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Medi-Cal Rates Information

Medi-Cal Rates as of 02/15/2020 (Codes 14020 thru 21100)

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month


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Proc Type Proc Code Procedure Description Unit Value Basic Rate Child Rate ER Rate Conv Ind ER Ind Cut-back Ind Prof % Rental Rate Non-Physn. Med.Prac. Ind
O 14020 TIS TRNFR S/A/L 10 SQ CM/< 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 14020 TIS TRNFR S/A/L 10 SQ CM/< 6.80 $253.16 --- $319.26 004 1 1 0.00 $0.00 Y
K 14021 TIS TRNFR S/A/L 10.1-30 SQCM 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 14021 TIS TRNFR S/A/L 10.1-30 SQCM 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 14040 TIS TRNFR F/C/C/M/N/A/G/H/F 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
P 14040 TIS TRNFR F/C/C/M/N/A/G/H/F 9.06 $337.30 --- -- 015 0 1 0.00 $0.00 Y
K 14040 TIS TRNFR F/C/C/M/N/A/G/H/F 9.06 $337.30 --- $425.37 004 1 1 0.00 $0.00 Y
K 14041 TIS TRNFR F/C/C/M/N/A/G/H/F 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 14041 TIS TRNFR F/C/C/M/N/A/G/H/F 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 14060 TIS TRNFR E/N/E/L 10 SQ CM/< 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 14060 TIS TRNFR E/N/E/L 10 SQ CM/< 11.33 $421.82 --- $531.94 004 1 1 0.00 $0.00 Y
K 14061 TIS TRNFR E/N/E/L10.1-30SQCM 19.90 $740.88 --- $934.31 004 1 0 0.00 $0.00 Y
O 14061 TIS TRNFR E/N/E/L10.1-30SQCM 3.98 $148.18 --- $186.86 004 1 0 0.00 $0.00 Y
O 14301 TIS TRNFR ANY 30.1-60 SQ CM 4.77 $177.59 --- -- 004 0 0 0.00 $0.00 Y
K 14301 TIS TRNFR ANY 30.1-60 SQ CM 23.87 $888.68 --- -- 004 0 0 0.00 $0.00 Y
K 14302 TIS TRNFR ADDL 30 SQ CM 5.09 $189.50 --- -- 004 0 0 0.00 $0.00 Y
O 14302 TIS TRNFR ADDL 30 SQ CM 1.02 $37.97 --- -- 004 0 0 0.00 $0.00 Y
O 14350 FILLETED FINGER/TOE FLAP 2.70 $100.52 --- $126.77 004 1 0 0.00 $0.00 Y
P 14350 FILLETED FINGER/TOE FLAP 13.51 $502.98 --- -- 015 1 1 0.00 $0.00 Y
K 14350 FILLETED FINGER/TOE FLAP 13.51 $502.98 --- $634.29 004 1 1 0.00 $0.00 Y
K 15002 WOUND PREP TRK/ARM/LEG 7.26 $270.16 --- -- 004 0 0 0.00 $0.00 Y
O 15002 WOUND PREP TRK/ARM/LEG 1.45 $54.03 --- -- 004 0 0 0.00 $0.00 Y
O 15003 WOUND PREP ADDL 100 CM 0.32 $11.91 --- -- 004 0 0 0.00 $0.00 Y
K 15003 WOUND PREP ADDL 100 CM 1.61 $59.94 --- -- 004 0 0 0.00 $0.00 Y
K 15004 WOUND PREP F/N/HF/G 8.73 $325.13 --- -- 004 0 0 0.00 $0.00 Y
O 15004 WOUND PREP F/N/HF/G 1.75 $65.03 --- -- 004 0 0 0.00 $0.00 Y
P 15004 WOUND PREP F/N/HF/G 8.73 $325.02 --- -- 015 0 0 0.00 $0.00 Y
O 15005 WND PREP F/N/HF/G ADDL CM 0.54 $20.10 --- -- 004 0 0 0.00 $0.00 Y
K 15005 WND PREP F/N/HF/G ADDL CM 2.69 $100.15 --- -- 004 0 0 0.00 $0.00 Y
K 15040 HARVEST CULTURED SKIN GRAFT 5.79 $215.56 --- $271.84 004 1 0 0.00 $0.00 Y
O 15040 HARVEST CULTURED SKIN GRAFT 1.16 $43.19 --- $54.46 004 1 0 0.00 $0.00 Y
O 15050 SKIN PINCH GRAFT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
P 15050 SKIN PINCH GRAFT 4.26 $158.60 --- -- 015 0 1 0.00 $0.00 Y
K 15050 SKIN PINCH GRAFT 4.26 $158.60 --- $200.01 004 1 1 0.00 $0.00 Y
K 15100 SKIN SPLT GRFT TRNK/ARM/LEG 7.13 $265.45 --- $334.75 004 1 0 0.00 $0.00 Y
P 15100 SKIN SPLT GRFT TRNK/ARM/LEG 7.13 $265.45 --- -- 015 0 0 0.00 $0.00 Y
O 15100 SKIN SPLT GRFT TRNK/ARM/LEG 1.43 $53.24 --- $67.14 004 1 0 0.00 $0.00 Y
O 15101 SKIN SPLT GRFT T/A/L ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15101 SKIN SPLT GRFT T/A/L ADD-ON 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 15110 EPIDRM AUTOGRFT TRNK/ARM/LEG 17.90 $666.42 --- $840.41 004 1 0 0.00 $0.00 Y
O 15110 EPIDRM AUTOGRFT TRNK/ARM/LEG 3.58 $133.28 --- $168.08 004 1 0 0.00 $0.00 Y
O 15111 EPIDRM AUTOGRFT T/A/L ADDON 0.56 $20.85 --- $26.29 004 1 0 0.00 $0.00 Y
K 15111 EPIDRM AUTOGRFT T/A/L ADDON 2.79 $103.87 --- $130.99 004 1 0 0.00 $0.00 Y
K 15115 EPIDRM AGRFT FACE/NCK/HF/G 16.77 $624.35 --- $787.35 004 1 0 0.00 $0.00 Y
O 15115 EPIDRM AGRFT FACE/NCK/HF/G 3.35 $124.72 --- $157.28 004 1 0 0.00 $0.00 Y
P 15115 EPIDRM AGRFT FACE/NCK/HF/G 16.77 $624.35 --- -- 015 1 0 0.00 $0.00 Y
P 15116 EPIDRM AGRFT F/N/HF/G ADDL 3.61 $134.40 --- -- 015 1 0 0.00 $0.00 Y
O 15116 EPIDRM AGRFT F/N/HF/G ADDL 0.72 $26.81 --- $33.80 004 1 0 0.00 $0.00 Y
K 15116 EPIDRM AGRFT F/N/HF/G ADDL 3.61 $134.40 --- $169.49 004 1 0 0.00 $0.00 Y
K 15120 SKN SPLT AGRFT FAC/NCK/HF/G 12.46 $463.89 --- $585.00 004 1 0 0.00 $0.00 Y
O 15120 SKN SPLT AGRFT FAC/NCK/HF/G 2.49 $92.70 --- $116.91 004 1 0 0.00 $0.00 Y
P 15120 SKN SPLT AGRFT FAC/NCK/HF/G 12.46 $463.89 --- -- 015 1 0 0.00 $0.00 Y
P 15121 SKN SPLT AGRFT F/N/HF/G ADD 2.27 $84.51 --- -- 015 1 0 0.00 $0.00 Y
O 15121 SKN SPLT AGRFT F/N/HF/G ADD 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15121 SKN SPLT AGRFT F/N/HF/G ADD 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 15130 DERM AUTOGRAFT TRNK/ARM/LEG 14.97 $557.33 --- $702.84 004 1 0 0.00 $0.00 Y
O 15130 DERM AUTOGRAFT TRNK/ARM/LEG 2.99 $111.32 --- $140.38 004 1 0 0.00 $0.00 Y
O 15131 DERM AUTOGRAFT T/A/L ADDON 0.46 $17.13 --- $21.60 004 1 0 0.00 $0.00 Y
K 15131 DERM AUTOGRAFT T/A/L ADDON 2.28 $84.88 --- $107.05 004 1 0 0.00 $0.00 Y
K 15135 DERM AUTOGRAFT FACE/NCK/HF/G 17.95 $668.28 --- $842.75 004 1 0 0.00 $0.00 Y
O 15135 DERM AUTOGRAFT FACE/NCK/HF/G 3.59 $133.66 --- $168.55 004 1 0 0.00 $0.00 Y
P 15135 DERM AUTOGRAFT FACE/NCK/HF/G 17.95 $668.28 --- -- 015 1 0 0.00 $0.00 Y
P 15136 DERM AUTOGRAFT F/N/HF/G ADD 2.12 $78.93 --- -- 015 1 0 0.00 $0.00 Y
O 15136 DERM AUTOGRAFT F/N/HF/G ADD 0.42 $15.64 --- $19.72 004 1 0 0.00 $0.00 Y
K 15136 DERM AUTOGRAFT F/N/HF/G ADD 2.12 $78.93 --- $99.53 004 1 0 0.00 $0.00 Y
K 15150 CULT SKIN GRFT T/ARM/LEG 14.83 $552.12 --- $696.27 004 1 0 0.00 $0.00 Y
K 15151 CULT SKIN GRFT T/A/L ADDL 2.94 $109.46 --- $138.03 004 1 0 0.00 $0.00 Y
K 15152 CULT SKIN GRAFT T/A/L +% 3.61 $134.40 --- $169.49 004 1 0 0.00 $0.00 Y
K 15155 CULT SKIN GRAFT F/N/HF/G 14.81 $551.38 --- $695.33 004 1 0 0.00 $0.00 Y
P 15155 CULT SKIN GRAFT F/N/HF/G 14.81 $551.38 --- -- 015 1 0 0.00 $0.00 Y
P 15156 CULT SKIN GRFT F/N/HFG ADD 3.81 $141.85 --- -- 015 1 0 0.00 $0.00 Y
K 15156 CULT SKIN GRFT F/N/HFG ADD 3.81 $141.85 --- $178.88 004 1 0 0.00 $0.00 Y
K 15157 CULT EPIDERM GRFT F/N/HFG +% 4.23 $157.48 --- $198.60 004 1 0 0.00 $0.00 Y
