 |
| Release of Finger Nerve | other | $1,417 | $1,417 | $1,417 | 1 |
| Removal of Growth of Muscle of Back OR Lower Sides, 5.0 Cm OR More | surgery | $1,417 | $1,417 | $1,417 | 1 |
| Repair of Abdominal Muscle Hernia | surgery | $1,421 | $1,421 | $1,421 | 1 |
| Victoza 3-pak 18 Mg/3 Ml Pen | other | $1,422 | $1,422 | $1,422 | 1 |
| Aspiration of Fluid From Cyst of Spinal Cord OR Fluid-filled Cavity | other | $1,428 | $1,428 | $1,428 | 1 |
| Aspiration of Bone Marrow Sample for Diagnosis | other | $1,436 | $1,436 | $1,436 | 1 |
| Creation of Opening From Small Bowel to Skin with Insertion of a Tube for Dec... | other | $1,436 | $1,436 | $1,436 | 1 |
| Annuloplasty Ring 25mm #tarp | other | $1,437 | $1,437 | $1,437 | 1 |
| Annuloplasty Ring 29mm #tarp | other | $1,437 | $1,437 | $1,437 | 1 |
| Annuloplasty Ring 31mm #tarp | other | $1,437 | $1,437 | $1,437 | 1 |
| Annuloplasty Ring 33mm #tarp | other | $1,437 | $1,437 | $1,437 | 1 |
| Treatment of Broken Outer Lower Leg Bone At Ankle | other | $1,439 | $1,439 | $1,439 | 1 |
| Lead, Cardioverter-defibrillator, Endocardial Dual Coil | other | $1,440 | $1,440 | $1,440 | 1 |
| Lead, Left Ventricular Coronary Venous System | cardiac | $1,440 | $1,440 | $1,440 | 1 |
| Repair Recurrent Incisional OR Ventral Hernia; Incarcerated OR Strangulated | surgery | $1,441 | $1,441 | $1,441 | 1 |
| Removal of Cyst OR Growth of Lower Leg Bone | surgery | $1,441 | $1,441 | $1,441 | 1 |
| Multiple Incisions of Connective Tissue of Thigh And/or Knee to Relieve Pressure | other | $1,442 | $1,442 | $1,442 | 1 |
| Repair of Joint Between Hand and Finger Bones with Prosthesis | surgery | $1,450 | $1,450 | $1,450 | 1 |
| Shock Wave Crushing of Kidney Stones | other | $1,450 | $1,450 | $1,450 | 1 |
| Preparatory, Below Knee 'ptb' Type Socket, Non-alignable System, No Cover, Sa... | other | $1,453 | $1,453 | $1,453 | 1 |
| Drainage of Deep Abscess OR Blood Accumulation of Pelvis OR Hip Near Joint | other | $1,460 | $1,460 | $1,460 | 1 |
| Removal and Replacement of Multiple Lead Defibrillator | surgery | $1,460 | $1,460 | $1,460 | 1 |
| Removal of Polyps OR Growths of Esophagus, Stomach, And/or Upper Small Bowel ... | surgery | $1,461 | $1,461 | $1,461 | 1 |
| Release of Ligaments At Outer Side of Knee Joint Using an Endoscope | other | $1,463 | $1,463 | $1,463 | 1 |
| CT Scan of Face with Contrast | imaging | $1,466 | $1,466 | $1,466 | 1 |
| Limited Removal of Abnormal Shoulder Joint Tissue Using Endoscope | surgery | $1,467 | $1,467 | $1,467 | 1 |
| Correction of Rigid Deformity of First Joint of Big Toe Using Implant | surgery | $1,470 | $1,470 | $1,470 | 1 |
| Exam of Nose and Sinus with Removal of Nasal Sinus Using an Endoscope | surgery | $1,473 | $1,473 | $1,473 | 1 |
| Removal of Foreign Body in Abdominal Cavity | surgery | $1,474 | $1,474 | $1,474 | 1 |
| Incision of Tendon of Forearm And/or Wrist, Open Procedure | other | $1,475 | $1,475 | $1,475 | 1 |
| Repair of Tendon OR Muscle On Top Side of Forearm OR Wrist with Graft | surgery | $1,475 | $1,475 | $1,475 | 1 |
| Partial Removal of Knee Joint Lining Using an Endoscope | surgery | $1,477 | $1,477 | $1,477 | 1 |
| Lengthening OR Shortening of Tendon of Forearm And/or Wrist | other | $1,480 | $1,480 | $1,480 | 1 |
| Treatment of Broken Midpart of Forearm Bone On Thumb Side | other | $1,480 | $1,480 | $1,480 | 1 |
| Creation of Surgical Opening From Stomach to Skin Using an Endoscope | surgery | $1,486 | $1,486 | $1,486 | 1 |
| Injection, Ferumoxytol, for Treatment of Iron Deficiency Anemia, 1 Mg | other | $1,489 | $770 | $2,208 | 2 |
| Destruction of Growth of Rectum | other | $1,489 | $1,489 | $1,489 | 1 |
| Repair of Trapped OR Strangulated Groin Hernia | surgery | $1,493 | $1,493 | $1,493 | 1 |
| Aspiration of Fluid From Chest Cavity Using Imaging Guidance | other | $1,493 | $1,493 | $1,493 | 1 |
| Removal of Tissue From Sphenoid Sinus Using an Endoscope | surgery | $1,494 | $1,494 | $1,494 | 1 |
| Insertion of Stomach Feeding Tube | other | $1,496 | $1,496 | $1,496 | 1 |
| Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian OR Epigastric He... | surgery | $1,497 | $1,497 | $1,497 | 1 |
| CT Scan of Chest with Contrast | imaging | $1,499 | $1,499 | $1,499 | 1 |
| CT Scan of Chest without Contrast | imaging | $1,499 | $1,499 | $1,499 | 1 |
| Laparoscopy, Surgical, Repair, Incisional Hernia (includes Mesh Insertion, Wh... | surgery | $1,500 | $1,500 | $1,500 | 1 |
| Laparoscopy, Surgical, Repair, Recurrent Incisional Hernia (includes Mesh Ins... | surgery | $1,500 | $1,500 | $1,500 | 1 |
| Probe 10cm Malleable A000683 | other | $1,500 | $1,500 | $1,500 | 1 |
| Removal of Diseased Part of Forearm Bone On Small Finger Side | surgery | $1,503 | $1,503 | $1,503 | 1 |
| Biopsy of Breast and Placement of Locating Device Using Mri, Each Additional ... | imaging | $1,506 | $1,506 | $1,506 | 1 |
| Repair Initial Incisional OR Ventral Hernia; Incarcerated OR Strangulated | surgery | $1,506 | $1,506 | $1,506 | 1 |
| Addition to Lower Limb Prosthesis, Vertical Shock Reducing Pylon Feature | other | $1,507 | $1,507 | $1,507 | 1 |
| Exchange of Abdominal Cavity Drainage Tube Using Imaging Guidance | other | $1,516 | $1,516 | $1,516 | 1 |
| Removal and Replacement of Stent in Kidney and Ureter Using Fluoroscopic Guid... | surgery | $1,517 | $1,517 | $1,517 | 1 |
| Treatment of Broken Wrist Bone Located Near Base of Thumb | other | $1,519 | $1,519 | $1,519 | 1 |
| Incision and Repair of Elbow Tendon with Removal of Tissue OR Bone | surgery | $1,520 | $1,520 | $1,520 | 1 |
| Instillation, Bupivacaine and Meloxicam, 1 Mg/0.03 Mg | other | $1,527 | $1,527 | $1,527 | 1 |
| Insertion of Tube Into Small Bowel | other | $1,528 | $1,528 | $1,528 | 1 |
| Creation of Permanent Opening of Windpipe for Breathing | other | $1,529 | $1,529 | $1,529 | 1 |
| Catheter, Transluminal Angioplasty, Drug-coated, Non-laser | cardiac | $1,530 | $1,530 | $1,530 | 1 |
| Treatment of Broken Finger OR Hand At Base of Finger | other | $1,530 | $1,530 | $1,530 | 1 |
| Fusion of Joint Between Finger and Hand | surgery | $1,533 | $1,533 | $1,533 | 1 |
| Complicated Plastic Repair of Salivary Duct | surgery | $1,538 | $1,538 | $1,538 | 1 |
| Core Needle Biopsy of Lung OR Center Cavity of Chest (mediastinum), Accessed ... | lab | $1,539 | $1,539 | $1,539 | 1 |
| Biopsy of Esophagus, Stomach, And/or Upper Small Bowel Using a Flexible Endos... | lab | $1,543 | $1,543 | $1,543 | 1 |
| Control of Bleeding of Esophagus, Stomach, And/or Upper Small Bowel Using a F... | other | $1,543 | $1,543 | $1,543 | 1 |
| Insertion of Guide Wire with Dilation of Esophagus Using a Flexible Endoscope | other | $1,543 | $1,543 | $1,543 | 1 |
| Insertion of Stomach Tube Using a Flexible Endoscope | other | $1,543 | $1,543 | $1,543 | 1 |
| Coronary Artery Bypass Using Vein OR Artery Graft, 2 Grafts | cardiac | $1,547 | $1,547 | $1,547 | 1 |
| Intracept Access Instrument Rlv 0055 | other | $1,548 | $1,548 | $1,548 | 1 |
| Destruction of Subsequent Incompetent Veins of Arm OR Leg Using Radiofrequenc... | other | $1,549 | $1,549 | $1,549 | 1 |
| Repair of Wound of Eyelid Margin | surgery | $1,550 | $1,550 | $1,550 | 1 |
| Suture of Recent Wound of Eyelid | other | $1,550 | $1,550 | $1,550 | 1 |
| Incision of Bladder with Insertion of Tube OR Stent in Ureter | cardiac | $1,552 | $1,552 | $1,552 | 1 |
| Removal of Bony Growths of Ear Canal | surgery | $1,552 | $1,552 | $1,552 | 1 |
| Express Tray 15/2 First Fracture with Kyphx | other | $1,554 | $1,554 | $1,554 | 1 |
| CT Scan Head OR Brain with Contrast | imaging | $1,555 | $1,555 | $1,555 | 1 |
| Removal OR Repair of Wrist Cartilage Using an Endoscope | surgery | $1,556 | $1,556 | $1,556 | 1 |
| Removal OR Shaving of Knee Joint Cartilage Using an Endoscope | surgery | $1,557 | $1,557 | $1,557 | 1 |
| Removal of Growth of Muscle of Pelvis and Hip, 5.0 Cm OR More | surgery | $1,558 | $1,558 | $1,558 | 1 |
| Repair of Ligament of Finger OR Hand and Finger Joint | surgery | $1,559 | $1,559 | $1,559 | 1 |
| Clamp Long Jaw A000362 | other | $1,560 | $1,560 | $1,560 | 1 |
| Clamp Short Jaw A000432 | other | $1,560 | $1,560 | $1,560 | 1 |
| Endovascular Repair of Iliac Artery (eg, Aneurysm, Pseudoaneurysm, Arterioven... | surgery | $1,560 | $1,560 | $1,560 | 1 |
| Balloon Dilation of Groin Artery, Each Additional Vessel | other | $1,561 | $1,561 | $1,561 | 1 |
| Tying, Incision, and Stripping of Short Leg Vein | other | $1,561 | $1,561 | $1,561 | 1 |
| Relocation of Tendon of Forearm And/or Wrist | other | $1,562 | $1,562 | $1,562 | 1 |
| Removal of Infected Skin, Tissue OR Muscle of Genitals, Perineum, OR Abdomen | surgery | $1,562 | $1,562 | $1,562 | 1 |
| CT Angiography Chest | imaging | $1,562 | $1,132 | $5,578 | 4 |
| Repositioning of Defibrillator Electrode | other | $1,564 | $1,564 | $1,564 | 1 |
| Treatment of Broken Thumb At Wrist | other | $1,564 | $1,564 | $1,564 | 1 |
| CT Abdomen and Pelvis with and without Contrast | imaging | $1,564 | $1,564 | $1,564 | 1 |
| Exploration of Abdominal Cavity | other | $1,566 | $1,566 | $1,566 | 1 |
| Complete Exam of Nose and Sinuses Using an Endoscope | other | $1,569 | $1,569 | $1,569 | 1 |
| Repair of Congenital Defect of Bladder | surgery | $1,570 | $1,570 | $1,570 | 1 |
| Removal of Loose OR Foreign Body in Knee Joint Using an Endoscope | surgery | $1,576 | $1,576 | $1,576 | 1 |
| Nuclear Medicine Study of Lung Circulation | imaging | $1,579 | $1,579 | $1,579 | 1 |
| Nuclear Medicine Study of Lung Ventilation and Circulation | imaging | $1,580 | $1,580 | $1,580 | 1 |
| Amputation of Finger OR Thumb | other | $1,582 | $1,582 | $1,582 | 1 |
| Removal of Growth of Rectum Through Anus with Removal of a Portion of Muscle | surgery | $1,585 | $1,585 | $1,585 | 1 |
| Amputation of Thigh Through Thigh Bone Leaving Wound | other | $1,587 | $1,587 | $1,587 | 1 |
| Removal of Growth Under Nasal Bone OR Cartilage | surgery | $1,588 | $1,588 | $1,588 | 1 |
| Removal of Scar Tissue to Release Tendon of Forearm OR Wrist | surgery | $1,589 | $1,589 | $1,589 | 1 |
| Catheter, Intravascular Ultrasound | imaging | $1,590 | $1,590 | $1,590 | 1 |
| Insertion of Tube Into Right Heart OR Main Pulmonary Artery | cardiac | $1,594 | $1,594 | $1,594 | 1 |
| Insertion of Stomach Tube Using Fluoroscopic Guidance with Contrast | other | $1,597 | $1,186 | $2,007 | 2 |
| Diagnostic Exam of Large Bowel Using an Endoscope Inserted Through Surgically... | surgery | $1,603 | $1,603 | $1,603 | 1 |
| Removal of Growths OR Polyps of Large Bowel By Mechanical Snare Using an Endo... | surgery | $1,603 | $1,603 | $1,603 | 1 |
| Insertion of Tube Into Chest Aorta for Diagnosis OR Treatment with Review By ... | other | $1,604 | $1,604 | $1,604 | 1 |
| Destruction of Nasal Nerve By Heat Using an Endoscope | other | $1,605 | $1,605 | $1,605 | 1 |
| Removal of Multiple Wrist Bones | surgery | $1,610 | $1,610 | $1,610 | 1 |
| CT Angio Abd&pelv W/o&w/dye | other | $1,610 | $1,610 | $1,610 | 1 |
| Anchoring of Flexing Tendon of Fingers to Wrist Bone | other | $1,611 | $1,611 | $1,611 | 1 |
| Repair of Ruptured Achilles Tendon | surgery | $1,611 | $1,611 | $1,611 | 1 |
| Nuclear Medicine Study of Liver and Bile Duct System | imaging | $1,611 | $1,611 | $1,611 | 1 |
| Nuclear Medicine Study of Liver and Bile Duct System with Use of Drugs | imaging | $1,611 | $1,611 | $1,611 | 1 |
| Repair of Ligament of Hand to Finger Joint with Local Tissue | surgery | $1,612 | $1,612 | $1,612 | 1 |
| Removal of Blood Clot and Portion of Tibial OR Peroneal Artery, Each Addition... | surgery | $1,615 | $1,615 | $1,615 | 1 |
| Removal of Connective Tissue of Palm | surgery | $1,616 | $1,616 | $1,616 | 1 |
| Insertion of Tube Into Vein, First Order Branch | other | $1,619 | $1,619 | $1,619 | 1 |
| Creation of Opening of Windpipe and Insertion of Speech Prosthesis | other | $1,622 | $1,622 | $1,622 | 1 |
| Delivery of Simple High Precision Radiation Treatment | obstetric | $1,624 | $1,624 | $1,624 | 1 |
| Incision of Corner of Eye At Eyelid | other | $1,624 | $1,624 | $1,624 | 1 |
| Central Line Insertion | other | $1,626 | $184 | $3,030 | 17 |
| Biopsy of Lung Lining | lab | $1,627 | $1,627 | $1,627 | 1 |
| Repair of Joint Between Finger and Palm | surgery | $1,639 | $1,639 | $1,639 | 1 |
| Removal of Infected Neck Graft | surgery | $1,645 | $1,645 | $1,645 | 1 |
| Transfer of Deep Tendon of Foot with Muscle Rerouting | other | $1,645 | $1,645 | $1,645 | 1 |
| Insertion of Tube Into Artery for Drug Infusion for Blood Clot with Review By... | surgery | $1,646 | $1,646 | $1,646 | 1 |
| Catheter Spyscope Ds #m00546600 | cardiac | $1,646 | $1,646 | $1,646 | 1 |
| Spyscope Ds Ii Access & Delivery Catheter M00546610 | cardiac | $1,646 | $1,646 | $1,646 | 1 |
| Partial Removal of Shoulder Joint Lining Using an Endoscope | surgery | $1,649 | $1,649 | $1,649 | 1 |
| Clip Pro 35mm Atriclip #a000824 | other | $1,650 | $1,650 | $1,650 | 1 |
| Clip Pro 40mm Atriclip #a000825 | other | $1,650 | $1,650 | $1,650 | 1 |
| Clip Pro 50mm Atriclip #a000827 | other | $1,650 | $1,650 | $1,650 | 1 |
| Hearing Aid, Digital, Monaural, Bte | other | $1,650 | $1,650 | $1,650 | 1 |
| Scp Foot & Ankle Kit #514.315 | other | $1,650 | $1,650 | $1,650 | 1 |
| Drainage of Fluid Collection of Abdominal Cavity By Tube Using Imaging Guidance | other | $1,651 | $1,651 | $1,651 | 1 |
| X-ray of Lower Spinal Canal with Review By Radiologist | imaging | $1,652 | $1,652 | $1,652 | 1 |
| CT Scan of Cranial Cavity with Contrast | imaging | $1,653 | $1,653 | $1,653 | 1 |
| CT Scan of Cranial Cavity without Contrast | imaging | $1,653 | $1,653 | $1,653 | 1 |
| Partial Removal of Liver Tissue | surgery | $1,655 | $1,655 | $1,655 | 1 |
| X-ray of Middle Spinal Canal with Review By Radiologist | imaging | $1,656 | $1,656 | $1,656 | 1 |
| X-ray of Upper Spinal Canal with Review By Radiologist | imaging | $1,656 | $1,656 | $1,656 | 1 |
| Ultrasound Guided Needle Aspiration OR Biopsy of Esophagus Using a Flexible E... | imaging | $1,659 | $1,659 | $1,659 | 1 |
| Destruction of Polyp OR Growth of Lower Large Bowel Using a Flexible Endoscope | other | $1,661 | $1,661 | $1,661 | 1 |
| Complicated Treatment of Dislocated Midhand Bone At Wrist | other | $1,663 | $1,663 | $1,663 | 1 |
| Nuclear Medicine Study of Whole Body for Thyroid Cancer | imaging | $1,664 | $1,664 | $1,664 | 1 |
| Knee Ankle Foot Orthosis, Fracture Orthosis, Femoral Fracture Cast Orthosis, ... | other | $1,665 | $1,665 | $1,665 | 1 |
| Repair of Joint Capsule of Hand and Palm, 1 Finger | surgery | $1,669 | $1,669 | $1,669 | 1 |
| Closure of Surgically Created Opening From Stomach to Skin | surgery | $1,673 | $1,673 | $1,673 | 1 |
| Biopsy of Fluid Collection of Lung | lab | $1,674 | $1,674 | $1,674 | 1 |
| Treatment of 2 Broken Lower Forearm Bone Pieces On Thumb Side Inside Wrist Jo... | other | $1,675 | $1,675 | $1,675 | 1 |
| CT Scan of the Chest | imaging | $1,675 | $992 | $5,578 | 8 |
| Lutonix .018" Dcb 130cm 4x220mm # Lx1813042204f | other | $1,680 | $1,680 | $1,680 | 1 |
| Lutonix .018" Dcb 130cm 5x220mm #lx1813052205f | other | $1,680 | $1,680 | $1,680 | 1 |
| Lutonix .018" Dcb 130cm 6x220mm #lx1813062205f | other | $1,680 | $1,680 | $1,680 | 1 |
| Lutonix .018" Dcb 130cm 7x220mm #lx1813072205f | other | $1,680 | $1,680 | $1,680 | 1 |
| Repair of Nasal Passage Through Nose | surgery | $1,685 | $1,685 | $1,685 | 1 |
| Reshaping of Tip of Nose | other | $1,685 | $1,685 | $1,685 | 1 |
| Nuclear Medicine Study of Kidney and Blood Flow | imaging | $1,687 | $1,687 | $1,687 | 1 |
| Repair of Hand Muscle | surgery | $1,693 | $1,693 | $1,693 | 1 |
| Simple Complete Removal of Breast | surgery | $1,695 | $1,695 | $1,695 | 1 |
| Byfavo 20 Mg Vial | other | $1,696 | $1,696 | $1,696 | 1 |
| Remimazolam Besylate 20 Mg IV Solr | other | $1,696 | $1,696 | $1,696 | 1 |
| Repair of Non-healed Wrist Bone, Scaphoid OR Navicular At the Base of the Thumb | surgery | $1,697 | $1,697 | $1,697 | 1 |
| Removal of Growth of Muscle of Thigh OR Knee, 5.0 Cm OR More | surgery | $1,699 | $1,699 | $1,699 | 1 |
| Exploration of Arm OR Leg for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $1,699 | $1,699 | $1,699 | 1 |
| Prosthetic Implant, Not Otherwise Specified | surgery | $1,700 | $1,700 | $1,700 | 1 |
| Forcep - Fenestrated Bipolar | other | $1,701 | $1,701 | $1,701 | 1 |
| Forcep Maryland Bipolar | other | $1,701 | $1,701 | $1,701 | 1 |
| Forceps Cadiere #471049 | other | $1,701 | $1,701 | $1,701 | 1 |
| Forceps Prograsp #471093 | other | $1,701 | $1,701 | $1,701 | 1 |
| Partial Removal of Wrist Joint Lining Using an Endoscope | surgery | $1,706 | $1,706 | $1,706 | 1 |
| Conversion of Kidney Tube to Nephroureteral Tube Using Imaging Guidance and S... | other | $1,707 | $1,707 | $1,707 | 1 |
| Treatment of Dislocated Wrist Bones | other | $1,708 | $1,708 | $1,708 | 1 |
| Kyphon 10/2 #kex102eb | other | $1,710 | $1,710 | $1,710 | 1 |
| Kyphon Kit 15/2 #kex152eb | other | $1,710 | $1,710 | $1,710 | 1 |
| Stent, Coated/covered, with Delivery System | cardiac | $1,710 | $1,710 | $1,710 | 1 |
| Kyphon 15/3 Expender Ii Tray #kpx153pb | other | $1,711 | $1,711 | $1,711 | 1 |
| Injection, Abatacept, 10 Mg | other | $1,711 | $1,711 | $1,711 | 1 |
| Drug Delivery Using a Drug-coated Balloon for Male Treatment of Urethral Stri... | obstetric | $1,713 | $1,713 | $1,713 | 1 |
| CT Chest | imaging | $1,715 | $535 | $5,578 | 25 |
| Removal of Extensive Shoulder Joint Tissue Using an Endoscope | surgery | $1,718 | $1,718 | $1,718 | 1 |
| Repair of Muscle of Stomach Outlet Into Upper Small Bowel | surgery | $1,721 | $1,721 | $1,721 | 1 |
| Repair of Forearm And/or Wrist Tendon Covering with Graft | surgery | $1,723 | $1,723 | $1,723 | 1 |
| Removal of Gallbladder Using an Endoscope | surgery | $1,725 | $1,725 | $1,725 | 1 |
| Intraop Cyto Path Consult 1 | other | $1,726 | $1,726 | $1,726 | 1 |
| CT Scan Head OR Brain without Contrast | imaging | $1,729 | $1,729 | $1,729 | 1 |
| Biopsy of Growth of Lung | lab | $1,731 | $1,731 | $1,731 | 1 |
| Ca15l2 15cm Reinforced Percutaneous Antenna X1 | other | $1,731 | $1,731 | $1,731 | 1 |
| Ca20l2 Reinforced Percutaneous Antenna Emprint X1 | other | $1,731 | $1,731 | $1,731 | 1 |
| Control of Bleeding of First OR Second Part of Small Bowel Using an Endoscope | other | $1,735 | $1,735 | $1,735 | 1 |
| Treatment of Broken Kneecap with Placement of Stabilizing Device And/or Remov... | other | $1,735 | $1,735 | $1,735 | 1 |
| Amputation of Thigh Through Thigh Bone | other | $1,742 | $1,742 | $1,742 | 1 |
| Biopsy and Aspiration of Bone Marrow Sample for Diagnosis | lab | $1,742 | $1,742 | $1,742 | 1 |
| Treatment of Both Broken Lower Leg Bones At Ankle | other | $1,744 | $1,744 | $1,744 | 1 |
| Destruction of Second and Third Division of Face Nerve Branch | other | $1,745 | $1,745 | $1,745 | 1 |
| Vascular Graft Material, Synthetic, Implant | surgery | $1,745 | $1,745 | $1,745 | 1 |
| Removal of Knee Cartilage Using an Endoscope | surgery | $1,746 | $1,746 | $1,746 | 1 |
| Astigmatism-correct Function | other | $1,746 | $1,746 | $1,746 | 1 |
| Removal of Loose OR Foreign Body in Shoulder Joint Using an Endoscope | surgery | $1,747 | $1,747 | $1,747 | 1 |
| Initiation of Ecmo External Vein to Vein Blood Circulation in Heart and Lungs... | cardiac | $1,753 | $1,753 | $1,753 | 1 |
| Removal of Lymph Nodes of Groin | surgery | $1,757 | $1,757 | $1,757 | 1 |
| Removal of Shoulder Scar Tissue Using an Endoscope | surgery | $1,759 | $1,759 | $1,759 | 1 |
| Small Clip Applier Xi #470401 Intuitive Surgical | surgery | $1,764 | $1,764 | $1,764 | 1 |
| CT Spine | imaging | $1,764 | $668 | $6,049 | 15 |
| Exploration of Neck for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $1,765 | $1,765 | $1,765 | 1 |
| Genomic Sequence Analysis Panel of Dna OR Combined Dna and Rna of 5-50 Genes ... | lab | $1,769 | $1,769 | $1,769 | 1 |
| Destruction of Polyp OR Growth of Small Bowel Using an Endoscope | other | $1,775 | $1,775 | $1,775 | 1 |
| Suture Repair of Ureter | surgery | $1,780 | $1,780 | $1,780 | 1 |
| Removal of Scar Tissue From Knee Using an Endoscope | surgery | $1,781 | $1,781 | $1,781 | 1 |
| Preparatory, Below Knee 'ptb' Type Socket, Non-alignable System, Pylon, No Co... | other | $1,787 | $1,787 | $1,787 | 1 |
| Catheter, Intracardiac Echocardiography | imaging | $1,787 | $1,787 | $1,787 | 1 |
| Incision OR Partial Removal of Middle Portion of Thigh Bone | surgery | $1,791 | $1,791 | $1,791 | 1 |
| Severing of Muscle At Stomach Outlet to Upper Small Bowel | other | $1,794 | $1,794 | $1,794 | 1 |
| Release of Small Bowel Scar Tissue Using an Endoscope | other | $1,795 | $1,795 | $1,795 | 1 |
| Knee Ankle Foot Orthosis, Full Plastic, Double Upright, with OR without Free ... | other | $1,801 | $1,801 | $1,801 | 1 |
| Insertion of Implant in Urethra Within Prostate Gland Using an Endoscope, 1 I... | surgery | $1,802 | $1,802 | $1,802 | 1 |
| Closure of Surgically Created Large OR Small Bowel Opening | surgery | $1,804 | $1,804 | $1,804 | 1 |
| Amputation of Both Lower Leg Bones | other | $1,805 | $1,805 | $1,805 | 1 |
| Fusion of Thumb At Wrist with Bone Graft | surgery | $1,805 | $1,805 | $1,805 | 1 |
| CT Scan of Blood Vessels of Arm with Contrast | imaging | $1,807 | $1,807 | $1,807 | 1 |
| CT Scan of Blood Vessels of Lower Leg with Contrast | imaging | $1,807 | $1,807 | $1,807 | 1 |
| Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram | other | $1,808 | $1,808 | $1,808 | 1 |
| Replacement of Kidney Drainage Tube Using Imaging Guidance with Review By Rad... | surgery | $1,816 | $1,816 | $1,816 | 1 |
| Treatment of 3 OR More Broken Lower Forearm Bone Pieces On Thumb Side Inside ... | other | $1,819 | $1,819 | $1,819 | 1 |
| Balloon Dilation of Artery of Leg, Each Additional Vessel | other | $1,821 | $1,821 | $1,821 | 1 |
| X-ray of Multiple Regions of Spinal Canal with Review By Radiologist | imaging | $1,822 | $1,822 | $1,822 | 1 |
| Removal of Defect in Wall of Esophagus Through Neck | surgery | $1,823 | $1,823 | $1,823 | 1 |
| Partial Removal of Roof of Mouth | surgery | $1,825 | $1,825 | $1,825 | 1 |
| Deb Bone 20 SQ Cm/< | other | $1,825 | $1,825 | $1,825 | 1 |
| Upper GI Endoscopy (EGD) | diagnostic | $1,827 | $1,183 | $5,710 | 4 |
