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Medi-Cal Rates Information

Medi-Cal Rates as of 03/15/2020 (Codes 36248 thru 42725)

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
K 36248 PLACE CATHETER IN ARTERY 1.24 $46.17 --- $58.22 004 1 0 0.00 $0.00 Y
K 36251 INS CATH REN ART 1ST UNILAT 6.12 $227.71 --- -- 004 0 0 0.00 $0.00 Y
K 36252 INS CATH REN ART 1ST BILAT 7.97 $296.54 --- -- 004 0 0 0.00 $0.00 Y
K 36253 INS CATH REN ART 2ND+ UNILAT 8.50 $316.27 --- -- 004 0 0 0.00 $0.00 Y
K 36254 INS CATH REN ART 2ND+ BILAT 9.16 $341.19 --- -- 004 0 0 0.00 $0.00 Y
K 36260 INSERTION OF INFUSION PUMP 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
O 36260 INSERTION OF INFUSION PUMP 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
O 36261 REVISION OF INFUSION PUMP 1.45 $53.98 --- $68.08 004 1 0 0.00 $0.00 Y
K 36261 REVISION OF INFUSION PUMP 7.25 $269.92 --- $340.39 004 1 0 0.00 $0.00 Y
K 36262 REMOVAL OF INFUSION PUMP 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 36262 REMOVAL OF INFUSION PUMP 1.20 $44.68 --- $56.34 004 1 0 0.00 $0.00 Y
O 36299 VESSEL INJECTION PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 36299 VESSEL INJECTION PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 36400 BL DRAW < 3 YRS FEM/JUGULAR 0.45 $16.75 --- $21.13 004 1 1 0.00 $0.00 Y
K 36405 BL DRAW <3 YRS SCALP VEIN 0.48 $17.87 --- $22.54 004 1 1 0.00 $0.00 Y
K 36406 BL DRAW <3 YRS OTHER VEIN 0.63 $23.45 --- $29.58 004 1 0 0.00 $0.00 Y
K 36410 NON-ROUTINE BL DRAW 3/> YRS 0.29 $10.80 --- $13.62 004 1 1 0.00 $0.00 Y
K 36420 VEIN ACCESS CUTDOWN < 1 YR 1.13 $42.07 --- $53.05 004 1 1 0.00 $0.00 Y
K 36425 VEIN ACCESS CUTDOWN > 1 YR 1.61 $59.94 --- $75.59 004 1 1 0.00 $0.00 Y
K 36440 BL PUSH TRANSFUSE 2 YR/< 0.95 $35.37 --- $44.60 004 1 0 0.00 $0.00 Y
K 36450 BL EXCHANGE/TRANSFUSE NB 3.51 $130.68 --- $164.79 004 1 0 0.00 $0.00 Y
K 36455 BL EXCHANGE/TRANSFUSE NON-NB 3.11 $115.79 --- $146.01 004 1 0 0.00 $0.00 Y
O 36455 BL EXCHANGE/TRANSFUSE NON-NB 0.62 $23.08 --- $29.11 004 1 0 0.00 $0.00 Y
O 36456 PRTL EXCHANGE TRANSFUSE NB 0.49 $18.24 --- -- 004 0 0 0.00 $0.00 Y
K 36456 PRTL EXCHANGE TRANSFUSE NB 2.47 $91.96 --- -- 004 0 0 0.00 $0.00 Y
K 36460 TRANSFUSION SERVICE FETAL 8.32 $309.75 --- -- 004 0 0 0.00 $0.00 Y
K 36465 NJX NONCMPND SCLRSNT 1 VEIN 39.77 $1480.64 --- -- 004 0 0 0.00 $0.00 Y
K 36466 NJX NONCMPND SCLRSNT MLT VN 41.46 $1543.62 --- -- 004 0 0 0.00 $0.00 Y
K 36470 INJECTION THERAPY OF VEIN 1.81 $67.39 --- $84.98 004 1 1 0.00 $0.00 Y
K 36471 INJECTION THERAPY OF VEINS 2.24 $83.40 --- $105.17 004 1 1 0.00 $0.00 Y
K 36473 ENDOVENOUS MCHNCHEM 1ST VEIN 37.09 $1380.86 --- -- 004 0 0 0.00 $0.00 Y
K 36474 ENDOVENOUS MCHNCHEM ADD-ON 6.63 $246.83 --- -- 004 0 0 0.00 $0.00 Y
K 36475 ENDOVENOUS RF 1ST VEIN 53.43 $1989.03 --- $2508.54 004 1 0 0.00 $0.00 Y
O 36475 ENDOVENOUS RF 1ST VEIN 10.69 $397.81 --- $501.90 004 1 0 0.00 $0.00 Y
O 36476 ENDOVENOUS RF VEIN ADD-ON 2.05 $76.31 --- $96.25 004 1 0 0.00 $0.00 Y
K 36476 ENDOVENOUS RF VEIN ADD-ON 10.25 $381.54 --- $481.24 004 1 0 0.00 $0.00 Y
K 36478 ENDOVENOUS LASER 1ST VEIN 49.15 $1829.93 --- $2307.59 004 1 0 0.00 $0.00 Y
O 36478 ENDOVENOUS LASER 1ST VEIN 9.83 $365.99 --- $461.52 004 1 0 0.00 $0.00 Y
O 36479 ENDOVENOUS LASER VEIN ADDON 2.07 $77.07 --- $97.19 004 1 0 0.00 $0.00 Y
K 36479 ENDOVENOUS LASER VEIN ADDON 10.35 $385.33 --- $485.93 004 1 0 0.00 $0.00 Y
K 36481 INSERTION OF CATHETER VEIN 7.82 $291.14 --- $367.15 004 1 0 0.00 $0.00 Y
O 36481 INSERTION OF CATHETER VEIN 1.56 $58.08 --- $73.24 004 1 0 0.00 $0.00 Y
K 36482 ENDOVEN THER CHEM ADHES 1ST 52.88 $1968.74 --- -- 004 0 0 0.00 $0.00 Y
K 36483 ENDOVEN THER CHEM ADHES SBSQ 3.33 $124.26 --- -- 004 0 0 0.00 $0.00 Y
K 36500 INSERTION OF CATHETER VEIN 3.06 $113.92 --- $143.67 004 1 0 0.00 $0.00 Y
K 36510 INSERTION OF CATHETER VEIN 0.69 $25.69 --- $32.40 004 1 0 0.00 $0.00 Y
K 36511 APHERESIS WBC 26.25 $977.29 --- $1232.44 004 1 0 0.00 $0.00 Y
K 36512 APHERESIS RBC 26.25 $977.29 --- $1232.44 004 1 0 0.00 $0.00 Y
K 36513 APHERESIS PLATELETS 8.05 $299.70 --- $377.95 004 1 0 0.00 $0.00 Y
K 36514 APHERESIS PLASMA 26.25 $977.29 --- $1232.44 004 1 0 0.00 $0.00 Y
K 36516 APHERESIS IMMUNOADS SLCTV 79.50 $2959.79 --- $3732.53 004 1 0 0.00 $0.00 Y
K 36522 PHOTOPHERESIS 79.50 $2959.79 --- -- 004 0 0 0.00 $0.00 Y
K 36555 INSERT NONTUNNEL CV CATH 2.32 $86.50 --- $108.92 004 1 0 0.00 $0.00 Y
K 36556 INSERT NONTUNNEL CV CATH 1.99 $74.21 --- $93.43 004 1 0 0.00 $0.00 Y
K 36557 INSERT TUNNELED CV CATH 3.72 $138.41 --- $174.65 004 1 0 0.00 $0.00 Y
K 36558 INSERT TUNNELED CV CATH 3.64 $135.63 --- $170.90 004 1 0 0.00 $0.00 Y
K 36560 INSERT TUNNELED CV CATH 7.05 $262.29 --- $331.00 004 1 0 0.00 $0.00 Y
K 36561 INSERT TUNNELED CV CATH 6.98 $260.00 --- $327.71 004 1 0 0.00 $0.00 Y
K 36563 INSERT TUNNELED CV CATH 8.56 $318.69 --- $401.89 004 1 0 0.00 $0.00 Y
K 36565 INSERT TUNNELED CV CATH 5.60 $208.43 --- $262.92 004 1 0 0.00 $0.00 Y
K 36566 INSERT TUNNELED CV CATH 5.85 $217.74 --- $274.66 004 1 0 0.00 $0.00 Y
K 36568 INSERT PICC CATH 1.84 $68.56 --- $86.39 004 1 0 0.00 $0.00 Y
K 36569 INSERT PICC CATH 1.54 $57.52 --- $72.30 004 1 0 0.00 $0.00 Y
K 36570 INSERT PICVAD CATH 9.09 $338.42 --- $426.78 004 1 0 0.00 $0.00 Y
K 36571 INSERT PICVAD CATH 8.16 $303.70 --- $383.11 004 1 0 0.00 $0.00 Y
K 36572 INSJ PICC RS&I <5 YR 10.38 $386.45 --- -- 004 0 0 0.00 $0.00 Y
K 36573 INSJ PICC RS&I 5 YR+ 9.75 $362.99 --- -- 004 0 0 0.00 $0.00 Y
K 36575 REPAIR TUNNELED CV CATH 1.23 $45.64 --- $57.75 004 1 0 0.00 $0.00 Y
K 36576 REPAIR TUNNELED CV CATH 3.09 $114.88 --- $145.08 004 1 0 0.00 $0.00 Y
K 36578 REPLACE TUNNELED CV CATH 3.95 $147.24 --- $185.45 004 1 0 0.00 $0.00 Y
K 36580 REPLACE CVAD CATH 1.93 $71.87 --- $90.61 004 1 0 0.00 $0.00 Y
K 36581 REPLACE TUNNELED CV CATH 4.70 $174.93 --- $220.67 004 1 0 0.00 $0.00 Y
K 36582 REPLACE TUNNELED CV CATH 8.87 $330.28 --- $416.45 004 1 0 0.00 $0.00 Y
K 36583 REPLACE TUNNELED CV CATH 5.50 $204.77 --- $258.23 004 1 0 0.00 $0.00 Y
K 36584 REPLACE PICC CATH 1.70 $63.30 --- $79.82 004 1 0 0.00 $0.00 Y
K 36585 REPLACE PICVAD CATH 11.22 $417.87 --- $526.78 004 1 0 0.00 $0.00 Y
K 36589 REMOVAL TUNNELED CV CATH 3.65 $135.89 --- $171.37 004 1 0 0.00 $0.00 Y
K 36590 REMOVAL TUNNELED CV CATH 4.30 $160.09 --- $201.89 004 1 0 0.00 $0.00 Y
K 36593 DECLOT VASCULAR DEVICE 0.90 $33.51 --- -- 004 0 0 0.00 $0.00 Y