P 15157 CULT EPIDERM GRFT F/N/HFG +% 4.23 $157.48 --- -- 015 1 0 0.00 $0.00 Y
O 15200 SKIN FULL GRAFT TRUNK 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15200 SKIN FULL GRAFT TRUNK 7.90 $294.12 --- $370.91 004 1 0 0.00 $0.00 Y
K 15201 SKIN FULL GRAFT TRUNK ADD-ON 2.06 $76.69 --- $96.72 004 1 0 0.00 $0.00 Y
O 15201 SKIN FULL GRAFT TRUNK ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 15220 SKIN FULL GRAFT SCLP/ARM/LEG 1.58 $58.82 --- $74.18 004 1 0 0.00 $0.00 Y
K 15220 SKIN FULL GRAFT SCLP/ARM/LEG 7.92 $294.86 --- $371.84 004 1 0 0.00 $0.00 Y
K 15221 SKIN FULL GRAFT ADD-ON 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
O 15221 SKIN FULL GRAFT ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 15240 SKIN FULL GRFT FACE/GENIT/HF 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
P 15240 SKIN FULL GRFT FACE GENIT/HF 9.06 $337.30 --- -- 015 1 0 0.00 $0.00 Y
K 15240 SKIN FULL GRFT FACE/GENIT/HF 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
K 15241 SKIN FULL GRAFT ADD-ON 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
P 15241 SKIN FULL GRAFT ADD-ON 4.00 $148.92 --- -- 015 1 0 0.00 $0.00 Y
O 15241 SKIN FULL GRAFT ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 15260 SKIN FULL GRAFT EEN & LIPS 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 15260 SKIN FULL GRAFT EEN & LIPS 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 15261 SKIN FULL GRAFT ADD-ON 5.00 $186.15 --- $234.75 004 1 0 0.00 $0.00 Y
O 15261 SKIN FULL GRAFT ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15271 SKIN SUB GRAFT TRNK/ARM/LEG 1.94 $72.20 --- $91.08 004 1 0 0.00 $0.00 Y
K 15272 SKIN SUB GRAFT T/A/L ADD-ON 0.38 $14.31 --- $17.84 004 1 0 0.00 $0.00 Y
K 15273 SKIN SUB GRFT T/ARM/LG CHILD 4.62 $171.97 --- $216.91 004 1 0 0.00 $0.00 Y
K 15274 SKN SUB GRFT T/A/L CHILD ADD 0.98 $36.64 --- $46.01 004 1 0 0.00 $0.00 Y
K 15275 SKIN SUB GRAFT FACE/NK/HF/G 2.23 $83.09 --- $104.70 004 1 0 0.00 $0.00 Y
P 15275 SKIN SUB GRAFT FACE/NK/HF/G 2.23 $83.09 --- -- 015 1 0 0.00 $0.00 Y
P 15276 SKIN SUB GRAFT F/N/HF/G ADDL 0.55 $20.36 --- -- 015 1 0 0.00 $0.00 Y
K 15276 SKIN SUB GRAFT F/N/HF/G ADDL 0.55 $20.26 --- $25.82 004 1 0 0.00 $0.00 Y
K 15277 SKN SUB GRFT F/N/HF/G CHILD 4.76 $177.15 --- $223.48 004 1 0 0.00 $0.00 Y
P 15277 SKN SUB GRFT F/N/HF/G CHILD 4.76 $177.15 --- -- 015 1 0 0.00 $0.00 Y
P 15278 SKN SUB GRFT F/N/HF/G CH ADD 1.22 $45.42 --- -- 015 1 0 0.00 $0.00 Y
K 15278 SKN SUB GRFT F/N/HF/G CH ADD 1.22 $45.26 --- $57.28 004 1 0 0.00 $0.00 Y
K 15570 SKIN PEDICLE FLAP TRUNK 15.50 $577.07 --- $727.73 004 1 0 0.00 $0.00 Y
O 15570 SKIN PEDICLE FLAP TRUNK 3.10 $115.41 --- $145.55 004 1 0 0.00 $0.00 Y
O 15572 SKIN PEDICLE FLAP ARMS/LEGS 2.94 $109.46 --- $138.03 004 1 0 0.00 $0.00 Y
K 15572 SKIN PEDICLE FLAP ARMS/LEGS 14.70 $547.28 --- $690.17 004 1 0 0.00 $0.00 Y
K 15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F 15.59 $580.42 --- $731.95 004 1 0 0.00 $0.00 Y
O 15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F 3.12 $116.16 --- $146.48 004 1 0 0.00 $0.00 Y
P 15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F 15.59 $580.42 --- -- 015 1 0 0.00 $0.00 Y
O 15576 PEDICLE E/N/E/L/NTRORAL 1.70 $63.29 --- $79.82 004 1 0 0.00 $0.00 Y
K 15576 PEDICLE E/N/E/L/NTRORAL 8.49 $316.08 --- $398.61 004 1 0 0.00 $0.00 Y
K 15600 DELAY FLAP TRUNK 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 15600 DELAY FLAP TRUNK 0.90 $33.51 --- $42.26 004 1 0 0.00 $0.00 Y
O 15610 DELAY FLAP ARMS/LEGS 1.00 $37.23 --- $46.95 004 1 0 0.00 $0.00 Y
K 15610 DELAY FLAP ARMS/LEGS 5.00 $186.15 --- $234.75 004 1 0 0.00 $0.00 Y
K 15620 DELAY FLAP F/C/C/N/AX/G/H/F 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 15620 DELAY FLAP F/C/C/N/AX/G/H/F 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
P 15620 DELAY FLAP F/C/C/N/AX/G/H/F 6.80 $253.16 --- -- 015 1 0 0.00 $0.00 Y
O 15630 DELAY FLAP EYE/NOS/EAR/LIP 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 15630 DELAY FLAP EYE/NOS/EAR/LIP 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 15650 TRANSFER SKIN PEDICLE FLAP 176.86 $176.86 --- -- 042 0 0 0.00 $0.00 Y
O 15650 TRANSFER SKIN PEDICLE FLAP 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15730 MDFC FLAP W/PRSERV VASC PEDCL 37.44 $1394.25 --- -- 004 0 0 0.00 $0.00 Y
K 15731 FOREHEAD FLAP W/VASC PEDICLE 24.08 $896.64 --- -- 004 0 0 0.00 $0.00 Y
O 15731 FOREHEAD FLAP W/VASC PEDICLE 4.82 $179.33 --- -- 004 0 0 0.00 $0.00 Y
K 15733 MUSC MYOQ/FSCQ FLP H&N PEDCL 24.59 $915.73 --- -- 004 0 0 0.00 $0.00 Y
K 15734 MUSCLE-SKIN GRAFT TRUNK 25.24 $939.69 --- $1185.02 004 1 0 0.00 $0.00 Y
O 15734 MUSCLE-SKIN GRAFT TRUNK 5.05 $188.01 --- $237.10 004 1 0 0.00 $0.00 Y
O 15736 MUSCLE-SKIN GRAFT ARM 4.66 $173.49 --- $218.79 004 1 0 0.00 $0.00 Y
K 15736 MUSCLE-SKIN GRAFT ARM 23.30 $867.46 --- $1093.94 004 1 0 0.00 $0.00 Y
K 15738 MUSCLE-SKIN GRAFT LEG 25.27 $940.80 --- $1186.43 004 1 0 0.00 $0.00 Y
O 15738 MUSCLE-SKIN GRAFT LEG 5.05 $188.01 --- $237.10 004 1 0 0.00 $0.00 Y
O 15740 ISLAND PEDICLE FLAP GRAFT 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 15740 ISLAND PEDICLE FLAP GRAFT 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 15750 NEUROVASCULAR PEDICLE FLAP 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 15750 NEUROVASCULAR PEDICLE FLAP 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 15756 FREE MYO/SKIN FLAP MICROVASC 9.93 $369.69 --- $466.21 004 1 0 0.00 $0.00 Y
K 15756 FREE MYO/SKIN FLAP MICROVASC 49.66 $1848.84 --- $2331.54 004 1 0 0.00 $0.00 Y
K 15757 FREE SKIN FLAP MICROVASC 49.99 $1861.13 --- $2347.03 004 1 0 0.00 $0.00 Y
O 15757 FREE SKIN FLAP MICROVASC 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
O 15758 FREE FASCIAL FLAP MICROVASC 9.95 $370.44 --- $467.15 004 1 0 0.00 $0.00 Y
K 15758 FREE FASCIAL FLAP MICROVASC 49.74 $1851.82 --- $2335.29 004 1 0 0.00 $0.00 Y
K 15760 COMPOSITE SKIN GRAFT 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 15760 COMPOSITE SKIN GRAFT 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 15769 GRFG AUTOL SOFT TISS DIR EXC 2.27 $84.88 --- -- 004 0 0 0.00 $0.00 Y
P 15769 GRFG AUTOL SOFT TISS DIR EXC 11.39 $424.38 --- -- 015 0 0 0.00 $0.00 Y
K 15769 GRFG AUTOL SOFT TISS DIR EXC 11.39 $424.38 --- -- 004 0 0 0.00 $0.00 Y
