| 26951 | Amputation of finger/thumb | $6,703 | Private Pay | $7,429 |
| 26951 | Amputation of finger/thumb | $6,703 | BC PPO | $3,358 |
| 26951 | Amputation of finger/thumb | $6,703 | BC HMO | $2,947 |
| 26951 | Amputation of finger/thumb | $6,703 | BC FMOL | $2,975 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICARE | $2,449 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICARE – BLUE CROSS | $2,449 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICARE – UNITED | $2,449 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICARE – COVENTRY | $2,449 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICARE – VANTAGE | $2,449 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICARE -PEOPLES | $2,449 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICARE- HUMANA | $2,400 |
| 26951 | Amputation of finger/thumb | $6,703 | HUMANA | $3,673 |
| 26951 | Amputation of finger/thumb | $6,703 | VANTAGE | $4,163 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICAID | $446 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICAID – AETNA BETTER HEALTH | $446 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICAID – UNITED | $446 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICAID – HEALTHY BLUE | $446 |
| 26951 | Amputation of finger/thumb | $6,703 | MEDICAID – AMERIHEALTH | $446 |
| 26951 | Amputation of finger/thumb | $6,703 | UNITED | $734 |
| 26951 | Amputation of finger/thumb | $6,703 | AETNA | $1,019 |
| 26951 | Amputation of finger/thumb | $6,703 | CIGNA | $1,102 |
| 26951 | Amputation of finger/thumb | $6,703 | LWCC | $6,296 |
| 26951 | Amputation of finger/thumb | $6,703 | PPOPLUS | $4,532 |
| 26951 | Amputation of finger/thumb | $6,703 | GILSBAR | $3,643 |
| 26951 | Amputation of finger/thumb | $6,703 | LSU | $4,022 |
| 26951 | Amputation of finger/thumb | $6,703 | VERITY | $3,386 |
| 26951 | Amputation of finger/thumb | $6,703 | MULTIPLAN | $3,386 |
| 26951 | Amputation of finger/thumb | $6,703 | LA WORK COMP | $6,703 |
| 26951 | Amputation of finger/thumb | $6,703 | | $7,429 |
| 26952 | Amputation of finger/thumb | $6,296 | Private Pay | $6,869 |
| 26952 | Amputation of finger/thumb | $6,296 | BC PPO | $3,358 |
| 26952 | Amputation of finger/thumb | $6,296 | BC HMO | $2,947 |
| 26952 | Amputation of finger/thumb | $6,296 | BC FMOL | $2,975 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICARE | $2,449 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICARE – BLUE CROSS | $2,449 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICARE – UNITED | $2,449 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICARE – COVENTRY | $2,449 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICARE – VANTAGE | $2,449 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICARE -PEOPLES | $2,449 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICARE- HUMANA | $2,400 |
| 26952 | Amputation of finger/thumb | $6,296 | HUMANA | $3,673 |
| 26952 | Amputation of finger/thumb | $6,296 | VANTAGE | $4,163 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICAID | $659 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICAID – UNITED | $659 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICAID – HEALTHY BLUE | $659 |
| 26952 | Amputation of finger/thumb | $6,296 | MEDICAID – AMERIHEALTH | $659 |
| 26952 | Amputation of finger/thumb | $6,296 | UNITED | $734 |
| 26952 | Amputation of finger/thumb | $6,296 | AETNA | $1,494 |
| 26952 | Amputation of finger/thumb | $6,296 | CIGNA | $634 |
| 26952 | Amputation of finger/thumb | $6,296 | LWCC | $6,296 |
| 26952 | Amputation of finger/thumb | $6,296 | PPOPLUS | $4,190 |
| 26952 | Amputation of finger/thumb | $6,296 | GILSBAR | $3,369 |
| 26952 | Amputation of finger/thumb | $6,296 | LSU | $4,022 |
| 26952 | Amputation of finger/thumb | $6,296 | VERITY | $3,386 |
| 26952 | Amputation of finger/thumb | $6,296 | MULTIPLAN | $3,386 |
| 26952 | Amputation of finger/thumb | $6,296 | LA WORK COMP | $6,199 |
| 26952 | Amputation of finger/thumb | $6,296 | | |
| 28820 | Amputation of toe | $7,963 | Private Pay | $8,819 |
| 28820 | Amputation of toe | $7,963 | BC PPO | $1,714 |
| 28820 | Amputation of toe | $7,963 | BC HMO | $1,504 |
| 28820 | Amputation of toe | $7,963 | BC FMOL | $1,518 |
| 28820 | Amputation of toe | $7,963 | MEDICARE | $2,449 |
| 28820 | Amputation of toe | $7,963 | MEDICARE – BLUE CROSS | $2,449 |
| 28820 | Amputation of toe | $7,963 | MEDICARE – UNITED | $2,449 |
| 28820 | Amputation of toe | $7,963 | MEDICARE – COVENTRY | $2,449 |
| 28820 | Amputation of toe | $7,963 | MEDICARE – VANTAGE | $2,449 |
| 28820 | Amputation of toe | $7,963 | MEDICARE -PEOPLES | $2,449 |
| 28820 | Amputation of toe | $7,963 | MEDICARE- HUMANA | $2,400 |
| 28820 | Amputation of toe | $7,963 | HUMANA | $3,673 |
| 28820 | Amputation of toe | $7,963 | VANTAGE | $4,163 |
| 28820 | Amputation of toe | $7,963 | MEDICAID | $466 |
| 28820 | Amputation of toe | $7,963 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28820 | Amputation of toe | $7,963 | MEDICAID – UNITED | $466 |
| 28820 | Amputation of toe | $7,963 | MEDICAID – HEALTHY BLUE | $466 |
| 28820 | Amputation of toe | $7,963 | MEDICAID – AMERIHEALTH | $466 |
| 28820 | Amputation of toe | $7,963 | UNITED | $2,188 |
| 28820 | Amputation of toe | $7,963 | AETNA | $1,029 |
| 28820 | Amputation of toe | $7,963 | CIGNA | $1,102 |
| 28820 | Amputation of toe | $7,963 | LWCC | $6,296 |
| 28820 | Amputation of toe | $7,963 | PPOPLUS | $5,380 |
| 28820 | Amputation of toe | $7,963 | GILSBAR | $4,326 |
| 28820 | Amputation of toe | $7,963 | LSU | $4,034 |
| 28820 | Amputation of toe | $7,963 | VERITY | $1,728 |
| 28820 | Amputation of toe | $7,963 | MULTIPLAN | $1,728 |
| 28820 | Amputation of toe | $7,963 | LA WORK COMP | $7,963 |
| 28820 | Amputation of toe | $7,963 | | |
| 28810 | Amputation toe & metatarsal | $10,788 | Private Pay | $11,986 |
| 28810 | Amputation toe & metatarsal | $10,788 | BC PPO | $2,913 |
| 28810 | Amputation toe & metatarsal | $10,788 | BC HMO | $2,556 |
| 28810 | Amputation toe & metatarsal | $10,788 | BC FMOL | $2,580 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICARE | $2,449 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICARE – BLUE CROSS | $2,449 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICARE – UNITED | $2,449 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICARE – COVENTRY | $2,449 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICARE – VANTAGE | $2,449 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICARE -PEOPLES | $2,449 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICARE- HUMANA | $2,400 |
| 28810 | Amputation toe & metatarsal | $10,788 | HUMANA | $3,673 |
| 28810 | Amputation toe & metatarsal | $10,788 | VANTAGE | $4,163 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICAID | $466 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICAID – UNITED | $466 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICAID – HEALTHY BLUE | $466 |
| 28810 | Amputation toe & metatarsal | $10,788 | MEDICAID – AMERIHEALTH | $466 |
| 28810 | Amputation toe & metatarsal | $10,788 | UNITED | $2,188 |
| 28810 | Amputation toe & metatarsal | $10,788 | AETNA | $1,000 |
| 28810 | Amputation toe & metatarsal | $10,788 | CIGNA | $1,102 |
| 28810 | Amputation toe & metatarsal | $10,788 | LWCC | $6,296 |
| 28810 | Amputation toe & metatarsal | $10,788 | PPOPLUS | $7,312 |
| 28810 | Amputation toe & metatarsal | $10,788 | GILSBAR | $5,873 |
| 28810 | Amputation toe & metatarsal | $10,788 | LSU | $4,000 |
| 28810 | Amputation toe & metatarsal | $10,788 | VERITY | $3,386 |
| 28810 | Amputation toe & metatarsal | $10,788 | MULTIPLAN | $3,386 |
| 28810 | Amputation toe & metatarsal | $10,788 | LA WORK COMP | $10,788 |
| 28810 | Amputation toe & metatarsal | $10,788 | | |
| 29891 | Ankle arthroscopy/surgery | $24,244 | Private Pay | $24,015 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | BC PPO | $2,296 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | BC HMO | $2,015 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | BC FMOL | $2,034 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICARE | $2,449 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICARE – BLUE CROSS | $2,449 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICARE – UNITED | $2,449 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICARE – COVENTRY | $2,449 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICARE – VANTAGE | $2,449 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICARE -PEOPLES | $2,449 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICARE- HUMANA | $2,400 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | HUMANA | $3,673 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | VANTAGE | $4,163 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICAID | $533 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICAID – UNITED | $533 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICAID – HEALTHY BLUE | $533 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MEDICAID – AMERIHEALTH | $533 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | UNITED | $4,460 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | AETNA | $4,094 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | CIGNA | $4,465 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | LWCC | $6,296 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | PPOPLUS | $14,649 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | GILSBAR | $12,241 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | LSU | $7,420 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | VERITY | $3,386 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | MULTIPLAN | $3,386 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | LA WORK COMP | $24,244 |
| 29891 | Ankle arthroscopy/surgery | $24,244 | | |
| 29897 | Ankle arthroscopy/surgery | $12,286 | Private Pay | $13,625 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | BC PPO | $2,296 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | BC HMO | $2,015 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | BC FMOL | $2,034 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICARE | $2,449 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICARE – BLUE CROSS | $2,449 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICARE – UNITED | $2,449 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICARE – COVENTRY | $2,449 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICARE – VANTAGE | $2,449 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICARE -PEOPLES | $2,449 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICARE- HUMANA | $2,400 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | HUMANA | $3,673 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | VANTAGE | $4,163 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICAID | $533 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICAID – UNITED | $533 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICAID – HEALTHY BLUE | $533 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MEDICAID – AMERIHEALTH | $533 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | UNITED | $2,923 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | AETNA | $1,225 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | CIGNA | $1,022 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | LWCC | $6,296 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | PPOPLUS | $8,311 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | GILSBAR | $6,680 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | LSU | $4,030 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | VERITY | $3,386 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | MULTIPLAN | $3,386 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | LA WORK COMP | $12,286 |
| 29897 | Ankle arthroscopy/surgery | $12,286 | | |
| 29898 | Ankle arthroscopy/surgery | $11,886 | Private Pay | $13,207 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | BC PPO | $2,296 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | BC HMO | $2,015 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | BC FMOL | $2,034 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICARE | $2,449 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICARE – BLUE CROSS | $2,449 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICARE – UNITED | $2,449 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICARE – COVENTRY | $2,449 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICARE – VANTAGE | $2,449 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICARE -PEOPLES | $2,449 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICARE- HUMANA | $2,400 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | HUMANA | $3,673 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | VANTAGE | $4,163 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICAID | $533 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICAID – UNITED | $533 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICAID – HEALTHY BLUE | $533 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MEDICAID – AMERIHEALTH | $533 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | UNITED | $2,923 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | AETNA | $1,200 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | CIGNA | $2,756 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | LWCC | $6,296 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | PPOPLUS | $8,056 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | GILSBAR | $6,472 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | LSU | $4,000 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | VERITY | $3,386 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | MULTIPLAN | $3,386 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | LA WORK COMP | $11,025 |
| 29898 | Ankle arthroscopy/surgery | $11,886 | | |
| 24305 | Arm tendon lengthening | $11,025 | Private Pay | $9,264 |
| 24305 | Arm tendon lengthening | $11,025 | BC PPO | $2,296 |
| 24305 | Arm tendon lengthening | $11,025 | BC HMO | $2,015 |
| 24305 | Arm tendon lengthening | $11,025 | BC FMOL | $2,034 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICARE | $2,449 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICARE – BLUE CROSS | $2,449 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICARE – UNITED | $2,449 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICARE – COVENTRY | $2,449 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICARE – VANTAGE | $2,449 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICARE -PEOPLES | $2,449 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICARE- HUMANA | $2,400 |
| 24305 | Arm tendon lengthening | $11,025 | HUMANA | $3,673 |
| 24305 | Arm tendon lengthening | $11,025 | VANTAGE | $4,163 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICAID | $659 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICAID – UNITED | $659 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICAID – HEALTHY BLUE | $659 |
| 24305 | Arm tendon lengthening | $11,025 | MEDICAID – AMERIHEALTH | $659 |
| 24305 | Arm tendon lengthening | $11,025 | UNITED | $2,923 |
| 24305 | Arm tendon lengthening | $11,025 | AETNA | $4,432 |
| 24305 | Arm tendon lengthening | $11,025 | CIGNA | $4,650 |
| 24305 | Arm tendon lengthening | $11,025 | LWCC | $6,296 |
| 24305 | Arm tendon lengthening | $11,025 | PPOPLUS | $5,651 |
| 24305 | Arm tendon lengthening | $11,025 | GILSBAR | $5,023 |
| 24305 | Arm tendon lengthening | $11,025 | LSU | $7,494 |
| 24305 | Arm tendon lengthening | $11,025 | VERITY | $3,386 |
| 24305 | Arm tendon lengthening | $11,025 | MULTIPLAN | $3,386 |
| 24305 | Arm tendon lengthening | $11,025 | LA WORK COMP | $11,025 |
| 24305 | Arm tendon lengthening | $11,025 | | |
| 29827 | Arthroscop rotator cuff repr | $18,525 | Private Pay | $18,756 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | BC PPO | $5,520 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | BC HMO | $4,843 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | BC FMOL | $4,889 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICARE | $5,351 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICARE – BLUE CROSS | $5,351 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICARE – UNITED | $5,351 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICARE – COVENTRY | $5,351 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICARE – VANTAGE | $5,351 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICARE -PEOPLES | $5,351 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICARE- HUMANA | $5,244 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | HUMANA | $8,026 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | VANTAGE | $9,097 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICAID | $750 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICAID – UNITED | $750 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICAID – HEALTHY BLUE | $750 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MEDICAID – AMERIHEALTH | $750 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | UNITED | $4,460 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | AETNA | $3,459 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | CIGNA | $3,273 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | LWCC | $13,758 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | PPOPLUS | $11,441 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | GILSBAR | $9,487 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | LSU | $6,138 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | VERITY | $7,176 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | MULTIPLAN | $7,176 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | LA WORK COMP | $18,525 |
| 29827 | Arthroscop rotator cuff repr | $18,525 | | |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | Private Pay | $16,719 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | BC PPO | $4,866 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | BC HMO | $4,270 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | BC FMOL | $4,310 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICARE | $5,351 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICARE – BLUE CROSS | $5,351 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICARE – UNITED | $5,351 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICARE – COVENTRY | $5,351 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICARE – VANTAGE | $5,351 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICARE -PEOPLES | $5,351 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICARE- HUMANA | $5,244 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | HUMANA | $8,026 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | VANTAGE | $9,097 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICAID | $- |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICAID – AETNA BETTER HEALTH | $- |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICAID – UNITED | $- |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICAID – HEALTHY BLUE | $- |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MEDICAID – AMERIHEALTH | $- |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | UNITED | $4,460 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | AETNA | $2,195 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | CIGNA | $2,296 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | LWCC | $13,758 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | PPOPLUS | $10,199 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | GILSBAR | $8,355 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | LSU | $5,176 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | VERITY | $7,176 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | MULTIPLAN | $7,176 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | LA WORK COMP | $15,952 |
| 29828 | Arthroscopy biceps tenodesis | $15,952 | | |
| 55700 | Biopsy of prostate | $5,734 | Private Pay | $6,371 |
| 55700 | Biopsy of prostate | $5,734 | BC PPO | $2,197 |
| 55700 | Biopsy of prostate | $5,734 | BC HMO | $1,927 |
| 55700 | Biopsy of prostate | $5,734 | BC FMOL | $1,946 |
| 55700 | Biopsy of prostate | $5,734 | MEDICARE | $1,585 |
| 55700 | Biopsy of prostate | $5,734 | MEDICARE – BLUE CROSS | $1,585 |
| 55700 | Biopsy of prostate | $5,734 | MEDICARE – UNITED | $1,585 |
| 55700 | Biopsy of prostate | $5,734 | MEDICARE – COVENTRY | $1,585 |
| 55700 | Biopsy of prostate | $5,734 | MEDICARE – VANTAGE | $1,585 |
| 55700 | Biopsy of prostate | $5,734 | MEDICARE -PEOPLES | $1,585 |
| 55700 | Biopsy of prostate | $5,734 | MEDICARE- HUMANA | $1,553 |
| 55700 | Biopsy of prostate | $5,734 | HUMANA | $2,377 |
| 55700 | Biopsy of prostate | $5,734 | VANTAGE | $2,694 |
| 55700 | Biopsy of prostate | $5,734 | MEDICAID | $466 |
| 55700 | Biopsy of prostate | $5,734 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 55700 | Biopsy of prostate | $5,734 | MEDICAID – UNITED | $466 |
| 55700 | Biopsy of prostate | $5,734 | MEDICAID – HEALTHY BLUE | $466 |
| 55700 | Biopsy of prostate | $5,734 | MEDICAID – AMERIHEALTH | $466 |
| 55700 | Biopsy of prostate | $5,734 | UNITED | $734 |
| 55700 | Biopsy of prostate | $5,734 | AETNA | $1,000 |
| 55700 | Biopsy of prostate | $5,734 | CIGNA | $854 |
| 55700 | Biopsy of prostate | $5,734 | LWCC | $4,075 |
| 55700 | Biopsy of prostate | $5,734 | PPOPLUS | $3,887 |
| 55700 | Biopsy of prostate | $5,734 | GILSBAR | $3,122 |
| 55700 | Biopsy of prostate | $5,734 | LSU | $4,000 |
| 55700 | Biopsy of prostate | $5,734 | VERITY | $2,170 |
| 55700 | Biopsy of prostate | $5,734 | MULTIPLAN | $2,170 |
| 55700 | Biopsy of prostate | $5,734 | LA WORK COMP | $5,734 |
| 55700 | Biopsy of prostate | $5,734 | | |
| 38510 | Biopsy/removal lymph nodes | $7,894 | Private Pay | $8,771 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | BC PPO | $3,322 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | BC HMO | $2,915 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | BC FMOL | $2,942 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICARE | $2,710 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICARE – BLUE CROSS | $2,710 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICARE – UNITED | $2,710 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICARE – COVENTRY | $2,710 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICARE – VANTAGE | $2,710 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICARE -PEOPLES | $2,710 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICARE- HUMANA | $2,656 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | HUMANA | $4,065 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | VANTAGE | $4,607 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICAID | $466 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICAID – UNITED | $466 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICAID – HEALTHY BLUE | $466 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MEDICAID – AMERIHEALTH | $466 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | UNITED | $2,188 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | AETNA | $1,000 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | CIGNA | $1,102 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | LWCC | $6,968 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | PPOPLUS | $5,350 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | GILSBAR | $4,298 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | LSU | $4,000 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | VERITY | $3,491 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | MULTIPLAN | $3,491 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | LA WORK COMP | $7,894 |
| 38510 | Biopsy/removal lymph nodes | $7,894 | | |
| 64721 | Carpal tunnel surgery | $6,534 | Private Pay | $6,055 |
| 64721 | Carpal tunnel surgery | $6,534 | BC PPO | $1,961 |
| 64721 | Carpal tunnel surgery | $6,534 | BC HMO | $1,721 |
| 64721 | Carpal tunnel surgery | $6,534 | BC FMOL | $1,737 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICARE | $1,538 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICARE – BLUE CROSS | $1,538 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICARE – UNITED | $1,538 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICARE – COVENTRY | $1,538 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICARE – VANTAGE | $1,538 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICARE -PEOPLES | $1,538 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICARE- HUMANA | $1,507 |
| 64721 | Carpal tunnel surgery | $6,534 | HUMANA | $2,307 |
| 64721 | Carpal tunnel surgery | $6,534 | VANTAGE | $2,615 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICAID | $466 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICAID – UNITED | $466 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICAID – HEALTHY BLUE | $466 |
| 64721 | Carpal tunnel surgery | $6,534 | MEDICAID – AMERIHEALTH | $466 |
| 64721 | Carpal tunnel surgery | $6,534 | UNITED | $2,188 |
| 64721 | Carpal tunnel surgery | $6,534 | AETNA | $3,144 |
| 64721 | Carpal tunnel surgery | $6,534 | CIGNA | $3,427 |
| 64721 | Carpal tunnel surgery | $6,534 | LWCC | $3,955 |
| 64721 | Carpal tunnel surgery | $6,534 | PPOPLUS | $3,694 |
| 64721 | Carpal tunnel surgery | $6,534 | GILSBAR | $3,318 |
| 64721 | Carpal tunnel surgery | $6,534 | LSU | $6,534 |
| 64721 | Carpal tunnel surgery | $6,534 | VERITY | $2,061 |
| 64721 | Carpal tunnel surgery | $6,534 | MULTIPLAN | $2,061 |
| 64721 | Carpal tunnel surgery | $6,534 | LA WORK COMP | $3,890 |
| 64721 | Carpal tunnel surgery | $6,534 | | |
| 22856 | Cerv artific diskectomy | $49,318 | Private Pay | $44,240 |
| 22856 | Cerv artific diskectomy | $49,318 | BC PPO | $18,717 |
| 22856 | Cerv artific diskectomy | $49,318 | BC HMO | $16,424 |
| 22856 | Cerv artific diskectomy | $49,318 | BC FMOL | $16,580 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICARE | $14,264 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICARE – BLUE CROSS | $14,264 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICARE – UNITED | $14,264 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICARE – COVENTRY | $14,264 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICARE – VANTAGE | $14,264 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICARE -PEOPLES | $14,264 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICARE- HUMANA | $13,979 |
| 22856 | Cerv artific diskectomy | $49,318 | HUMANA | $21,396 |
| 22856 | Cerv artific diskectomy | $49,318 | VANTAGE | $24,249 |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICAID | $- |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICAID – AETNA BETTER HEALTH | $- |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICAID – UNITED | $- |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICAID – HEALTHY BLUE | $- |
| 22856 | Cerv artific diskectomy | $49,318 | MEDICAID – AMERIHEALTH | $- |
| 22856 | Cerv artific diskectomy | $49,318 | UNITED | $13,335 |
| 22856 | Cerv artific diskectomy | $49,318 | AETNA | $11,253 |
| 22856 | Cerv artific diskectomy | $49,318 | CIGNA | $13,866 |
| 22856 | Cerv artific diskectomy | $49,318 | LWCC | $36,676 |
| 22856 | Cerv artific diskectomy | $49,318 | PPOPLUS | $26,986 |
| 22856 | Cerv artific diskectomy | $49,318 | GILSBAR | $23,388 |
| 22856 | Cerv artific diskectomy | $49,318 | LSU | $16,353 |
| 22856 | Cerv artific diskectomy | $49,318 | VERITY | $19,674 |
| 22856 | Cerv artific diskectomy | $49,318 | MULTIPLAN | $19,674 |
| 22856 | Cerv artific diskectomy | $49,318 | LA WORK COMP | $49,318 |
| 22856 | Cerv artific diskectomy | $49,318 | | |
| 54161 | Circum 28 days or older | $7,314 | Private Pay | $8,126 |
| 54161 | Circum 28 days or older | $7,314 | BC PPO | $2,065 |
| 54161 | Circum 28 days or older | $7,314 | BC HMO | $1,812 |
| 54161 | Circum 28 days or older | $7,314 | BC FMOL | $1,829 |
| 54161 | Circum 28 days or older | $7,314 | MEDICARE | $1,585 |
| 54161 | Circum 28 days or older | $7,314 | MEDICARE – BLUE CROSS | $1,585 |
| 54161 | Circum 28 days or older | $7,314 | MEDICARE – UNITED | $1,585 |
| 54161 | Circum 28 days or older | $7,314 | MEDICARE – COVENTRY | $1,585 |
| 54161 | Circum 28 days or older | $7,314 | MEDICARE – VANTAGE | $1,585 |
| 54161 | Circum 28 days or older | $7,314 | MEDICARE -PEOPLES | $1,585 |
| 54161 | Circum 28 days or older | $7,314 | MEDICARE- HUMANA | $1,553 |
| 54161 | Circum 28 days or older | $7,314 | HUMANA | $2,377 |
| 54161 | Circum 28 days or older | $7,314 | VANTAGE | $2,694 |
| 54161 | Circum 28 days or older | $7,314 | MEDICAID | $466 |
| 54161 | Circum 28 days or older | $7,314 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 54161 | Circum 28 days or older | $7,314 | MEDICAID – UNITED | $466 |
| 54161 | Circum 28 days or older | $7,314 | MEDICAID – HEALTHY BLUE | $466 |
| 54161 | Circum 28 days or older | $7,314 | MEDICAID – AMERIHEALTH | $466 |
| 54161 | Circum 28 days or older | $7,314 | UNITED | $2,188 |
| 54161 | Circum 28 days or older | $7,314 | AETNA | $1,000 |
| 54161 | Circum 28 days or older | $7,314 | CIGNA | $992 |
| 54161 | Circum 28 days or older | $7,314 | LWCC | $4,075 |
| 54161 | Circum 28 days or older | $7,314 | PPOPLUS | $4,957 |
| 54161 | Circum 28 days or older | $7,314 | GILSBAR | $3,982 |
| 54161 | Circum 28 days or older | $7,314 | LSU | $4,000 |
| 54161 | Circum 28 days or older | $7,314 | VERITY | $2,170 |
| 54161 | Circum 28 days or older | $7,314 | MULTIPLAN | $2,170 |
| 54161 | Circum 28 days or older | $7,314 | LA WORK COMP | $7,314 |
| 54161 | Circum 28 days or older | $7,314 | | |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | Private Pay | $6,730 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | BC PPO | $2,678 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | BC HMO | $2,350 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | BC FMOL | $2,372 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICARE | $2,343 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICARE – BLUE CROSS | $2,343 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICARE – UNITED | $2,343 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICARE – COVENTRY | $2,343 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICARE – VANTAGE | $2,343 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICARE -PEOPLES | $2,343 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICARE- HUMANA | $2,296 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | HUMANA | $3,515 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | VANTAGE | $3,983 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICAID | $466 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICAID – UNITED | $466 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICAID – HEALTHY BLUE | $466 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MEDICAID – AMERIHEALTH | $466 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | UNITED | $734 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | AETNA | $1,150 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | CIGNA | $854 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | LWCC | $6,024 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | PPOPLUS | $4,105 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | GILSBAR | $3,322 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | LSU | $4,177 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | VERITY | $2,815 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | MULTIPLAN | $2,815 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | LA WORK COMP | $6,193 |
| 21320 | Closed tx nose fx w/ stablj | $6,193 | | |
| 57282 | Colpopexy extraperitoneal | $25,634 | Private Pay | $25,376 |
| 57282 | Colpopexy extraperitoneal | $25,634 | BC PPO | $5,457 |
| 57282 | Colpopexy extraperitoneal | $25,634 | BC HMO | $4,788 |
| 57282 | Colpopexy extraperitoneal | $25,634 | BC FMOL | $4,834 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICARE | $5,997 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICARE – BLUE CROSS | $5,997 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICARE – UNITED | $5,997 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICARE – COVENTRY | $5,997 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICARE – VANTAGE | $5,997 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICARE -PEOPLES | $5,997 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICARE- HUMANA | $5,877 |
| 57282 | Colpopexy extraperitoneal | $25,634 | HUMANA | $8,995 |
| 57282 | Colpopexy extraperitoneal | $25,634 | VANTAGE | $10,194 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICAID | $- |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICAID – AETNA BETTER HEALTH | $- |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICAID – UNITED | $- |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICAID – HEALTHY BLUE | $- |
| 57282 | Colpopexy extraperitoneal | $25,634 | MEDICAID – AMERIHEALTH | $- |
| 57282 | Colpopexy extraperitoneal | $25,634 | UNITED | $3,860 |
| 57282 | Colpopexy extraperitoneal | $25,634 | AETNA | $4,725 |
| 57282 | Colpopexy extraperitoneal | $25,634 | CIGNA | $4,544 |
| 57282 | Colpopexy extraperitoneal | $25,634 | LWCC | $15,418 |
| 57282 | Colpopexy extraperitoneal | $25,634 | PPOPLUS | $15,480 |
| 57282 | Colpopexy extraperitoneal | $25,634 | GILSBAR | $12,938 |
| 57282 | Colpopexy extraperitoneal | $25,634 | LSU | $7,634 |
| 57282 | Colpopexy extraperitoneal | $25,634 | VERITY | $8,047 |
| 57282 | Colpopexy extraperitoneal | $25,634 | MULTIPLAN | $8,047 |
| 57282 | Colpopexy extraperitoneal | $25,634 | LA WORK COMP | $25,634 |
| 57282 | Colpopexy extraperitoneal | $25,634 | | |
| 57283 | Colpopexy intraperitoneal | $19,885 | Private Pay | $19,801 |
| 57283 | Colpopexy intraperitoneal | $19,885 | BC PPO | $5,457 |
| 57283 | Colpopexy intraperitoneal | $19,885 | BC HMO | $4,788 |
| 57283 | Colpopexy intraperitoneal | $19,885 | BC FMOL | $4,834 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICARE | $5,997 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICARE – BLUE CROSS | $5,997 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICARE – UNITED | $5,997 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICARE – COVENTRY | $5,997 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICARE – VANTAGE | $5,997 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICARE -PEOPLES | $5,997 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICARE- HUMANA | $5,877 |
| 57283 | Colpopexy intraperitoneal | $19,885 | HUMANA | $8,995 |
| 57283 | Colpopexy intraperitoneal | $19,885 | VANTAGE | $10,194 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICAID | $- |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICAID – AETNA BETTER HEALTH | $- |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICAID – UNITED | $- |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICAID – HEALTHY BLUE | $- |
| 57283 | Colpopexy intraperitoneal | $19,885 | MEDICAID – AMERIHEALTH | $- |
| 57283 | Colpopexy intraperitoneal | $19,885 | UNITED | $3,860 |
| 57283 | Colpopexy intraperitoneal | $19,885 | AETNA | $3,070 |
| 57283 | Colpopexy intraperitoneal | $19,885 | CIGNA | $3,358 |
| 57283 | Colpopexy intraperitoneal | $19,885 | LWCC | $15,418 |
| 57283 | Colpopexy intraperitoneal | $19,885 | PPOPLUS | $12,079 |
| 57283 | Colpopexy intraperitoneal | $19,885 | GILSBAR | $10,074 |
| 57283 | Colpopexy intraperitoneal | $19,885 | LSU | $6,683 |
| 57283 | Colpopexy intraperitoneal | $19,885 | VERITY | $8,047 |
| 57283 | Colpopexy intraperitoneal | $19,885 | MULTIPLAN | $8,047 |
| 57283 | Colpopexy intraperitoneal | $19,885 | LA WORK COMP | $19,885 |
| 57283 | Colpopexy intraperitoneal | $19,885 | | |
| 10180 | Complex drainage wound | $6,843 | Private Pay | $7,603 |
| 10180 | Complex drainage wound | $6,843 | BC PPO | $2,831 |
| 10180 | Complex drainage wound | $6,843 | BC HMO | $2,484 |
| 10180 | Complex drainage wound | $6,843 | BC FMOL | $2,508 |
| 10180 | Complex drainage wound | $6,843 | MEDICARE | $2,074 |
| 10180 | Complex drainage wound | $6,843 | MEDICARE – BLUE CROSS | $2,074 |
| 10180 | Complex drainage wound | $6,843 | MEDICARE – UNITED | $2,074 |
| 10180 | Complex drainage wound | $6,843 | MEDICARE – COVENTRY | $2,074 |
| 10180 | Complex drainage wound | $6,843 | MEDICARE – VANTAGE | $2,074 |
| 10180 | Complex drainage wound | $6,843 | MEDICARE -PEOPLES | $2,074 |
| 10180 | Complex drainage wound | $6,843 | MEDICARE- HUMANA | $2,033 |
| 10180 | Complex drainage wound | $6,843 | HUMANA | $3,111 |
| 10180 | Complex drainage wound | $6,843 | VANTAGE | $3,526 |
| 10180 | Complex drainage wound | $6,843 | MEDICAID | $466 |
| 10180 | Complex drainage wound | $6,843 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 10180 | Complex drainage wound | $6,843 | MEDICAID – UNITED | $466 |
| 10180 | Complex drainage wound | $6,843 | MEDICAID – HEALTHY BLUE | $466 |
| 10180 | Complex drainage wound | $6,843 | MEDICAID – AMERIHEALTH | $466 |
| 10180 | Complex drainage wound | $6,843 | UNITED | $2,188 |
| 10180 | Complex drainage wound | $6,843 | AETNA | $1,000 |
| 10180 | Complex drainage wound | $6,843 | CIGNA | $2,756 |
| 10180 | Complex drainage wound | $6,843 | LWCC | $5,333 |
| 10180 | Complex drainage wound | $6,843 | PPOPLUS | $4,638 |
| 10180 | Complex drainage wound | $6,843 | GILSBAR | $3,725 |
| 10180 | Complex drainage wound | $6,843 | LSU | $4,000 |
| 10180 | Complex drainage wound | $6,843 | VERITY | $2,976 |
| 10180 | Complex drainage wound | $6,843 | MULTIPLAN | $2,976 |
| 10180 | Complex drainage wound | $6,843 | LA WORK COMP | $6,843 |
| 10180 | Complex drainage wound | $6,843 | | |
| 30903 | Control of nosebleed | $7,143 | Private Pay | $7,936 |
| 30903 | Control of nosebleed | $7,143 | BC PPO | $136 |
| 30903 | Control of nosebleed | $7,143 | BC HMO | $119 |
| 30903 | Control of nosebleed | $7,143 | BC FMOL | $121 |
| 30903 | Control of nosebleed | $7,143 | MEDICARE | $98 |
| 30903 | Control of nosebleed | $7,143 | MEDICARE – BLUE CROSS | $98 |
| 30903 | Control of nosebleed | $7,143 | MEDICARE – UNITED | $98 |
| 30903 | Control of nosebleed | $7,143 | MEDICARE – COVENTRY | $98 |