K 36595 MECH REMOV TUNNELED CV CATH 19.55 $728.03 --- $917.87 004 1 0 0.00 $0.00 Y
K 36596 MECH REMOV TUNNELED CV CATH 4.49 $167.29 --- $210.81 004 1 0 0.00 $0.00 Y
K 36597 REPOSITION VENOUS CATHETER 1.20 $44.68 --- $56.34 004 1 0 0.00 $0.00 Y
K 36598 INJ W/FLUOR EVAL CV DEVICE 2.97 $110.57 --- $139.44 004 1 0 0.00 $0.00 Y
K 36600 WITHDRAWAL OF ARTERIAL BLOOD 0.34 $12.66 --- $15.96 004 1 0 0.00 $0.00 Y
K 36620 INSERTION CATHETER ARTERY 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
K 36625 INSERTION CATHETER ARTERY 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 36640 INSERTION CATHETER ARTERY 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 36660 INSERTION CATHETER ARTERY 0.85 $31.65 --- $39.91 004 1 0 0.00 $0.00 Y
K 36680 INSERT NEEDLE BONE CAVITY 1.40 $52.12 --- $65.73 004 1 0 0.00 $0.00 Y
K 36800 INSERTION OF CANNULA FOR HEMODIALYSIS 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
K 36810 INSERTION OF CANNULA 9.00 $335.07 --- $422.55 004 1 1 0.00 $0.00 Y
O 36810 INSERTION OF CANNULA 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 36815 INSERTION OF CANNULA 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 36815 INSERTION OF CANNULA 6.00 $223.38 --- $281.70 004 1 1 0.00 $0.00 Y
K 36818 AV FUSE UPPR ARM CEPHALIC 10.94 $407.16 --- $513.63 004 1 0 0.00 $0.00 Y
O 36818 AV FUSE UPPR ARM CEPHALIC 2.19 $81.43 --- $102.82 004 1 0 0.00 $0.00 Y
O 36819 AV FUSE UPPR ARM BASILIC 2.92 $108.71 --- $137.09 004 1 0 0.00 $0.00 Y
K 36819 AV FUSE UPPR ARM BASILIC 14.61 $543.93 --- $685.94 004 1 0 0.00 $0.00 Y
K 36820 *02 AV FUSION/FOREARM VEIN 17.96 $668.65 --- $843.22 004 1 0 0.00 $0.00 Y
O 36820 *02 AV FUSION/FOREARM VEIN 3.59 $133.66 --- $168.55 004 1 0 0.00 $0.00 Y
O 36821 AV FUSION DIRECT ANY SITE 2.38 $88.61 --- $111.74 004 1 0 0.00 $0.00 Y
K 36821 AV FUSION DIRECT ANY SITE 11.67 $434.47 --- $547.91 004 1 0 0.00 $0.00 Y
K 36823 INSERTION OF CANNULA(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 36825 ARTERYVEIN AUTOGRAFT 16.60 $618.02 --- $779.37 004 1 0 0.00 $0.00 Y
O 36825 ARTERYVEIN AUTOGRAFT 3.30 $122.86 --- $154.94 004 1 0 0.00 $0.00 Y
O 36830 ARTERYVEIN NONAUTOGRAFT 3.17 $118.02 --- $148.83 004 1 0 0.00 $0.00 Y
K 36830 ARTERYVEIN NONAUTOGRAFT 15.63 $581.90 --- $733.83 004 1 0 0.00 $0.00 Y
K 36831 OPEN THROMBECT AV FISTULA 9.48 $352.94 --- $445.09 004 1 0 0.00 $0.00 Y
O 36831 OPEN THROMBECT AV FISTULA 1.90 $70.74 --- $89.21 004 1 0 0.00 $0.00 Y
O 36832 AV FISTULA REVISION OPEN 3.30 $122.86 --- $154.94 004 1 0 0.00 $0.00 Y
K 36832 AV FISTULA REVISION OPEN 16.60 $618.02 --- $779.37 004 1 0 0.00 $0.00 Y
K 36833 AV FISTULA REVISION 14.65 $545.42 --- $687.82 004 1 0 0.00 $0.00 Y
O 36833 AV FISTULA REVISION 2.93 $109.08 --- $137.56 004 1 0 0.00 $0.00 Y
O 36835 INSERTION OF THOMAS SHUNT 3.30 $122.86 --- $154.94 004 1 0 0.00 $0.00 Y
K 36835 INSERTION OF THOMAS SHUNT 16.60 $618.02 --- $779.37 004 1 0 0.00 $0.00 Y
K 36838 DIST REVAS LIGATION HEMO 18.42 $685.72 --- $864.82 004 1 0 0.00 $0.00 Y
O 36838 DIST REVAS LIGATION HEMO 3.68 $137.14 --- $172.78 004 1 0 0.00 $0.00 Y
O 36860 EXTERNAL CANNULA DECLOTTING 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 36860 EXTERNAL CANNULA DECLOTTING 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 36861 CANNULA DECLOTTING 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 36861 CANNULA DECLOTTING 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 36901 INTRO CATH DIALYSIS CIRCUIT 13.92 $518.24 --- -- 004 0 0 0.00 $0.00 Y
K 36902 INTRO CATH DIALYSIS CIRCUIT 29.87 $1112.06 --- -- 004 0 0 0.00 $0.00 Y
K 36903 INTRO CATH DIALYSIS CIRCUIT 139.00 $5174.97 --- -- 004 0 0 0.00 $0.00 Y
K 36904 THRMBC/NFS DIALYSIS CIRCUIT 43.48 $1618.76 --- -- 004 0 0 0.00 $0.00 Y
K 36905 THRMBC/NFS DIALYSIS CIRCUIT 55.66 $2072.22 --- -- 004 0 0 0.00 $0.00 Y
K 36906 THRMBC/NFS DIALYSIS CIRCUIT 168.14 $6259.85 --- -- 004 0 0 0.00 $0.00 Y
K 36907 BALO ANGIOP CTR DIALYSIS SEG 17.88 $665.67 --- -- 004 0 0 0.00 $0.00 Y
K 36908 STENT PLMT CTR DIALYSIS SEG 66.67 $2482.12 --- -- 004 0 0 0.00 $0.00 Y
K 36909 DIALYSIS CIRCUIT EMBOLJ 48.51 $1806.03 --- -- 004 0 0 0.00 $0.00 Y
K 37140 REVISION OF CIRCULATION 32.00 $1191.36 --- $1502.40 004 1 0 0.00 $0.00 Y
O 37140 REVISION OF CIRCULATION 6.40 $238.27 --- $300.48 004 1 0 0.00 $0.00 Y
O 37145 VENOUS ANASTOMOSIS 6.40 $238.27 --- $300.48 004 1 0 0.00 $0.00 Y
K 37145 VENOUS ANASTOMOSIS 32.00 $1191.36 --- $1502.40 004 1 0 0.00 $0.00 Y
K 37160 VENOUS ANASTOMISIS 32.00 $1191.36 --- $1502.40 004 1 0 0.00 $0.00 Y
O 37160 VANOUS ANASTOMOSIS 6.40 $238.27 --- $300.48 004 1 0 0.00 $0.00 Y
O 37180 VENOUS ANASTOMOSIS 6.40 $238.27 --- $300.48 004 1 0 0.00 $0.00 Y
K 37180 VENOUS ANASTOMOSIS 32.00 $1191.36 --- $1502.40 004 1 0 0.00 $0.00 Y
K 37181 SPLICE SPLEEN/KIDNEY VEINS 33.16 $1234.55 --- $1556.86 004 1 0 0.00 $0.00 Y
O 37181 SPLICE SPLEEN/KIDNEY VEINS 6.63 $246.83 --- $311.28 004 1 0 0.00 $0.00 Y
O 37182 INSERT HEPATIC SHUNT (TIPS) 2.93 $108.98 --- -- 004 0 0 0.00 $0.00 Y
K 37182 INSERT HEPATIC SHUNT (TIPS) 14.64 $544.88 --- -- 004 0 0 0.00 $0.00 Y
K 37183 REMOVE HEPATIC SHUNT (TIPS) 6.71 $249.86 --- -- 004 0 0 0.00 $0.00 Y
O 37183 REMOVE HEPATIC SHUNT (TIPS) 1.34 $49.97 --- -- 004 0 0 0.00 $0.00 Y
O 37184 PRIM ART M-THRMBC 1ST VSL 10.88 $405.06 --- $510.82 004 1 0 0.00 $0.00 Y
K 37184 PRIM ART M-THRMBC 1ST VSL 54.44 $2026.80 --- $2555.96 004 1 0 0.00 $0.00 Y
K 37185 PRIM ART M-THRMBC SBSQ VSL 23.03 $857.41 --- $1081.26 004 1 0 0.00 $0.00 Y
O 37185 PRIM ART M-THRMBC SBSQ VSL 4.61 $171.63 --- $216.44 004 1 0 0.00 $0.00 Y
O 37186 SEC ART THROMBECTOMY ADD-ON 9.58 $356.66 --- $449.78 004 1 0 0.00 $0.00 Y
K 37186 SEC ART THROMBECTOMY ADD-ON 47.88 $1782.57 --- $2247.97 004 1 0 0.00 $0.00 Y
K 37187 VENOUS MECH THROMBECTOMY 68.91 $2565.52 --- $3235.32 004 1 0 0.00 $0.00 Y
O 37187 VENOUS MECH THROMBECTOMY 13.78 $513.03 --- $646.97 004 1 0 0.00 $0.00 Y
O 37188 VEN MECHNL THRMBC REPEAT TX 11.94 $444.53 --- $560.58 004 1 0 0.00 $0.00 Y
K 37188 VEN MECHNL THRMBC REPEAT TX 59.69 $2222.26 --- $2802.45 004 1 0 0.00 $0.00 Y
K 37191 INS ENDOVAS VENA CAVA FILTR 5.27 $196.27 --- -- 004 0 0 0.00 $0.00 Y
K 37192 REDO ENDOVAS VENA CAVA FILTR 8.15 $303.47 --- -- 004 0 0 0.00 $0.00 Y
K 37193 REM ENDOVAS VENA CAVA FILTER 8.14 $303.15 --- -- 004 0 0 0.00 $0.00 Y
K 37195 THROMBOLYTIC THERAPY STROKE 6.67 $248.32 --- $313.16 004 1 0 0.00 $0.00 Y
K 37197 REMOVE INTRVAS FOREIGN BODY 6.81 $253.54 --- $319.73 004 1 0 0.00 $0.00 Y