K 15770 DERMAFATFASCIA GRAFT 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
O 15770 DERMAFATFASCIA GRAFT 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
K 15771 GRFG AUTOL FAT LIPO 50 CC/< 13.80 $514.01 --- -- 004 0 0 0.00 $0.00 Y
K 15772 GRFG AUTOL FAT LIPO EA ADDL 4.29 $159.88 --- -- 004 0 0 0.00 $0.00 Y
K 15773 GRFG AUTOL FAT LIPO 25 CC/< 13.93 $518.70 --- -- 004 0 0 0.00 $0.00 Y
P 15773 GRFG AUTOL FAT LIPO 25 CC/< 13.93 $518.70 --- -- 015 0 0 0.00 $0.00 Y
P 15774 GFRG AUTOL FAT LIPO EA ADDL 4.17 $155.27 --- -- 015 0 0 0.00 $0.00 Y
K 15774 GFRG AUTOL FAT LIPO EA ADDL 4.17 $155.27 --- -- 004 0 0 0.00 $0.00 Y
K 15777 ACELLULAR DERM MATRIX IMPLT 4.66 $173.61 --- -- 004 0 0 0.00 $0.00 Y
K 15780 DERMABRASION TOTAL FACE 12.19 $453.83 --- $572.32 004 1 0 0.00 $0.00 Y
O 15780 DERMABRASION TOTAL FACE 2.44 $90.84 --- $114.56 004 1 0 0.00 $0.00 Y
O 15781 DERMABRASION SEGMENTAL FACE 0.91 $33.88 --- $42.72 004 1 0 0.00 $0.00 Y
K 15781 DERMABRASION SEGMENTAL FACE 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
K 15782 DERMABRASION OTHER THAN FACE 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 15782 DERMABRASION OTHER THAN FACE 0.91 $33.88 --- $42.72 004 1 0 0.00 $0.00 Y
K 15783 DERMABRASION SUPRFL ANY SITE 4.05 $150.78 --- $190.15 004 1 0 0.00 $0.00 Y
K 15786 ABRASION LESION SINGLE 1.73 $64.41 --- $81.22 004 1 1 0.00 $0.00 Y
O 15786 ABRASION LESION SINGLE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 15787 ABRASION LESIONS ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15787 ABRASION LESIONS ADD-ON 0.28 $10.42 --- $13.15 004 1 1 0.00 $0.00 Y
K 15788 CHEMICAL PEEL FACE EPIDERM 3.07 $114.30 --- $144.14 004 1 0 0.00 $0.00 Y
O 15788 CHEMICAL PEEL FACE EPIDERM 0.61 $22.71 --- $28.64 004 1 0 0.00 $0.00 Y
O 15789 CHEMICAL PEEL FACE DERMAL 0.98 $36.49 --- $46.01 004 1 0 0.00 $0.00 Y
K 15789 CHEMICAL PEEL FACE DERMAL 4.91 $182.80 --- $230.52 004 1 0 0.00 $0.00 Y
K 15792 CHEMICAL PEEL NONFACIAL 2.15 $80.04 --- $100.94 004 1 0 0.00 $0.00 Y
O 15792 CHEMICAL PEEL NONFACIAL 0.43 $16.01 --- $20.19 004 1 0 0.00 $0.00 Y
O 15793 CHEMICAL PEEL NONFACIAL 0.67 $24.94 --- $31.46 004 1 0 0.00 $0.00 Y
K 15793 CHEMICAL PEEL NONFACIAL 3.31 $123.23 --- $155.40 004 1 0 0.00 $0.00 Y
K 15820 REVISION OF LOWER EYELID 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
O 15820 REVISION OF LOWER EYELID 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 15821 REVISION OF LOWER EYELID 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
K 15821 REVISION OF LOWER EYELID 13.98 $520.48 --- $656.36 004 1 0 0.00 $0.00 Y
K 15822 REVISION OF UPPER EYELID 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 15822 REVISION OF UPPER EYELID 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 15823 REVISION OF UPPER EYELID 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15823 REVISION OF UPPER EYELID 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
K 15840 NERVE PALSY FASCIAL GRAFT 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 15840 NERVE PALSY FASCIAL GRAFT 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 15841 NERVE PALSY MUSCLE GRAFT 6.70 $249.44 --- $314.57 004 1 0 0.00 $0.00 Y
K 15841 NERVE PALSY MUSCLE GRAFT 33.52 $1247.95 --- $1573.76 004 1 0 0.00 $0.00 Y
K 15842 NERVE PALSY MICROSURG GRAFT 33.98 $1265.08 --- $1595.36 004 1 0 0.00 $0.00 Y
O 15842 NERVE PALSY MICROSURG GRAFT 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 15845 SKIN AND MUSCLE REPAIR FACE 4.01 $149.29 --- $188.27 004 1 0 0.00 $0.00 Y
K 15845 SKIN AND MUSCLE REPAIR FACE 20.07 $747.21 --- $942.29 004 1 0 0.00 $0.00 Y
K 15851 REMOVE SUTURES DIFF SURGEON 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
P 15851 REMOVE SUTURES DIFF SURGEON 1.13 $42.07 --- -- 015 0 0 0.00 $0.00 Y
K 15860 TEST FOR BLOOD FLOW IN GRAFT 2.78 $103.50 --- $130.52 004 1 0 0.00 $0.00 Y
K 15920 REMOVAL OF TAIL BONE ULCER 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 15920 REMOVAL OF TAIL BONE ULCER 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
O 15922 REMOVAL OF TAIL BONE ULCER 3.09 $115.04 --- $145.08 004 1 0 0.00 $0.00 Y
K 15922 REMOVAL OF TAIL BONE ULCER 15.43 $574.46 --- $724.44 004 1 0 0.00 $0.00 Y
K 15931 REMOVE SACRUM PRESSURE SORE 10.19 $379.37 --- $478.42 004 1 0 0.00 $0.00 Y
O 15931 REMOVE SACRUM PRESSURE SORE 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
O 15933 REMOVE SACRUM PRESSURE SORE 2.90 $107.97 --- $136.16 004 1 0 0.00 $0.00 Y
K 15933 REMOVE SACRUM PRESSURE SORE 14.50 $539.84 --- $680.78 004 1 0 0.00 $0.00 Y
K 15934 REMOVE SACRUM PRESSURE SORE 18.21 $677.96 --- $854.96 004 1 0 0.00 $0.00 Y
O 15934 REMOVE SACRUM PRESSURE SORE 3.64 $135.52 --- $170.90 004 1 0 0.00 $0.00 Y
O 15935 REMOVE SACRUM PRESSURE SORE 4.47 $166.42 --- $209.87 004 1 0 0.00 $0.00 Y
K 15935 REMOVE SACRUM PRESSURE SORE 22.35 $832.09 --- $1049.33 004 1 0 0.00 $0.00 Y
K 15936 REMOVE SACRUM PRESSURE SORE 18.35 $683.17 --- $861.53 004 1 0 0.00 $0.00 Y
O 15936 REMOVE SACRUM PRESSURE SORE 3.67 $136.63 --- $172.31 004 1 0 0.00 $0.00 Y
O 15937 REMOVE SACRUM PRESSURE SORE 4.20 $156.37 --- $197.19 004 1 0 0.00 $0.00 Y
K 15937 REMOVE SACRUM PRESSURE SORE 21.00 $781.83 --- $985.95 004 1 0 0.00 $0.00 Y
K 15940 REMOVE HIP PRESSURE SORE 13.25 $493.30 --- $622.09 004 1 0 0.00 $0.00 Y
O 15940 REMOVE HIP PRESSURE SORE 2.65 $98.66 --- $124.42 004 1 0 0.00 $0.00 Y
O 15941 REMOVE HIP PRESSURE SORE 3.75 $139.61 --- $176.06 004 1 0 0.00 $0.00 Y
K 15941 REMOVE HIP PRESSURE SORE 18.76 $698.43 --- $880.78 004 1 0 0.00 $0.00 Y
K 15944 REMOVE HIP PRESSURE SORE 17.20 $640.36 --- $807.54 004 1 0 0.00 $0.00 Y
O 15944 REMOVE HIP PRESSURE SORE 3.44 $128.07 --- $161.51 004 1 0 0.00 $0.00 Y
O 15945 REMOVE HIP PRESSURE SORE 3.81 $141.85 --- $178.88 004 1 0 0.00 $0.00 Y
K 15945 REMOVE HIP PRESSURE SORE 19.06 $709.60 --- $894.87 004 1 0 0.00 $0.00 Y
K 15946 REMOVE HIP PRESSURE SORE 26.62 $991.06 --- $1249.81 004 1 0 0.00 $0.00 Y
O 15946 REMOVE HIP PRESSURE SORE 5.32 $198.06 --- $249.77 004 1 0 0.00 $0.00 Y
O 15950 REMOVE THIGH PRESSURE SORE 2.23 $83.02 --- $104.70 004 1 0 0.00 $0.00 Y
K 15950 REMOVE THIGH PRESSURE SORE 11.13 $414.37 --- $522.55 004 1 0 0.00 $0.00 Y
K 15951 REMOVE THIGH PRESSURE SORE 17.05 $634.77 --- $800.50 004 1 0 0.00 $0.00 Y