| Labor Room/delivery - General Classification | obstetric | $1,829 | $1,829 | $1,829 | 1 |
| Removal of Foreskin | surgery | $1,829 | $1,829 | $1,829 | 1 |
| Tlso, Triplanar Control, Two Piece Rigid Plastic Shell with Interface Liner, ... | other | $1,830 | $1,830 | $1,830 | 1 |
| Primary Repair of Torn Ligament OR Joint Capsule At Outside Part of Knee | surgery | $1,831 | $1,831 | $1,831 | 1 |
| Injection, Dactinomycin, 0.5 Mg | other | $1,831 | $1,831 | $1,831 | 1 |
| Technetium Tc-99m Tilmanocept, Diagnostic, Up to 0.5 Millicuries | other | $1,835 | $1,835 | $1,835 | 1 |
| MRI Scan of Blood Vessels of Neck without Contrast | imaging | $1,837 | $1,790 | $1,884 | 2 |
| Partial Removal of Finger Bone | surgery | $1,838 | $1,838 | $1,838 | 1 |
| Release of Arm OR Leg Nerve | other | $1,839 | $1,839 | $1,839 | 1 |
| CT Scan of Middle Spine with Contrast | imaging | $1,841 | $1,841 | $1,841 | 1 |
| Removal of Lymph Nodes From Chin to Thyroid Cartilage | surgery | $1,843 | $1,843 | $1,843 | 1 |
| Injection, Penicillin G Benzathine, 100,000 Units | other | $1,843 | $1,843 | $1,843 | 1 |
| Inject Epidural Patch | other | $1,843 | $1,843 | $1,843 | 1 |
| Review By Radiologist of Major Upper Body Vein Image | other | $1,844 | $1,844 | $1,844 | 1 |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck without Contrast | imaging | $1,845 | $1,675 | $2,015 | 2 |
| Incision OR Removal of Spinal Nerve | surgery | $1,847 | $1,847 | $1,847 | 1 |
| Removal and Replacement of Stent in Ureter with Review By Radiologist | surgery | $1,848 | $1,848 | $1,848 | 1 |
| MRI Scan of Blood Vessels of Head with Contrast | imaging | $1,854 | $1,854 | $1,854 | 1 |
| MRI Scan of Blood Vessels of Neck with Contrast | imaging | $1,854 | $1,854 | $1,854 | 1 |
| Secondary Repair of Ruptured Achilles Tendon | surgery | $1,855 | $1,855 | $1,855 | 1 |
| Plastic OR Reconstructive Repair of Throat | surgery | $1,857 | $1,857 | $1,857 | 1 |
| Repair of Torn Ligament And/or Joint Capsule At Front of Knee | surgery | $1,859 | $1,859 | $1,859 | 1 |
| Creation of Open Flap Tract for Drainage of Infected Material From Lining Aro... | other | $1,861 | $1,861 | $1,861 | 1 |
| Insertion of Tube Into Extracranial Artery for Diagnosis OR Treatment with Re... | other | $1,868 | $1,868 | $1,868 | 1 |
| Removal of Leg At Knee Joint | surgery | $1,873 | $1,873 | $1,873 | 1 |
| Addition, Endoskeletal, Knee-shin System, Stance Flexion Feature, Adjustable | other | $1,875 | $1,875 | $1,875 | 1 |
| Nuclear Medicine Study of Kidney, Blood Flow, and Function | imaging | $1,875 | $1,875 | $1,875 | 1 |
| Nuclear Medicine Study, Whole Body Requiring Multiple Imaging Days | imaging | $1,876 | $1,876 | $1,876 | 1 |
| Exploration Behind Abdominal Cavity | other | $1,878 | $1,878 | $1,878 | 1 |
| MRI Scan of Blood Vessels of Head without Contrast | imaging | $1,887 | $1,789 | $1,985 | 2 |
| Complex Measurement of Pressure of Urine Flow in Bladder with Urethra Pressur... | other | $1,888 | $1,888 | $1,888 | 1 |
| Relocation of Nerve and Muscle to Restore Voice Box Function | other | $1,888 | $1,888 | $1,888 | 1 |
| Removal of Infected Skin, Tissue OR Muscle of Abdomen | surgery | $1,888 | $1,888 | $1,888 | 1 |
| Ca30l2 Reinforced Percutaneous Antenna Emprint X1 | other | $1,889 | $1,889 | $1,889 | 1 |
| Cath Ensite Cath Array #ec1000-204 5/bx | other | $1,890 | $1,890 | $1,890 | 1 |
| Removal of Gallbladder with X-ray Study of Bile Ducts Using an Endoscope | imaging | $1,891 | $1,891 | $1,891 | 1 |
| Ropivacaine/ Ketorolac 400 Ml On-q Pump (greenlaw) - Compounded | other | $1,900 | $1,900 | $1,900 | 1 |
| Repair of Knee Joint with Drilling and OR Scraping of Joint Using an Endoscope | surgery | $1,902 | $1,902 | $1,902 | 1 |
| CT Scan of Leg without Contrast | imaging | $1,904 | $1,904 | $1,904 | 1 |
| CT Scan of Leg with Contrast Material | imaging | $1,908 | $1,789 | $2,027 | 2 |
| CT Scan of Abdomen without Contrast | imaging | $1,909 | $1,909 | $1,909 | 1 |
| CT Scan of Pelvis without Contrast | imaging | $1,909 | $1,909 | $1,909 | 1 |
| Replacement of Joint Between Wrist and Fingers Using Tissue | surgery | $1,915 | $1,915 | $1,915 | 1 |
| Colonoscopy (Diagnostic) | diagnostic | $1,916 | $1,600 | $2,656 | 4 |
| Lead, Neurostimulator | other | $1,920 | $1,920 | $1,920 | 1 |
| Removal of Lymph Nodes of Underarm | surgery | $1,920 | $1,920 | $1,920 | 1 |
| Adhesion of Linings of Lung Using an Endoscope | other | $1,923 | $1,923 | $1,923 | 1 |
| Thoracentesis | other | $1,923 | $467 | $2,261 | 13 |
| Injection, Estrogen Conjugated, Per 25 Mg | other | $1,926 | $1,926 | $1,926 | 1 |
| Reopening of Recent Abdominal Incision | other | $1,927 | $1,927 | $1,927 | 1 |
| Insertion of Stents with Balloon Dilation of Coronary Artery OR Branch, Each ... | cardiac | $1,928 | $1,928 | $1,928 | 1 |
| Partial Removal of Breast and Underarm Lymph Nodes | surgery | $1,931 | $1,931 | $1,931 | 1 |
| Recording of Right Lower Heart Chamber Rhythm | cardiac | $1,939 | $1,939 | $1,939 | 1 |
| Glucagon Emergency Kit 1 Mg | emergency | $1,943 | $1,943 | $1,943 | 1 |
| Destr Paravertebrl Nerve | other | $1,944 | $1,944 | $1,944 | 1 |
| Removal of Gallbladder | surgery | $1,945 | $1,945 | $1,945 | 1 |
| Destr L/s Facet Jnt | other | $1,947 | $1,947 | $1,947 | 1 |
| Relocation of Defibrillator Skin Pocket | other | $1,950 | $1,950 | $1,950 | 1 |
| Relocation of Pacemaker Skin Pocket | cardiac | $1,950 | $1,950 | $1,950 | 1 |
| Removal of Gallbladder with Exploration of Common Bile Duct Using an Endoscope | surgery | $1,951 | $1,951 | $1,951 | 1 |
| Repair of Shoulder Rotator Cuff Using an Endoscope | surgery | $1,953 | $1,953 | $1,953 | 1 |
| Removal of Connective Tissue of Palm and Release of Finger, First Digit | surgery | $1,955 | $1,955 | $1,955 | 1 |
| MRI Scan of Leg with Contrast | imaging | $1,958 | $1,538 | $2,377 | 2 |
| Balloon Dilation of Artery with Review By Radiologist, Each Additional Artery | other | $1,959 | $1,959 | $1,959 | 1 |
| Repair of Shoulder Joint Capsule Using an Endoscope | surgery | $1,961 | $1,961 | $1,961 | 1 |
| Lymph OR Ln Nm Scan | other | $1,966 | $1,966 | $1,966 | 1 |
| Shortening of One of the Forearm Bones | other | $1,967 | $1,967 | $1,967 | 1 |
| Suture of Hand OR Foot Digital Nerve, First Digital Nerve | other | $1,968 | $1,968 | $1,968 | 1 |
| Treatment of 3 Broken Lower Leg Bones At Ankle | other | $1,969 | $1,969 | $1,969 | 1 |
| Insertion of Tube for Ecmo External Blood Circulation in Heart and Lungs Usin... | cardiac | $1,970 | $1,970 | $1,970 | 1 |
| Reconstruction of Opening From Small Bowel to Skin | other | $1,970 | $1,970 | $1,970 | 1 |
| CT Scan of Arm with Contrast | imaging | $1,971 | $1,971 | $1,971 | 1 |
| Release And/or Relocation of Cranial Nerve | other | $1,972 | $1,972 | $1,972 | 1 |
| MRI Scan of Jaw Joint | imaging | $1,975 | $1,972 | $1,978 | 2 |
| Valvulotome 1.8 Expandable #1009 | other | $1,979 | $1,979 | $1,979 | 1 |
| Re-amputation of Thigh Through Thigh Bone | other | $1,981 | $1,981 | $1,981 | 1 |
| Treatment of Broken Shin Bone At Knee | other | $1,982 | $1,982 | $1,982 | 1 |
| Catheter, Transluminal Atherectomy, Rotational | cardiac | $1,984 | $1,984 | $1,984 | 1 |
| Balloon Dilation of Coronary Artery OR Branch, Each Additional Artery OR Branch | cardiac | $1,986 | $1,986 | $1,986 | 1 |
| MRI Scan of Both Breasts without Contrast | imaging | $1,987 | $1,987 | $1,987 | 1 |
| Biopsy of Breast and Placement of Locating Device Using X-ray with Needle, Fi... | imaging | $1,987 | $1,987 | $1,987 | 1 |
| Release of Intestinal Scar Tissue | other | $1,994 | $1,994 | $1,994 | 1 |
| Coronary Artery Bypass Using Vein OR Artery Graft, 3 Grafts | cardiac | $1,995 | $1,995 | $1,995 | 1 |
| Indium-111 Pentetate | other | $1,996 | $1,996 | $1,996 | 1 |
| Catheter, Extravascular Tissue Ablation, Any Modality | cardiac | $1,997 | $1,997 | $1,997 | 1 |
| Skin Graft Except for Skin Ulcer OR Cellulitis without Cc/mcc | other | $1,999 | $1,999 | $1,999 | 1 |
| MRI Scan of Chest without Contrast | imaging | $2,003 | $1,915 | $2,090 | 2 |
| Review By Radiologist of Liver Vein Image with Assessment of Blood Flow | other | $2,009 | $2,009 | $2,009 | 1 |
| Removal of Foreskin Using Clamp OR Device | surgery | $2,013 | $2,013 | $2,013 | 1 |
| Repair of Throat At Esophagus | surgery | $2,015 | $2,015 | $2,015 | 1 |
| Repair of Twisted OR Herniated Small Bowel | surgery | $2,019 | $2,019 | $2,019 | 1 |
| Deep Biopsy of Bone Using Needle OR Trocar | lab | $2,024 | $1,519 | $2,528 | 2 |
| Biopsy OR Removal of Lymph Nodes of Breast | surgery | $2,024 | $2,024 | $2,024 | 1 |
| Complicated Reconstruction of Opening From Large Bowel to Skin | other | $2,033 | $2,033 | $2,033 | 1 |
| Csi Burr 1.5 Classic | other | $2,037 | $2,037 | $2,037 | 1 |
| Csi Burr 2.0 Classic | other | $2,037 | $2,037 | $2,037 | 1 |
| Stealth 1.5 Classic Crown #dbp-150classic145 | other | $2,037 | $2,037 | $2,037 | 1 |
| Stealth 2.0 #dbp-200classic145 | other | $2,037 | $2,037 | $2,037 | 1 |
| Stealth Th 1.5 Solid Crown #dbp-150solid145 | other | $2,037 | $2,037 | $2,037 | 1 |
| Suture of Tear OR Hole in Large Bowel | other | $2,037 | $2,037 | $2,037 | 1 |
| Fusion of Part of Wrist Joint with Patient-derived Bone Graft | surgery | $2,039 | $2,039 | $2,039 | 1 |
| Exploration of Ureter | other | $2,041 | $2,041 | $2,041 | 1 |
| Extensive Removal of Tonsils, Tissue, Muscle, and Bone | surgery | $2,048 | $2,048 | $2,048 | 1 |
| Insertion of Sacral Nerve Neurostimulator Electrode | other | $2,051 | $2,051 | $2,051 | 1 |
| Repair of Ruptured Bowel Into Bladder | surgery | $2,054 | $2,054 | $2,054 | 1 |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Ab... | imaging | $2,055 | $2,055 | $2,055 | 1 |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Pe... | imaging | $2,055 | $2,055 | $2,055 | 1 |
| Removal of Joint Lining From Multiple Knee Joint Compartments Using an Endoscope | surgery | $2,056 | $2,056 | $2,056 | 1 |
| Nuclear Medicine Study of Bone Taken At Different Times | imaging | $2,060 | $2,060 | $2,060 | 1 |
| Injection, Ceftazidime and Avibactam, 0.5 G/0.125 G | other | $2,069 | $2,069 | $2,069 | 1 |
| Catheter, Transluminal Intravascular Lithotripsy, Coronary | cardiac | $2,070 | $2,070 | $2,070 | 1 |
| Implantable/insertable Device, Not Otherwise Classified | surgery | $2,070 | $2,070 | $2,070 | 1 |
| Forceps Maryland Bipolar #471172 | other | $2,073 | $2,073 | $2,073 | 1 |
| Removal of Infected Graft of Arm OR Leg | surgery | $2,074 | $2,074 | $2,074 | 1 |
| Respiratory Syncytial Virus Antibody for Injection Into Tissue OR Muscle | other | $2,075 | $2,075 | $2,075 | 1 |
| Removal of Less Than Half of Tongue | surgery | $2,087 | $2,087 | $2,087 | 1 |
| Repair of Tendons of Outer Forearm At Wrist Joint | surgery | $2,089 | $2,089 | $2,089 | 1 |
| Initial Removal of Wedge of Lung Tissue | surgery | $2,092 | $2,092 | $2,092 | 1 |
| Probe, Image-guided, Robotic, Waterjet Ablation | other | $2,094 | $2,094 | $2,094 | 1 |
| Repair Non-healed Fracture of Forearm Bone | surgery | $2,096 | $2,096 | $2,096 | 1 |
| Repair of Eardrum and Ear Canal with Opening to Ear Bones | surgery | $2,096 | $2,096 | $2,096 | 1 |
| Removal of Blood Flow Assist Device in Aorta with Repair of Upper Leg Artery | surgery | $2,101 | $2,101 | $2,101 | 1 |
| Repair of Wound By Transferring Skin, 30.1-60.0 SQ Cm | surgery | $2,102 | $2,102 | $2,102 | 1 |
| Exploration, Drainage, Biopsy, OR Removal of Foreign Body in Chest Cavity | surgery | $2,102 | $2,102 | $2,102 | 1 |
| MRI Scan of Arm with Contrast | imaging | $2,103 | $2,046 | $2,159 | 2 |
| Removal of Middle Ear (mastoid) Bone | surgery | $2,103 | $2,103 | $2,103 | 1 |
| Simple Partial Removal of Bladder | surgery | $2,103 | $2,103 | $2,103 | 1 |
| Fusion of Wrist Joint with Graft From Hip OR Other Bone | surgery | $2,104 | $2,104 | $2,104 | 1 |
| Dupixent 200 Mg/1.14 Ml Syring | other | $2,106 | $2,106 | $2,106 | 1 |
| Dupixent 300 Mg/2 Ml Syringe | other | $2,106 | $2,106 | $2,106 | 1 |
| Repair of Dislocating Kneecap with Realignment | surgery | $2,107 | $2,107 | $2,107 | 1 |
| Pacemaker, Single Chamber, Rate-responsive | cardiac | $2,111 | $2,111 | $2,111 | 1 |
| Partial Removal of Pelvic and Aortic Lymph Nodes | surgery | $2,111 | $2,111 | $2,111 | 1 |
| Replacement of Tunneled Central Venous Tube | surgery | $2,111 | $2,111 | $2,111 | 1 |
| Repositioning of Left Lower Heart Electrode | cardiac | $2,111 | $2,111 | $2,111 | 1 |
| Removal of Growth of Peripheral Nerve | surgery | $2,112 | $2,112 | $2,112 | 1 |
| CT Scan of Middle Spine without Contrast | imaging | $2,113 | $2,113 | $2,113 | 1 |
| Injection, Infliximab, Excludes Biosimilar, 10 Mg | other | $2,114 | $1,366 | $2,861 | 2 |
| Delivery of Complex High Precision Radiation Treatment | obstetric | $2,114 | $2,114 | $2,114 | 1 |
| Insertion of Tube Through the Skin for Ecmo External Blood Circulation in Hea... | other | $2,116 | $2,116 | $2,116 | 1 |
| CT Scan of Abdomen with Contrast | imaging | $2,122 | $2,122 | $2,122 | 1 |
| CT Scan of Face without Contrast | imaging | $2,122 | $2,122 | $2,122 | 1 |
| CT Scan of Pelvis with Contrast | imaging | $2,122 | $2,122 | $2,122 | 1 |
| CT Scan of Soft Tissue of Neck with Contrast | imaging | $2,125 | $2,125 | $2,125 | 1 |
| Creation of Opening From Large Bowel to Skin | other | $2,126 | $2,126 | $2,126 | 1 |
| Initial Removal of Wedge of Lung Tissue Using an Endoscope | surgery | $2,126 | $2,126 | $2,126 | 1 |
| Incision of Mastoid Bone | other | $2,131 | $2,131 | $2,131 | 1 |
| Tying, Incision, and Stripping of Long Leg Vein | other | $2,131 | $2,131 | $2,131 | 1 |
| Endoscopy | preventive | $2,131 | $1,183 | $5,710 | 12 |
| Laryngoscopy | other | $2,136 | $178 | $9,713 | 16 |
| Removal of Gallbladder with X-ray Study of Bile Ducts | imaging | $2,137 | $2,137 | $2,137 | 1 |
| Balloon Viabahn Bx 7mmx59mm 7fr Bxa075902a | other | $2,138 | $2,138 | $2,138 | 1 |
| Removal of Growth of Esophagus Through Chest OR Abdomen | surgery | $2,138 | $2,138 | $2,138 | 1 |
| Injection, Tetanus Immune Globulin, Human, Up to 250 Units | other | $2,138 | $1,963 | $2,313 | 2 |
| Insertion of Blood Flow Assist Device in Aorta Through Skin | other | $2,143 | $2,143 | $2,143 | 1 |
| Removal of Blood Flow Assist Device in Aorta | surgery | $2,143 | $2,143 | $2,143 | 1 |
| Release And/or Relocation of Elbow Nerve | other | $2,145 | $2,145 | $2,145 | 1 |
| Other Antepartum Diagnoses without O.r. Procedures without Cc/mcc | other | $2,150 | $1,562 | $2,738 | 2 |
| Repair of Prolapsed Rectum Through Anus | surgery | $2,152 | $2,152 | $2,152 | 1 |
| Removal of Blood Clot in Artery of Upper Arm | surgery | $2,154 | $2,154 | $2,154 | 1 |
| Strontium Sr-89 Chloride, Therapeutic, Per Millicurie | other | $2,154 | $2,154 | $2,154 | 1 |
| Theraskin, Per Square Centimeter | other | $2,157 | $2,157 | $2,157 | 1 |
| Infasurf 35 Mg/ml Vial | other | $2,159 | $2,159 | $2,159 | 1 |
| Destruction of Cyst of Kidney Using an Endoscope | other | $2,160 | $2,160 | $2,160 | 1 |
| Creation of Opening From Small Bowel to Skin | other | $2,162 | $2,162 | $2,162 | 1 |
| Repair of Inside OR Outside Knee Joint Cartilage Using an Endoscope | surgery | $2,162 | $2,162 | $2,162 | 1 |
| Extensive Removal of Growth of Face OR Scalp, 2.0 Cm OR More | surgery | $2,163 | $2,163 | $2,163 | 1 |
| Removal of Gallbladder with Exploration of Common Bile Duct | surgery | $2,166 | $2,166 | $2,166 | 1 |
| Removal of Both Knee Cartilages Using an Endoscope | surgery | $2,168 | $2,168 | $2,168 | 1 |
| Rabies Immune Globulin for Injection | other | $2,170 | $2,170 | $2,170 | 1 |
| Repair of Dislocating Kneecap | surgery | $2,173 | $2,173 | $2,173 | 1 |
| MRI Scan of Pelvis Before and After Contrast | imaging | $2,174 | $1,795 | $2,553 | 2 |
| Insertion of Brain Neurostimulator Pulse Device with Connection to 2 OR More ... | other | $2,175 | $2,175 | $2,175 | 1 |
| Creation of Opening From Large Bowel to Skin with Multiple Bowel Biopsies | other | $2,176 | $2,176 | $2,176 | 1 |
| Injection, Remdesivir, 1 Mg | other | $2,180 | $1,715 | $2,644 | 2 |
| MRI of the Shoulder | imaging | $2,182 | $163 | $5,980 | 24 |
| CT Scan of Abdominal Aorta and Both Leg Arteries with Contrast | imaging | $2,189 | $1,741 | $2,636 | 2 |
| Creation of Opening From Small Bowel to Skin Using an Endoscope | other | $2,190 | $2,190 | $2,190 | 1 |
| Implantation of Cochlear Stimulating System Into Skull with Attachment Throug... | surgery | $2,191 | $2,191 | $2,191 | 1 |
| Creation of Flap Graft to Nose, Forehead, Temple, OR Scalp | other | $2,192 | $2,192 | $2,192 | 1 |
| Limb Ext Iliac Cuff Left #is20-25/c55 Sa | other | $2,196 | $2,196 | $2,196 | 1 |
| Limb Extension Cuff #is20-25/c65 Sa | other | $2,196 | $2,196 | $2,196 | 1 |
| Limb Extensions Cuff #i16-16/c55f Sa | other | $2,196 | $2,196 | $2,196 | 1 |
| Limb Extensions Cuff #i20-13/c88f Sa | other | $2,196 | $2,196 | $2,196 | 1 |
| Limb Extensions Cuff #i20-20/c55f Sa | other | $2,196 | $2,196 | $2,196 | 1 |
| Removal of Growth of Ear Canal | surgery | $2,196 | $2,196 | $2,196 | 1 |
| Suture of Perforated Ulcer, Wound, OR Injury of Stomach OR Upper Small Bowel | other | $2,203 | $2,203 | $2,203 | 1 |
| Repair of Knee Joint with Bone Graft Using an Endoscope | surgery | $2,204 | $2,204 | $2,204 | 1 |
| Revision of Opening From Large Bowel to Skin with Repair of Hernia | surgery | $2,206 | $2,206 | $2,206 | 1 |
| Gore Excluder Endorosthesis Iliac Branch Comp #hgb161007a | other | $2,210 | $2,210 | $2,210 | 1 |
| Repair of Nerve Using Nerve Graft, First Strand | surgery | $2,215 | $2,215 | $2,215 | 1 |
| Reconstruction of Dislocating Kneecap with Removal | surgery | $2,217 | $2,217 | $2,217 | 1 |
| Repair of Penis | surgery | $2,225 | $2,225 | $2,225 | 1 |
| Zynrelef Implant (bupivacaine | surgery | $2,228 | $2,228 | $2,228 | 1 |
| Imaging of Esophagus Done From the Inside of the Esophagus | other | $2,231 | $2,231 | $2,231 | 1 |
| CT Abdomen and Pelvis without Contrast | imaging | $2,231 | $1,021 | $7,710 | 9 |
| Review By Radiologist of Image for Insertion of Material to Block Blood Flow | other | $2,234 | $2,234 | $2,234 | 1 |
| MRI Scan of Pelvis without Contrast | imaging | $2,239 | $2,078 | $2,400 | 2 |
| MRI Scan of Chest with Contrast | imaging | $2,240 | $2,071 | $2,408 | 2 |
| Coronary Artery Bypass OR Valve Procedure Reoperation More Than 1 Month After... | cardiac | $2,242 | $2,242 | $2,242 | 1 |
| Repair of Nerve with Graft | surgery | $2,242 | $2,242 | $2,242 | 1 |
| Injection of Bile Duct for X-ray Through Already Existing Skin Access Using I... | imaging | $2,243 | $2,243 | $2,243 | 1 |
| Misc Implant | surgery | $2,244 | $2,244 | $2,244 | 1 |
| CT Scan of Chest Before and After Contrast | imaging | $2,244 | $2,244 | $2,244 | 1 |
| Removal of Blood Clot of Artery OR Vein Graft | surgery | $2,245 | $2,245 | $2,245 | 1 |
| Injection, Tocilizumab-aazg (tyenne), Biosimilar, 1 Mg | other | $2,246 | $2,246 | $2,246 | 1 |
| Mechanical Heart Valve Aortic Size 27mm 27agn | cardiac | $2,250 | $2,250 | $2,250 | 1 |
| Suture of Bleeding Stomach Ulcer | other | $2,251 | $2,251 | $2,251 | 1 |
| Gore Excluder Aaa Endoprosthesis 12fr Pll161207 | other | $2,252 | $2,252 | $2,252 | 1 |
| Gore Excluder Aaa Endoprosthesis 16mm X 14.5mm Pll161407 | other | $2,252 | $2,252 | $2,252 | 1 |
| Repair of Nasal Passage | surgery | $2,255 | $2,255 | $2,255 | 1 |
| MRI Scan of Pelvis with Contrast | imaging | $2,256 | $2,232 | $2,280 | 2 |
| Biopsy OR Removal of Foreign Body in Large Bowel | surgery | $2,257 | $2,257 | $2,257 | 1 |
| Suture of Hand Median Motor Nerve | other | $2,259 | $2,259 | $2,259 | 1 |
| Colonoscopy | preventive | $2,259 | $222 | $8,490 | 16 |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck with Contrast | imaging | $2,261 | $2,225 | $2,296 | 2 |
| CT Scan of Soft Tissue of Neck without Contrast | imaging | $2,261 | $2,261 | $2,261 | 1 |
| Dilation of Windpipe Cartilage OR Treatment of Broken Windpipe Cartilage Usin... | other | $2,263 | $2,263 | $2,263 | 1 |
| MRI Spine | imaging | $2,264 | $876 | $6,283 | 26 |
| Incision of Chest Cavity for Complications After Surgery | surgery | $2,267 | $2,267 | $2,267 | 1 |
| Repair of Wrist Joint | surgery | $2,279 | $2,279 | $2,279 | 1 |
| Hearing Aid, Digital, Binaural, Ite | other | $2,280 | $2,280 | $2,280 | 1 |
| Removal of Growth of Windpipe Cartilage | surgery | $2,281 | $2,281 | $2,281 | 1 |
| Reshaping of Bone, Cartilage, And/or Tip of Nose | other | $2,281 | $2,281 | $2,281 | 1 |
| Insertion of Indwelling Tube for Drainage of Lung Fluid | other | $2,284 | $1,642 | $2,925 | 2 |
| Insertion of Stent in Ureter | cardiac | $2,292 | $2,292 | $2,292 | 1 |
| Reconstruction of Ligaments Outside Knee Joint | other | $2,295 | $2,295 | $2,295 | 1 |
| Repair of Upper End of Shin Bone At Knee Joint | surgery | $2,295 | $2,295 | $2,295 | 1 |
| Suture of Tear of Hole in Small Bowel | other | $2,308 | $2,308 | $2,308 | 1 |
| Partial Removal of Small Bowel with Reconnection | surgery | $2,311 | $2,311 | $2,311 | 1 |
| CT Scan of Leg Before and After Contrast | imaging | $2,313 | $1,980 | $2,645 | 2 |
| Removal of Growth Plate of Both Lower Leg Bones | surgery | $2,316 | $2,316 | $2,316 | 1 |
| Isoproterenol 1 Mg/5 Ml Vial | other | $2,319 | $2,319 | $2,319 | 1 |
| Removal OR Destruction of Growth(s) in the Abdomen, 5.0 Cm OR Less | surgery | $2,320 | $2,320 | $2,320 | 1 |
| Revision to Reshape Nasal Bones After Previous Repair | surgery | $2,323 | $2,323 | $2,323 | 1 |
| Gore Excluder Aortic Extender Endoprosthesis 28.5mm X 3.3cm #pla280300 | other | $2,326 | $2,326 | $2,326 | 1 |
| Implantation of Self Cartilage Cells Into Knee Bone | surgery | $2,326 | $2,326 | $2,326 | 1 |
| Removal of Growth of Saliva Gland with Release of Facial Nerve | surgery | $2,329 | $2,329 | $2,329 | 1 |
| Balloon Dilation Treatment of Stricture of Ureter Using Imaging Guidance with... | other | $2,332 | $2,332 | $2,332 | 1 |
| Arthroflex, Per Square Centimeter | other | $2,333 | $2,333 | $2,333 | 1 |
| Removal of Bone Cavity Behind Eye for Decompression | surgery | $2,334 | $2,334 | $2,334 | 1 |
| Removal of Extra Finger | surgery | $2,335 | $2,335 | $2,335 | 1 |