K 37200 TRANSCATHETER BIOPSY 3.70 $137.75 --- $173.72 004 1 0 0.00 $0.00 Y
O 37200 TRANSCATHETER BIOPSY 0.74 $27.55 --- $34.74 004 1 0 0.00 $0.00 Y
K 37211 THROMBOLYTIC ART THERAPY 8.82 $328.37 --- -- 004 0 0 0.00 $0.00 Y
K 37212 THROMBOLYTIC VENOUS THERAPY 7.76 $288.90 --- -- 004 0 0 0.00 $0.00 Y
K 37213 THROMBLYTIC ART/VEN THERAPY 5.41 $201.41 --- -- 004 0 0 0.00 $0.00 Y
K 37214 CESSJ THERAPY CATH REMOVAL 3.21 $119.51 --- -- 004 0 0 0.00 $0.00 Y
K 37215 TRANSCATH STENT CCA W/EPS 16.45 $612.43 --- $772.33 004 1 0 0.00 $0.00 Y
O 37215 TRANSCATH STENT CCA W/EPS 3.29 $122.49 --- $154.47 004 1 0 0.00 $0.00 Y
O 37216 TRANSCATH STENT CCA W/O EPS 3.16 $117.65 --- -- 004 0 0 0.00 $0.00 Y
K 37216 TRANSCATH STENT CCA W/O EPS 15.80 $588.23 --- -- 004 0 0 0.00 $0.00 Y
K 37217 STENT PLACEMT RETRO CAROTID 25.48 $948.62 --- -- 004 0 0 0.00 $0.00 Y
O 37217 STENT PLACEMT RETRO CAROTID 5.10 $189.87 --- -- 004 0 0 0.00 $0.00 Y
O 37218 STENT PLACEMT ANTE CAROTID 3.80 $141.47 --- -- 004 0 0 0.00 $0.00 Y
K 37218 STENT PLACEMT ANTE CAROTID 19.04 $708.86 --- -- 004 0 0 0.00 $0.00 Y
K 37220 ILIAC REVASC 9.49 $353.38 --- -- 004 0 0 0.00 $0.00 Y
O 37220 ILIAC REVASC 1.90 $70.68 --- -- 004 0 0 0.00 $0.00 Y
O 37221 ILIAC REVASC W/STENT 2.32 $86.34 --- -- 004 0 0 0.00 $0.00 Y
K 37221 ILIAC REVASC W/STENT 11.60 $431.69 --- -- 004 0 0 0.00 $0.00 Y
K 37222 ILIAC REVASC ADD-ON 4.31 $160.31 --- -- 004 0 0 0.00 $0.00 Y
O 37222 ILIAC REVASC ADD-ON 0.86 $32.06 --- -- 004 0 0 0.00 $0.00 Y
O 37223 ILIAC REVASC W/STENT ADD-ON 0.98 $36.46 --- -- 004 0 0 0.00 $0.00 Y
K 37223 ILIAC REVASC W/STENT ADD-ON 4.90 $182.32 --- -- 004 0 0 0.00 $0.00 Y
K 37224 FEM/POPL REVAS W/TLA 10.46 $389.49 --- -- 004 0 0 0.00 $0.00 Y
O 37224 FEM/POPL REVAS W/TLA 2.09 $77.90 --- -- 004 0 0 0.00 $0.00 Y
O 37225 FEM/POPL REVAS W/ATHER 2.81 $104.80 --- -- 004 0 0 0.00 $0.00 Y
K 37225 FEM/POPL REVAS W/ATHER 14.07 $524.00 --- -- 004 0 0 0.00 $0.00 Y
K 37226 FEM/POPL REVASC W/STENT 11.85 $441.08 --- -- 004 0 0 0.00 $0.00 Y
O 37226 FEM/POPL REVASC W/STENT 2.37 $88.22 --- -- 004 0 0 0.00 $0.00 Y
O 37227 FEM/POPL REVASC STNT & ATHER 3.40 $126.56 --- -- 004 0 0 0.00 $0.00 Y
K 37227 FEM/POPL REVASC STNT & ATHER 17.00 $632.81 --- -- 004 0 0 0.00 $0.00 Y
K 37228 TIB/PER REVASC W/TLA 12.77 $475.25 --- -- 004 0 0 0.00 $0.00 Y
O 37228 TIB/PER REVASC W/TLA 2.55 $95.05 --- -- 004 0 0 0.00 $0.00 Y
O 37229 TIB/PER REVASC W/ATHER 3.29 $122.65 --- -- 004 0 0 0.00 $0.00 Y
K 37229 TIB/PER REVASC W/ATHER 16.47 $613.25 --- -- 004 0 0 0.00 $0.00 Y
K 37230 TIB/PER REVASC W/STENT 15.97 $594.57 --- -- 004 0 0 0.00 $0.00 Y
O 37230 TIB/PER REVASC W/STENT 3.19 $118.91 --- -- 004 0 0 0.00 $0.00 Y
O 37231 TIB/PER REVASC STENT & ATHER 3.47 $129.24 --- -- 004 0 0 0.00 $0.00 Y
K 37231 TIB/PER REVASC STENT & ATHER 17.36 $646.18 --- -- 004 0 0 0.00 $0.00 Y
K 37232 TIB/PER REVASC ADD-ON 4.61 $171.77 --- -- 004 0 0 0.00 $0.00 Y
O 37232 TIB/PER REVASC ADD-ON 0.92 $34.35 --- -- 004 0 0 0.00 $0.00 Y
O 37233 TIBPER REVASC W/ATHER ADD-ON 1.52 $56.62 --- -- 004 0 0 0.00 $0.00 Y
K 37233 TIBPER REVASC W/ATHER ADD-ON 7.60 $283.11 --- -- 004 0 0 0.00 $0.00 Y
K 37234 REVSC OPN/PRQ TIB/PERO STENT 6.33 $235.68 --- -- 004 0 0 0.00 $0.00 Y
O 37234 REVSC OPN/PRQ TIB/PERO STENT 1.27 $47.14 --- -- 004 0 0 0.00 $0.00 Y
O 37235 TIB/PER REVASC STNT & ATHER 1.80 $66.90 --- -- 004 0 0 0.00 $0.00 Y
K 37235 TIB/PER REVASC STNT & ATHER 8.98 $334.50 --- -- 004 0 0 0.00 $0.00 Y
K 37236 OPEN/PERQ PLACE STENT 1ST 10.54 $392.40 --- -- 004 0 0 0.00 $0.00 Y
O 37236 OPEN/PERQ PLACE STENT 1ST 2.11 $78.56 --- -- 004 0 0 0.00 $0.00 Y
O 37237 OPEN/PERQ PLACE STENT EA ADD 0.98 $36.49 --- -- 004 0 0 0.00 $0.00 Y
K 37237 OPEN/PERQ PLACE STENT EA ADD 4.91 $182.80 --- -- 004 0 0 0.00 $0.00 Y
K 37238 OPEN/PERQ PLACE STENT SAME 7.39 $275.13 --- -- 004 0 0 0.00 $0.00 Y
O 37238 OPEN/PERQ PLACE STENT SAME 1.48 $55.10 --- -- 004 0 0 0.00 $0.00 Y
O 37239 OPEN/PERQ PLACE STENT EA ADD 0.68 $25.32 --- -- 004 0 0 0.00 $0.00 Y
K 37239 OPEN/PERQ PLACE STENT EA ADD 3.42 $127.33 --- -- 004 0 0 0.00 $0.00 Y
K 37241 VASC EMBOLIZE/OCCLUDE VENOUS 117.69 $4381.60 --- -- 004 0 0 0.00 $0.00 Y
K 37242 VASC EMBOLIZE/OCCLUDE ARTERY 11.50 $428.15 --- -- 004 0 0 0.00 $0.00 Y
K 37243 VASC EMBOLIZE/OCCLUDE ORGAN 13.70 $510.05 --- -- 004 0 0 0.00 $0.00 Y
K 37244 VASC EMBOLIZE/OCCLUDE BLEED 15.99 $595.31 --- -- 004 0 0 0.00 $0.00 Y
K 37246 TRLUML BALO ANGIOP 1ST ART 52.66 $1960.53 --- -- 004 0 0 0.00 $0.00 Y
K 37247 TRLUML BALO ANGIOP ADDL ART 21.21 $789.65 --- -- 004 0 0 0.00 $0.00 Y
K 37248 TRLUML BALO ANGIOP 1ST VEIN 36.31 $1351.82 --- -- 004 0 0 0.00 $0.00 Y
K 37249 TRLUML BALO ANGIOP ADDL VEIN 15.50 $577.07 --- -- 004 0 0 0.00 $0.00 Y
K 37252 INTRVASC US NONCORONARY 1ST 34.95 $1301.19 --- -- 004 0 0 0.00 $0.00 Y
K 37253 INTRVASC US NONCORONARY ADDL 5.25 $195.46 --- -- 004 0 0 0.00 $0.00 Y
K 37500 ENDOSCOPY LIGATE PERF VEINS 9.10 $338.93 --- $427.25 004 1 0 0.00 $0.00 Y
K 37501 VASCULAR ENDOSCOPY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 37565 LIGATION INTERNAL JUGULAR VEIN 7.10 $264.33 --- $333.35 004 1 0 0.00 $0.00 Y
O 37565 LIGATION INTERNAL JUGLAR VEIN 1.42 $52.87 --- $66.67 004 1 0 0.00 $0.00 Y
O 37600 LIGATION OF NECK ARTERY 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
K 37600 LIGATION OF NECK ARTERY 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
K 37605 LIGATION OF NECK ARTERY 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
O 37605 LIGATION OF NECK ARTERY 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
O 37606 LIGATION OF NECK ARTERY 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
K 37606 LIGATION OF NECK ARTERY 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
K 37607 LIGATION OF A-V FISTULA 7.32 $272.52 --- $343.67 004 1 0 0.00 $0.00 Y
O 37607 LIGATION OF A-V FISTULA 1.46 $54.36 --- $68.55 004 1 0 0.00 $0.00 Y
O 37609 TEMPORAL ARTERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 37609 TEMPORAL ARTERY PROCEDURE 4.06 $151.15 --- $190.62 004 1 0 0.00 $0.00 Y
K 37615 LIGATION OF NECK ARTERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 37615 LIGATION OF NECK ARTERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 37616 LIGATION OF CHEST ARTERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 37616 LIGATION OF CHEST ARTERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 37617 LIGATION OF ABDOMEN ARTERY 20.76 $772.89 --- $974.68 004 1 0 0.00 $0.00 Y