O 15951 REMOVE THIGH PRESSURE SORE 3.41 $126.95 --- $160.10 004 1 0 0.00 $0.00 Y
O 15952 REMOVE THIGH PRESSURE SORE 3.41 $126.95 --- $160.10 004 1 0 0.00 $0.00 Y
K 15952 REMOVE THIGH PRESSURE SORE 17.04 $634.40 --- $800.03 004 1 0 0.00 $0.00 Y
K 15953 REMOVE THIGH PRESSURE SORE 21.30 $793.00 --- $1000.04 004 1 0 0.00 $0.00 Y
O 15953 REMOVE THIGH PRESSURE SORE 4.26 $158.60 --- $200.01 004 1 0 0.00 $0.00 Y
O 15956 REMOVE THIGH PRESSURE SORE 4.37 $162.70 --- $205.17 004 1 0 0.00 $0.00 Y
K 15956 REMOVE THIGH PRESSURE SORE 21.86 $813.85 --- $1026.33 004 1 0 0.00 $0.00 Y
K 15958 REMOVE THIGH PRESSURE SORE 22.53 $838.79 --- $1057.78 004 1 0 0.00 $0.00 Y
O 15958 REMOVE THIGH PRESSURE SORE 4.51 $167.91 --- $211.74 004 1 0 0.00 $0.00 Y
O 15999 REMOVAL OF PRESSURE SORE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 15999 REMOVAL OF PRESSURE SORE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 16000 INITIAL TREATMENT OF BURN(S) 0.86 $32.02 --- $40.38 004 1 1 0.00 $0.00 Y
P 16000 INITIAL TREATMENT OF BURN(S) 0.86 $32.02 --- -- 015 0 1 0.00 $0.00 Y
P 16020 DRESS/DEBRID P-THICK BURN S 0.85 $31.65 --- -- 015 0 1 0.00 $0.00 Y
O 16020 DRESS/DEBRID P-THICK BURN S 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 16020 DRESS/DEBRID P-THICK BURN S 0.85 $31.65 --- $39.91 004 1 1 0.00 $0.00 Y
K 16025 DRESS/DEBRID P-THICK BURN M 1.62 $60.31 --- $76.06 004 1 0 0.00 $0.00 Y
O 16025 DRESS/DEBRID P-THICK BURN M 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 16030 DRESS/DEBRID P-THICK BURN L 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 16030 DRESS/DEBRID P-THICK BURN L 2.19 $81.53 --- $102.82 004 1 0 0.00 $0.00 Y
K 16035 INCISION OF BURN SCAB INITI 6.76 $251.67 --- $317.38 004 1 0 0.00 $0.00 Y
O 16035 INCISION OF BURN SCAB INITI 1.35 $50.26 --- $63.38 004 1 0 0.00 $0.00 Y
P 16035 INCISION OF BURN SCAB INITI 6.76 $251.67 --- -- 015 0 0 0.00 $0.00 Y
O 16036 ESCHAROTOMY ADDL INCISION 0.40 $14.89 --- $18.78 004 1 0 0.00 $0.00 Y
K 16036 ESCHAROTOMY ADDL INCISION 1.99 $74.09 --- $93.43 004 1 0 0.00 $0.00 Y
K 17000 DESTRUCT PREMALG LESION 1.87 $69.80 --- $87.80 004 1 1 0.00 $0.00 Y
P 17000 DESTRUCT PREMALG LESION 1.87 $69.80 --- -- 015 0 1 0.00 $0.00 Y
P 17003 DESTRUCT PREMALG LES 2-14 0.16 $5.93 --- -- 015 0 0 0.00 $0.00 Y
K 17003 DESTRUCT PREMALG LES 2-14 0.16 $5.93 --- $7.51 004 1 0 0.00 $0.00 Y
K 17004 DESTROY PREMAL LESIONS 15/> 3.88 $144.45 --- $182.17 004 1 1 0.00 $0.00 Y
P 17004 DESTROY PREMLG LESIONS 15+ 3.88 $144.45 --- -- 015 1 0 0.00 $0.00 Y
P 17106 DEST.CUT.VASC.LESION 4.99 $185.78 --- -- 015 0 1 0.00 $0.00 Y
K 17106 DESTRUCT,CUT.VAS.LESION 4.98 $185.41 --- $233.81 004 1 1 0.00 $0.00 Y
K 17107 DESTRUCT.CUT.LESION 10-50 SQ. CM. 8.49 $316.08 --- $398.61 004 1 1 0.00 $0.00 Y
P 17107 DEST.CUT.VASC.LESION10 TO 50 SQ. CM. 8.50 $316.46 --- -- 015 0 0 0.00 $0.00 Y
P 17108 DESTRUCT.VAS.LESION > 50 SQ CM 18.42 $685.78 --- -- 015 0 0 0.00 $0.00 Y
K 17108 DEST.VAS.LESION > 50 SQ.CM. 18.43 $686.15 --- $865.29 004 1 1 0.00 $0.00 Y
K 17110 DESTRUCT B9 LESION 1-14 2.68 $99.78 --- $125.83 004 1 1 0.00 $0.00 Y
P 17110 DESTRUCT B9 LESION 1-14 2.68 $99.78 --- -- 015 0 1 0.00 $0.00 Y
P 17111 DESTRUCT LESION 15 OR MORE 3.17 $118.02 --- -- 015 0 0 0.00 $0.00 Y
K 17111 DESTRUCT LESION 15 OR MORE 3.17 $118.02 --- $148.83 004 1 0 0.00 $0.00 Y
K 17250 CHEM CAUT OF GRANLTJ TISSUE 0.54 $20.10 --- $25.35 004 1 0 0.00 $0.00 Y
K 17260 DESTRUCTION OF SKIN LESIONS 1.01 $37.60 --- $47.42 004 1 1 0.00 $0.00 Y
K 17261 DESTRUCTION OF SKIN LESION 1.18 $43.93 --- $55.40 004 1 1 0.00 $0.00 Y
K 17262 DESTRUCTIOIN OF SKIN LESION 1.63 $60.68 --- $76.53 004 1 1 0.00 $0.00 Y
K 17263 DESTRUCTION OF SKIN LESION 1.85 $68.88 --- $86.86 004 1 1 0.00 $0.00 Y
K 17264 DESTRUCTION OF SKIN LESION 2.02 $75.20 --- $94.84 004 1 1 0.00 $0.00 Y
K 17266 DESTRUCTION OF SKIN LESION 2.43 $90.47 --- $114.09 004 1 1 0.00 $0.00 Y
K 17270 DESTRUCTION OF SKIN LESIONS 1.29 $48.03 --- $60.57 004 1 1 0.00 $0.00 Y
P 17270 DESTRUCTION OF SKIN LESIONS 1.28 $47.65 --- -- 015 0 1 0.00 $0.00 Y
P 17271 DESTRUCTION OF SKIN LESION 1.53 $56.96 --- -- 015 0 1 0.00 $0.00 Y
K 17271 DESTRUCTION OF SKIN LESION 1.53 $56.96 --- $71.83 004 1 1 0.00 $0.00 Y
K 17272 DESTRUCTION OF SKIN LESION 1.82 $67.76 --- $85.45 004 1 1 0.00 $0.00 Y
P 17272 DESTRUCTION OF SKIN LESION 1.83 $68.13 --- -- 015 0 1 0.00 $0.00 Y
P 17273 DESTRUCTION OF SKIN LESION 2.15 $80.04 --- -- 015 0 1 0.00 $0.00 Y
K 17273 DESTRUCTION OF SKIN LESION 2.15 $80.04 --- $100.94 004 1 1 0.00 $0.00 Y
K 17274 DESTRUCTION OF SKIN LESION 2.70 $100.52 --- $126.77 004 1 1 0.00 $0.00 Y
P 17274 DESTRUCTION OF SKIN LESION 2.70 $100.52 --- -- 015 0 1 0.00 $0.00 Y
P 17276 DESTRUCTION OF SKIN LESION 3.35 $124.72 --- -- 015 0 1 0.00 $0.00 Y
K 17276 DESTRUCTION OF SKIN LESION 3.35 $124.72 --- $157.28 004 1 1 0.00 $0.00 Y
K 17280 DESTRUCTION OF SKIN LESIONS 1.18 $43.93 --- $55.40 004 1 1 0.00 $0.00 Y
K 17281 DESTRUCTION OF SKIN LESION 1.77 $65.90 --- $83.10 004 1 1 0.00 $0.00 Y
K 17282 DESTRUCTION OF SKIN LESION 2.12 $78.93 --- $99.53 004 1 1 0.00 $0.00 Y
K 17283 DESTRUCTION OF SKIN LESION 2.75 $102.38 --- $129.11 004 1 1 0.00 $0.00 Y
K 17284 DESTRUCTION OF SKIN LESION 3.59 $133.66 --- $168.55 004 1 1 0.00 $0.00 Y
K 17286 DESTRUCTION OF SKIN LESION 4.66 $173.49 --- $218.79 004 1 1 0.00 $0.00 Y
K 17311 MOHS 1 STAGE H/N/HF/G 15.50 $577.07 --- -- 004 0 0 0.00 $0.00 Y
K 17312 MOHS ADDL STAGE 9.36 $348.46 --- -- 004 0 0 0.00 $0.00 Y
K 17313 MOHS 1 STAGE T/A/L 14.16 $527.28 --- -- 004 0 0 0.00 $0.00 Y
K 17314 MOHS ADDL STAGE T/A/L 8.67 $322.78 --- -- 004 0 0 0.00 $0.00 Y
K 17315 MOHS SURG ADDL BLOCK 1.83 $68.13 --- -- 004 0 0 0.00 $0.00 Y
K 17340 CRYOTHERAPY OF SKIN 1.00 $37.23 --- $46.95 004 1 1 0.00 $0.00 Y
K 17360 SKIN PEEL THERAPY 1.37 $51.01 --- $64.32 004 1 1 0.00 $0.00 Y
K 17999 SKIN TISSUE PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
P 17999 SKIN TISSUE PROCEDURE 0.00 $0.00 --- -- 015 0 0 0.00 $0.00 Y
O 17999 SKIN TISSUE PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 19000 PUNCTURE ASPIRATION,BREAST CYST 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 19000 PUNCTURE ASPIRATION,BREAST CYST 0.94 $35.00 --- $44.13 004 1 1 0.00 $0.00 Y
K 19001 DRAIN BREAST LESION ADD-ON 0.56 $20.85 --- $26.29 004 1 1 0.00 $0.00 Y