| Catheter, Electrophysiology, Diagnostic/ablation, Other Than 3d OR Vector Map... | cardiac | $2,340 | $2,340 | $2,340 | 1 |
| Lead, Cardioverter-defibrillator, Endocardial Single Coil | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 19mm #esp100-19-00 Epic Supra | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 21mm #e100-21a-00 Epic | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 21mm #esp100-21-00 Epic Supra | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 23mm #e100-23a-00 Epic | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 23mm #esp100-23-00 Epic Supra | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 25mm #e100-25a-00 Epic | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 25mm #esp100-25-00 Epic Supra | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 27mm #e100-27a-00 Epic | other | $2,340 | $2,340 | $2,340 | 1 |
| Valve Aortic 27mm #esp100-27-00 Epic Supra | other | $2,340 | $2,340 | $2,340 | 1 |
| Insertion of Tube Into First Order Main and Accessory Arteries of Kidney for ... | other | $2,341 | $2,341 | $2,341 | 1 |
| Repair of Knee Joint with Bone Graft and Internal Stabilizing Device Using an... | surgery | $2,345 | $2,345 | $2,345 | 1 |
| Delivery of Fixation Device to Graft with Review By Radiologist | obstetric | $2,355 | $2,355 | $2,355 | 1 |
| Repositioning of Pacemaker OR Defibrillator Electrode | cardiac | $2,359 | $2,359 | $2,359 | 1 |
| Injection of Bile Duct for X-ray Through New Skin Access Using Imaging Guidan... | imaging | $2,366 | $2,366 | $2,366 | 1 |
| Placement of External Drainage Tube of Biliary Duct Using Imaging Guidance wi... | other | $2,366 | $2,366 | $2,366 | 1 |
| Placement of Internal-external Drainage Tube of Biliary Duct Using Imaging Gu... | other | $2,366 | $2,366 | $2,366 | 1 |
| Replacement of Liver Duct Drainage Tube Using Imaging Guidance with Review By... | surgery | $2,366 | $2,366 | $2,366 | 1 |
| CT Scan of Blood Vessels of Neck with Contrast | imaging | $2,367 | $2,367 | $2,367 | 1 |
| MRI Scan of Leg Joint without Contrast | imaging | $2,378 | $2,149 | $2,606 | 2 |
| Removal of Stone OR Debris From Bile OR Pancreatic Duct Using a Flexible Endo... | surgery | $2,378 | $2,378 | $2,378 | 1 |
| Dissector Curved Bipolar #471344 | other | $2,381 | $2,381 | $2,381 | 1 |
| Partial Destruction and Reconstruction of Right Upper Heart Chamber | cardiac | $2,385 | $2,385 | $2,385 | 1 |
| Njx Aa&/strd Brach Plexus | other | $2,394 | $2,394 | $2,394 | 1 |
| MRI Scan of Brain without Contrast | imaging | $2,397 | $2,179 | $2,615 | 2 |
| Insertion of Tube Into External Neck Artery for Diagnosis OR Treatment with R... | other | $2,398 | $2,398 | $2,398 | 1 |
| **obsolete** Valve Mitral 25mm Bicor #b100-25m | other | $2,400 | $2,400 | $2,400 | 1 |
| Valve Mitral 25mm #e100-25m-00 Epic | other | $2,400 | $2,400 | $2,400 | 1 |
| Valve Mitral 27mm #b100-27m Bicor | other | $2,400 | $2,400 | $2,400 | 1 |
| Valve Mitral 27mm #e100-27m-00 Epic | other | $2,400 | $2,400 | $2,400 | 1 |
| Valve Mitral 29mm #b100-29m Bicor | other | $2,400 | $2,400 | $2,400 | 1 |
| Valve Mitral 29mm #e100-29m-00 Epic | other | $2,400 | $2,400 | $2,400 | 1 |
| Valve Mitral 31mm #e100-31m-00 Epic | other | $2,400 | $2,400 | $2,400 | 1 |
| Valve Mitral 33mm #e100-33m-00 Epic | other | $2,400 | $2,400 | $2,400 | 1 |
| MRI Scan of Lower Spinal Canal without Contrast | imaging | $2,402 | $2,140 | $2,663 | 2 |
| MRI Scan of Middle Spinal Canal without Contrast | imaging | $2,402 | $2,140 | $2,663 | 2 |
| CT Scan of Lower Spine with Contrast | imaging | $2,405 | $2,405 | $2,405 | 1 |
| CT Scan of Upper Spine with Contrast | imaging | $2,405 | $2,405 | $2,405 | 1 |
| Injection, Carfilzomib, 1 Mg | other | $2,407 | $2,407 | $2,407 | 1 |
| CT Scan of Cranial Cavity Before and After Contrast | imaging | $2,412 | $2,412 | $2,412 | 1 |
| Removal of Lymph Nodes of Neck | surgery | $2,413 | $2,413 | $2,413 | 1 |
| Injection, Crotalidae Polyvalent Immune Fab (ovine), Up to 1 Gram | other | $2,418 | $2,418 | $2,418 | 1 |
| MRI Scan of Leg Joint with Contrast | imaging | $2,420 | $2,329 | $2,510 | 2 |
| Replacement of Joint Between Wrist and Fingers Using Tendon OR Stitches | surgery | $2,424 | $2,424 | $2,424 | 1 |
| Ustekinumab, for Intravenous Injection, 1 Mg | other | $2,428 | $2,428 | $2,428 | 1 |
| Treatment of Broken Side of Lower End of Thigh Bone | other | $2,429 | $2,429 | $2,429 | 1 |
| Other MRI Scan | imaging | $2,431 | $2,431 | $2,431 | 1 |
| CT Scan of Arm Before and After Contrast | imaging | $2,432 | $1,744 | $3,119 | 2 |
| Injection, Phentolamine Mesylate, Up to 5 Mg | other | $2,435 | $2,435 | $2,435 | 1 |
| Partial Removal of Large Bowel with Connection | surgery | $2,444 | $2,444 | $2,444 | 1 |
| Colonoscopy with Polypectomy | other | $2,444 | $932 | $3,968 | 10 |
| MRI Scan of Middle Spinal Canal with Contrast | imaging | $2,445 | $2,055 | $2,835 | 2 |
| Extensive Removal of Growth of Forearm OR Wrist, 3.0 Cm OR More | surgery | $2,446 | $2,446 | $2,446 | 1 |
| Release of Tendon Connecting Biceps Muscle and Shoulder Using an Endoscope | other | $2,451 | $2,451 | $2,451 | 1 |
| Removal of Ureter and Partial Removal of Bladder | surgery | $2,453 | $2,453 | $2,453 | 1 |
| N Block Inj Fem Cont Inf | other | $2,455 | $2,455 | $2,455 | 1 |
| MRI Scan of Upper Spinal Canal without Contrast | imaging | $2,456 | $2,276 | $2,636 | 2 |
| Injection, Trastuzumab-anns, Biosimilar, (kanjinti), 10 Mg | other | $2,456 | $2,456 | $2,456 | 1 |
| Normal Newborn | other | $2,457 | $2,436 | $2,477 | 2 |
| MRI Scan of Abdomen without Contrast | imaging | $2,459 | $2,435 | $2,483 | 2 |
| CT Scan of Blood Vessels of Head with Contrast | imaging | $2,460 | $2,460 | $2,460 | 1 |
| Strengthening of Muscle Between Esophagus and Stomach By Wrapping Part of Sto... | other | $2,461 | $2,461 | $2,461 | 1 |
| Sleep Study (Polysomnography) | diagnostic | $2,461 | $354 | $4,975 | 27 |
| Coronary Artery Bypass Using Vein OR Artery Graft, 4 Grafts | cardiac | $2,462 | $2,462 | $2,462 | 1 |
| Removal of Kidney Stone | surgery | $2,463 | $2,463 | $2,463 | 1 |
| Release of Scar Tissue At Ureter | other | $2,464 | $2,464 | $2,464 | 1 |
| Partial Removal of Small Bowel with Creation of Opening to Skin | surgery | $2,466 | $2,466 | $2,466 | 1 |
| Removal of Lower Part of Stomach with Reattachment of Remaining Stomach to Fi... | surgery | $2,467 | $2,467 | $2,467 | 1 |
| Addition to Lower Extremity, Ischial Containment/narrow M-l Socket | other | $2,468 | $2,468 | $2,468 | 1 |
| Repair Non-healed Fracture of Forearm Bone with Patient-derived Bone Graft | surgery | $2,468 | $2,468 | $2,468 | 1 |
| MRI Scan of Abdomen with Contrast | imaging | $2,471 | $2,237 | $2,704 | 2 |
| Removal of Foreign Body in Lining of Chest Cavity Using an Endoscope | surgery | $2,479 | $2,479 | $2,479 | 1 |
| Leuprolide Acetate (for Depot Suspension), 7.5 Mg | other | $2,487 | $2,487 | $2,487 | 1 |
| Repair of Side of Voice Box By Moving Vocal Cord to Middle | surgery | $2,488 | $2,488 | $2,488 | 1 |
| Injection, Belimumab, 10 Mg | other | $2,489 | $2,489 | $2,489 | 1 |
| Removal of Breast and Underarm Lymph Nodes | surgery | $2,491 | $2,491 | $2,491 | 1 |
| Probe/needle, Cryoablation | other | $2,493 | $2,493 | $2,493 | 1 |
| Endograft Iliac Limb 14x12x160 | other | $2,496 | $2,496 | $2,496 | 1 |
| Removal of Defibrillator | surgery | $2,502 | $2,502 | $2,502 | 1 |
| Removal of Single Electrode From Right Heart | surgery | $2,502 | $2,502 | $2,502 | 1 |
| Primary Removal and Dissolving of Blood Clot From Artery OR Artery Graft Usin... | surgery | $2,508 | $2,508 | $2,508 | 1 |
| Removal of Stomach Ulcer OR Growth | surgery | $2,508 | $2,508 | $2,508 | 1 |
| Stabilization of Thigh Bone with Device | other | $2,508 | $2,508 | $2,508 | 1 |
| Other Circulatory System Diagnoses without Cc/mcc | other | $2,521 | $1,149 | $3,892 | 2 |
| Creation of Large Bowel Opening Using an Endoscope | other | $2,528 | $2,528 | $2,528 | 1 |
| Insertion of Tube in Peripheral Blood Vessel for Heart-lung Machine Support | cardiac | $2,531 | $2,531 | $2,531 | 1 |
| Removal of Malignant Growth of Stomach | surgery | $2,538 | $2,538 | $2,538 | 1 |
| Removal of Plaque with Balloon Dilation of Single Coronary Artery OR Branch | surgery | $2,538 | $2,538 | $2,538 | 1 |
| Repair of Eardrum, Ear Canal, and Bones with Insertion of Prosthesis | surgery | $2,539 | $2,539 | $2,539 | 1 |
| MRI Scan of Leg Before and After Contrast | imaging | $2,543 | $2,312 | $2,773 | 2 |
| MRI of the Brain | imaging | $2,543 | $1,331 | $6,239 | 26 |
| Injection, Tafasitamab-cxix, 2 Mg | other | $2,548 | $2,548 | $2,548 | 1 |
| Injection, Secukinumab, Intravenous, 1 Mg | other | $2,551 | $2,551 | $2,551 | 1 |
| CT Scan of Soft Tissue of Neck Before and After Contrast | imaging | $2,554 | $2,554 | $2,554 | 1 |
| White Blood Cell Count | other | $2,555 | $2,555 | $2,555 | 1 |
| Biopsy of Gallbladder, Pancreatic, Liver, and Bile Ducts Using a Flexible End... | lab | $2,558 | $2,558 | $2,558 | 1 |
| Repair of Paraesophageal Hernia Through Abdomen | surgery | $2,563 | $2,563 | $2,563 | 1 |
| Review By Radiologist of Abdominal Aorta Image | other | $2,564 | $2,564 | $2,564 | 1 |
| MRI Scan of Upper Spinal Canal with Contrast | imaging | $2,564 | $2,316 | $2,812 | 2 |
| Exploration of Neck Artery | other | $2,566 | $2,566 | $2,566 | 1 |
| IUD Insertion | other | $2,572 | $71 | $9,904 | 29 |
| CT Scan of Middle Spine Before and After Contrast | imaging | $2,581 | $2,412 | $2,750 | 2 |
| Complex Repair of Eardrum and Ear Canal with Removal of Mastoid Bone | surgery | $2,583 | $2,583 | $2,583 | 1 |
| Biopsy of Lobe of Lung Using an Endoscope, 1 Lobe | lab | $2,587 | $2,587 | $2,587 | 1 |
| Repair of Shoulder Socket Using an Endoscope | surgery | $2,590 | $2,590 | $2,590 | 1 |
| MRI of the Lower Back (Lumbar) | imaging | $2,592 | $1,886 | $6,283 | 8 |
| Suture and Relocation of Arm OR Leg Peripheral Nerve | other | $2,593 | $2,593 | $2,593 | 1 |
| CT Scan of Head OR Brain Before and After Contrast | imaging | $2,594 | $2,594 | $2,594 | 1 |
| Cardiac Catheterization | cardiac | $2,597 | $101 | $99,048 | 26 |
| Insertion of Tube Into Gallbladder Using Imaging Guidance with Review By Radi... | other | $2,600 | $2,600 | $2,600 | 1 |
| Incision and Exploration of Chest Cavity | other | $2,601 | $2,601 | $2,601 | 1 |
| MRI Scan of Lower Spinal Canal with Contrast | imaging | $2,602 | $2,525 | $2,679 | 2 |
| Repair of Paraesophageal Hernia Through Chest | surgery | $2,610 | $2,610 | $2,610 | 1 |
| Incision of Pancreatic Outlet Using a Flexible Endoscope | other | $2,630 | $2,630 | $2,630 | 1 |
| Removal of Gallbladder and Creation of Bile Duct Drainage to Bowel | surgery | $2,634 | $2,634 | $2,634 | 1 |
| Removal of Kidney and Partial Removal of Ureter Using an Endoscope | surgery | $2,635 | $2,635 | $2,635 | 1 |
| CT Scan of Blood Vessels of Abdomen with Contrast | imaging | $2,636 | $2,636 | $2,636 | 1 |
| Repositioning of Ureter Using an Endoscope | other | $2,638 | $2,638 | $2,638 | 1 |
| Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm OR Dissection; Us... | surgery | $2,641 | $2,641 | $2,641 | 1 |
| Repair of Rectal Prolapse Using an Endoscope | surgery | $2,641 | $2,641 | $2,641 | 1 |
| CT Scan of Blood Vessels of Chest with Contrast | imaging | $2,643 | $2,643 | $2,643 | 1 |
| Veklury 100 Mg Vial | other | $2,644 | $2,644 | $2,644 | 1 |
| Removal of Defibrillator Electrodes Through Vein | surgery | $2,644 | $2,644 | $2,644 | 1 |
| Removal of Dual Electrodes From Right Heart | surgery | $2,644 | $2,644 | $2,644 | 1 |
| MRI Scan of Arm Joint without Contrast | imaging | $2,645 | $2,645 | $2,645 | 1 |
| Endograft Iliac Limb 14x10x100 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x10x160 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x12x100 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x12x120 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x12x140 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x14x100 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x14x120 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x14x140 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x14x160 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x14x80 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x16x100 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x16x120 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x16x140 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x16x160 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x18x120 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x18x140 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x22x140 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x22x160 | other | $2,646 | $2,646 | $2,646 | 1 |
| Endograft Iliac Limb 14x28x140 | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Ext System Ovation Ix Pma 10-10-45 #tv-ex101045-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Ext System Ovation Ix Pma 12-12-45 #tv-ex121245-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Ext System Ovation Ix Pma 14-14-45 #tv-ex141445-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Ext System Ovation Ix Pma 16-16-45 #tv-ex161645-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Ext System Ovation Ix Pma 18-18-45 #tv-ex181845-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Ext System Ovation Ix Pma 28-28-45 #tv-ex282845-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-10-120 #tv-il1410120-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-10-80 #tv-il141080-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-12-80 #tv-il141280-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-16-80 #tv-il141680-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-18-100 #tv-il1418100-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-18-160 #tv-il1418160-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-18-80 #tv-il141880-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-22-100 #tv-il1422100-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-22-120 #tv-il1422120-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-22-80 #tv-il142280-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-28-100 #tv-il1428100-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-28-120 #tv-il1428120-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Iliac Limb System Ovation Ix Pma 14-28-80 #tv-il142880-j | other | $2,646 | $2,646 | $2,646 | 1 |
| Ovation Ix Iliac Stent Graft Tv-il1428160-j | cardiac | $2,646 | $2,646 | $2,646 | 1 |
| Placement of Tube of Kidney Using Imaging Guidance with Review By Radiologist | other | $2,647 | $2,647 | $2,647 | 1 |
| Exploration of Abdomen for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $2,648 | $2,648 | $2,648 | 1 |
| Insertion of Stent in Groin Artery, Additional Vessel | cardiac | $2,648 | $2,648 | $2,648 | 1 |
| CT Scan of Abdomen Before and After Contrast | imaging | $2,650 | $2,650 | $2,650 | 1 |
| CT Scan of Pelvis Before and After Contrast | imaging | $2,650 | $2,650 | $2,650 | 1 |
| Injection, Trastuzumab-dkst, Biosimilar, (ogivri), 10 Mg | other | $2,651 | $2,651 | $2,651 | 1 |
| Extensive Removal of Growth of Neck OR Front of Chest, 5.0 Cm OR More | surgery | $2,651 | $2,651 | $2,651 | 1 |
| Removal of Plaque, Insertion of Stent and Balloon Dilation of Single Coronary... | surgery | $2,653 | $2,653 | $2,653 | 1 |
| Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Li... | other | $2,654 | $2,654 | $2,654 | 1 |
| Insertion of Tube Into First Order Main and Accessory Arteries of Both Kidney... | other | $2,657 | $2,657 | $2,657 | 1 |
| Reconstruction of Wrist Joint | other | $2,665 | $2,665 | $2,665 | 1 |
| MRI Scan of Arm without Contrast | imaging | $2,668 | $2,659 | $2,676 | 2 |
| Removal of Uterus, Tubes, And/or Ovaries Through Abdomen Using an Endoscope, ... | surgery | $2,672 | $2,672 | $2,672 | 1 |
| Connection of Ureter to Bladder | other | $2,679 | $2,679 | $2,679 | 1 |
| Partial Removal of Small and Large Bowel with Attachment of Small and Large B... | surgery | $2,687 | $2,687 | $2,687 | 1 |
| Injection, Fomepizole, 15 Mg | other | $2,694 | $2,694 | $2,694 | 1 |
| Other Male Reproductive System O.r. Procedures Except Malignancy with Cc/mcc | other | $2,700 | $2,700 | $2,700 | 1 |
| Repair of Knee Cartilage and Bone with Patient-derived Healthy Cartilage Tran... | surgery | $2,702 | $2,702 | $2,702 | 1 |
| Removal of Vena Cava Filter with Review By Radiologist | surgery | $2,705 | $2,705 | $2,705 | 1 |
| Closure of Abnormal Drainage Tract From Small Bowel to Urinary Bladder with R... | other | $2,706 | $2,706 | $2,706 | 1 |
| Injection, Risperidone (risperdal Consta), 0.5 Mg | other | $2,710 | $2,710 | $2,710 | 1 |
| Angiojet Solent Dista Set #111303 | other | $2,712 | $2,712 | $2,712 | 1 |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck Before and After Contrast | imaging | $2,714 | $2,431 | $2,996 | 2 |
| Destruction of Heart Conduction Tissue to Create Heart Block | cardiac | $2,719 | $2,719 | $2,719 | 1 |
| Transfer of Chest Artery to Neck Artery and Repair of Descending Aorta | surgery | $2,728 | $2,728 | $2,728 | 1 |
| Ultrasound Evaluation of Heart Blood Vessel During Diagnosis OR Treatment, In... | imaging | $2,743 | $2,743 | $2,743 | 1 |
| Repair of Tear of Lung And/or Control of Traumatic Bleeding Through Chest | surgery | $2,746 | $2,746 | $2,746 | 1 |
| Drainage of Hematoma/fluid | other | $2,751 | $2,751 | $2,751 | 1 |
| Reconstruction of Ear Canal | other | $2,755 | $2,755 | $2,755 | 1 |
| Removal of Total Knee Joint Prosthesis | surgery | $2,756 | $2,756 | $2,756 | 1 |
| Insertion of Abdominal Tube Using Imaging Guidance with Review By Radiologist | other | $2,759 | $2,759 | $2,759 | 1 |
| Simple Surgical Treatment of Kidney Stone with Imaging Guidance | surgery | $2,759 | $2,759 | $2,759 | 1 |
| Partial Removal of Chest Cavity Lining and Lung Lining Using an Endoscope | surgery | $2,759 | $2,759 | $2,759 | 1 |
| CT Scan of Lower Spine without Contrast | imaging | $2,762 | $2,762 | $2,762 | 1 |
| Repair of Eardrum, Ear Canal, and Bones | surgery | $2,763 | $2,763 | $2,763 | 1 |
| MRI Scan of Blood Vessels of Neck Before and After Contrast | imaging | $2,767 | $2,670 | $2,863 | 2 |
| Injection, Cangrelor, 1 Mg | other | $2,768 | $2,768 | $2,768 | 1 |
| Addition to Lower Limb Prosthesis, Multiaxial Ankle with Swing Phase Active D... | other | $2,771 | $2,771 | $2,771 | 1 |
| CT Scan of Face Before and After Contrast | imaging | $2,779 | $2,779 | $2,779 | 1 |
| Repair of Rectal Prolapse with Partial Removal of Lower Large Bowel Using an ... | surgery | $2,782 | $2,782 | $2,782 | 1 |
| CT Abdomen and Pelvis | imaging | $2,783 | $729 | $7,710 | 20 |
| CT Scan of Blood Vessels of Pelvis with Contrast | imaging | $2,784 | $2,784 | $2,784 | 1 |
| Event Recorder, Cardiac | cardiac | $2,787 | $2,787 | $2,787 | 1 |
| Processing, Preserving and Transporting Corneal Tissue | other | $2,790 | $2,790 | $2,790 | 1 |
| Removal of Growth of Saliva Gland OR Saliva Gland with Release of Facial Nerve | surgery | $2,791 | $2,791 | $2,791 | 1 |
| Removal of Lymph Nodes of Both Sides of Pelvis Using an Endoscope | surgery | $2,795 | $2,795 | $2,795 | 1 |
| Hearing Aid, Digital, Binaural, Bte | other | $2,796 | $2,796 | $2,796 | 1 |
| Repair of Chronic Injury to Muscle Separating Chest and Abdominal Cavities | surgery | $2,804 | $2,804 | $2,804 | 1 |
| Removal of Air Sac of Lung Using an Endoscope | surgery | $2,806 | $2,806 | $2,806 | 1 |
| Partial Removal of Large Bowel Using an Endoscope | surgery | $2,815 | $2,815 | $2,815 | 1 |
| Removal of Thymus Gland Using an Endoscope | surgery | $2,817 | $2,817 | $2,817 | 1 |
| Catheter, Transluminal Angioplasty, Non-laser | cardiac | $2,820 | $2,820 | $2,820 | 1 |
| Ethacrynate Sodium 50 Mg Vial | other | $2,825 | $2,825 | $2,825 | 1 |
| Destruction of Stone of Bile OR Pancreatic Duct Using a Flexible Endoscope | other | $2,827 | $2,827 | $2,827 | 1 |
| MRI Scan of Leg without Contrast | imaging | $2,831 | $2,461 | $3,200 | 2 |
| Injection, Secretin, Synthetic, Human, 1 Microgram | other | $2,834 | $2,834 | $2,834 | 1 |
| Insert Picc Cath - OR | other | $2,836 | $2,836 | $2,836 | 1 |
| Endurant Ii Contralateral Limb 16mm X 16mm X 124mm #etlw1616c124e | other | $2,837 | $2,837 | $2,837 | 1 |
| Suture of Injured Bile Duct | other | $2,839 | $2,839 | $2,839 | 1 |
| MRI Scan of Chest Before and After Contrast | imaging | $2,839 | $2,431 | $3,247 | 2 |
| Below Knee, Molded Socket, Shin, Sach Foot, Endoskeletal System | other | $2,845 | $2,845 | $2,845 | 1 |
| Catheter, Electrophysiology, Diagnostic/ablation, 3d OR Vector Mapping | cardiac | $2,846 | $2,846 | $2,846 | 1 |
| Repair of Prolapsed Rectum Through Abdomen and Anus | surgery | $2,847 | $2,847 | $2,847 | 1 |
| Extensive Removal of Growth of Back OR Lower Side, 5.0 Cm OR More | surgery | $2,849 | $2,849 | $2,849 | 1 |
| Injection, Onabotulinumtoxina, 1 Unit | other | $2,849 | $2,849 | $2,849 | 1 |
| Kidney and Urinary Tract Neoplasms without Cc/mcc | other | $2,853 | $2,853 | $2,853 | 1 |
| Pacemaker, Dual Chamber, Rate-responsive | cardiac | $2,856 | $2,856 | $2,856 | 1 |
| Dexametha Opth Insert 0.1 Mg | imaging | $2,867 | $2,867 | $2,867 | 1 |
| Partial Removal of Large Bowel with Creation of Opening From Large Bowel to Skin | surgery | $2,873 | $2,873 | $2,873 | 1 |
| CT Scan of Lower Spine Before and After Contrast | imaging | $2,877 | $2,471 | $3,282 | 2 |
| MRI Scan of Brain with Contrast | imaging | $2,885 | $2,555 | $3,215 | 2 |
| Drainage of Abscess OR Cyst of Liver | other | $2,885 | $2,885 | $2,885 | 1 |
| Insertion of Sacral Nerve Neurostimulator Electrode Array | other | $2,896 | $2,896 | $2,896 | 1 |
| Partial Removal of Large Bowel with Creation of Opening From Large Bowel to S... | surgery | $2,899 | $2,899 | $2,899 | 1 |
| Closure of Surgically Created Large OR Small Bowel Opening with Bowel Removal... | surgery | $2,900 | $2,900 | $2,900 | 1 |
| Replacement of Knee Joint On Side of Knee | surgery | $2,906 | $2,906 | $2,906 | 1 |
| MRI Scan of Blood Vessels of Head Before and After Contrast | imaging | $2,913 | $2,913 | $2,913 | 1 |