O 37617 LIGATION OF ABDOMEN ARTERY 4.15 $154.50 --- $194.84 004 1 0 0.00 $0.00 Y
O 37618 LIGATION OF EXTREMITY ARTERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 37618 LIGATION OF EXTREMITY ARTERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 37619 LIGATION OF INF VENA CAVA 35.66 $1327.61 --- -- 004 0 0 0.00 $0.00 Y
O 37619 LIGATION OF INF VENA CAVA 7.13 $265.52 --- -- 004 0 0 0.00 $0.00 Y
O 37650 LIGATION OF FEMORAL VEIN 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
K 37650 LIGATION OF FEMORAL VEIN 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
K 37660 LIGATION OF COMMON ILIAC VEIN 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
O 37660 LIGATION OF COMMON ILIAC VEIN 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
O 37700 REVISE LEG VEIN 1.09 $40.58 --- $51.18 004 1 0 0.00 $0.00 Y
K 37700 REVISE LEG VEIN 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
K 37718 LIGATE/STRIP SHORT LEG VEIN 9.10 $338.79 --- $427.25 004 1 0 0.00 $0.00 Y
O 37718 LIGATE/STRIP SHORT LEG VEIN 1.82 $67.76 --- $85.45 004 1 0 0.00 $0.00 Y
O 37722 LIGATE/STRIP LONG LEG VEIN 2.14 $79.67 --- $100.47 004 1 0 0.00 $0.00 Y
K 37722 LIGATE/STRIP LONG LEG VEIN 10.70 $398.36 --- $502.37 004 1 0 0.00 $0.00 Y
K 37735 REMOVAL OF LEG VEINS/LESION 12.01 $447.13 --- $563.87 004 1 0 0.00 $0.00 Y
O 37735 REMOVAL OF LEG VEINS/LESION 2.38 $88.61 --- $111.74 004 1 0 0.00 $0.00 Y
O 37760 LIGATE LEG VEINS RADICAL 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 37760 LIGATE LEG VEINS RADICAL 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 37761 LIGATE LEG VEINS OPEN 12.86 $478.78 --- -- 004 0 0 0.00 $0.00 Y
O 37761 LIGATE LEG VEINS OPEN 2.57 $95.68 --- -- 004 0 0 0.00 $0.00 Y
K 37765 STAB PHLEB VEINS XTR 10-20 6.19 $230.41 --- -- 004 0 0 0.00 $0.00 Y
K 37766 PHLEB VEINS - EXTREM 20+ 7.75 $288.49 --- -- 004 0 0 0.00 $0.00 Y
O 37766 PHLEB VEINS - EXTREM 20+ 1.55 $57.70 --- -- 004 0 0 0.00 $0.00 Y
K 37780 REVISION OF LEG VEIN 3.29 $122.49 --- $154.47 004 1 0 0.00 $0.00 Y
K 37785 LIGATE/DIVIDE/EXCISE VEIN 5.06 $188.38 --- $237.57 004 1 0 0.00 $0.00 Y
K 37799 VASCULAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 37799 VASCULAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
P 37799 VASCULAR SURGERY PROCEDURE 0.00 $0.00 --- -- 015 0 0 0.00 $0.00 Y
O 38100 REMOVAL OF SPLEEN TOTAL 3.28 $122.11 --- $154.00 004 1 0 0.00 $0.00 Y
K 38100 REMOVAL OF SPLEEN TOTAL 16.42 $611.32 --- $770.92 004 1 0 0.00 $0.00 Y
K 38101 REMOVAL OF SPLEEN PARTIAL 18.06 $672.37 --- $847.92 004 1 0 0.00 $0.00 Y
O 38101 REMOVAL OF SPLEEN PARTIAL 3.61 $134.40 --- $169.49 004 1 0 0.00 $0.00 Y
O 38102 REMOVAL OF SPLEEN TOTAL 1.11 $41.33 --- $52.11 004 1 0 0.00 $0.00 Y
K 38102 REMOVAL OF SPLEEN TOTAL 5.55 $206.63 --- $260.57 004 1 0 0.00 $0.00 Y
K 38115 REPAIR OF RUPTURED SPLEEN 18.12 $674.61 --- $850.73 004 1 0 0.00 $0.00 Y
O 38115 REPAIR OF RUPTURED SPLEEN 3.62 $134.77 --- $169.96 004 1 0 0.00 $0.00 Y
O 38120 LAPAROSCOPY SPLENECTOMY 2.90 $107.97 --- $136.16 004 1 0 0.00 $0.00 Y
K 38120 LAPAROSCOPY SPLENECTOMY 14.50 $539.84 --- $680.78 004 1 0 0.00 $0.00 Y
K 38129 LAPAROSCOPE PROC SPLEEN 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38129 LAPAROSCOPE PROC SPLEEN 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 38200 INJECTION FOR SPLEEN XRAY 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 38204 BL DONOR SEARCH MANAGEMENT 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38205 HARVEST ALLOGENEIC STEM CELL 1.82 $67.76 --- $85.45 004 1 0 0.00 $0.00 Y
K 38206 HARVEST AUTO STEM CELLS 1.85 $68.88 --- $86.86 004 1 0 0.00 $0.00 Y
K 38207 CRYOPRESERVE STEM CELLS 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38208 THAW PRESERVED STEM CELLS 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38209 WASH HARVEST STEM CELLS 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38210 TCELL DEPLETION OF HARVEST 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38211 TUMOR CELL DEPLETE OF HARVST 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38212 RBC DEPLETION OF HARVEST 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38213 PLATELET DEPLETE OF HARVEST 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38214 VOLUME DEPLETE OF HARVEST 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38215 HARVEST STEM CELL CONCENTRTE 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 38220 BONE MARROW ASPIRATION 4.93 $183.54 --- $231.46 004 1 0 0.00 $0.00 Y
K 38221 BONE MARROW BIOPSY 5.26 $195.83 --- $246.96 004 1 0 0.00 $0.00 Y
K 38222 DX BONE MARROW BX & ASPIR 4.14 $154.20 --- -- 004 0 0 0.00 $0.00 Y
O 38222 DX BONE MARROW BX & ASPIR 0.82 $30.84 --- -- 004 0 0 0.00 $0.00 Y
O 38230 BONE MARROW HARVESTING FOR TRANSPLANT 1.18 $43.93 --- $55.40 004 1 0 0.00 $0.00 Y
K 38230 BONE MARROW HARVESTING FOR TRANSPLANT 5.94 $221.15 --- $278.88 004 1 0 0.00 $0.00 Y
K 38232 BONE MARROW HARVEST AUTOLOG 4.03 $150.15 --- -- 004 0 0 0.00 $0.00 Y
O 38232 BONE MARROW HARVEST AUTOLOG 0.81 $30.03 --- -- 004 0 0 0.00 $0.00 Y
K 38240 TRANSPLT ALLO HCT/DONOR 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 N
K 38241 TRANSPLT AUTOL HCT/DONOR 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 N
K 38242 TRANSPLT ALLO LYMPHOCYTES 2.14 $79.67 --- -- 004 0 0 0.00 $0.00 Y
K 38243 TRANSPLJ HEMATOPOIETIC BOOST 2.64 $98.29 --- -- 004 0 0 0.00 $0.00 Y
K 38300 DRAINAGE LYMPH NODE LESION 2.52 $93.82 --- $118.31 004 1 1 0.00 $0.00 Y
K 38305 DRAINAGE LYMPH NODE LESION 213.95 $213.95 --- -- 042 0 0 0.00 $0.00 Y
O 38305 DRAINAGE LYMPH NODE LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38308 INCISION OF LYMPH CHANNELS 1.74 $64.78 --- $81.69 004 1 0 0.00 $0.00 Y
K 38308 INCISION OF LYMPH CHANNELS 8.68 $323.16 --- $407.53 004 1 0 0.00 $0.00 Y
K 38380 THORACIC DUCT PROCEDURE 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 38380 THORACIC DUCT PROCEDURE 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 38381 THORACIC DUCT PROCEDURE 4.46 $166.05 --- $209.40 004 1 0 0.00 $0.00 Y
K 38381 THORACIC DUCT PROCEDURE 22.30 $830.23 --- $1046.99 004 1 0 0.00 $0.00 Y
K 38382 THORACIC DUCT PROCEDURE 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 38382 THORACIC DUCT PROCEDURE 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 38500 BIOPSY/REMOVAL LYMPH NODES 2.58 $96.05 --- $121.13 004 1 1 0.00 $0.00 Y