O 19001 DRAIN BREAST LESION ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 19020 BREAST INCISION W/EXPLORAT. OR DRAINAGE 0.94 $35.00 --- $44.13 004 1 0 0.00 $0.00 Y
K 19020 BREAST INCISION W/EXPLORAT. OR DRAINAGE 4.68 $174.24 --- $219.73 004 1 0 0.00 $0.00 Y
K 19030 INJECTION FOR BREAST X-RAY 5.20 $193.60 --- $244.14 004 1 0 0.00 $0.00 Y
K 19081 BX BREAST 1ST LESION STRTCTC 16.98 $632.17 --- -- 004 0 0 0.00 $0.00 Y
K 19082 BX BREAST ADD LESION STRTCTC 14.15 $526.80 --- -- 004 0 0 0.00 $0.00 Y
K 19083 BX BREAST 1ST LESION US IMAG 16.49 $613.92 --- -- 004 0 0 0.00 $0.00 Y
K 19084 BX BREAST ADD LESION US IMAG 13.61 $506.70 --- -- 004 0 0 0.00 $0.00 Y
K 19085 BX BREAST 1ST LESION MR IMAG 4.47 $166.42 --- -- 004 0 0 0.00 $0.00 Y
K 19086 BX BREAST ADD LESION MR IMAG 2.08 $77.44 --- -- 004 0 0 0.00 $0.00 Y
K 19100 BX BREAST PERCUT W/O IMAGE 2.04 $75.95 --- $95.78 004 1 1 0.00 $0.00 Y
K 19101 BIOPSY OF BREAST OPEN 5.53 $205.88 --- $259.63 004 1 1 0.00 $0.00 Y
O 19101 BIOPSY OF BREAST OPEN 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 19110 NIPPLE EXPLORATION 2.06 $76.69 --- $96.72 004 1 0 0.00 $0.00 Y
K 19110 NIPPLE EXPLORATION 10.31 $383.84 --- $484.05 004 1 1 0.00 $0.00 Y
K 19112 EXCISE BREAST DUCT FISTULA 9.17 $341.40 --- $430.53 004 1 1 0.00 $0.00 Y
O 19112 EXCISE BREAST DUCT FISTULA 1.83 $68.13 --- $85.92 004 1 0 0.00 $0.00 Y
O 19120 REMOVAL OF BREAST LESION 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 19120 REMOVAL OF BREAST LESION 5.66 $210.72 --- -- 004 0 0 0.00 $0.00 Y
K 19125 EXCISION BREAST LESION 6.46 $240.51 --- $303.30 004 1 0 0.00 $0.00 Y
O 19125 EXCISION BREAST LESION 1.29 $48.03 --- $60.57 004 1 0 0.00 $0.00 Y
O 19126 EXCISION ADDL BREAST LESION 0.65 $24.20 --- $30.52 004 1 0 0.00 $0.00 Y
K 19126 EXCISION ADDL BREAST LESION 3.24 $120.63 --- $152.12 004 1 0 0.00 $0.00 Y
K 19281 PERQ DEVICE BREAST 1ST IMAG 5.80 $215.93 --- -- 004 0 0 0.00 $0.00 Y
K 19282 PERQ DEVICE BREAST EA IMAG 4.07 $151.53 --- -- 004 0 0 0.00 $0.00 Y
K 19283 PERQ DEV BREAST 1ST STRTCTC 6.57 $244.60 --- -- 004 0 0 0.00 $0.00 Y
K 19284 PERQ DEV BREAST ADD STRTCTC 5.00 $186.15 --- -- 004 0 0 0.00 $0.00 Y
K 19285 PERQ DEV BREAST 1ST US IMAG 12.79 $476.17 --- -- 004 0 0 0.00 $0.00 Y
K 19286 PERQ DEV BREAST ADD US IMAG 11.23 $418.09 --- -- 004 0 0 0.00 $0.00 Y
K 19287 PERQ DEV BREAST 1ST MR GUIDE 3.19 $118.76 --- -- 004 0 0 0.00 $0.00 Y
K 19288 PERQ DEV BREAST ADD MR GUIDE 1.48 $55.10 --- -- 004 0 0 0.00 $0.00 Y
K 19294 PREP TUM CAV IORT PRTL MAST 3.70 $137.97 --- -- 004 0 0 0.00 $0.00 Y
O 19294 PREP TUM CAV IORT PRTL MAST 0.74 $27.59 --- -- 004 0 0 0.00 $0.00 Y
K 19296 PLACE PO BREAST CATH FOR RAD 119.27 $4440.40 --- $5599.73 004 1 0 0.00 $0.00 Y
K 19297 PLACE BREAST CATH FOR RAD 1.56 $58.03 --- $73.24 004 1 0 0.00 $0.00 Y
K 19298 PLACE BREAST RAD TUBE/CATHS 44.32 $1650.17 --- $2080.82 004 1 0 0.00 $0.00 Y
K 19300 REMOVAL OF BREAST TISSUE 12.29 $457.55 --- -- 004 0 0 0.00 $0.00 Y
O 19300 REMOVAL OF BREAST TISSUE 2.46 $91.51 --- -- 004 0 0 0.00 $0.00 Y
O 19301 PARTIAL MASTECTOMY 1.79 $66.71 --- -- 004 0 0 0.00 $0.00 Y
K 19301 PARTIAL MASTECTOMY 8.96 $333.55 --- -- 004 0 0 0.00 $0.00 Y
K 19302 PMASTECTOMY W/LN REMOVAL 18.60 $692.51 --- -- 004 0 0 0.00 $0.00 Y
O 19302 PMASTECTOMY W/LN REMOVAL 3.72 $138.50 --- -- 004 0 0 0.00 $0.00 Y
O 19303 MAST SIMPLE COMPLETE 4.10 $152.58 --- -- 004 0 0 0.00 $0.00 Y
K 19303 MAST SIMPLE COMPLETE 20.49 $762.88 --- -- 004 0 0 0.00 $0.00 Y
K 19305 MAST RADICAL 23.38 $870.58 --- -- 004 0 0 0.00 $0.00 Y
O 19305 MAST RADICAL 4.69 $174.58 --- -- 004 0 0 0.00 $0.00 Y
O 19306 MAST RAD URBAN TYPE 4.89 $181.94 --- -- 004 0 0 0.00 $0.00 Y
K 19306 MAST RAD URBAN TYPE 24.43 $909.71 --- -- 004 0 0 0.00 $0.00 Y
K 19307 MAST MOD RAD 24.69 $919.31 --- -- 004 0 0 0.00 $0.00 Y
O 19307 MAST MOD RAD 4.94 $183.86 --- -- 004 0 0 0.00 $0.00 Y
O 19316 MASTOPEXY 2.47 $91.96 --- -- 004 0 0 0.00 $0.00 Y
K 19316 MASTOPEXY 12.74 $474.31 --- -- 004 0 0 0.00 $0.00 Y
K 19318 REDUCTION MAMMAPLASTY 26.70 $994.04 --- $1253.57 004 1 0 0.00 $0.00 Y
O 19318 REDUCTION MAMMAPLASTY 5.30 $197.32 --- $248.84 004 1 0 0.00 $0.00 Y
O 19324 BREAST AUGMENT.;WITHOUT PROSTH.IMPL. 3.60 $134.03 --- $169.02 004 1 0 0.00 $0.00 Y
K 19324 BREAST AUGMENT.;WITHOUT PROSTH. IMPL 18.00 $670.14 --- $845.10 004 1 0 0.00 $0.00 Y
K 19325 BREAST AUGMENT.WITH PROSTH.IMPLANT 18.00 $670.14 --- $845.10 004 1 0 0.00 $0.00 Y
O 19325 BREAST AUGMENT.WITH PROSTH.IMPLANT 3.60 $134.03 --- $169.02 004 1 0 0.00 $0.00 Y
O 19328 REML.INTACT BREAST IMPLANT 1.73 $64.41 --- $81.22 004 1 0 0.00 $0.00 Y
K 19328 REML.INTACT BREAST IMPLANT 8.67 $322.78 --- $407.06 004 1 1 0.00 $0.00 Y
K 19330 REML.MAMMARY IMPLANT MATERIAL 11.50 $428.15 --- $539.93 004 1 1 0.00 $0.00 Y
O 19330 REML.MAMMARY IMPLANT MATERIAL 2.30 $85.63 --- $107.99 004 1 0 0.00 $0.00 Y
O 19340 IMMED.INSERT.BREAST.PROSTH.FOLL.SURG. 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
K 19340 IMMED.INSERT.BREAST PROSTH.FOLL.SURG. 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
K 19342 DELAY INSERT.BREAST PROSTH.FOLL.SURG 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 19342 DELAY INSERT.BREAST PROSTH.FOLL.SURG 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 19350 NIPPLE/AREOLA RECONSTRUCT. 3.59 $133.66 --- $168.55 004 1 0 0.00 $0.00 Y
K 19350 NIPPLE/AREOLA RECONSTRUCT. 17.96 $668.65 --- $843.22 004 1 0 0.00 $0.00 Y
K 19357 BREAST RECONSTRUCTION 19.04 $708.86 --- $893.93 004 1 0 0.00 $0.00 Y
O 19357 BREAST RECONSTRUCTION 3.81 $141.85 --- $178.88 004 1 0 0.00 $0.00 Y
O 19361 BREAST RECONSTR W/LAT FLAP 7.52 $280.10 --- $353.06 004 1 0 0.00 $0.00 Y
K 19361 BREAST RECONSTR W/LAT FLAP 37.62 $1400.50 --- $1766.26 004 1 0 0.00 $0.00 Y
K 19364 BREAST RECONST. W/FREE FLAP 45.87 $1707.74 --- $2153.60 004 1 0 0.00 $0.00 Y
O 19364 BREAST RECONST.W/FREE FLAP 9.17 $341.40 --- $430.53 004 1 0 0.00 $0.00 Y
O 19366 BREAST RECONST.W/OTHER TECHNIQUE 6.12 $227.85 --- $287.33 004 1 0 0.00 $0.00 Y
K 19366 BREAST RECONST. W/OTHER TECHNIQUE 30.62 $1139.98 --- $1437.61 004 1 0 0.00 $0.00 Y
K 19367 BREAST RECONS/TRANSVERSE RECTUS ABDOMINI 28.32 $1054.35 --- $1329.62 004 1 0 0.00 $0.00 Y
O 19367 BREAST RECONS/TRANSVERSE RECTUS ABDOMINI 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