| Addition, Endoskeletal System, High Activity Knee Control Frame | other | $2,916 | $2,916 | $2,916 | 1 |
| Repair of Paraesophageal Hernia with Mesh Implant Through Abdomen | surgery | $2,920 | $2,920 | $2,920 | 1 |
| Addition, Endoskeletal Knee-shin System, Single Axis, Fluid Swing and Stance ... | other | $2,921 | $2,921 | $2,921 | 1 |
| Diagnostic Exam of Gallbladder and Pancreatic, Liver, and Bile Ducts Using an... | other | $2,924 | $2,924 | $2,924 | 1 |
| MRI of the Knee | imaging | $2,925 | $370 | $6,283 | 24 |
| Coronary Artery Bypass Using Vein OR Artery Graft, 5 Grafts | cardiac | $2,936 | $2,936 | $2,936 | 1 |
| Injection, Trastuzumab, Excludes Biosimilar, 10 Mg | other | $2,945 | $2,945 | $2,945 | 1 |
| Injection, Dalbavancin, 5 Mg | other | $2,947 | $2,947 | $2,947 | 1 |
| MRI Scan of Arm Joint with Contrast | imaging | $2,948 | $2,159 | $3,737 | 2 |
| Closure of Opening From Large OR Small Bowel to Skin Using an Endoscope | other | $2,953 | $2,953 | $2,953 | 1 |
| Repair of Nonhealed Broken Thigh Bone with Self Bone Graft | surgery | $2,954 | $2,954 | $2,954 | 1 |
| Insertion of Tube Into Second OR Third Order Branches of Arteries of Kidney f... | other | $2,959 | $2,959 | $2,959 | 1 |
| Ankle Surgery | other | $2,960 | $400 | $13,546 | 6 |
| Replacement, Socket, Below Knee, Molded to Patient Model | surgery | $2,963 | $2,963 | $2,963 | 1 |
| CT Scan of Blood Vessels of Abdomen and Pelvis with Contrast | imaging | $2,968 | $2,968 | $2,968 | 1 |
| MRI Scan of Leg Joint Before and After Contrast | imaging | $2,970 | $2,911 | $3,028 | 2 |
| Repair of Anterior Cruciate Ligament of Knee Using an Endoscope | surgery | $2,976 | $2,976 | $2,976 | 1 |
| Epic Plus Aortic Valve 29mm E200-29a | other | $2,983 | $2,983 | $2,983 | 1 |
| Epic Supra Plus Aortic Valve 19mm Esp200 | other | $2,983 | $2,983 | $2,983 | 1 |
| Epic Supra Plus Aortic Valve 21mm Esp200 | other | $2,983 | $2,983 | $2,983 | 1 |
| Epic Supra Plus Aortic Valve 23mm Esp200 | other | $2,983 | $2,983 | $2,983 | 1 |
| Epic Supra Plus Aortic Valve 25mm Esp200 | other | $2,983 | $2,983 | $2,983 | 1 |
| Epic Supra Plus Aortic Valve 27mm Esp200 | other | $2,983 | $2,983 | $2,983 | 1 |
| Repair of Eardrum and Ear Canal with Removal of Middle Ear Bone | surgery | $2,986 | $2,986 | $2,986 | 1 |
| Injection, Paclitaxel Protein-bound Particles, 1 Mg | other | $2,986 | $2,986 | $2,986 | 1 |
| CT Scan of Upper Spine Before and After Contrast | imaging | $2,995 | $2,396 | $3,593 | 2 |
| Repair of Muscle At Lower Esophagus and Stomach Using an Endoscope | surgery | $2,997 | $2,997 | $2,997 | 1 |
| Other Procedure On Stomach | other | $3,000 | $3,000 | $3,000 | 1 |
| Repair of Kidney Using an Endoscope | surgery | $3,004 | $3,004 | $3,004 | 1 |
| Endograft Vela Infrarenal #a25-25/c75v | other | $3,015 | $3,015 | $3,015 | 1 |
| Endograft Vela Infrarenal #a28-28/c95v | other | $3,015 | $3,015 | $3,015 | 1 |
| Endograft Vela Infrarenal #a34-34/c100v | other | $3,015 | $3,015 | $3,015 | 1 |
| Endograft Vela Infrarenal #a34-34/c80v | other | $3,015 | $3,015 | $3,015 | 1 |
| Vela Suprarenal Endograft 25mm X 25mm / 75mm X 20mm #a25-25/c75-o20v | other | $3,015 | $3,015 | $3,015 | 1 |
| Insertion of Tube Into Chest Artery for Diagnosis OR Treatment with Review By... | other | $3,018 | $3,018 | $3,018 | 1 |
| Partial Replacement of Thigh Bone At Hip Joint with Prosthesis | surgery | $3,021 | $3,021 | $3,021 | 1 |
| Neonate with Other Significant Problems | other | $3,025 | $2,895 | $3,154 | 2 |
| Addition, Endoskeletal Knee-shin System, Polycentric, Hydraulic Swing Phase C... | other | $3,027 | $3,027 | $3,027 | 1 |
| Repair of Eardrum, Ear Canal, and Bones with Placement of Implant and Opening... | surgery | $3,029 | $3,029 | $3,029 | 1 |
| Custom Breast Prosthesis, Post Mastectomy, Molded to Patient Model | other | $3,037 | $3,037 | $3,037 | 1 |
| Removal of Kidney, Lymph Nodes, And/or Blood Clot From Major Vein with Partia... | surgery | $3,037 | $3,037 | $3,037 | 1 |
| Closure of Abnormal Drainage Tract Within Small Bowel OR Small to Large Bowel | other | $3,039 | $3,039 | $3,039 | 1 |
| Injection, Belatacept, 1 Mg | other | $3,055 | $3,055 | $3,055 | 1 |
| Release of Major Arm OR Leg Nerve | other | $3,056 | $3,056 | $3,056 | 1 |
| 25mj-501 Valve Mitral Size 25 Mm Rotatable Standard Cuff Mechanical | other | $3,060 | $3,060 | $3,060 | 1 |
| Valve Aortic Mechanical 21mm #21aj | other | $3,060 | $3,060 | $3,060 | 1 |
| Valve Mitral 27mm St Jude Cuffed #27mj | other | $3,060 | $3,060 | $3,060 | 1 |
| Valve Mitral 29mm St Jude Cuffed #29mj | other | $3,060 | $3,060 | $3,060 | 1 |
| Valve Mitral 31mm St Jude Cuffed #31mj | other | $3,060 | $3,060 | $3,060 | 1 |
| Valve Mitral 33mm St Jude Cuffed #33mj | other | $3,060 | $3,060 | $3,060 | 1 |
| Biopsy of Breast and Placement of Locating Device Using Mri, First Growth | imaging | $3,061 | $3,061 | $3,061 | 1 |
| Partial Removal of Large Bowel and Reattachment to Rectum | surgery | $3,061 | $3,061 | $3,061 | 1 |
| Insertion of Electrode to Outer Layer of Heart | cardiac | $3,067 | $3,067 | $3,067 | 1 |
| Insertion of Electrode to Outer Layer of Heart Using an Endoscope | cardiac | $3,071 | $3,071 | $3,071 | 1 |
| Removal of Cyst Below Breast Bone | surgery | $3,072 | $3,072 | $3,072 | 1 |
| Hosp Obs Hrs 8 & Above | other | $3,091 | $3,091 | $3,091 | 1 |
| Partial Removal of Large Bowel with Creation of Opening to Skin | surgery | $3,092 | $3,092 | $3,092 | 1 |
| Mitomycin Pyelocalyceal Instillation, 1 Mg | other | $3,097 | $3,097 | $3,097 | 1 |
| All Lower Extremity Prostheses, Flex-walk System OR Equal | other | $3,098 | $3,098 | $3,098 | 1 |
| Review By Radiologist of Imaging Guidance for Removal of Blood Sample | surgery | $3,104 | $3,104 | $3,104 | 1 |
| Removal of Blood Clot in Artery of Lower Leg | surgery | $3,106 | $3,106 | $3,106 | 1 |
| Removal of Air Sac of Lung Through Chest | surgery | $3,107 | $3,107 | $3,107 | 1 |
| MRI Scan of Abdomen Before and After Contrast | imaging | $3,109 | $3,074 | $3,143 | 2 |
| Repair of Collapsed Nostril Using Implant in Side of Nose | surgery | $3,119 | $3,119 | $3,119 | 1 |
| Valve Aortic 19mm Mech #19agn | other | $3,120 | $3,120 | $3,120 | 1 |
| Valve Aortic 21mm Mech #21agn | other | $3,120 | $3,120 | $3,120 | 1 |
| Valve Aortic 23mm Mech #23agn | other | $3,120 | $3,120 | $3,120 | 1 |
| Valve Aortic 25mm Mech #25agn | other | $3,120 | $3,120 | $3,120 | 1 |
| Reshaping of Bony Cartilage Dividing Nasal Passages | other | $3,127 | $3,127 | $3,127 | 1 |
| Removal of Blood Clot and Portion of Upper Thigh Artery | surgery | $3,127 | $3,127 | $3,127 | 1 |
| Removal of Kidney and Ureter Using an Endoscope | surgery | $3,128 | $3,128 | $3,128 | 1 |
| Removal of Defect in Wall of Esophagus Through Chest | surgery | $3,131 | $3,131 | $3,131 | 1 |
| Partial Removal of Kidney Using an Endoscope | surgery | $3,137 | $3,137 | $3,137 | 1 |
| Review By Radiologist of Arteries of Both Lungs Image | other | $3,139 | $3,139 | $3,139 | 1 |
| Laminectomy (Back Decompression) | other | $3,139 | $2,711 | $15,929 | 5 |
| Partial Removal and Reconnection of Small Bowel Using an Endoscope | surgery | $3,145 | $3,145 | $3,145 | 1 |
| Partial Removal of Kidney | surgery | $3,157 | $3,157 | $3,157 | 1 |
| Insertion OR Replacement of Ear Bone Hearing Device | surgery | $3,165 | $3,165 | $3,165 | 1 |
| CT Scan of the Abdomen and Pelvis | imaging | $3,166 | $1,610 | $7,710 | 4 |
| Complex Surgical Treatment of Kidney Stone with Imaging Guidance | surgery | $3,171 | $3,171 | $3,171 | 1 |
| Correction of Abnormal Rotation of Small Bowel | other | $3,173 | $3,173 | $3,173 | 1 |
| Repositioning of Ureter and Insertion of Stent Using an Endoscope | cardiac | $3,173 | $3,173 | $3,173 | 1 |
| Extensive Repair of Eardrum and Ear Canal with Removal of Middle Ear Bone | surgery | $3,175 | $3,175 | $3,175 | 1 |
| Placement of Stent of Ureter and Separate Tube in Kidney Through New Skin Acc... | cardiac | $3,178 | $3,178 | $3,178 | 1 |
| Epic Mitral Plus Mitral Valve 29mm E200-29m | other | $3,180 | $3,180 | $3,180 | 1 |
| Epic Mitral Plus Mitral Valve 31mm E200-31m | other | $3,180 | $3,180 | $3,180 | 1 |
| Epic Mitral Plus Mitral Valve 33mm E200-33m | other | $3,180 | $3,180 | $3,180 | 1 |
| CT Scan of Upper Spine without Contrast | imaging | $3,180 | $3,180 | $3,180 | 1 |
| Injection, Tocilizumab, 1 Mg | other | $3,187 | $3,187 | $3,187 | 1 |
| Removal of Cyst OR Growth of Chest Cavity Using an Endoscope | surgery | $3,187 | $3,187 | $3,187 | 1 |
| Partial Removal of Large Bowel with Creation of 2 Openings From Small OR Larg... | surgery | $3,190 | $3,190 | $3,190 | 1 |
| Extensive Removal of Growth of Pelvis and Hip, Less Than 5.0 Cm | surgery | $3,191 | $3,191 | $3,191 | 1 |
| Gore Excluder Aaa Endoprosthesis 12fr Plc121000 | other | $3,201 | $3,201 | $3,201 | 1 |
| Gore Excluder Aaa Endoprosthesis Plc141000 | other | $3,201 | $3,201 | $3,201 | 1 |
| Gore Excluder Aaa Endoprosthesis Plc141200 | other | $3,201 | $3,201 | $3,201 | 1 |
| Gore Excluder Aaa Endoprosthesis 16mm X 1105cm Plc161200 | other | $3,203 | $3,203 | $3,203 | 1 |
| Removal of Kidney and Ureter with Partial Removal of Bladder Through Same Inc... | surgery | $3,206 | $3,206 | $3,206 | 1 |
| Cystoscopy | diagnostic | $3,207 | $423 | $10,948 | 18 |
| MRI Scan of Arm Before and After Contrast | imaging | $3,208 | $2,465 | $3,950 | 2 |
| Repair of Lung Airway with Graft | surgery | $3,211 | $3,211 | $3,211 | 1 |
| Exclusion of Appendage of Left Upper Chamber of Heart Using an Endoscope | cardiac | $3,218 | $3,218 | $3,218 | 1 |
| Implantation of Donor Cartilage Cells Into Knee Joint | surgery | $3,229 | $3,229 | $3,229 | 1 |
| Injection, Dmso, Dimethyl Sulfoxide, 50%, 50 Ml | other | $3,232 | $3,232 | $3,232 | 1 |
| Injection, Crotalidae Immune F(ab')2 (equine), 120 Mg | other | $3,234 | $3,234 | $3,234 | 1 |
| Insertion of Tube Through the Chest for Ecmo External Blood Circulation in He... | other | $3,235 | $3,235 | $3,235 | 1 |
| Atricure Isolator Synergy Encompass Long #olh | other | $3,240 | $3,240 | $3,240 | 1 |
| Reconstruction Ligaments Inside Knee Joint | other | $3,242 | $3,242 | $3,242 | 1 |
| Cath, Bal Dil, Non-vascular | other | $3,247 | $3,247 | $3,247 | 1 |
| Carpal Tunnel Release | surgery | $3,251 | $229 | $8,082 | 12 |
| Addition to Lower Limb Prosthesis, Vacuum Pump, Residual Limb Volume Manageme... | other | $3,261 | $3,261 | $3,261 | 1 |
| Removal of Blood Clot in Neck to Chest Artery | surgery | $3,263 | $3,263 | $3,263 | 1 |
| MRI Scan of Middle Spinal Canal Before and After Contrast | imaging | $3,269 | $3,045 | $3,493 | 2 |
| Removal of Lobe of Lung | surgery | $3,271 | $3,271 | $3,271 | 1 |
| Secondary Removal and Dissolving of Blood Clot From Artery OR Artery Graft Us... | surgery | $3,277 | $3,277 | $3,277 | 1 |
| Osteogenesis Stimulator, Electrical, Surgically Implanted | surgery | $3,285 | $3,285 | $3,285 | 1 |
| MRI Scan of Upper Spinal Canal Before and After Contrast | imaging | $3,289 | $3,084 | $3,493 | 2 |
| Removal of Rectum for Congenital Defect Through Abdomen and Region Between Th... | surgery | $3,292 | $3,292 | $3,292 | 1 |
| Partial Removal of Stomach with Attachment of Stomach to Small Bowel | surgery | $3,293 | $3,293 | $3,293 | 1 |
| Atriclip Pro-v Device 35mm #prov35 | other | $3,300 | $3,300 | $3,300 | 1 |
| Atriclip Pro-v Device 45mm #prov45 | other | $3,300 | $3,300 | $3,300 | 1 |
| Atriclip Pro-v Device 50mm #prov50 | other | $3,300 | $3,300 | $3,300 | 1 |
| Atriclip Prov-5 Device 40mm #prov40 | other | $3,300 | $3,300 | $3,300 | 1 |
| Repair of Knee Cartilage and Bone with Donor Cartilage Graft Using an Endoscope | surgery | $3,302 | $3,302 | $3,302 | 1 |
| Replacement of Knee Joint, Both Sides of Knee | surgery | $3,308 | $3,308 | $3,308 | 1 |
| IOL Crystalens OR Trulign | other | $3,312 | $3,312 | $3,312 | 1 |
| MRI Scan of Arm Joint Before and After Contrast | imaging | $3,316 | $2,525 | $4,106 | 2 |
| Repair of Aneurysm OR Arm Artery with Graft | surgery | $3,317 | $3,317 | $3,317 | 1 |
| MRI Scan of Lower Spinal Canal Before and After Contrast | imaging | $3,321 | $3,148 | $3,493 | 2 |
| Repair of Abnormal Artery-vein Connection in Arm OR Leg | surgery | $3,330 | $3,330 | $3,330 | 1 |
| Placement of Stent of Ureter Through Existing Skin Access Using Imaging Guida... | cardiac | $3,342 | $3,342 | $3,342 | 1 |
| Removal of Chest Cavity Lining and Lung Lining Using an Endoscope | surgery | $3,343 | $3,343 | $3,343 | 1 |
| Removal of Blood Clot in Artery of Groin and Leg | surgery | $3,354 | $3,354 | $3,354 | 1 |
| Byetta 5 Mcg Dose Pen Inj | other | $3,355 | $3,355 | $3,355 | 1 |
| Byetta 10 Mcg Dose Pen Inj | other | $3,355 | $3,355 | $3,355 | 1 |
| Removal of Extra Skin and Tissue of Abdomen | surgery | $3,355 | $3,355 | $3,355 | 1 |
| Gore Excluder Aaa Endoproshesis Contralateral Leg 16mm X 20mm X 13.5cm 12fr P... | other | $3,361 | $3,361 | $3,361 | 1 |
| Gore Excluder Aaa Endoprosthesis Plc201200 | other | $3,361 | $3,361 | $3,361 | 1 |
| Gore Excluder Aaa Endoprosthesis Plc271400 | other | $3,361 | $3,361 | $3,361 | 1 |
| Gore Excluder Aortic Extender Endoprosthesis 23mm X 10cm #plc231000 | other | $3,361 | $3,361 | $3,361 | 1 |
| Gore Excluder Endoprosthesis Aaa #plc181200 | other | $3,361 | $3,361 | $3,361 | 1 |
| Gore Excluder Endoprosthesis Aaa #plc271200 | other | $3,361 | $3,361 | $3,361 | 1 |
| Revision of Component of Total Knee Joint Prosthesis | other | $3,368 | $3,368 | $3,368 | 1 |
| Removal of Lymph Nodes, Muscle, and Tissue of Neck | surgery | $3,372 | $3,372 | $3,372 | 1 |
| Removal of Blood Clot in Artery of Lower Arm | surgery | $3,373 | $3,373 | $3,373 | 1 |
| Acute Myocardial Infarction, Expired without Cc/mcc | other | $3,376 | $3,376 | $3,376 | 1 |
| Repair of Hernia of Muscle At Esophagus and Stomach Using an Endoscope | surgery | $3,379 | $3,379 | $3,379 | 1 |
| PET Scan | imaging | $3,383 | $144 | $5,104 | 13 |
| Removal of Defibrillator Electrode | surgery | $3,389 | $3,389 | $3,389 | 1 |
| Partial Removal of Pancreas | surgery | $3,397 | $3,397 | $3,397 | 1 |
| Extensive Destruction and Reconstruction of Right Upper Heart Chamber On Hear... | cardiac | $3,397 | $3,397 | $3,397 | 1 |
| Indium in 111 Labeled Autologous White Blood Cells | other | $3,402 | $3,402 | $3,402 | 1 |
| Repair of 2 Electrodes for Permanent Pacemaker OR Defibrillator | surgery | $3,407 | $3,407 | $3,407 | 1 |
| MRI Scan of Brain Before and After Contrast | imaging | $3,415 | $3,147 | $3,682 | 2 |
| Repair of Blood Vessel of Arm with Graft | surgery | $3,421 | $3,421 | $3,421 | 1 |
| Repair of Blood Vessel of Leg with Graft | surgery | $3,421 | $3,421 | $3,421 | 1 |
| Removal OR Destruction of Growth(s) in the Abdomen, 10.1 to 20.0 Cm | surgery | $3,422 | $3,422 | $3,422 | 1 |
| Neuragen | other | $3,423 | $3,423 | $3,423 | 1 |
| Removal of Blood Clot and Portion of Superficial Femoral Artery | surgery | $3,433 | $3,433 | $3,433 | 1 |
| Repair of Blood Vessel of Arm | surgery | $3,440 | $3,440 | $3,440 | 1 |
| Complex Removal of Soft Tissue of Roof of Mouth | surgery | $3,441 | $3,441 | $3,441 | 1 |
| Removal and Dissolving of Blood Clot From Vein Using Fluoroscopic Guidance, R... | surgery | $3,443 | $3,443 | $3,443 | 1 |
| Partial Removal of Large Bowel and Reattachment to Rectum Using an Endoscope | surgery | $3,447 | $3,447 | $3,447 | 1 |
| Repair of Aneurysm OR Forearm Artery with Graft | surgery | $3,447 | $3,447 | $3,447 | 1 |
| Repositioning of Ureter with Creation of Bladder OR Muscle Flap | other | $3,449 | $3,449 | $3,449 | 1 |
| Injection, Eptinezumab-jjmr, 1 Mg | other | $3,455 | $3,455 | $3,455 | 1 |
| Injection, Cetuximab, 10 Mg | other | $3,457 | $3,457 | $3,457 | 1 |
| Repair of Eardrum, Ear Canal, and Bones with Removal of Mastoid Bone, with In... | surgery | $3,460 | $3,460 | $3,460 | 1 |
| Technetium Tc-99m Exametazime Labeled Autologous White Blood Cells, Diagnosti... | other | $3,465 | $3,465 | $3,465 | 1 |
| Viral Meningitis without Cc/mcc | other | $3,476 | $3,476 | $3,476 | 1 |
| Repair of Blood Vessel of Leg | surgery | $3,479 | $3,479 | $3,479 | 1 |
| Removal of Growth OR Cyst of From Heart Sac | surgery | $3,491 | $3,491 | $3,491 | 1 |
| Propel Mometasone Furoate Sinu | other | $3,497 | $3,497 | $3,497 | 1 |
| Removal of Blood Clot and Portion of Deep Upper Thigh Artery | surgery | $3,502 | $3,502 | $3,502 | 1 |
| Repair of Hernia of Muscle At Esophagus and Stomach with Implantation of Mesh... | surgery | $3,519 | $3,519 | $3,519 | 1 |
| Breast Biopsy | other | $3,520 | $815 | $88,425 | 17 |
| Bypass of Diseased OR Blocked Arm to Chest Artery with Other Than Vein | other | $3,522 | $3,522 | $3,522 | 1 |
| Catheter, Transluminal Atherectomy, Directional | cardiac | $3,534 | $3,534 | $3,534 | 1 |
| Prematurity without Major Problems | other | $3,538 | $3,125 | $3,950 | 2 |
| Drainage OR Removal of Bile Duct Stone with Redirection of Bile Flow and Inci... | surgery | $3,542 | $3,542 | $3,542 | 1 |
| Repair of Aorta OR Great Vessels with Sutures | surgery | $3,557 | $3,557 | $3,557 | 1 |
| Replacement, Socket, Above Knee/knee Disarticulation, Including Attachment Pl... | surgery | $3,559 | $3,559 | $3,559 | 1 |
| Placement of Tubes in Breast for Radiation Treatment Using Imaging Guidance D... | other | $3,580 | $3,580 | $3,580 | 1 |
| Bypass of Diseased OR Blocked Chest to Opposite Chest Artery with Other Than ... | other | $3,581 | $3,581 | $3,581 | 1 |
| Neonates, Died OR Transferred to Another Acute Care Facility | other | $3,592 | $3,532 | $3,652 | 2 |
| Injection, Mepolizumab, 1 Mg | other | $3,595 | $3,595 | $3,595 | 1 |
| Repair of Blood Vessel of Neck | surgery | $3,596 | $3,596 | $3,596 | 1 |
| Injection, Calcitonin Salmon, Up to 400 Units | other | $3,603 | $457 | $6,749 | 2 |
| Removal of Rectum with Creation of Opening From Large Bowel to Skin Through A... | surgery | $3,603 | $3,603 | $3,603 | 1 |
| Factor Ix, Complex, Per I.u. | other | $3,605 | $3,605 | $3,605 | 1 |
| Dilation of Nasal Sinus Using an Endoscope | other | $3,611 | $3,611 | $3,611 | 1 |
| Nuclear Medicine Study of Heart Muscle At Rest and with Stress and SPECT | imaging | $3,619 | $3,619 | $3,619 | 1 |
| Image-guided Robotic Linear Accelerator-based Stereotactic Radiosurgery, Deli... | surgery | $3,622 | $3,622 | $3,622 | 1 |
| Addition, Endoskeletal Knee/shin System, 4-bar Linkage OR Multiaxial, Pneumat... | other | $3,629 | $3,629 | $3,629 | 1 |
| Injection, Zolbetuximab-clzb, 1 Mg | other | $3,629 | $3,629 | $3,629 | 1 |
| Vyloy 100 Mg Vial | other | $3,629 | $3,629 | $3,629 | 1 |
| Replacement of Aortic Valve Through the Skin and Femoral Artery | surgery | $3,630 | $3,630 | $3,630 | 1 |
| Revision of Leg Artery Bypass with Vein Patch | other | $3,640 | $3,640 | $3,640 | 1 |
| Division of Extra Arch of Aorta | other | $3,647 | $3,647 | $3,647 | 1 |
| Injection, Avelumab, 10 Mg | other | $3,659 | $3,659 | $3,659 | 1 |
| Removal of Lung Segment to Reduce Lung Volume Through Chest | surgery | $3,662 | $3,662 | $3,662 | 1 |
| Endurant Ii Contralateral Limb 16mm X 13mm X 146mm Etlw1613c146e | other | $3,686 | $3,686 | $3,686 | 1 |
| Nuclear Medicine Studies of Heart Muscle At Rest and with Stress and SPECT | imaging | $3,692 | $1,747 | $5,637 | 2 |
| Injection, Pegfilgrastim-bmez (ziextenzo), Biosimilar, 0.5 Mg | other | $3,710 | $3,710 | $3,710 | 1 |
| Replacement of Thigh Bone and Hip Joint with Prosthesis | surgery | $3,711 | $3,711 | $3,711 | 1 |
| Destruction of Tongue Tissue, Per Session | other | $3,715 | $3,715 | $3,715 | 1 |
| Removal of Rectum with Creation of Opening From Large Bowel to Skin Using an ... | surgery | $3,726 | $3,726 | $3,726 | 1 |
| Incision OR Partial Removal of Upper Portion of Lower Leg Bone to Repair Defo... | surgery | $3,734 | $3,734 | $3,734 | 1 |
| Repair of Groin Artery with Graft for Other Than Rupture with Review By Radio... | surgery | $3,734 | $3,734 | $3,734 | 1 |
| Injection, Thyrotropin Alpha, 0.9 Mg, Provided in 1.1 Mg Vial | other | $3,737 | $3,737 | $3,737 | 1 |
| Injection, Bevacizumab-bvzr, Biosimilar, (zirabev), 10 Mg | other | $3,743 | $3,743 | $3,743 | 1 |
| Placement of Stent of Ureter Through New Skin Access Using Imaging Guidance w... | cardiac | $3,747 | $3,747 | $3,747 | 1 |
| Removal of Blood Clot and Portion of Popliteal Artery | surgery | $3,750 | $3,750 | $3,750 | 1 |
| Indium In-111 Pentetreotide IV Diagnostic | other | $3,755 | $3,755 | $3,755 | 1 |
| Otitis Media and Uri without Mcc | other | $3,772 | $2,873 | $4,670 | 2 |
| Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg | other | $3,778 | $3,778 | $3,778 | 1 |
| Insertion of Hypoglossal Nerve Neurostimulator Electrode and Generator and Br... | other | $3,791 | $3,791 | $3,791 | 1 |
| Insertion of Vena Cava Filter with Review By Radiologist | other | $3,793 | $3,793 | $3,793 | 1 |
| Removal of Blood Clot and Revision of Artery OR Vein Graft | surgery | $3,796 | $3,796 | $3,796 | 1 |
| Removal of Lower Portion of Stomach with Reattachment of Upper Portion of Rem... | surgery | $3,799 | $3,799 | $3,799 | 1 |
| Balloon Dilation of Groin Artery, Initial Vessel | other | $3,806 | $3,806 | $3,806 | 1 |
| Ultrasound Evaluation of Heart Blood Vessel OR Graft with Review By Radiologi... | imaging | $3,808 | $3,808 | $3,808 | 1 |
| Bypass of Diseased OR Blocked Knee to Lower Leg Arteries with Other Than Vein | other | $3,826 | $3,826 | $3,826 | 1 |
| Removal of Blood Clot and Portion of Artery of Upper Thigh | surgery | $3,830 | $3,830 | $3,830 | 1 |
| All Lower Extremity Prostheses, Flex Foot System | other | $3,835 | $3,835 | $3,835 | 1 |
| Depressive Neuroses | other | $3,836 | $3,836 | $3,836 | 1 |
| Review By Radiologist of Pelvis Artery Image | other | $3,841 | $3,841 | $3,841 | 1 |
| Bypass of Diseased OR Blocked Upper Leg to Lower Thigh Artery with Other Than... | other | $3,848 | $3,848 | $3,848 | 1 |
| Ultrasound Evaluation of Heart Blood Vessel with Review By Radiologist | imaging | $3,860 | $3,860 | $3,860 | 1 |
| Removal of Blood Clot and Portion of Chest, Neck, OR Brain Artery | surgery | $3,860 | $3,860 | $3,860 | 1 |
| Papaverine 30 Mg in 100 Ml 0.9% Sodium Chloride - Irrigation - Compounded | other | $3,866 | $3,866 | $3,866 | 1 |