K 38505 NEEDLE BIOPSY LYMPH NODES 1.90 $70.74 --- $89.21 004 1 0 0.00 $0.00 Y
K 38510 BIOPSY/REMOVAL LYMPH NODES 3.88 $144.45 --- $182.17 004 1 0 0.00 $0.00 Y
O 38510 BIOPSY/REMOVAL LYMPH NODES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38520 BIOPSY/REMOVAL LYMPH NODES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 38520 BIOPSY/REMOVAL LYMPH NODES 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
K 38525 BIOPSY/REMOVAL LYMPH NODES 3.97 $147.80 --- $186.39 004 1 0 0.00 $0.00 Y
O 38525 BIOPSY/REMOVAL LYMPH NODES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38530 BIOPSY/REMOVAL LYMPH NODES 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 38530 BIOPSY/REMOVAL LYMPH NODES 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 38531 OPEN BX/EXC INGUINOFEM NODES 10.11 $376.40 --- -- 004 0 0 0.00 $0.00 Y
O 38531 OPEN BX/EXC INGUINOFEM NODES 2.02 $75.20 --- -- 004 0 0 0.00 $0.00 Y
O 38542 EXPLORE DEEP NODE(S) NECK 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 38542 EXPLORE DEEP NODE(S) NECK 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 38550 REMOVAL NECK/ARMPIT LESION 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 38550 REMOVAL NECK/ARMPIT LESION 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
O 38555 REMOVAL NECK/ARMPIT LESION 3.38 $125.84 --- $158.69 004 1 0 0.00 $0.00 Y
K 38555 REMOVAL NECK/ARMPIT LESION 16.88 $628.44 --- $792.52 004 1 0 0.00 $0.00 Y
K 38562 REMOVAL PELVIC LYMPH NODES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38562 REMOVAL PELVIC LYMPH NODES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38564 REMOVAL ABDOMEN LYMPH NODES 3.26 $121.37 --- $153.06 004 1 0 0.00 $0.00 Y
K 38564 REMOVAL ABDOMEN LYMPH NODES 16.29 $606.48 --- $764.82 004 1 0 0.00 $0.00 Y
K 38570 LAPAROSCOPY LYMPH NODE BIOP 10.29 $383.10 --- $483.12 004 1 0 0.00 $0.00 Y
O 38570 LAPAROSCOPY LYMPH NODE BIOP 2.06 $76.69 --- $96.72 004 1 0 0.00 $0.00 Y
O 38571 LAPAROSCOPY LYMPHADENECTOMY 2.59 $96.43 --- $121.60 004 1 0 0.00 $0.00 Y
K 38571 LAPAROSCOPY LYMPHADENECTOMY 12.94 $481.76 --- $607.53 004 1 0 0.00 $0.00 Y
K 38572 LAPAROSCOPY LYMPHADENECTOMY 16.14 $600.89 --- $757.77 004 1 0 0.00 $0.00 Y
O 38572 LAPAROSCOPY LYMPHADENECTOMY 3.23 $120.25 --- $151.65 004 1 0 0.00 $0.00 Y
O 38573 LAPS PELVIC LYMPHADEC 5.34 $198.86 --- -- 004 0 0 0.00 $0.00 Y
K 38573 LAPS PELVIC LYMPHADEC 26.70 $994.31 --- -- 004 0 0 0.00 $0.00 Y
K 38589 LAPAROSCOPE PROC LYMPHATIC 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38589 LAPAROSCOPE PROC LYMPHATIC 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38700 REMOVAL OF LYMPH NODES NECK 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 38700 REMOVAL OF LYMPH NODES NECK 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 38720 REMOVAL OF LYMPH NODES NECK 21.52 $801.19 --- $1010.36 004 1 0 0.00 $0.00 Y
O 38720 REMOVAL OF LYMPH NODES NECK 4.30 $160.09 --- $201.89 004 1 0 0.00 $0.00 Y
O 38724 REMOVAL OF LYMPH NODES NECK 4.30 $160.09 --- $201.89 004 1 0 0.00 $0.00 Y
K 38724 REMOVAL OF LYMPH NODES NECK 21.52 $801.19 --- $1010.36 004 1 0 0.00 $0.00 Y
K 38740 REMOVE ARMPIT LYMPH NODES 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 38740 REMOVE ARMPIT LYMPH NODES 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 38745 REMOVE ARMPIT LYMPH NODES 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
K 38745 REMOVE ARMPIT LYMPH NODES 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
K 38746 REMOVE THORACIC LYMPH NODES 5.07 $188.76 --- $238.04 004 1 0 0.00 $0.00 Y
O 38746 REMOVE THORACIC LYMPH NODES 1.02 $37.97 --- $47.89 004 1 0 0.00 $0.00 Y
O 38747 REMOVE ABDOMINAL LYMPH NODES 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
K 38747 REMOVE ABDOMINAL LYMPH NODES 5.65 $210.35 --- $265.27 004 1 0 0.00 $0.00 Y
K 38760 REMOVE GROIN LYMPH NODES 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 38760 REMOVE GROIN LYMPH NODES 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 38765 REMOVE GROIN LYMPH NODES 4.52 $168.28 --- $212.21 004 1 0 0.00 $0.00 Y
K 38765 REMOVE GROIN LYMPH NODES 22.58 $840.65 --- $1060.13 004 1 0 0.00 $0.00 Y
K 38770 REMOVE PELVIS LYMPH NODES 17.14 $638.12 --- $804.72 004 1 0 0.00 $0.00 Y
O 38770 REMOVE PELVIS LYMPH NODES 3.41 $126.95 --- $160.10 004 1 0 0.00 $0.00 Y
O 38780 REMOVE ABDOMEN LYMPH NODES 5.60 $208.49 --- $262.92 004 1 0 0.00 $0.00 Y
K 38780 REMOVE ABDOMEN LYMPH NODES 28.00 $1042.44 --- $1314.60 004 1 0 0.00 $0.00 Y
K 38790 INJECT FOR LYMPHATIC X-RAY 12.15 $452.34 --- $570.44 004 1 0 0.00 $0.00 Y
K 38792 IDENTIFY SENTINEL NODE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 38794 ACCESS THORACIC LYMPH DUCT 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 38794 ACCESS THORACIC LYMPH DUCT 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
O 38900 IO MAP OF SENT LYMPH NODE 0.60 $22.27 --- -- 004 0 0 0.00 $0.00 Y
K 38900 IO MAP OF SENT LYMPH NODE 2.99 $111.37 --- -- 004 0 0 0.00 $0.00 Y
K 38999 BLOOD/LYMPH SYSTEM PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 38999 BLOOD/LYMPH SYSTEM PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 39000 MEDIASTINOTOMY W/EXPLOR DRAIN REMOVAL 1.54 $57.33 --- $72.30 004 1 0 0.00 $0.00 Y
K 39000 MEDIASTINOTOMY W/EXPLOR DRAIN REMOVAL 7.68 $285.93 --- $360.58 004 1 0 0.00 $0.00 Y
K 39010 MEDIASTINOTOMY W/EXPLOR DRAIN REMOVAL 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 39010 MEDIASTINOTOMY W/EXPLOR DRAIN REMOVAL 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 39200 REMOVAL MEDIASTINAL LESION 4.08 $151.90 --- $191.56 004 1 0 0.00 $0.00 Y
K 39200 REMOVAL MEDIASTINAL LESION 20.39 $759.12 --- $957.31 004 1 0 0.00 $0.00 Y
K 39220 REMOVAL MEDIASTINAL LESION 20.39 $759.12 --- $957.31 004 1 0 0.00 $0.00 Y
O 39220 REMOVAL MEDIASTINAL LESION 4.08 $151.90 --- $191.56 004 1 0 0.00 $0.00 Y
K 39401 MEDIASTINOSCPY W/MEDSTNL BX 7.15 $266.19 --- -- 004 0 0 0.00 $0.00 Y
K 39402 MEDIASTINOSCPY W/LMPH NOD BX 9.31 $346.61 --- -- 004 0 0 0.00 $0.00 Y
K 39499 MEDIASTINAL PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 39499 MEDIASTINAL PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 39501 REPAIR LACERATION OF DIAPHRAGM ANY APPRO 3.84 $142.96 --- $180.29 004 1 0 0.00 $0.00 Y
K 39501 REPAIR LACERATION OF DIAPHRAGM ANY APPRO 19.20 $714.82 --- $901.44 004 1 0 0.00 $0.00 Y
K 39503 REPAIR OF DIAGHRAGM HERNIA 24.92 $927.77 --- $1169.99 004 1 0 0.00 $0.00 Y