| 30903 | Control of nosebleed | $7,143 | MEDICARE – VANTAGE | $98 |
| 30903 | Control of nosebleed | $7,143 | MEDICARE -PEOPLES | $98 |
| 30903 | Control of nosebleed | $7,143 | MEDICARE- HUMANA | $96 |
| 30903 | Control of nosebleed | $7,143 | HUMANA | $146 |
| 30903 | Control of nosebleed | $7,143 | VANTAGE | $166 |
| 30903 | Control of nosebleed | $7,143 | MEDICAID | $348 |
| 30903 | Control of nosebleed | $7,143 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 30903 | Control of nosebleed | $7,143 | MEDICAID – UNITED | $348 |
| 30903 | Control of nosebleed | $7,143 | MEDICAID – HEALTHY BLUE | $348 |
| 30903 | Control of nosebleed | $7,143 | MEDICAID – AMERIHEALTH | $348 |
| 30903 | Control of nosebleed | $7,143 | UNITED | $392 |
| 30903 | Control of nosebleed | $7,143 | AETNA | $750 |
| 30903 | Control of nosebleed | $7,143 | CIGNA | $634 |
| 30903 | Control of nosebleed | $7,143 | LWCC | $251 |
| 30903 | Control of nosebleed | $7,143 | PPOPLUS | $4,841 |
| 30903 | Control of nosebleed | $7,143 | GILSBAR | $3,889 |
| 30903 | Control of nosebleed | $7,143 | LSU | $4,000 |
| 30903 | Control of nosebleed | $7,143 | VERITY | $134 |
| 30903 | Control of nosebleed | $7,143 | MULTIPLAN | $134 |
| 30903 | Control of nosebleed | $7,143 | LA WORK COMP | $7,143 |
| 30903 | Control of nosebleed | $7,143 | | |
| 42962 | Control throat bleeding | $7,114 | Private Pay | $7,904 |
| 42962 | Control throat bleeding | $7,114 | BC PPO | $2,678 |
| 42962 | Control throat bleeding | $7,114 | BC HMO | $2,350 |
| 42962 | Control throat bleeding | $7,114 | BC FMOL | $2,372 |
| 42962 | Control throat bleeding | $7,114 | MEDICARE | $2,343 |
| 42962 | Control throat bleeding | $7,114 | MEDICARE – BLUE CROSS | $2,343 |
| 42962 | Control throat bleeding | $7,114 | MEDICARE – UNITED | $2,343 |
| 42962 | Control throat bleeding | $7,114 | MEDICARE – COVENTRY | $2,343 |
| 42962 | Control throat bleeding | $7,114 | MEDICARE – VANTAGE | $2,343 |
| 42962 | Control throat bleeding | $7,114 | MEDICARE -PEOPLES | $2,343 |
| 42962 | Control throat bleeding | $7,114 | MEDICARE- HUMANA | $2,296 |
| 42962 | Control throat bleeding | $7,114 | HUMANA | $3,515 |
| 42962 | Control throat bleeding | $7,114 | VANTAGE | $3,983 |
| 42962 | Control throat bleeding | $7,114 | MEDICAID | $466 |
| 42962 | Control throat bleeding | $7,114 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 42962 | Control throat bleeding | $7,114 | MEDICAID – UNITED | $466 |
| 42962 | Control throat bleeding | $7,114 | MEDICAID – HEALTHY BLUE | $466 |
| 42962 | Control throat bleeding | $7,114 | MEDICAID – AMERIHEALTH | $466 |
| 42962 | Control throat bleeding | $7,114 | UNITED | $2,188 |
| 42962 | Control throat bleeding | $7,114 | AETNA | $1,000 |
| 42962 | Control throat bleeding | $7,114 | CIGNA | $992 |
| 42962 | Control throat bleeding | $7,114 | LWCC | $6,024 |
| 42962 | Control throat bleeding | $7,114 | PPOPLUS | $4,822 |
| 42962 | Control throat bleeding | $7,114 | GILSBAR | $3,873 |
| 42962 | Control throat bleeding | $7,114 | LSU | $4,000 |
| 42962 | Control throat bleeding | $7,114 | VERITY | $2,815 |
| 42962 | Control throat bleeding | $7,114 | MULTIPLAN | $2,815 |
| 42962 | Control throat bleeding | $7,114 | LA WORK COMP | $7,114 |
| 42962 | Control throat bleeding | $7,114 | | |
| 28292 | Correction of bunion | $15,854 | Private Pay | $17,114 |
| 28292 | Correction of bunion | $15,854 | BC PPO | $2,296 |
| 28292 | Correction of bunion | $15,854 | BC HMO | $2,015 |
| 28292 | Correction of bunion | $15,854 | BC FMOL | $2,034 |
| 28292 | Correction of bunion | $15,854 | MEDICARE | $2,449 |
| 28292 | Correction of bunion | $15,854 | MEDICARE – BLUE CROSS | $2,449 |
| 28292 | Correction of bunion | $15,854 | MEDICARE – UNITED | $2,449 |
| 28292 | Correction of bunion | $15,854 | MEDICARE – COVENTRY | $2,449 |
| 28292 | Correction of bunion | $15,854 | MEDICARE – VANTAGE | $2,449 |
| 28292 | Correction of bunion | $15,854 | MEDICARE -PEOPLES | $2,449 |
| 28292 | Correction of bunion | $15,854 | MEDICARE- HUMANA | $2,400 |
| 28292 | Correction of bunion | $15,854 | HUMANA | $3,673 |
| 28292 | Correction of bunion | $15,854 | VANTAGE | $4,163 |
| 28292 | Correction of bunion | $15,854 | MEDICAID | $466 |
| 28292 | Correction of bunion | $15,854 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28292 | Correction of bunion | $15,854 | MEDICAID – UNITED | $466 |
| 28292 | Correction of bunion | $15,854 | MEDICAID – HEALTHY BLUE | $466 |
| 28292 | Correction of bunion | $15,854 | MEDICAID – AMERIHEALTH | $466 |
| 28292 | Correction of bunion | $15,854 | UNITED | $2,923 |
| 28292 | Correction of bunion | $15,854 | AETNA | $1,497 |
| 28292 | Correction of bunion | $15,854 | CIGNA | $854 |
| 28292 | Correction of bunion | $15,854 | LWCC | $6,296 |
| 28292 | Correction of bunion | $15,854 | PPOPLUS | $10,439 |
| 28292 | Correction of bunion | $15,854 | GILSBAR | $8,467 |
| 28292 | Correction of bunion | $15,854 | LSU | $4,587 |
| 28292 | Correction of bunion | $15,854 | VERITY | $3,386 |
| 28292 | Correction of bunion | $15,854 | MULTIPLAN | $3,386 |
| 28292 | Correction of bunion | $15,854 | LA WORK COMP | $15,854 |
| 28292 | Correction of bunion | $15,854 | | |
| 28296 | Correction of bunion | $16,435 | Private Pay | $16,984 |
| 28296 | Correction of bunion | $16,435 | BC PPO | $2,604 |
| 28296 | Correction of bunion | $16,435 | BC HMO | $2,285 |
| 28296 | Correction of bunion | $16,435 | BC FMOL | $2,307 |
| 28296 | Correction of bunion | $16,435 | MEDICARE | $2,449 |
| 28296 | Correction of bunion | $16,435 | MEDICARE – BLUE CROSS | $2,449 |
| 28296 | Correction of bunion | $16,435 | MEDICARE – UNITED | $2,449 |
| 28296 | Correction of bunion | $16,435 | MEDICARE – COVENTRY | $2,449 |
| 28296 | Correction of bunion | $16,435 | MEDICARE – VANTAGE | $2,449 |
| 28296 | Correction of bunion | $16,435 | MEDICARE -PEOPLES | $2,449 |
| 28296 | Correction of bunion | $16,435 | MEDICARE- HUMANA | $2,400 |
| 28296 | Correction of bunion | $16,435 | HUMANA | $3,673 |
| 28296 | Correction of bunion | $16,435 | VANTAGE | $4,163 |
| 28296 | Correction of bunion | $16,435 | MEDICAID | $533 |
| 28296 | Correction of bunion | $16,435 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 28296 | Correction of bunion | $16,435 | MEDICAID – UNITED | $533 |
| 28296 | Correction of bunion | $16,435 | MEDICAID – HEALTHY BLUE | $533 |
| 28296 | Correction of bunion | $16,435 | MEDICAID – AMERIHEALTH | $533 |
| 28296 | Correction of bunion | $16,435 | UNITED | $2,923 |
| 28296 | Correction of bunion | $16,435 | AETNA | $2,464 |
| 28296 | Correction of bunion | $16,435 | CIGNA | $2,619 |
| 28296 | Correction of bunion | $16,435 | LWCC | $6,296 |
| 28296 | Correction of bunion | $16,435 | PPOPLUS | $10,360 |
| 28296 | Correction of bunion | $16,435 | GILSBAR | $8,529 |
| 28296 | Correction of bunion | $16,435 | LSU | $5,494 |
| 28296 | Correction of bunion | $16,435 | VERITY | $3,386 |
| 28296 | Correction of bunion | $16,435 | MULTIPLAN | $3,386 |
| 28296 | Correction of bunion | $16,435 | LA WORK COMP | $16,435 |
| 28296 | Correction of bunion | $16,435 | | |
| 28299 | Correction of bunion | $23,074 | Private Pay | $23,241 |
| 28299 | Correction of bunion | $23,074 | BC PPO | $2,296 |
| 28299 | Correction of bunion | $23,074 | BC HMO | $2,015 |
| 28299 | Correction of bunion | $23,074 | BC FMOL | $2,034 |
| 28299 | Correction of bunion | $23,074 | MEDICARE | $5,351 |
| 28299 | Correction of bunion | $23,074 | MEDICARE – BLUE CROSS | $5,351 |
| 28299 | Correction of bunion | $23,074 | MEDICARE – UNITED | $5,351 |
| 28299 | Correction of bunion | $23,074 | MEDICARE – COVENTRY | $5,351 |
| 28299 | Correction of bunion | $23,074 | MEDICARE – VANTAGE | $5,351 |
| 28299 | Correction of bunion | $23,074 | MEDICARE -PEOPLES | $5,351 |
| 28299 | Correction of bunion | $23,074 | MEDICARE- HUMANA | $5,244 |
| 28299 | Correction of bunion | $23,074 | HUMANA | $8,026 |
| 28299 | Correction of bunion | $23,074 | VANTAGE | $9,097 |
| 28299 | Correction of bunion | $23,074 | MEDICAID | $750 |
| 28299 | Correction of bunion | $23,074 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 28299 | Correction of bunion | $23,074 | MEDICAID – UNITED | $750 |
| 28299 | Correction of bunion | $23,074 | MEDICAID – HEALTHY BLUE | $750 |
| 28299 | Correction of bunion | $23,074 | MEDICAID – AMERIHEALTH | $750 |
| 28299 | Correction of bunion | $23,074 | UNITED | $2,923 |
| 28299 | Correction of bunion | $23,074 | AETNA | $4,023 |
| 28299 | Correction of bunion | $23,074 | CIGNA | $4,171 |
| 28299 | Correction of bunion | $23,074 | LWCC | $13,758 |
| 28299 | Correction of bunion | $23,074 | PPOPLUS | $14,177 |
| 28299 | Correction of bunion | $23,074 | GILSBAR | $11,776 |
| 28299 | Correction of bunion | $23,074 | LSU | $6,805 |
| 28299 | Correction of bunion | $23,074 | VERITY | $3,386 |
| 28299 | Correction of bunion | $23,074 | MULTIPLAN | $3,386 |
| 28299 | Correction of bunion | $23,074 | LA WORK COMP | $23,074 |
| 28299 | Correction of bunion | $23,074 | | |
| 69436 | Create eardrum opening | $4,477 | Private Pay | $4,912 |
| 69436 | Create eardrum opening | $4,477 | BC PPO | $1,474 |
| 69436 | Create eardrum opening | $4,477 | BC HMO | $1,294 |
| 69436 | Create eardrum opening | $4,477 | BC FMOL | $1,306 |
| 69436 | Create eardrum opening | $4,477 | MEDICARE | $1,207 |
| 69436 | Create eardrum opening | $4,477 | MEDICARE – BLUE CROSS | $1,207 |
| 69436 | Create eardrum opening | $4,477 | MEDICARE – UNITED | $1,207 |
| 69436 | Create eardrum opening | $4,477 | MEDICARE – COVENTRY | $1,207 |
| 69436 | Create eardrum opening | $4,477 | MEDICARE – VANTAGE | $1,207 |
| 69436 | Create eardrum opening | $4,477 | MEDICARE -PEOPLES | $1,207 |
| 69436 | Create eardrum opening | $4,477 | MEDICARE- HUMANA | $1,183 |
| 69436 | Create eardrum opening | $4,477 | HUMANA | $1,811 |
| 69436 | Create eardrum opening | $4,477 | VANTAGE | $2,052 |
| 69436 | Create eardrum opening | $4,477 | MEDICAID | $533 |
| 69436 | Create eardrum opening | $4,477 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 69436 | Create eardrum opening | $4,477 | MEDICAID – UNITED | $533 |
| 69436 | Create eardrum opening | $4,477 | MEDICAID – HEALTHY BLUE | $533 |
| 69436 | Create eardrum opening | $4,477 | MEDICAID – AMERIHEALTH | $533 |
| 69436 | Create eardrum opening | $4,477 | UNITED | $734 |
| 69436 | Create eardrum opening | $4,477 | AETNA | $1,262 |
| 69436 | Create eardrum opening | $4,477 | CIGNA | $1,066 |
| 69436 | Create eardrum opening | $4,477 | LWCC | $3,103 |
| 69436 | Create eardrum opening | $4,477 | PPOPLUS | $2,996 |
| 69436 | Create eardrum opening | $4,477 | GILSBAR | $2,417 |
| 69436 | Create eardrum opening | $4,477 | LSU | $4,073 |
| 69436 | Create eardrum opening | $4,477 | VERITY | $1,457 |
| 69436 | Create eardrum opening | $4,477 | MULTIPLAN | $1,457 |
| 69436 | Create eardrum opening | $4,477 | LA WORK COMP | $4,477 |
| 69436 | Create eardrum opening | $4,477 | | |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | Private Pay | $14,077 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | BC PPO | $4,705 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | BC HMO | $4,128 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | BC FMOL | $4,168 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICARE | $3,785 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICARE – BLUE CROSS | $3,785 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICARE – UNITED | $3,785 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICARE – COVENTRY | $3,785 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICARE – VANTAGE | $3,785 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICARE -PEOPLES | $3,785 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICARE- HUMANA | $3,710 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | HUMANA | $5,678 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | VANTAGE | $6,435 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICAID | $659 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICAID – UNITED | $659 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICAID – HEALTHY BLUE | $659 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MEDICAID – AMERIHEALTH | $659 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | UNITED | $3,860 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | AETNA | $1,848 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | CIGNA | $1,439 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | LWCC | $9,733 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | PPOPLUS | $8,587 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | GILSBAR | $6,959 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | LSU | $4,441 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | VERITY | $4,743 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | MULTIPLAN | $4,743 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | LA WORK COMP | $13,008 |
| 52356 | Cysto/uretero w/lithotripsy | $13,008 | | |
| 52000 | Cystoscopy | $7,126 | Private Pay | $7,917 |
| 52000 | Cystoscopy | $7,126 | BC PPO | $733 |
| 52000 | Cystoscopy | $7,126 | BC HMO | $643 |
| 52000 | Cystoscopy | $7,126 | BC FMOL | $649 |
| 52000 | Cystoscopy | $7,126 | MEDICARE | $498 |
| 52000 | Cystoscopy | $7,126 | MEDICARE – BLUE CROSS | $498 |
| 52000 | Cystoscopy | $7,126 | MEDICARE – UNITED | $498 |
| 52000 | Cystoscopy | $7,126 | MEDICARE – COVENTRY | $498 |
| 52000 | Cystoscopy | $7,126 | MEDICARE – VANTAGE | $498 |
| 52000 | Cystoscopy | $7,126 | MEDICARE -PEOPLES | $498 |
| 52000 | Cystoscopy | $7,126 | MEDICARE- HUMANA | $488 |
| 52000 | Cystoscopy | $7,126 | HUMANA | $747 |
| 52000 | Cystoscopy | $7,126 | VANTAGE | $846 |
| 52000 | Cystoscopy | $7,126 | MEDICAID | $348 |
| 52000 | Cystoscopy | $7,126 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 52000 | Cystoscopy | $7,126 | MEDICAID – UNITED | $348 |
| 52000 | Cystoscopy | $7,126 | MEDICAID – HEALTHY BLUE | $348 |
| 52000 | Cystoscopy | $7,126 | MEDICAID – AMERIHEALTH | $348 |
| 52000 | Cystoscopy | $7,126 | UNITED | $610 |
| 52000 | Cystoscopy | $7,126 | AETNA | $750 |
| 52000 | Cystoscopy | $7,126 | CIGNA | $1,433 |
| 52000 | Cystoscopy | $7,126 | LWCC | $1,280 |
| 52000 | Cystoscopy | $7,126 | PPOPLUS | $4,830 |
| 52000 | Cystoscopy | $7,126 | GILSBAR | $3,879 |
| 52000 | Cystoscopy | $7,126 | LSU | $4,000 |
| 52000 | Cystoscopy | $7,126 | VERITY | $724 |
| 52000 | Cystoscopy | $7,126 | MULTIPLAN | $724 |
| 52000 | Cystoscopy | $7,126 | LA WORK COMP | $7,126 |
| 52000 | Cystoscopy | $7,126 | | |
| 52005 | Cystoscopy & ureter catheter | $8,075 | Private Pay | $8,633 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | BC PPO | $1,867 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | BC HMO | $1,638 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | BC FMOL | $1,654 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICARE | $1,585 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICARE – BLUE CROSS | $1,585 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICARE – UNITED | $1,585 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICARE – COVENTRY | $1,585 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICARE – VANTAGE | $1,585 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICARE -PEOPLES | $1,585 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICARE- HUMANA | $1,553 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | HUMANA | $2,377 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | VANTAGE | $2,694 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICAID | $466 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICAID – UNITED | $466 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICAID – HEALTHY BLUE | $466 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MEDICAID – AMERIHEALTH | $466 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | UNITED | $2,188 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | AETNA | $1,335 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | CIGNA | $1,102 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | LWCC | $4,075 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | PPOPLUS | $5,266 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | GILSBAR | $4,285 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | LSU | $4,396 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | VERITY | $2,170 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | MULTIPLAN | $2,170 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | LA WORK COMP | $8,075 |
| 52005 | Cystoscopy & ureter catheter | $8,075 | | |
| 52224 | Cystoscopy and treatment | $7,895 | Private Pay | $8,434 |
| 52224 | Cystoscopy and treatment | $7,895 | BC PPO | $2,065 |
| 52224 | Cystoscopy and treatment | $7,895 | BC HMO | $1,812 |
| 52224 | Cystoscopy and treatment | $7,895 | BC FMOL | $1,829 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICARE | $1,585 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICARE – BLUE CROSS | $1,585 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICARE – UNITED | $1,585 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICARE – COVENTRY | $1,585 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICARE – VANTAGE | $1,585 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICARE -PEOPLES | $1,585 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICARE- HUMANA | $1,553 |
| 52224 | Cystoscopy and treatment | $7,895 | HUMANA | $2,377 |
| 52224 | Cystoscopy and treatment | $7,895 | VANTAGE | $2,694 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICAID | $466 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICAID – UNITED | $466 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICAID – HEALTHY BLUE | $466 |
| 52224 | Cystoscopy and treatment | $7,895 | MEDICAID – AMERIHEALTH | $466 |
| 52224 | Cystoscopy and treatment | $7,895 | UNITED | $2,188 |
| 52224 | Cystoscopy and treatment | $7,895 | AETNA | $1,335 |
| 52224 | Cystoscopy and treatment | $7,895 | CIGNA | $1,394 |
| 52224 | Cystoscopy and treatment | $7,895 | LWCC | $4,075 |
| 52224 | Cystoscopy and treatment | $7,895 | PPOPLUS | $5,145 |
| 52224 | Cystoscopy and treatment | $7,895 | GILSBAR | $4,188 |
| 52224 | Cystoscopy and treatment | $7,895 | LSU | $4,396 |
| 52224 | Cystoscopy and treatment | $7,895 | VERITY | $2,170 |
| 52224 | Cystoscopy and treatment | $7,895 | MULTIPLAN | $2,170 |
| 52224 | Cystoscopy and treatment | $7,895 | LA WORK COMP | $7,895 |
| 52224 | Cystoscopy and treatment | $7,895 | | |
| 52234 | Cystoscopy and treatment | $9,353 | Private Pay | $10,041 |
| 52234 | Cystoscopy and treatment | $9,353 | BC PPO | $3,284 |
| 52234 | Cystoscopy and treatment | $9,353 | BC HMO | $2,881 |
| 52234 | Cystoscopy and treatment | $9,353 | BC FMOL | $2,909 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICARE | $2,700 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICARE – BLUE CROSS | $2,700 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICARE – UNITED | $2,700 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICARE – COVENTRY | $2,700 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICARE – VANTAGE | $2,700 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICARE -PEOPLES | $2,700 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICARE- HUMANA | $2,646 |
| 52234 | Cystoscopy and treatment | $9,353 | HUMANA | $4,050 |
| 52234 | Cystoscopy and treatment | $9,353 | VANTAGE | $4,590 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICAID | $466 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICAID – UNITED | $466 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICAID – HEALTHY BLUE | $466 |
| 52234 | Cystoscopy and treatment | $9,353 | MEDICAID – AMERIHEALTH | $466 |
| 52234 | Cystoscopy and treatment | $9,353 | UNITED | $2,188 |
| 52234 | Cystoscopy and treatment | $9,353 | AETNA | $1,348 |
| 52234 | Cystoscopy and treatment | $9,353 | CIGNA | $1,102 |
| 52234 | Cystoscopy and treatment | $9,353 | LWCC | $6,943 |
| 52234 | Cystoscopy and treatment | $9,353 | PPOPLUS | $6,125 |
| 52234 | Cystoscopy and treatment | $9,353 | GILSBAR | $4,977 |
| 52234 | Cystoscopy and treatment | $9,353 | LSU | $4,411 |
| 52234 | Cystoscopy and treatment | $9,353 | VERITY | $3,452 |
| 52234 | Cystoscopy and treatment | $9,353 | MULTIPLAN | $3,452 |
| 52234 | Cystoscopy and treatment | $9,353 | LA WORK COMP | $9,353 |
| 52234 | Cystoscopy and treatment | $9,353 | | |
| 52235 | Cystoscopy and treatment | $10,376 | Private Pay | $11,083 |
| 52235 | Cystoscopy and treatment | $10,376 | BC PPO | $3,284 |
| 52235 | Cystoscopy and treatment | $10,376 | BC HMO | $2,881 |
| 52235 | Cystoscopy and treatment | $10,376 | BC FMOL | $2,909 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICARE | $2,700 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICARE – BLUE CROSS | $2,700 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICARE – UNITED | $2,700 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICARE – COVENTRY | $2,700 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICARE – VANTAGE | $2,700 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICARE -PEOPLES | $2,700 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICARE- HUMANA | $2,646 |
| 52235 | Cystoscopy and treatment | $10,376 | HUMANA | $4,050 |
| 52235 | Cystoscopy and treatment | $10,376 | VANTAGE | $4,590 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICAID | $533 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICAID – UNITED | $533 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICAID – HEALTHY BLUE | $533 |
| 52235 | Cystoscopy and treatment | $10,376 | MEDICAID – AMERIHEALTH | $533 |
| 52235 | Cystoscopy and treatment | $10,376 | UNITED | $2,188 |
| 52235 | Cystoscopy and treatment | $10,376 | AETNA | $1,641 |
| 52235 | Cystoscopy and treatment | $10,376 | CIGNA | $854 |
| 52235 | Cystoscopy and treatment | $10,376 | LWCC | $6,943 |
| 52235 | Cystoscopy and treatment | $10,376 | PPOPLUS | $6,760 |
| 52235 | Cystoscopy and treatment | $10,376 | GILSBAR | $5,503 |
| 52235 | Cystoscopy and treatment | $10,376 | LSU | $4,522 |
| 52235 | Cystoscopy and treatment | $10,376 | VERITY | $3,452 |
| 52235 | Cystoscopy and treatment | $10,376 | MULTIPLAN | $3,452 |
| 52235 | Cystoscopy and treatment | $10,376 | LA WORK COMP | $10,376 |
| 52235 | Cystoscopy and treatment | $10,376 | | |
| 52240 | Cystoscopy and treatment | $12,612 | Private Pay | $13,619 |
| 52240 | Cystoscopy and treatment | $12,612 | BC PPO | $4,513 |
| 52240 | Cystoscopy and treatment | $12,612 | BC HMO | $3,960 |
| 52240 | Cystoscopy and treatment | $12,612 | BC FMOL | $3,998 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICARE | $3,785 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICARE – BLUE CROSS | $3,785 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICARE – UNITED | $3,785 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICARE – COVENTRY | $3,785 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICARE – VANTAGE | $3,785 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICARE -PEOPLES | $3,785 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICARE- HUMANA | $3,710 |
| 52240 | Cystoscopy and treatment | $12,612 | HUMANA | $5,678 |
| 52240 | Cystoscopy and treatment | $12,612 | VANTAGE | $6,435 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICAID | $533 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICAID – UNITED | $533 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICAID – HEALTHY BLUE | $533 |
| 52240 | Cystoscopy and treatment | $12,612 | MEDICAID – AMERIHEALTH | $533 |
| 52240 | Cystoscopy and treatment | $12,612 | UNITED | $2,188 |
| 52240 | Cystoscopy and treatment | $12,612 | AETNA | $1,591 |
| 52240 | Cystoscopy and treatment | $12,612 | CIGNA | $1,102 |
| 52240 | Cystoscopy and treatment | $12,612 | LWCC | $9,733 |
| 52240 | Cystoscopy and treatment | $12,612 | PPOPLUS | $8,307 |
| 52240 | Cystoscopy and treatment | $12,612 | GILSBAR | $6,737 |
| 52240 | Cystoscopy and treatment | $12,612 | LSU | $4,462 |
| 52240 | Cystoscopy and treatment | $12,612 | VERITY | $4,743 |
| 52240 | Cystoscopy and treatment | $12,612 | MULTIPLAN | $4,743 |
| 52240 | Cystoscopy and treatment | $12,612 | LA WORK COMP | $12,612 |
| 52240 | Cystoscopy and treatment | $12,612 | | |
| 52276 | Cystoscopy and treatment | $8,903 | Private Pay | $9,892 |
| 52276 | Cystoscopy and treatment | $8,903 | BC PPO | $2,065 |
| 52276 | Cystoscopy and treatment | $8,903 | BC HMO | $1,812 |
| 52276 | Cystoscopy and treatment | $8,903 | BC FMOL | $1,829 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICARE | $1,585 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICARE – BLUE CROSS | $1,585 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICARE – UNITED | $1,585 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICARE – COVENTRY | $1,585 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICARE – VANTAGE | $1,585 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICARE -PEOPLES | $1,585 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICARE- HUMANA | $1,553 |
| 52276 | Cystoscopy and treatment | $8,903 | HUMANA | $2,377 |
| 52276 | Cystoscopy and treatment | $8,903 | VANTAGE | $2,694 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICAID | $533 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICAID – UNITED | $533 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICAID – HEALTHY BLUE | $533 |
| 52276 | Cystoscopy and treatment | $8,903 | MEDICAID – AMERIHEALTH | $533 |
| 52276 | Cystoscopy and treatment | $8,903 | UNITED | $2,188 |
| 52276 | Cystoscopy and treatment | $8,903 | AETNA | $1,200 |
| 52276 | Cystoscopy and treatment | $8,903 | CIGNA | $992 |
| 52276 | Cystoscopy and treatment | $8,903 | LWCC | $4,075 |
| 52276 | Cystoscopy and treatment | $8,903 | PPOPLUS | $6,034 |
| 52276 | Cystoscopy and treatment | $8,903 | GILSBAR | $4,847 |
| 52276 | Cystoscopy and treatment | $8,903 | LSU | $4,000 |
| 52276 | Cystoscopy and treatment | $8,903 | VERITY | $2,170 |
| 52276 | Cystoscopy and treatment | $8,903 | MULTIPLAN | $2,170 |
| 52276 | Cystoscopy and treatment | $8,903 | LA WORK COMP | $8,903 |
| 52276 | Cystoscopy and treatment | $8,903 | | |
| 52281 | Cystoscopy and treatment | $7,689 | Private Pay | $8,543 |
| 52281 | Cystoscopy and treatment | $7,689 | BC PPO | $2,153 |
| 52281 | Cystoscopy and treatment | $7,689 | BC HMO | $1,889 |
| 52281 | Cystoscopy and treatment | $7,689 | BC FMOL | $1,907 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICARE | $1,585 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICARE – BLUE CROSS | $1,585 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICARE – UNITED | $1,585 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICARE – COVENTRY | $1,585 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICARE – VANTAGE | $1,585 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICARE -PEOPLES | $1,585 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICARE- HUMANA | $1,553 |
| 52281 | Cystoscopy and treatment | $7,689 | HUMANA | $2,377 |
| 52281 | Cystoscopy and treatment | $7,689 | VANTAGE | $2,694 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICAID | $466 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICAID – UNITED | $466 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICAID – HEALTHY BLUE | $466 |
| 52281 | Cystoscopy and treatment | $7,689 | MEDICAID – AMERIHEALTH | $466 |
| 52281 | Cystoscopy and treatment | $7,689 | UNITED | $734 |
| 52281 | Cystoscopy and treatment | $7,689 | AETNA | $1,000 |
| 52281 | Cystoscopy and treatment | $7,689 | CIGNA | $1,323 |
| 52281 | Cystoscopy and treatment | $7,689 | LWCC | $4,075 |
| 52281 | Cystoscopy and treatment | $7,689 | PPOPLUS | $5,211 |
| 52281 | Cystoscopy and treatment | $7,689 | GILSBAR | $4,186 |
| 52281 | Cystoscopy and treatment | $7,689 | LSU | $4,000 |
| 52281 | Cystoscopy and treatment | $7,689 | VERITY | $2,170 |
| 52281 | Cystoscopy and treatment | $7,689 | MULTIPLAN | $2,170 |
| 52281 | Cystoscopy and treatment | $7,689 | LA WORK COMP | $7,689 |
| 52281 | Cystoscopy and treatment | $7,689 | | |
| 52310 | Cystoscopy and treatment | $5,787 | Private Pay | $6,430 |
| 52310 | Cystoscopy and treatment | $5,787 | BC PPO | $2,153 |
| 52310 | Cystoscopy and treatment | $5,787 | BC HMO | $1,889 |
| 52310 | Cystoscopy and treatment | $5,787 | BC FMOL | $1,907 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICARE | $1,585 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICARE – BLUE CROSS | $1,585 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICARE – UNITED | $1,585 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICARE – COVENTRY | $1,585 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICARE – VANTAGE | $1,585 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICARE -PEOPLES | $1,585 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICARE- HUMANA | $1,553 |
| 52310 | Cystoscopy and treatment | $5,787 | HUMANA | $2,377 |
| 52310 | Cystoscopy and treatment | $5,787 | VANTAGE | $2,694 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICAID | $466 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICAID – UNITED | $466 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICAID – HEALTHY BLUE | $466 |
| 52310 | Cystoscopy and treatment | $5,787 | MEDICAID – AMERIHEALTH | $466 |
| 52310 | Cystoscopy and treatment | $5,787 | UNITED | $734 |
| 52310 | Cystoscopy and treatment | $5,787 | AETNA | $1,000 |
| 52310 | Cystoscopy and treatment | $5,787 | CIGNA | $1,323 |
| 52310 | Cystoscopy and treatment | $5,787 | LWCC | $4,075 |
| 52310 | Cystoscopy and treatment | $5,787 | PPOPLUS | $3,922 |
| 52310 | Cystoscopy and treatment | $5,787 | GILSBAR | $3,151 |
| 52310 | Cystoscopy and treatment | $5,787 | LSU | $4,000 |
| 52310 | Cystoscopy and treatment | $5,787 | VERITY | $2,170 |
| 52310 | Cystoscopy and treatment | $5,787 | MULTIPLAN | $2,170 |
| 52310 | Cystoscopy and treatment | $5,787 | LA WORK COMP | $5,787 |
| 52310 | Cystoscopy and treatment | $5,787 | | |
| 52332 | Cystoscopy and treatment | $9,145 | Private Pay | $9,747 |
| 52332 | Cystoscopy and treatment | $9,145 | BC PPO | $2,969 |
| 52332 | Cystoscopy and treatment | $9,145 | BC HMO | $2,606 |
| 52332 | Cystoscopy and treatment | $9,145 | BC FMOL | $2,630 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICARE | $2,700 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICARE – BLUE CROSS | $2,700 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICARE – UNITED | $2,700 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICARE – COVENTRY | $2,700 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICARE – VANTAGE | $2,700 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICARE -PEOPLES | $2,700 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICARE- HUMANA | $2,646 |
| 52332 | Cystoscopy and treatment | $9,145 | HUMANA | $4,050 |
| 52332 | Cystoscopy and treatment | $9,145 | VANTAGE | $4,590 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICAID | $466 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICAID – UNITED | $466 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICAID – HEALTHY BLUE | $466 |
| 52332 | Cystoscopy and treatment | $9,145 | MEDICAID – AMERIHEALTH | $466 |
| 52332 | Cystoscopy and treatment | $9,145 | UNITED | $2,188 |
| 52332 | Cystoscopy and treatment | $9,145 | AETNA | $1,410 |
| 52332 | Cystoscopy and treatment | $9,145 | CIGNA | $634 |
| 52332 | Cystoscopy and treatment | $9,145 | LWCC | $6,943 |
| 52332 | Cystoscopy and treatment | $9,145 | PPOPLUS | $5,946 |
| 52332 | Cystoscopy and treatment | $9,145 | GILSBAR | $4,843 |
| 52332 | Cystoscopy and treatment | $9,145 | LSU | $4,485 |
| 52332 | Cystoscopy and treatment | $9,145 | VERITY | $3,452 |
| 52332 | Cystoscopy and treatment | $9,145 | MULTIPLAN | $3,452 |
| 52332 | Cystoscopy and treatment | $9,145 | LA WORK COMP | $9,145 |
| 52332 | Cystoscopy and treatment | $9,145 | | |
| 52287 | Cystoscopy chemodenervation | $8,837 | Private Pay | $8,741 |
| 52287 | Cystoscopy chemodenervation | $8,837 | BC PPO | $2,153 |
| 52287 | Cystoscopy chemodenervation | $8,837 | BC HMO | $1,889 |
| 52287 | Cystoscopy chemodenervation | $8,837 | BC FMOL | $1,907 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICARE | $1,585 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICARE – BLUE CROSS | $1,585 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICARE – UNITED | $1,585 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICARE – COVENTRY | $1,585 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICARE – VANTAGE | $1,585 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICARE -PEOPLES | $1,585 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICARE- HUMANA | $1,553 |
| 52287 | Cystoscopy chemodenervation | $8,837 | HUMANA | $2,377 |
| 52287 | Cystoscopy chemodenervation | $8,837 | VANTAGE | $2,694 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICAID | $466 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICAID – UNITED | $466 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICAID – HEALTHY BLUE | $466 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MEDICAID – AMERIHEALTH | $466 |
| 52287 | Cystoscopy chemodenervation | $8,837 | UNITED | $734 |
| 52287 | Cystoscopy chemodenervation | $8,837 | AETNA | $2,067 |
| 52287 | Cystoscopy chemodenervation | $8,837 | CIGNA | $2,272 |
| 52287 | Cystoscopy chemodenervation | $8,837 | LWCC | $4,075 |
| 52287 | Cystoscopy chemodenervation | $8,837 | PPOPLUS | $5,332 |
| 52287 | Cystoscopy chemodenervation | $8,837 | GILSBAR | $4,458 |
| 52287 | Cystoscopy chemodenervation | $8,837 | LSU | $5,261 |
| 52287 | Cystoscopy chemodenervation | $8,837 | VERITY | $2,170 |
| 52287 | Cystoscopy chemodenervation | $8,837 | MULTIPLAN | $2,170 |
| 52287 | Cystoscopy chemodenervation | $8,837 | LA WORK COMP | $8,837 |
| 52287 | Cystoscopy chemodenervation | $8,837 | | |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | Private Pay | $8,859 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | BC PPO | $1,867 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | BC HMO | $1,638 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | BC FMOL | $1,654 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICARE | $1,585 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICARE – BLUE CROSS | $1,585 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICARE – UNITED | $1,585 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICARE – COVENTRY | $1,585 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICARE – VANTAGE | $1,585 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICARE -PEOPLES | $1,585 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICARE- HUMANA | $1,553 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | HUMANA | $2,377 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | VANTAGE | $2,694 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICAID | $466 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICAID – UNITED | $466 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICAID – HEALTHY BLUE | $466 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MEDICAID – AMERIHEALTH | $466 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | UNITED | $2,188 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | AETNA | $1,335 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | CIGNA | $1,394 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | LWCC | $4,075 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | PPOPLUS | $5,404 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | GILSBAR | $4,396 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | LSU | $4,396 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | VERITY | $2,170 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | MULTIPLAN | $2,170 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | LA WORK COMP | $8,278 |
| 52204 | Cystoscopy w/biopsy(s) | $8,278 | | |
| 52351 | Cystouretero & or pyeloscope | $8,277 | Private Pay | $9,196 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | BC PPO | $2,065 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | BC HMO | $1,812 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | BC FMOL | $1,829 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICARE | $2,700 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICARE – BLUE CROSS | $2,700 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICARE – UNITED | $2,700 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICARE – COVENTRY | $2,700 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICARE – VANTAGE | $2,700 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICARE -PEOPLES | $2,700 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICARE- HUMANA | $2,646 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | HUMANA | $4,050 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | VANTAGE | $4,590 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICAID | $533 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICAID – UNITED | $533 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICAID – HEALTHY BLUE | $533 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MEDICAID – AMERIHEALTH | $533 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | UNITED | $2,188 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | AETNA | $1,200 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | CIGNA | $1,102 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | LWCC | $6,943 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | PPOPLUS | $5,610 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | GILSBAR | $4,506 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | LSU | $4,000 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | VERITY | $2,170 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | MULTIPLAN | $2,170 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | LA WORK COMP | $8,277 |
| 52351 | Cystouretero & or pyeloscope | $8,277 | | |
| 52354 | Cystouretero w/biopsy | $13,740 | Private Pay | $14,893 |
| 52354 | Cystouretero w/biopsy | $13,740 | BC PPO | $4,513 |
| 52354 | Cystouretero w/biopsy | $13,740 | BC HMO | $3,960 |