| Bypass of Diseased OR Blocked Upper Arm to Opposite Arm Artery with Vein | other | $3,866 | $3,866 | $3,866 | 1 |
| Repair of Descending Aorta, Initial Extension | surgery | $3,870 | $3,870 | $3,870 | 1 |
| Repair of Aneurysm OR Upper Thigh Artery with Graft | surgery | $3,871 | $3,871 | $3,871 | 1 |
| Incision and Exploration of Heart | cardiac | $3,872 | $3,872 | $3,872 | 1 |
| Bypass of Diseased OR Blocked Upper Leg to Opposite Upper Leg Artery with Oth... | other | $3,878 | $3,878 | $3,878 | 1 |
| Removal of Kidney and Lymph Nodes Using an Endoscope | surgery | $3,882 | $3,882 | $3,882 | 1 |
| Revision of Hip Socket Part of Hip Prosthesis | other | $3,887 | $3,887 | $3,887 | 1 |
| Ryanodex 250 Mg Vial | other | $3,900 | $3,900 | $3,900 | 1 |
| Revision to Reshape Nasal Bones and Tip of Nose After Previous Repair | surgery | $3,908 | $3,908 | $3,908 | 1 |
| Removal of Large Bowel with Attachment of Small Bowel to Rectum OR Creation o... | surgery | $3,919 | $3,919 | $3,919 | 1 |
| Retrieval of Foreign Body in Blood Vessel with Review By Radiologist | other | $3,929 | $3,929 | $3,929 | 1 |
| Revision of Leg Artery Bypass with Placement of Relocated Vein | other | $3,935 | $3,935 | $3,935 | 1 |
| Injection, Trastuzumab-qyyp, Biosimilar, (trazimera), 10 Mg | other | $3,947 | $3,947 | $3,947 | 1 |
| Repair of Aorta with Graft for Other Than Rupture with Review By Radiologist | surgery | $3,975 | $3,975 | $3,975 | 1 |
| Coronary Artery Bypass Using Vein OR Artery Graft, 6 OR More Grafts | cardiac | $3,980 | $3,980 | $3,980 | 1 |
| Exclusion of Appendage of Left Upper Chamber of Heart | cardiac | $3,981 | $3,981 | $3,981 | 1 |
| Removal of Segment of Lung Tissue Using an Endoscope | surgery | $3,982 | $3,982 | $3,982 | 1 |
| Repair of Aorta OR Great Vessels with Sutures Using a Shunt Bypass | surgery | $3,984 | $3,984 | $3,984 | 1 |
| Full Term Neonate with Major Problems | other | $4,015 | $3,563 | $4,467 | 2 |
| Extensive Repair and Reconstruction of Eardrum and Ear Canal with Removal of ... | surgery | $4,015 | $4,015 | $4,015 | 1 |
| Repair of Blood Vessel of Leg with Vein Graft | surgery | $4,022 | $4,022 | $4,022 | 1 |
| Balloon Dilation of Artery of Leg | other | $4,028 | $4,028 | $4,028 | 1 |
| Removal of Blood Clot and Portion of Artery of Groin | surgery | $4,040 | $4,040 | $4,040 | 1 |
| Cataract Surgery | surgery | $4,041 | $1,751 | $10,212 | 7 |
| Removal of 2 Lobes of Lung Using an Endoscope | surgery | $4,043 | $4,043 | $4,043 | 1 |
| Antithrombin Iii (human), Per I.u. | other | $4,049 | $4,049 | $4,049 | 1 |
| Injection, Inclisiran, 1 Mg | other | $4,058 | $4,058 | $4,058 | 1 |
| Repair of Blood Vessel of Neck with Graft | surgery | $4,061 | $4,061 | $4,061 | 1 |
| Revision of Thigh Bone Prosthesis | other | $4,072 | $4,072 | $4,072 | 1 |
| Other Antepartum Diagnoses without O.r. Procedures with Cc | other | $4,075 | $3,283 | $4,867 | 2 |
| Removal of Lung | surgery | $4,084 | $4,084 | $4,084 | 1 |
| Destruction of Growth OR Polyp of Large Bowel Using an Endoscope Inserted Thr... | other | $4,096 | $4,096 | $4,096 | 1 |
| Extensive Removal of Growth of Thigh OR Knee, 5.0 Cm OR More | surgery | $4,097 | $4,097 | $4,097 | 1 |
| Insertion of Tube in Upper And/or Lower Heart Chambers to Record and Identify... | cardiac | $4,105 | $4,105 | $4,105 | 1 |
| Above Knee, Molded Socket, Open End, Sach Foot, Endoskeletal System, Single A... | other | $4,124 | $4,124 | $4,124 | 1 |
| Placement of Tube of Kidney and Urinary Tube Through New Skin Access Using Im... | other | $4,127 | $4,127 | $4,127 | 1 |
| Removal of 2 Lobes of Lung | surgery | $4,135 | $4,135 | $4,135 | 1 |
| Revision OR Replacement of Hypoglossal Nerve Neurostimulator Electrode and Br... | surgery | $4,136 | $4,136 | $4,136 | 1 |
| Repair of Electrode for Permanent Pacemaker OR Defibrillator | surgery | $4,143 | $4,143 | $4,143 | 1 |
| Repair of Aneurysm OR Lower Leg Artery with Graft | surgery | $4,154 | $4,154 | $4,154 | 1 |
| Graft Conduit 21mm Aortic Valved 21cavgj | other | $4,170 | $4,170 | $4,170 | 1 |
| Graft Conduit 23mm Aortic Valved 23cavgj | other | $4,170 | $4,170 | $4,170 | 1 |
| Graft Conduit 27mm Aortic Valved 27cavgj | other | $4,170 | $4,170 | $4,170 | 1 |
| Graft Conduit 29mm Aortic Valved 29cavgj | other | $4,170 | $4,170 | $4,170 | 1 |
| Graft Conduit 31mm Aortic Valved 31cavgj | other | $4,170 | $4,170 | $4,170 | 1 |
| Removal of Growth of Saliva Gland OR Saliva Gland, and Surrounding Lymph Node... | surgery | $4,190 | $4,190 | $4,190 | 1 |
| Removal of Blood Clot and Portion of Tibial OR Peroneal Artery, Initial Artery | surgery | $4,195 | $4,195 | $4,195 | 1 |
| CT Scan of Abdomen and Pelvis without Contrast | imaging | $4,196 | $4,196 | $4,196 | 1 |
| Pacemaker, Other Than Single OR Dual Chamber | cardiac | $4,197 | $4,197 | $4,197 | 1 |
| Bypass of Diseased OR Blocked Upper Leg to Opposite Upper Leg Artery with Vein | other | $4,199 | $4,199 | $4,199 | 1 |
| Postpartum and Post Abortion Diagnoses without O.r. Procedures | obstetric | $4,208 | $3,733 | $4,683 | 2 |
| Repair of Ruptured Aneurysm of Arm Artery with Graft | surgery | $4,228 | $4,228 | $4,228 | 1 |
| Insertion of Stent and Blood Clot Protection Device in Neck Artery with Revie... | cardiac | $4,232 | $4,232 | $4,232 | 1 |
| CT Scan of Abdomen and Pelvis with Contrast | imaging | $4,240 | $4,240 | $4,240 | 1 |
| Relocation And/or Reimplantation of Neck Artery to Chest Artery | surgery | $4,254 | $4,254 | $4,254 | 1 |
| Insertion of Catheters for Recording, Pacing, and Induction of Abnormal Heart... | cardiac | $4,256 | $4,256 | $4,256 | 1 |
| Bronchitis and Asthma without Cc/mcc | other | $4,273 | $2,915 | $5,630 | 2 |
| Repair of Aneurysm OR Upper Chest OR Neck Artery with Graft | surgery | $4,279 | $4,279 | $4,279 | 1 |
| Septal Defect Implant System, Intracardiac | surgery | $4,294 | $4,294 | $4,294 | 1 |
| Removal of Growth of Lung and Reconstruction of Chest Wall | surgery | $4,306 | $4,306 | $4,306 | 1 |
| Bypass of Diseased OR Blocked Arm to Both Lower Thigh Arteries with Other Tha... | other | $4,333 | $4,333 | $4,333 | 1 |
| MRI of the Abdomen | imaging | $4,344 | $1,402 | $6,221 | 13 |
| Bypass of Diseased OR Blocked Upper Arm to Arm Artery with Vein | other | $4,346 | $4,346 | $4,346 | 1 |
| Partial Removal of Large Bowel and Reattachment to Rectum and Creation of Lar... | surgery | $4,352 | $4,352 | $4,352 | 1 |
| Removal of Blood Clot and Portion of Tibioperoneal Trunk Artery | surgery | $4,364 | $4,364 | $4,364 | 1 |
| Nuclear Medicine Study From Skull Base to Mid-thigh with CT Scan | imaging | $4,365 | $4,365 | $4,365 | 1 |
| Repair of Blood Vessel of Arm with Vein Graft | surgery | $4,384 | $4,384 | $4,384 | 1 |
| Revision of Total Shoulder Repair, Total Shoulder | surgery | $4,397 | $4,397 | $4,397 | 1 |
| Transfer of Nerve to Injured Nerve, Stage 1 of 2 | other | $4,409 | $4,409 | $4,409 | 1 |
| Repair of Aortic Arch with Graft On Heart-lung Machine | surgery | $4,414 | $4,414 | $4,414 | 1 |
| Injection, Margetuximab-cmkb, 5 Mg | other | $4,464 | $4,464 | $4,464 | 1 |
| Injection, Von Willebrand Factor Complex (humate-p), Per Iu Vwf:rco | other | $4,472 | $4,472 | $4,472 | 1 |
| Bypass of Diseased OR Blocked Neck to Chest Artery with Other Than Vein | other | $4,475 | $4,475 | $4,475 | 1 |
| Repair of Ruptured Aneurysm of Upper Thigh Artery with Graft | surgery | $4,482 | $4,482 | $4,482 | 1 |
| Nuclear Medicine Study Whole Body with CT Scan | imaging | $4,499 | $4,499 | $4,499 | 1 |
| Pericardial Tissue Heart Valve All Sizes #3300tfx | cardiac | $4,500 | $4,500 | $4,500 | 1 |
| Removal of Growth Below Breast Bone | surgery | $4,502 | $4,502 | $4,502 | 1 |
| Insertion of Stent in Groin Artery, Initial Vessel | cardiac | $4,511 | $4,511 | $4,511 | 1 |
| Prosthesis, Urinary Sphincter | other | $4,512 | $4,512 | $4,512 | 1 |
| Bypass of Diseased OR Blocked Thigh to Knee Artery with Vein Graft | other | $4,528 | $4,528 | $4,528 | 1 |
| Limited Reconstruction of Upper Heart Chamber and Alteration of Electrical Pa... | cardiac | $4,529 | $4,529 | $4,529 | 1 |
| Partial Destruction and Reconstruction of Upper Heart Chamber | cardiac | $4,535 | $4,535 | $4,535 | 1 |
| Injection, Belinostat, 10 Mg | other | $4,539 | $4,539 | $4,539 | 1 |
| Injection, Icatibant, 1 Mg | other | $4,546 | $4,546 | $4,546 | 1 |
| Bypass of Diseased OR Blocked Lower Leg to Lower Leg Artery with Vein | other | $4,551 | $4,551 | $4,551 | 1 |
| Complicated Partial Removal of Bladder | surgery | $4,564 | $4,564 | $4,564 | 1 |
| Repair of Aorta OR Great Vessels with Sutures On Heart-lung Machine | surgery | $4,611 | $4,611 | $4,611 | 1 |
| Bypass of Diseased OR Blocked Upper Leg to Lower Leg Artery with Other Than Vein | other | $4,621 | $4,621 | $4,621 | 1 |
| Bypass of Diseased OR Blocked Groin to Upper Leg Artery with Other Than Vein | other | $4,642 | $4,642 | $4,642 | 1 |
| Implant Pat-active Ht Record | surgery | $4,646 | $4,646 | $4,646 | 1 |
| Repair of Aneurysm OR Neck OR Upper Chest Artery with Graft | surgery | $4,650 | $4,650 | $4,650 | 1 |
| Revision of Groin Artery Bypass with Patch Graft | other | $4,650 | $4,650 | $4,650 | 1 |
| Repair of Infrarenal Aorta and Groin Artery with Graft for Other Than Rupture... | surgery | $4,652 | $4,652 | $4,652 | 1 |
| Removal of Blood Clot and Portion of Artery of Abdominal Organ | surgery | $4,655 | $4,655 | $4,655 | 1 |
| Injection, Sacituzumab Govitecan-hziy, 2.5 Mg | other | $4,657 | $4,657 | $4,657 | 1 |
| Partial Removal of Large Bowel and Reattachment to Rectum and Creation of Ope... | surgery | $4,678 | $4,678 | $4,678 | 1 |
| Repair of Aneurysm OR Groin Artery with Graft | surgery | $4,681 | $4,681 | $4,681 | 1 |
| Endocrine Disorders without Cc/mcc | other | $4,688 | $4,688 | $4,688 | 1 |
| Vaginal Delivery | obstetric | $4,705 | $1,106 | $26,063 | 17 |
| Partial Removal of Tongue and Surrounding Lymph Nodes On Side of Neck | surgery | $4,709 | $4,709 | $4,709 | 1 |
| Revision of Thigh and Lower Leg Bone Components of Total Knee Joint Prosthesis | other | $4,718 | $4,718 | $4,718 | 1 |
| Injection, Aripiprazole (abilify Maintena), 1 Mg | other | $4,721 | $4,721 | $4,721 | 1 |
| Anesthesia for Procedure On Esophagus | other | $4,724 | $4,724 | $4,724 | 1 |
| Balloon Dilation of Artery with Review By Radiologist, Initial Artery | other | $4,740 | $4,740 | $4,740 | 1 |
| Repair of Ruptured Aneurysm of Lower Leg Artery with Graft | surgery | $4,747 | $4,747 | $4,747 | 1 |
| IOL Staar Visian Clearlens Exc | other | $4,755 | $4,755 | $4,755 | 1 |
| Revision of Groin Artery Bypass with Vein Patch Graft | other | $4,757 | $4,757 | $4,757 | 1 |
| Bypass of Diseased OR Blocked Upper to Lower Leg Artery with Vein | other | $4,782 | $4,782 | $4,782 | 1 |
| Repair of Congenital Bowel Defect | surgery | $4,793 | $4,793 | $4,793 | 1 |
| Hernia Repair (Inguinal) | surgery | $4,797 | $2,347 | $18,386 | 4 |
| Bypass of Diseased OR Blocked Neck to Opposite Neck Artery with Vein | other | $4,806 | $4,806 | $4,806 | 1 |
| Cardiac Congenital and Valvular Disorders without Mcc | cardiac | $4,843 | $1,737 | $7,949 | 2 |
| Removal of Blood Clot and Portion of Chest OR Neck Artery | surgery | $4,846 | $4,846 | $4,846 | 1 |
| Repair of Blood Vessel of Chest with Vein Graft On Heart-lung Machine | surgery | $4,868 | $4,868 | $4,868 | 1 |
| Replacement of Aortic Valve By Through Femoral Artery | surgery | $4,879 | $4,879 | $4,879 | 1 |
| Balloon Dilation of Pulmonary Artery, Single Vessel | other | $4,888 | $4,888 | $4,888 | 1 |
| Prematurity with Major Problems | other | $4,909 | $3,812 | $6,005 | 2 |
| Balloon Dilation of Artery of Leg, Initial Vessel | other | $4,914 | $4,914 | $4,914 | 1 |
| Inspira Resilian Aortic Valve 19mm #11500a19 | other | $4,920 | $4,920 | $4,920 | 1 |
| Inspira Resilian Aortic Valve 21mmá #11500a21 | other | $4,920 | $4,920 | $4,920 | 1 |
| Inspira Resilian Aortic Valve 23mmá #11500a23 | other | $4,920 | $4,920 | $4,920 | 1 |
| Inspira Resilian Aortic Valve 25mmá #11500a25 | other | $4,920 | $4,920 | $4,920 | 1 |
| Inspira Resilian Aortic Valve 27mmá #11500a27 | other | $4,920 | $4,920 | $4,920 | 1 |
| Inspira Resilian Aortic Valve 29mmá #11500a29 | other | $4,920 | $4,920 | $4,920 | 1 |
| Image-guided Robotic Linear Accelerator-based Stereotactic Radiosurgery, Comp... | surgery | $4,929 | $4,929 | $4,929 | 1 |
| Removal of Remaining Lung After Previous Partial Removal of Lung | surgery | $4,972 | $4,972 | $4,972 | 1 |
| Flotufolastat F 18, Diagnostic, 1 Millicurie | other | $4,978 | $4,978 | $4,978 | 1 |
| Dilation of Sphenoid Nasal Sinus Using an Endoscope | other | $4,996 | $4,996 | $4,996 | 1 |
| Bypass of Diseased OR Blocked Under Arm to Arm Artery with Vein | other | $5,039 | $5,039 | $5,039 | 1 |
| Dilation of Frontal Nasal Sinus Using an Endoscope | other | $5,043 | $5,043 | $5,043 | 1 |
| Replacement of Aortic Valve Through Axillary Artery | surgery | $5,044 | $5,044 | $5,044 | 1 |
| Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg | other | $5,064 | $5,064 | $5,064 | 1 |
| Bypass of Diseased OR Blocked Upper Leg to Lower Leg Artery with Vein Graft | other | $5,068 | $5,068 | $5,068 | 1 |
| Shoulder Surgery | surgery | $5,107 | $459 | $11,679 | 9 |
| Integra Silicone Pip Implant | surgery | $5,150 | $5,150 | $5,150 | 1 |
| Removal of Blood Clot and Portion of Abdominal Aorta and Groin Artery | surgery | $5,159 | $5,159 | $5,159 | 1 |
| Destruction Neurolytic Agt Gen | other | $5,222 | $5,222 | $5,222 | 1 |
| Insertion of Catheters for Recording and Pacing of Left Lower Heart Chamber R... | cardiac | $5,230 | $5,230 | $5,230 | 1 |
| Bypass of Diseased OR Blocked Aorta to Upper Leg Artery with Other Than Vein | other | $5,260 | $5,260 | $5,260 | 1 |
| Goserelin Acetate Implant, Per 3.6 Mg | surgery | $5,261 | $5,261 | $5,261 | 1 |
| Deb Musc/fascia 20 SQ Cm/< | other | $5,266 | $675 | $36,565 | 4 |
| Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg | other | $5,270 | $5,270 | $5,270 | 1 |
| CT Scan of Abdomen and Pelvis Before and After Contrast | imaging | $5,295 | $5,295 | $5,295 | 1 |
| Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg | other | $5,308 | $5,308 | $5,308 | 1 |
| Destruction of First Incompetent Vein of Arm OR Leg Using Radiofrequency and ... | other | $5,326 | $5,326 | $5,326 | 1 |
| Repair of Knee Cartilage with Donor Cartilage Graft Using an Endoscope | surgery | $5,332 | $5,332 | $5,332 | 1 |
| Insertion of Stent in Artery of Leg, Each Additional Vessel | cardiac | $5,354 | $5,354 | $5,354 | 1 |
| Injection, Irinotecan Liposome, 1 Mg | other | $5,358 | $5,358 | $5,358 | 1 |
| Implant Neuroelectrodes | surgery | $5,400 | $5,400 | $5,400 | 1 |
| Bypass of Diseased OR Blocked Major Upper to Lower Leg Artery with Vein | other | $5,412 | $5,412 | $5,412 | 1 |
| Removal of Blood Clot in Artery of Abdominal Organs | surgery | $5,426 | $5,426 | $5,426 | 1 |
| Treatment of Broken Lower Spine Bone with Placement of Stabilizing Device | other | $5,435 | $5,435 | $5,435 | 1 |
| Treatment of Broken Middle Spine Bone with Placement of Stabilizing Device Us... | other | $5,435 | $5,435 | $5,435 | 1 |
| Treatment of Broken Spine Bone with Stabilizing Device, Each Additional Segment | other | $5,435 | $5,435 | $5,435 | 1 |
| Abortion without D&c | other | $5,478 | $4,102 | $6,853 | 2 |
| Insertion of Left Lower Heart Electrode for Pacemaker OR Defibrillator | cardiac | $5,480 | $5,480 | $5,480 | 1 |
| Extensive Destruction and Reconstruction of Upper Heart Chamber | cardiac | $5,485 | $5,485 | $5,485 | 1 |
| Injection, Certolizumab Pegol, 1 Mg | other | $5,490 | $5,490 | $5,490 | 1 |
| Repair of Ruptured Aneurysm of Groin Artery with Graft | surgery | $5,497 | $5,497 | $5,497 | 1 |
| Partial Removal of Lower Esophagus | surgery | $5,505 | $5,505 | $5,505 | 1 |
| Tonsillectomy | surgery | $5,514 | $1,193 | $11,970 | 8 |
| Injection, Daratumumab, 10 Mg | other | $5,531 | $5,531 | $5,531 | 1 |
| Interspinous Process Distraction Device | other | $5,550 | $5,550 | $5,550 | 1 |
| Revision of Thigh Bone and Hip Joint Prosthesis | other | $5,588 | $5,588 | $5,588 | 1 |
| Balloon Dilation of Vein with Review By Radiologist, Initial Vein | other | $5,596 | $5,596 | $5,596 | 1 |
| Bypass of Diseased OR Blocked Artery Aorta to Upper Leg and Opposite Upper Le... | other | $5,599 | $5,599 | $5,599 | 1 |
| Bunionectomy | other | $5,601 | $1,165 | $11,610 | 8 |
| Iodine I-123 Iobenguane, Diagnostic, Per Study Dose, Up to 15 Millicuries | other | $5,605 | $5,605 | $5,605 | 1 |
| Alcohol, Drug Abuse OR Dependence, Left Ama | other | $5,609 | $3,977 | $7,241 | 2 |
| Other Skin, Subcutaneous Tissue and Breast Procedures without Cc/mcc | other | $5,617 | $5,433 | $5,801 | 2 |
| Injection, Elotuzumab, 1 Mg | other | $5,622 | $5,622 | $5,622 | 1 |
| Dilation of Bile Ducts with Stent Insertion Using an Endoscope | cardiac | $5,626 | $5,626 | $5,626 | 1 |
| Insertion of Temporary Pacemaker Lead in Single Heart Chamber | cardiac | $5,634 | $5,634 | $5,634 | 1 |
| Repair of Aorta OR Great Vessels with Graft | surgery | $5,635 | $5,635 | $5,635 | 1 |
| Removal of Infected Chest Graft | surgery | $5,677 | $5,677 | $5,677 | 1 |
| Repair of Ruptured Aorta with Graft with Review By Radiologist | surgery | $5,686 | $5,686 | $5,686 | 1 |
| Repair of Groin Artery with Graft for Rupture with Review By Radiologist | surgery | $5,709 | $5,709 | $5,709 | 1 |
| Insertion of Pacemaker Pulse Generator with Existing Single Lead | cardiac | $5,731 | $5,731 | $5,731 | 1 |
| Insertion of 1 Electrode for Permanent Pacemaker OR Defibrillator | cardiac | $5,740 | $5,740 | $5,740 | 1 |
| Stent Endograft Endurant Iis Bifurcated 28mm X 14mm X 103mm #esbf2814c103e | cardiac | $5,746 | $5,746 | $5,746 | 1 |
| Dilation of Canal Between Middle Ear and Throat (eustachian Tube) On One Side... | other | $5,750 | $5,750 | $5,750 | 1 |
| Catheter, Thrombectomy/embolectomy | cardiac | $5,790 | $5,790 | $5,790 | 1 |
| Ascending Aorta Graft, with Cardiopulmonary Bypass, Includes Valve Suspension... | other | $5,792 | $5,792 | $5,792 | 1 |
| Peripheral Vascular Disorders without Cc/mcc | other | $5,795 | $5,435 | $6,154 | 2 |
| Removal of Plaque in Artery of Leg, Each Additional Vessel | surgery | $5,811 | $5,811 | $5,811 | 1 |
| Bypass of Diseased OR Blocked Aorta to Groin Artery with Other Than Vein | other | $5,825 | $5,825 | $5,825 | 1 |
| Dental and Oral Diseases without Cc/mcc | other | $5,830 | $3,229 | $8,430 | 2 |
| Removal of Large Bowel, Rectum, Bladder and Ureter | surgery | $5,858 | $5,858 | $5,858 | 1 |
| Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter | other | $5,866 | $5,866 | $5,866 | 1 |
| Removal of Permanent Pacemaker Pulse Generator | surgery | $5,916 | $5,916 | $5,916 | 1 |
| Iris Prosthesis | other | $5,940 | $5,940 | $5,940 | 1 |
| Dilation of Canal Between Middle Ear and Throat (eustachian Tube) On Both Sid... | other | $5,961 | $5,961 | $5,961 | 1 |
| ACL Reconstruction | surgery | $5,989 | $201 | $17,086 | 17 |
| Dermacell, Dermacell Awm OR Dermacell Awm Porous, Per Square Centimeter | other | $5,997 | $5,997 | $5,997 | 1 |
| Lithotripsy-s/w | other | $5,999 | $5,999 | $5,999 | 1 |
| Injection, Bevacizumab, 10 Mg | other | $6,025 | $6,025 | $6,025 | 1 |
| Injection, Benralizumab, 1 Mg | other | $6,029 | $6,029 | $6,029 | 1 |
| Repair of Wound to Heart | surgery | $6,036 | $6,036 | $6,036 | 1 |
| Extensive Reconstruction of Upper Heart Chamber and Alteration of Electrical ... | cardiac | $6,092 | $6,092 | $6,092 | 1 |
| Anesthesia for Closed Drainage of Lung Fluid | other | $6,158 | $6,158 | $6,158 | 1 |
| Repair of Aorta OR Great Vessels with Graft On Heart-lung Machine | surgery | $6,198 | $6,198 | $6,198 | 1 |
| Insertion of Stent in Artery of Leg, Initial Vessel | cardiac | $6,208 | $6,208 | $6,208 | 1 |
| Vaginal Delivery with OR Procedure except Sterilization/D&C | obstetric | $6,233 | $4,878 | $7,588 | 2 |
| Hysteroscopy | other | $6,234 | $164 | $11,993 | 12 |
| Prothrombin Complex Concentrate (human), Kcentra, Per I.u. of Factor Ix Activity | other | $6,254 | $3,569 | $8,938 | 2 |
| Injection, C-1 Esterase Inhibitor (human), Cinryze, 10 Units | other | $6,257 | $6,257 | $6,257 | 1 |
| Injection, Anifrolumab-fnia, 1 Mg | other | $6,275 | $6,275 | $6,275 | 1 |
| Dilation of Sphenoid and Frontal Nasal Sinus Using an Endoscope | other | $6,326 | $6,326 | $6,326 | 1 |
| COPD Management | other | $6,357 | $91 | $12,941 | 19 |
| Exploration of Chest for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $6,376 | $6,376 | $6,376 | 1 |
| Rotator Cuff Repair | surgery | $6,431 | $3,460 | $9,402 | 2 |
| Extensive Destruction and Reconstruction of Upper Heart Chamber On Heart-lung... | cardiac | $6,448 | $6,448 | $6,448 | 1 |
| Allergic Reactions without Mcc | other | $6,468 | $6,468 | $6,468 | 1 |
| Other Respiratory System Diagnoses without Mcc | other | $6,473 | $6,473 | $6,473 | 1 |
| Repair of Aneurysm OR Abdominal Aorta with Graft | surgery | $6,485 | $6,485 | $6,485 | 1 |
| Major Chest Trauma without Cc/mcc | emergency | $6,506 | $4,671 | $8,340 | 2 |
| Other Kidney and Urinary Tract Procedures without Cc/mcc | other | $6,520 | $6,520 | $6,520 | 1 |
| Coronary Artery Bypass Using Vein Graft, 1 Graft | cardiac | $6,543 | $6,543 | $6,543 | 1 |
| Major Skin Disorders with Mcc | other | $6,568 | $6,568 | $6,568 | 1 |
| Acute Myocardial Infarction, Expired with Cc | other | $6,616 | $6,616 | $6,616 | 1 |
| Insertion of 2 Electrodes for Permanent Pacemaker OR Defibrillator | cardiac | $6,623 | $6,623 | $6,623 | 1 |
| Other Factors Influencing Health Status | other | $6,721 | $6,382 | $7,059 | 2 |
| Bypass of Diseased OR Blocked Aorta to Groin to Opposite Groin Artery with Ot... | other | $6,736 | $6,736 | $6,736 | 1 |
| Diabetes without Cc/mcc | other | $6,828 | $6,828 | $6,828 | 1 |
| Epi-sense Guided 6130 Device #cdp-4330 | other | $6,900 | $6,900 | $6,900 | 1 |
| Kidney Stone Removal | other | $6,903 | $2,729 | $94,477 | 22 |
| Testes Procedures without Cc/mcc | other | $6,930 | $6,930 | $6,930 | 1 |
| Injection, Dostarlimab-gxly, 10 Mg | other | $6,938 | $6,938 | $6,938 | 1 |
| Repair of Infrarenal Aorta and Groin Artery with Graft for Rupture On Both Si... | surgery | $6,941 | $6,941 | $6,941 | 1 |