O 39503 REPAIR OF DIAGHRAGM HERNIA 4.98 $185.41 --- $233.81 004 1 0 0.00 $0.00 Y
O 39540 REPAIR OF DIAPHRAGM HERNIA 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 39540 REPAIR OF DIAPHRAGM HERNIA 736.98 $736.98 --- -- 042 0 0 0.00 $0.00 Y
K 39541 REPAIR OF DIAPHRAGM HERNIA 19.25 $716.68 --- $903.79 004 1 0 0.00 $0.00 Y
O 39541 REPAIR OF DIAPHRAGM HERNIA 3.85 $143.34 --- $180.76 004 1 0 0.00 $0.00 Y
O 39545 IMBRICATION OF DIAPHRAGM FOR EVENTRATION 4.60 $171.26 --- $215.97 004 1 0 0.00 $0.00 Y
K 39545 IMBRICATION OF DIAPHRAGM FOR EVENTRATION 23.20 $863.74 --- $1089.24 004 1 0 0.00 $0.00 Y
K 39560 RESECT DIAPHRAGM SIMPLE 14.68 $546.54 --- $689.23 004 1 0 0.00 $0.00 Y
O 39560 RESECT DIAPHRAGM SIMPLE 2.94 $109.46 --- $138.03 004 1 0 0.00 $0.00 Y
O 39561 RESECT DIAPHRAGM COMPLEX 4.01 $149.29 --- $188.27 004 1 0 0.00 $0.00 Y
K 39561 RESECT DIAPHRAGM COMPLEX 20.04 $746.09 --- $940.88 004 1 0 0.00 $0.00 Y
K 39599 DIAPHRAGM SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 39599 DIAPHRAGM SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 40490 BIOPSY OF LIP 1.30 $48.40 --- $61.04 004 1 1 0.00 $0.00 Y
K 40500 PARTIAL EXCISION OF LIP 10.50 $390.92 --- $492.98 004 1 0 0.00 $0.00 Y
O 40500 PARTIAL EXCISION OF LIP 2.10 $78.18 --- $98.60 004 1 0 0.00 $0.00 Y
O 40510 PARTIAL EXCISION OF LIP 2.10 $78.18 --- $98.60 004 1 0 0.00 $0.00 Y
K 40510 PARTIAL EXCISION OF LIP 10.50 $390.92 --- $492.98 004 1 0 0.00 $0.00 Y
K 40520 PARTIAL EXCISION OF LIP 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 40520 PARTIAL EXCISION OF LIP 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
O 40525 RECONSTRUCT LIP WITH FLAP 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 40525 RECONSTRUCT LIP WITH FLAP 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 40527 RECONSTRUCT LIP WITH FLAP 15.02 $559.19 --- $705.19 004 1 0 0.00 $0.00 Y
O 40527 RECONSTRUCT LIP WITH FLAP 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
O 40530 PARTIAL REMOVAL OF LIP 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 40530 PARTIAL REMOVAL OF LIP 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 40650 REPAIR LIP 7.15 $266.19 --- $335.69 004 1 1 0.00 $0.00 Y
O 40650 REPAIR LIP 1.43 $53.24 --- $67.14 004 1 0 0.00 $0.00 Y
O 40652 REPAIR LIP 1.73 $64.41 --- $81.22 004 1 0 0.00 $0.00 Y
K 40652 REPAIR LIP 8.67 $322.78 --- $407.06 004 1 1 0.00 $0.00 Y
K 40654 REPAIR LIP 10.08 $375.28 --- $473.26 004 1 1 0.00 $0.00 Y
O 40654 REPAIR LIP 2.02 $75.20 --- $94.84 004 1 0 0.00 $0.00 Y
O 40700 PLASTIC REPAIR CLEFT LIP/NASAL DEFORMITY 3.62 $134.77 --- $169.96 004 1 0 0.00 $0.00 Y
K 40700 PLASTIC REPAIR CLEFT LIP/NASAL DEFORMITY 18.12 $674.61 --- $850.73 004 1 0 0.00 $0.00 Y
K 40701 REPAIR CLEFT LIP 22.65 $843.26 --- $1063.42 004 1 0 0.00 $0.00 Y
O 40701 REPAIR CLEFT LIP 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 40702 REPAIR CLEFT LIP 3.17 $118.02 --- $148.83 004 1 0 0.00 $0.00 Y
K 40702 REPAIR CLEFT LIP 15.86 $590.47 --- $744.63 004 1 0 0.00 $0.00 Y
K 40720 REPAIR CLEFT LIP 18.12 $674.61 --- $850.73 004 1 0 0.00 $0.00 Y
O 40720 REPAIR CLEFT LIP 3.62 $134.77 --- $169.96 004 1 0 0.00 $0.00 Y
O 40761 REPAIR CLEFT LIP 5.11 $190.25 --- $239.91 004 1 0 0.00 $0.00 Y
K 40761 REPAIR CLEFT LIP 25.56 $951.60 --- $1200.04 004 1 0 0.00 $0.00 Y
K 40799 LIP SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 40799 LIP SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 40800 DRAINAGE OF MOUTH LESION 1.33 $49.52 --- $62.44 004 1 1 0.00 $0.00 Y
K 40801 DRAINAGE OF MOUTH LESION 4.12 $153.39 --- $193.43 004 1 0 0.00 $0.00 Y
K 40804 REMOVAL FOREIGN BODY MOUTH 1.64 $61.06 --- $77.00 004 1 1 0.00 $0.00 Y
K 40805 REMOVAL FOREIGN BODY MOUTH 2.51 $93.45 --- $117.84 004 1 0 0.00 $0.00 Y
K 40808 BIOPSY OF MOUTH LESION 1.27 $47.28 --- $59.63 004 1 1 0.00 $0.00 Y
K 40812 EXCISE/REPAIR MOUTH LESION 2.31 $86.00 --- $108.45 004 1 1 0.00 $0.00 Y
K 40814 EXCISE/REPAIR MOUTH LESION 6.37 $237.16 --- $299.07 004 1 0 0.00 $0.00 Y
O 40814 EXCISE/REPAIR MOUTH LESION 1.27 $47.28 --- $59.63 004 1 0 0.00 $0.00 Y
K 40816 EXCISION OF MOUTH LESION 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 40818 EXCISE ORAL MUCOSA FOR GRAFT 5.42 $201.79 --- $254.47 004 1 0 0.00 $0.00 Y
O 40818 EXCISE ORAL MUCOSA FOR GRAFT 1.09 $40.58 --- $51.18 004 1 0 0.00 $0.00 Y
K 40819 EXCISE LIP OR CHEEK FOLD 4.90 $182.43 --- $230.06 004 1 0 0.00 $0.00 Y
K 40820 TREATMENT OF MOUTH LESION 1.56 $58.08 --- $73.24 004 1 1 0.00 $0.00 Y
K 40830 REPAIR MOUTH LACERATION 1.84 $68.50 --- $86.39 004 1 1 0.00 $0.00 Y
K 40831 REPAIR MOUTH LACERATION 4.11 $153.02 --- $192.96 004 1 0 0.00 $0.00 Y
O 40831 REPAIR MOUTH LACERATION 0.82 $30.53 --- $38.50 004 1 0 0.00 $0.00 Y
O 40840 RECONSTRUCTION OF MOUTH 2.65 $98.66 --- $124.42 004 1 0 0.00 $0.00 Y
K 40840 RECONSTRUCTION OF MOUTH 13.24 $492.93 --- $621.62 004 1 0 0.00 $0.00 Y
K 40842 RECONSTRUCTION OF MOUTH 13.23 $492.55 --- $621.15 004 1 0 0.00 $0.00 Y
O 40842 RECONSTRUCTION OF MOUTH 2.65 $98.66 --- $124.42 004 1 0 0.00 $0.00 Y
O 40843 RECONSTRUCTION OF MOUTH 3.48 $129.56 --- $163.39 004 1 0 0.00 $0.00 Y
K 40843 RECONSTRUCTION OF MOUTH 17.41 $648.17 --- $817.40 004 1 0 0.00 $0.00 Y
K 40844 RECONSTRUCTION OF MOUTH 22.37 $832.84 --- $1050.27 004 1 0 0.00 $0.00 Y
O 40844 RECONSTRUCTION OF MOUTH 4.47 $166.42 --- $209.87 004 1 0 0.00 $0.00 Y
O 40845 RECONSTRUCTION OF MOUTH 5.31 $197.69 --- $249.30 004 1 0 0.00 $0.00 Y
K 40845 RECONSTRUCTION OF MOUTH 26.56 $988.83 --- $1246.99 004 1 0 0.00 $0.00 Y
K 40899 MOUTH SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 40899 MOUTH SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 41000 DRAINAGE OF MOUTH LESION 1.54 $57.33 --- $72.30 004 1 1 0.00 $0.00 Y
K 41005 DRAINAGE OF MOUTH LESION 1.45 $53.98 --- $68.08 004 1 1 0.00 $0.00 Y
K 41006 DRAINAGE OF MOUTH LESION 5.95 $221.52 --- $279.35 004 1 0 0.00 $0.00 Y
O 41006 DRAINAGE OF MOUTH LESION 1.19 $44.30 --- $55.87 004 1 0 0.00 $0.00 Y
K 41007 DRAINAGE OF MOUTH LESION 5.64 $209.98 --- $264.80 004 1 0 0.00 $0.00 Y
K 41008 DRAINAGE OF MOUTH LESION 5.88 $218.91 --- $276.07 004 1 0 0.00 $0.00 Y
K 41009 DRAINAGE OF MOUTH LESION 6.16 $229.34 --- $289.21 004 1 0 0.00 $0.00 Y
K 41010 INCISION OF TONGUE FOLD 4.11 $153.02 --- $192.96 004 1 0 0.00 $0.00 Y
K 41015 DRAINAGE OF MOUTH LESION 3.60 $134.03 --- $169.02 004 1 0 0.00 $0.00 Y
O 41015 DRAINAGE OF MOUTH LESION 0.72 $26.81 --- $33.80 004 1 0 0.00 $0.00 Y