| 52354 | Cystouretero w/biopsy | $13,740 | BC FMOL | $3,998 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICARE | $3,785 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICARE – BLUE CROSS | $3,785 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICARE – UNITED | $3,785 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICARE – COVENTRY | $3,785 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICARE – VANTAGE | $3,785 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICARE -PEOPLES | $3,785 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICARE- HUMANA | $3,710 |
| 52354 | Cystouretero w/biopsy | $13,740 | HUMANA | $5,678 |
| 52354 | Cystouretero w/biopsy | $13,740 | VANTAGE | $6,435 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICAID | $659 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICAID – UNITED | $659 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICAID – HEALTHY BLUE | $659 |
| 52354 | Cystouretero w/biopsy | $13,740 | MEDICAID – AMERIHEALTH | $659 |
| 52354 | Cystouretero w/biopsy | $13,740 | UNITED | $2,188 |
| 52354 | Cystouretero w/biopsy | $13,740 | AETNA | $1,845 |
| 52354 | Cystouretero w/biopsy | $13,740 | CIGNA | $854 |
| 52354 | Cystouretero w/biopsy | $13,740 | LWCC | $9,733 |
| 52354 | Cystouretero w/biopsy | $13,740 | PPOPLUS | $9,085 |
| 52354 | Cystouretero w/biopsy | $13,740 | GILSBAR | $7,358 |
| 52354 | Cystouretero w/biopsy | $13,740 | LSU | $4,437 |
| 52354 | Cystouretero w/biopsy | $13,740 | VERITY | $4,743 |
| 52354 | Cystouretero w/biopsy | $13,740 | MULTIPLAN | $4,743 |
| 52354 | Cystouretero w/biopsy | $13,740 | LA WORK COMP | $13,740 |
| 52354 | Cystouretero w/biopsy | $13,740 | | |
| 52352 | Cystouretero w/stone remove | $11,685 | Private Pay | $12,595 |
| 52352 | Cystouretero w/stone remove | $11,685 | BC PPO | $4,081 |
| 52352 | Cystouretero w/stone remove | $11,685 | BC HMO | $3,581 |
| 52352 | Cystouretero w/stone remove | $11,685 | BC FMOL | $3,615 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICARE | $2,700 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICARE – BLUE CROSS | $2,700 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICARE – UNITED | $2,700 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICARE – COVENTRY | $2,700 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICARE – VANTAGE | $2,700 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICARE -PEOPLES | $2,700 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICARE- HUMANA | $2,646 |
| 52352 | Cystouretero w/stone remove | $11,685 | HUMANA | $4,050 |
| 52352 | Cystouretero w/stone remove | $11,685 | VANTAGE | $4,590 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICAID | $659 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICAID – UNITED | $659 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICAID – HEALTHY BLUE | $659 |
| 52352 | Cystouretero w/stone remove | $11,685 | MEDICAID – AMERIHEALTH | $659 |
| 52352 | Cystouretero w/stone remove | $11,685 | UNITED | $2,188 |
| 52352 | Cystouretero w/stone remove | $11,685 | AETNA | $1,860 |
| 52352 | Cystouretero w/stone remove | $11,685 | CIGNA | $634 |
| 52352 | Cystouretero w/stone remove | $11,685 | LWCC | $6,943 |
| 52352 | Cystouretero w/stone remove | $11,685 | PPOPLUS | $7,683 |
| 52352 | Cystouretero w/stone remove | $11,685 | GILSBAR | $6,234 |
| 52352 | Cystouretero w/stone remove | $11,685 | LSU | $4,455 |
| 52352 | Cystouretero w/stone remove | $11,685 | VERITY | $4,743 |
| 52352 | Cystouretero w/stone remove | $11,685 | MULTIPLAN | $4,743 |
| 52352 | Cystouretero w/stone remove | $11,685 | LA WORK COMP | $11,685 |
| 52352 | Cystouretero w/stone remove | $11,685 | | |
| 11044 | Deb bone 20 sq cm/< | $9,190 | Private Pay | $9,758 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | BC PPO | $1,641 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | BC HMO | $1,440 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | BC FMOL | $1,454 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICARE | $1,228 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICARE – BLUE CROSS | $1,228 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICARE – UNITED | $1,228 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICARE – COVENTRY | $1,228 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICARE – VANTAGE | $1,228 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICARE -PEOPLES | $1,228 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICARE- HUMANA | $1,203 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | HUMANA | $1,842 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | VANTAGE | $2,087 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICAID | $466 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICAID – UNITED | $466 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICAID – HEALTHY BLUE | $466 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MEDICAID – AMERIHEALTH | $466 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | UNITED | $610 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | AETNA | $1,449 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | CIGNA | $1,323 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | LWCC | $3,157 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | PPOPLUS | $5,952 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | GILSBAR | $4,855 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | LSU | $4,530 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | VERITY | $1,725 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | MULTIPLAN | $1,725 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | LA WORK COMP | $9,190 |
| 11044 | Deb bone 20 sq cm/< | $9,190 | | |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | Private Pay | $9,918 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | BC PPO | $632 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | BC HMO | $555 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | BC FMOL | $560 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICARE | $445 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICARE – BLUE CROSS | $445 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICARE – UNITED | $445 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICARE – COVENTRY | $445 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICARE – VANTAGE | $445 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICARE -PEOPLES | $445 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICARE- HUMANA | $436 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | HUMANA | $667 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | VANTAGE | $756 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICAID | $466 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICAID – UNITED | $466 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICAID – HEALTHY BLUE | $466 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MEDICAID – AMERIHEALTH | $466 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | UNITED | $392 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | AETNA | $1,000 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | CIGNA | $1,323 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | LWCC | $1,143 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | PPOPLUS | $6,050 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | GILSBAR | $4,860 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | LSU | $4,000 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | VERITY | $625 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | MULTIPLAN | $625 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | LA WORK COMP | $8,926 |
| 11043 | Deb musc/fascia 20 sq cm/< | $8,926 | | |
| 11012 | Deb skin bone at fx site | $6,502 | Private Pay | $7,208 |
| 11012 | Deb skin bone at fx site | $6,502 | BC PPO | $2,560 |
| 11012 | Deb skin bone at fx site | $6,502 | BC HMO | $2,246 |
| 11012 | Deb skin bone at fx site | $6,502 | BC FMOL | $2,268 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICARE | $2,074 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICARE – BLUE CROSS | $2,074 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICARE – UNITED | $2,074 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICARE – COVENTRY | $2,074 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICARE – VANTAGE | $2,074 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICARE -PEOPLES | $2,074 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICARE- HUMANA | $2,033 |
| 11012 | Deb skin bone at fx site | $6,502 | HUMANA | $3,111 |
| 11012 | Deb skin bone at fx site | $6,502 | VANTAGE | $466 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICAID | $466 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICAID – UNITED | $466 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICAID – HEALTHY BLUE | $466 |
| 11012 | Deb skin bone at fx site | $6,502 | MEDICAID – AMERIHEALTH | $466 |
| 11012 | Deb skin bone at fx site | $6,502 | UNITED | $610 |
| 11012 | Deb skin bone at fx site | $6,502 | AETNA | $1,016 |
| 11012 | Deb skin bone at fx site | $6,502 | CIGNA | $1,929 |
| 11012 | Deb skin bone at fx site | $6,502 | LWCC | $5,333 |
| 11012 | Deb skin bone at fx site | $6,502 | PPOPLUS | $4,397 |
| 11012 | Deb skin bone at fx site | $6,502 | GILSBAR | $3,535 |
| 11012 | Deb skin bone at fx site | $6,502 | LSU | $4,019 |
| 11012 | Deb skin bone at fx site | $6,502 | VERITY | $2,976 |
| 11012 | Deb skin bone at fx site | $6,502 | MULTIPLAN | $2,976 |
| 11012 | Deb skin bone at fx site | $6,502 | LA WORK COMP | $6,502 |
| 11012 | Deb skin bone at fx site | $6,502 | | |
| 11010 | Debride skin at fx site | $7,299 | Private Pay | $8,110 |
| 11010 | Debride skin at fx site | $7,299 | BC PPO | $742 |
| 11010 | Debride skin at fx site | $7,299 | BC HMO | $651 |
| 11010 | Debride skin at fx site | $7,299 | BC FMOL | $657 |
| 11010 | Debride skin at fx site | $7,299 | MEDICARE | $546 |
| 11010 | Debride skin at fx site | $7,299 | MEDICARE – BLUE CROSS | $546 |
| 11010 | Debride skin at fx site | $7,299 | MEDICARE – UNITED | $546 |
| 11010 | Debride skin at fx site | $7,299 | MEDICARE – COVENTRY | $546 |
| 11010 | Debride skin at fx site | $7,299 | MEDICARE – VANTAGE | $546 |
| 11010 | Debride skin at fx site | $7,299 | MEDICARE -PEOPLES | $546 |
| 11010 | Debride skin at fx site | $7,299 | MEDICARE- HUMANA | $535 |
| 11010 | Debride skin at fx site | $7,299 | HUMANA | $818 |
| 11010 | Debride skin at fx site | $7,299 | VANTAGE | $928 |
| 11010 | Debride skin at fx site | $7,299 | MEDICAID | $466 |
| 11010 | Debride skin at fx site | $7,299 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 11010 | Debride skin at fx site | $7,299 | MEDICAID – UNITED | $466 |
| 11010 | Debride skin at fx site | $7,299 | MEDICAID – HEALTHY BLUE | $466 |
| 11010 | Debride skin at fx site | $7,299 | MEDICAID – AMERIHEALTH | $466 |
| 11010 | Debride skin at fx site | $7,299 | UNITED | $610 |
| 11010 | Debride skin at fx site | $7,299 | AETNA | $1,000 |
| 11010 | Debride skin at fx site | $7,299 | CIGNA | $1,102 |
| 11010 | Debride skin at fx site | $7,299 | LWCC | $1,403 |
| 11010 | Debride skin at fx site | $7,299 | PPOPLUS | $4,947 |
| 11010 | Debride skin at fx site | $7,299 | GILSBAR | $3,974 |
| 11010 | Debride skin at fx site | $7,299 | LSU | $4,000 |
| 11010 | Debride skin at fx site | $7,299 | VERITY | $733 |
| 11010 | Debride skin at fx site | $7,299 | MULTIPLAN | $733 |
| 11010 | Debride skin at fx site | $7,299 | LA WORK COMP | $7,299 |
| 11010 | Debride skin at fx site | $7,299 | | |
| 26020 | Drain hand tendon sheath | $9,194 | Private Pay | $10,216 |
| 26020 | Drain hand tendon sheath | $9,194 | BC PPO | $3,358 |
| 26020 | Drain hand tendon sheath | $9,194 | BC HMO | $2,947 |
| 26020 | Drain hand tendon sheath | $9,194 | BC FMOL | $2,975 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICARE | $2,449 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICARE – BLUE CROSS | $2,449 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICARE – UNITED | $2,449 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICARE – COVENTRY | $2,449 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICARE – VANTAGE | $2,449 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICARE -PEOPLES | $2,449 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICARE- HUMANA | $2,400 |
| 26020 | Drain hand tendon sheath | $9,194 | HUMANA | $3,673 |
| 26020 | Drain hand tendon sheath | $9,194 | VANTAGE | $4,163 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICAID | $466 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICAID – UNITED | $466 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICAID – HEALTHY BLUE | $466 |
| 26020 | Drain hand tendon sheath | $9,194 | MEDICAID – AMERIHEALTH | $466 |
| 26020 | Drain hand tendon sheath | $9,194 | UNITED | $734 |
| 26020 | Drain hand tendon sheath | $9,194 | AETNA | $1,000 |
| 26020 | Drain hand tendon sheath | $9,194 | CIGNA | $1,323 |
| 26020 | Drain hand tendon sheath | $9,194 | LWCC | $6,296 |
| 26020 | Drain hand tendon sheath | $9,194 | PPOPLUS | $6,232 |
| 26020 | Drain hand tendon sheath | $9,194 | GILSBAR | $5,006 |
| 26020 | Drain hand tendon sheath | $9,194 | LSU | $4,000 |
| 26020 | Drain hand tendon sheath | $9,194 | VERITY | $3,386 |
| 26020 | Drain hand tendon sheath | $9,194 | MULTIPLAN | $3,386 |
| 26020 | Drain hand tendon sheath | $9,194 | LA WORK COMP | $9,194 |
| 26020 | Drain hand tendon sheath | $9,194 | | |
| 27603 | Drain lower leg lesion | $10,145 | Private Pay | $11,273 |
| 27603 | Drain lower leg lesion | $10,145 | BC PPO | $3,012 |
| 27603 | Drain lower leg lesion | $10,145 | BC HMO | $2,643 |
| 27603 | Drain lower leg lesion | $10,145 | BC FMOL | $2,668 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICARE | $2,074 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICARE – BLUE CROSS | $2,074 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICARE – UNITED | $2,074 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICARE – COVENTRY | $2,074 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICARE – VANTAGE | $2,074 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICARE -PEOPLES | $2,074 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICARE- HUMANA | $2,033 |
| 27603 | Drain lower leg lesion | $10,145 | HUMANA | $3,111 |
| 27603 | Drain lower leg lesion | $10,145 | VANTAGE | $3,526 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICAID | $466 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICAID – UNITED | $466 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICAID – HEALTHY BLUE | $466 |
| 27603 | Drain lower leg lesion | $10,145 | MEDICAID – AMERIHEALTH | $466 |
| 27603 | Drain lower leg lesion | $10,145 | UNITED | $2,188 |
| 27603 | Drain lower leg lesion | $10,145 | AETNA | $1,000 |
| 27603 | Drain lower leg lesion | $10,145 | CIGNA | $854 |
| 27603 | Drain lower leg lesion | $10,145 | LWCC | $5,333 |
| 27603 | Drain lower leg lesion | $10,145 | PPOPLUS | $6,876 |
| 27603 | Drain lower leg lesion | $10,145 | GILSBAR | $5,524 |
| 27603 | Drain lower leg lesion | $10,145 | LSU | $4,000 |
| 27603 | Drain lower leg lesion | $10,145 | VERITY | $2,976 |
| 27603 | Drain lower leg lesion | $10,145 | MULTIPLAN | $2,976 |
| 27603 | Drain lower leg lesion | $10,145 | LA WORK COMP | $10,145 |
| 27603 | Drain lower leg lesion | $10,145 | | |
| 27301 | Drain thigh/knee lesion | $11,492 | Private Pay | $10,515 |
| 27301 | Drain thigh/knee lesion | $11,492 | BC PPO | $2,951 |
| 27301 | Drain thigh/knee lesion | $11,492 | BC HMO | $2,590 |
| 27301 | Drain thigh/knee lesion | $11,492 | BC FMOL | $2,614 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICARE | $2,074 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICARE – BLUE CROSS | $2,074 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICARE – UNITED | $2,074 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICARE – COVENTRY | $2,074 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICARE – VANTAGE | $2,074 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICARE -PEOPLES | $2,074 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICARE- HUMANA | $2,033 |
| 27301 | Drain thigh/knee lesion | $11,492 | HUMANA | $3,111 |
| 27301 | Drain thigh/knee lesion | $11,492 | VANTAGE | $3,526 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICAID | $533 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICAID – UNITED | $533 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICAID – HEALTHY BLUE | $533 |
| 27301 | Drain thigh/knee lesion | $11,492 | MEDICAID – AMERIHEALTH | $533 |
| 27301 | Drain thigh/knee lesion | $11,492 | UNITED | $2,188 |
| 27301 | Drain thigh/knee lesion | $11,492 | AETNA | $3,431 |
| 27301 | Drain thigh/knee lesion | $11,492 | CIGNA | $3,780 |
| 27301 | Drain thigh/knee lesion | $11,492 | LWCC | $5,333 |
| 27301 | Drain thigh/knee lesion | $11,492 | PPOPLUS | $6,414 |
| 27301 | Drain thigh/knee lesion | $11,492 | GILSBAR | $5,518 |
| 27301 | Drain thigh/knee lesion | $11,492 | LSU | $6,637 |
| 27301 | Drain thigh/knee lesion | $11,492 | VERITY | $2,976 |
| 27301 | Drain thigh/knee lesion | $11,492 | MULTIPLAN | $2,976 |
| 27301 | Drain thigh/knee lesion | $11,492 | LA WORK COMP | $11,492 |
| 27301 | Drain thigh/knee lesion | $11,492 | | |
| 26011 | Drainage of finger abscess | $6,162 | Private Pay | $6,847 |
| 26011 | Drainage of finger abscess | $6,162 | BC PPO | $1,711 |
| 26011 | Drainage of finger abscess | $6,162 | BC HMO | $1,502 |
| 26011 | Drainage of finger abscess | $6,162 | BC FMOL | $1,516 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICARE | $1,228 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICARE – BLUE CROSS | $1,228 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICARE – UNITED | $1,228 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICARE – COVENTRY | $1,228 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICARE – VANTAGE | $1,228 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICARE -PEOPLES | $1,228 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICARE- HUMANA | $1,203 |
| 26011 | Drainage of finger abscess | $6,162 | HUMANA | $1,842 |
| 26011 | Drainage of finger abscess | $6,162 | VANTAGE | $2,087 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICAID | $348 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICAID – UNITED | $348 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICAID – HEALTHY BLUE | $348 |
| 26011 | Drainage of finger abscess | $6,162 | MEDICAID – AMERIHEALTH | $348 |
| 26011 | Drainage of finger abscess | $6,162 | UNITED | $734 |
| 26011 | Drainage of finger abscess | $6,162 | AETNA | $750 |
| 26011 | Drainage of finger abscess | $6,162 | CIGNA | $1,102 |
| 26011 | Drainage of finger abscess | $6,162 | LWCC | $3,157 |
| 26011 | Drainage of finger abscess | $6,162 | PPOPLUS | $4,176 |
| 26011 | Drainage of finger abscess | $6,162 | GILSBAR | $3,355 |
| 26011 | Drainage of finger abscess | $6,162 | LSU | $4,000 |
| 26011 | Drainage of finger abscess | $6,162 | VERITY | $1,725 |
| 26011 | Drainage of finger abscess | $6,162 | MULTIPLAN | $1,725 |
| 26011 | Drainage of finger abscess | $6,162 | LA WORK COMP | $6,162 |
| 26011 | Drainage of finger abscess | $6,162 | | |
| 54700 | Drainage of scrotum | $8,814 | Private Pay | $9,793 |
| 54700 | Drainage of scrotum | $8,814 | BC PPO | $2,197 |
| 54700 | Drainage of scrotum | $8,814 | BC HMO | $1,927 |
| 54700 | Drainage of scrotum | $8,814 | BC FMOL | $1,946 |
| 54700 | Drainage of scrotum | $8,814 | MEDICARE | $1,585 |
| 54700 | Drainage of scrotum | $8,814 | MEDICARE – BLUE CROSS | $1,585 |
| 54700 | Drainage of scrotum | $8,814 | MEDICARE – UNITED | $1,585 |
| 54700 | Drainage of scrotum | $8,814 | MEDICARE – COVENTRY | $1,585 |
| 54700 | Drainage of scrotum | $8,814 | MEDICARE – VANTAGE | $1,585 |
| 54700 | Drainage of scrotum | $8,814 | MEDICARE -PEOPLES | $1,585 |
| 54700 | Drainage of scrotum | $8,814 | MEDICARE- HUMANA | $1,553 |
| 54700 | Drainage of scrotum | $8,814 | HUMANA | $2,377 |
| 54700 | Drainage of scrotum | $8,814 | VANTAGE | $2,694 |
| 54700 | Drainage of scrotum | $8,814 | MEDICAID | $466 |
| 54700 | Drainage of scrotum | $8,814 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 54700 | Drainage of scrotum | $8,814 | MEDICAID – UNITED | $466 |
| 54700 | Drainage of scrotum | $8,814 | MEDICAID – HEALTHY BLUE | $466 |
| 54700 | Drainage of scrotum | $8,814 | MEDICAID – AMERIHEALTH | $466 |
| 54700 | Drainage of scrotum | $8,814 | UNITED | $2,188 |
| 54700 | Drainage of scrotum | $8,814 | AETNA | $1,000 |
| 54700 | Drainage of scrotum | $8,814 | CIGNA | $2,756 |
| 54700 | Drainage of scrotum | $8,814 | LWCC | $4,075 |
| 54700 | Drainage of scrotum | $8,814 | PPOPLUS | $5,974 |
| 54700 | Drainage of scrotum | $8,814 | GILSBAR | $4,799 |
| 54700 | Drainage of scrotum | $8,814 | LSU | $4,000 |
| 54700 | Drainage of scrotum | $8,814 | VERITY | $2,170 |
| 54700 | Drainage of scrotum | $8,814 | MULTIPLAN | $2,170 |
| 54700 | Drainage of scrotum | $8,814 | LA WORK COMP | $8,814 |
| 54700 | Drainage of scrotum | $8,814 | | |
| 10061 | Drainage of skin abscess | $6,826 | Private Pay | $7,584 |
| 10061 | Drainage of skin abscess | $6,826 | BC PPO | $403 |
| 10061 | Drainage of skin abscess | $6,826 | BC HMO | $353 |
| 10061 | Drainage of skin abscess | $6,826 | BC FMOL | $357 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICARE | $286 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICARE – BLUE CROSS | $286 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICARE – UNITED | $286 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICARE – COVENTRY | $286 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICARE – VANTAGE | $286 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICARE -PEOPLES | $286 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICARE- HUMANA | $280 |
| 10061 | Drainage of skin abscess | $6,826 | HUMANA | $429 |
| 10061 | Drainage of skin abscess | $6,826 | VANTAGE | $486 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICAID | $348 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICAID – UNITED | $348 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICAID – HEALTHY BLUE | $348 |
| 10061 | Drainage of skin abscess | $6,826 | MEDICAID – AMERIHEALTH | $348 |
| 10061 | Drainage of skin abscess | $6,826 | UNITED | $392 |
| 10061 | Drainage of skin abscess | $6,826 | AETNA | $750 |
| 10061 | Drainage of skin abscess | $6,826 | CIGNA | $1,323 |
| 10061 | Drainage of skin abscess | $6,826 | LWCC | $735 |
| 10061 | Drainage of skin abscess | $6,826 | PPOPLUS | $4,626 |
| 10061 | Drainage of skin abscess | $6,826 | GILSBAR | $3,716 |
| 10061 | Drainage of skin abscess | $6,826 | LSU | $4,000 |
| 10061 | Drainage of skin abscess | $6,826 | VERITY | $502 |
| 10061 | Drainage of skin abscess | $6,826 | MULTIPLAN | $502 |
| 10061 | Drainage of skin abscess | $6,826 | LA WORK COMP | $6,826 |
| 10061 | Drainage of skin abscess | $6,826 | | |
| 29838 | Elbow arthroscopy/surgery | $11,320 | Private Pay | $12,569 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | BC PPO | $2,604 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | BC HMO | $2,285 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | BC FMOL | $2,307 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICARE | $2,449 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICARE – BLUE CROSS | $2,449 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICARE – UNITED | $2,449 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICARE – COVENTRY | $2,449 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICARE – VANTAGE | $2,449 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICARE -PEOPLES | $2,449 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICARE- HUMANA | $2,400 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | HUMANA | $3,673 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | VANTAGE | $4,163 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICAID | $533 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICAID – UNITED | $533 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICAID – HEALTHY BLUE | $533 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MEDICAID – AMERIHEALTH | $533 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | UNITED | $2,923 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | AETNA | $1,209 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | CIGNA | $854 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | LWCC | $6,296 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | PPOPLUS | $7,667 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | GILSBAR | $6,160 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | LSU | $4,011 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | VERITY | $3,386 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | MULTIPLAN | $3,386 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | LA WORK COMP | $11,320 |
| 29838 | Elbow arthroscopy/surgery | $11,320 | | |
| 51715 | Endoscopic injection/implant | $10,365 | Private Pay | $10,273 |
| 51715 | Endoscopic injection/implant | $10,365 | BC PPO | $3,424 |
| 51715 | Endoscopic injection/implant | $10,365 | BC HMO | $3,004 |
| 51715 | Endoscopic injection/implant | $10,365 | BC FMOL | $3,033 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICARE | $2,700 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICARE – BLUE CROSS | $2,700 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICARE – UNITED | $2,700 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICARE – COVENTRY | $2,700 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICARE – VANTAGE | $2,700 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICARE -PEOPLES | $2,700 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICARE- HUMANA | $2,646 |
| 51715 | Endoscopic injection/implant | $10,365 | HUMANA | $4,050 |
| 51715 | Endoscopic injection/implant | $10,365 | VANTAGE | $4,590 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICAID | $533 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICAID – UNITED | $533 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICAID – HEALTHY BLUE | $533 |
| 51715 | Endoscopic injection/implant | $10,365 | MEDICAID – AMERIHEALTH | $533 |
| 51715 | Endoscopic injection/implant | $10,365 | UNITED | $2,923 |
| 51715 | Endoscopic injection/implant | $10,365 | AETNA | $2,432 |
| 51715 | Endoscopic injection/implant | $10,365 | CIGNA | $2,801 |
| 51715 | Endoscopic injection/implant | $10,365 | LWCC | $6,943 |
| 51715 | Endoscopic injection/implant | $10,365 | PPOPLUS | $6,266 |
| 51715 | Endoscopic injection/implant | $10,365 | GILSBAR | $5,235 |
| 51715 | Endoscopic injection/implant | $10,365 | LSU | $5,456 |
| 51715 | Endoscopic injection/implant | $10,365 | VERITY | $3,452 |
| 51715 | Endoscopic injection/implant | $10,365 | MULTIPLAN | $3,452 |
| 51715 | Endoscopic injection/implant | $10,365 | LA WORK COMP | $10,365 |
| 51715 | Endoscopic injection/implant | $10,365 | | |
| 31267 | Endoscopy maxillary sinus | $12,513 | Private Pay | $11,573 |
| 31267 | Endoscopy maxillary sinus | $12,513 | BC PPO | $2,835 |
| 31267 | Endoscopy maxillary sinus | $12,513 | BC HMO | $2,488 |
| 31267 | Endoscopy maxillary sinus | $12,513 | BC FMOL | $2,512 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICARE | $4,867 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICARE – BLUE CROSS | $4,867 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICARE – UNITED | $4,867 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICARE – COVENTRY | $4,867 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICARE – VANTAGE | $4,867 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICARE -PEOPLES | $4,867 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICARE- HUMANA | $4,769 |
| 31267 | Endoscopy maxillary sinus | $12,513 | HUMANA | $7,300 |
| 31267 | Endoscopy maxillary sinus | $12,513 | VANTAGE | $8,273 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICAID | $533 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICAID – UNITED | $533 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICAID – HEALTHY BLUE | $533 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MEDICAID – AMERIHEALTH | $533 |
| 31267 | Endoscopy maxillary sinus | $12,513 | UNITED | $2,188 |
| 31267 | Endoscopy maxillary sinus | $12,513 | AETNA | $1,200 |
| 31267 | Endoscopy maxillary sinus | $12,513 | CIGNA | $854 |
| 31267 | Endoscopy maxillary sinus | $12,513 | LWCC | $12,513 |
| 31267 | Endoscopy maxillary sinus | $12,513 | PPOPLUS | $7,060 |
| 31267 | Endoscopy maxillary sinus | $12,513 | GILSBAR | $5,671 |
| 31267 | Endoscopy maxillary sinus | $12,513 | LSU | $4,000 |
| 31267 | Endoscopy maxillary sinus | $12,513 | VERITY | $6,226 |
| 31267 | Endoscopy maxillary sinus | $12,513 | MULTIPLAN | $6,226 |
| 31267 | Endoscopy maxillary sinus | $12,513 | LA WORK COMP | $10,416 |
| 31267 | Endoscopy maxillary sinus | $12,513 | | |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | Private Pay | $12,540 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | BC PPO | $2,289 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | BC HMO | $2,008 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | BC FMOL | $2,028 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICARE | $2,074 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICARE – BLUE CROSS | $2,074 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICARE – UNITED | $2,074 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICARE – COVENTRY | $2,074 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICARE – VANTAGE | $2,074 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICARE -PEOPLES | $2,074 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICARE- HUMANA | $2,033 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | HUMANA | $3,111 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | VANTAGE | $3,526 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICAID | $466 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICAID – UNITED | $466 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICAID – HEALTHY BLUE | $466 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MEDICAID – AMERIHEALTH | $466 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | UNITED | $2,188 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | AETNA | $800 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | CIGNA | $854 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | LWCC | $5,333 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | PPOPLUS | $7,649 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | GILSBAR | $6,144 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | LSU | $4,000 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | VERITY | $2,976 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | MULTIPLAN | $2,976 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | LA WORK COMP | $11,286 |
| 28041 | Exc foot/toe tum dep 1.5cm/> | $11,286 | | |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | Private Pay | $7,505 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | BC PPO | $2,560 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | BC HMO | $2,246 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | BC FMOL | $2,268 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICARE | $2,074 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICARE – BLUE CROSS | $2,074 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICARE – UNITED | $2,074 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICARE – COVENTRY | $2,074 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICARE – VANTAGE | $2,074 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICARE -PEOPLES | $2,074 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICARE- HUMANA | $2,033 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | HUMANA | $3,111 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | VANTAGE | $3,526 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICAID | $348 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICAID – UNITED | $348 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICAID – HEALTHY BLUE | $348 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MEDICAID – AMERIHEALTH | $348 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | UNITED | $2,188 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | AETNA | $750 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | CIGNA | $992 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | LWCC | $5,333 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | PPOPLUS | $4,578 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | GILSBAR | $3,678 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | LSU | $4,000 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | VERITY | $2,976 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | MULTIPLAN | $2,976 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | LA WORK COMP | $6,755 |
| 28039 | Exc foot/toe tum sc 1.5 cm/> | $6,755 | | |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | Private Pay | $6,615 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | BC PPO | $1,746 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | BC HMO | $1,532 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | BC FMOL | $1,547 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICARE | $1,228 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICARE – BLUE CROSS | $1,228 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICARE – UNITED | $1,228 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICARE – COVENTRY | $1,228 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICARE – VANTAGE | $1,228 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICARE -PEOPLES | $1,228 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICARE- HUMANA | $1,203 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | HUMANA | $1,842 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | VANTAGE | $2,087 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICAID | $466 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICAID – UNITED | $466 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICAID – HEALTHY BLUE | $466 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MEDICAID – AMERIHEALTH | $466 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | UNITED | $734 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | AETNA | $1,000 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | CIGNA | $1,929 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | LWCC | $3,157 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | PPOPLUS | $4,035 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | GILSBAR | $3,241 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | LSU | $4,000 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | VERITY | $1,725 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | MULTIPLAN | $1,725 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | LA WORK COMP | $5,953 |
| 25075 | Exc forearm les sc < 3 cm | $5,953 | | |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | Private Pay | $8,341 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | BC PPO | $2,560 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | BC HMO | $2,246 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | BC FMOL | $2,268 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICARE | $2,074 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICARE – BLUE CROSS | $2,074 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICARE – UNITED | $2,074 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICARE – COVENTRY | $2,074 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICARE – VANTAGE | $2,074 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICARE -PEOPLES | $2,074 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICARE- HUMANA | $2,033 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | HUMANA | $3,111 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | VANTAGE | $3,526 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICAID | $466 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICAID – UNITED | $466 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICAID – HEALTHY BLUE | $466 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MEDICAID – AMERIHEALTH | $466 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | UNITED | $2,188 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | AETNA | $800 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | CIGNA | $1,323 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | LWCC | $5,333 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | PPOPLUS | $5,088 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | GILSBAR | $4,087 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | LSU | $4,000 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | VERITY | $2,976 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | MULTIPLAN | $2,976 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | LA WORK COMP | $7,507 |
| 25073 | Exc forearm tum deep 3 cm/> | $7,507 | | |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | Private Pay | $6,108 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | BC PPO | $1,641 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | BC HMO | $1,440 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | BC FMOL | $1,454 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICARE | $1,228 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICARE – BLUE CROSS | $1,228 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICARE – UNITED | $1,228 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICARE – COVENTRY | $1,228 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICARE – VANTAGE | $1,228 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICARE -PEOPLES | $1,228 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICARE- HUMANA | $1,203 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | HUMANA | $1,842 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | VANTAGE | $2,087 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICAID | $466 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICAID – UNITED | $466 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICAID – HEALTHY BLUE | $466 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MEDICAID – AMERIHEALTH | $466 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | UNITED | $734 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | AETNA | $1,000 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | CIGNA | $1,323 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | LWCC | $3,157 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | PPOPLUS | $3,726 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | GILSBAR | $2,993 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | LSU | $4,000 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | VERITY | $1,725 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | MULTIPLAN | $1,725 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | LA WORK COMP | $5,498 |