O 19368 BREAST RECONS TRANSVERSE RECTUS ABDOMINI 7.88 $293.37 --- $369.97 004 1 0 0.00 $0.00 Y
K 19368 BREAST RECONS TRANSVERSE TECTUS ABDOMINI 39.40 $1466.86 --- $1849.83 004 1 0 0.00 $0.00 Y
K 19369 BREAST RECONS TRANSVERSE RECTUS ABDOMINI 46.33 $1724.87 --- $2175.19 004 1 0 0.00 $0.00 Y
O 19369 BREAST RECONS TRANSVERSE RECTUS ABDOMINI 9.27 $345.12 --- $435.23 004 1 0 0.00 $0.00 Y
O 19370 OPEN PERIPROSTH.CAPSULOTOMY,BREAST 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 19370 OPEN PERIPROSTH.CAPSULOTOMY,BREAST 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 19371 PERIPROSTH.CAPSULOTOMY,BREAST 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 19371 PERIPROSTH.CAPSULOTOMY,BREAST 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 19380 REVISE BREAST RECONSTRUCTION 2.75 $102.38 --- $129.11 004 1 0 0.00 $0.00 Y
K 19380 REVISE BREAST RECONSTRUCTION 13.76 $512.28 --- $646.03 004 1 0 0.00 $0.00 Y
K 19396 DESIGN CUSTOM BREAST IMPLANT 5.78 $215.19 --- $271.37 004 1 0 0.00 $0.00 Y
O 19396 DESIGN CUSTOM BREAST IMPLANT 1.16 $43.19 --- $54.46 004 1 0 0.00 $0.00 Y
O 19499 UNLISTED PROCEDURE, BREAST 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 19499 UNLISTED PROCEDURE, BREAST 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20100 EXPLORE WOUND NECK 9.39 $349.59 --- $440.86 004 1 0 0.00 $0.00 Y
O 20100 EXPLORE WOUND NECK 1.88 $69.99 --- $88.27 004 1 0 0.00 $0.00 Y
O 20101 EXPLORE WOUND CHEST 0.60 $22.34 --- $28.17 004 1 0 0.00 $0.00 Y
K 20101 EXPLORE WOUND CHEST 3.01 $112.06 --- $141.32 004 1 0 0.00 $0.00 Y
K 20102 EXPLORE WOUND ABDOMEN 3.64 $135.52 --- $170.90 004 1 0 0.00 $0.00 Y
O 20102 EXPLORE WOUND ABDOMEN 0.72 $26.81 --- $33.80 004 1 0 0.00 $0.00 Y
O 20103 EXPLORE WOUND EXTREMITY 0.97 $36.11 --- $45.54 004 1 0 0.00 $0.00 Y
P 20103 EXPLORE WOUND EXTREMITY 4.90 $182.43 --- -- 015 0 0 0.00 $0.00 Y
K 20103 EXPLORE WOUND EXTREMITY 4.89 $182.05 --- $229.59 004 1 0 0.00 $0.00 Y
K 20150 EXCISE EPIPHYSEAL BAR 19.76 $735.66 --- $927.73 004 1 0 0.00 $0.00 Y
O 20150 EXCISE EPIPHYSEAL BAR 3.95 $147.06 --- $185.45 004 1 0 0.00 $0.00 Y
P 20200 MUSCLE BIOPSY 1.46 $54.36 --- -- 015 0 1 0.00 $0.00 Y
K 20200 MUSCLE BIOPSY 1.46 $54.36 --- $68.55 004 1 1 0.00 $0.00 Y
K 20205 DEEP MUSCLE BIOPSY 2.93 $109.08 --- $137.56 004 1 0 0.00 $0.00 Y
P 20205 DEEP MUSCLE BIOPSY 2.92 $108.71 --- -- 015 0 0 0.00 $0.00 Y
O 20205 DEEP MUSCLE BIOPSY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20206 NEEDLE BIOPSY MUSCLE 1.77 $65.90 --- $83.10 004 1 0 0.00 $0.00 Y
K 20220 BONE BIOPSY TROCAR/NEEDLE 2.29 $85.26 --- $107.52 004 1 0 0.00 $0.00 Y
K 20225 BONE BIOPSY TROCAR/NEEDLE 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 20225 BONE BIOPSY TROCAR/NEEDLE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20240 BONE BIOPSY OPEN SUPERFICIAL 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
K 20245 BONE BIOPSY OPEN DEEP 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
O 20245 BONE BIOPSY OPEN DEEP 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20250 OPEN BONE BIOPSY 1.56 $58.08 --- $73.24 004 1 0 0.00 $0.00 Y
K 20250 OPEN BONE BIOPSY 7.78 $289.65 --- $365.27 004 1 0 0.00 $0.00 Y
K 20251 OPEN BONE BIOPSY 9.70 $361.13 --- $455.42 004 1 0 0.00 $0.00 Y
O 20251 OPEN BONE BIOPSY 1.94 $72.23 --- $91.08 004 1 0 0.00 $0.00 Y
P 20500 INJECTION OF SINUS TRACT 2.84 $105.73 --- -- 015 0 1 0.00 $0.00 Y
K 20500 INJECTION OF SINUS TRACT 2.85 $106.11 --- $133.81 004 1 1 0.00 $0.00 Y
K 20501 INJECT SINUS TRACT FOR XRAY 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
P 20501 INJECT SINUS TRACT FOR XRAY 6.00 $223.38 --- -- 015 0 0 0.00 $0.00 Y
P 20520 REMOVAL OF FOREIGN BODY 3.02 $112.43 --- -- 015 0 1 0.00 $0.00 Y
K 20520 REMOVAL OF FOREIGN BODY 3.02 $112.43 --- $141.79 004 1 1 0.00 $0.00 Y
K 20525 REMOVE MUSCLE FOREIGN BODY 7.79 $290.02 --- $365.74 004 1 0 0.00 $0.00 Y
P 20525 REMOVE MUSCLE FOREIGN BODY 7.79 $290.02 --- -- 015 0 0 0.00 $0.00 Y
O 20525 REMOVE MUSCLE FOREIGN BODY 1.56 $58.08 --- $73.24 004 1 0 0.00 $0.00 Y
K 20526 THER INJECTION CARP TUNNEL 1.41 $52.49 --- $66.20 004 1 1 0.00 $0.00 Y
K 20527 INJ DUPUYTREN CORD W/ENZYME 1.32 $49.32 --- $61.97 004 1 1 0.00 $0.00 Y
K 20550 INJ TENDON SHEATH/LIGAMENT 1.23 $45.79 --- $57.75 004 1 1 0.00 $0.00 Y
P 20550 INJ TENDON SHEATH/LIGAMENT 1.23 $45.79 --- -- 015 0 1 0.00 $0.00 Y
P 20551 INJ TENDON ORIGIN/INSERTION 1.41 $52.49 --- -- 015 0 0 0.00 $0.00 Y
K 20551 INJ TENDON ORIGIN/INSERTION 1.41 $52.49 --- -- 004 0 0 0.00 $0.00 Y
K 20552 INJ TRIGGER POINT 1/2 MUSCL 1.41 $52.49 --- -- 004 0 0 0.00 $0.00 Y
P 20552 INJ TRIGGER POINT 1/2 MUSCL 1.41 $52.49 --- -- 015 0 0 0.00 $0.00 Y
P 20553 INJECT TRIGGER POINTS 3/> 1.51 $56.22 --- -- 015 0 0 0.00 $0.00 Y
K 20553 INJECT TRIGGER POINTS 3/> 1.51 $56.22 --- -- 004 0 0 0.00 $0.00 Y
K 20555 PLACE NDL MUSC/TIS FOR RT 6.61 $246.09 --- -- 004 0 0 0.00 $0.00 Y
K 20560 NDL INSJ W/O NJX 1 OR 2 MUSC 0.62 $23.24 --- -- 004 0 0 0.00 $0.00 Y
P 20560 NDL INSJ W/O NJX 1 OR 2 MUSC 0.62 $23.24 --- -- 015 0 0 0.00 $0.00 Y
P 20561 NDL INSJ W/O NJX 3+ MUSC 0.92 $34.44 --- -- 015 0 0 0.00 $0.00 Y
K 20561 NDL INSJ W/O NJX 3+ MUSC 0.92 $34.44 --- -- 004 0 0 0.00 $0.00 Y
K 20600 DRAIN/INJECT JOINT/BURSA 0.87 $32.39 --- $40.85 004 1 1 0.00 $0.00 Y
P 20600 DRAIN/INJECT JOINT/BURSA 0.87 $32.39 --- -- 015 0 1 0.00 $0.00 Y
P 20604 DRAIN/INJ JOINT/BURSA W/US 1.06 $39.46 --- $49.77 004 1 1 0.00 $0.00 Y
K 20604 DRAIN/INJ JOINT/BURSA W/US 1.06 $39.46 --- $49.77 004 1 1 0.00 $0.00 Y
K 20605 DRAIN/INJECT JOINT/BURSA 1.02 $37.97 --- $47.89 004 1 1 0.00 $0.00 Y
P 20605 DRAIN/INJECT JOINT/BURSA 1.02 $37.97 --- -- 015 0 1 0.00 $0.00 Y
P 20606 DRAIN/INJ JOINT/BURSA W/US 1.21 $45.05 --- $56.81 004 1 1 0.00 $0.00 Y
K 20606 DRAIN/INJ JOINT/BURSA W/US 1.21 $45.05 --- $56.81 004 1 1 0.00 $0.00 Y
K 20610 DRAIN/INJECT JOINT/BURSA 1.23 $45.79 --- $57.75 004 1 1 0.00 $0.00 Y
K 20611 DRAIN/INJ JOINT/BURSA W/US 1.42 $52.87 --- $66.67 004 1 1 0.00 $0.00 Y
K 20612 ASPIRATE/INJ GANGLION CYST 1.46 $54.36 --- $68.55 004 1 1 0.00 $0.00 Y
K 20615 TREATMENT OF BONE CYST 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
K 20650 INSERT AND REMOVE BONE PIN 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