| Graft Bifurcated Stent #ba28-100/i16 | cardiac | $6,948 | $6,948 | $6,948 | 1 |
| Respiratory Neoplasms without Cc/mcc | other | $6,953 | $6,953 | $6,953 | 1 |
| Repair of Infrarenal Aorta and Groin Artery with Graft for Rupture with Revie... | surgery | $6,961 | $6,961 | $6,961 | 1 |
| Repair of Descending Aorta and Subclavian Artery with Insertion of Graft and ... | surgery | $6,964 | $6,964 | $6,964 | 1 |
| Bypass of Diseased OR Blocked Arm to Lower Thigh OR Leg Artery with Other Tha... | other | $7,006 | $7,006 | $7,006 | 1 |
| Injection, Darbepoetin Alfa, 1 Microgram | other | $7,124 | $7,124 | $7,124 | 1 |
| Shockwave Destruction of Calcified Plaque in Coronary Artery Accessed Through... | cardiac | $7,129 | $7,129 | $7,129 | 1 |
| Coronary Artery Bypass Using Artery Graft, 1 Graft | cardiac | $7,139 | $7,139 | $7,139 | 1 |
| Injection, Bezlotoxumab, 10 Mg | other | $7,182 | $7,182 | $7,182 | 1 |
| Insertion of Tube for 3d Mapping of Electrical Impulses to Heart Muscle | cardiac | $7,185 | $7,185 | $7,185 | 1 |
| Destruction of Growth of Kidney By Freezing | other | $7,207 | $7,207 | $7,207 | 1 |
| Other Kidney and Urinary Tract Diagnoses without Cc/mcc | other | $7,222 | $5,189 | $9,255 | 2 |
| Dental and Oral Diseases with Cc | other | $7,231 | $5,753 | $8,709 | 2 |
| Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg | other | $7,236 | $7,236 | $7,236 | 1 |
| Repair of Blood Vessel of Chest | surgery | $7,265 | $7,265 | $7,265 | 1 |
| Alloderm 1518320 | other | $7,326 | $7,326 | $7,326 | 1 |
| Removal of Growth of Heart On Heart-lung Machine | surgery | $7,361 | $7,361 | $7,361 | 1 |
| Endograft Aortic Body 23mm Tv-ab2380-j | other | $7,383 | $7,383 | $7,383 | 1 |
| Endograft Aortic Body 26mm Tv-ab2680-n | other | $7,383 | $7,383 | $7,383 | 1 |
| Endograft Aortic Body 29mm Tv-ab2980-n | other | $7,383 | $7,383 | $7,383 | 1 |
| Endograft Aortic Body 34mm Tv-ab3480-n | other | $7,383 | $7,383 | $7,383 | 1 |
| Other Disorders of Nervous System without Cc/mcc | other | $7,429 | $5,311 | $9,547 | 2 |
| Injection, Isatuximab-irfc, 10 Mg | other | $7,480 | $7,480 | $7,480 | 1 |
| Incision OR Removal of Tissue Below Aortic Valve | surgery | $7,500 | $7,500 | $7,500 | 1 |
| Cardiac Arrhythmia and Conduction Disorders without Cc/mcc | cardiac | $7,505 | $6,401 | $8,608 | 2 |
| Insertion of Pacemaker Pulse Generator with Existing Dual Leads | cardiac | $7,519 | $7,519 | $7,519 | 1 |
| Insertion of Stent in Arteries of Leg | cardiac | $7,522 | $7,522 | $7,522 | 1 |
| All Lower Extremity Prosthesis, Shank Foot System with Vertical Loading Pylon | other | $7,524 | $7,524 | $7,524 | 1 |
| Strattice Tm, Per Square Centimeter | other | $7,532 | $7,532 | $7,532 | 1 |
| Cardioverter-defibrillator, Dual Chamber | other | $7,620 | $7,620 | $7,620 | 1 |
| Endometrial Ablation | other | $7,646 | $2,687 | $14,150 | 8 |
| Coronary Artery Bypass Using Vein Graft, 2 Grafts | cardiac | $7,721 | $7,721 | $7,721 | 1 |
| Removal and Dissolving of Blood Clot From Vein Using Fluoroscopic Guidance, I... | surgery | $7,753 | $7,753 | $7,753 | 1 |
| Viral Illness without Mcc | other | $7,780 | $6,991 | $8,568 | 2 |
| Hernia Repair | surgery | $7,790 | $1,177 | $20,414 | 11 |
| Injection, Durvalumab, 10 Mg | other | $7,802 | $7,802 | $7,802 | 1 |
| Infections, Female Reproductive System without Cc/mcc | other | $7,806 | $7,806 | $7,806 | 1 |
| Gore Excluder Aaa Endoprosthesis 26mm X 14.5mm Rlt261414 | other | $7,807 | $7,807 | $7,807 | 1 |
| Repair of Aorta At Heart | surgery | $7,811 | $7,811 | $7,811 | 1 |
| Urinary Stones without Mcc | other | $7,819 | $5,485 | $10,152 | 2 |
| Repair of Aneurysm Above Heart Valve to Lung On Heart-lung Machine | surgery | $7,831 | $7,831 | $7,831 | 1 |
| Injection, Rho D Immune Globulin, Intravenous, Human, Solvent Detergent, 100 Iu | other | $7,838 | $7,838 | $7,838 | 1 |
| Hand OR Wrist Procedures, Except Major Thumb OR Joint Procedures without Cc/mcc | other | $7,853 | $7,853 | $7,853 | 1 |
| Cardioverter-defibrillator, Single Chamber | other | $7,862 | $7,862 | $7,862 | 1 |
| Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and... | other | $7,880 | $3,928 | $11,831 | 2 |
| Insertion of Left Lower Heart Electrode and Attachment to Pacemaker OR Defibr... | cardiac | $7,895 | $7,895 | $7,895 | 1 |
| Insertion of Pacemaker and Lower Heart Chamber Electrode | cardiac | $7,895 | $7,895 | $7,895 | 1 |
| Injection, Collagenase, Clostridium Histolyticum, 0.01 Mg | other | $7,901 | $7,901 | $7,901 | 1 |
| Repair of Congenital Defect Between Upper Heart Chambers On Heart-lung Machine | surgery | $7,902 | $7,902 | $7,902 | 1 |
| Gore Excluder Endoporsthesis Iliac Branch Comp #ceb231010a | other | $7,919 | $7,919 | $7,919 | 1 |
| Gore Excluder Iliac Branch Endoprosthesis Iliac Branch Component 14.35mm X 10... | other | $7,919 | $7,919 | $7,919 | 1 |
| Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg | other | $7,924 | $7,924 | $7,924 | 1 |
| Insertion of 2 Chamber Pacemaker System | cardiac | $7,936 | $7,936 | $7,936 | 1 |
| Aftercare without Cc/mcc | other | $7,944 | $7,944 | $7,944 | 1 |
| Injection, Enfortumab Vedotin-ejfv, 0.25 Mg | other | $7,964 | $7,964 | $7,964 | 1 |
| Bypass of Diseased OR Blocked Artery Aorta to Abdominal OR Kidney Artery with... | other | $7,969 | $7,969 | $7,969 | 1 |
| Other Ear, Nose, Mouth and Throat O.r. Procedures with Mcc | other | $8,025 | $8,025 | $8,025 | 1 |
| Traumatic Injury without Mcc | emergency | $8,032 | $4,129 | $11,935 | 2 |
| Major Skin Disorders without Mcc | other | $8,043 | $6,511 | $9,574 | 2 |
| Insertion of Catheters for Recording and Pacing of Left Upper Heart Chamber R... | cardiac | $8,057 | $8,057 | $8,057 | 1 |
| Gore Excluder Ipsilateral Leg Endoprosthesis 28.5mm X 14.5mm X 12cm #rlt281412 | other | $8,065 | $8,065 | $8,065 | 1 |
| Removal of Heart Sac On Heart-lung Machine | surgery | $8,090 | $8,090 | $8,090 | 1 |
| Wound Debridements for Injuries without Cc/mcc | other | $8,164 | $8,164 | $8,164 | 1 |
| Multiple Sclerosis and Cerebellar Ataxia with Cc | other | $8,191 | $7,988 | $8,393 | 2 |
| Other O.r. Procedures of the Blood and Blood Forming Organs without Cc/mcc | other | $8,292 | $8,292 | $8,292 | 1 |
| Coronary Artery Bypass Using Artery Graft, 2 Grafts | cardiac | $8,302 | $8,302 | $8,302 | 1 |
| Injection, Digoxin Immune Fab (ovine), Per Vial | other | $8,341 | $8,341 | $8,341 | 1 |
| Coronary Artery Bypass Using Vein Graft, 3 Grafts | cardiac | $8,342 | $8,342 | $8,342 | 1 |
| Pneumothorax with Cc | other | $8,365 | $5,811 | $10,919 | 2 |
| Endocrine Disorders with Cc | other | $8,366 | $5,530 | $11,202 | 2 |
| Insertion of Pacemaker and Upper and Lower Heart Chamber Electrode | cardiac | $8,377 | $8,377 | $8,377 | 1 |
| Other Antepartum Diagnoses without O.r. Procedures with Mcc | other | $8,384 | $6,757 | $10,010 | 2 |
| Hepatobiliary Diagnostic Procedures with Cc | other | $8,393 | $8,393 | $8,393 | 1 |
| Coronary Artery Bypass Using Vein Graft, 4 Grafts | cardiac | $8,424 | $8,424 | $8,424 | 1 |
| Removal Tunneled Cv Cath | surgery | $8,480 | $8,480 | $8,480 | 1 |
| Coronary Artery Bypass Using Vein Graft, 5 Grafts | cardiac | $8,567 | $8,567 | $8,567 | 1 |
| Major Gastrointestinal Disorders and Peritoneal Infections without Cc/mcc | other | $8,596 | $8,596 | $8,596 | 1 |
| Renal Failure without CC/MCC | other | $8,609 | $8,148 | $9,070 | 2 |
| Bifurcated Stent #bea28-90/i16 | cardiac | $8,613 | $8,613 | $8,613 | 1 |
| Bifurcated Stent #bea28-90/i20 | cardiac | $8,613 | $8,613 | $8,613 | 1 |
| Bifurcated Stent Bea22-60/i16 | cardiac | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Afx2 #bea25-100/i16 | other | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Afx2 #bea25-100/i20 | other | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Afx2 #bea25-90/i16 | other | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Afx2 #bea28-100/i16 | other | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Afx2 #bea28-70/i16 | other | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Afx2 #bea28-80/i16 | other | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Afx2 #bea28-80/i20 | other | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Stent #ba25-100/i20 | cardiac | $8,613 | $8,613 | $8,613 | 1 |
| Graft Bifurcated Stent #bea25-90/i20 | cardiac | $8,613 | $8,613 | $8,613 | 1 |
| Removal of Blood Clot in Pulmonary Artery On Heart-lung Machine | surgery | $8,664 | $8,664 | $8,664 | 1 |
| Balloon Dilation Repair of Aortic Valve | surgery | $8,755 | $8,755 | $8,755 | 1 |
| HIV with Major Related Condition with Cc | other | $8,765 | $8,765 | $8,765 | 1 |
| Non-extensive Burns | other | $8,817 | $8,817 | $8,817 | 1 |
| Injection, Rituximab, 10 Mg | other | $8,878 | $8,878 | $8,878 | 1 |
| Septoplasty | surgery | $8,930 | $3,626 | $9,949 | 4 |
| Injection, Prothrombin Complex Concentrate, Human-lans, Per I.u. of Factor Ix... | other | $8,938 | $8,938 | $8,938 | 1 |
| Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg | other | $8,974 | $8,974 | $8,974 | 1 |
| Repair of Tricuspid Valve with Ring Insertion | surgery | $8,988 | $8,988 | $8,988 | 1 |
| Heart Failure and Shock without CC/MCC | cardiac | $9,012 | $6,000 | $12,023 | 2 |
| Gore Excluder Conformable Aaa Endoprosthesis 18fr Cxt321414 | other | $9,013 | $9,013 | $9,013 | 1 |
| Gore Excluder Conformable Aaa Endoprosthesis Cxt281412 | other | $9,013 | $9,013 | $9,013 | 1 |
| Principal Diagnosis Invalid As Discharge Diagnosis | other | $9,015 | $9,015 | $9,015 | 1 |
| Destruction of Growths and Adjacent Soft Tissue | other | $9,029 | $9,029 | $9,029 | 1 |
| Replacement of Aortic Valve On Heart-lung Machine | surgery | $9,034 | $9,034 | $9,034 | 1 |
| Other O.r. Procedures for Injuries without Cc/mcc | other | $9,164 | $9,164 | $9,164 | 1 |
| Inflammatory Bowel Disease without Cc/mcc | other | $9,228 | $9,228 | $9,228 | 1 |
| Skin Ulcers with Cc | other | $9,266 | $6,467 | $12,064 | 2 |
| Infections, Female Reproductive System with Mcc | other | $9,307 | $9,307 | $9,307 | 1 |
| Gore Excluder Endoprosthesis Aaa Conformable Endo #cxt261412 | other | $9,311 | $9,311 | $9,311 | 1 |
| Coronary Artery Bypass Using Artery Graft, 4 Grafts | cardiac | $9,332 | $9,332 | $9,332 | 1 |
| COPD without CC/MCC | other | $9,344 | $6,357 | $12,330 | 2 |
| Knee Arthroscopy | other | $9,370 | $318 | $12,707 | 9 |
| Insertion of Catheters for Recording and Pacing of Right Heart Chambers Rhyth... | cardiac | $9,391 | $9,391 | $9,391 | 1 |
| Lumpectomy (Breast) | surgery | $9,421 | $7,903 | $9,911 | 5 |
| Allergic Reactions with Mcc | other | $9,426 | $4,581 | $14,271 | 2 |
| Local Excision and Removal of Internal Fixation Devices Except Hip and Femur ... | surgery | $9,438 | $9,438 | $9,438 | 1 |
| C-Section (Cesarean Delivery) | obstetric | $9,441 | $1,129 | $21,792 | 20 |
| Occlusion of Growths OR Obstructed Vessels with Review By Radiologist | other | $9,451 | $9,451 | $9,451 | 1 |
| Occlusion of Vein with Review By Radiologist | other | $9,451 | $9,451 | $9,451 | 1 |
| Gastrointestinal Obstruction without Cc/mcc | other | $9,470 | $9,367 | $9,572 | 2 |
| Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes wit... | other | $9,597 | $7,934 | $11,260 | 2 |
| Insertion of Pacemaker and Upper Heart Chamber Electrode | cardiac | $9,599 | $9,599 | $9,599 | 1 |
| Repair of Mitral Valve with Artificial Valve On Heart-lung Machine | surgery | $9,614 | $9,614 | $9,614 | 1 |
| Replacement of Tricuspid Valve On Heart-lung Machine | surgery | $9,622 | $9,622 | $9,622 | 1 |
| Pulmonary Embolism without MCC | other | $9,634 | $9,283 | $9,984 | 2 |
| Cirrhosis and Alcoholic Hepatitis without Cc/mcc | other | $9,672 | $9,672 | $9,672 | 1 |
| Radical Reconstruction of Mitral Valve On Heart-lung Machine | cardiac | $9,679 | $9,679 | $9,679 | 1 |
| Insertion of Expandable Tube in Breast for Radiation Treatment Using Imaging ... | other | $9,700 | $9,700 | $9,700 | 1 |
| Cardioverter-defibrillator, Other Than Single OR Dual Chamber | other | $9,742 | $9,742 | $9,742 | 1 |
| Chest Pain | other | $9,746 | $9,746 | $9,746 | 1 |
| Diabetes with Cc | other | $9,750 | $9,549 | $9,950 | 2 |
| Otitis Media and Uri with Mcc | other | $9,761 | $7,032 | $12,489 | 2 |
| Acute Major Eye Infections with Cc/mcc | other | $9,813 | $9,813 | $9,813 | 1 |
| Wound Debridements for Injuries with Cc | other | $9,857 | $9,857 | $9,857 | 1 |
| Injection, Romiplostim, 1 Microgram | other | $9,910 | $9,910 | $9,910 | 1 |
| Acute Leukemia with Cc | other | $9,929 | $9,929 | $9,929 | 1 |
| Hypertension without Mcc | other | $9,943 | $9,398 | $10,488 | 2 |
| Poisoning and Toxic Effects of Drugs without MCC | emergency | $10,012 | $10,012 | $10,012 | 1 |
| Prosthesis, Penile, Inflatable | other | $10,062 | $10,062 | $10,062 | 1 |
| Pneumothorax without Cc/mcc | other | $10,068 | $10,068 | $10,068 | 1 |
| Skin Grafts for Injuries with Cc/mcc | other | $10,077 | $10,077 | $10,077 | 1 |
| Other Musculoskeletal System and Connective Tissue Diagnoses without Cc/mcc | other | $10,079 | $10,018 | $10,139 | 2 |
| Non-malignant Breast Disorders without Cc/mcc | other | $10,086 | $10,086 | $10,086 | 1 |
| Replacement of Mitral Valve On Heart-lung Machine | surgery | $10,099 | $10,099 | $10,099 | 1 |
| Septic Arthritis with Cc | other | $10,119 | $10,050 | $10,188 | 2 |
| Integra 10x25cm | other | $10,127 | $10,127 | $10,127 | 1 |
| Cellulitis without Mcc | other | $10,132 | $10,034 | $10,230 | 2 |
| Injection, Rasburicase, 0.5 Mg | other | $10,154 | $10,154 | $10,154 | 1 |
| Watchman Flex Device 20mm Wu5020 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flex Device 24mm Wu5024 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flex Device 27mm Wu5027 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flex Device 31mm Wu5031 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flx Pro Laa Closure 20mm Wu6020 M635wu60200 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flx Pro Laa Closure 24mm Wu6024 M635wu60240 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flx Pro Laa Closure 27mm Wu6027 M635wu60270 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flx Pro Laa Closure 31mm Wu6031 M635wu60310 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flx Pro Laa Closure 35mm Wu6035 M635wu60350 | other | $10,200 | $10,200 | $10,200 | 1 |
| Watchman Flx Pro Laa Closure 40mm Wu6040 M635wu60400 | other | $10,200 | $10,200 | $10,200 | 1 |
| Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh without Cc/mcc | other | $10,243 | $10,243 | $10,243 | 1 |
| Fever and Inflammatory Conditions | other | $10,281 | $6,945 | $13,616 | 2 |
| Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy w... | other | $10,334 | $7,796 | $12,872 | 2 |
| Mouth Procedures without Cc/mcc | other | $10,398 | $10,398 | $10,398 | 1 |
| Injection, Vedolizumab, Intravenous, 1 Mg | other | $10,400 | $10,400 | $10,400 | 1 |
| Insertion of Stent in Vein with Review By Radiologist, Initial Vein | cardiac | $10,402 | $10,402 | $10,402 | 1 |
| Bronchitis and Asthma with Cc/mcc | other | $10,443 | $8,635 | $12,251 | 2 |
| Trauma to the Skin, Subcutaneous Tissue and Breast without Mcc | emergency | $10,453 | $9,829 | $11,077 | 2 |
| Disorders of Pancreas Except Malignancy without Cc/mcc | other | $10,511 | $8,240 | $12,781 | 2 |
| Cardiac Arrhythmia and Conduction Disorders with Cc | cardiac | $10,573 | $10,322 | $10,823 | 2 |
| Removal of Thickened Heart Muscle At Left Lower Heart Chamber | surgery | $10,585 | $10,585 | $10,585 | 1 |
| Kidney and Urinary Tract Infections without MCC | other | $10,622 | $9,737 | $11,506 | 2 |
| Fractures of Hip and Pelvis without Mcc | other | $10,681 | $10,234 | $11,128 | 2 |
| Peripheral Vascular Disorders with Cc | other | $10,687 | $9,589 | $11,785 | 2 |
| Tendonitis, Myositis and Bursitis without Mcc | other | $10,689 | $10,596 | $10,782 | 2 |
| Alcohol/Drug Abuse or Dependence without Rehabilitation without MCC | therapy | $10,792 | $8,959 | $12,624 | 2 |
| Amplatzer Amulet Laao 16mm 9-acp2-007 | other | $10,800 | $10,800 | $10,800 | 1 |
| Amplatzer Amulet Laao 18mm 9-acp2-007 | other | $10,800 | $10,800 | $10,800 | 1 |
| Amplatzer Amulet Laao 20mm 9-acp2-007 | other | $10,800 | $10,800 | $10,800 | 1 |
| Amplatzer Amulet Laao 22mm 9-acp2-007 | other | $10,800 | $10,800 | $10,800 | 1 |
| Amplatzer Amulet Laao 25mm 9-acp2-010 | other | $10,800 | $10,800 | $10,800 | 1 |
| Amplatzer Amulet Laao 28mm 9-acp2-010 | other | $10,800 | $10,800 | $10,800 | 1 |
| Amplatzer Amulet Laao 31mm 9-acp2-010 | other | $10,800 | $10,800 | $10,800 | 1 |
| Amplatzer Amulet Laao 34mm 9-acp2-010 | other | $10,800 | $10,800 | $10,800 | 1 |
| Watchman Device 27mm | other | $10,800 | $10,800 | $10,800 | 1 |
| Watchman Device 30mm | other | $10,800 | $10,800 | $10,800 | 1 |
| Watchman Device 33mm | other | $10,800 | $10,800 | $10,800 | 1 |
| Watchman Flex Device 35mm Wu5035 | other | $10,800 | $10,800 | $10,800 | 1 |
| Minor Skin Disorders without Mcc | other | $10,818 | $7,817 | $13,819 | 2 |
| Valiant Thoracic Stent Graft W/ Captivia Delivery System 38mm X 34mm X 150mm ... | cardiac | $10,875 | $10,875 | $10,875 | 1 |
| Hypertensive Encephalopathy with Cc | other | $10,919 | $10,097 | $11,740 | 2 |
| Injection, Pembrolizumab, 1 Mg | other | $10,928 | $10,928 | $10,928 | 1 |
| Repair of Wound to Heart On Heart-lung Machine | surgery | $10,953 | $10,953 | $10,953 | 1 |
| Coronary Artery Bypass Using Vein Graft, 6 OR More Grafts | cardiac | $10,997 | $10,997 | $10,997 | 1 |
| Uncomplicated Peptic Ulcer without Mcc | other | $11,039 | $11,039 | $11,039 | 1 |
| Simple Pneumonia with CC | other | $11,071 | $10,393 | $11,748 | 2 |
| Replacement of Aortic Valve with Aorta Enlargement | surgery | $11,107 | $11,107 | $11,107 | 1 |
| Myeloproliferative Disorders OR Poorly Differentiated Neoplasms with Other Pr... | other | $11,193 | $11,193 | $11,193 | 1 |
| Disorders of Liver Except Malignancy, Cirrhosis OR Alcoholic Hepatitis with Cc | other | $11,206 | $8,350 | $14,061 | 2 |
| Minor Bladder Procedures without Cc/mcc | other | $11,211 | $11,211 | $11,211 | 1 |
| Atherosclerosis without Mcc | other | $11,231 | $9,524 | $12,938 | 2 |
| COPD with CC | other | $11,251 | $10,697 | $11,804 | 2 |
| Renal Failure with CC | other | $11,317 | $10,637 | $11,997 | 2 |
| Skin Graft for Skin Ulcer OR Cellulitis without Cc/mcc | other | $11,325 | $11,325 | $11,325 | 1 |
| Peripheral, Cranial Nerve and Other Nervous System Procedures without Cc/mcc | other | $11,350 | $11,350 | $11,350 | 1 |
| Injection, Siltuximab, 10 Mg | other | $11,351 | $11,351 | $11,351 | 1 |
| Acute and Subacute Endocarditis with Cc | other | $11,357 | $11,357 | $11,357 | 1 |
| Gastrointestinal Hemorrhage without Cc/mcc | other | $11,360 | $11,309 | $11,410 | 2 |
| Generator, Neurostimulator (implantable), with Rechargeable Battery and Charg... | surgery | $11,400 | $11,400 | $11,400 | 1 |
| Osteomyelitis with Cc | other | $11,416 | $11,416 | $11,416 | 1 |
| Inflammation of the Male Reproductive System without Mcc | other | $11,429 | $8,459 | $14,399 | 2 |
| Valiant Thoracic Stent Graft with the Captivia Delivery System Vamf3838c200tu | cardiac | $11,463 | $11,463 | $11,463 | 1 |
| Other Multiple Significant Trauma with Cc | emergency | $11,473 | $3,858 | $19,088 | 2 |
| Hypertension with Mcc | other | $11,527 | $10,598 | $12,456 | 2 |
| Extracranial Procedures with Cc | other | $11,529 | $11,529 | $11,529 | 1 |
| Cranial and Peripheral Nerve Disorders without Mcc | other | $11,555 | $10,857 | $12,252 | 2 |
| Kcentra 1,000 Unit Injection V | other | $11,591 | $11,591 | $11,591 | 1 |
| Esophagitis and GI Disorders with MCC | other | $11,601 | $10,800 | $12,402 | 2 |
| Graft Thoracic 10cmx21mmx21mm Tgm212110 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 10cmx28mmx28mm Tgm282810 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 10cmx31mmx26mm Tgmr312610 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 10cmx31mmx31mm Tgmr313110 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 15cmx31mmx31mm Tgmr313115 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 15cmx34mmx34mm Tgm343415 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 15cmx37mmx37mm Tgmr373715 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 15cmx40mmx40mm Tgmr404015 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 15cmx45mmx45mm Tgm454515 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 20cmx31mmx31mm Tgmr313120 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 20cmx37mmx37mm Tgmr373720 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 20cmx40mmx40mm Tgmr404020 | other | $11,647 | $11,647 | $11,647 | 1 |
| Graft Thoracic 20cmx45mmx45mm Tgm454520 | other | $11,647 | $11,647 | $11,647 | 1 |
| Inflammatory Bowel Disease with Cc | other | $11,685 | $11,512 | $11,857 | 2 |
| Pleural Effusion with Cc | surgery | $11,688 | $11,688 | $11,688 | 1 |
| Angioplasty with Stent (PCI) | other | $11,703 | $4,022 | $162,164 | 15 |
| Postpartum and Post Abortion Diagnoses with O.r. Procedures | obstetric | $11,736 | $7,121 | $16,351 | 2 |
| Other Ear, Nose, Mouth and Throat O.r. Procedures without Cc/mcc | other | $11,738 | $11,738 | $11,738 | 1 |
| Repair of Mitral Valve On Heart-lung Machine | surgery | $11,803 | $11,803 | $11,803 | 1 |
| Syncope and Collapse | other | $11,808 | $11,757 | $11,859 | 2 |
| Multiple Sclerosis and Cerebellar Ataxia without Cc/mcc | other | $11,837 | $11,837 | $11,837 | 1 |
| COPD with MCC | other | $11,847 | $9,968 | $13,725 | 2 |
| Gastric Sleeve (Weight Loss Surgery) | other | $11,870 | $11,870 | $11,870 | 1 |
| Injection, Ado-trastuzumab Emtansine, 1 Mg | other | $11,886 | $11,886 | $11,886 | 1 |
| Injection, Octreotide, Depot Form for Intramuscular Injection, 1 Mg | other | $11,934 | $11,934 | $11,934 | 1 |
| Other Cerebrovascular Disorders without Cc/mcc | other | $11,998 | $8,057 | $15,939 | 2 |
| Malignancy, Female Reproductive System with Cc | other | $12,048 | $8,269 | $15,827 | 2 |
| Anchor Tissue to Bone | other | $12,062 | $12,062 | $12,062 | 1 |
| Other Digestive System O.r. Procedures without Cc/mcc | other | $12,066 | $12,066 | $12,066 | 1 |
| Nervous System Neoplasms without Mcc | other | $12,079 | $10,531 | $13,626 | 2 |