| 26115 | Exc hand les sc < 1.5 cm | $5,498 | | |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | Private Pay | $5,995 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | BC PPO | $1,484 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | BC HMO | $1,302 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | BC FMOL | $1,315 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICARE | $1,228 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICARE – BLUE CROSS | $1,228 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICARE – UNITED | $1,228 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICARE – COVENTRY | $1,228 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICARE – VANTAGE | $1,228 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICARE -PEOPLES | $1,228 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICARE- HUMANA | $1,203 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | HUMANA | $1,842 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | VANTAGE | $2,087 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICAID | $466 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICAID – UNITED | $466 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICAID – HEALTHY BLUE | $466 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MEDICAID – AMERIHEALTH | $466 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | UNITED | $2,188 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | AETNA | $800 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | CIGNA | $1,323 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | LWCC | $3,157 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | PPOPLUS | $3,657 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | GILSBAR | $2,938 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | LSU | $4,000 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | VERITY | $1,725 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | MULTIPLAN | $1,725 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | LA WORK COMP | $5,396 |
| 26111 | Exc hand les sc 1.5 cm/> | $5,396 | | |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | Private Pay | $6,387 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | BC PPO | $1,484 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | BC HMO | $1,302 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | BC FMOL | $1,315 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICARE | $1,228 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICARE – BLUE CROSS | $1,228 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICARE – UNITED | $1,228 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICARE – COVENTRY | $1,228 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICARE – VANTAGE | $1,228 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICARE -PEOPLES | $1,228 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICARE- HUMANA | $1,203 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | HUMANA | $1,842 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | VANTAGE | $2,087 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICAID | $466 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICAID – UNITED | $466 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICAID – HEALTHY BLUE | $466 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MEDICAID – AMERIHEALTH | $466 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | UNITED | $734 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | AETNA | $1,000 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | CIGNA | $1,102 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | LWCC | $3,157 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | PPOPLUS | $3,896 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | GILSBAR | $3,130 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | LSU | $4,000 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | VERITY | $1,725 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | MULTIPLAN | $1,725 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | LA WORK COMP | $5,748 |
| 26116 | Exc hand tum deep < 1.5 cm | $5,748 | | |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | Private Pay | $8,203 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | BC PPO | $1,327 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | BC HMO | $1,165 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | BC FMOL | $1,176 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICARE | $1,228 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICARE – BLUE CROSS | $1,228 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICARE – UNITED | $1,228 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICARE – COVENTRY | $1,228 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICARE – VANTAGE | $1,228 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICARE -PEOPLES | $1,228 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICARE- HUMANA | $1,203 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | HUMANA | $1,842 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | VANTAGE | $2,087 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICAID | $466 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICAID – UNITED | $466 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICAID – HEALTHY BLUE | $466 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MEDICAID – AMERIHEALTH | $466 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | UNITED | $2,188 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | AETNA | $800 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | CIGNA | $854 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | LWCC | $3,157 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | PPOPLUS | $5,004 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | GILSBAR | $4,019 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | LSU | $4,000 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | VERITY | $1,725 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | MULTIPLAN | $1,725 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | LA WORK COMP | $7,382 |
| 26113 | Exc hand tum deep 1.5 cm/> | $7,382 | | |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | Private Pay | $5,768 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | BC PPO | $1,327 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | BC HMO | $1,165 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | BC FMOL | $1,176 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICARE | $1,228 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICARE – BLUE CROSS | $1,228 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICARE – UNITED | $1,228 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICARE – COVENTRY | $1,228 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICARE – VANTAGE | $1,228 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICARE -PEOPLES | $1,228 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICARE- HUMANA | $1,203 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | HUMANA | $1,842 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | VANTAGE | $2,087 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICAID | $466 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICAID – UNITED | $466 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICAID – HEALTHY BLUE | $466 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MEDICAID – AMERIHEALTH | $466 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | UNITED | $610 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | AETNA | $1,000 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | CIGNA | $1,323 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | LWCC | $3,157 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | PPOPLUS | $3,518 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | GILSBAR | $2,826 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | LSU | $4,000 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | VERITY | $1,725 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | MULTIPLAN | $1,725 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | LA WORK COMP | $5,191 |
| 11420 | Exc h-f-nk-sp b9+marg 0.5/< | $5,191 | | |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | Private Pay | $6,241 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | BC PPO | $742 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | BC HMO | $651 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | BC FMOL | $657 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICARE | $546 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICARE – BLUE CROSS | $546 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICARE – UNITED | $546 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICARE – COVENTRY | $546 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICARE – VANTAGE | $546 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICARE -PEOPLES | $546 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICARE- HUMANA | $535 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | HUMANA | $818 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | VANTAGE | $928 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICAID | $466 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICAID – UNITED | $466 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICAID – HEALTHY BLUE | $466 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MEDICAID – AMERIHEALTH | $466 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | UNITED | $610 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | AETNA | $1,000 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | CIGNA | $1,102 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | LWCC | $1,403 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | PPOPLUS | $3,807 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | GILSBAR | $3,058 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | LSU | $4,000 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | VERITY | $733 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | MULTIPLAN | $733 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | LA WORK COMP | $5,617 |
| 11421 | Exc h-f-nk-sp b9+marg 0.6-1 | $5,617 | | |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | Private Pay | $7,126 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | BC PPO | $1,484 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | BC HMO | $1,302 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | BC FMOL | $1,315 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICARE | $1,228 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICARE – BLUE CROSS | $1,228 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICARE – UNITED | $1,228 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICARE – COVENTRY | $1,228 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICARE – VANTAGE | $1,228 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICARE -PEOPLES | $1,228 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICARE- HUMANA | $1,203 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | HUMANA | $1,842 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | VANTAGE | $2,087 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICAID | $466 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICAID – UNITED | $466 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICAID – HEALTHY BLUE | $466 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MEDICAID – AMERIHEALTH | $466 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | UNITED | $610 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | AETNA | $750 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | CIGNA | $854 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | LWCC | $3,157 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | PPOPLUS | $4,347 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | GILSBAR | $3,492 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | LSU | $4,000 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | VERITY | $1,725 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | MULTIPLAN | $1,725 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | LA WORK COMP | $6,413 |
| 11422 | Exc h-f-nk-sp b9+marg 1.1-2 | $6,413 | | |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | Private Pay | $9,133 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | BC PPO | $2,951 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | BC HMO | $2,590 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | BC FMOL | $2,614 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICARE | $2,074 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICARE – BLUE CROSS | $2,074 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICARE – UNITED | $2,074 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICARE – COVENTRY | $2,074 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICARE – VANTAGE | $2,074 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICARE -PEOPLES | $2,074 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICARE- HUMANA | $2,033 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | HUMANA | $3,111 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | VANTAGE | $3,526 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICAID | $466 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICAID – UNITED | $466 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICAID – HEALTHY BLUE | $466 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MEDICAID – AMERIHEALTH | $466 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | UNITED | $2,188 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | AETNA | $1,000 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | CIGNA | $854 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | LWCC | $5,333 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | PPOPLUS | $5,571 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | GILSBAR | $4,475 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | LSU | $4,000 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | VERITY | $2,976 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | MULTIPLAN | $2,976 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | LA WORK COMP | $8,220 |
| 21556 | Exc neck tum deep < 5 cm | $8,220 | | |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | Private Pay | $7,505 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | BC PPO | $1,484 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | BC HMO | $1,302 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | BC FMOL | $1,315 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICARE | $1,228 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICARE – BLUE CROSS | $1,228 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICARE – UNITED | $1,228 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICARE – COVENTRY | $1,228 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICARE – VANTAGE | $1,228 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICARE -PEOPLES | $1,228 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICARE- HUMANA | $1,203 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | HUMANA | $1,842 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | VANTAGE | $2,087 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICAID | $466 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICAID – UNITED | $466 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICAID – HEALTHY BLUE | $466 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MEDICAID – AMERIHEALTH | $466 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | UNITED | $2,188 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | AETNA | $800 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | CIGNA | $1,323 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | LWCC | $3,157 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | PPOPLUS | $4,578 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | GILSBAR | $3,678 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | LSU | $4,000 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | VERITY | $1,725 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | MULTIPLAN | $1,725 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | LA WORK COMP | $6,755 |
| 23071 | Exc shoulder les sc 3 cm/> | $6,755 | | |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | Private Pay | $8,203 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | BC PPO | $742 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | BC HMO | $651 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | BC FMOL | $657 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICARE | $546 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICARE – BLUE CROSS | $546 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICARE – UNITED | $546 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICARE – COVENTRY | $546 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICARE – VANTAGE | $546 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICARE -PEOPLES | $546 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICARE- HUMANA | $535 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | HUMANA | $818 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | VANTAGE | $928 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICAID | $348 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICAID – UNITED | $348 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICAID – HEALTHY BLUE | $348 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MEDICAID – AMERIHEALTH | $348 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | UNITED | $610 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | AETNA | $750 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | CIGNA | $634 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | LWCC | $1,403 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | PPOPLUS | $5,004 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | GILSBAR | $4,019 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | LSU | $4,000 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | VERITY | $733 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | MULTIPLAN | $733 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | LA WORK COMP | $7,383 |
| 11403 | Exc tr-ext b9+marg 2.1-3cm/< | $7,383 | | |
| 25118 | Excise wrist tendon sheath | $7,063 | Private Pay | $7,848 |
| 25118 | Excise wrist tendon sheath | $7,063 | BC PPO | $1,644 |
| 25118 | Excise wrist tendon sheath | $7,063 | BC HMO | $1,442 |
| 25118 | Excise wrist tendon sheath | $7,063 | BC FMOL | $1,456 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICARE | $1,212 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICARE – BLUE CROSS | $1,212 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICARE – UNITED | $1,212 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICARE – COVENTRY | $1,212 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICARE – VANTAGE | $1,212 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICARE -PEOPLES | $1,212 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICARE- HUMANA | $1,188 |
| 25118 | Excise wrist tendon sheath | $7,063 | HUMANA | $1,819 |
| 25118 | Excise wrist tendon sheath | $7,063 | VANTAGE | $2,061 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICAID | $466 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICAID – UNITED | $466 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICAID – HEALTHY BLUE | $466 |
| 25118 | Excise wrist tendon sheath | $7,063 | MEDICAID – AMERIHEALTH | $466 |
| 25118 | Excise wrist tendon sheath | $7,063 | UNITED | $2,188 |
| 25118 | Excise wrist tendon sheath | $7,063 | AETNA | $1,000 |
| 25118 | Excise wrist tendon sheath | $7,063 | CIGNA | $1,323 |
| 25118 | Excise wrist tendon sheath | $7,063 | LWCC | $3,117 |
| 25118 | Excise wrist tendon sheath | $7,063 | PPOPLUS | $4,787 |
| 25118 | Excise wrist tendon sheath | $7,063 | GILSBAR | $3,845 |
| 25118 | Excise wrist tendon sheath | $7,063 | LSU | $4,000 |
| 25118 | Excise wrist tendon sheath | $7,063 | VERITY | $1,728 |
| 25118 | Excise wrist tendon sheath | $7,063 | MULTIPLAN | $1,728 |
| 25118 | Excise wrist tendon sheath | $7,063 | LA WORK COMP | $7,063 |
| 25118 | Excise wrist tendon sheath | $7,063 | | |
| 20103 | Explore wound extremity | $7,020 | Private Pay | $7,801 |
| 20103 | Explore wound extremity | $7,020 | BC PPO | $742 |
| 20103 | Explore wound extremity | $7,020 | BC HMO | $651 |
| 20103 | Explore wound extremity | $7,020 | BC FMOL | $657 |
| 20103 | Explore wound extremity | $7,020 | MEDICARE | $546 |
| 20103 | Explore wound extremity | $7,020 | MEDICARE – BLUE CROSS | $546 |
| 20103 | Explore wound extremity | $7,020 | MEDICARE – UNITED | $546 |
| 20103 | Explore wound extremity | $7,020 | MEDICARE – COVENTRY | $546 |
| 20103 | Explore wound extremity | $7,020 | MEDICARE – VANTAGE | $546 |
| 20103 | Explore wound extremity | $7,020 | MEDICARE -PEOPLES | $546 |
| 20103 | Explore wound extremity | $7,020 | MEDICARE- HUMANA | $535 |
| 20103 | Explore wound extremity | $7,020 | HUMANA | $818 |
| 20103 | Explore wound extremity | $7,020 | VANTAGE | $928 |
| 20103 | Explore wound extremity | $7,020 | MEDICAID | $533 |
| 20103 | Explore wound extremity | $7,020 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 20103 | Explore wound extremity | $7,020 | MEDICAID – UNITED | $533 |
| 20103 | Explore wound extremity | $7,020 | MEDICAID – HEALTHY BLUE | $533 |
| 20103 | Explore wound extremity | $7,020 | MEDICAID – AMERIHEALTH | $533 |
| 20103 | Explore wound extremity | $7,020 | UNITED | $610 |
| 20103 | Explore wound extremity | $7,020 | AETNA | $750 |
| 20103 | Explore wound extremity | $7,020 | CIGNA | $1,102 |
| 20103 | Explore wound extremity | $7,020 | LWCC | $1,403 |
| 20103 | Explore wound extremity | $7,020 | PPOPLUS | $4,758 |
| 20103 | Explore wound extremity | $7,020 | GILSBAR | $3,822 |
| 20103 | Explore wound extremity | $7,020 | LSU | $4,000 |
| 20103 | Explore wound extremity | $7,020 | VERITY | $733 |
| 20103 | Explore wound extremity | $7,020 | MULTIPLAN | $733 |
| 20103 | Explore wound extremity | $7,020 | LA WORK COMP | $7,020 |
| 20103 | Explore wound extremity | $7,020 | | |
| 26075 | Explore/treat finger joint | $7,116 | Private Pay | $7,907 |
| 26075 | Explore/treat finger joint | $7,116 | BC PPO | $2,913 |
| 26075 | Explore/treat finger joint | $7,116 | BC HMO | $2,556 |
| 26075 | Explore/treat finger joint | $7,116 | BC FMOL | $2,580 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICARE | $2,449 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICARE – BLUE CROSS | $2,449 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICARE – UNITED | $2,449 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICARE – COVENTRY | $2,449 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICARE – VANTAGE | $2,449 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICARE -PEOPLES | $2,449 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICARE- HUMANA | $2,400 |
| 26075 | Explore/treat finger joint | $7,116 | HUMANA | $3,673 |
| 26075 | Explore/treat finger joint | $7,116 | VANTAGE | $4,163 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICAID | $659 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICAID – UNITED | $659 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICAID – HEALTHY BLUE | $659 |
| 26075 | Explore/treat finger joint | $7,116 | MEDICAID – AMERIHEALTH | $659 |
| 26075 | Explore/treat finger joint | $7,116 | UNITED | $734 |
| 26075 | Explore/treat finger joint | $7,116 | AETNA | $1,475 |
| 26075 | Explore/treat finger joint | $7,116 | CIGNA | $992 |
| 26075 | Explore/treat finger joint | $7,116 | LWCC | $6,296 |
| 26075 | Explore/treat finger joint | $7,116 | PPOPLUS | $4,823 |
| 26075 | Explore/treat finger joint | $7,116 | GILSBAR | $3,874 |
| 26075 | Explore/treat finger joint | $7,116 | LSU | $4,000 |
| 26075 | Explore/treat finger joint | $7,116 | VERITY | $3,386 |
| 26075 | Explore/treat finger joint | $7,116 | MULTIPLAN | $3,386 |
| 26075 | Explore/treat finger joint | $7,116 | LA WORK COMP | $7,116 |
| 26075 | Explore/treat finger joint | $7,116 | | |
| 26080 | Explore/treat finger joint | $6,013 | Private Pay | $6,681 |
| 26080 | Explore/treat finger joint | $6,013 | BC PPO | $1,486 |
| 26080 | Explore/treat finger joint | $6,013 | BC HMO | $1,304 |
| 26080 | Explore/treat finger joint | $6,013 | BC FMOL | $1,317 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICARE | $1,212 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICARE – BLUE CROSS | $1,212 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICARE – UNITED | $1,212 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICARE – COVENTRY | $1,212 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICARE – VANTAGE | $1,212 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICARE -PEOPLES | $1,212 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICARE- HUMANA | $1,188 |
| 26080 | Explore/treat finger joint | $6,013 | HUMANA | $1,819 |
| 26080 | Explore/treat finger joint | $6,013 | VANTAGE | $2,061 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICAID | $659 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICAID – UNITED | $659 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICAID – HEALTHY BLUE | $659 |
| 26080 | Explore/treat finger joint | $6,013 | MEDICAID – AMERIHEALTH | $659 |
| 26080 | Explore/treat finger joint | $6,013 | UNITED | $734 |
| 26080 | Explore/treat finger joint | $6,013 | AETNA | $1,475 |
| 26080 | Explore/treat finger joint | $6,013 | CIGNA | $1,102 |
| 26080 | Explore/treat finger joint | $6,013 | LWCC | $3,117 |
| 26080 | Explore/treat finger joint | $6,013 | PPOPLUS | $4,076 |
| 26080 | Explore/treat finger joint | $6,013 | GILSBAR | $3,274 |
| 26080 | Explore/treat finger joint | $6,013 | LSU | $4,000 |
| 26080 | Explore/treat finger joint | $6,013 | VERITY | $1,728 |
| 26080 | Explore/treat finger joint | $6,013 | MULTIPLAN | $1,728 |
| 26080 | Explore/treat finger joint | $6,013 | LA WORK COMP | $6,013 |
| 26080 | Explore/treat finger joint | $6,013 | | |
| 27570 | Fixation of knee joint | $7,432 | Private Pay | $8,257 |
| 27570 | Fixation of knee joint | $7,432 | BC PPO | $1,644 |
| 27570 | Fixation of knee joint | $7,432 | BC HMO | $1,442 |
| 27570 | Fixation of knee joint | $7,432 | BC FMOL | $1,456 |
| 27570 | Fixation of knee joint | $7,432 | MEDICARE | $1,212 |
| 27570 | Fixation of knee joint | $7,432 | MEDICARE – BLUE CROSS | $1,212 |
| 27570 | Fixation of knee joint | $7,432 | MEDICARE – UNITED | $1,212 |
| 27570 | Fixation of knee joint | $7,432 | MEDICARE – COVENTRY | $1,212 |
| 27570 | Fixation of knee joint | $7,432 | MEDICARE – VANTAGE | $1,212 |
| 27570 | Fixation of knee joint | $7,432 | MEDICARE -PEOPLES | $1,212 |
| 27570 | Fixation of knee joint | $7,432 | MEDICARE- HUMANA | $1,188 |
| 27570 | Fixation of knee joint | $7,432 | HUMANA | $1,819 |
| 27570 | Fixation of knee joint | $7,432 | VANTAGE | $2,061 |
| 27570 | Fixation of knee joint | $7,432 | MEDICAID | $348 |
| 27570 | Fixation of knee joint | $7,432 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 27570 | Fixation of knee joint | $7,432 | MEDICAID – UNITED | $348 |
| 27570 | Fixation of knee joint | $7,432 | MEDICAID – HEALTHY BLUE | $348 |
| 27570 | Fixation of knee joint | $7,432 | MEDICAID – AMERIHEALTH | $348 |
| 27570 | Fixation of knee joint | $7,432 | UNITED | $734 |
| 27570 | Fixation of knee joint | $7,432 | AETNA | $750 |
| 27570 | Fixation of knee joint | $7,432 | CIGNA | $854 |
| 27570 | Fixation of knee joint | $7,432 | LWCC | $3,117 |
| 27570 | Fixation of knee joint | $7,432 | PPOPLUS | $5,037 |
| 27570 | Fixation of knee joint | $7,432 | GILSBAR | $4,046 |
| 27570 | Fixation of knee joint | $7,432 | LSU | $4,000 |
| 27570 | Fixation of knee joint | $7,432 | VERITY | $1,728 |
| 27570 | Fixation of knee joint | $7,432 | MULTIPLAN | $1,728 |
| 27570 | Fixation of knee joint | $7,432 | LA WORK COMP | $7,432 |
| 27570 | Fixation of knee joint | $7,432 | | |
| 23700 | Fixation of shoulder | $8,014 | Private Pay | $8,904 |
| 23700 | Fixation of shoulder | $8,014 | BC PPO | $1,644 |
| 23700 | Fixation of shoulder | $8,014 | BC HMO | $1,442 |
| 23700 | Fixation of shoulder | $8,014 | BC FMOL | $1,456 |
| 23700 | Fixation of shoulder | $8,014 | MEDICARE | $1,212 |
| 23700 | Fixation of shoulder | $8,014 | MEDICARE – BLUE CROSS | $1,212 |
| 23700 | Fixation of shoulder | $8,014 | MEDICARE – UNITED | $1,212 |
| 23700 | Fixation of shoulder | $8,014 | MEDICARE – COVENTRY | $1,212 |
| 23700 | Fixation of shoulder | $8,014 | MEDICARE – VANTAGE | $1,212 |
| 23700 | Fixation of shoulder | $8,014 | MEDICARE -PEOPLES | $1,212 |
| 23700 | Fixation of shoulder | $8,014 | MEDICARE- HUMANA | $1,188 |
| 23700 | Fixation of shoulder | $8,014 | HUMANA | $1,819 |
| 23700 | Fixation of shoulder | $8,014 | VANTAGE | $2,061 |
| 23700 | Fixation of shoulder | $8,014 | MEDICAID | $348 |
| 23700 | Fixation of shoulder | $8,014 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 23700 | Fixation of shoulder | $8,014 | MEDICAID – UNITED | $348 |
| 23700 | Fixation of shoulder | $8,014 | MEDICAID – HEALTHY BLUE | $348 |
| 23700 | Fixation of shoulder | $8,014 | MEDICAID – AMERIHEALTH | $348 |
| 23700 | Fixation of shoulder | $8,014 | UNITED | $734 |
| 23700 | Fixation of shoulder | $8,014 | AETNA | $750 |
| 23700 | Fixation of shoulder | $8,014 | CIGNA | $854 |
| 23700 | Fixation of shoulder | $8,014 | LWCC | $3,117 |
| 23700 | Fixation of shoulder | $8,014 | PPOPLUS | $5,432 |
| 23700 | Fixation of shoulder | $8,014 | GILSBAR | $4,363 |
| 23700 | Fixation of shoulder | $8,014 | LSU | $4,000 |
| 23700 | Fixation of shoulder | $8,014 | VERITY | $1,728 |
| 23700 | Fixation of shoulder | $8,014 | MULTIPLAN | $1,728 |
| 23700 | Fixation of shoulder | $8,014 | LA WORK COMP | $8,014 |
| 23700 | Fixation of shoulder | $8,014 | | |
| 25825 | Fuse hand bones with graft | $18,720 | Private Pay | $17,831 |
| 25825 | Fuse hand bones with graft | $18,720 | BC PPO | $7,263 |
| 25825 | Fuse hand bones with graft | $18,720 | BC HMO | $6,373 |
| 25825 | Fuse hand bones with graft | $18,720 | BC FMOL | $6,433 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICARE | $5,351 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICARE – BLUE CROSS | $5,351 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICARE – UNITED | $5,351 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICARE – COVENTRY | $5,351 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICARE – VANTAGE | $5,351 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICARE -PEOPLES | $5,351 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICARE- HUMANA | $5,244 |
| 25825 | Fuse hand bones with graft | $18,720 | HUMANA | $8,026 |
| 25825 | Fuse hand bones with graft | $18,720 | VANTAGE | $9,097 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICAID | $750 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICAID – UNITED | $750 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICAID – HEALTHY BLUE | $750 |
| 25825 | Fuse hand bones with graft | $18,720 | MEDICAID – AMERIHEALTH | $750 |
| 25825 | Fuse hand bones with graft | $18,720 | UNITED | $4,460 |
| 25825 | Fuse hand bones with graft | $18,720 | AETNA | $4,590 |
| 25825 | Fuse hand bones with graft | $18,720 | CIGNA | $4,630 |
| 25825 | Fuse hand bones with graft | $18,720 | LWCC | $13,758 |
| 25825 | Fuse hand bones with graft | $18,720 | PPOPLUS | $10,877 |
| 25825 | Fuse hand bones with graft | $18,720 | GILSBAR | $9,218 |
| 25825 | Fuse hand bones with graft | $18,720 | LSU | $7,474 |
| 25825 | Fuse hand bones with graft | $18,720 | VERITY | $7,176 |
| 25825 | Fuse hand bones with graft | $18,720 | MULTIPLAN | $7,176 |
| 25825 | Fuse hand bones with graft | $18,720 | LA WORK COMP | $18,720 |
| 25825 | Fuse hand bones with graft | $18,720 | | |
| 27870 | Fusion of ankle joint open | $52,101 | Private Pay | $48,912 |
| 27870 | Fusion of ankle joint open | $52,101 | BC PPO | $11,146 |
| 27870 | Fusion of ankle joint open | $52,101 | BC HMO | $9,781 |
| 27870 | Fusion of ankle joint open | $52,101 | BC FMOL | $9,874 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICARE | $10,645 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICARE – BLUE CROSS | $10,645 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICARE – UNITED | $10,645 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICARE – COVENTRY | $10,645 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICARE – VANTAGE | $10,645 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICARE -PEOPLES | $10,645 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICARE- HUMANA | $10,433 |
| 27870 | Fusion of ankle joint open | $52,101 | HUMANA | $15,968 |
| 27870 | Fusion of ankle joint open | $52,101 | VANTAGE | $18,097 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICAID | $659 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICAID – UNITED | $659 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICAID – HEALTHY BLUE | $659 |
| 27870 | Fusion of ankle joint open | $52,101 | MEDICAID – AMERIHEALTH | $659 |
| 27870 | Fusion of ankle joint open | $52,101 | UNITED | $12,007 |
| 27870 | Fusion of ankle joint open | $52,101 | AETNA | $10,363 |
| 27870 | Fusion of ankle joint open | $52,101 | CIGNA | $13,422 |
| 27870 | Fusion of ankle joint open | $52,101 | LWCC | $27,372 |
| 27870 | Fusion of ankle joint open | $52,101 | PPOPLUS | $29,836 |
| 27870 | Fusion of ankle joint open | $52,101 | GILSBAR | $25,421 |
| 27870 | Fusion of ankle joint open | $52,101 | LSU | $14,504 |
| 27870 | Fusion of ankle joint open | $52,101 | VERITY | $12,956 |
| 27870 | Fusion of ankle joint open | $52,101 | MULTIPLAN | $12,956 |
| 27870 | Fusion of ankle joint open | $52,101 | LA WORK COMP | $52,101 |
| 27870 | Fusion of ankle joint open | $52,101 | | |
| 28750 | Fusion of big toe joint | $25,334 | Private Pay | $24,498 |
| 28750 | Fusion of big toe joint | $25,334 | BC PPO | $5,520 |
| 28750 | Fusion of big toe joint | $25,334 | BC HMO | $4,843 |
| 28750 | Fusion of big toe joint | $25,334 | BC FMOL | $4,889 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICARE | $5,351 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICARE – BLUE CROSS | $5,351 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICARE – UNITED | $5,351 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICARE – COVENTRY | $5,351 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICARE – VANTAGE | $5,351 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICARE -PEOPLES | $5,351 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICARE- HUMANA | $5,244 |
| 28750 | Fusion of big toe joint | $25,334 | HUMANA | $8,026 |
| 28750 | Fusion of big toe joint | $25,334 | VANTAGE | $9,097 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICAID | $659 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICAID – UNITED | $659 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICAID – HEALTHY BLUE | $659 |
| 28750 | Fusion of big toe joint | $25,334 | MEDICAID – AMERIHEALTH | $659 |
| 28750 | Fusion of big toe joint | $25,334 | UNITED | $4,460 |
| 28750 | Fusion of big toe joint | $25,334 | AETNA | $5,090 |
| 28750 | Fusion of big toe joint | $25,334 | CIGNA | $5,440 |
| 28750 | Fusion of big toe joint | $25,334 | LWCC | $13,758 |
| 28750 | Fusion of big toe joint | $25,334 | PPOPLUS | $14,944 |
| 28750 | Fusion of big toe joint | $25,334 | GILSBAR | $12,595 |
| 28750 | Fusion of big toe joint | $25,334 | LSU | $8,272 |
| 28750 | Fusion of big toe joint | $25,334 | VERITY | $7,176 |
| 28750 | Fusion of big toe joint | $25,334 | MULTIPLAN | $7,176 |
| 28750 | Fusion of big toe joint | $25,334 | LA WORK COMP | $25,334 |
| 28750 | Fusion of big toe joint | $25,334 | | |
| 28755 | Fusion of big toe joint | $17,134 | Private Pay | $17,890 |
| 28755 | Fusion of big toe joint | $17,134 | BC PPO | $6,827 |
| 28755 | Fusion of big toe joint | $17,134 | BC HMO | $5,990 |
| 28755 | Fusion of big toe joint | $17,134 | BC FMOL | $6,047 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICARE | $5,351 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICARE – BLUE CROSS | $5,351 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICARE – UNITED | $5,351 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICARE – COVENTRY | $5,351 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICARE – VANTAGE | $5,351 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICARE -PEOPLES | $5,351 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICARE- HUMANA | $5,244 |
| 28755 | Fusion of big toe joint | $17,134 | HUMANA | $8,026 |
| 28755 | Fusion of big toe joint | $17,134 | VANTAGE | $9,097 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICAID | $659 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICAID – UNITED | $659 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICAID – HEALTHY BLUE | $659 |
| 28755 | Fusion of big toe joint | $17,134 | MEDICAID – AMERIHEALTH | $659 |
| 28755 | Fusion of big toe joint | $17,134 | UNITED | $2,188 |
| 28755 | Fusion of big toe joint | $17,134 | AETNA | $2,612 |
| 28755 | Fusion of big toe joint | $17,134 | CIGNA | $2,466 |
| 28755 | Fusion of big toe joint | $17,134 | LWCC | $13,758 |