P 20650 INSERT AND REMOVE BONE PIN 2.81 $104.62 --- -- 015 0 0 0.00 $0.00 Y
K 20660 APPLY REM FIXATION DEVICE 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
K 20661 APPLICATION OF HEAD BRACE 5.31 $197.69 --- $249.30 004 1 0 0.00 $0.00 Y
O 20661 APPLICATION OF HEAD BRACE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20662 APPLICATION OF PELVIS BRACE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20662 APPLICATION OF PELVIS BRACE 5.21 $193.97 --- $244.61 004 1 0 0.00 $0.00 Y
K 20663 APPLICATION OF THIGH BRACE 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 20663 APPLICATION OF THIGH BRACE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20664 APPLICATION OF HALO 1.91 $71.11 --- $89.67 004 1 0 0.00 $0.00 Y
K 20664 APPLICATION OF HALO 9.59 $357.04 --- $450.25 004 1 0 0.00 $0.00 Y
K 20665 REMOVAL OF FIXATION DEVICE 1.64 $61.06 --- $77.00 004 1 0 0.00 $0.00 Y
K 20670 REMOVAL OF SUPPORT IMPLANT 3.11 $115.79 --- $146.01 004 1 1 0.00 $0.00 Y
P 20670 REMOVAL OF SUPPORT IMPLANT 3.11 $115.79 --- -- 015 0 1 0.00 $0.00 Y
P 20680 REMOVAL OF SUPPORT IMPLANT 4.08 $151.90 --- -- 015 0 0 0.00 $0.00 Y
O 20680 REMOVAL OF SUPPORT IMPLANT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20680 REMOVAL OF SUPPORT IMPLANT 4.08 $151.90 --- $191.56 004 1 0 0.00 $0.00 Y
K 20690 APPLY BONE FIXATION DEVICE 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
K 20692 APPLY BONE FIXATION DEVICE 7.14 $265.82 --- $335.22 004 1 1 0.00 $0.00 Y
K 20693 ADJ/REV EXT FIX 7.56 $281.46 --- $354.94 004 1 1 0.00 $0.00 Y
K 20694 RML, EXT FIX 5.39 $200.67 --- $253.06 004 1 1 0.00 $0.00 Y
K 20696 COMP MULTIPLANE EXT FIXATION 19.85 $739.02 --- -- 004 0 0 0.00 $0.00 Y
O 20696 COMP MULTIPLANE EXT FIXATION 3.97 $147.80 --- -- 004 0 0 0.00 $0.00 Y
O 20697 COMP EXT FIXATE STRUT CHANGE 5.72 $212.96 --- -- 004 0 0 0.00 $0.00 Y
K 20697 COMP EXT FIXATE STRUT CHANGE 28.61 $1065.15 --- -- 004 0 0 0.00 $0.00 Y
K 20700 MNL PREP&INSJ DP RX DLVR DEV 1.95 $72.61 --- -- 004 0 0 0.00 $0.00 Y
K 20701 RMVL DEEP RX DELIVERY DEVICE 1.45 $54.29 --- -- 004 0 0 0.00 $0.00 Y
K 20702 MNL PREP&INSJ IMED RX DEV 3.24 $120.65 --- -- 004 0 0 0.00 $0.00 Y
K 20703 RMVL IMED RX DELIVERY DEVICE 2.32 $86.74 --- -- 004 0 0 0.00 $0.00 Y
K 20704 MNL PREP&INSJ I-ARTIC RX DEV 3.37 $125.70 --- -- 004 0 0 0.00 $0.00 Y
K 20705 RMVL I-ARTIC RX DELIVERY DEV 2.78 $103.60 --- -- 004 0 0 0.00 $0.00 Y
K 20802 REPLANTATION ARM COMPLETE 61.93 $2305.65 --- $2907.61 004 1 0 0.00 $0.00 Y
O 20802 REPLANTATION ARM COMPLETE 12.39 $461.28 --- $581.71 004 1 0 0.00 $0.00 Y
O 20805 REPLANT FOREARM COMPLETE 17.06 $635.14 --- $800.97 004 1 0 0.00 $0.00 Y
K 20805 REPLANT FOREARM COMPLETE 85.32 $3176.46 --- $4005.77 004 1 0 0.00 $0.00 Y
K 20808 REPLANTATION HAND COMPLETE 94.60 $3521.96 --- $4441.47 004 1 0 0.00 $0.00 Y
O 20808 REPLANTATION HAND COMPLETE 18.92 $704.39 --- $888.29 004 1 0 0.00 $0.00 Y
O 20816 REPLANTATION DIGIT COMPLETE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20816 REPLANTATION DIGIT COMPLETE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20822 REPLANTATION DIGIT COMPLETE 51.27 $1908.78 --- $2407.13 004 1 0 0.00 $0.00 Y
O 20822 REPLANTATION DIGIT COMPLETE 10.25 $381.61 --- $481.24 004 1 0 0.00 $0.00 Y
O 20824 REPLANTATION THUMB COMPLETE 12.60 $469.10 --- $591.57 004 1 0 0.00 $0.00 Y
K 20824 REPLANTATION THUMB COMPLETE 62.99 $2345.12 --- $2957.38 004 1 0 0.00 $0.00 Y
K 20827 REPLANTATION THUMB COMPLETE 55.02 $2048.39 --- $2583.19 004 1 0 0.00 $0.00 Y
O 20827 REPLANTATION THUMB COMPLETE 11.00 $409.53 --- $516.45 004 1 0 0.00 $0.00 Y
O 20838 REPLANTATION FOOT COMPLETE 13.72 $510.80 --- $644.15 004 1 0 0.00 $0.00 Y
P 20838 REPLANTATION FOOT COMPLETE 0.00 $0.00 --- -- 015 0 0 0.00 $0.00 Y
K 20838 REPLANTATION FOOT COMPLETE 68.62 $2554.72 --- $3221.71 004 1 0 0.00 $0.00 Y
K 20900 REMOVAL OF BONE FOR GRAFT 5.18 $192.85 --- $243.20 004 1 0 0.00 $0.00 Y
O 20900 REMOVAL OF BONE FOR GRAFT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20902 REMOVAL OF BONE FOR GRAFT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20902 REMOVAL OF BONE FOR GRAFT 7.34 $273.27 --- $344.61 004 1 0 0.00 $0.00 Y
K 20910 REMOVE CARTILAGE FOR GRAFT 5.69 $211.84 --- $267.15 004 1 0 0.00 $0.00 Y
O 20910 REMOVE CARTILAGE FOR GRAFT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20912 REMOVE CARTILAGE FOR GRAFT 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
K 20912 REMOVE CARTILAGE FOR GRAFT 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
K 20920 REMOVAL OF FASCIA FOR GRAFT 4.88 $181.68 --- $229.12 004 1 0 0.00 $0.00 Y
O 20920 REMOVAL OF FASCIA FOR GRAFT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20922 REMOVAL OF FASCIA FOR GRAFT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20922 REMOVAL OF FASCIA FOR GRAFT 7.56 $281.46 --- $354.94 004 1 0 0.00 $0.00 Y
K 20924 REMOVAL OF TENDON FOR GRAFT 11.69 $435.22 --- $548.85 004 1 0 0.00 $0.00 Y
O 20924 REMOVAL OF TENDON FOR GRAFT 2.34 $87.12 --- $109.86 004 1 0 0.00 $0.00 Y
O 20930 SP BONE ALGRFT MORSEL ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20930 SP BONE ALGRFT MORSEL ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20931 SP BONE ALGRFT STRUCT ADD-ON 2.25 $83.77 --- $105.64 004 1 0 0.00 $0.00 Y
O 20931 SP BONE ALGRFT STRUCT ADD-ON 0.45 $16.75 --- $21.13 004 1 0 0.00 $0.00 Y
K 20932 OSTEOART ALGRFT W/SURF & B1 16.31 $607.22 --- -- 004 0 0 0.00 $0.00 Y
K 20933 HEMICRT INTRCLRY ALGRFT PRTL 14.96 $556.96 --- -- 004 0 0 0.00 $0.00 Y
K 20934 INTERCALARY ALGRFT COMPL 16.30 $606.85 --- -- 004 0 0 0.00 $0.00 Y
K 20936 SP BONE AGRFT LOCAL ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20936 SP BONE AGRFT LOCAL ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20937 SP BONE AGRFT MORSEL ADD-ON 0.69 $25.69 --- $32.40 004 1 0 0.00 $0.00 Y
K 20937 SP BONE AGRFT MORSEL ADD-ON 3.48 $129.56 --- $163.39 004 1 0 0.00 $0.00 Y
K 20938 SP BONE AGRFT STRUCT ADD-ON 3.75 $139.61 --- $176.06 004 1 0 0.00 $0.00 Y
O 20938 SP BONE AGRFT STRUCT ADD-ON 0.75 $27.92 --- $35.21 004 1 0 0.00 $0.00 Y
O 20939 BONE MARROW ASPIR BONE GRFG 0.30 $11.51 --- -- 004 0 0 0.00 $0.00 Y
K 20939 BONE MARROW ASPIR BONE GRFG 1.54 $57.57 --- -- 004 0 0 0.00 $0.00 Y