| Other Digestive System Diagnoses without Cc/mcc | other | $12,082 | $9,849 | $14,314 | 2 |
| Repositioning of Tricuspid Valve | other | $12,083 | $12,083 | $12,083 | 1 |
| Signs and Symptoms of Musculoskeletal System and Connective Tissue without Mcc | other | $12,090 | $12,090 | $12,090 | 1 |
| Fractures of Hip and Pelvis with Mcc | other | $12,195 | $11,753 | $12,637 | 2 |
| Menstrual and Other Female Reproductive System Disorders without Cc/mcc | other | $12,233 | $12,233 | $12,233 | 1 |
| Generator, Neurostimulator (implantable), Non-rechargeable | surgery | $12,300 | $12,300 | $12,300 | 1 |
| Disorders of Pancreas Except Malignancy with Cc | other | $12,319 | $11,553 | $13,084 | 2 |
| Injection, Pertuzumab, 1 Mg | other | $12,336 | $12,336 | $12,336 | 1 |
| Neurological Eye Disorders | other | $12,339 | $12,339 | $12,339 | 1 |
| Peripheral, Cranial Nerve and Other Nervous System Procedures with Cc OR Peri... | other | $12,350 | $12,350 | $12,350 | 1 |
| Foot Procedures with Cc | other | $12,362 | $11,322 | $13,402 | 2 |
| Prostatectomy with Cc | other | $12,381 | $12,381 | $12,381 | 1 |
| Uncomplicated Peptic Ulcer with Mcc | other | $12,402 | $5,605 | $19,198 | 2 |
| Injection, Rituximab 10 Mg and Hyaluronidase | other | $12,430 | $12,430 | $12,430 | 1 |
| Repair of Lower Heart Chamber Following Heart Attack | surgery | $12,464 | $12,464 | $12,464 | 1 |
| Heart Failure and Shock with CC | cardiac | $12,466 | $11,503 | $13,428 | 2 |
| Pulmonary Edema and Respiratory Failure | other | $12,472 | $12,015 | $12,929 | 2 |
| Concussion with Cc | other | $12,477 | $12,477 | $12,477 | 1 |
| Skin Debridement without Cc/mcc | other | $12,478 | $8,316 | $16,640 | 2 |
| Interstitial Lung Disease with Mcc | other | $12,613 | $12,613 | $12,613 | 1 |
| Major Chest Trauma with Cc | emergency | $12,614 | $12,614 | $12,614 | 1 |
| Respiratory Infections and Inflammations with Cc | other | $12,625 | $11,396 | $13,853 | 2 |
| Soft Tissue Procedures without Cc/mcc | other | $12,662 | $12,662 | $12,662 | 1 |
| Prostatectomy without Cc/mcc | other | $12,698 | $12,698 | $12,698 | 1 |
| Respiratory Neoplasms with Cc | other | $12,702 | $10,320 | $15,084 | 2 |
| Other Ear, Nose, Mouth and Throat Diagnoses with Cc | other | $12,704 | $12,704 | $12,704 | 1 |
| Injection, Panitumumab, 10 Mg | other | $12,717 | $12,717 | $12,717 | 1 |
| Mastectomy for Malignancy without Cc/mcc | other | $12,732 | $12,732 | $12,732 | 1 |
| Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh ... | other | $12,736 | $11,499 | $13,973 | 2 |
| Knee Procedures without Principal Diagnosis of Infection with Cc/mcc | other | $12,755 | $12,755 | $12,755 | 1 |
| Traumatic Stupor and Coma >1 Hour with Cc | emergency | $12,768 | $10,738 | $14,798 | 2 |
| Implantable Wireless Pulmonary Artery Pressure Sensor with Delivery Catheter,... | surgery | $12,840 | $12,840 | $12,840 | 1 |
| Reticuloendothelial and Immunity Disorders with Cc | other | $12,875 | $10,426 | $15,324 | 2 |
| Urethral Stricture | other | $12,876 | $12,876 | $12,876 | 1 |
| Repair of Tricuspid Valve | surgery | $12,910 | $12,910 | $12,910 | 1 |
| Simple Pneumonia without CC/MCC | other | $12,956 | $8,923 | $16,988 | 2 |
| Angina Pectoris | other | $12,988 | $12,988 | $12,988 | 1 |
| Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with Mcc | other | $13,002 | $10,708 | $15,296 | 2 |
| Extracranial Vascular Procedures with MCC | other | $13,071 | $13,071 | $13,071 | 1 |
| Repair of Ascending Aorta with Graft On Heart-lung Machine with Aortic Root R... | surgery | $13,073 | $13,073 | $13,073 | 1 |
| Other Endocrine, Nutritional and Metabolic O.r. Procedures without Cc/mcc | lab | $13,119 | $13,119 | $13,119 | 1 |
| Removal of Plaque in Artery of Leg, Initial Vessel | surgery | $13,163 | $13,163 | $13,163 | 1 |
| Nervous System Neoplasms with Mcc | other | $13,166 | $8,809 | $17,522 | 2 |
| Signs and Symptoms with Mcc | other | $13,183 | $13,183 | $13,183 | 1 |
| Multiple Sclerosis and Cerebellar Ataxia with Mcc | other | $13,193 | $13,193 | $13,193 | 1 |
| Other Injury, Poisoning and Toxic Effect Diagnoses without Mcc | other | $13,194 | $11,905 | $14,482 | 2 |
| Penis Procedures with Cc/mcc | other | $13,196 | $6,079 | $20,313 | 2 |
| Other Kidney and Urinary Tract Diagnoses with Cc | other | $13,259 | $12,810 | $13,707 | 2 |
| Peripheral Vascular Disorders with Mcc | other | $13,289 | $12,301 | $14,276 | 2 |
| Seizures without MCC | other | $13,300 | $13,299 | $13,300 | 2 |
| Connective Tissue Disorders with Cc | other | $13,313 | $6,880 | $19,745 | 2 |
| Aftercare, Musculoskeletal System and Connective Tissue with Cc | other | $13,332 | $10,137 | $16,527 | 2 |
| Other Antepartum Diagnoses with O.r. Procedures with Mcc | other | $13,350 | $6,587 | $20,112 | 2 |
| Gastrointestinal Obstruction with Cc | other | $13,377 | $13,232 | $13,521 | 2 |
| Psychoses | therapy | $13,385 | $6,288 | $20,481 | 2 |
| Coronary Artery Bypass Using Artery Graft, 3 Grafts | cardiac | $13,447 | $13,447 | $13,447 | 1 |
| CABG (Heart Bypass Surgery) | other | $13,452 | $4,615 | $31,144 | 7 |
| Thyroidectomy | surgery | $13,492 | $2,442 | $21,255 | 6 |
| Cardiac Arrhythmia and Conduction Disorders with Mcc | cardiac | $13,554 | $11,615 | $15,493 | 2 |
| Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Li... | other | $13,711 | $13,711 | $13,711 | 1 |
| Other Disorders of Nervous System with Cc | other | $13,712 | $13,562 | $13,861 | 2 |
| Tracheostomy for Face, Mouth and Neck Diagnoses OR Laryngectomy without Cc/mcc | other | $13,747 | $13,747 | $13,747 | 1 |
| Injection, Ramucirumab, 5 Mg | other | $13,767 | $13,767 | $13,767 | 1 |
| Heart Failure and Shock with MCC | cardiac | $13,786 | $13,342 | $14,229 | 2 |
| Intracranial Hemorrhage or Cerebral Infarction with CC | other | $13,806 | $12,159 | $15,453 | 2 |
| Simple Pneumonia with MCC | other | $13,826 | $13,466 | $14,186 | 2 |
| Hand Procedures for Injuries | other | $14,003 | $9,222 | $18,784 | 2 |
| Hernia Procedures Except Inguinal and Femoral without Cc/mcc | other | $14,013 | $12,871 | $15,155 | 2 |
| Complications of Treatment with Mcc | other | $14,031 | $4,181 | $23,880 | 2 |
| Hand OR Wrist Procedures, Except Major Thumb OR Joint Procedures with Cc/mcc | other | $14,039 | $13,043 | $15,034 | 2 |
| Medical Back Problems without Mcc | other | $14,048 | $12,075 | $16,021 | 2 |
| Organic Disturbances and Intellectual Disability | other | $14,121 | $12,076 | $16,166 | 2 |
| Skin Graft for Skin Ulcer OR Cellulitis with Cc | other | $14,151 | $14,151 | $14,151 | 1 |
| Removal of Plaque in Arteries of Leg | surgery | $14,195 | $14,195 | $14,195 | 1 |
| Amputation for Musculoskeletal System and Connective Tissue Disorders without... | other | $14,263 | $14,263 | $14,263 | 1 |
| Respiratory Infections and Inflammations without Cc/mcc | other | $14,263 | $6,128 | $22,398 | 2 |
| Dermacell, Awm, Porous SQ Cm | other | $14,345 | $14,345 | $14,345 | 1 |
| Other Myeloproliferative Disorders OR Poorly Differentiated Neoplastic Diagno... | other | $14,365 | $9,446 | $19,283 | 2 |
| Anal and Stomal Procedures with Cc | other | $14,373 | $10,852 | $17,893 | 2 |
| Red Blood Cell Disorders without Mcc | other | $14,395 | $9,980 | $18,810 | 2 |
| Other Circulatory System Diagnoses with Cc | other | $14,398 | $14,285 | $14,510 | 2 |
| Injection, Nivolumab, 1 Mg | other | $14,429 | $14,429 | $14,429 | 1 |
| Minor Skin Disorders with Mcc | other | $14,470 | $14,470 | $14,470 | 1 |
| Other Musculoskeletal System and Connective Tissue Diagnoses with Mcc | other | $14,477 | $10,635 | $18,318 | 2 |
| Headaches without Mcc | other | $14,498 | $11,987 | $17,008 | 2 |
| ERCP Duct Stent Placement | cardiac | $14,520 | $14,520 | $14,520 | 1 |
| Major Chest Trauma with Mcc | emergency | $14,555 | $14,555 | $14,555 | 1 |
| Major Head and Neck Procedures with Cc | other | $14,583 | $14,583 | $14,583 | 1 |
| Urinary Stones with Mcc | other | $14,618 | $13,153 | $16,082 | 2 |
| Kidney and Ureter Procedures for Non-neoplasm without Cc/mcc | other | $14,650 | $11,808 | $17,491 | 2 |
| Precerebral Occlusion without Infarction with Mcc | other | $14,661 | $14,661 | $14,661 | 1 |
| Gallbladder Removal (Laparoscopic) | surgery | $14,674 | $573 | $48,472 | 22 |
| Kidney and Urinary Tract Infections with MCC | other | $14,681 | $14,140 | $15,222 | 2 |
| Malignant Breast Disorders with Cc | other | $14,741 | $14,741 | $14,741 | 1 |
| Inflammation of the Male Reproductive System with Mcc | other | $14,765 | $7,822 | $21,707 | 2 |
| Breast Biopsy, Local Excision and Other Breast Procedures with Cc/mcc | surgery | $14,772 | $14,772 | $14,772 | 1 |
| Septicemia or Severe Sepsis without Ventilator 96+ Hours without MCC | other | $14,817 | $13,789 | $15,845 | 2 |
| Skin Debridement with Mcc | other | $14,854 | $10,298 | $19,409 | 2 |
| Bone Diseases and Arthropathies without Mcc | other | $14,873 | $9,717 | $20,029 | 2 |
| Abortion with D&c, Aspiration Curettage OR Hysterotomy | other | $14,892 | $8,748 | $21,035 | 2 |
| Seizures with Mcc | other | $14,911 | $13,785 | $16,037 | 2 |
| Impella Cp #4000021 | other | $15,000 | $15,000 | $15,000 | 1 |
| Other Respiratory System O.r. Procedures without Cc/mcc | other | $15,033 | $15,033 | $15,033 | 1 |
| Intracranial Hemorrhage or Cerebral Infarction | other | $15,106 | $14,259 | $15,952 | 2 |
| Acute Myocardial Infarction Discharged Alive with CC | cardiac | $15,114 | $7,033 | $23,194 | 2 |
| Pulmonary Embolism with MCC | other | $15,115 | $10,937 | $19,292 | 2 |
| Benign Prostatic Hypertrophy without Mcc | other | $15,158 | $15,158 | $15,158 | 1 |
| Injection, Lurbinectedin, 0.1 Mg | other | $15,177 | $15,177 | $15,177 | 1 |
| Cardiac Pacemaker Revision Except Device Replacement with Cc | surgery | $15,219 | $15,219 | $15,219 | 1 |
| Nutritional and Metabolic Disorders without MCC | other | $15,255 | $13,463 | $17,046 | 2 |
| Samarium Sm 153 Lexidronam 1850 Mbq/ml IV Soln | other | $15,265 | $15,265 | $15,265 | 1 |
| Pacemaker Insertion | cardiac | $15,289 | $6,102 | $58,276 | 15 |
| Injection, Tenecteplase, 1 Mg | other | $15,336 | $13,651 | $17,020 | 2 |
| Corneal Tissue Processing | other | $15,355 | $15,355 | $15,355 | 1 |
| Traumatic Injury with Mcc | emergency | $15,372 | $5,703 | $25,040 | 2 |
| Acute Adjustment Reaction and Psychosocial Dysfunction | other | $15,422 | $12,361 | $18,482 | 2 |
| Complications of Treatment with Cc | other | $15,424 | $13,084 | $17,763 | 2 |
| Aftercare, Musculoskeletal System and Connective Tissue without Cc/mcc | other | $15,464 | $9,303 | $21,625 | 2 |
| Signs and Symptoms without Mcc | other | $15,489 | $15,489 | $15,489 | 1 |
| Injection, Natalizumab, 1 Mg | other | $15,516 | $15,516 | $15,516 | 1 |
| Craniotomy and Endovascular Intracranial Procedures without Cc/mcc | other | $15,543 | $15,543 | $15,543 | 1 |
| Disorders of the Biliary Tract without Cc/mcc | other | $15,571 | $10,589 | $20,552 | 2 |
| Injection, Obinutuzumab, 10 Mg | other | $15,577 | $15,577 | $15,577 | 1 |
| Generator, Neurostimulator (implantable), High Frequency, with Rechargeable B... | surgery | $15,600 | $15,600 | $15,600 | 1 |
| Degenerative Nervous System Disorders without Mcc | other | $15,657 | $10,063 | $21,251 | 2 |
| Lymphoma and Non-acute Leukemia with Cc | other | $15,677 | $12,970 | $18,383 | 2 |
| Endocrine Disorders with Mcc | other | $15,769 | $13,230 | $18,308 | 2 |
| Aftercare with Cc/mcc | other | $15,919 | $15,919 | $15,919 | 1 |
| Renal Failure with MCC | other | $16,010 | $15,914 | $16,106 | 2 |
| Removal of Plaque and Insertion of Stents in Arteries of Leg | surgery | $16,022 | $16,022 | $16,022 | 1 |
| Medical Back Problems with Mcc | other | $16,031 | $16,031 | $16,031 | 1 |
| Other Injury, Poisoning and Toxic Effect Diagnoses with Mcc | other | $16,195 | $16,195 | $16,195 | 1 |
| Thyroid, Parathyroid and Thyroglossal Procedures without Cc/mcc | other | $16,196 | $16,196 | $16,196 | 1 |
| Other Digestive System Diagnoses with Cc | other | $16,240 | $13,894 | $18,585 | 2 |
| Tendonitis, Myositis and Bursitis with Mcc | other | $16,254 | $14,945 | $17,563 | 2 |
| Other Antepartum Diagnoses with O.r. Procedures without Cc/mcc | other | $16,256 | $16,256 | $16,256 | 1 |
| Epistaxis without Mcc | other | $16,286 | $16,286 | $16,286 | 1 |
| Major Esophageal Disorders with Cc | other | $16,453 | $11,720 | $21,186 | 2 |
| GI Hemorrhage with CC | other | $16,490 | $13,863 | $19,116 | 2 |
| Other Musculoskeletal System and Connective Tissue Diagnoses with Cc | other | $16,524 | $14,139 | $18,909 | 2 |
| Bone Diseases and Arthropathies with Mcc | other | $16,556 | $6,844 | $26,267 | 2 |
| Dysequilibrium | other | $16,562 | $16,562 | $16,562 | 1 |
| Complicated Peptic Ulcer without Cc/mcc | other | $16,572 | $16,572 | $16,572 | 1 |
| Inborn and Other Disorders of Metabolism | other | $16,628 | $13,580 | $19,676 | 2 |
| Degenerative Nervous System Disorders with Mcc | other | $16,634 | $15,221 | $18,046 | 2 |
| Cardiac Ablation | other | $16,650 | $5,235 | $30,324 | 7 |
| Connective Tissue Disorders with Mcc | other | $16,672 | $13,937 | $19,406 | 2 |
| Kidney and Urinary Tract Neoplasms with Cc | other | $16,782 | $13,228 | $20,336 | 2 |
| Transurethral Procedures with Cc | other | $16,896 | $16,896 | $16,896 | 1 |
| Kidney and Urinary Tract Signs and Symptoms without Mcc | other | $16,913 | $10,693 | $23,132 | 2 |
| Cranial and Peripheral Nerve Disorders with Mcc | other | $16,971 | $14,141 | $19,801 | 2 |
| Wound Debridement | surgery | $17,004 | $295 | $78,271 | 13 |
| Exactech Total Shoulder | other | $17,020 | $17,020 | $17,020 | 1 |
| Other Infectious and Parasitic Diseases Diagnoses with Mcc | other | $17,055 | $14,947 | $19,163 | 2 |
| Spinal Disorders and Injuries with Cc/mcc | other | $17,144 | $17,144 | $17,144 | 1 |
| Other Kidney and Urinary Tract Diagnoses with Mcc | other | $17,168 | $16,590 | $17,745 | 2 |
| Appendectomy (Laparoscopic) | surgery | $17,388 | $3,778 | $28,955 | 12 |
| Hysterectomy (Laparoscopic) | surgery | $17,448 | $2,400 | $47,448 | 13 |
| Other Digestive System Diagnoses with Mcc | other | $17,463 | $14,214 | $20,711 | 2 |
| Prostatectomy | other | $17,467 | $9,554 | $38,386 | 13 |
| Concussion with Mcc | other | $17,484 | $17,484 | $17,484 | 1 |
| Upper Limb and Toe Amputation for Circulatory System Disorders with Cc | other | $17,494 | $14,447 | $20,540 | 2 |
| Hip and Femur Procedures except Major Joint without CC/MCC | surgery | $17,550 | $16,044 | $19,055 | 2 |
| Other Cerebrovascular Disorders with Cc | other | $17,560 | $16,664 | $18,455 | 2 |
| Insertion of Defibrillator with Existing Single Lead | other | $17,575 | $17,575 | $17,575 | 1 |
| Other Skin, Subcutaneous Tissue and Breast Procedures with Cc | other | $17,579 | $15,606 | $19,551 | 2 |
| Dental and Oral Diseases with Mcc | other | $17,714 | $17,714 | $17,714 | 1 |
| Aftercare, Musculoskeletal System and Connective Tissue with Mcc | other | $17,720 | $15,426 | $20,013 | 2 |
| Spinal Fusion (Lumbar) | surgery | $17,741 | $3,141 | $32,341 | 2 |
| Peritoneal Adhesiolysis without Cc/mcc | other | $17,757 | $17,757 | $17,757 | 1 |
| Postoperative OR Post-traumatic Infections with O.r. Procedures without Cc/mcc | emergency | $17,819 | $17,819 | $17,819 | 1 |
| Other Disorders of Nervous System with Mcc | other | $17,862 | $15,852 | $19,871 | 2 |
| HIV with Major Related Condition without Cc/mcc | other | $17,886 | $17,886 | $17,886 | 1 |
| Nontraumatic Stupor and Coma with Mcc | emergency | $17,979 | $17,979 | $17,979 | 1 |
| Transient Ischemia | other | $17,995 | $17,156 | $18,833 | 2 |
| Acute Myocardial Infarction Discharged Alive with MCC | cardiac | $18,012 | $14,536 | $21,487 | 2 |
| Injection, Lanreotide, (cipla), 1 Mg | other | $18,072 | $18,072 | $18,072 | 1 |
| Drugs Unclassified Injection | other | $18,095 | $18,095 | $18,095 | 1 |
| Major Gastrointestinal Disorders and Peritoneal Infections with Cc | other | $18,118 | $15,252 | $20,984 | 2 |
| Inguinal and Femoral Hernia Procedures without Cc/mcc | other | $18,208 | $18,208 | $18,208 | 1 |
| Alcohol, Drug Abuse OR Dependence without Rehabilitation Therapy with Mcc | therapy | $18,243 | $17,249 | $19,236 | 2 |
| Gastrointestinal Obstruction with Mcc | other | $18,246 | $13,934 | $22,558 | 2 |
| Digestive Malignancy with Cc | other | $18,248 | $17,560 | $18,935 | 2 |
| Diabetes with Mcc | other | $18,263 | $15,215 | $21,311 | 2 |
| Malignancy, Female Reproductive System with Mcc | other | $18,277 | $18,277 | $18,277 | 1 |
| Respiratory Infections with MCC | other | $18,289 | $16,806 | $19,771 | 2 |
| Ungroupable | other | $18,293 | $18,293 | $18,293 | 1 |
| Lymphoma and Non-acute Leukemia with Mcc | other | $18,337 | $14,933 | $21,741 | 2 |
| Major Head and Neck Procedures without Cc/mcc | other | $18,422 | $18,422 | $18,422 | 1 |
| Injection, Alteplase Recombinant, 1 Mg | other | $18,481 | $18,481 | $18,481 | 1 |
| Injection, Daratumumab, 10 Mg and Hyaluronidase-fihj | other | $18,848 | $18,848 | $18,848 | 1 |
| Inguinal and Femoral Hernia Procedures with Cc | other | $18,918 | $17,630 | $20,206 | 2 |
| Biopsies of Musculoskeletal System and Connective Tissue without Cc/mcc | other | $18,962 | $18,962 | $18,962 | 1 |
| Acute Myocardial Infarction Discharged Alive without CC/MCC | cardiac | $19,032 | $14,764 | $23,299 | 2 |
| Complicated Peptic Ulcer with Cc | other | $19,050 | $18,543 | $19,556 | 2 |
| Inflammatory Bowel Disease with Mcc | other | $19,076 | $14,987 | $23,165 | 2 |
| Kidney and Urinary Tract Neoplasms with Mcc | other | $19,080 | $19,080 | $19,080 | 1 |
| Disorders of the Biliary Tract with Cc | other | $19,122 | $12,724 | $25,519 | 2 |
| Reticuloendothelial and Immunity Disorders with Mcc | other | $19,159 | $16,419 | $21,898 | 2 |
| Poisoning and Toxic Effects of Drugs with MCC | emergency | $19,226 | $13,540 | $24,911 | 2 |
| Cardiac Congenital and Valvular Disorders with Mcc | cardiac | $19,235 | $11,465 | $27,004 | 2 |
| Heart Valve Replacement | other | $19,336 | $2,567 | $114,394 | 11 |
| Rectal Resection with Cc | other | $19,486 | $19,486 | $19,486 | 1 |
| Cirrhosis and Alcoholic Hepatitis with Cc | other | $19,490 | $16,386 | $22,593 | 2 |
| Transcath Heart Valve 20mm Sapien 3 Ref# S3ucm220a | cardiac | $19,500 | $19,500 | $19,500 | 1 |
| Transcath Heart Valve 23mm Sapien 3 S3ucm223a | cardiac | $19,500 | $19,500 | $19,500 | 1 |
| Transcath Heart Valve 26mm Sapien 3 S3ucm226a | cardiac | $19,500 | $19,500 | $19,500 | 1 |
| Transcath Heart Valve 29mm Sapien 3 9600cm29a | cardiac | $19,500 | $19,500 | $19,500 | 1 |
| Hepatobiliary Diagnostic Procedures without Cc/mcc | other | $19,526 | $19,526 | $19,526 | 1 |
| Traumatic Stupor and Coma <1 Hour with Mcc | emergency | $19,604 | $16,503 | $22,705 | 2 |
| Other Infectious and Parasitic Diseases Diagnoses with Cc | other | $19,684 | $19,684 | $19,684 | 1 |
| Soft Tissue Procedures with Cc | other | $19,795 | $17,591 | $21,998 | 2 |
| Cellulitis with Mcc | other | $19,808 | $14,363 | $25,253 | 2 |
| Stomach, Esophageal and Duodenal Procedures without Cc/mcc | other | $19,850 | $14,094 | $25,605 | 2 |
| Injection, Glofitamab-gxbm, 2.5 Mg | other | $19,893 | $19,893 | $19,893 | 1 |
| Disorders of Liver Except Malignancy, Cirrhosis OR Alcoholic Hepatitis with Mcc | other | $20,097 | $18,385 | $21,808 | 2 |
| Cirrhosis and Alcoholic Hepatitis with Mcc | other | $20,188 | $19,369 | $21,007 | 2 |
| Postoperative OR Post-traumatic Infections with O.r. Procedures with Cc | emergency | $20,227 | $13,512 | $26,942 | 2 |
| Trauma to the Skin, Subcutaneous Tissue and Breast with Mcc | emergency | $20,291 | $20,291 | $20,291 | 1 |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis without Cc/mcc | other | $20,380 | $17,123 | $23,637 | 2 |
| Transcath Heart Valve 20mm Sapien 3 Resilia S3urcm20a | cardiac | $20,400 | $20,400 | $20,400 | 1 |
| Transcath Heart Valve 23mm Sapien 3 Resilia S3urcm23a | cardiac | $20,400 | $20,400 | $20,400 | 1 |
| Transcath Heart Valve 26mm Sapien 3 Resilia S3urcm26a | cardiac | $20,400 | $20,400 | $20,400 | 1 |
| Transcath Heart Valve 29mm Sapien 3 Resilia S3urcm29a | cardiac | $20,400 | $20,400 | $20,400 | 1 |
| Viral Illness with Mcc | other | $20,434 | $20,434 | $20,434 | 1 |
| Repair of Congenital Abnormality in Wall Between Upper Heart Chambers with Im... | surgery | $20,446 | $20,446 | $20,446 | 1 |
| Uterine and Adnexa Procedures for Non-malignancy with Cc/mcc | other | $20,460 | $20,460 | $20,460 | 1 |
| Appendix Procedures with Cc | other | $20,476 | $16,235 | $24,717 | 2 |
| Biliary Tract Procedures Except Only Cholecystectomy with OR without C.d.e. w... | other | $20,497 | $17,111 | $23,883 | 2 |
| Postoperative and Post-traumatic Infections with Mcc | emergency | $20,579 | $16,447 | $24,711 | 2 |
| Urethral Procedures with Cc/mcc | other | $20,592 | $20,592 | $20,592 | 1 |
| Skin Ulcers with Mcc | other | $20,645 | $19,703 | $21,587 | 2 |
| Complicated Peptic Ulcer with Mcc | other | $20,692 | $20,692 | $20,692 | 1 |
| Appendix Procedures without Cc/mcc | other | $20,763 | $14,891 | $26,634 | 2 |
| Pneumothorax with Mcc | other | $20,842 | $12,726 | $28,958 | 2 |
| D&c, Conization, Laparoscopy and Tubal Interruption with Cc/mcc | surgery | $20,866 | $12,941 | $28,790 | 2 |
| Spinal Procedures without Cc/mcc | other | $20,878 | $20,878 | $20,878 | 1 |
| Other Respiratory System O.r. Procedures with Cc | other | $20,921 | $20,921 | $20,921 | 1 |
| Intracranial Hemorrhage OR Cerebral Infarction with Mcc | other | $20,974 | $20,942 | $21,006 | 2 |
| Knee Procedures without Principal Diagnosis of Infection without Cc/mcc | other | $20,986 | $20,986 | $20,986 | 1 |
| Factor Viia (antihemophilic Factor, Recombinant), (novoseven Rt), 1 Microgram | other | $21,174 | $21,174 | $21,174 | 1 |
| Malignancy of Hepatobiliary System OR Pancreas with Cc | other | $21,178 | $11,471 | $30,885 | 2 |
| Other Male Reproductive System O.r. Procedures Except Malignancy without Cc/mcc | other | $21,199 | $21,199 | $21,199 | 1 |
| Infectious and Parasitic Diseases with O.r. Procedures with Cc | other | $21,224 | $19,245 | $23,202 | 2 |
| Adrenal and Pituitary Procedures with CC/MCC | surgery | $21,528 | $21,528 | $21,528 | 1 |