| 28755 | Fusion of big toe joint | $17,134 | PPOPLUS | $10,913 |
| 28755 | Fusion of big toe joint | $17,134 | GILSBAR | $8,952 |
| 28755 | Fusion of big toe joint | $17,134 | LSU | $5,343 |
| 28755 | Fusion of big toe joint | $17,134 | VERITY | $7,176 |
| 28755 | Fusion of big toe joint | $17,134 | MULTIPLAN | $7,176 |
| 28755 | Fusion of big toe joint | $17,134 | LA WORK COMP | $17,134 |
| 28755 | Fusion of big toe joint | $17,134 | | |
| 26860 | Fusion of finger joint | $9,570 | Private Pay | $9,829 |
| 26860 | Fusion of finger joint | $9,570 | BC PPO | $2,913 |
| 26860 | Fusion of finger joint | $9,570 | BC HMO | $2,556 |
| 26860 | Fusion of finger joint | $9,570 | BC FMOL | $2,580 |
| 26860 | Fusion of finger joint | $9,570 | MEDICARE | $2,449 |
| 26860 | Fusion of finger joint | $9,570 | MEDICARE – BLUE CROSS | $2,449 |
| 26860 | Fusion of finger joint | $9,570 | MEDICARE – UNITED | $2,449 |
| 26860 | Fusion of finger joint | $9,570 | MEDICARE – COVENTRY | $2,449 |
| 26860 | Fusion of finger joint | $9,570 | MEDICARE – VANTAGE | $2,449 |
| 26860 | Fusion of finger joint | $9,570 | MEDICARE -PEOPLES | $2,449 |
| 26860 | Fusion of finger joint | $9,570 | MEDICARE- HUMANA | $2,400 |
| 26860 | Fusion of finger joint | $9,570 | HUMANA | $3,673 |
| 26860 | Fusion of finger joint | $9,570 | VANTAGE | $4,163 |
| 26860 | Fusion of finger joint | $9,570 | MEDICAID | $533 |
| 26860 | Fusion of finger joint | $9,570 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 26860 | Fusion of finger joint | $9,570 | MEDICAID – UNITED | $533 |
| 26860 | Fusion of finger joint | $9,570 | MEDICAID – HEALTHY BLUE | $533 |
| 26860 | Fusion of finger joint | $9,570 | MEDICAID – AMERIHEALTH | $533 |
| 26860 | Fusion of finger joint | $9,570 | UNITED | $2,923 |
| 26860 | Fusion of finger joint | $9,570 | AETNA | $1,996 |
| 26860 | Fusion of finger joint | $9,570 | CIGNA | $1,102 |
| 26860 | Fusion of finger joint | $9,570 | LWCC | $6,296 |
| 26860 | Fusion of finger joint | $9,570 | PPOPLUS | $5,995 |
| 26860 | Fusion of finger joint | $9,570 | GILSBAR | $4,946 |
| 26860 | Fusion of finger joint | $9,570 | LSU | $4,941 |
| 26860 | Fusion of finger joint | $9,570 | VERITY | $3,386 |
| 26860 | Fusion of finger joint | $9,570 | MULTIPLAN | $3,386 |
| 26860 | Fusion of finger joint | $9,570 | LA WORK COMP | $9,570 |
| 26860 | Fusion of finger joint | $9,570 | | |
| 28715 | Fusion of foot bones | $41,636 | Private Pay | $38,452 |
| 28715 | Fusion of foot bones | $41,636 | BC PPO | $11,146 |
| 28715 | Fusion of foot bones | $41,636 | BC HMO | $9,781 |
| 28715 | Fusion of foot bones | $41,636 | BC FMOL | $9,874 |
| 28715 | Fusion of foot bones | $41,636 | MEDICARE | $10,645 |
| 28715 | Fusion of foot bones | $41,636 | MEDICARE – BLUE CROSS | $10,645 |
| 28715 | Fusion of foot bones | $41,636 | MEDICARE – UNITED | $10,645 |
| 28715 | Fusion of foot bones | $41,636 | MEDICARE – COVENTRY | $10,645 |
| 28715 | Fusion of foot bones | $41,636 | MEDICARE – VANTAGE | $10,645 |
| 28715 | Fusion of foot bones | $41,636 | MEDICARE -PEOPLES | $10,645 |
| 28715 | Fusion of foot bones | $41,636 | MEDICARE- HUMANA | $10,433 |
| 28715 | Fusion of foot bones | $41,636 | HUMANA | $15,968 |
| 28715 | Fusion of foot bones | $41,636 | VANTAGE | $18,097 |
| 28715 | Fusion of foot bones | $41,636 | MEDICAID | $659 |
| 28715 | Fusion of foot bones | $41,636 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 28715 | Fusion of foot bones | $41,636 | MEDICAID – UNITED | $659 |
| 28715 | Fusion of foot bones | $41,636 | MEDICAID – HEALTHY BLUE | $659 |
| 28715 | Fusion of foot bones | $41,636 | MEDICAID – AMERIHEALTH | $659 |
| 28715 | Fusion of foot bones | $41,636 | UNITED | $11,025 |
| 28715 | Fusion of foot bones | $41,636 | AETNA | $9,207 |
| 28715 | Fusion of foot bones | $41,636 | CIGNA | $10,271 |
| 28715 | Fusion of foot bones | $41,636 | LWCC | $27,372 |
| 28715 | Fusion of foot bones | $41,636 | PPOPLUS | $23,455 |
| 28715 | Fusion of foot bones | $41,636 | GILSBAR | $20,107 |
| 28715 | Fusion of foot bones | $41,636 | LSU | $13,138 |
| 28715 | Fusion of foot bones | $41,636 | VERITY | $12,956 |
| 28715 | Fusion of foot bones | $41,636 | MULTIPLAN | $12,956 |
| 28715 | Fusion of foot bones | $41,636 | LA WORK COMP | $41,636 |
| 28715 | Fusion of foot bones | $41,636 | | |
| 28725 | Fusion of foot bones | $32,642 | Private Pay | $32,194 |
| 28725 | Fusion of foot bones | $32,642 | BC PPO | $9,966 |
| 28725 | Fusion of foot bones | $32,642 | BC HMO | $8,745 |
| 28725 | Fusion of foot bones | $32,642 | BC FMOL | $8,828 |
| 28725 | Fusion of foot bones | $32,642 | MEDICARE | $10,645 |
| 28725 | Fusion of foot bones | $32,642 | MEDICARE – BLUE CROSS | $10,645 |
| 28725 | Fusion of foot bones | $32,642 | MEDICARE – UNITED | $10,645 |
| 28725 | Fusion of foot bones | $32,642 | MEDICARE – COVENTRY | $10,645 |
| 28725 | Fusion of foot bones | $32,642 | MEDICARE – VANTAGE | $10,645 |
| 28725 | Fusion of foot bones | $32,642 | MEDICARE -PEOPLES | $10,645 |
| 28725 | Fusion of foot bones | $32,642 | MEDICARE- HUMANA | $10,433 |
| 28725 | Fusion of foot bones | $32,642 | HUMANA | $15,968 |
| 28725 | Fusion of foot bones | $32,642 | VANTAGE | $18,097 |
| 28725 | Fusion of foot bones | $32,642 | MEDICAID | $659 |
| 28725 | Fusion of foot bones | $32,642 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 28725 | Fusion of foot bones | $32,642 | MEDICAID – UNITED | $659 |
| 28725 | Fusion of foot bones | $32,642 | MEDICAID – HEALTHY BLUE | $659 |
| 28725 | Fusion of foot bones | $32,642 | MEDICAID – AMERIHEALTH | $659 |
| 28725 | Fusion of foot bones | $32,642 | UNITED | $4,460 |
| 28725 | Fusion of foot bones | $32,642 | AETNA | $5,509 |
| 28725 | Fusion of foot bones | $32,642 | CIGNA | $7,597 |
| 28725 | Fusion of foot bones | $32,642 | LWCC | $27,372 |
| 28725 | Fusion of foot bones | $32,642 | PPOPLUS | $19,638 |
| 28725 | Fusion of foot bones | $32,642 | GILSBAR | $16,435 |
| 28725 | Fusion of foot bones | $32,642 | LSU | $8,768 |
| 28725 | Fusion of foot bones | $32,642 | VERITY | $12,956 |
| 28725 | Fusion of foot bones | $32,642 | MULTIPLAN | $12,956 |
| 28725 | Fusion of foot bones | $32,642 | LA WORK COMP | $32,642 |
| 28725 | Fusion of foot bones | $32,642 | | |
| 28730 | Fusion of foot bones | $30,062 | Private Pay | $27,681 |
| 28730 | Fusion of foot bones | $30,062 | BC PPO | $9,966 |
| 28730 | Fusion of foot bones | $30,062 | BC HMO | $8,745 |
| 28730 | Fusion of foot bones | $30,062 | BC FMOL | $8,828 |
| 28730 | Fusion of foot bones | $30,062 | MEDICARE | $10,645 |
| 28730 | Fusion of foot bones | $30,062 | MEDICARE – BLUE CROSS | $10,645 |
| 28730 | Fusion of foot bones | $30,062 | MEDICARE – UNITED | $10,645 |
| 28730 | Fusion of foot bones | $30,062 | MEDICARE – COVENTRY | $10,645 |
| 28730 | Fusion of foot bones | $30,062 | MEDICARE – VANTAGE | $10,645 |
| 28730 | Fusion of foot bones | $30,062 | MEDICARE -PEOPLES | $10,645 |
| 28730 | Fusion of foot bones | $30,062 | MEDICARE- HUMANA | $10,433 |
| 28730 | Fusion of foot bones | $30,062 | HUMANA | $15,968 |
| 28730 | Fusion of foot bones | $30,062 | VANTAGE | $18,097 |
| 28730 | Fusion of foot bones | $30,062 | MEDICAID | $659 |
| 28730 | Fusion of foot bones | $30,062 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 28730 | Fusion of foot bones | $30,062 | MEDICAID – UNITED | $659 |
| 28730 | Fusion of foot bones | $30,062 | MEDICAID – HEALTHY BLUE | $659 |
| 28730 | Fusion of foot bones | $30,062 | MEDICAID – AMERIHEALTH | $659 |
| 28730 | Fusion of foot bones | $30,062 | UNITED | $9,269 |
| 28730 | Fusion of foot bones | $30,062 | AETNA | $7,139 |
| 28730 | Fusion of foot bones | $30,062 | CIGNA | $8,120 |
| 28730 | Fusion of foot bones | $30,062 | LWCC | $27,372 |
| 28730 | Fusion of foot bones | $30,062 | PPOPLUS | $16,885 |
| 28730 | Fusion of foot bones | $30,062 | GILSBAR | $14,490 |
| 28730 | Fusion of foot bones | $30,062 | LSU | $10,694 |
| 28730 | Fusion of foot bones | $30,062 | VERITY | $12,956 |
| 28730 | Fusion of foot bones | $30,062 | MULTIPLAN | $12,956 |
| 28730 | Fusion of foot bones | $30,062 | LA WORK COMP | $30,062 |
| 28730 | Fusion of foot bones | $30,062 | | |
| 28740 | Fusion of foot bones | $19,554 | Private Pay | $19,689 |
| 28740 | Fusion of foot bones | $19,554 | BC PPO | $4,866 |
| 28740 | Fusion of foot bones | $19,554 | BC HMO | $4,270 |
| 28740 | Fusion of foot bones | $19,554 | BC FMOL | $4,310 |
| 28740 | Fusion of foot bones | $19,554 | MEDICARE | $5,351 |
| 28740 | Fusion of foot bones | $19,554 | MEDICARE – BLUE CROSS | $5,351 |
| 28740 | Fusion of foot bones | $19,554 | MEDICARE – UNITED | $5,351 |
| 28740 | Fusion of foot bones | $19,554 | MEDICARE – COVENTRY | $5,351 |
| 28740 | Fusion of foot bones | $19,554 | MEDICARE – VANTAGE | $5,351 |
| 28740 | Fusion of foot bones | $19,554 | MEDICARE -PEOPLES | $5,351 |
| 28740 | Fusion of foot bones | $19,554 | MEDICARE- HUMANA | $5,244 |
| 28740 | Fusion of foot bones | $19,554 | HUMANA | $8,026 |
| 28740 | Fusion of foot bones | $19,554 | VANTAGE | $9,097 |
| 28740 | Fusion of foot bones | $19,554 | MEDICAID | $659 |
| 28740 | Fusion of foot bones | $19,554 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 28740 | Fusion of foot bones | $19,554 | MEDICAID – UNITED | $659 |
| 28740 | Fusion of foot bones | $19,554 | MEDICAID – HEALTHY BLUE | $659 |
| 28740 | Fusion of foot bones | $19,554 | MEDICAID – AMERIHEALTH | $659 |
| 28740 | Fusion of foot bones | $19,554 | UNITED | $4,460 |
| 28740 | Fusion of foot bones | $19,554 | AETNA | $3,492 |
| 28740 | Fusion of foot bones | $19,554 | CIGNA | $3,275 |
| 28740 | Fusion of foot bones | $19,554 | LWCC | $13,758 |
| 28740 | Fusion of foot bones | $19,554 | PPOPLUS | $12,010 |
| 28740 | Fusion of foot bones | $19,554 | GILSBAR | $9,978 |
| 28740 | Fusion of foot bones | $19,554 | LSU | $6,384 |
| 28740 | Fusion of foot bones | $19,554 | VERITY | $7,176 |
| 28740 | Fusion of foot bones | $19,554 | MULTIPLAN | $7,176 |
| 28740 | Fusion of foot bones | $19,554 | LA WORK COMP | $19,554 |
| 28740 | Fusion of foot bones | $19,554 | | |
| 26850 | Fusion of knuckle | $13,854 | Private Pay | $13,888 |
| 26850 | Fusion of knuckle | $13,854 | BC PPO | $6,827 |
| 26850 | Fusion of knuckle | $13,854 | BC HMO | $5,990 |
| 26850 | Fusion of knuckle | $13,854 | BC FMOL | $6,047 |
| 26850 | Fusion of knuckle | $13,854 | MEDICARE | $5,351 |
| 26850 | Fusion of knuckle | $13,854 | MEDICARE – BLUE CROSS | $5,351 |
| 26850 | Fusion of knuckle | $13,854 | MEDICARE – UNITED | $5,351 |
| 26850 | Fusion of knuckle | $13,854 | MEDICARE – COVENTRY | $5,351 |
| 26850 | Fusion of knuckle | $13,854 | MEDICARE – VANTAGE | $5,351 |
| 26850 | Fusion of knuckle | $13,854 | MEDICARE -PEOPLES | $5,351 |
| 26850 | Fusion of knuckle | $13,854 | MEDICARE- HUMANA | $5,244 |
| 26850 | Fusion of knuckle | $13,854 | HUMANA | $8,026 |
| 26850 | Fusion of knuckle | $13,854 | VANTAGE | $9,097 |
| 26850 | Fusion of knuckle | $13,854 | MEDICAID | $659 |
| 26850 | Fusion of knuckle | $13,854 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 26850 | Fusion of knuckle | $13,854 | MEDICAID – UNITED | $659 |
| 26850 | Fusion of knuckle | $13,854 | MEDICAID – HEALTHY BLUE | $659 |
| 26850 | Fusion of knuckle | $13,854 | MEDICAID – AMERIHEALTH | $659 |
| 26850 | Fusion of knuckle | $13,854 | UNITED | $2,923 |
| 26850 | Fusion of knuckle | $13,854 | AETNA | $2,965 |
| 26850 | Fusion of knuckle | $13,854 | CIGNA | $3,112 |
| 26850 | Fusion of knuckle | $13,854 | LWCC | $13,758 |
| 26850 | Fusion of knuckle | $13,854 | PPOPLUS | $8,472 |
| 26850 | Fusion of knuckle | $13,854 | GILSBAR | $7,049 |
| 26850 | Fusion of knuckle | $13,854 | LSU | $5,761 |
| 26850 | Fusion of knuckle | $13,854 | VERITY | $7,176 |
| 26850 | Fusion of knuckle | $13,854 | MULTIPLAN | $7,176 |
| 26850 | Fusion of knuckle | $13,854 | LA WORK COMP | $13,854 |
| 26850 | Fusion of knuckle | $13,854 | | |
| 25810 | Fusion/graft of wrist joint | $33,025 | Private Pay | $29,754 |
| 25810 | Fusion/graft of wrist joint | $33,025 | BC PPO | $12,326 |
| 25810 | Fusion/graft of wrist joint | $33,025 | BC HMO | $10,816 |
| 25810 | Fusion/graft of wrist joint | $33,025 | BC FMOL | $10,919 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICARE | $10,645 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICARE – BLUE CROSS | $10,645 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICARE – UNITED | $10,645 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICARE – COVENTRY | $10,645 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICARE – VANTAGE | $10,645 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICARE -PEOPLES | $10,645 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICARE- HUMANA | $10,433 |
| 25810 | Fusion/graft of wrist joint | $33,025 | HUMANA | $15,968 |
| 25810 | Fusion/graft of wrist joint | $33,025 | VANTAGE | $18,097 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICAID | $750 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICAID – UNITED | $750 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICAID – HEALTHY BLUE | $750 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MEDICAID – AMERIHEALTH | $750 |
| 25810 | Fusion/graft of wrist joint | $33,025 | UNITED | $10,294 |
| 25810 | Fusion/graft of wrist joint | $33,025 | AETNA | $8,521 |
| 25810 | Fusion/graft of wrist joint | $33,025 | CIGNA | $9,347 |
| 25810 | Fusion/graft of wrist joint | $33,025 | LWCC | $27,372 |
| 25810 | Fusion/graft of wrist joint | $33,025 | PPOPLUS | $18,150 |
| 25810 | Fusion/graft of wrist joint | $33,025 | GILSBAR | $15,704 |
| 25810 | Fusion/graft of wrist joint | $33,025 | LSU | $12,120 |
| 25810 | Fusion/graft of wrist joint | $33,025 | VERITY | $12,956 |
| 25810 | Fusion/graft of wrist joint | $33,025 | MULTIPLAN | $12,956 |
| 25810 | Fusion/graft of wrist joint | $33,025 | LA WORK COMP | $33,025 |
| 25810 | Fusion/graft of wrist joint | $33,025 | | |
| 29862 | Hip arthr0 w/debridement | $21,031 | Private Pay | $21,797 |
| 29862 | Hip arthr0 w/debridement | $21,031 | BC PPO | $6,827 |
| 29862 | Hip arthr0 w/debridement | $21,031 | BC HMO | $5,990 |
| 29862 | Hip arthr0 w/debridement | $21,031 | BC FMOL | $6,047 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICARE | $5,351 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICARE – BLUE CROSS | $5,351 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICARE – UNITED | $5,351 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICARE – COVENTRY | $5,351 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICARE – VANTAGE | $5,351 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICARE -PEOPLES | $5,351 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICARE- HUMANA | $5,244 |
| 29862 | Hip arthr0 w/debridement | $21,031 | HUMANA | $8,026 |
| 29862 | Hip arthr0 w/debridement | $21,031 | VANTAGE | $9,097 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICAID | $1,400 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICAID – AETNA BETTER HEALTH | $1,400 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICAID – UNITED | $1,400 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICAID – HEALTHY BLUE | $1,400 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MEDICAID – AMERIHEALTH | $1,400 |
| 29862 | Hip arthr0 w/debridement | $21,031 | UNITED | $4,460 |
| 29862 | Hip arthr0 w/debridement | $21,031 | AETNA | $3,029 |
| 29862 | Hip arthr0 w/debridement | $21,031 | CIGNA | $3,794 |
| 29862 | Hip arthr0 w/debridement | $21,031 | LWCC | $13,758 |
| 29862 | Hip arthr0 w/debridement | $21,031 | PPOPLUS | $13,296 |
| 29862 | Hip arthr0 w/debridement | $21,031 | GILSBAR | $10,935 |
| 29862 | Hip arthr0 w/debridement | $21,031 | LSU | $5,837 |
| 29862 | Hip arthr0 w/debridement | $21,031 | VERITY | $7,176 |
| 29862 | Hip arthr0 w/debridement | $21,031 | MULTIPLAN | $7,176 |
| 29862 | Hip arthr0 w/debridement | $21,031 | LA WORK COMP | $21,031 |
| 29862 | Hip arthr0 w/debridement | $21,031 | | |
| 29915 | Hip arthro acetabuloplasty | $26,846 | Private Pay | $28,934 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | BC PPO | $5,520 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | BC HMO | $4,843 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | BC FMOL | $4,889 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICARE | $5,351 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICARE – BLUE CROSS | $5,351 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICARE – UNITED | $5,351 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICARE – COVENTRY | $5,351 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICARE – VANTAGE | $5,351 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICARE -PEOPLES | $5,351 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICARE- HUMANA | $5,244 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | HUMANA | $8,026 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | VANTAGE | $9,097 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICAID | $659 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICAID – UNITED | $659 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICAID – HEALTHY BLUE | $659 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MEDICAID – AMERIHEALTH | $659 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | UNITED | $4,460 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | AETNA | $2,362 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | CIGNA | $1,918 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | LWCC | $13,758 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | PPOPLUS | $17,650 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | GILSBAR | $14,323 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | LSU | $5,048 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | VERITY | $7,176 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | MULTIPLAN | $7,176 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | LA WORK COMP | $26,846 |
| 29915 | Hip arthro acetabuloplasty | $26,846 | | |
| 29914 | Hip arthro w/femoroplasty | $22,592 | Private Pay | $24,363 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | BC PPO | $4,866 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | BC HMO | $4,270 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | BC FMOL | $4,310 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICARE | $5,351 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICARE – BLUE CROSS | $5,351 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICARE – UNITED | $5,351 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICARE – COVENTRY | $5,351 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICARE – VANTAGE | $5,351 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICARE -PEOPLES | $5,351 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICARE- HUMANA | $5,244 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | HUMANA | $8,026 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | VANTAGE | $9,097 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICAID | $659 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICAID – UNITED | $659 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICAID – HEALTHY BLUE | $659 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MEDICAID – AMERIHEALTH | $659 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | UNITED | $4,460 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | AETNA | $2,208 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | CIGNA | $1,102 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | LWCC | $13,758 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | PPOPLUS | $14,861 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | GILSBAR | $12,058 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | LSU | $4,866 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | VERITY | $7,176 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | MULTIPLAN | $7,176 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | LA WORK COMP | $22,592 |
| 29914 | Hip arthro w/femoroplasty | $22,592 | | |
| 29916 | Hip arthro w/labral repair | $25,435 | Private Pay | $27,302 |
| 29916 | Hip arthro w/labral repair | $25,435 | BC PPO | $6,173 |
| 29916 | Hip arthro w/labral repair | $25,435 | BC HMO | $5,417 |
| 29916 | Hip arthro w/labral repair | $25,435 | BC FMOL | $5,468 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICARE | $5,351 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICARE – BLUE CROSS | $5,351 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICARE – UNITED | $5,351 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICARE – COVENTRY | $5,351 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICARE – VANTAGE | $5,351 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICARE -PEOPLES | $5,351 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICARE- HUMANA | $5,244 |
| 29916 | Hip arthro w/labral repair | $25,435 | HUMANA | $8,026 |
| 29916 | Hip arthro w/labral repair | $25,435 | VANTAGE | $9,097 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICAID | $659 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICAID – UNITED | $659 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICAID – HEALTHY BLUE | $659 |
| 29916 | Hip arthro w/labral repair | $25,435 | MEDICAID – AMERIHEALTH | $659 |
| 29916 | Hip arthro w/labral repair | $25,435 | UNITED | $4,460 |
| 29916 | Hip arthro w/labral repair | $25,435 | AETNA | $2,424 |
| 29916 | Hip arthro w/labral repair | $25,435 | CIGNA | $2,241 |
| 29916 | Hip arthro w/labral repair | $25,435 | LWCC | $13,758 |
| 29916 | Hip arthro w/labral repair | $25,435 | PPOPLUS | $16,654 |
| 29916 | Hip arthro w/labral repair | $25,435 | GILSBAR | $13,533 |
| 29916 | Hip arthro w/labral repair | $25,435 | LSU | $5,122 |
| 29916 | Hip arthro w/labral repair | $25,435 | VERITY | $7,176 |
| 29916 | Hip arthro w/labral repair | $25,435 | MULTIPLAN | $7,176 |
| 29916 | Hip arthro w/labral repair | $25,435 | LA WORK COMP | $25,435 |
| 29916 | Hip arthro w/labral repair | $25,435 | | |
| 26055 | Incise finger tendon sheath | $5,023 | Private Pay | $5,581 |
| 26055 | Incise finger tendon sheath | $5,023 | BC PPO | $1,486 |
| 26055 | Incise finger tendon sheath | $5,023 | BC HMO | $1,304 |
| 26055 | Incise finger tendon sheath | $5,023 | BC FMOL | $1,317 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICARE | $1,212 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICARE – BLUE CROSS | $1,212 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICARE – UNITED | $1,212 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICARE – COVENTRY | $1,212 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICARE – VANTAGE | $1,212 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICARE -PEOPLES | $1,212 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICARE- HUMANA | $1,188 |
| 26055 | Incise finger tendon sheath | $5,023 | HUMANA | $1,819 |
| 26055 | Incise finger tendon sheath | $5,023 | VANTAGE | $2,061 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICAID | $466 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICAID – UNITED | $466 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICAID – HEALTHY BLUE | $466 |
| 26055 | Incise finger tendon sheath | $5,023 | MEDICAID – AMERIHEALTH | $466 |
| 26055 | Incise finger tendon sheath | $5,023 | UNITED | $734 |
| 26055 | Incise finger tendon sheath | $5,023 | AETNA | $1,000 |
| 26055 | Incise finger tendon sheath | $5,023 | CIGNA | $1,102 |
| 26055 | Incise finger tendon sheath | $5,023 | LWCC | $3,117 |
| 26055 | Incise finger tendon sheath | $5,023 | PPOPLUS | $3,405 |
| 26055 | Incise finger tendon sheath | $5,023 | GILSBAR | $2,735 |
| 26055 | Incise finger tendon sheath | $5,023 | LSU | $4,000 |
| 26055 | Incise finger tendon sheath | $5,023 | VERITY | $1,728 |
| 26055 | Incise finger tendon sheath | $5,023 | MULTIPLAN | $1,728 |
| 26055 | Incise finger tendon sheath | $5,023 | LA WORK COMP | $5,023 |
| 26055 | Incise finger tendon sheath | $5,023 | | |
| 28300 | Incision of heel bone | $31,417 | Private Pay | $30,972 |
| 28300 | Incision of heel bone | $31,417 | BC PPO | $3,268 |
| 28300 | Incision of heel bone | $31,417 | BC HMO | $2,868 |
| 28300 | Incision of heel bone | $31,417 | BC FMOL | $2,895 |
| 28300 | Incision of heel bone | $31,417 | MEDICARE | $5,351 |
| 28300 | Incision of heel bone | $31,417 | MEDICARE – BLUE CROSS | $5,351 |
| 28300 | Incision of heel bone | $31,417 | MEDICARE – UNITED | $5,351 |
| 28300 | Incision of heel bone | $31,417 | MEDICARE – COVENTRY | $5,351 |
| 28300 | Incision of heel bone | $31,417 | MEDICARE – VANTAGE | $5,351 |
| 28300 | Incision of heel bone | $31,417 | MEDICARE -PEOPLES | $5,351 |
| 28300 | Incision of heel bone | $31,417 | MEDICARE- HUMANA | $5,244 |
| 28300 | Incision of heel bone | $31,417 | HUMANA | $8,026 |
| 28300 | Incision of heel bone | $31,417 | VANTAGE | $9,097 |
| 28300 | Incision of heel bone | $31,417 | MEDICAID | $466 |
| 28300 | Incision of heel bone | $31,417 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28300 | Incision of heel bone | $31,417 | MEDICAID – UNITED | $466 |
| 28300 | Incision of heel bone | $31,417 | MEDICAID – HEALTHY BLUE | $466 |
| 28300 | Incision of heel bone | $31,417 | MEDICAID – AMERIHEALTH | $466 |
| 28300 | Incision of heel bone | $31,417 | UNITED | $4,460 |
| 28300 | Incision of heel bone | $31,417 | AETNA | $4,896 |
| 28300 | Incision of heel bone | $31,417 | CIGNA | $5,999 |
| 28300 | Incision of heel bone | $31,417 | LWCC | $13,758 |
| 28300 | Incision of heel bone | $31,417 | PPOPLUS | $18,893 |
| 28300 | Incision of heel bone | $31,417 | GILSBAR | $15,814 |
| 28300 | Incision of heel bone | $31,417 | LSU | $8,605 |
| 28300 | Incision of heel bone | $31,417 | VERITY | $7,176 |
| 28300 | Incision of heel bone | $31,417 | MULTIPLAN | $7,176 |
| 28300 | Incision of heel bone | $31,417 | LA WORK COMP | $31,417 |
| 28300 | Incision of heel bone | $31,417 | | |
| 28308 | Incision of metatarsal | $18,268 | Private Pay | $17,918 |
| 28308 | Incision of metatarsal | $18,268 | BC PPO | $2,296 |
| 28308 | Incision of metatarsal | $18,268 | BC HMO | $2,015 |
| 28308 | Incision of metatarsal | $18,268 | BC FMOL | $2,034 |
| 28308 | Incision of metatarsal | $18,268 | MEDICARE | $2,449 |
| 28308 | Incision of metatarsal | $18,268 | MEDICARE – BLUE CROSS | $2,449 |
| 28308 | Incision of metatarsal | $18,268 | MEDICARE – UNITED | $2,449 |
| 28308 | Incision of metatarsal | $18,268 | MEDICARE – COVENTRY | $2,449 |
| 28308 | Incision of metatarsal | $18,268 | MEDICARE – VANTAGE | $2,449 |
| 28308 | Incision of metatarsal | $18,268 | MEDICARE -PEOPLES | $2,449 |
| 28308 | Incision of metatarsal | $18,268 | MEDICARE- HUMANA | $2,400 |
| 28308 | Incision of metatarsal | $18,268 | HUMANA | $3,673 |
| 28308 | Incision of metatarsal | $18,268 | VANTAGE | $4,163 |
| 28308 | Incision of metatarsal | $18,268 | MEDICAID | $466 |
| 28308 | Incision of metatarsal | $18,268 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28308 | Incision of metatarsal | $18,268 | MEDICAID – UNITED | $466 |
| 28308 | Incision of metatarsal | $18,268 | MEDICAID – HEALTHY BLUE | $466 |
| 28308 | Incision of metatarsal | $18,268 | MEDICAID – AMERIHEALTH | $466 |
| 28308 | Incision of metatarsal | $18,268 | UNITED | $2,188 |
| 28308 | Incision of metatarsal | $18,268 | AETNA | $3,355 |
| 28308 | Incision of metatarsal | $18,268 | CIGNA | $3,928 |
| 28308 | Incision of metatarsal | $18,268 | LWCC | $6,296 |
| 28308 | Incision of metatarsal | $18,268 | PPOPLUS | $10,930 |
| 28308 | Incision of metatarsal | $18,268 | GILSBAR | $9,165 |
| 28308 | Incision of metatarsal | $18,268 | LSU | $6,783 |
| 28308 | Incision of metatarsal | $18,268 | VERITY | $3,386 |
| 28308 | Incision of metatarsal | $18,268 | MULTIPLAN | $3,386 |
| 28308 | Incision of metatarsal | $18,268 | LA WORK COMP | $18,268 |
| 28308 | Incision of metatarsal | $18,268 | | |
| 25000 | Incision of tendon sheath | $5,804 | Private Pay | $6,449 |
| 25000 | Incision of tendon sheath | $5,804 | BC PPO | $1,486 |
| 25000 | Incision of tendon sheath | $5,804 | BC HMO | $1,304 |
| 25000 | Incision of tendon sheath | $5,804 | BC FMOL | $1,317 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICARE | $1,212 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICARE – BLUE CROSS | $1,212 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICARE – UNITED | $1,212 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICARE – COVENTRY | $1,212 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICARE – VANTAGE | $1,212 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICARE -PEOPLES | $1,212 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICARE- HUMANA | $1,188 |
| 25000 | Incision of tendon sheath | $5,804 | HUMANA | $1,819 |
| 25000 | Incision of tendon sheath | $5,804 | VANTAGE | $2,061 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICAID | $533 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICAID – UNITED | $533 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICAID – HEALTHY BLUE | $533 |
| 25000 | Incision of tendon sheath | $5,804 | MEDICAID – AMERIHEALTH | $533 |
| 25000 | Incision of tendon sheath | $5,804 | UNITED | $2,188 |
| 25000 | Incision of tendon sheath | $5,804 | AETNA | $1,200 |
| 25000 | Incision of tendon sheath | $5,804 | CIGNA | $1,433 |
| 25000 | Incision of tendon sheath | $5,804 | LWCC | $3,117 |
| 25000 | Incision of tendon sheath | $5,804 | PPOPLUS | $3,934 |
| 25000 | Incision of tendon sheath | $5,804 | GILSBAR | $3,160 |
| 25000 | Incision of tendon sheath | $5,804 | LSU | $4,000 |
| 25000 | Incision of tendon sheath | $5,804 | VERITY | $1,728 |
| 25000 | Incision of tendon sheath | $5,804 | MULTIPLAN | $1,728 |
| 25000 | Incision of tendon sheath | $5,804 | LA WORK COMP | $5,804 |
| 25000 | Incision of tendon sheath | $5,804 | | |
| 41010 | Incision of tongue fold | $4,378 | Private Pay | $4,811 |
| 41010 | Incision of tongue fold | $4,378 | BC PPO | $1,474 |
| 41010 | Incision of tongue fold | $4,378 | BC HMO | $1,294 |
| 41010 | Incision of tongue fold | $4,378 | BC FMOL | $1,306 |
| 41010 | Incision of tongue fold | $4,378 | MEDICARE | $1,207 |
| 41010 | Incision of tongue fold | $4,378 | MEDICARE – BLUE CROSS | $1,207 |
| 41010 | Incision of tongue fold | $4,378 | MEDICARE – UNITED | $1,207 |
| 41010 | Incision of tongue fold | $4,378 | MEDICARE – COVENTRY | $1,207 |
| 41010 | Incision of tongue fold | $4,378 | MEDICARE – VANTAGE | $1,207 |
| 41010 | Incision of tongue fold | $4,378 | MEDICARE -PEOPLES | $1,207 |
| 41010 | Incision of tongue fold | $4,378 | MEDICARE- HUMANA | $1,183 |
| 41010 | Incision of tongue fold | $4,378 | HUMANA | $1,811 |
| 41010 | Incision of tongue fold | $4,378 | VANTAGE | $2,052 |
| 41010 | Incision of tongue fold | $4,378 | MEDICAID | $348 |
| 41010 | Incision of tongue fold | $4,378 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 41010 | Incision of tongue fold | $4,378 | MEDICAID – UNITED | $348 |
| 41010 | Incision of tongue fold | $4,378 | MEDICAID – HEALTHY BLUE | $348 |
| 41010 | Incision of tongue fold | $4,378 | MEDICAID – AMERIHEALTH | $348 |
| 41010 | Incision of tongue fold | $4,378 | UNITED | $734 |
| 41010 | Incision of tongue fold | $4,378 | AETNA | $803 |
| 41010 | Incision of tongue fold | $4,378 | CIGNA | $1,102 |
| 41010 | Incision of tongue fold | $4,378 | LWCC | $3,103 |
| 41010 | Incision of tongue fold | $4,378 | PPOPLUS | $2,935 |
| 41010 | Incision of tongue fold | $4,378 | GILSBAR | $2,366 |
| 41010 | Incision of tongue fold | $4,378 | LSU | $4,062 |
| 41010 | Incision of tongue fold | $4,378 | VERITY | $1,457 |
| 41010 | Incision of tongue fold | $4,378 | MULTIPLAN | $1,457 |
| 41010 | Incision of tongue fold | $4,378 | LA WORK COMP | $4,378 |
| 41010 | Incision of tongue fold | $4,378 | | |
| 53020 | Incision of urethra | $5,606 | Private Pay | $6,229 |
| 53020 | Incision of urethra | $5,606 | BC PPO | $2,065 |
| 53020 | Incision of urethra | $5,606 | BC HMO | $1,812 |
| 53020 | Incision of urethra | $5,606 | BC FMOL | $1,829 |
| 53020 | Incision of urethra | $5,606 | MEDICARE | $1,585 |
| 53020 | Incision of urethra | $5,606 | MEDICARE – BLUE CROSS | $1,585 |
| 53020 | Incision of urethra | $5,606 | MEDICARE – UNITED | $1,585 |
| 53020 | Incision of urethra | $5,606 | MEDICARE – COVENTRY | $1,585 |
| 53020 | Incision of urethra | $5,606 | MEDICARE – VANTAGE | $1,585 |
| 53020 | Incision of urethra | $5,606 | MEDICARE -PEOPLES | $1,585 |
| 53020 | Incision of urethra | $5,606 | MEDICARE- HUMANA | $1,553 |
| 53020 | Incision of urethra | $5,606 | HUMANA | $2,377 |
| 53020 | Incision of urethra | $5,606 | VANTAGE | $2,694 |
| 53020 | Incision of urethra | $5,606 | MEDICAID | $348 |
| 53020 | Incision of urethra | $5,606 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 53020 | Incision of urethra | $5,606 | MEDICAID – UNITED | $348 |
| 53020 | Incision of urethra | $5,606 | MEDICAID – HEALTHY BLUE | $348 |
| 53020 | Incision of urethra | $5,606 | MEDICAID – AMERIHEALTH | $348 |
| 53020 | Incision of urethra | $5,606 | UNITED | $2,188 |
| 53020 | Incision of urethra | $5,606 | AETNA | $750 |
| 53020 | Incision of urethra | $5,606 | CIGNA | $992 |
| 53020 | Incision of urethra | $5,606 | LWCC | $4,075 |
| 53020 | Incision of urethra | $5,606 | PPOPLUS | $3,800 |
| 53020 | Incision of urethra | $5,606 | GILSBAR | $3,052 |
| 53020 | Incision of urethra | $5,606 | LSU | $4,000 |
| 53020 | Incision of urethra | $5,606 | VERITY | $2,170 |
| 53020 | Incision of urethra | $5,606 | MULTIPLAN | $2,170 |
| 53020 | Incision of urethra | $5,606 | LA WORK COMP | $5,606 |
| 53020 | Incision of urethra | $5,606 | | |
| 64483 | Inj foramen epidural l/s | $3,568 | Private Pay | $3,964 |
| 64483 | Inj foramen epidural l/s | $3,568 | BC PPO | $871 |
| 64483 | Inj foramen epidural l/s | $3,568 | BC HMO | $764 |
| 64483 | Inj foramen epidural l/s | $3,568 | BC FMOL | $771 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICARE | $726 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICARE – BLUE CROSS | $726 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICARE – UNITED | $726 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICARE – COVENTRY | $726 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICARE – VANTAGE | $726 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICARE -PEOPLES | $726 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICARE- HUMANA | $712 |
| 64483 | Inj foramen epidural l/s | $3,568 | HUMANA | $1,090 |
| 64483 | Inj foramen epidural l/s | $3,568 | VANTAGE | $1,235 |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICAID | $- |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICAID – AETNA BETTER HEALTH | $- |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICAID – UNITED | $- |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICAID – HEALTHY BLUE | $- |
| 64483 | Inj foramen epidural l/s | $3,568 | MEDICAID – AMERIHEALTH | $- |
| 64483 | Inj foramen epidural l/s | $3,568 | UNITED | $610 |
| 64483 | Inj foramen epidural l/s | $3,568 | AETNA | $750 |
| 64483 | Inj foramen epidural l/s | $3,568 | CIGNA | $634 |
| 64483 | Inj foramen epidural l/s | $3,568 | LWCC | $1,868 |
| 64483 | Inj foramen epidural l/s | $3,568 | PPOPLUS | $2,418 |
| 64483 | Inj foramen epidural l/s | $3,568 | GILSBAR | $1,943 |
| 64483 | Inj foramen epidural l/s | $3,568 | LSU | $2,313 |
| 64483 | Inj foramen epidural l/s | $3,568 | VERITY | $860 |
| 64483 | Inj foramen epidural l/s | $3,568 | MULTIPLAN | $860 |
| 64483 | Inj foramen epidural l/s | $3,568 | LA WORK COMP | $3,568 |
| 64483 | Inj foramen epidural l/s | $3,568 | | |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | Private Pay | $5,910 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | BC PPO | $871 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | BC HMO | $764 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | BC FMOL | $771 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICARE | $726 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICARE – BLUE CROSS | $726 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICARE – UNITED | $726 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICARE – COVENTRY | $726 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICARE – VANTAGE | $726 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICARE -PEOPLES | $726 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICARE- HUMANA | $712 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | HUMANA | $1,090 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | VANTAGE | $1,235 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICAID | $- |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICAID – AETNA BETTER HEALTH | $- |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICAID – UNITED | $- |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICAID – HEALTHY BLUE | $- |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MEDICAID – AMERIHEALTH | $- |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | UNITED | $610 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | AETNA | $750 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | CIGNA | $1,102 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | LWCC | $1,868 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | PPOPLUS | $3,605 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | GILSBAR | $2,896 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | LSU | $3,448 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | VERITY | $860 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | MULTIPLAN | $860 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | LA WORK COMP | $5,319 |