K 20950 FLUID PRESSURE MUSCLE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20955 FIBULA BONE GRAFT MICROVASC 62.29 $2319.06 --- $2924.52 004 1 0 0.00 $0.00 Y
O 20955 FIBULA BONE GRAFT MICROVASC 12.46 $463.89 --- $585.00 004 1 0 0.00 $0.00 Y
O 20956 ILIAC BONE GRAFT MICROVASC 10.70 $398.36 --- $502.37 004 1 0 0.00 $0.00 Y
K 20956 ILIAC BONE GRAFT MICROVASC 53.52 $1992.55 --- $2512.76 004 1 0 0.00 $0.00 Y
K 20957 MT BONE GRAFT MICROVASC 52.49 $1954.20 --- $2464.41 004 1 0 0.00 $0.00 Y
O 20957 MT BONE GRAFT MICROVASC 10.50 $390.92 --- $492.98 004 1 0 0.00 $0.00 Y
O 20962 OTHER BONE GRAFT MICROVASC 12.23 $455.32 --- $574.20 004 1 0 0.00 $0.00 Y
K 20962 OTHER BONE GRAFT MICROVASC 61.16 $2276.99 --- $2871.46 004 1 0 0.00 $0.00 Y
K 20969 BONE/SKIN GRAFT MICROVASC 64.37 $2396.50 --- $3022.17 004 1 0 0.00 $0.00 Y
O 20969 BONE/SKIN GRAFT MICROVASC 12.87 $479.15 --- $604.25 004 1 0 0.00 $0.00 Y
O 20970 BONE/SKIN GRAFT ILIAC CREST 13.24 $492.93 --- $621.62 004 1 0 0.00 $0.00 Y
K 20970 BONE/SKIN GRAFT ILIAC CREST 66.22 $2465.37 --- $3109.03 004 1 0 0.00 $0.00 Y
K 20972 BONE/SKIN GRAFT METATARSAL 59.71 $2223.00 --- $2803.38 004 1 0 0.00 $0.00 Y
O 20972 BONE/SKIN GRAFT METATARSAL 11.94 $444.53 --- $560.58 004 1 0 0.00 $0.00 Y
O 20973 BONE/SKIN GRAFT GREAT TOE 13.70 $510.05 --- $643.22 004 1 0 0.00 $0.00 Y
K 20973 BONE/SKIN GRAFT GREAT TOE 68.49 $2549.88 --- $3215.61 004 1 0 0.00 $0.00 Y
K 20974 ELECTRICAL BONE STIMULATION 1.12 $41.70 --- $52.58 004 1 0 0.00 $0.00 Y
K 20975 ELECTRICAL BONE STIMULATION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 20975 ELECTRICAL BONE STIMULATION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20979 US BONE STIMULATION 0.29 $10.80 --- $13.62 004 1 0 0.00 $0.00 Y
K 20982 ABLATE BONE TUMOR(S) PERQ 98.79 $3678.13 --- $4638.19 004 1 0 0.00 $0.00 Y
K 20983 ABLATE BONE TUMOR(S) PERQ 9.21 $342.89 --- $432.41 004 1 0 0.00 $0.00 Y
K 20985 CPTRASST DIR MS PX 2.98 $110.95 --- -- 004 0 0 0.00 $0.00 Y
O 20985 CPTRASST DIR MS PX 0.60 $22.34 --- -- 004 0 0 0.00 $0.00 Y
O 20999 MUSCULOSKELETAL SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 20999 MUSCULOSKELETAL SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
R 2101 REV - ACUPUNCTURE 0.00 $0.00 --- -- 009 0 0 0.00 $0.00 N
O 21010 INCISION OF JAW JOINT 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 21010 INCISION OF JAW JOINT 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 21011 EXC FACE LES SC <2 CM 7.25 $269.92 --- $340.39 004 1 0 0.00 $0.00 Y
O 21011 EXC FACE LES SC <2 CM 1.45 $53.98 --- $68.08 004 1 0 0.00 $0.00 Y
O 21012 EXC FACE LES SBQ 2 CM/< 1.51 $56.22 --- $70.89 004 1 0 0.00 $0.00 Y
K 21012 EXC FACE LES SBQ 2 CM/< 7.55 $281.09 --- $354.47 004 1 0 0.00 $0.00 Y
K 21013 EXC FACE TUM DEEP < 2 CM 11.13 $414.37 --- $522.55 004 1 0 0.00 $0.00 Y
O 21013 EXC FACE TUM DEEP < 2 CM 2.23 $83.02 --- $104.70 004 1 0 0.00 $0.00 Y
O 21014 EXC FACE TUM DEEP 2 CM/> 2.32 $86.37 --- $108.92 004 1 0 0.00 $0.00 Y
K 21014 EXC FACE TUM DEEP 2 CM/> 11.62 $432.61 --- $545.56 004 1 0 0.00 $0.00 Y
K 21015 RESECT FACE TUM < 2 CM 13.26 $493.67 --- $622.56 004 1 0 0.00 $0.00 Y
O 21015 RESECT FACE TUM < 2 CM 2.65 $98.66 --- $124.42 004 1 0 0.00 $0.00 Y
O 21016 RESECT FACE TUM 2 CM/> 4.62 $172.00 --- $216.91 004 1 0 0.00 $0.00 Y
K 21016 RESECT FACE TUM 2 CM/> 23.10 $860.01 --- $1084.55 004 1 0 0.00 $0.00 Y
K 21025 EXCISION OF BONE LOWER JAW 7.95 $295.98 --- $373.25 004 1 0 0.00 $0.00 Y
O 21025 EXCISION OF BONE LOWER JAW 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
O 21026 EXCISION OF FACIAL BONE(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21026 EXCISION OF FACIAL BONE(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21029 RML. TUMOR, FACIAL BONE 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
O 21029 RESECT TUMOR FACIAL BONE 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
O 21030 EXCISE MAX/ZYGOMA B9 TUMOR 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21030 EXCISE MAX/ZYGOMA B9 TUMOR 5.41 $201.41 --- $254.00 004 1 0 0.00 $0.00 Y
K 21031 REMOVE EXOSTOSIS MANDIBLE 5.59 $208.12 --- $262.45 004 1 0 0.00 $0.00 Y
O 21031 REMOVE EXOSTOSIS MANDIBLE 1.12 $41.70 --- $52.58 004 1 0 0.00 $0.00 Y
O 21032 REMOVE EXOSTOSIS MAXILLA 1.11 $41.33 --- $52.11 004 1 0 0.00 $0.00 Y
K 21032 REMOVE EXOSTOSIS MAXILLA 5.57 $207.37 --- $261.51 004 1 0 0.00 $0.00 Y
K 21034 EXCISE MAX/ZYGOMA MLG TUMOR 11.95 $444.90 --- $561.05 004 1 0 0.00 $0.00 Y
O 21034 EXCISE MAX/ZYGOMA MLG TUMOR 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 21040 EXCISE MANDIBLE LESION 1.00 $37.23 --- $46.95 004 1 0 0.00 $0.00 Y
K 21040 EXCISE MANDIBLE LESION 5.00 $186.15 --- $234.75 004 1 0 0.00 $0.00 Y
K 21044 REMOVAL OF JAW BONE LESION 9.13 $339.91 --- $428.65 004 1 0 0.00 $0.00 Y
O 21044 REMOVAL OF JAW BONE LESION 1.83 $68.13 --- $85.92 004 1 0 0.00 $0.00 Y
O 21045 EXTENSIVE JAW SURGERY 4.54 $169.02 --- $213.15 004 1 0 0.00 $0.00 Y
K 21045 EXTENSIVE JAW SURGERY 22.71 $845.49 --- $1066.23 004 1 0 0.00 $0.00 Y
K 21046 REMOVE MANDIBLE CYST COMPLEX 11.11 $413.55 --- $521.61 004 1 0 0.00 $0.00 Y
O 21046 REMOVE MANDIBLE CYST COMPLEX 2.22 $82.71 --- $104.23 004 1 0 0.00 $0.00 Y
O 21047 EXCISE LWR JAW CYST W/REPAIR 3.21 $119.65 --- $150.71 004 1 0 0.00 $0.00 Y
K 21047 EXCISE LWR JAW CYST W/REPAIR 16.07 $598.23 --- $754.49 004 1 0 0.00 $0.00 Y
K 21048 REMOVE MAXILLA CYST COMPLEX 11.51 $428.51 --- $540.39 004 1 0 0.00 $0.00 Y
O 21048 REMOVE MAXILLA CYST COMPLEX 2.30 $85.70 --- $107.99 004 1 0 0.00 $0.00 Y
O 21049 EXCIS UPPR JAW CYST W/REPAIR 3.03 $112.81 --- $142.26 004 1 0 0.00 $0.00 Y
K 21049 EXCIS UPPR JAW CYST W/REPAIR 15.13 $563.21 --- $710.35 004 1 0 0.00 $0.00 Y
K 21050 REMOVAL OF JAW JOINT 18.83 $701.04 --- $884.07 004 1 0 0.00 $0.00 Y
K 21060 REMOVE JAW JOINT CARTILAGE 18.00 $670.14 --- $845.10 004 1 0 0.00 $0.00 Y
O 21060 REMOVE JAW JOINT CARTILAGE 3.60 $134.03 --- $169.02 004 1 0 0.00 $0.00 Y
O 21070 REMOVE CORONOID PROCESS 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 21070 REMOVE CORONOID PROCESS 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 21073 MNPJ OF TMJ W/ANESTH 7.42 $276.25 --- -- 004 0 0 0.00 $0.00 Y
K 21100 MAXILLOFACIAL FIXATION 4.11 $153.02 --- $192.96 004 1 0 0.00 $0.00 Y
O 21100 MAXILLOFACIAL FIXATION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y