K 41016 DRAINAGE OF MOUTH LESION 6.60 $245.72 --- $309.87 004 1 0 0.00 $0.00 Y
K 41017 DRAINAGE OF MOUTH LESION 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 41018 DRAINAGE OF MOUTH LESION 8.24 $306.78 --- $386.87 004 1 0 0.00 $0.00 Y
K 41019 PLACE NEEDLES H&N FOR RT 9.77 $363.74 --- -- 004 0 0 0.00 $0.00 Y
O 41019 PLACE NEEDLES H&N FOR RT 1.95 $72.60 --- -- 004 0 0 0.00 $0.00 Y
K 41100 BIOPSY OF TONGUE 1.82 $67.76 --- $85.45 004 1 1 0.00 $0.00 Y
K 41105 BIOPSY OF TONGUE 1.62 $60.31 --- $76.06 004 1 1 0.00 $0.00 Y
K 41108 BIOPSY OF FLOOR OF MOUTH 2.61 $97.17 --- $122.54 004 1 0 0.00 $0.00 Y
K 41110 EXCISION OF TONGUE LESION 3.59 $133.66 --- $168.55 004 1 0 0.00 $0.00 Y
O 41110 EXCISION OF TONGUE LESION 0.72 $26.81 --- $33.80 004 1 0 0.00 $0.00 Y
O 41112 EXCISION OF TONGUE LESION 1.03 $38.35 --- $48.36 004 1 0 0.00 $0.00 Y
K 41112 EXCISION OF TONGUE LESION 5.14 $191.36 --- $241.32 004 1 0 0.00 $0.00 Y
K 41113 EXCISION OF TONGUE LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 41113 EXCISION OF TONGUE LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 41114 EXCISION OF TONGUE LESION 2.50 $93.08 --- $117.38 004 1 0 0.00 $0.00 Y
K 41114 EXCISION OF TONGUE LESION 12.51 $465.75 --- $587.34 004 1 0 0.00 $0.00 Y
K 41116 EXCISION OF MOUTH LESION 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 41120 PARTIAL REMOVAL OF TONGUE 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 41120 PARTIAL REMOVAL OF TONGUE 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 41130 PARTIAL REMOVAL OF TONGUE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 41130 PARTIAL REMOVAL OF TONGUE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 41135 TONGUE AND NECK SURGERY 29.45 $1096.42 --- $1382.68 004 1 0 0.00 $0.00 Y
O 41135 TONGUE AND NECK SURGERY 5.89 $219.28 --- $276.54 004 1 0 0.00 $0.00 Y
O 41140 REMOVAL OF TONGUE 4.08 $151.90 --- $191.56 004 1 0 0.00 $0.00 Y
K 41140 REMOVAL OF TONGUE 20.39 $759.12 --- $957.31 004 1 0 0.00 $0.00 Y
K 41145 TONGUE REMOVAL NECK SURGERY 29.45 $1096.42 --- $1382.68 004 1 0 0.00 $0.00 Y
O 41145 TONGUE REMOVAL NECK SURGERY 5.89 $219.28 --- $276.54 004 1 0 0.00 $0.00 Y
O 41150 TONGUE MOUTH JAW SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 41150 TONGUE MOUTH JAW SURGERY 29.61 $1102.38 --- $1390.19 004 1 0 0.00 $0.00 Y
K 41153 TONGUE MOUTH NECK SURGERY 39.41 $1467.23 --- $1850.30 004 1 0 0.00 $0.00 Y
O 41153 TONGUE MOUTH NECK SURGERY 7.88 $293.37 --- $369.97 004 1 0 0.00 $0.00 Y
O 41155 TONGUE JAW & NECK SURGERY 8.20 $305.29 --- $384.99 004 1 0 0.00 $0.00 Y
K 41155 TONGUE JAW & NECK SURGERY 40.99 $1526.06 --- $1924.48 004 1 0 0.00 $0.00 Y
K 41250 REPAIR TONGUE LACERATION 2.01 $74.83 --- $94.37 004 1 1 0.00 $0.00 Y
K 41251 REPAIR TONGUE LACERATION 2.06 $76.69 --- $96.72 004 1 0 0.00 $0.00 Y
K 41252 REPAIR TONGUE LACERATION 5.14 $191.36 --- $241.32 004 1 0 0.00 $0.00 Y
O 41252 REPAIR TONGUE LACERATION 1.03 $38.35 --- $48.36 004 1 0 0.00 $0.00 Y
O 41510 TONGUE TO LIP SURGERY 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
K 41510 TONGUE TO LIP SURGERY 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
K 41512 TONGUE SUSPENSION 11.66 $434.10 --- -- 004 0 0 0.00 $0.00 Y
O 41512 TONGUE SUSPENSION 2.33 $86.75 --- -- 004 0 0 0.00 $0.00 Y
K 41520 RECONSTRUCTION TONGUE FOLD 6.30 $234.55 --- $295.79 004 1 0 0.00 $0.00 Y
K 41530 TONGUE BASE VOL REDUCTION 7.64 $284.44 --- -- 004 0 0 0.00 $0.00 Y
K 41599 TONGUE AND MOUTH SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 41599 TONGUE AND MOUTH SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 41800 DRAINAGE OF GUM LESION 1.34 $49.89 --- $62.91 004 1 1 0.00 $0.00 Y
K 41805 REMOVAL FOREIGN BODY GUM 2.56 $95.31 --- $120.19 004 1 1 0.00 $0.00 Y
O 41805 REMOVAL FOREIGN BODY GUM 0.51 $18.99 --- $23.94 004 1 0 0.00 $0.00 Y
O 41806 REMOVAL FOREIGN BODY JAWBONE 0.88 $32.76 --- $41.32 004 1 0 0.00 $0.00 Y
K 41806 REMOVAL FOREIGN BODY JAWBONE 4.42 $164.56 --- $207.52 004 1 0 0.00 $0.00 Y
K 41820 EXCISION GUM EACH QUADRANT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 41821 EXCISION OF GUM FLAP 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 41822 EXCISION OF GUM LESION 4.29 $159.72 --- $201.42 004 1 0 0.00 $0.00 Y
K 41823 EXCISION OF GUM LESION 5.83 $217.05 --- $273.72 004 1 0 0.00 $0.00 Y
K 41825 EXCISION OF GUM LESION 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
K 41826 EXCISION OF GUM LESION 4.21 $156.74 --- $197.66 004 1 0 0.00 $0.00 Y
K 41827 EXCISION OF GUM LESION 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 41827 EXCISION OF GUM LESION 1.20 $44.68 --- $56.34 004 1 0 0.00 $0.00 Y
K 41828 EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA 5.31 $197.69 --- $249.30 004 1 0 0.00 $0.00 Y
K 41830 REMOVAL OF GUM TISSUE 5.68 $211.47 --- $266.68 004 1 0 0.00 $0.00 Y
K 41850 TREATMENT OF GUM LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 41850 TREATMENT OF GUM LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 41870 GUM GRAFT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 41872 GINGIVOPLASTY EACH QUADRANT 4.62 $172.00 --- $216.91 004 1 0 0.00 $0.00 Y
K 41874 ALVEOLOPLASTY, EACH QUADRANT 5.15 $191.73 --- $241.79 004 1 0 0.00 $0.00 Y
K 41899 GUM SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 41899 GUM SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 42000 DRAINAGE MOUTH ROOF LESION 1.56 $58.08 --- $73.24 004 1 1 0.00 $0.00 Y
K 42100 BIOPSY ROOF OF MOUTH 1.57 $58.45 --- $73.71 004 1 1 0.00 $0.00 Y
K 42104 EXCISION LESION MOUTH ROOF 3.25 $121.00 --- $152.59 004 1 1 0.00 $0.00 Y
O 42104 EXCISION LESION MOUTH ROOF 0.65 $24.20 --- $30.52 004 1 0 0.00 $0.00 Y
O 42106 EXCISION LESION MOUTH ROOF 0.80 $29.78 --- $37.56 004 1 0 0.00 $0.00 Y
K 42106 EXCISION LESION MOUTH ROOF 4.00 $148.92 --- $187.80 004 1 1 0.00 $0.00 Y
K 42107 EXCISION LESION MOUTH ROOF 7.42 $276.25 --- $348.37 004 1 1 0.00 $0.00 Y
O 42107 EXCISION LESION MOUTH ROOF 1.48 $55.10 --- $69.49 004 1 0 0.00 $0.00 Y
O 42120 REMOVE PALATE/LESION 2.03 $75.58 --- $95.31 004 1 0 0.00 $0.00 Y
K 42120 REMOVE PALATE/LESION 10.14 $377.51 --- $476.07 004 1 0 0.00 $0.00 Y
K 42140 EXCISION OF UVULA 2.18 $81.16 --- $102.35 004 1 0 0.00 $0.00 Y
K 42145 REPAIR PALATE PHARYNX/UVULA 12.97 $482.87 --- $608.94 004 1 0 0.00 $0.00 Y
O 42145 REPAIR PALATE PHARYNX/UVULA 2.59 $96.43 --- $121.60 004 1 0 0.00 $0.00 Y