| 64490 | Inj paravert f jnt c/t 1 lev | $5,319 | | |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | Private Pay | $7,412 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | BC PPO | $871 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | BC HMO | $764 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | BC FMOL | $771 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICARE | $726 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICARE – BLUE CROSS | $726 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICARE – UNITED | $726 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICARE – COVENTRY | $726 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICARE – VANTAGE | $726 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICARE -PEOPLES | $726 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICARE- HUMANA | $712 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | HUMANA | $1,090 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | VANTAGE | $1,235 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICAID | $- |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICAID – AETNA BETTER HEALTH | $- |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICAID – UNITED | $- |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICAID – HEALTHY BLUE | $- |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MEDICAID – AMERIHEALTH | $- |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | UNITED | $610 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | AETNA | $750 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | CIGNA | $1,433 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | LWCC | $1,868 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | PPOPLUS | $4,521 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | GILSBAR | $3,632 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | LSU | $4,323 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | VERITY | $860 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | MULTIPLAN | $860 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | LA WORK COMP | $6,670 |
| 64493 | Inj paravert f jnt l/s 1 lev | $6,670 | | |
| 64640 | Injection treatment of nerve | $4,241 | Private Pay | $4,712 |
| 64640 | Injection treatment of nerve | $4,241 | BC PPO | $871 |
| 64640 | Injection treatment of nerve | $4,241 | BC HMO | $764 |
| 64640 | Injection treatment of nerve | $4,241 | BC FMOL | $771 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICARE | $726 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICARE – BLUE CROSS | $726 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICARE – UNITED | $726 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICARE – COVENTRY | $726 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICARE – VANTAGE | $726 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICARE -PEOPLES | $726 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICARE- HUMANA | $712 |
| 64640 | Injection treatment of nerve | $4,241 | HUMANA | $1,090 |
| 64640 | Injection treatment of nerve | $4,241 | VANTAGE | $1,235 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICAID | $348 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICAID – UNITED | $348 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICAID – HEALTHY BLUE | $348 |
| 64640 | Injection treatment of nerve | $4,241 | MEDICAID – AMERIHEALTH | $348 |
| 64640 | Injection treatment of nerve | $4,241 | UNITED | $610 |
| 64640 | Injection treatment of nerve | $4,241 | AETNA | $750 |
| 64640 | Injection treatment of nerve | $4,241 | CIGNA | $1,323 |
| 64640 | Injection treatment of nerve | $4,241 | LWCC | $1,868 |
| 64640 | Injection treatment of nerve | $4,241 | PPOPLUS | $2,874 |
| 64640 | Injection treatment of nerve | $4,241 | GILSBAR | $2,309 |
| 64640 | Injection treatment of nerve | $4,241 | LSU | $2,748 |
| 64640 | Injection treatment of nerve | $4,241 | VERITY | $860 |
| 64640 | Injection treatment of nerve | $4,241 | MULTIPLAN | $860 |
| 64640 | Injection treatment of nerve | $4,241 | LA WORK COMP | $4,241 |
| 64640 | Injection treatment of nerve | $4,241 | | |
| 36561 | Insert tunneled cv cath | $10,334 | Private Pay | $10,313 |
| 36561 | Insert tunneled cv cath | $10,334 | BC PPO | $3,229 |
| 36561 | Insert tunneled cv cath | $10,334 | BC HMO | $2,833 |
| 36561 | Insert tunneled cv cath | $10,334 | BC FMOL | $2,860 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICARE | $2,479 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICARE – BLUE CROSS | $2,479 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICARE – UNITED | $2,479 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICARE – COVENTRY | $2,479 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICARE – VANTAGE | $2,479 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICARE -PEOPLES | $2,479 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICARE- HUMANA | $2,429 |
| 36561 | Insert tunneled cv cath | $10,334 | HUMANA | $3,718 |
| 36561 | Insert tunneled cv cath | $10,334 | VANTAGE | $4,214 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICAID | $533 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICAID – UNITED | $533 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICAID – HEALTHY BLUE | $533 |
| 36561 | Insert tunneled cv cath | $10,334 | MEDICAID – AMERIHEALTH | $533 |
| 36561 | Insert tunneled cv cath | $10,334 | UNITED | $2,923 |
| 36561 | Insert tunneled cv cath | $10,334 | AETNA | $2,357 |
| 36561 | Insert tunneled cv cath | $10,334 | CIGNA | $2,490 |
| 36561 | Insert tunneled cv cath | $10,334 | LWCC | $6,374 |
| 36561 | Insert tunneled cv cath | $10,334 | PPOPLUS | $6,291 |
| 36561 | Insert tunneled cv cath | $10,334 | GILSBAR | $5,243 |
| 36561 | Insert tunneled cv cath | $10,334 | LSU | $5,367 |
| 36561 | Insert tunneled cv cath | $10,334 | VERITY | $3,190 |
| 36561 | Insert tunneled cv cath | $10,334 | MULTIPLAN | $3,190 |
| 36561 | Insert tunneled cv cath | $10,334 | LA WORK COMP | $10,334 |
| 36561 | Insert tunneled cv cath | $10,334 | | |
| 29870 | Knee arthroscopy dx | $8,878 | Private Pay | $9,865 |
| 29870 | Knee arthroscopy dx | $8,878 | BC PPO | $2,913 |
| 29870 | Knee arthroscopy dx | $8,878 | BC HMO | $2,556 |
| 29870 | Knee arthroscopy dx | $8,878 | BC FMOL | $2,580 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICARE | $2,449 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICARE – BLUE CROSS | $2,449 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICARE – UNITED | $2,449 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICARE – COVENTRY | $2,449 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICARE – VANTAGE | $2,449 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICARE -PEOPLES | $2,449 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICARE- HUMANA | $2,400 |
| 29870 | Knee arthroscopy dx | $8,878 | HUMANA | $3,673 |
| 29870 | Knee arthroscopy dx | $8,878 | VANTAGE | $4,163 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICAID | $533 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICAID – UNITED | $533 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICAID – HEALTHY BLUE | $533 |
| 29870 | Knee arthroscopy dx | $8,878 | MEDICAID – AMERIHEALTH | $533 |
| 29870 | Knee arthroscopy dx | $8,878 | UNITED | $2,923 |
| 29870 | Knee arthroscopy dx | $8,878 | AETNA | $1,200 |
| 29870 | Knee arthroscopy dx | $8,878 | CIGNA | $1,102 |
| 29870 | Knee arthroscopy dx | $8,878 | LWCC | $6,296 |
| 29870 | Knee arthroscopy dx | $8,878 | PPOPLUS | $6,017 |
| 29870 | Knee arthroscopy dx | $8,878 | GILSBAR | $4,834 |
| 29870 | Knee arthroscopy dx | $8,878 | LSU | $4,000 |
| 29870 | Knee arthroscopy dx | $8,878 | VERITY | $3,386 |
| 29870 | Knee arthroscopy dx | $8,878 | MULTIPLAN | $3,386 |
| 29870 | Knee arthroscopy dx | $8,878 | LA WORK COMP | $8,878 |
| 29870 | Knee arthroscopy dx | $8,878 | | |
| 29873 | Knee arthroscopy/surgery | $9,127 | Private Pay | $10,141 |
| 29873 | Knee arthroscopy/surgery | $9,127 | BC PPO | $2,296 |
| 29873 | Knee arthroscopy/surgery | $9,127 | BC HMO | $2,015 |
| 29873 | Knee arthroscopy/surgery | $9,127 | BC FMOL | $2,034 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICARE | $2,449 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICARE – BLUE CROSS | $2,449 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICARE – UNITED | $2,449 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICARE – COVENTRY | $2,449 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICARE – VANTAGE | $2,449 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICARE -PEOPLES | $2,449 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICARE- HUMANA | $2,400 |
| 29873 | Knee arthroscopy/surgery | $9,127 | HUMANA | $3,673 |
| 29873 | Knee arthroscopy/surgery | $9,127 | VANTAGE | $4,163 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICAID | $533 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICAID – UNITED | $533 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICAID – HEALTHY BLUE | $533 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MEDICAID – AMERIHEALTH | $533 |
| 29873 | Knee arthroscopy/surgery | $9,127 | UNITED | $2,923 |
| 29873 | Knee arthroscopy/surgery | $9,127 | AETNA | $1,200 |
| 29873 | Knee arthroscopy/surgery | $9,127 | CIGNA | $634 |
| 29873 | Knee arthroscopy/surgery | $9,127 | LWCC | $6,296 |
| 29873 | Knee arthroscopy/surgery | $9,127 | PPOPLUS | $6,186 |
| 29873 | Knee arthroscopy/surgery | $9,127 | GILSBAR | $4,969 |
| 29873 | Knee arthroscopy/surgery | $9,127 | LSU | $4,000 |
| 29873 | Knee arthroscopy/surgery | $9,127 | VERITY | $3,386 |
| 29873 | Knee arthroscopy/surgery | $9,127 | MULTIPLAN | $3,386 |
| 29873 | Knee arthroscopy/surgery | $9,127 | LA WORK COMP | $9,127 |
| 29873 | Knee arthroscopy/surgery | $9,127 | | |
| 29875 | Knee arthroscopy/surgery | $10,581 | Private Pay | $9,709 |
| 29875 | Knee arthroscopy/surgery | $10,581 | BC PPO | $3,221 |
| 29875 | Knee arthroscopy/surgery | $10,581 | BC HMO | $2,826 |
| 29875 | Knee arthroscopy/surgery | $10,581 | BC FMOL | $2,853 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICARE | $2,449 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICARE – BLUE CROSS | $2,449 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICARE – UNITED | $2,449 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICARE – COVENTRY | $2,449 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICARE – VANTAGE | $2,449 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICARE -PEOPLES | $2,449 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICARE- HUMANA | $2,400 |
| 29875 | Knee arthroscopy/surgery | $10,581 | HUMANA | $3,673 |
| 29875 | Knee arthroscopy/surgery | $10,581 | VANTAGE | $4,163 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICAID | $659 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICAID – UNITED | $659 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICAID – HEALTHY BLUE | $659 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MEDICAID – AMERIHEALTH | $659 |
| 29875 | Knee arthroscopy/surgery | $10,581 | UNITED | $2,923 |
| 29875 | Knee arthroscopy/surgery | $10,581 | AETNA | $3,502 |
| 29875 | Knee arthroscopy/surgery | $10,581 | CIGNA | $3,756 |
| 29875 | Knee arthroscopy/surgery | $10,581 | LWCC | $6,296 |
| 29875 | Knee arthroscopy/surgery | $10,581 | PPOPLUS | $5,923 |
| 29875 | Knee arthroscopy/surgery | $10,581 | GILSBAR | $5,089 |
| 29875 | Knee arthroscopy/surgery | $10,581 | LSU | $6,396 |
| 29875 | Knee arthroscopy/surgery | $10,581 | VERITY | $3,386 |
| 29875 | Knee arthroscopy/surgery | $10,581 | MULTIPLAN | $3,386 |
| 29875 | Knee arthroscopy/surgery | $10,581 | LA WORK COMP | $10,581 |
| 29875 | Knee arthroscopy/surgery | $10,581 | | |
| 29876 | Knee arthroscopy/surgery | $10,634 | Private Pay | $11,815 |
| 29876 | Knee arthroscopy/surgery | $10,634 | BC PPO | $2,604 |
| 29876 | Knee arthroscopy/surgery | $10,634 | BC HMO | $2,285 |
| 29876 | Knee arthroscopy/surgery | $10,634 | BC FMOL | $2,307 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICARE | $2,449 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICARE – BLUE CROSS | $2,449 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICARE – UNITED | $2,449 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICARE – COVENTRY | $2,449 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICARE – VANTAGE | $2,449 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICARE -PEOPLES | $2,449 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICARE- HUMANA | $2,400 |
| 29876 | Knee arthroscopy/surgery | $10,634 | HUMANA | $3,673 |
| 29876 | Knee arthroscopy/surgery | $10,634 | VANTAGE | $4,163 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICAID | $659 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICAID – UNITED | $659 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICAID – HEALTHY BLUE | $659 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MEDICAID – AMERIHEALTH | $659 |
| 29876 | Knee arthroscopy/surgery | $10,634 | UNITED | $2,923 |
| 29876 | Knee arthroscopy/surgery | $10,634 | AETNA | $1,475 |
| 29876 | Knee arthroscopy/surgery | $10,634 | CIGNA | $992 |
| 29876 | Knee arthroscopy/surgery | $10,634 | LWCC | $6,296 |
| 29876 | Knee arthroscopy/surgery | $10,634 | PPOPLUS | $7,207 |
| 29876 | Knee arthroscopy/surgery | $10,634 | GILSBAR | $5,790 |
| 29876 | Knee arthroscopy/surgery | $10,634 | LSU | $4,000 |
| 29876 | Knee arthroscopy/surgery | $10,634 | VERITY | $3,386 |
| 29876 | Knee arthroscopy/surgery | $10,634 | MULTIPLAN | $3,386 |
| 29876 | Knee arthroscopy/surgery | $10,634 | LA WORK COMP | $10,634 |
| 29876 | Knee arthroscopy/surgery | $10,634 | | |
| 29877 | Knee arthroscopy/surgery | $11,167 | Private Pay | $10,593 |
| 29877 | Knee arthroscopy/surgery | $11,167 | BC PPO | $3,221 |
| 29877 | Knee arthroscopy/surgery | $11,167 | BC HMO | $2,826 |
| 29877 | Knee arthroscopy/surgery | $11,167 | BC FMOL | $2,853 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICARE | $2,449 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICARE – BLUE CROSS | $2,449 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICARE – UNITED | $2,449 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICARE – COVENTRY | $2,449 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICARE – VANTAGE | $2,449 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICARE -PEOPLES | $2,449 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICARE- HUMANA | $2,400 |
| 29877 | Knee arthroscopy/surgery | $11,167 | HUMANA | $3,673 |
| 29877 | Knee arthroscopy/surgery | $11,167 | VANTAGE | $4,163 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICAID | $659 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICAID – UNITED | $659 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICAID – HEALTHY BLUE | $659 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MEDICAID – AMERIHEALTH | $659 |
| 29877 | Knee arthroscopy/surgery | $11,167 | UNITED | $2,923 |
| 29877 | Knee arthroscopy/surgery | $11,167 | AETNA | $3,272 |
| 29877 | Knee arthroscopy/surgery | $11,167 | CIGNA | $4,912 |
| 29877 | Knee arthroscopy/surgery | $11,167 | LWCC | $6,296 |
| 29877 | Knee arthroscopy/surgery | $11,167 | PPOPLUS | $6,462 |
| 29877 | Knee arthroscopy/surgery | $11,167 | GILSBAR | $5,485 |
| 29877 | Knee arthroscopy/surgery | $11,167 | LSU | $6,123 |
| 29877 | Knee arthroscopy/surgery | $11,167 | VERITY | $3,386 |
| 29877 | Knee arthroscopy/surgery | $11,167 | MULTIPLAN | $3,386 |
| 29877 | Knee arthroscopy/surgery | $11,167 | LA WORK COMP | $11,167 |
| 29877 | Knee arthroscopy/surgery | $11,167 | | |
| 29879 | Knee arthroscopy/surgery | $10,060 | Private Pay | $10,729 |
| 29879 | Knee arthroscopy/surgery | $10,060 | BC PPO | $2,604 |
| 29879 | Knee arthroscopy/surgery | $10,060 | BC HMO | $2,285 |
| 29879 | Knee arthroscopy/surgery | $10,060 | BC FMOL | $2,307 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICARE | $2,449 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICARE – BLUE CROSS | $2,449 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICARE – UNITED | $2,449 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICARE – COVENTRY | $2,449 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICARE – VANTAGE | $2,449 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICARE -PEOPLES | $2,449 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICARE- HUMANA | $2,400 |
| 29879 | Knee arthroscopy/surgery | $10,060 | HUMANA | $3,673 |
| 29879 | Knee arthroscopy/surgery | $10,060 | VANTAGE | $4,163 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICAID | $533 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICAID – UNITED | $533 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICAID – HEALTHY BLUE | $533 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MEDICAID – AMERIHEALTH | $533 |
| 29879 | Knee arthroscopy/surgery | $10,060 | UNITED | $2,923 |
| 29879 | Knee arthroscopy/surgery | $10,060 | AETNA | $1,644 |
| 29879 | Knee arthroscopy/surgery | $10,060 | CIGNA | $1,102 |
| 29879 | Knee arthroscopy/surgery | $10,060 | LWCC | $6,296 |
| 29879 | Knee arthroscopy/surgery | $10,060 | PPOPLUS | $6,545 |
| 29879 | Knee arthroscopy/surgery | $10,060 | GILSBAR | $5,330 |
| 29879 | Knee arthroscopy/surgery | $10,060 | LSU | $4,525 |
| 29879 | Knee arthroscopy/surgery | $10,060 | VERITY | $3,386 |
| 29879 | Knee arthroscopy/surgery | $10,060 | MULTIPLAN | $3,386 |
| 29879 | Knee arthroscopy/surgery | $10,060 | LA WORK COMP | $10,060 |
| 29879 | Knee arthroscopy/surgery | $10,060 | | |
| 29880 | Knee arthroscopy/surgery | $9,002 | Private Pay | $9,239 |
| 29880 | Knee arthroscopy/surgery | $9,002 | BC PPO | $3,221 |
| 29880 | Knee arthroscopy/surgery | $9,002 | BC HMO | $2,826 |
| 29880 | Knee arthroscopy/surgery | $9,002 | BC FMOL | $2,853 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICARE | $2,449 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICARE – BLUE CROSS | $2,449 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICARE – UNITED | $2,449 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICARE – COVENTRY | $2,449 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICARE – VANTAGE | $2,449 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICARE -PEOPLES | $2,449 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICARE- HUMANA | $2,400 |
| 29880 | Knee arthroscopy/surgery | $9,002 | HUMANA | $3,673 |
| 29880 | Knee arthroscopy/surgery | $9,002 | VANTAGE | $4,163 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICAID | $659 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICAID – UNITED | $659 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICAID – HEALTHY BLUE | $659 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MEDICAID – AMERIHEALTH | $659 |
| 29880 | Knee arthroscopy/surgery | $9,002 | UNITED | $2,923 |
| 29880 | Knee arthroscopy/surgery | $9,002 | AETNA | $2,231 |
| 29880 | Knee arthroscopy/surgery | $9,002 | CIGNA | $1,899 |
| 29880 | Knee arthroscopy/surgery | $9,002 | LWCC | $6,296 |
| 29880 | Knee arthroscopy/surgery | $9,002 | PPOPLUS | PPOPLUS |
| 29880 | Knee arthroscopy/surgery | $9,002 | GILSBAR | $4,651 |
| 29880 | Knee arthroscopy/surgery | $9,002 | LSU | $4,893 |
| 29880 | Knee arthroscopy/surgery | $9,002 | VERITY | $3,386 |
| 29880 | Knee arthroscopy/surgery | $9,002 | MULTIPLAN | $3,386 |
| 29880 | Knee arthroscopy/surgery | $9,002 | LA WORK COMP | $9,002 |
| 29880 | Knee arthroscopy/surgery | $9,002 | | |
| 29881 | Knee arthroscopy/surgery | $10,213 | Private Pay | $9,323 |
| 29881 | Knee arthroscopy/surgery | $10,213 | BC PPO | $3,221 |
| 29881 | Knee arthroscopy/surgery | $10,213 | BC HMO | $2,826 |
| 29881 | Knee arthroscopy/surgery | $10,213 | BC FMOL | $2,853 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICARE | $2,449 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICARE – BLUE CROSS | $2,449 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICARE – UNITED | $2,449 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICARE – COVENTRY | $2,449 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICARE – VANTAGE | $2,449 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICARE -PEOPLES | $2,449 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICARE- HUMANA | $2,400 |
| 29881 | Knee arthroscopy/surgery | $10,213 | HUMANA | $3,673 |
| 29881 | Knee arthroscopy/surgery | $10,213 | VANTAGE | $4,163 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICAID | $659 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICAID – UNITED | $659 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICAID – HEALTHY BLUE | $659 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MEDICAID – AMERIHEALTH | $659 |
| 29881 | Knee arthroscopy/surgery | $10,213 | UNITED | $2,923 |
| 29881 | Knee arthroscopy/surgery | $10,213 | AETNA | $3,479 |
| 29881 | Knee arthroscopy/surgery | $10,213 | CIGNA | $3,728 |
| 29881 | Knee arthroscopy/surgery | $10,213 | LWCC | $6,296 |
| 29881 | Knee arthroscopy/surgery | $10,213 | PPOPLUS | $5,687 |
| 29881 | Knee arthroscopy/surgery | $10,213 | GILSBAR | $4,896 |
| 29881 | Knee arthroscopy/surgery | $10,213 | LSU | $6,368 |
| 29881 | Knee arthroscopy/surgery | $10,213 | VERITY | $3,386 |
| 29881 | Knee arthroscopy/surgery | $10,213 | MULTIPLAN | $3,386 |
| 29881 | Knee arthroscopy/surgery | $10,213 | LA WORK COMP | $10,213 |
| 29881 | Knee arthroscopy/surgery | $10,213 | | |
| 29882 | Knee arthroscopy/surgery | $18,308 | Private Pay | $18,858 |
| 29882 | Knee arthroscopy/surgery | $18,308 | BC PPO | $2,913 |
| 29882 | Knee arthroscopy/surgery | $18,308 | BC HMO | $2,556 |
| 29882 | Knee arthroscopy/surgery | $18,308 | BC FMOL | $2,580 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICARE | $2,449 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICARE – BLUE CROSS | $2,449 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICARE – UNITED | $2,449 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICARE – COVENTRY | $2,449 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICARE – VANTAGE | $2,449 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICARE -PEOPLES | $2,449 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICARE- HUMANA | $2,400 |
| 29882 | Knee arthroscopy/surgery | $18,308 | HUMANA | $3,673 |
| 29882 | Knee arthroscopy/surgery | $18,308 | VANTAGE | $4,163 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICAID | $533 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICAID – UNITED | $533 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICAID – HEALTHY BLUE | $533 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MEDICAID – AMERIHEALTH | $533 |
| 29882 | Knee arthroscopy/surgery | $18,308 | UNITED | $2,923 |
| 29882 | Knee arthroscopy/surgery | $18,308 | AETNA | $2,669 |
| 29882 | Knee arthroscopy/surgery | $18,308 | CIGNA | $2,865 |
| 29882 | Knee arthroscopy/surgery | $18,308 | LWCC | $6,296 |
| 29882 | Knee arthroscopy/surgery | $18,308 | PPOPLUS | $11,504 |
| 29882 | Knee arthroscopy/surgery | $18,308 | GILSBAR | $9,481 |
| 29882 | Knee arthroscopy/surgery | $18,308 | LSU | $5,736 |
| 29882 | Knee arthroscopy/surgery | $18,308 | VERITY | $3,386 |
| 29882 | Knee arthroscopy/surgery | $18,308 | MULTIPLAN | $3,386 |
| 29882 | Knee arthroscopy/surgery | $18,308 | LA WORK COMP | $18,308 |
| 29882 | Knee arthroscopy/surgery | $18,308 | | |
| 29884 | Knee arthroscopy/surgery | $9,667 | Private Pay | $10,254 |
| 29884 | Knee arthroscopy/surgery | $9,667 | BC PPO | $3,221 |
| 29884 | Knee arthroscopy/surgery | $9,667 | BC HMO | $2,826 |
| 29884 | Knee arthroscopy/surgery | $9,667 | BC FMOL | $2,853 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICARE | $2,449 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICARE – BLUE CROSS | $2,449 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICARE – UNITED | $2,449 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICARE – COVENTRY | $2,449 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICARE – VANTAGE | $2,449 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICARE -PEOPLES | $2,449 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICARE- HUMANA | $2,400 |
| 29884 | Knee arthroscopy/surgery | $9,667 | HUMANA | $3,673 |
| 29884 | Knee arthroscopy/surgery | $9,667 | VANTAGE | $4,163 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICAID | $533 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICAID – UNITED | $533 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICAID – HEALTHY BLUE | $533 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MEDICAID – AMERIHEALTH | $533 |
| 29884 | Knee arthroscopy/surgery | $9,667 | UNITED | $2,923 |
| 29884 | Knee arthroscopy/surgery | $9,667 | AETNA | $1,682 |
| 29884 | Knee arthroscopy/surgery | $9,667 | CIGNA | $1,102 |
| 29884 | Knee arthroscopy/surgery | $9,667 | LWCC | $6,296 |
| 29884 | Knee arthroscopy/surgery | $9,667 | PPOPLUS | $6,255 |
| 29884 | Knee arthroscopy/surgery | $9,667 | GILSBAR | $5,104 |
| 29884 | Knee arthroscopy/surgery | $9,667 | LSU | $4,570 |
| 29884 | Knee arthroscopy/surgery | $9,667 | VERITY | $3,386 |
| 29884 | Knee arthroscopy/surgery | $9,667 | MULTIPLAN | $3,386 |
| 29884 | Knee arthroscopy/surgery | $9,667 | LA WORK COMP | $9,667 |
| 29884 | Knee arthroscopy/surgery | $9,667 | | |
| 29888 | Knee arthroscopy/surgery | $22,756 | Private Pay | $22,958 |
| 29888 | Knee arthroscopy/surgery | $22,756 | BC PPO | $6,173 |
| 29888 | Knee arthroscopy/surgery | $22,756 | BC HMO | $5,417 |
| 29888 | Knee arthroscopy/surgery | $22,756 | BC FMOL | $5,468 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICARE | $5,351 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICARE – BLUE CROSS | $5,351 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICARE – UNITED | $5,351 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICARE – COVENTRY | $5,351 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICARE – VANTAGE | $5,351 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICARE -PEOPLES | $5,351 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICARE- HUMANA | $5,244 |
| 29888 | Knee arthroscopy/surgery | $22,756 | HUMANA | $8,026 |
| 29888 | Knee arthroscopy/surgery | $22,756 | VANTAGE | $9,097 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICAID | $533 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICAID – UNITED | $533 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICAID – HEALTHY BLUE | $533 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MEDICAID – AMERIHEALTH | $533 |
| 29888 | Knee arthroscopy/surgery | $22,756 | UNITED | $4,460 |
| 29888 | Knee arthroscopy/surgery | $22,756 | AETNA | $3,503 |
| 29888 | Knee arthroscopy/surgery | $22,756 | CIGNA | $3,756 |
| 29888 | Knee arthroscopy/surgery | $22,756 | LWCC | $13,758 |
| 29888 | Knee arthroscopy/surgery | $22,756 | PPOPLUS | $14,004 |
| 29888 | Knee arthroscopy/surgery | $22,756 | GILSBAR | $11,626 |
| 29888 | Knee arthroscopy/surgery | $22,756 | LSU | $6,722 |
| 29888 | Knee arthroscopy/surgery | $22,756 | VERITY | $7,176 |
| 29888 | Knee arthroscopy/surgery | $22,756 | MULTIPLAN | $7,176 |
| 29888 | Knee arthroscopy/surgery | $22,756 | LA WORK COMP | $22,756 |
| 29888 | Knee arthroscopy/surgery | $22,756 | | |
| 29889 | Knee arthroscopy/surgery | $65,682 | Private Pay | $61,628 |
| 29889 | Knee arthroscopy/surgery | $65,682 | BC PPO | $12,851 |
| 29889 | Knee arthroscopy/surgery | $65,682 | BC HMO | $11,277 |
| 29889 | Knee arthroscopy/surgery | $65,682 | BC FMOL | $11,384 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICARE | $10,645 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICARE – BLUE CROSS | $10,645 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICARE – UNITED | $10,645 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICARE – COVENTRY | $10,645 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICARE – VANTAGE | $10,645 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICARE -PEOPLES | $10,645 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICARE- HUMANA | $10,433 |
| 29889 | Knee arthroscopy/surgery | $65,682 | HUMANA | $15,968 |
| 29889 | Knee arthroscopy/surgery | $65,682 | VANTAGE | $18,097 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICAID | $533 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICAID – UNITED | $533 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICAID – HEALTHY BLUE | $533 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MEDICAID – AMERIHEALTH | $533 |
| 29889 | Knee arthroscopy/surgery | $65,682 | UNITED | $14,002 |
| 29889 | Knee arthroscopy/surgery | $65,682 | AETNA | $12,438 |
| 29889 | Knee arthroscopy/surgery | $65,682 | CIGNA | $14,809 |
| 29889 | Knee arthroscopy/surgery | $65,682 | LWCC | $27,372 |
| 29889 | Knee arthroscopy/surgery | $65,682 | PPOPLUS | $37,593 |
| 29889 | Knee arthroscopy/surgery | $65,682 | GILSBAR | $32,037 |
| 29889 | Knee arthroscopy/surgery | $65,682 | LSU | $17,281 |
| 29889 | Knee arthroscopy/surgery | $65,682 | VERITY | $12,956 |
| 29889 | Knee arthroscopy/surgery | $65,682 | MULTIPLAN | $12,956 |
| 29889 | Knee arthroscopy/surgery | $65,682 | LA WORK COMP | $65,682 |
| 29889 | Knee arthroscopy/surgery | $65,682 | | |
| 63042 | Laminotomy single lumbar | $16,710 | Private Pay | $17,607 |
| 63042 | Laminotomy single lumbar | $16,710 | BC PPO | $7,117 |
| 63042 | Laminotomy single lumbar | $16,710 | BC HMO | $6,245 |
| 63042 | Laminotomy single lumbar | $16,710 | BC FMOL | $6,305 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICARE | $5,351 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICARE – BLUE CROSS | $5,351 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICARE – UNITED | $5,351 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICARE – COVENTRY | $5,351 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICARE – VANTAGE | $5,351 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICARE -PEOPLES | $5,351 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICARE- HUMANA | $5,244 |
| 63042 | Laminotomy single lumbar | $16,710 | HUMANA | $8,026 |
| 63042 | Laminotomy single lumbar | $16,710 | VANTAGE | $9,097 |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICAID | $- |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICAID – AETNA BETTER HEALTH | $- |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICAID – UNITED | $- |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICAID – HEALTHY BLUE | $- |
| 63042 | Laminotomy single lumbar | $16,710 | MEDICAID – AMERIHEALTH | $- |
| 63042 | Laminotomy single lumbar | $16,710 | UNITED | $4,460 |
| 63042 | Laminotomy single lumbar | $16,710 | AETNA | $2,600 |
| 63042 | Laminotomy single lumbar | $16,710 | CIGNA | $1,774 |
| 63042 | Laminotomy single lumbar | $16,710 | LWCC | $13,758 |
| 63042 | Laminotomy single lumbar | $16,710 | PPOPLUS | $10,741 |
| 63042 | Laminotomy single lumbar | $16,710 | GILSBAR | $8,783 |
| 63042 | Laminotomy single lumbar | $16,710 | LSU | $5,123 |
| 63042 | Laminotomy single lumbar | $16,710 | VERITY | $7,176 |
| 63042 | Laminotomy single lumbar | $16,710 | MULTIPLAN | $7,176 |
| 63042 | Laminotomy single lumbar | $16,710 | LA WORK COMP | $16,710 |
| 63042 | Laminotomy single lumbar | $16,710 | | |
| 49650 | Lap ing hernia repair init | $24,169 | Private Pay | $26,317 |
| 49650 | Lap ing hernia repair init | $24,169 | BC PPO | $5,466 |
| 49650 | Lap ing hernia repair init | $24,169 | BC HMO | $4,796 |
| 49650 | Lap ing hernia repair init | $24,169 | BC FMOL | $4,842 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICARE | $4,324 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICARE – BLUE CROSS | $4,324 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICARE – UNITED | $4,324 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICARE – COVENTRY | $4,324 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICARE – VANTAGE | $4,324 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICARE -PEOPLES | $4,324 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICARE- HUMANA | $4,237 |
| 49650 | Lap ing hernia repair init | $24,169 | HUMANA | $6,486 |
| 49650 | Lap ing hernia repair init | $24,169 | VANTAGE | $7,351 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICAID | $659 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICAID – UNITED | $659 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICAID – HEALTHY BLUE | $659 |
| 49650 | Lap ing hernia repair init | $24,169 | MEDICAID – AMERIHEALTH | $659 |
| 49650 | Lap ing hernia repair init | $24,169 | UNITED | $4,460 |
| 49650 | Lap ing hernia repair init | $24,169 | AETNA | $2,007 |
| 49650 | Lap ing hernia repair init | $24,169 | CIGNA | $2,756 |
| 49650 | Lap ing hernia repair init | $24,169 | LWCC | $11,118 |
| 49650 | Lap ing hernia repair init | $24,169 | PPOPLUS | $16,053 |
| 49650 | Lap ing hernia repair init | $24,169 | GILSBAR | $12,982 |
| 49650 | Lap ing hernia repair init | $24,169 | LSU | $4,629 |
| 49650 | Lap ing hernia repair init | $24,169 | VERITY | $5,745 |
| 49650 | Lap ing hernia repair init | $24,169 | MULTIPLAN | $5,745 |
| 49650 | Lap ing hernia repair init | $24,169 | LA WORK COMP | $24,169 |
| 49650 | Lap ing hernia repair init | $24,169 | | |
| 49651 | Lap ing hernia repair recur | $22,927 | Private Pay | $25,032 |
| 49651 | Lap ing hernia repair recur | $22,927 | BC PPO | $5,466 |
| 49651 | Lap ing hernia repair recur | $22,927 | BC HMO | $4,796 |
| 49651 | Lap ing hernia repair recur | $22,927 | BC FMOL | $4,842 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICARE | $4,324 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICARE – BLUE CROSS | $4,324 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICARE – UNITED | $4,324 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICARE – COVENTRY | $4,324 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICARE – VANTAGE | $4,324 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICARE -PEOPLES | $4,324 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICARE- HUMANA | $4,237 |
| 49651 | Lap ing hernia repair recur | $22,927 | HUMANA | $6,486 |
| 49651 | Lap ing hernia repair recur | $22,927 | VANTAGE | $7,351 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICAID | $1,040 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICAID – AETNA BETTER HEALTH | $1,040 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICAID – UNITED | $1,040 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICAID – HEALTHY BLUE | $1,040 |
| 49651 | Lap ing hernia repair recur | $22,927 | MEDICAID – AMERIHEALTH | $1,040 |
| 49651 | Lap ing hernia repair recur | $22,927 | UNITED | $4,460 |
| 49651 | Lap ing hernia repair recur | $22,927 | AETNA | $2,539 |
| 49651 | Lap ing hernia repair recur | $22,927 | CIGNA | $1,323 |
| 49651 | Lap ing hernia repair recur | $22,927 | LWCC | $11,118 |
| 49651 | Lap ing hernia repair recur | $22,927 | PPOPLUS | $15,270 |
| 49651 | Lap ing hernia repair recur | $22,927 | GILSBAR | $12,337 |
| 49651 | Lap ing hernia repair recur | $22,927 | LSU | $4,518 |
| 49651 | Lap ing hernia repair recur | $22,927 | VERITY | $5,745 |
| 49651 | Lap ing hernia repair recur | $22,927 | MULTIPLAN | $5,745 |
| 49651 | Lap ing hernia repair recur | $22,927 | LA WORK COMP | $22,927 |
| 49651 | Lap ing hernia repair recur | $22,927 | | |
| 49653 | Lap vent/abd hern proc comp | $27,745 | Private Pay | $29,736 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | BC PPO | $5,698 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | BC HMO | $5,000 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | BC FMOL | $5,048 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICARE | $4,324 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICARE – BLUE CROSS | $4,324 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICARE – UNITED | $4,324 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICARE – COVENTRY | $4,324 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICARE – VANTAGE | $4,324 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICARE -PEOPLES | $4,324 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICARE- HUMANA | $4,237 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | HUMANA | $6,486 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | VANTAGE | $7,351 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICAID | $1,040 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICAID – AETNA BETTER HEALTH | $1,040 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICAID – UNITED | $1,040 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICAID – HEALTHY BLUE | $1,040 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MEDICAID – AMERIHEALTH | $1,040 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | UNITED | $4,460 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | AETNA | $2,556 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | CIGNA | $2,399 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | LWCC | $11,118 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | PPOPLUS | $18,139 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | GILSBAR | $14,748 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | LSU | $5,278 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | VERITY | $5,745 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | MULTIPLAN | $5,745 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | LA WORK COMP | $27,745 |
| 49653 | Lap vent/abd hern proc comp | $27,745 | | |
| 49652 | Lap vent/abd hernia repair | $26,623 | Private Pay | $28,590 |
| 49652 | Lap vent/abd hernia repair | $26,623 | BC PPO | $5,466 |
| 49652 | Lap vent/abd hernia repair | $26,623 | BC HMO | $4,796 |
| 49652 | Lap vent/abd hernia repair | $26,623 | BC FMOL | $4,842 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICARE | $4,324 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICARE – BLUE CROSS | $4,324 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICARE – UNITED | $4,324 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICARE – COVENTRY | $4,324 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICARE – VANTAGE | $4,324 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICARE -PEOPLES | $4,324 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICARE- HUMANA | $4,237 |
| 49652 | Lap vent/abd hernia repair | $26,623 | HUMANA | $6,486 |
| 49652 | Lap vent/abd hernia repair | $26,623 | VANTAGE | $7,351 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICAID | $1,040 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICAID – AETNA BETTER HEALTH | $1,040 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICAID – UNITED | $1,040 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICAID – HEALTHY BLUE | $1,040 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MEDICAID – AMERIHEALTH | $1,040 |
| 49652 | Lap vent/abd hernia repair | $26,623 | UNITED | $4,460 |