| Other Hepatobiliary OR Pancreas O.r. Procedures with Cc | other | $21,575 | $21,575 | $21,575 | 1 |
| Major Small and Large Bowel Procedures without CC/MCC | surgery | $21,642 | $17,385 | $25,899 | 2 |
| Cardiac Pacemaker Revision Except Device Replacement without Cc/mcc | surgery | $21,697 | $21,697 | $21,697 | 1 |
| Transurethral Procedures with Mcc | other | $21,765 | $19,680 | $23,850 | 2 |
| Kidney and Ureter Procedures for Neoplasm without Cc/mcc | other | $21,871 | $21,871 | $21,871 | 1 |
| Red Blood Cell Disorders with Mcc | other | $21,947 | $14,054 | $29,840 | 2 |
| Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liqu... | other | $21,997 | $21,997 | $21,997 | 1 |
| Lower Extremity and Humerus Procedures Except Hip, Foot and Femur without Cc/mcc | other | $22,014 | $18,912 | $25,116 | 2 |
| Coagulation Disorders | other | $22,041 | $17,493 | $26,588 | 2 |
| Minor Small and Large Bowel Procedures with Mcc | other | $22,124 | $22,124 | $22,124 | 1 |
| Myeloproliferative Disorders OR Poorly Differentiated Neoplasms with Major O.... | other | $22,152 | $22,152 | $22,152 | 1 |
| Minor Bladder Procedures with Cc | other | $22,188 | $22,188 | $22,188 | 1 |
| Injection, Brentuximab Vedotin, 1 Mg | other | $22,192 | $22,192 | $22,192 | 1 |
| Digestive Malignancy with Mcc | other | $22,200 | $16,690 | $27,710 | 2 |
| Shoulder, Elbow OR Forearm Procedures, Except Major Joint Procedures without ... | other | $22,209 | $19,077 | $25,340 | 2 |
| Repair of Left Upper Heart Chamber with Implant with Review By Radiologist | surgery | $22,408 | $22,408 | $22,408 | 1 |
| Injection, Luspatercept-aamt, 0.25 Mg | other | $22,416 | $22,416 | $22,416 | 1 |
| Major Gastrointestinal Disorders and Peritoneal Infections with Mcc | other | $22,463 | $19,706 | $25,219 | 2 |
| Acute Myocardial Infarction, Expired with Mcc | other | $22,479 | $7,482 | $37,475 | 2 |
| Cervical Spinal Fusion with CC | surgery | $22,505 | $22,505 | $22,505 | 1 |
| Vagina, Cervix and Vulva Procedures with Cc/mcc | other | $22,585 | $22,585 | $22,585 | 1 |
| Rectal Resection without Cc/mcc | other | $22,912 | $19,291 | $26,532 | 2 |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe with Cc | other | $22,924 | $14,395 | $31,452 | 2 |
| Thyroid, Parathyroid and Thyroglossal Procedures with Cc | other | $23,002 | $23,002 | $23,002 | 1 |
| Injection, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf, Per 10 Mg | other | $23,005 | $23,005 | $23,005 | 1 |
| Non-extensive O.r. Procedures Unrelated to Principal Diagnosis with Cc | other | $23,037 | $17,886 | $28,188 | 2 |
| Respiratory Neoplasms with Mcc | other | $23,050 | $21,666 | $24,433 | 2 |
| Other Cerebrovascular Disorders with Mcc | other | $23,076 | $21,420 | $24,731 | 2 |
| Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders w... | lab | $23,169 | $22,740 | $23,598 | 2 |
| Major Shoulder OR Elbow Joint Procedures with Cc/mcc | other | $23,280 | $23,280 | $23,280 | 1 |
| Other Female Reproductive System O.r. Procedures without Cc/mcc | other | $23,317 | $23,317 | $23,317 | 1 |
| Laparoscopic Cholecystectomy without CC/MCC | surgery | $23,458 | $17,432 | $29,483 | 2 |
| Tracheostomy for Face, Mouth and Neck Diagnoses OR Laryngectomy with Cc | other | $23,604 | $23,604 | $23,604 | 1 |
| Injection, Ocrelizumab, 1 Mg | other | $23,657 | $23,657 | $23,657 | 1 |
| Skin Debridement with Cc | other | $23,690 | $20,886 | $26,494 | 2 |
| Major Esophageal Disorders with Mcc | other | $23,819 | $23,819 | $23,819 | 1 |
| Septicemia or Severe Sepsis without Ventilator 96+ Hours with MCC | other | $23,853 | $23,692 | $24,013 | 2 |
| Kidney and Ureter Procedures for Neoplasm with Cc | other | $24,140 | $24,140 | $24,140 | 1 |
| Kidney and Ureter Procedures for Non-neoplasm with Cc | other | $24,145 | $21,400 | $26,889 | 2 |
| Major Thumb OR Joint Procedures | other | $24,164 | $24,164 | $24,164 | 1 |
| Non-bacterial Infection of Nervous System Except Viral Meningitis without Cc/mcc | other | $24,175 | $24,175 | $24,175 | 1 |
| Major Male Pelvic Procedures without Cc/mcc | other | $24,429 | $24,429 | $24,429 | 1 |
| Insertion of Implantable Defibrillator System | surgery | $24,494 | $24,494 | $24,494 | 1 |
| Hip and Femur Procedures except Major Joint with CC | surgery | $24,811 | $24,599 | $25,023 | 2 |
| Benign Prostatic Hypertrophy with Mcc | other | $24,823 | $13,541 | $36,105 | 2 |
| Soft Tissue Procedures with Mcc | other | $24,867 | $19,609 | $30,125 | 2 |
| Lower Extremity and Humerus Procedures Except Hip, Foot and Femur with Cc | other | $24,920 | $24,920 | $24,920 | 1 |
| Lymphoma and Non-acute Leukemia with Other Procedures with Cc | other | $24,989 | $24,989 | $24,989 | 1 |
| Malignancy, Male Reproductive System with Cc | other | $25,068 | $25,068 | $25,068 | 1 |
| Other Circulatory System O.r. Procedures | other | $25,295 | $19,768 | $30,821 | 2 |
| Other Digestive System O.r. Procedures with Cc | other | $25,310 | $20,247 | $30,373 | 2 |
| Splenic Procedures without Cc/mcc | other | $25,441 | $25,441 | $25,441 | 1 |
| Wound Debridement and Skin Graft Except Hand for Musculoskeletal and Connecti... | other | $25,571 | $24,457 | $26,685 | 2 |
| Transurethral Prostatectomy with Cc/mcc | other | $25,634 | $18,200 | $33,068 | 2 |
| Chemotherapy without Acute Leukemia As Secondary Diagnosis with Cc | other | $25,764 | $25,764 | $25,764 | 1 |
| Postoperative and Post-traumatic Infections without Mcc | emergency | $25,945 | $20,115 | $31,775 | 2 |
| Laparoscopic Cholecystectomy without Common Duct with CC | surgery | $26,166 | $21,051 | $31,281 | 2 |
| Lifecell Strattice Tissue 16x2 | other | $26,226 | $26,226 | $26,226 | 1 |
| Disorders of Pancreas Except Malignancy with Mcc | other | $26,238 | $24,193 | $28,282 | 2 |
| Hypertensive Encephalopathy with Mcc | other | $26,265 | $26,265 | $26,265 | 1 |
| Minor Small and Large Bowel Procedures with Cc | other | $26,267 | $23,665 | $28,869 | 2 |
| Extracranial Procedures with Mcc | other | $26,304 | $26,304 | $26,304 | 1 |
| Other Multiple Significant Trauma without Cc/mcc | emergency | $26,312 | $26,312 | $26,312 | 1 |
| Other Kidney and Urinary Tract Procedures with Cc | other | $26,326 | $22,936 | $29,716 | 2 |
| Cholecystectomy with C.d.e. with Mcc | other | $26,332 | $26,332 | $26,332 | 1 |
| Pleural Effusion with Mcc | surgery | $26,443 | $16,095 | $36,791 | 2 |
| Hypertensive Encephalopathy without Cc/mcc | other | $26,468 | $26,468 | $26,468 | 1 |
| Peritoneal Adhesiolysis with Mcc | other | $26,667 | $25,192 | $28,142 | 2 |
| Fractures of Femur without Mcc | other | $26,998 | $26,998 | $26,998 | 1 |
| Knee Procedures with Principal Diagnosis of Infection without Cc/mcc | other | $27,149 | $27,149 | $27,149 | 1 |
| Other Endocrine, Nutritional and Metabolic O.r. Procedures with Cc | lab | $27,324 | $24,898 | $29,750 | 2 |
| GI Hemorrhage with MCC | other | $27,338 | $25,831 | $28,844 | 2 |
| Minor Bladder Procedures with Mcc | other | $27,434 | $15,982 | $38,886 | 2 |
| Local Excision and Removal of Internal Fixation Devices of Hip and Femur with... | surgery | $27,438 | $23,018 | $31,858 | 2 |
| Skin Graft Except for Skin Ulcer OR Cellulitis with Mcc | other | $27,712 | $27,712 | $27,712 | 1 |
| Minor Small and Large Bowel Procedures without Cc/mcc | other | $27,725 | $17,061 | $38,389 | 2 |
| Other Vascular Procedures without Cc/mcc | other | $27,836 | $27,836 | $27,836 | 1 |
| Other Hepatobiliary OR Pancreas O.r. Procedures with Mcc | other | $28,197 | $28,197 | $28,197 | 1 |
| Upper Limb and Toe Amputation for Circulatory System Disorders with Mcc | other | $28,199 | $21,744 | $34,653 | 2 |
| Other Musculoskeletal System and Connective Tissue O.r. Procedures with Cc | other | $28,215 | $11,918 | $44,511 | 2 |
| Bacterial and Tuberculous Infections of Nervous System without Cc/mcc | other | $28,266 | $9,590 | $46,942 | 2 |
| Insertion OR Replacement of Defibrillator with Electrode | surgery | $28,391 | $28,391 | $28,391 | 1 |
| Major Bladder Procedures without Cc/mcc | other | $28,501 | $28,501 | $28,501 | 1 |
| Prostatectomy with Mcc | other | $28,524 | $28,524 | $28,524 | 1 |
| Total Knee Replacement | surgery | $28,839 | $1,567 | $86,855 | 26 |
| Other Vascular Procedures with Cc | other | $29,070 | $29,070 | $29,070 | 1 |
| Total Hip Replacement | surgery | $29,112 | $251 | $66,173 | 24 |
| Other Disorders of the Eye with Mcc OR Thrombolytic Agent | other | $29,338 | $29,338 | $29,338 | 1 |
| Other Respiratory System Diagnoses with Mcc | other | $29,490 | $21,742 | $37,237 | 2 |
| Respiratory System Diagnosis with Ventilator Support <=96 Hours | other | $29,511 | $23,905 | $35,116 | 2 |
| Zevalin Y-90 Vial | other | $29,579 | $29,579 | $29,579 | 1 |
| Uterine and Adnexa Procedures for Non-ovarian and Non-adnexal Malignancy with Cc | other | $29,587 | $29,587 | $29,587 | 1 |
| Other Circulatory System Diagnoses with Mcc | other | $29,628 | $23,936 | $35,320 | 2 |
| Cardiac Pacemaker Revision Except Device Replacement with Mcc | surgery | $29,687 | $29,687 | $29,687 | 1 |
| Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Di... | lab | $29,697 | $18,573 | $40,821 | 2 |
| Osteomyelitis with Mcc | other | $29,942 | $26,105 | $33,778 | 2 |
| Major Joint OR Limb Reattachment Procedures of Upper Extremities | other | $29,995 | $29,995 | $29,995 | 1 |
| Testes Procedures with Cc/mcc | other | $30,051 | $26,630 | $33,471 | 2 |
| Disorders of the Biliary Tract with Mcc | other | $30,102 | $30,102 | $30,102 | 1 |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe with Mcc | other | $30,670 | $23,463 | $37,877 | 2 |
| Other O.r. Procedures for Injuries with Mcc | other | $30,891 | $30,891 | $30,891 | 1 |
| Major Chest Procedures without Cc/mcc | other | $30,976 | $30,976 | $30,976 | 1 |
| Permanent Cardiac Pacemaker Implant without Cc/mcc | surgery | $31,032 | $31,032 | $31,032 | 1 |
| Major Hip and Knee Joint Replacement without MCC | surgery | $31,074 | $27,879 | $34,269 | 2 |
| Bilateral or Multiple Major Joint Procedures of Lower Extremity | surgery | $31,126 | $31,126 | $31,126 | 1 |
| Ischemic Stroke, Precerebral Occlusion OR Transient Ischemia with Thrombolyti... | other | $31,340 | $31,340 | $31,340 | 1 |
| Adrenal and Pituitary Procedures without Cc/mcc | other | $31,880 | $31,880 | $31,880 | 1 |
| Kidney and Ureter Procedures for Neoplasm with Mcc | other | $32,046 | $32,046 | $32,046 | 1 |
| Percutaneous Cardiovascular Procedures without Intraluminal Device without Mcc | cardiac | $32,638 | $32,638 | $32,638 | 1 |
| Hernia Procedures Except Inguinal and Femoral with Cc | other | $32,956 | $24,514 | $41,397 | 2 |
| Hip and Femur Procedures except Major Joint with MCC | surgery | $33,195 | $32,777 | $33,612 | 2 |
| Anal and Stomal Procedures with Mcc | other | $33,214 | $33,214 | $33,214 | 1 |
| Kidney and Ureter Procedures for Non-neoplasm with Mcc | other | $33,525 | $32,391 | $34,658 | 2 |
| Other Endocrine, Nutritional and Metabolic O.r. Procedures with Mcc | lab | $33,582 | $33,582 | $33,582 | 1 |
| Major Small and Large Bowel Procedures with CC | surgery | $33,897 | $27,241 | $40,553 | 2 |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis with Cc | other | $34,104 | $32,021 | $36,186 | 2 |
| Cardiac Pacemaker Device Replacement with Mcc | surgery | $34,188 | $34,188 | $34,188 | 1 |
| Stomach, Esophageal and Duodenal Procedures with Mcc | other | $34,207 | $25,501 | $42,913 | 2 |
| Lymphoma and Leukemia with Major O.r. Procedures without Cc/mcc | other | $34,439 | $34,439 | $34,439 | 1 |
| Cholecystectomy Except By Laparoscope without C.d.e. without Cc/mcc | surgery | $34,450 | $34,450 | $34,450 | 1 |
| Shoulder, Elbow OR Forearm Procedures, Except Major Joint Procedures with Cc | other | $34,555 | $34,555 | $34,555 | 1 |
| Other Musculoskeletal System and Connective Tissue O.r. Procedures with Mcc | other | $34,782 | $34,782 | $34,782 | 1 |
| Fractures of Femur with Mcc | other | $34,933 | $34,933 | $34,933 | 1 |
| Transurethral Prostatectomy without Cc/mcc | other | $35,037 | $35,037 | $35,037 | 1 |
| Wound Debridements for Injuries with Mcc | other | $35,161 | $35,161 | $35,161 | 1 |
| Injection, Pegloticase, 1 Mg | other | $35,183 | $35,183 | $35,183 | 1 |
| Malignancy of Hepatobiliary System OR Pancreas with Mcc | other | $35,554 | $30,889 | $40,219 | 2 |
| Sipuleucel-t, Minimum of 50 Million Autologous Cd54+ Cells Activated with Pap... | other | $35,602 | $35,602 | $35,602 | 1 |
| Stomach, Esophageal and Duodenal Procedures with Cc | other | $35,720 | $35,720 | $35,720 | 1 |
| Postoperative OR Post-traumatic Infections with O.r. Procedures with Mcc | emergency | $36,373 | $25,114 | $47,632 | 2 |
| Permanent Cardiac Pacemaker Implant with Mcc | surgery | $36,642 | $36,642 | $36,642 | 1 |
| Other O.r. Procedures for Injuries with Cc | other | $36,746 | $24,466 | $49,025 | 2 |
| Other Digestive System O.r. Procedures with Mcc | other | $36,942 | $20,792 | $53,092 | 2 |
| Peripheral, Cranial Nerve and Other Nervous System Procedures with Mcc | other | $37,012 | $37,012 | $37,012 | 1 |
| Major Chest Procedures with Cc | other | $37,220 | $37,220 | $37,220 | 1 |
| Spinal Fusion except Cervical without MCC | surgery | $37,562 | $37,562 | $37,562 | 1 |
| Ear, Nose, Mouth and Throat Malignancy with Mcc | other | $38,095 | $38,095 | $38,095 | 1 |
| Knee Procedures with Principal Diagnosis of Infection with Mcc | other | $38,227 | $33,924 | $42,530 | 2 |
| Amputation for Musculoskeletal System and Connective Tissue Disorders with Cc | other | $38,396 | $38,396 | $38,396 | 1 |
| Non-extensive O.r. Procedures Unrelated to Principal Diagnosis with Mcc | other | $39,009 | $25,677 | $52,341 | 2 |
| Other Respiratory System O.r. Procedures with Mcc | other | $39,414 | $39,414 | $39,414 | 1 |
| Cardiac Pacemaker Device Replacement without Mcc | surgery | $39,633 | $39,633 | $39,633 | 1 |
| Percutaneous Cardiovascular Procedures with Intraluminal Device without Mcc | cardiac | $39,800 | $39,800 | $39,800 | 1 |
| Cholecystectomy with C.d.e. with Cc | other | $39,851 | $39,851 | $39,851 | 1 |
| Appendix Procedures with Mcc | other | $39,857 | $31,075 | $48,639 | 2 |
| Major Hip and Knee Joint Replacement with MCC | surgery | $40,157 | $40,157 | $40,157 | 1 |
| Other Antepartum Diagnoses with O.r. Procedures with Cc | other | $40,566 | $40,566 | $40,566 | 1 |
| O.r. Procedures with Principal Diagnosis of Mental Illness | other | $41,674 | $41,674 | $41,674 | 1 |
| Hepatobiliary Diagnostic Procedures with Mcc | other | $41,782 | $41,782 | $41,782 | 1 |
| Biopsies of Musculoskeletal System and Connective Tissue with Cc | other | $42,088 | $35,513 | $48,663 | 2 |
| Peritoneal Adhesiolysis with Cc | other | $42,734 | $32,708 | $52,760 | 2 |
| Major Bladder Procedures with Cc | other | $43,066 | $43,066 | $43,066 | 1 |
| Limb Reattachment, Hip and Femur Procedures for Multiple Significant Trauma | emergency | $43,246 | $43,246 | $43,246 | 1 |
| Carotid Artery Stent Procedures without Cc/mcc | cardiac | $43,763 | $43,763 | $43,763 | 1 |
| Cardiac Arrest, Unexplained with Mcc | cardiac | $44,660 | $44,660 | $44,660 | 1 |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe without... | other | $44,830 | $44,830 | $44,830 | 1 |
| Permanent Cardiac Pacemaker Implant with Cc | surgery | $45,283 | $45,283 | $45,283 | 1 |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis with Mcc | other | $45,390 | $30,019 | $60,761 | 2 |
| Bacterial and Tuberculous Infections of Nervous System with Cc | other | $45,523 | $45,523 | $45,523 | 1 |
| Other Musculoskeletal System and Connective Tissue O.r. Procedures without Cc... | other | $45,545 | $45,545 | $45,545 | 1 |
| Infectious and Parasitic Diseases with O.r. Procedures with Mcc | other | $45,669 | $37,250 | $54,087 | 2 |
| Cervical Spinal Fusion without CC/MCC | surgery | $45,752 | $37,516 | $53,987 | 2 |
| Hernia Procedures Except Inguinal and Femoral with Mcc | other | $46,298 | $46,298 | $46,298 | 1 |
| Back and Neck Procedures except Spinal Fusion without CC/MCC | surgery | $46,565 | $46,565 | $46,565 | 1 |
| Other Skin, Subcutaneous Tissue and Breast Procedures with Mcc | other | $46,974 | $36,837 | $57,111 | 2 |
| Knee Procedures with Principal Diagnosis of Infection with Cc | other | $47,453 | $47,453 | $47,453 | 1 |
| Lymphoma and Non-acute Leukemia with Other Procedures with Mcc | other | $47,576 | $47,576 | $47,576 | 1 |
| Splenic Procedures with Mcc | other | $47,806 | $37,543 | $58,069 | 2 |
| Carotid Artery Stent Procedures with Cc | cardiac | $48,941 | $48,941 | $48,941 | 1 |
| Other Kidney and Urinary Tract Procedures with Mcc | other | $49,654 | $48,118 | $51,190 | 2 |
| Major Small and Large Bowel Procedures with MCC | surgery | $49,821 | $26,217 | $73,425 | 2 |
| Coronary Bypass without Cardiac Catheter without MCC | cardiac | $50,278 | $50,278 | $50,278 | 1 |
| Non-bacterial Infection of Nervous System Except Viral Meningitis with Mcc | other | $51,239 | $51,239 | $51,239 | 1 |
| Lymphoma and Non-acute Leukemia with Other Procedures without Cc/mcc | other | $51,684 | $51,684 | $51,684 | 1 |
| Percutaneous Cardiovascular Procedures without Intraluminal Device with Mcc | cardiac | $52,231 | $52,231 | $52,231 | 1 |
| O.r. Procedures with Diagnoses of Other Contact with Health Services with Cc | other | $52,433 | $52,433 | $52,433 | 1 |
| Percutaneous Cardiovascular Procedures with Intraluminal Device with Mcc OR 4... | cardiac | $53,521 | $53,521 | $53,521 | 1 |
| Other Vascular Procedures with Mcc | other | $53,931 | $53,931 | $53,931 | 1 |
| Spinal Fusion | surgery | $54,890 | $2,711 | $117,382 | 14 |
| Septicemia OR Severe Sepsis with Mv >96 Hours | other | $56,167 | $39,704 | $72,630 | 2 |
| Thyroid, Parathyroid and Thyroglossal Procedures with Mcc | other | $58,274 | $58,274 | $58,274 | 1 |
| Other Cardiothoracic Procedures without Mcc | other | $61,122 | $61,122 | $61,122 | 1 |
| Malignancy, Male Reproductive System with Mcc | other | $63,039 | $63,039 | $63,039 | 1 |
| HIV with Major Related Condition with Mcc | other | $63,957 | $63,957 | $63,957 | 1 |
| Respiratory System Diagnosis with Ventilator 96+ Hours | other | $65,137 | $65,137 | $65,137 | 1 |
| Aortic and Heart Assist Procedures Except Pulsation Balloon without Mcc | cardiac | $65,477 | $65,477 | $65,477 | 1 |
| Injection, Ipilimumab, 1 Mg | other | $65,796 | $65,796 | $65,796 | 1 |
| Coronary Intravascular Lithotripsy with Intraluminal Device without Mcc | cardiac | $66,999 | $66,999 | $66,999 | 1 |
| Tracheostomy for Face, Mouth and Neck Diagnoses OR Laryngectomy with Mcc | other | $70,353 | $70,353 | $70,353 | 1 |
| Other Major Cardiovascular Procedures with Cc | cardiac | $70,427 | $70,427 | $70,427 | 1 |
| Other Endovascular Cardiac Valve Procedures with Mcc | cardiac | $73,126 | $73,126 | $73,126 | 1 |
| Cardiac Valve and Other Major Cardiothoracic without Cardiac Catheter | cardiac | $73,328 | $73,328 | $73,328 | 1 |
| O.r. Procedures with Diagnoses of Other Contact with Health Services without ... | other | $73,945 | $73,945 | $73,945 | 1 |
| Aortic and Heart Assist Procedures Except Pulsation Balloon with Mcc | cardiac | $76,415 | $76,415 | $76,415 | 1 |
| Acute and Subacute Endocarditis with Mcc | other | $80,377 | $80,377 | $80,377 | 1 |
| Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structur... | imaging | $80,813 | $80,813 | $80,813 | 1 |
| Spinal Procedures with Mcc | other | $82,354 | $82,354 | $82,354 | 1 |
| Major Chest Procedures with Mcc | other | $82,621 | $82,621 | $82,621 | 1 |
| Other Major Cardiovascular Procedures with Mcc | cardiac | $82,736 | $82,736 | $82,736 | 1 |
| Coronary Intravascular Lithotripsy with Intraluminal Device with Mcc | cardiac | $86,743 | $86,743 | $86,743 | 1 |
| Foot Procedures with Mcc | other | $88,313 | $88,313 | $88,313 | 1 |
| Percutaneous and Other Intracardiac Procedures without Mcc | cardiac | $89,756 | $89,756 | $89,756 | 1 |
| Cardiac Defibrillator Implant without Mcc | surgery | $96,095 | $96,095 | $96,095 | 1 |
| Major Bladder Procedures with Mcc | other | $98,472 | $98,472 | $98,472 | 1 |
| Coronary Bypass with PTCA without Mcc | cardiac | $99,732 | $99,732 | $99,732 | 1 |
| Percutaneous and Other Intracardiac Procedures with Mcc | cardiac | $99,837 | $99,837 | $99,837 | 1 |
| Coronary Bypass with PTCA with MCC | cardiac | $100,179 | $100,179 | $100,179 | 1 |
| Cardiac Defibrillator Implant with Mcc OR Carotid Sinus Neurostimulator | surgery | $103,200 | $103,200 | $103,200 | 1 |
| Other Major Cardiovascular Procedures without Cc/mcc | cardiac | $107,434 | $107,434 | $107,434 | 1 |
| Coronary Bypass with Cardiac Catheter with MCC | cardiac | $112,142 | $112,142 | $112,142 | 1 |
| Endovascular Cardiac Valve Replacement and Supplement Procedures without Mcc | surgery | $114,394 | $114,394 | $114,394 | 1 |
| Cardiac Valve and Other Major Cardiothoracic with Cardiac Catheter | cardiac | $114,409 | $114,409 | $114,409 | 1 |
| Endovascular Cardiac Valve Replacement and Supplement Procedures with Mcc | surgery | $134,471 | $134,471 | $134,471 | 1 |
| Cholecystectomy Except By Laparoscope without C.d.e. with Mcc | surgery | $143,226 | $143,226 | $143,226 | 1 |
| Other Heart Assist System Implant | surgery | $144,810 | $144,810 | $144,810 | 1 |
| Aicd Generator Procedures | other | $171,794 | $171,794 | $171,794 | 1 |
| Tracheostomy with Mv >96 Hours OR Principal Diagnosis Except Face, Mouth and ... | other | $205,313 | $205,313 | $205,313 | 1 |
| Ecmo OR Tracheostomy with Mv >96 Hours OR Principal Diagnosis Except Face, Mo... | other | $276,348 | $276,348 | $276,348 | 1 |
Every shoppable procedure with real Charlotte pricing data across 58 hospitals. Sort by median price, variability, or number of reporting hospitals.
Ranked by their median price position across all reporting procedures, relative to the Charlotte metro median. Lower index scores mean consistently cheaper.
Plain-English answers to the questions consumers and journalists ask most about Charlotte hospital pricing.
See how Charlotte prices stack up against neighboring metros.
Pricing data sourced from federally mandated hospital Machine-Readable Files.
Disclosure required by 45 CFR Part 180.
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