K 42160 TREATMENT MOUTH ROOF LESION 2.03 $75.58 --- $95.31 004 1 1 0.00 $0.00 Y
K 42180 REPAIR PALATE 4.21 $156.74 --- $197.66 004 1 1 0.00 $0.00 Y
K 42182 REPAIR PALATE 5.73 $213.33 --- $269.02 004 1 0 0.00 $0.00 Y
O 42182 REPAIR PALATE 1.15 $42.81 --- $53.99 004 1 0 0.00 $0.00 Y
O 42200 RECONSTRUCT CLEFT PALATE 3.62 $134.77 --- $169.96 004 1 0 0.00 $0.00 Y
K 42200 RECONSTRUCT CLEFT PALATE 18.12 $674.61 --- $850.73 004 1 0 0.00 $0.00 Y
K 42205 RECONSTRUCT CLEFT PALATE 20.00 $744.60 --- $939.00 004 1 1 0.00 $0.00 Y
O 42205 RECONSTRUCT CLEFT PALATE 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 42210 RECONSTRUCT CLEFT PALATE 4.40 $163.81 --- $206.58 004 1 0 0.00 $0.00 Y
K 42210 RECONSTRUCT CLEFT PALATE 22.00 $819.06 --- $1032.90 004 1 0 0.00 $0.00 Y
K 42215 RECONSTRUCT CLEFT PALATE 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
O 42215 RECONSTRUCT CLEFT PALATE 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
O 42220 RECONSTRUCT CLEFT PALATE 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
K 42220 RECONSTRUCT CLEFT PALATE 17.00 $632.91 --- $798.15 004 1 0 0.00 $0.00 Y
K 42225 RECONSTRUCT CLEFT PALATE 17.00 $632.91 --- $798.15 004 1 0 0.00 $0.00 Y
O 42225 RECONSTRUCT CLEFT PALATE 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
O 42226 LENGTHENING OF PALATE 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
K 42226 LENGTHENING OF PALATE 17.00 $632.91 --- $798.15 004 1 0 0.00 $0.00 Y
K 42227 LENGTHENING OF PALATE 17.00 $632.91 --- $798.15 004 1 0 0.00 $0.00 Y
O 42227 LENGTHENING OF PALATE 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
O 42235 REPAIR PALATE 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
K 42235 REPAIR PALATE 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
K 42260 REPAIR NOSE TO LIP FISTULA 14.60 $543.56 --- $685.47 004 1 1 0.00 $0.00 Y
O 42260 REPAIR NOSE TO LIP FISTULA 2.92 $108.71 --- $137.09 004 1 0 0.00 $0.00 Y
K 42280 PREPARATION PALATE MOLD 2.56 $95.31 --- $120.19 004 1 1 0.00 $0.00 Y
K 42281 INSERTION PALATE PROSTHESIS 3.02 $112.43 --- $141.79 004 1 1 0.00 $0.00 Y
K 42299 PALATE/UVULA SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 42299 PALATE/UVULA SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 42300 DRAINAGE OF SALIVARY GLAND 1.99 $74.09 --- $93.43 004 1 1 0.00 $0.00 Y
K 42305 DRAINAGE OF SALIVARY GLAND 11.01 $409.90 --- $516.92 004 1 0 0.00 $0.00 Y
O 42305 DRAINAGE OF SALIVARY GLAND 2.20 $81.91 --- $103.29 004 1 0 0.00 $0.00 Y
K 42310 DRAINAGE OF SALIVARY GLAND 1.73 $64.41 --- $81.22 004 1 1 0.00 $0.00 Y
K 42320 DRAINAGE OF SALIVARY GLAND 2.38 $88.61 --- $111.74 004 1 0 0.00 $0.00 Y
K 42330 REMOVAL OF SALIVARY STONE 2.19 $81.53 --- $102.82 004 1 1 0.00 $0.00 Y
K 42335 REMOVAL OF SALIVARY STONE 3.09 $115.04 --- $145.08 004 1 0 0.00 $0.00 Y
K 42340 REMOVAL OF SALIVARY STONE 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 42340 REMOVAL OF SALIVARY STONE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 42400 BIOPSY OF SALIVARY GLAND 1.35 $50.26 --- $63.38 004 1 1 0.00 $0.00 Y
K 42405 BIOPSY OF SALIVARY GLAND 2.95 $109.83 --- $138.50 004 1 0 0.00 $0.00 Y
K 42408 EXCISION OF SALIVARY CYST 7.32 $272.52 --- $343.67 004 1 0 0.00 $0.00 Y
O 42408 EXCISION OF SALIVARY CYST 1.46 $54.36 --- $68.55 004 1 0 0.00 $0.00 Y
O 42409 DRAINAGE OF SALIVARY CYST 1.02 $37.97 --- $47.89 004 1 0 0.00 $0.00 Y
K 42409 DRAINAGE OF SALIVARY CYST 5.11 $190.25 --- $239.91 004 1 0 0.00 $0.00 Y
K 42410 EXCISE PAROTID GLAND/LESION 7.81 $290.77 --- $366.68 004 1 0 0.00 $0.00 Y
O 42410 EXCISE PAROTID GLAND/LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 42415 EXCISE PAROTID GLAND/LESION 3.28 $122.11 --- $154.00 004 1 0 0.00 $0.00 Y
K 42415 EXCISE PAROTID GLAND/LESION 16.42 $611.32 --- $770.92 004 1 0 0.00 $0.00 Y
K 42420 EXCISE PAROTID GLAND/LESION 20.39 $759.12 --- $957.31 004 1 0 0.00 $0.00 Y
O 42420 EXCISE PAROTID GLAND/LESION 4.08 $151.90 --- $191.56 004 1 0 0.00 $0.00 Y
O 42425 EXCISE PAROTID GLAND/LESION 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 42425 EXCISE PAROTID GLAND/LESION 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 42426 EXCISE PAROTID GLAND/LESION 31.18 $1160.83 --- $1463.90 004 1 0 0.00 $0.00 Y
O 42426 EXCISE PAROTID GLAND/LESION 6.21 $231.20 --- $291.56 004 1 0 0.00 $0.00 Y
O 42440 EXCISE SUBMAXILLARY GLAND 2.18 $81.16 --- $102.35 004 1 0 0.00 $0.00 Y
K 42440 EXCISE SUBMAXILLARY GLAND 10.91 $406.18 --- $512.22 004 1 0 0.00 $0.00 Y
K 42450 EXCISE SUBLINGUAL GLAND 6.23 $231.94 --- $292.50 004 1 0 0.00 $0.00 Y
O 42450 EXCISE SUBLINGUAL GLAND 1.25 $46.54 --- $58.69 004 1 0 0.00 $0.00 Y
O 42500 REPAIR SALIVARY DUCT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 42500 REPAIR SALIVARY DUCT 7.51 $279.60 --- $352.59 004 1 0 0.00 $0.00 Y
K 42505 REPAIR SALIVARY DUCT 10.39 $386.82 --- $487.81 004 1 0 0.00 $0.00 Y
O 42505 REPAIR SALIVARY DUCT 2.08 $77.44 --- $97.66 004 1 0 0.00 $0.00 Y
O 42507 PAROTID DUCT DIVERSION 2.34 $87.12 --- $109.86 004 1 0 0.00 $0.00 Y
K 42507 PAROTID DUCT DIVERSION 11.68 $434.85 --- $548.38 004 1 0 0.00 $0.00 Y
K 42509 PAROTID DUCT DIVERSION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 42509 PAROTID DUCT DIVERSION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 42510 PAROTID DUCT DIVERSION 2.54 $94.56 --- $119.25 004 1 0 0.00 $0.00 Y
K 42510 PAROTID DUCT DIVERSION 12.69 $472.45 --- $595.80 004 1 0 0.00 $0.00 Y
K 42550 INJECTION FOR SALIVARY XRAY 5.87 $218.54 --- $275.60 004 1 0 0.00 $0.00 Y
K 42600 CLOSURE OF SALIVARY FISTULA 9.19 $342.14 --- $431.47 004 1 0 0.00 $0.00 Y
O 42600 CLOSURE OF SALIVARY FISTULA 1.84 $68.50 --- $86.39 004 1 0 0.00 $0.00 Y
K 42650 DILATION OF SALIVARY DUCT 0.81 $30.16 --- $38.03 004 1 1 0.00 $0.00 Y
K 42660 DILATION OF SALIVARY DUCT 1.05 $39.09 --- $49.30 004 1 1 0.00 $0.00 Y
K 42665 LIGATION OF SALIVARY DUCT 5.22 $194.34 --- $245.08 004 1 0 0.00 $0.00 Y
O 42665 LIGATION OF SALIVARY DUCT 1.04 $38.72 --- $48.83 004 1 0 0.00 $0.00 Y
O 42699 SALIVARY SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 42699 SALIVARY SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 42700 DRAINAGE OF TONSIL ABSCESS 1.96 $72.97 --- $92.02 004 1 0 0.00 $0.00 Y
K 42720 DRAINAGE OF THROAT ABSCESS 4.66 $173.49 --- $218.79 004 1 0 0.00 $0.00 Y
K 42725 DRAINAGE OF THROAT ABSCESS 16.45 $612.43 --- $772.33 004 1 0 0.00 $0.00 Y
O 42725 DRAINAGE OF THROAT ABSCESS 3.29 $122.49 --- $154.47 004 1 0 0.00 $0.00 Y