| 49652 | Lap vent/abd hernia repair | $26,623 | AETNA | $2,456 |
| 49652 | Lap vent/abd hernia repair | $26,623 | CIGNA | $2,031 |
| 49652 | Lap vent/abd hernia repair | $26,623 | LWCC | $11,118 |
| 49652 | Lap vent/abd hernia repair | $26,623 | PPOPLUS | $17,440 |
| 49652 | Lap vent/abd hernia repair | $26,623 | GILSBAR | $14,170 |
| 49652 | Lap vent/abd hernia repair | $26,623 | LSU | $5,160 |
| 49652 | Lap vent/abd hernia repair | $26,623 | VERITY | $5,745 |
| 49652 | Lap vent/abd hernia repair | $26,623 | MULTIPLAN | $5,745 |
| 49652 | Lap vent/abd hernia repair | $26,623 | LA WORK COMP | $26,623 |
| 49652 | Lap vent/abd hernia repair | $26,623 | | |
| 55550 | Laparo ligate spermatic vein | $11,118 | Private Pay | $10,270 |
| 55550 | Laparo ligate spermatic vein | $11,118 | BC PPO | $5,466 |
| 55550 | Laparo ligate spermatic vein | $11,118 | BC HMO | $4,796 |
| 55550 | Laparo ligate spermatic vein | $11,118 | BC FMOL | $4,842 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICARE | $4,324 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICARE – BLUE CROSS | $4,324 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICARE – UNITED | $4,324 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICARE – COVENTRY | $4,324 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICARE – VANTAGE | $4,324 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICARE -PEOPLES | $4,324 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICARE- HUMANA | $4,237 |
| 55550 | Laparo ligate spermatic vein | $11,118 | HUMANA | $6,486 |
| 55550 | Laparo ligate spermatic vein | $11,118 | VANTAGE | $7,351 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICAID | $1,400 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICAID – AETNA BETTER HEALTH | $1,400 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICAID – UNITED | $1,400 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICAID – HEALTHY BLUE | $1,400 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MEDICAID – AMERIHEALTH | $1,400 |
| 55550 | Laparo ligate spermatic vein | $11,118 | UNITED | $4,460 |
| 55550 | Laparo ligate spermatic vein | $11,118 | AETNA | $1,875 |
| 55550 | Laparo ligate spermatic vein | $11,118 | CIGNA | $854 |
| 55550 | Laparo ligate spermatic vein | $11,118 | LWCC | $11,118 |
| 55550 | Laparo ligate spermatic vein | $11,118 | PPOPLUS | $6,265 |
| 55550 | Laparo ligate spermatic vein | $11,118 | GILSBAR | $5,032 |
| 55550 | Laparo ligate spermatic vein | $11,118 | LSU | $4,000 |
| 55550 | Laparo ligate spermatic vein | $11,118 | VERITY | $5,745 |
| 55550 | Laparo ligate spermatic vein | $11,118 | MULTIPLAN | $5,745 |
| 55550 | Laparo ligate spermatic vein | $11,118 | LA WORK COMP | $9,243 |
| 55550 | Laparo ligate spermatic vein | $11,118 | | |
| 50543 | Laparo partial nephrectomy | $32,114 | Private Pay | $35,027 |
| 50543 | Laparo partial nephrectomy | $32,114 | BC PPO | $9,839 |
| 50543 | Laparo partial nephrectomy | $32,114 | BC HMO | $8,634 |
| 50543 | Laparo partial nephrectomy | $32,114 | BC FMOL | $8,716 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICARE | $7,526 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICARE – BLUE CROSS | $7,526 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICARE – UNITED | $7,526 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICARE – COVENTRY | $7,526 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICARE – VANTAGE | $7,526 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICARE -PEOPLES | $7,526 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICARE- HUMANA | $7,375 |
| 50543 | Laparo partial nephrectomy | $32,114 | HUMANA | $11,289 |
| 50543 | Laparo partial nephrectomy | $32,114 | VANTAGE | $12,794 |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICAID | $- |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICAID – AETNA BETTER HEALTH | $- |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICAID – UNITED | $- |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICAID – HEALTHY BLUE | $- |
| 50543 | Laparo partial nephrectomy | $32,114 | MEDICAID – AMERIHEALTH | $- |
| 50543 | Laparo partial nephrectomy | $32,114 | UNITED | $4,460 |
| 50543 | Laparo partial nephrectomy | $32,114 | AETNA | $2,748 |
| 50543 | Laparo partial nephrectomy | $32,114 | CIGNA | $1,323 |
| 50543 | Laparo partial nephrectomy | $32,114 | LWCC | $19,350 |
| 50543 | Laparo partial nephrectomy | $32,114 | PPOPLUS | $21,367 |
| 50543 | Laparo partial nephrectomy | $32,114 | GILSBAR | $17,270 |
| 50543 | Laparo partial nephrectomy | $32,114 | LSU | $4,766 |
| 50543 | Laparo partial nephrectomy | $32,114 | VERITY | $9,721 |
| 50543 | Laparo partial nephrectomy | $32,114 | MULTIPLAN | $9,721 |
| 50543 | Laparo partial nephrectomy | $32,114 | LA WORK COMP | $32,114 |
| 50543 | Laparo partial nephrectomy | $32,114 | | |
| 55866 | Laparo radical prostatectomy | $38,778 | Private Pay | $41,393 |
| 55866 | Laparo radical prostatectomy | $38,778 | BC PPO | $9,839 |
| 55866 | Laparo radical prostatectomy | $38,778 | BC HMO | $8,634 |
| 55866 | Laparo radical prostatectomy | $38,778 | BC FMOL | $8,716 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICARE | $7,526 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICARE – BLUE CROSS | $7,526 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICARE – UNITED | $7,526 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICARE – COVENTRY | $7,526 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICARE – VANTAGE | $7,526 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICARE -PEOPLES | $7,526 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICARE- HUMANA | $7,375 |
| 55866 | Laparo radical prostatectomy | $38,778 | HUMANA | $11,289 |
| 55866 | Laparo radical prostatectomy | $38,778 | VANTAGE | $12,794 |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICAID | $- |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICAID – AETNA BETTER HEALTH | $- |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICAID – UNITED | $- |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICAID – HEALTHY BLUE | $- |
| 55866 | Laparo radical prostatectomy | $38,778 | MEDICAID – AMERIHEALTH | $- |
| 55866 | Laparo radical prostatectomy | $38,778 | UNITED | $6,420 |
| 55866 | Laparo radical prostatectomy | $38,778 | AETNA | $2,477 |
| 55866 | Laparo radical prostatectomy | $38,778 | CIGNA | $3,335 |
| 55866 | Laparo radical prostatectomy | $38,778 | LWCC | $19,350 |
| 55866 | Laparo radical prostatectomy | $38,778 | PPOPLUS | $25,250 |
| 55866 | Laparo radical prostatectomy | $38,778 | GILSBAR | $20,557 |
| 55866 | Laparo radical prostatectomy | $38,778 | LSU | $5,982 |
| 55866 | Laparo radical prostatectomy | $38,778 | VERITY | $9,721 |
| 55866 | Laparo radical prostatectomy | $38,778 | MULTIPLAN | $9,721 |
| 55866 | Laparo radical prostatectomy | $38,778 | LA WORK COMP | $38,778 |
| 55866 | Laparo radical prostatectomy | $38,778 | | |
| 47562 | Laparoscopic cholecystectomy | $12,256 | Private Pay | $12,522 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | BC PPO | $5,698 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | BC HMO | $5,000 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | BC FMOL | $5,048 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICARE | $4,324 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICARE – BLUE CROSS | $4,324 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICARE – UNITED | $4,324 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICARE – COVENTRY | $4,324 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICARE – VANTAGE | $4,324 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICARE -PEOPLES | $4,324 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICARE- HUMANA | $4,237 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | HUMANA | $6,486 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | VANTAGE | $7,351 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICAID | $533 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICAID – UNITED | $533 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICAID – HEALTHY BLUE | $533 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MEDICAID – AMERIHEALTH | $533 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | UNITED | $4,460 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | AETNA | $2,734 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | CIGNA | $2,293 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | LWCC | $11,118 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | PPOPLUS | $7,639 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | GILSBAR | $6,313 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | LSU | $5,281 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | VERITY | $5,745 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | MULTIPLAN | $5,745 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | LA WORK COMP | $12,256 |
| 47562 | Laparoscopic cholecystectomy | $12,256 | | |
| 52648 | Laser surgery of prostate | $16,427 | Private Pay | $17,665 |
| 52648 | Laser surgery of prostate | $16,427 | BC PPO | $4,705 |
| 52648 | Laser surgery of prostate | $16,427 | BC HMO | $4,128 |
| 52648 | Laser surgery of prostate | $16,427 | BC FMOL | $4,168 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICARE | $3,785 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICARE – BLUE CROSS | $3,785 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICARE – UNITED | $3,785 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICARE – COVENTRY | $3,785 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICARE – VANTAGE | $3,785 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICARE -PEOPLES | $3,785 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICARE- HUMANA | $3,710 |
| 52648 | Laser surgery of prostate | $16,427 | HUMANA | $5,678 |
| 52648 | Laser surgery of prostate | $16,427 | VANTAGE | $6,435 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICAID | $1,400 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICAID – AETNA BETTER HEALTH | $1,400 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICAID – UNITED | $1,400 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICAID – HEALTHY BLUE | $1,400 |
| 52648 | Laser surgery of prostate | $16,427 | MEDICAID – AMERIHEALTH | $1,400 |
| 52648 | Laser surgery of prostate | $16,427 | UNITED | $3,860 |
| 52648 | Laser surgery of prostate | $16,427 | AETNA | $2,231 |
| 52648 | Laser surgery of prostate | $16,427 | CIGNA | $1,689 |
| 52648 | Laser surgery of prostate | $16,427 | LWCC | $9,733 |
| 52648 | Laser surgery of prostate | $16,427 | PPOPLUS | $10,776 |
| 52648 | Laser surgery of prostate | $16,427 | GILSBAR | $8,751 |
| 52648 | Laser surgery of prostate | $16,427 | LSU | $4,686 |
| 52648 | Laser surgery of prostate | $16,427 | VERITY | $4,743 |
| 52648 | Laser surgery of prostate | $16,427 | MULTIPLAN | $4,743 |
| 52648 | Laser surgery of prostate | $16,427 | LA WORK COMP | $16,427 |
| 52648 | Laser surgery of prostate | $16,427 | | |
| 13160 | Late closure of wound | $7,548 | Private Pay | $8,387 |
| 13160 | Late closure of wound | $7,548 | BC PPO | $2,032 |
| 13160 | Late closure of wound | $7,548 | BC HMO | $1,783 |
| 13160 | Late closure of wound | $7,548 | BC FMOL | $1,800 |
| 13160 | Late closure of wound | $7,548 | MEDICARE | $1,452 |
| 13160 | Late closure of wound | $7,548 | MEDICARE – BLUE CROSS | $1,452 |
| 13160 | Late closure of wound | $7,548 | MEDICARE – UNITED | $1,452 |
| 13160 | Late closure of wound | $7,548 | MEDICARE – COVENTRY | $1,452 |
| 13160 | Late closure of wound | $7,548 | MEDICARE – VANTAGE | $1,452 |
| 13160 | Late closure of wound | $7,548 | MEDICARE -PEOPLES | $1,452 |
| 13160 | Late closure of wound | $7,548 | MEDICARE- HUMANA | $1,423 |
| 13160 | Late closure of wound | $7,548 | HUMANA | $2,177 |
| 13160 | Late closure of wound | $7,548 | VANTAGE | $2,468 |
| 13160 | Late closure of wound | $7,548 | MEDICAID | $466 |
| 13160 | Late closure of wound | $7,548 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 13160 | Late closure of wound | $7,548 | MEDICAID – UNITED | $466 |
| 13160 | Late closure of wound | $7,548 | MEDICAID – HEALTHY BLUE | $466 |
| 13160 | Late closure of wound | $7,548 | MEDICAID – AMERIHEALTH | $466 |
| 13160 | Late closure of wound | $7,548 | UNITED | $734 |
| 13160 | Late closure of wound | $7,548 | AETNA | $1,000 |
| 13160 | Late closure of wound | $7,548 | CIGNA | $1,323 |
| 13160 | Late closure of wound | $7,548 | LWCC | $3,732 |
| 13160 | Late closure of wound | $7,548 | PPOPLUS | $5,116 |
| 13160 | Late closure of wound | $7,548 | GILSBAR | $4,110 |
| 13160 | Late closure of wound | $7,548 | LSU | $4,000 |
| 13160 | Late closure of wound | $7,548 | VERITY | $2,007 |
| 13160 | Late closure of wound | $7,548 | MULTIPLAN | $2,007 |
| 13160 | Late closure of wound | $7,548 | LA WORK COMP | $7,548 |
| 13160 | Late closure of wound | $7,548 | | |
| 63030 | Low back disk surgery | $15,436 | Private Pay | $15,210 |
| 63030 | Low back disk surgery | $15,436 | BC PPO | $7,117 |
| 63030 | Low back disk surgery | $15,436 | BC HMO | $6,245 |
| 63030 | Low back disk surgery | $15,436 | BC FMOL | $6,305 |
| 63030 | Low back disk surgery | $15,436 | MEDICARE | $5,351 |
| 63030 | Low back disk surgery | $15,436 | MEDICARE – BLUE CROSS | $5,351 |
| 63030 | Low back disk surgery | $15,436 | MEDICARE – UNITED | $5,351 |
| 63030 | Low back disk surgery | $15,436 | MEDICARE – COVENTRY | $5,351 |
| 63030 | Low back disk surgery | $15,436 | MEDICARE – VANTAGE | $5,351 |
| 63030 | Low back disk surgery | $15,436 | MEDICARE -PEOPLES | $5,351 |
| 63030 | Low back disk surgery | $15,436 | MEDICARE- HUMANA | $5,244 |
| 63030 | Low back disk surgery | $15,436 | HUMANA | $8,026 |
| 63030 | Low back disk surgery | $15,436 | VANTAGE | $9,097 |
| 63030 | Low back disk surgery | $15,436 | MEDICAID | $- |
| 63030 | Low back disk surgery | $15,436 | MEDICAID – AETNA BETTER HEALTH | $- |
| 63030 | Low back disk surgery | $15,436 | MEDICAID – UNITED | $- |
| 63030 | Low back disk surgery | $15,436 | MEDICAID – HEALTHY BLUE | $- |
| 63030 | Low back disk surgery | $15,436 | MEDICAID – AMERIHEALTH | $- |
| 63030 | Low back disk surgery | $15,436 | UNITED | $4,460 |
| 63030 | Low back disk surgery | $15,436 | AETNA | $3,572 |
| 63030 | Low back disk surgery | $15,436 | CIGNA | $3,298 |
| 63030 | Low back disk surgery | $15,436 | LWCC | $13,758 |
| 63030 | Low back disk surgery | $15,436 | PPOPLUS | $9,278 |
| 63030 | Low back disk surgery | $15,436 | GILSBAR | $7,767 |
| 63030 | Low back disk surgery | $15,436 | LSU | $6,271 |
| 63030 | Low back disk surgery | $15,436 | VERITY | $7,176 |
| 63030 | Low back disk surgery | $15,436 | MULTIPLAN | $7,176 |
| 63030 | Low back disk surgery | $15,436 | LA WORK COMP | $15,436 |
| 63030 | Low back disk surgery | $15,436 | | |
| 64415 | N block inj brachial plexus | $7,981 | Private Pay | $1,123 |
| 64415 | N block inj brachial plexus | $7,981 | BC PPO | $871 |
| 64415 | N block inj brachial plexus | $7,981 | BC HMO | $764 |
| 64415 | N block inj brachial plexus | $7,981 | BC FMOL | $771 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICARE | $726 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICARE – BLUE CROSS | $726 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICARE – UNITED | $726 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICARE – COVENTRY | $726 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICARE – VANTAGE | $726 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICARE -PEOPLES | $726 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICARE- HUMANA | $712 |
| 64415 | N block inj brachial plexus | $7,981 | HUMANA | $1,090 |
| 64415 | N block inj brachial plexus | $7,981 | VANTAGE | $1,235 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICAID | $348 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICAID – UNITED | $348 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICAID – HEALTHY BLUE | $348 |
| 64415 | N block inj brachial plexus | $7,981 | MEDICAID – AMERIHEALTH | $348 |
| 64415 | N block inj brachial plexus | $7,981 | UNITED | $610 |
| 64415 | N block inj brachial plexus | $7,981 | AETNA | $4,118 |
| 64415 | N block inj brachial plexus | $7,981 | CIGNA | $5,365 |
| 64415 | N block inj brachial plexus | $7,981 | LWCC | $1,868 |
| 64415 | N block inj brachial plexus | $7,981 | PPOPLUS | $685 |
| 64415 | N block inj brachial plexus | $7,981 | GILSBAR | $1,101 |
| 64415 | N block inj brachial plexus | $7,981 | LSU | $7,981 |
| 64415 | N block inj brachial plexus | $7,981 | VERITY | $860 |
| 64415 | N block inj brachial plexus | $7,981 | MULTIPLAN | $860 |
| 64415 | N block inj brachial plexus | $7,981 | LA WORK COMP | $4,073 |
| 64415 | N block inj brachial plexus | $7,981 | | |
| 64510 | N block stellate ganglion | $4,000 | Private Pay | $4,423 |
| 64510 | N block stellate ganglion | $4,000 | BC PPO | $871 |
| 64510 | N block stellate ganglion | $4,000 | BC HMO | $764 |
| 64510 | N block stellate ganglion | $4,000 | BC FMOL | $771 |
| 64510 | N block stellate ganglion | $4,000 | MEDICARE | $726 |
| 64510 | N block stellate ganglion | $4,000 | MEDICARE – BLUE CROSS | $726 |
| 64510 | N block stellate ganglion | $4,000 | MEDICARE – UNITED | $726 |
| 64510 | N block stellate ganglion | $4,000 | MEDICARE – COVENTRY | $726 |
| 64510 | N block stellate ganglion | $4,000 | MEDICARE – VANTAGE | $726 |
| 64510 | N block stellate ganglion | $4,000 | MEDICARE -PEOPLES | $726 |
| 64510 | N block stellate ganglion | $4,000 | MEDICARE- HUMANA | $712 |
| 64510 | N block stellate ganglion | $4,000 | HUMANA | $1,090 |
| 64510 | N block stellate ganglion | $4,000 | VANTAGE | $1,235 |
| 64510 | N block stellate ganglion | $4,000 | MEDICAID | $348 |
| 64510 | N block stellate ganglion | $4,000 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 64510 | N block stellate ganglion | $4,000 | MEDICAID – UNITED | $348 |
| 64510 | N block stellate ganglion | $4,000 | MEDICAID – HEALTHY BLUE | $348 |
| 64510 | N block stellate ganglion | $4,000 | MEDICAID – AMERIHEALTH | $348 |
| 64510 | N block stellate ganglion | $4,000 | UNITED | $610 |
| 64510 | N block stellate ganglion | $4,000 | AETNA | $750 |
| 64510 | N block stellate ganglion | $4,000 | CIGNA | $1,433 |
| 64510 | N block stellate ganglion | $4,000 | LWCC | $1,868 |
| 64510 | N block stellate ganglion | $4,000 | PPOPLUS | $2,698 |
| 64510 | N block stellate ganglion | $4,000 | GILSBAR | $2,167 |
| 64510 | N block stellate ganglion | $4,000 | LSU | $4,000 |
| 64510 | N block stellate ganglion | $4,000 | VERITY | $860 |
| 64510 | N block stellate ganglion | $4,000 | MULTIPLAN | $860 |
| 64510 | N block stellate ganglion | $4,000 | LA WORK COMP | $3,981 |
| 64510 | N block stellate ganglion | $4,000 | | |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | Private Pay | $34,046 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | BC PPO | $12,851 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | BC HMO | $11,277 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | BC FMOL | $11,384 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICARE | $10,645 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICARE – BLUE CROSS | $10,645 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICARE – UNITED | $10,645 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICARE – COVENTRY | $10,645 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICARE – VANTAGE | $10,645 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICARE -PEOPLES | $10,645 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICARE- HUMANA | $10,433 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | HUMANA | $15,968 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | VANTAGE | $18,097 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICAID | $1,400 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICAID – AETNA BETTER HEALTH | $1,400 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICAID – UNITED | $1,400 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICAID – HEALTHY BLUE | $1,400 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MEDICAID – AMERIHEALTH | $1,400 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | UNITED | $9,558 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | AETNA | $6,804 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | CIGNA | $8,638 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | LWCC | $27,372 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | PPOPLUS | $20,768 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | GILSBAR | $17,665 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | LSU | $11,096 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | VERITY | $12,956 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | MULTIPLAN | $12,956 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | LA WORK COMP | $36,100 |
| 22551 | Neck spine fuse&remov bel c2 | $36,100 | | |
| 64905 | Nerve pedicle transfer | $15,958 | Private Pay | $17,731 |
| 64905 | Nerve pedicle transfer | $15,958 | BC PPO | $5,995 |
| 64905 | Nerve pedicle transfer | $15,958 | BC HMO | $5,260 |
| 64905 | Nerve pedicle transfer | $15,958 | BC FMOL | $5,310 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICARE | $4,928 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICARE – BLUE CROSS | $4,928 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICARE – UNITED | $4,928 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICARE – COVENTRY | $4,928 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICARE – VANTAGE | $4,928 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICARE -PEOPLES | $4,928 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICARE- HUMANA | $4,829 |
| 64905 | Nerve pedicle transfer | $15,958 | HUMANA | $7,392 |
| 64905 | Nerve pedicle transfer | $15,958 | VANTAGE | $8,377 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICAID | $466 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICAID – UNITED | $466 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICAID – HEALTHY BLUE | $466 |
| 64905 | Nerve pedicle transfer | $15,958 | MEDICAID – AMERIHEALTH | $466 |
| 64905 | Nerve pedicle transfer | $15,958 | UNITED | $3,860 |
| 64905 | Nerve pedicle transfer | $15,958 | AETNA | $1,000 |
| 64905 | Nerve pedicle transfer | $15,958 | CIGNA | $854 |
| 64905 | Nerve pedicle transfer | $15,958 | LWCC | $12,671 |
| 64905 | Nerve pedicle transfer | $15,958 | PPOPLUS | $10,816 |
| 64905 | Nerve pedicle transfer | $15,958 | GILSBAR | $8,688 |
| 64905 | Nerve pedicle transfer | $15,958 | LSU | $4,000 |
| 64905 | Nerve pedicle transfer | $15,958 | VERITY | $5,923 |
| 64905 | Nerve pedicle transfer | $15,958 | MULTIPLAN | $5,923 |
| 64905 | Nerve pedicle transfer | $15,958 | LA WORK COMP | $15,958 |
| 64905 | Nerve pedicle transfer | $15,958 | | |
| 64910 | Nerve repair w/allograft | $20,320 | Private Pay | $18,676 |
| 64910 | Nerve repair w/allograft | $20,320 | BC PPO | $5,995 |
| 64910 | Nerve repair w/allograft | $20,320 | BC HMO | $5,260 |
| 64910 | Nerve repair w/allograft | $20,320 | BC FMOL | $5,310 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICARE | $4,928 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICARE – BLUE CROSS | $4,928 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICARE – UNITED | $4,928 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICARE – COVENTRY | $4,928 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICARE – VANTAGE | $4,928 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICARE -PEOPLES | $4,928 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICARE- HUMANA | $4,829 |
| 64910 | Nerve repair w/allograft | $20,320 | HUMANA | $7,392 |
| 64910 | Nerve repair w/allograft | $20,320 | VANTAGE | $8,377 |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICAID | $- |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICAID – AETNA BETTER HEALTH | $- |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICAID – UNITED | $- |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICAID – HEALTHY BLUE | $- |
| 64910 | Nerve repair w/allograft | $20,320 | MEDICAID – AMERIHEALTH | $- |
| 64910 | Nerve repair w/allograft | $20,320 | UNITED | $3,860 |
| 64910 | Nerve repair w/allograft | $20,320 | AETNA | $4,862 |
| 64910 | Nerve repair w/allograft | $20,320 | CIGNA | $5,736 |
| 64910 | Nerve repair w/allograft | $20,320 | LWCC | $12,671 |
| 64910 | Nerve repair w/allograft | $20,320 | PPOPLUS | $11,393 |
| 64910 | Nerve repair w/allograft | $20,320 | GILSBAR | $9,783 |
| 64910 | Nerve repair w/allograft | $20,320 | LSU | $8,564 |
| 64910 | Nerve repair w/allograft | $20,320 | VERITY | $5,923 |
| 64910 | Nerve repair w/allograft | $20,320 | MULTIPLAN | $5,923 |
| 64910 | Nerve repair w/allograft | $20,320 | LA WORK COMP | $20,320 |
| 64910 | Nerve repair w/allograft | $20,320 | | |
| 27766 | Optx medial ankle fx | $16,440 | Private Pay | $17,043 |
| 27766 | Optx medial ankle fx | $16,440 | BC PPO | $6,827 |
| 27766 | Optx medial ankle fx | $16,440 | BC HMO | $5,990 |
| 27766 | Optx medial ankle fx | $16,440 | BC FMOL | $6,047 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICARE | $5,351 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICARE – BLUE CROSS | $5,351 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICARE – UNITED | $5,351 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICARE – COVENTRY | $5,351 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICARE – VANTAGE | $5,351 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICARE -PEOPLES | $5,351 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICARE- HUMANA | $5,244 |
| 27766 | Optx medial ankle fx | $16,440 | HUMANA | $8,026 |
| 27766 | Optx medial ankle fx | $16,440 | VANTAGE | $9,097 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICAID | $533 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICAID – UNITED | $533 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICAID – HEALTHY BLUE | $533 |
| 27766 | Optx medial ankle fx | $16,440 | MEDICAID – AMERIHEALTH | $533 |
| 27766 | Optx medial ankle fx | $16,440 | UNITED | $4,460 |
| 27766 | Optx medial ankle fx | $16,440 | AETNA | $2,411 |
| 27766 | Optx medial ankle fx | $16,440 | CIGNA | $2,776 |
| 27766 | Optx medial ankle fx | $16,440 | LWCC | $13,758 |
| 27766 | Optx medial ankle fx | $16,440 | PPOPLUS | $10,396 |
| 27766 | Optx medial ankle fx | $16,440 | GILSBAR | $8,549 |
| 27766 | Optx medial ankle fx | $16,440 | LSU | $5,431 |
| 27766 | Optx medial ankle fx | $16,440 | VERITY | $7,176 |
| 27766 | Optx medial ankle fx | $16,440 | MULTIPLAN | $7,176 |
| 27766 | Optx medial ankle fx | $16,440 | LA WORK COMP | $16,440 |
| 27766 | Optx medial ankle fx | $16,440 | | |
| 28825 | Partial amputation of toe | $8,180 | Private Pay | $9,089 |
| 28825 | Partial amputation of toe | $8,180 | BC PPO | $1,486 |
| 28825 | Partial amputation of toe | $8,180 | BC HMO | $1,304 |
| 28825 | Partial amputation of toe | $8,180 | BC FMOL | $1,317 |
| 28825 | Partial amputation of toe | $8,180 | MEDICARE | $2,449 |
| 28825 | Partial amputation of toe | $8,180 | MEDICARE – BLUE CROSS | $2,449 |
| 28825 | Partial amputation of toe | $8,180 | MEDICARE – UNITED | $2,449 |
| 28825 | Partial amputation of toe | $8,180 | MEDICARE – COVENTRY | $2,449 |
| 28825 | Partial amputation of toe | $8,180 | MEDICARE – VANTAGE | $2,449 |
| 28825 | Partial amputation of toe | $8,180 | MEDICARE -PEOPLES | $2,449 |
| 28825 | Partial amputation of toe | $8,180 | MEDICARE- HUMANA | $2,400 |
| 28825 | Partial amputation of toe | $8,180 | HUMANA | $3,673 |
| 28825 | Partial amputation of toe | $8,180 | VANTAGE | $4,163 |
| 28825 | Partial amputation of toe | $8,180 | MEDICAID | $466 |
| 28825 | Partial amputation of toe | $8,180 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28825 | Partial amputation of toe | $8,180 | MEDICAID – UNITED | $466 |
| 28825 | Partial amputation of toe | $8,180 | MEDICAID – HEALTHY BLUE | $466 |
| 28825 | Partial amputation of toe | $8,180 | MEDICAID – AMERIHEALTH | $466 |
| 28825 | Partial amputation of toe | $8,180 | UNITED | $2,188 |
| 28825 | Partial amputation of toe | $8,180 | AETNA | $1,000 |
| 28825 | Partial amputation of toe | $8,180 | CIGNA | $1,102 |
| 28825 | Partial amputation of toe | $8,180 | LWCC | $6,296 |
| 28825 | Partial amputation of toe | $8,180 | PPOPLUS | $5,544 |
| 28825 | Partial amputation of toe | $8,180 | GILSBAR | $4,454 |
| 28825 | Partial amputation of toe | $8,180 | LSU | $4,000 |
| 28825 | Partial amputation of toe | $8,180 | VERITY | $1,728 |
| 28825 | Partial amputation of toe | $8,180 | MULTIPLAN | $1,728 |
| 28825 | Partial amputation of toe | $8,180 | LA WORK COMP | $8,180 |
| 28825 | Partial amputation of toe | $8,180 | | |
| 60220 | Partial removal of thyroid | $17,087 | Private Pay | $18,759 |
| 60220 | Partial removal of thyroid | $17,087 | BC PPO | $5,698 |
| 60220 | Partial removal of thyroid | $17,087 | BC HMO | $5,000 |
| 60220 | Partial removal of thyroid | $17,087 | BC FMOL | $5,048 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICARE | $4,324 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICARE – BLUE CROSS | $4,324 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICARE – UNITED | $4,324 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICARE – COVENTRY | $4,324 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICARE – VANTAGE | $4,324 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICARE -PEOPLES | $4,324 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICARE- HUMANA | $4,237 |
| 60220 | Partial removal of thyroid | $17,087 | HUMANA | $6,486 |
| 60220 | Partial removal of thyroid | $17,087 | VANTAGE | $7,351 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICAID | $659 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICAID – UNITED | $659 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICAID – HEALTHY BLUE | $659 |
| 60220 | Partial removal of thyroid | $17,087 | MEDICAID – AMERIHEALTH | $659 |
| 60220 | Partial removal of thyroid | $17,087 | UNITED | $4,460 |
| 60220 | Partial removal of thyroid | $17,087 | AETNA | $1,225 |
| 60220 | Partial removal of thyroid | $17,087 | CIGNA | $634 |
| 60220 | Partial removal of thyroid | $17,087 | LWCC | $11,118 |
| 60220 | Partial removal of thyroid | $17,087 | PPOPLUS | $11,443 |
| 60220 | Partial removal of thyroid | $17,087 | GILSBAR | $9,229 |
| 60220 | Partial removal of thyroid | $17,087 | LSU | $4,266 |
| 60220 | Partial removal of thyroid | $17,087 | VERITY | $5,745 |
| 60220 | Partial removal of thyroid | $17,087 | MULTIPLAN | $5,745 |
| 60220 | Partial removal of thyroid | $17,087 | LA WORK COMP | $17,087 |
| 60220 | Partial removal of thyroid | $17,087 | | |
| 27299 | Pelvis/hip joint surgery | $21,984 | Private Pay | $21,676 |
| 27299 | Pelvis/hip joint surgery | $21,984 | BC PPO | $278 |
| 27299 | Pelvis/hip joint surgery | $21,984 | BC HMO | $244 |
| 27299 | Pelvis/hip joint surgery | $21,984 | BC FMOL | $247 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICARE | $193 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICARE – BLUE CROSS | $193 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICARE – UNITED | $193 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICARE – COVENTRY | $193 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICARE – VANTAGE | $193 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICARE -PEOPLES | $193 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICARE- HUMANA | $189 |
| 27299 | Pelvis/hip joint surgery | $21,984 | HUMANA | $289 |
| 27299 | Pelvis/hip joint surgery | $21,984 | VANTAGE | $328 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICAID | $- |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICAID – AETNA BETTER HEALTH | $- |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICAID – UNITED | $- |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICAID – HEALTHY BLUE | $- |
| 27299 | Pelvis/hip joint surgery | $21,984 | MEDICAID – AMERIHEALTH | $- |
| 27299 | Pelvis/hip joint surgery | $21,984 | UNITED | $392 |
| 27299 | Pelvis/hip joint surgery | $21,984 | AETNA | $3,523 |
| 27299 | Pelvis/hip joint surgery | $21,984 | CIGNA | $6,023 |
| 27299 | Pelvis/hip joint surgery | $21,984 | LWCC | $496 |
| 27299 | Pelvis/hip joint surgery | $21,984 | PPOPLUS | $13,222 |
| 27299 | Pelvis/hip joint surgery | $21,984 | GILSBAR | $11,067 |
| 27299 | Pelvis/hip joint surgery | $21,984 | LSU | $7,218 |
| 27299 | Pelvis/hip joint surgery | $21,984 | VERITY | $275 |
| 27299 | Pelvis/hip joint surgery | $21,984 | MULTIPLAN | $275 |
| 27299 | Pelvis/hip joint surgery | $21,984 | LA WORK COMP | $21,984 |
| 27299 | Pelvis/hip joint surgery | $21,984 | | |
| 26756 | Pin finger fracture each | $6,296 | Private Pay | $6,625 |
| 26756 | Pin finger fracture each | $6,296 | BC PPO | $2,913 |
| 26756 | Pin finger fracture each | $6,296 | BC HMO | $2,556 |
| 26756 | Pin finger fracture each | $6,296 | BC FMOL | $2,580 |
| 26756 | Pin finger fracture each | $6,296 | MEDICARE | $2,449 |
| 26756 | Pin finger fracture each | $6,296 | MEDICARE – BLUE CROSS | $2,449 |
| 26756 | Pin finger fracture each | $6,296 | MEDICARE – UNITED | $2,449 |
| 26756 | Pin finger fracture each | $6,296 | MEDICARE – COVENTRY | $2,449 |
| 26756 | Pin finger fracture each | $6,296 | MEDICARE – VANTAGE | $2,449 |
| 26756 | Pin finger fracture each | $6,296 | MEDICARE -PEOPLES | $2,449 |
| 26756 | Pin finger fracture each | $6,296 | MEDICARE- HUMANA | $2,400 |
| 26756 | Pin finger fracture each | $6,296 | HUMANA | $3,673 |
| 26756 | Pin finger fracture each | $6,296 | VANTAGE | $4,163 |
| 26756 | Pin finger fracture each | $6,296 | MEDICAID | $466 |
| 26756 | Pin finger fracture each | $6,296 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26756 | Pin finger fracture each | $6,296 | MEDICAID – UNITED | $466 |
| 26756 | Pin finger fracture each | $6,296 | MEDICAID – HEALTHY BLUE | $466 |
| 26756 | Pin finger fracture each | $6,296 | MEDICAID – AMERIHEALTH | $466 |
| 26756 | Pin finger fracture each | $6,296 | UNITED | $2,188 |
| 26756 | Pin finger fracture each | $6,296 | AETNA | $1,027 |
| 26756 | Pin finger fracture each | $6,296 | CIGNA | $1,323 |
| 26756 | Pin finger fracture each | $6,296 | LWCC | $6,296 |
| 26756 | Pin finger fracture each | $6,296 | PPOPLUS | $4,041 |
| 26756 | Pin finger fracture each | $6,296 | GILSBAR | $3,250 |
| 26756 | Pin finger fracture each | $6,296 | LSU | $4,032 |
| 26756 | Pin finger fracture each | $6,296 | VERITY | $3,386 |
| 26756 | Pin finger fracture each | $6,296 | MULTIPLAN | $3,386 |
| 26756 | Pin finger fracture each | $6,296 | LA WORK COMP | $5,987 |
| 26756 | Pin finger fracture each | $6,296 | | |
| 52601 | Prostatectomy (turp) | $11,961 | Private Pay | $13,290 |
| 52601 | Prostatectomy (turp) | $11,961 | BC PPO | $4,705 |
| 52601 | Prostatectomy (turp) | $11,961 | BC HMO | $4,128 |
| 52601 | Prostatectomy (turp) | $11,961 | BC FMOL | $4,168 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICARE | $3,785 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICARE – BLUE CROSS | $3,785 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICARE – UNITED | $3,785 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICARE – COVENTRY | $3,785 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICARE – VANTAGE | $3,785 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICARE -PEOPLES | $3,785 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICARE- HUMANA | $3,710 |
| 52601 | Prostatectomy (turp) | $11,961 | HUMANA | $5,678 |
| 52601 | Prostatectomy (turp) | $11,961 | VANTAGE | $6,435 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICAID | $659 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICAID – UNITED | $659 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICAID – HEALTHY BLUE | $659 |
| 52601 | Prostatectomy (turp) | $11,961 | MEDICAID – AMERIHEALTH | $659 |
| 52601 | Prostatectomy (turp) | $11,961 | UNITED | $3,860 |
| 52601 | Prostatectomy (turp) | $11,961 | AETNA | $1,475 |
| 52601 | Prostatectomy (turp) | $11,961 | CIGNA | $1,323 |
| 52601 | Prostatectomy (turp) | $11,961 | LWCC | $9,733 |
| 52601 | Prostatectomy (turp) | $11,961 | PPOPLUS | $8,107 |
| 52601 | Prostatectomy (turp) | $11,961 | GILSBAR | $6,512 |
| 52601 | Prostatectomy (turp) | $11,961 | LSU | $4,000 |
| 52601 | Prostatectomy (turp) | $11,961 | VERITY | $4,743 |
| 52601 | Prostatectomy (turp) | $11,961 | MULTIPLAN | $4,743 |
| 52601 | Prostatectomy (turp) | $11,961 | LA WORK COMP | $11,961 |
| 52601 | Prostatectomy (turp) | $11,961 | | |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | Private Pay | $11,980 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | BC PPO | $3,545 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | BC HMO | $3,111 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | BC FMOL | $3,140 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICARE | $2,781 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICARE – BLUE CROSS | $2,781 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICARE – UNITED | $2,781 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICARE – COVENTRY | $2,781 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICARE – VANTAGE | $2,781 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICARE -PEOPLES | $2,781 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICARE- HUMANA | $2,726 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | HUMANA | $4,172 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | VANTAGE | $4,728 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICAID | $659 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICAID – UNITED | $659 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICAID – HEALTHY BLUE | $659 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MEDICAID – AMERIHEALTH | $659 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | UNITED | $2,923 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | AETNA | $2,134 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | CIGNA | $1,783 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | LWCC | $7,151 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | PPOPLUS | $7,308 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | GILSBAR | $5,978 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | LSU | $4,779 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | VERITY | $3,726 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | MULTIPLAN | $3,726 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | LA WORK COMP | $11,381 |
| 49505 | Prp i/hern init reduc >5 yr | $11,381 | | |
| 26437 | Realignment of tendons | $6,435 | Private Pay | $7,150 |
| 26437 | Realignment of tendons | $6,435 | BC PPO | $1,644 |
| 26437 | Realignment of tendons | $6,435 | BC HMO | $1,442 |
| 26437 | Realignment of tendons | $6,435 | BC FMOL | $1,456 |
| 26437 | Realignment of tendons | $6,435 | MEDICARE | $2,449 |
| 26437 | Realignment of tendons | $6,435 | MEDICARE – BLUE CROSS | $2,449 |
| 26437 | Realignment of tendons | $6,435 | MEDICARE – UNITED | $2,449 |
| 26437 | Realignment of tendons | $6,435 | MEDICARE – COVENTRY | $2,449 |
| 26437 | Realignment of tendons | $6,435 | MEDICARE – VANTAGE | $2,449 |
| 26437 | Realignment of tendons | $6,435 | MEDICARE -PEOPLES | $2,449 |
| 26437 | Realignment of tendons | $6,435 | MEDICARE- HUMANA | $2,400 |
| 26437 | Realignment of tendons | $6,435 | HUMANA | $3,673 |
| 26437 | Realignment of tendons | $6,435 | VANTAGE | $4,163 |
| 26437 | Realignment of tendons | $6,435 | MEDICAID | $533 |
| 26437 | Realignment of tendons | $6,435 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 26437 | Realignment of tendons | $6,435 | MEDICAID – UNITED | $533 |
| 26437 | Realignment of tendons | $6,435 | MEDICAID – HEALTHY BLUE | $533 |
| 26437 | Realignment of tendons | $6,435 | MEDICAID – AMERIHEALTH | $533 |
| 26437 | Realignment of tendons | $6,435 | UNITED | $734 |
| 26437 | Realignment of tendons | $6,435 | AETNA | $1,200 |
| 26437 | Realignment of tendons | $6,435 | CIGNA | $1,323 |
| 26437 | Realignment of tendons | $6,435 | LWCC | $6,296 |
| 26437 | Realignment of tendons | $6,435 | PPOPLUS | $4,361 |
| 26437 | Realignment of tendons | $6,435 | GILSBAR | $3,503 |
| 26437 | Realignment of tendons | $6,435 | LSU | $4,000 |
| 26437 | Realignment of tendons | $6,435 | VERITY | $1,728 |
| 26437 | Realignment of tendons | $6,435 | MULTIPLAN | $1,728 |
| 26437 | Realignment of tendons | $6,435 | LA WORK COMP | $6,435 |
| 26437 | Realignment of tendons | $6,435 | | |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | Private Pay | $16,207 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | BC PPO | $12,326 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | BC HMO | $10,816 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | BC FMOL | $10,919 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICARE | $10,645 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICARE – BLUE CROSS | $10,645 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICARE – UNITED | $10,645 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICARE – COVENTRY | $10,645 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICARE – VANTAGE | $10,645 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICARE -PEOPLES | $10,645 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICARE- HUMANA | $10,433 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | HUMANA | $15,968 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | VANTAGE | $18,097 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICAID | $- |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICAID – AETNA BETTER HEALTH | $- |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICAID – UNITED | $- |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICAID – HEALTHY BLUE | $- |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MEDICAID – AMERIHEALTH | $- |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | UNITED | $3,860 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | AETNA | $2,375 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | CIGNA | $2,072 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | LWCC | $27,372 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | PPOPLUS | $9,886 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | GILSBAR | $8,089 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | LSU | $5,064 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | VERITY | $12,956 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | MULTIPLAN | $12,956 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | LA WORK COMP | $15,405 |
| 24346 | Reconstruct elbow med ligmnt | $27,372 | | |
| 23472 | Reconstruct shoulder joint | $59,792 | Private Pay | $52,416 |
| 23472 | Reconstruct shoulder joint | $59,792 | BC PPO | $13,113 |
| 23472 | Reconstruct shoulder joint | $59,792 | BC HMO | $11,507 |
| 23472 | Reconstruct shoulder joint | $59,792 | BC FMOL | $11,616 |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICARE | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICARE – BLUE CROSS | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICARE – UNITED | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICARE – COVENTRY | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICARE – VANTAGE | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICARE -PEOPLES | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICARE- HUMANA | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | HUMANA | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | VANTAGE | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICAID | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICAID – AETNA BETTER HEALTH | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICAID – UNITED | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICAID – HEALTHY BLUE | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | MEDICAID – AMERIHEALTH | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | UNITED | $18,205 |
| 23472 | Reconstruct shoulder joint | $59,792 | AETNA | $14,679 |
| 23472 | Reconstruct shoulder joint | $59,792 | CIGNA | $17,647 |
| 23472 | Reconstruct shoulder joint | $59,792 | LWCC | $- |
| 23472 | Reconstruct shoulder joint | $59,792 | PPOPLUS | $31,974 |
| 23472 | Reconstruct shoulder joint | $59,792 | GILSBAR | $27,955 |
| 23472 | Reconstruct shoulder joint | $59,792 | LSU | $20,403 |
| 23472 | Reconstruct shoulder joint | $59,792 | VERITY | $7,809 |
| 23472 | Reconstruct shoulder joint | $59,792 | MULTIPLAN | $7,809 |
| 23472 | Reconstruct shoulder joint | $59,792 | LA WORK COMP | $59,792 |
| 23472 | Reconstruct shoulder joint | $59,792 | | |
| 27427 | Reconstruction knee | $26,611 | Private Pay | $25,711 |
| 27427 | Reconstruction knee | $26,611 | BC PPO | $4,866 |
| 27427 | Reconstruction knee | $26,611 | BC HMO | $4,270 |
| 27427 | Reconstruction knee | $26,611 | BC FMOL | $4,310 |
| 27427 | Reconstruction knee | $26,611 | MEDICARE | $5,351 |
| 27427 | Reconstruction knee | $26,611 | MEDICARE – BLUE CROSS | $5,351 |
| 27427 | Reconstruction knee | $26,611 | MEDICARE – UNITED | $5,351 |
| 27427 | Reconstruction knee | $26,611 | MEDICARE – COVENTRY | $5,351 |
| 27427 | Reconstruction knee | $26,611 | MEDICARE – VANTAGE | $5,351 |
| 27427 | Reconstruction knee | $26,611 | MEDICARE -PEOPLES | $5,351 |
| 27427 | Reconstruction knee | $26,611 | MEDICARE- HUMANA | $5,244 |
| 27427 | Reconstruction knee | $26,611 | HUMANA | $8,026 |
| 27427 | Reconstruction knee | $26,611 | VANTAGE | $9,097 |
| 27427 | Reconstruction knee | $26,611 | MEDICAID | $533 |
| 27427 | Reconstruction knee | $26,611 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 27427 | Reconstruction knee | $26,611 | MEDICAID – UNITED | $533 |
| 27427 | Reconstruction knee | $26,611 | MEDICAID – HEALTHY BLUE | $533 |
| 27427 | Reconstruction knee | $26,611 | MEDICAID – AMERIHEALTH | $533 |
| 27427 | Reconstruction knee | $26,611 | UNITED | $4,460 |
| 27427 | Reconstruction knee | $26,611 | AETNA | $5,019 |
| 27427 | Reconstruction knee | $26,611 | CIGNA | $6,016 |
| 27427 | Reconstruction knee | $26,611 | LWCC | $13,758 |
| 27427 | Reconstruction knee | $26,611 | PPOPLUS | $15,684 |
| 27427 | Reconstruction knee | $26,611 | GILSBAR | $13,223 |
| 27427 | Reconstruction knee | $26,611 | LSU | $8,513 |
| 27427 | Reconstruction knee | $26,611 | VERITY | $7,176 |
| 27427 | Reconstruction knee | $26,611 | MULTIPLAN | $7,176 |
| 27427 | Reconstruction knee | $26,611 | LA WORK COMP | $26,611 |
| 27427 | Reconstruction knee | $26,611 | | |
| 26445 | Release hand/finger tendon | $9,367 | Private Pay | $9,439 |
| 26445 | Release hand/finger tendon | $9,367 | BC PPO | $1,542 |
| 26445 | Release hand/finger tendon | $9,367 | BC HMO | $1,353 |
| 26445 | Release hand/finger tendon | $9,367 | BC FMOL | $1,366 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICARE | $2,449 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICARE – BLUE CROSS | $2,449 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICARE – UNITED | $2,449 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICARE – COVENTRY | $2,449 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICARE – VANTAGE | $2,449 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICARE -PEOPLES | $2,449 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICARE- HUMANA | $2,400 |
| 26445 | Release hand/finger tendon | $9,367 | HUMANA | $3,673 |
| 26445 | Release hand/finger tendon | $9,367 | VANTAGE | $4,163 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICAID | $533 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICAID – UNITED | $533 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICAID – HEALTHY BLUE | $533 |
| 26445 | Release hand/finger tendon | $9,367 | MEDICAID – AMERIHEALTH | $533 |
| 26445 | Release hand/finger tendon | $9,367 | UNITED | $734 |
| 26445 | Release hand/finger tendon | $9,367 | AETNA | $2,158 |
| 26445 | Release hand/finger tendon | $9,367 | CIGNA | $2,473 |
| 26445 | Release hand/finger tendon | $9,367 | LWCC | $6,296 |
| 26445 | Release hand/finger tendon | $9,367 | PPOPLUS | $5,758 |
| 26445 | Release hand/finger tendon | $9,367 | GILSBAR | $4,782 |
| 26445 | Release hand/finger tendon | $9,367 | LSU | $5,132 |
| 26445 | Release hand/finger tendon | $9,367 | VERITY | $3,386 |
| 26445 | Release hand/finger tendon | $9,367 | MULTIPLAN | $3,386 |
| 26445 | Release hand/finger tendon | $9,367 | LA WORK COMP | $9,367 |
| 26445 | Release hand/finger tendon | $9,367 | | |
| 27680 | Release of lower leg tendon | $11,202 | Private Pay | $12,447 |
| 27680 | Release of lower leg tendon | $11,202 | BC PPO | $2,296 |
| 27680 | Release of lower leg tendon | $11,202 | BC HMO | $2,015 |
| 27680 | Release of lower leg tendon | $11,202 | BC FMOL | $2,034 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICARE | $2,449 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICARE – BLUE CROSS | $2,449 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICARE – UNITED | $2,449 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICARE – COVENTRY | $2,449 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICARE – VANTAGE | $2,449 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICARE -PEOPLES | $2,449 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICARE- HUMANA | $2,400 |
| 27680 | Release of lower leg tendon | $11,202 | HUMANA | $3,673 |
| 27680 | Release of lower leg tendon | $11,202 | VANTAGE | $4,163 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICAID | $533 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICAID – UNITED | $533 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICAID – HEALTHY BLUE | $533 |
| 27680 | Release of lower leg tendon | $11,202 | MEDICAID – AMERIHEALTH | $533 |
| 27680 | Release of lower leg tendon | $11,202 | UNITED | $2,923 |
| 27680 | Release of lower leg tendon | $11,202 | AETNA | $1,200 |
| 27680 | Release of lower leg tendon | $11,202 | CIGNA | $1,102 |
| 27680 | Release of lower leg tendon | $11,202 | LWCC | $6,296 |
| 27680 | Release of lower leg tendon | $11,202 | PPOPLUS | $7,593 |
| 27680 | Release of lower leg tendon | $11,202 | GILSBAR | $6,099 |
| 27680 | Release of lower leg tendon | $11,202 | LSU | $4,000 |
| 27680 | Release of lower leg tendon | $11,202 | VERITY | $3,386 |
| 27680 | Release of lower leg tendon | $11,202 | MULTIPLAN | $3,386 |
| 27680 | Release of lower leg tendon | $11,202 | LA WORK COMP | $11,202 |
| 27680 | Release of lower leg tendon | $11,202 | | |
| 26121 | Release palm contracture | $6,748 | Private Pay | $7,497 |
| 26121 | Release palm contracture | $6,748 | BC PPO | $3,221 |
| 26121 | Release palm contracture | $6,748 | BC HMO | $2,826 |
| 26121 | Release palm contracture | $6,748 | BC FMOL | $2,853 |
| 26121 | Release palm contracture | $6,748 | MEDICARE | $2,449 |
| 26121 | Release palm contracture | $6,748 | MEDICARE – BLUE CROSS | $2,449 |
| 26121 | Release palm contracture | $6,748 | MEDICARE – UNITED | $2,449 |
| 26121 | Release palm contracture | $6,748 | MEDICARE – COVENTRY | $2,449 |
| 26121 | Release palm contracture | $6,748 | MEDICARE – VANTAGE | $2,449 |
| 26121 | Release palm contracture | $6,748 | MEDICARE -PEOPLES | $2,449 |
| 26121 | Release palm contracture | $6,748 | MEDICARE- HUMANA | $2,400 |
| 26121 | Release palm contracture | $6,748 | HUMANA | $3,673 |
| 26121 | Release palm contracture | $6,748 | VANTAGE | $4,163 |
| 26121 | Release palm contracture | $6,748 | MEDICAID | $659 |
| 26121 | Release palm contracture | $6,748 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 26121 | Release palm contracture | $6,748 | MEDICAID – UNITED | $659 |
| 26121 | Release palm contracture | $6,748 | MEDICAID – HEALTHY BLUE | $659 |
| 26121 | Release palm contracture | $6,748 | MEDICAID – AMERIHEALTH | $659 |
| 26121 | Release palm contracture | $6,748 | UNITED | $2,923 |
| 26121 | Release palm contracture | $6,748 | AETNA | $1,475 |
| 26121 | Release palm contracture | $6,748 | CIGNA | $1,102 |
| 26121 | Release palm contracture | $6,748 | LWCC | $6,296 |
| 26121 | Release palm contracture | $6,748 | PPOPLUS | $4,573 |
| 26121 | Release palm contracture | $6,748 | GILSBAR | $3,674 |
| 26121 | Release palm contracture | $6,748 | LSU | $4,000 |
| 26121 | Release palm contracture | $6,748 | VERITY | $3,386 |
| 26121 | Release palm contracture | $6,748 | MULTIPLAN | $3,386 |
| 26121 | Release palm contracture | $6,748 | LA WORK COMP | $6,748 |
| 26121 | Release palm contracture | $6,748 | | |
| 26123 | Release palm contracture | $9,107 | Private Pay | $10,099 |
| 26123 | Release palm contracture | $9,107 | BC PPO | $2,913 |
| 26123 | Release palm contracture | $9,107 | BC HMO | $2,556 |
| 26123 | Release palm contracture | $9,107 | BC FMOL | $2,580 |
| 26123 | Release palm contracture | $9,107 | MEDICARE | $2,449 |
| 26123 | Release palm contracture | $9,107 | MEDICARE – BLUE CROSS | $2,449 |
| 26123 | Release palm contracture | $9,107 | MEDICARE – UNITED | $2,449 |
| 26123 | Release palm contracture | $9,107 | MEDICARE – COVENTRY | $2,449 |
| 26123 | Release palm contracture | $9,107 | MEDICARE – VANTAGE | $2,449 |
| 26123 | Release palm contracture | $9,107 | MEDICARE -PEOPLES | $2,449 |
| 26123 | Release palm contracture | $9,107 | MEDICARE- HUMANA | $2,400 |
| 26123 | Release palm contracture | $9,107 | HUMANA | $3,673 |
| 26123 | Release palm contracture | $9,107 | VANTAGE | $4,163 |
| 26123 | Release palm contracture | $9,107 | MEDICAID | $659 |
| 26123 | Release palm contracture | $9,107 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 26123 | Release palm contracture | $9,107 | MEDICAID – UNITED | $659 |
| 26123 | Release palm contracture | $9,107 | MEDICAID – HEALTHY BLUE | $659 |
| 26123 | Release palm contracture | $9,107 | MEDICAID – AMERIHEALTH | $659 |
| 26123 | Release palm contracture | $9,107 | UNITED | $2,923 |
| 26123 | Release palm contracture | $9,107 | AETNA | $1,494 |
| 26123 | Release palm contracture | $9,107 | CIGNA | $1,323 |
| 26123 | Release palm contracture | $9,107 | LWCC | $6,296 |
| 26123 | Release palm contracture | $9,107 | PPOPLUS | $6,161 |
| 26123 | Release palm contracture | $9,107 | GILSBAR | $4,952 |
| 26123 | Release palm contracture | $9,107 | LSU | $4,022 |
| 26123 | Release palm contracture | $9,107 | VERITY | $3,386 |
| 26123 | Release palm contracture | $9,107 | MULTIPLAN | $3,386 |
| 26123 | Release palm contracture | $9,107 | LA WORK COMP | $9,107 |
| 26123 | Release palm contracture | $9,107 | | |
| 25295 | Release wrist/forearm tendon | $8,839 | Private Pay | $9,822 |
| 25295 | Release wrist/forearm tendon | $8,839 | BC PPO | $1,542 |
| 25295 | Release wrist/forearm tendon | $8,839 | BC HMO | $1,353 |
| 25295 | Release wrist/forearm tendon | $8,839 | BC FMOL | $1,366 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICARE | $2,449 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICARE – BLUE CROSS | $2,449 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICARE – UNITED | $2,449 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICARE – COVENTRY | $2,449 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICARE – VANTAGE | $2,449 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICARE -PEOPLES | $2,449 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICARE- HUMANA | $2,400 |
| 25295 | Release wrist/forearm tendon | $8,839 | HUMANA | $3,673 |
| 25295 | Release wrist/forearm tendon | $8,839 | VANTAGE | $4,163 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICAID | $533 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICAID – UNITED | $533 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICAID – HEALTHY BLUE | $533 |
| 25295 | Release wrist/forearm tendon | $8,839 | MEDICAID – AMERIHEALTH | $533 |
| 25295 | Release wrist/forearm tendon | $8,839 | UNITED | $2,188 |
| 25295 | Release wrist/forearm tendon | $8,839 | AETNA | $1,200 |
| 25295 | Release wrist/forearm tendon | $8,839 | CIGNA | $854 |
| 25295 | Release wrist/forearm tendon | $8,839 | LWCC | $6,296 |
| 25295 | Release wrist/forearm tendon | $8,839 | PPOPLUS | $5,991 |
| 25295 | Release wrist/forearm tendon | $8,839 | GILSBAR | $4,813 |
| 25295 | Release wrist/forearm tendon | $8,839 | LSU | $4,000 |
| 25295 | Release wrist/forearm tendon | $8,839 | VERITY | $3,386 |
| 25295 | Release wrist/forearm tendon | $8,839 | MULTIPLAN | $3,386 |
| 25295 | Release wrist/forearm tendon | $8,839 | LA WORK COMP | $8,839 |
| 25295 | Release wrist/forearm tendon | $8,839 | | |
| 42830 | Removal of adenoids | $6,024 | Private Pay | $6,100 |
| 42830 | Removal of adenoids | $6,024 | BC PPO | $2,165 |
| 42830 | Removal of adenoids | $6,024 | BC HMO | $1,900 |
| 42830 | Removal of adenoids | $6,024 | BC FMOL | $1,918 |
| 42830 | Removal of adenoids | $6,024 | MEDICARE | $2,343 |
| 42830 | Removal of adenoids | $6,024 | MEDICARE – BLUE CROSS | $2,343 |
| 42830 | Removal of adenoids | $6,024 | MEDICARE – UNITED | $2,343 |
| 42830 | Removal of adenoids | $6,024 | MEDICARE – COVENTRY | $2,343 |
| 42830 | Removal of adenoids | $6,024 | MEDICARE – VANTAGE | $2,343 |
| 42830 | Removal of adenoids | $6,024 | MEDICARE -PEOPLES | $2,343 |
| 42830 | Removal of adenoids | $6,024 | MEDICARE- HUMANA | $2,296 |
| 42830 | Removal of adenoids | $6,024 | HUMANA | $3,515 |
| 42830 | Removal of adenoids | $6,024 | VANTAGE | $3,983 |
| 42830 | Removal of adenoids | $6,024 | MEDICAID | $659 |
| 42830 | Removal of adenoids | $6,024 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 42830 | Removal of adenoids | $6,024 | MEDICAID – UNITED | $659 |
| 42830 | Removal of adenoids | $6,024 | MEDICAID – HEALTHY BLUE | $659 |
| 42830 | Removal of adenoids | $6,024 | MEDICAID – AMERIHEALTH | $659 |
| 42830 | Removal of adenoids | $6,024 | UNITED | $2,188 |
| 42830 | Removal of adenoids | $6,024 | AETNA | $1,530 |
| 42830 | Removal of adenoids | $6,024 | CIGNA | $634 |
| 42830 | Removal of adenoids | $6,024 | LWCC | $6,024 |
| 42830 | Removal of adenoids | $6,024 | PPOPLUS | $3,721 |
| 42830 | Removal of adenoids | $6,024 | GILSBAR | $2,998 |
| 42830 | Removal of adenoids | $6,024 | LSU | $4,065 |
| 42830 | Removal of adenoids | $6,024 | VERITY | $2,815 |
| 42830 | Removal of adenoids | $6,024 | MULTIPLAN | $2,815 |
| 42830 | Removal of adenoids | $6,024 | LA WORK COMP | $5,540 |
| 42830 | Removal of adenoids | $6,024 | | |
| 42831 | Removal of adenoids | $6,299 | Private Pay | $6,959 |
| 42831 | Removal of adenoids | $6,299 | BC PPO | $2,165 |
| 42831 | Removal of adenoids | $6,299 | BC HMO | $1,900 |
| 42831 | Removal of adenoids | $6,299 | BC FMOL | $1,918 |
| 42831 | Removal of adenoids | $6,299 | MEDICARE | $2,343 |
| 42831 | Removal of adenoids | $6,299 | MEDICARE – BLUE CROSS | $2,343 |
| 42831 | Removal of adenoids | $6,299 | MEDICARE – UNITED | $2,343 |
| 42831 | Removal of adenoids | $6,299 | MEDICARE – COVENTRY | $2,343 |
| 42831 | Removal of adenoids | $6,299 | MEDICARE – VANTAGE | $2,343 |
| 42831 | Removal of adenoids | $6,299 | MEDICARE -PEOPLES | $2,343 |
| 42831 | Removal of adenoids | $6,299 | MEDICARE- HUMANA | $2,296 |
| 42831 | Removal of adenoids | $6,299 | HUMANA | $3,515 |
| 42831 | Removal of adenoids | $6,299 | VANTAGE | $3,983 |
| 42831 | Removal of adenoids | $6,299 | MEDICAID | $659 |
| 42831 | Removal of adenoids | $6,299 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 42831 | Removal of adenoids | $6,299 | MEDICAID – UNITED | $659 |
| 42831 | Removal of adenoids | $6,299 | MEDICAID – HEALTHY BLUE | $659 |
| 42831 | Removal of adenoids | $6,299 | MEDICAID – AMERIHEALTH | $659 |
| 42831 | Removal of adenoids | $6,299 | UNITED | $2,188 |
| 42831 | Removal of adenoids | $6,299 | AETNA | $1,515 |
| 42831 | Removal of adenoids | $6,299 | CIGNA | $1,102 |
| 42831 | Removal of adenoids | $6,299 | LWCC | $6,024 |
| 42831 | Removal of adenoids | $6,299 | PPOPLUS | $4,245 |
| 42831 | Removal of adenoids | $6,299 | GILSBAR | $3,417 |
| 42831 | Removal of adenoids | $6,299 | LSU | $4,047 |
| 42831 | Removal of adenoids | $6,299 | VERITY | $2,815 |
| 42831 | Removal of adenoids | $6,299 | MULTIPLAN | $2,815 |
| 42831 | Removal of adenoids | $6,299 | LA WORK COMP | $6,299 |
| 42831 | Removal of adenoids | $6,299 | | |
| 19120 | Removal of breast lesion | $6,968 | Private Pay | $7,305 |
| 19120 | Removal of breast lesion | $6,968 | BC PPO | $3,463 |
| 19120 | Removal of breast lesion | $6,968 | BC HMO | $3,039 |
| 19120 | Removal of breast lesion | $6,968 | BC FMOL | $3,068 |
| 19120 | Removal of breast lesion | $6,968 | MEDICARE | $2,710 |
| 19120 | Removal of breast lesion | $6,968 | MEDICARE – BLUE CROSS | $2,710 |
| 19120 | Removal of breast lesion | $6,968 | MEDICARE – UNITED | $2,710 |
| 19120 | Removal of breast lesion | $6,968 | MEDICARE – COVENTRY | $2,710 |
| 19120 | Removal of breast lesion | $6,968 | MEDICARE – VANTAGE | $2,710 |
| 19120 | Removal of breast lesion | $6,968 | MEDICARE -PEOPLES | $2,710 |
| 19120 | Removal of breast lesion | $6,968 | MEDICARE- HUMANA | $2,656 |
| 19120 | Removal of breast lesion | $6,968 | HUMANA | $4,065 |
| 19120 | Removal of breast lesion | $6,968 | VANTAGE | $4,607 |
| 19120 | Removal of breast lesion | $6,968 | MEDICAID | $533 |
| 19120 | Removal of breast lesion | $6,968 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 19120 | Removal of breast lesion | $6,968 | MEDICAID – UNITED | $533 |
| 19120 | Removal of breast lesion | $6,968 | MEDICAID – HEALTHY BLUE | $533 |
| 19120 | Removal of breast lesion | $6,968 | MEDICAID – AMERIHEALTH | $533 |
| 19120 | Removal of breast lesion | $6,968 | UNITED | $2,188 |
| 19120 | Removal of breast lesion | $6,968 | AETNA | $1,200 |
| 19120 | Removal of breast lesion | $6,968 | CIGNA | $992 |
| 19120 | Removal of breast lesion | $6,968 | LWCC | $6,968 |
| 19120 | Removal of breast lesion | $6,968 | PPOPLUS | $4,456 |
| 19120 | Removal of breast lesion | $6,968 | GILSBAR | $3,579 |
| 19120 | Removal of breast lesion | $6,968 | LSU | $4,000 |
| 19120 | Removal of breast lesion | $6,968 | VERITY | $3,491 |
| 19120 | Removal of breast lesion | $6,968 | MULTIPLAN | $3,491 |
| 19120 | Removal of breast lesion | $6,968 | LA WORK COMP | $6,575 |
| 19120 | Removal of breast lesion | $6,968 | | |
| 24105 | Removal of elbow bursa | $8,461 | Private Pay | $9,402 |
| 24105 | Removal of elbow bursa | $8,461 | BC PPO | $3,221 |
| 24105 | Removal of elbow bursa | $8,461 | BC HMO | $2,826 |
| 24105 | Removal of elbow bursa | $8,461 | BC FMOL | $2,853 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICARE | $2,449 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICARE – BLUE CROSS | $2,449 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICARE – UNITED | $2,449 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICARE – COVENTRY | $2,449 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICARE – VANTAGE | $2,449 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICARE -PEOPLES | $2,449 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICARE- HUMANA | $2,400 |
| 24105 | Removal of elbow bursa | $8,461 | HUMANA | $3,673 |
| 24105 | Removal of elbow bursa | $8,461 | VANTAGE | $4,163 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICAID | $533 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICAID – UNITED | $533 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICAID – HEALTHY BLUE | $533 |
| 24105 | Removal of elbow bursa | $8,461 | MEDICAID – AMERIHEALTH | $533 |
| 24105 | Removal of elbow bursa | $8,461 | UNITED | $2,188 |
| 24105 | Removal of elbow bursa | $8,461 | AETNA | $1,200 |
| 24105 | Removal of elbow bursa | $8,461 | CIGNA | $992 |
| 24105 | Removal of elbow bursa | $8,461 | LWCC | $6,296 |
| 24105 | Removal of elbow bursa | $8,461 | PPOPLUS | $5,735 |
| 24105 | Removal of elbow bursa | $8,461 | GILSBAR | $4,607 |
| 24105 | Removal of elbow bursa | $8,461 | LSU | $4,000 |
| 24105 | Removal of elbow bursa | $8,461 | VERITY | $3,386 |
| 24105 | Removal of elbow bursa | $8,461 | MULTIPLAN | $3,386 |
| 24105 | Removal of elbow bursa | $8,461 | LA WORK COMP | $8,461 |
| 24105 | Removal of elbow bursa | $8,461 | | |
| 31255 | Removal of ethmoid sinus | $12,513 | Private Pay | $13,619 |
| 31255 | Removal of ethmoid sinus | $12,513 | BC PPO | $2,835 |
| 31255 | Removal of ethmoid sinus | $12,513 | BC HMO | $2,488 |
| 31255 | Removal of ethmoid sinus | $12,513 | BC FMOL | $2,512 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICARE | $4,867 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICARE – BLUE CROSS | $4,867 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICARE – UNITED | $4,867 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICARE – COVENTRY | $4,867 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICARE – VANTAGE | $4,867 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICARE -PEOPLES | $4,867 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICARE- HUMANA | $4,769 |
| 31255 | Removal of ethmoid sinus | $12,513 | HUMANA | $7,300 |
| 31255 | Removal of ethmoid sinus | $12,513 | VANTAGE | $8,273 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICAID | $750 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICAID – UNITED | $750 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICAID – HEALTHY BLUE | $750 |
| 31255 | Removal of ethmoid sinus | $12,513 | MEDICAID – AMERIHEALTH | $750 |
| 31255 | Removal of ethmoid sinus | $12,513 | UNITED | $2,923 |
| 31255 | Removal of ethmoid sinus | $12,513 | AETNA | $1,650 |
| 31255 | Removal of ethmoid sinus | $12,513 | CIGNA | $1,102 |
| 31255 | Removal of ethmoid sinus | $12,513 | LWCC | $12,513 |
| 31255 | Removal of ethmoid sinus | $12,513 | PPOPLUS | $8,308 |
| 31255 | Removal of ethmoid sinus | $12,513 | GILSBAR | $6,674 |
| 31255 | Removal of ethmoid sinus | $12,513 | LSU | $4,000 |
| 31255 | Removal of ethmoid sinus | $12,513 | VERITY | $6,226 |
| 31255 | Removal of ethmoid sinus | $12,513 | MULTIPLAN | $6,226 |
| 31255 | Removal of ethmoid sinus | $12,513 | LA WORK COMP | $12,257 |
| 31255 | Removal of ethmoid sinus | $12,513 | | |
| 26210 | Removal of finger lesion | $5,949 | Private Pay | $6,225 |
| 26210 | Removal of finger lesion | $5,949 | BC PPO | $1,486 |
| 26210 | Removal of finger lesion | $5,949 | BC HMO | $1,304 |
| 26210 | Removal of finger lesion | $5,949 | BC FMOL | $1,317 |
| 26210 | Removal of finger lesion | $5,949 | MEDICARE | $1,212 |
| 26210 | Removal of finger lesion | $5,949 | MEDICARE – BLUE CROSS | $1,212 |
| 26210 | Removal of finger lesion | $5,949 | MEDICARE – UNITED | $1,212 |
| 26210 | Removal of finger lesion | $5,949 | MEDICARE – COVENTRY | $1,212 |
| 26210 | Removal of finger lesion | $5,949 | MEDICARE – VANTAGE | $1,212 |
| 26210 | Removal of finger lesion | $5,949 | MEDICARE -PEOPLES | $1,212 |
| 26210 | Removal of finger lesion | $5,949 | MEDICARE- HUMANA | $1,188 |
| 26210 | Removal of finger lesion | $5,949 | HUMANA | $1,819 |
| 26210 | Removal of finger lesion | $5,949 | VANTAGE | $2,061 |
| 26210 | Removal of finger lesion | $5,949 | MEDICAID | $466 |
| 26210 | Removal of finger lesion | $5,949 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 26210 | Removal of finger lesion | $5,949 | MEDICAID – UNITED | $466 |
| 26210 | Removal of finger lesion | $5,949 | MEDICAID – HEALTHY BLUE | $466 |
| 26210 | Removal of finger lesion | $5,949 | MEDICAID – AMERIHEALTH | $466 |
| 26210 | Removal of finger lesion | $5,949 | UNITED | $734 |
| 26210 | Removal of finger lesion | $5,949 | AETNA | $1,381 |
| 26210 | Removal of finger lesion | $5,949 | CIGNA | $1,449 |
| 26210 | Removal of finger lesion | $5,949 | LWCC | $3,117 |
| 26210 | Removal of finger lesion | $5,949 | PPOPLUS | $3,797 |
| 26210 | Removal of finger lesion | $5,949 | GILSBAR | $3,112 |
| 26210 | Removal of finger lesion | $5,949 | LSU | $4,450 |
| 26210 | Removal of finger lesion | $5,949 | VERITY | $1,728 |
| 26210 | Removal of finger lesion | $5,949 | MULTIPLAN | $1,728 |
| 26210 | Removal of finger lesion | $5,949 | LA WORK COMP | $5,949 |
| 26210 | Removal of finger lesion | $5,949 | | |
| 28190 | Removal of foot foreign body | $7,392 | Private Pay | $8,214 |
| 28190 | Removal of foot foreign body | $7,392 | BC PPO | $742 |
| 28190 | Removal of foot foreign body | $7,392 | BC HMO | $651 |
| 28190 | Removal of foot foreign body | $7,392 | BC FMOL | $657 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICARE | $546 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICARE – BLUE CROSS | $546 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICARE – UNITED | $546 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICARE – COVENTRY | $546 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICARE – VANTAGE | $546 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICARE -PEOPLES | $546 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICARE- HUMANA | $535 |
| 28190 | Removal of foot foreign body | $7,392 | HUMANA | $818 |
| 28190 | Removal of foot foreign body | $7,392 | VANTAGE | $928 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICAID | $348 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICAID – UNITED | $348 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICAID – HEALTHY BLUE | $348 |
| 28190 | Removal of foot foreign body | $7,392 | MEDICAID – AMERIHEALTH | $348 |
| 28190 | Removal of foot foreign body | $7,392 | UNITED | $610 |
| 28190 | Removal of foot foreign body | $7,392 | AETNA | $1,000 |
| 28190 | Removal of foot foreign body | $7,392 | CIGNA | $1,323 |
| 28190 | Removal of foot foreign body | $7,392 | LWCC | $1,403 |
| 28190 | Removal of foot foreign body | $7,392 | PPOPLUS | $5,010 |
| 28190 | Removal of foot foreign body | $7,392 | GILSBAR | $4,025 |
| 28190 | Removal of foot foreign body | $7,392 | LSU | $4,000 |
| 28190 | Removal of foot foreign body | $7,392 | VERITY | $733 |
| 28190 | Removal of foot foreign body | $7,392 | MULTIPLAN | $733 |
| 28190 | Removal of foot foreign body | $7,392 | LA WORK COMP | $7,392 |
| 28190 | Removal of foot foreign body | $7,392 | | |
| 28192 | Removal of foot foreign body | $6,563 | Private Pay | $7,293 |
| 28192 | Removal of foot foreign body | $6,563 | BC PPO | $1,711 |
| 28192 | Removal of foot foreign body | $6,563 | BC HMO | $1,502 |
| 28192 | Removal of foot foreign body | $6,563 | BC FMOL | $1,516 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICARE | $1,228 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICARE – BLUE CROSS | $1,228 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICARE – UNITED | $1,228 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICARE – COVENTRY | $1,228 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICARE – VANTAGE | $1,228 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICARE -PEOPLES | $1,228 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICARE- HUMANA | $1,203 |
| 28192 | Removal of foot foreign body | $6,563 | HUMANA | $1,842 |
| 28192 | Removal of foot foreign body | $6,563 | VANTAGE | $2,087 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICAID | $466 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICAID – UNITED | $466 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICAID – HEALTHY BLUE | $466 |
| 28192 | Removal of foot foreign body | $6,563 | MEDICAID – AMERIHEALTH | $466 |
| 28192 | Removal of foot foreign body | $6,563 | UNITED | $734 |
| 28192 | Removal of foot foreign body | $6,563 | AETNA | $1,000 |
| 28192 | Removal of foot foreign body | $6,563 | CIGNA | $1,433 |
| 28192 | Removal of foot foreign body | $6,563 | LWCC | $3,157 |
| 28192 | Removal of foot foreign body | $6,563 | PPOPLUS | $4,448 |
| 28192 | Removal of foot foreign body | $6,563 | GILSBAR | $3,573 |
| 28192 | Removal of foot foreign body | $6,563 | LSU | $4,000 |
| 28192 | Removal of foot foreign body | $6,563 | VERITY | $1,725 |
| 28192 | Removal of foot foreign body | $6,563 | MULTIPLAN | $1,725 |
| 28192 | Removal of foot foreign body | $6,563 | LA WORK COMP | $6,563 |
| 28192 | Removal of foot foreign body | $6,563 | | |
| 28080 | Removal of foot lesion | $9,393 | Private Pay | $10,436 |
| 28080 | Removal of foot lesion | $9,393 | BC PPO | $1,329 |
| 28080 | Removal of foot lesion | $9,393 | BC HMO | $1,166 |
| 28080 | Removal of foot lesion | $9,393 | BC FMOL | $1,177 |
| 28080 | Removal of foot lesion | $9,393 | MEDICARE | $1,212 |
| 28080 | Removal of foot lesion | $9,393 | MEDICARE – BLUE CROSS | $1,212 |
| 28080 | Removal of foot lesion | $9,393 | MEDICARE – UNITED | $1,212 |
| 28080 | Removal of foot lesion | $9,393 | MEDICARE – COVENTRY | $1,212 |
| 28080 | Removal of foot lesion | $9,393 | MEDICARE – VANTAGE | $1,212 |
| 28080 | Removal of foot lesion | $9,393 | MEDICARE -PEOPLES | $1,212 |
| 28080 | Removal of foot lesion | $9,393 | MEDICARE- HUMANA | $1,188 |
| 28080 | Removal of foot lesion | $9,393 | HUMANA | $1,819 |
| 28080 | Removal of foot lesion | $9,393 | VANTAGE | $2,061 |
| 28080 | Removal of foot lesion | $9,393 | MEDICAID | $533 |
| 28080 | Removal of foot lesion | $9,393 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 28080 | Removal of foot lesion | $9,393 | MEDICAID – UNITED | $533 |
| 28080 | Removal of foot lesion | $9,393 | MEDICAID – HEALTHY BLUE | $533 |
| 28080 | Removal of foot lesion | $9,393 | MEDICAID – AMERIHEALTH | $533 |
| 28080 | Removal of foot lesion | $9,393 | UNITED | $2,188 |
| 28080 | Removal of foot lesion | $9,393 | AETNA | $1,200 |
| 28080 | Removal of foot lesion | $9,393 | CIGNA | $1,323 |
| 28080 | Removal of foot lesion | $9,393 | LWCC | $3,117 |
| 28080 | Removal of foot lesion | $9,393 | PPOPLUS | $6,366 |
| 28080 | Removal of foot lesion | $9,393 | GILSBAR | $5,114 |
| 28080 | Removal of foot lesion | $9,393 | LSU | $4,000 |
| 28080 | Removal of foot lesion | $9,393 | VERITY | $1,728 |
| 28080 | Removal of foot lesion | $9,393 | MULTIPLAN | $1,728 |
| 28080 | Removal of foot lesion | $9,393 | LA WORK COMP | $9,393 |
| 28080 | Removal of foot lesion | $9,393 | | |
| 28090 | Removal of foot lesion | $8,868 | Private Pay | $9,853 |
| 28090 | Removal of foot lesion | $8,868 | BC PPO | $1,172 |
| 28090 | Removal of foot lesion | $8,868 | BC HMO | $1,028 |
| 28090 | Removal of foot lesion | $8,868 | BC FMOL | $1,038 |
| 28090 | Removal of foot lesion | $8,868 | MEDICARE | $1,212 |
| 28090 | Removal of foot lesion | $8,868 | MEDICARE – BLUE CROSS | $1,212 |
| 28090 | Removal of foot lesion | $8,868 | MEDICARE – UNITED | $1,212 |
| 28090 | Removal of foot lesion | $8,868 | MEDICARE – COVENTRY | $1,212 |
| 28090 | Removal of foot lesion | $8,868 | MEDICARE – VANTAGE | $1,212 |
| 28090 | Removal of foot lesion | $8,868 | MEDICARE -PEOPLES | $1,212 |
| 28090 | Removal of foot lesion | $8,868 | MEDICARE- HUMANA | $1,188 |
| 28090 | Removal of foot lesion | $8,868 | HUMANA | $1,819 |
| 28090 | Removal of foot lesion | $8,868 | VANTAGE | $2,061 |
| 28090 | Removal of foot lesion | $8,868 | MEDICAID | $533 |
| 28090 | Removal of foot lesion | $8,868 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 28090 | Removal of foot lesion | $8,868 | MEDICAID – UNITED | $533 |
| 28090 | Removal of foot lesion | $8,868 | MEDICAID – HEALTHY BLUE | $533 |
| 28090 | Removal of foot lesion | $8,868 | MEDICAID – AMERIHEALTH | $533 |
| 28090 | Removal of foot lesion | $8,868 | UNITED | $2,188 |
| 28090 | Removal of foot lesion | $8,868 | AETNA | $1,200 |
| 28090 | Removal of foot lesion | $8,868 | CIGNA | $1,323 |
| 28090 | Removal of foot lesion | $8,868 | LWCC | $3,117 |
| 28090 | Removal of foot lesion | $8,868 | PPOPLUS | $6,010 |
| 28090 | Removal of foot lesion | $8,868 | GILSBAR | $4,828 |
| 28090 | Removal of foot lesion | $8,868 | LSU | $4,000 |
| 28090 | Removal of foot lesion | $8,868 | VERITY | $1,728 |
| 28090 | Removal of foot lesion | $8,868 | MULTIPLAN | $1,728 |
| 28090 | Removal of foot lesion | $8,868 | LA WORK COMP | $8,868 |
| 28090 | Removal of foot lesion | $8,868 | | |
| 28104 | Removal of foot lesion | $8,245 | Private Pay | $9,161 |
| 28104 | Removal of foot lesion | $8,245 | BC PPO | $3,221 |
| 28104 | Removal of foot lesion | $8,245 | BC HMO | $2,826 |
| 28104 | Removal of foot lesion | $8,245 | BC FMOL | $2,853 |
| 28104 | Removal of foot lesion | $8,245 | MEDICARE | $2,449 |
| 28104 | Removal of foot lesion | $8,245 | MEDICARE – BLUE CROSS | $2,449 |
| 28104 | Removal of foot lesion | $8,245 | MEDICARE – UNITED | $2,449 |
| 28104 | Removal of foot lesion | $8,245 | MEDICARE – COVENTRY | $2,449 |
| 28104 | Removal of foot lesion | $8,245 | MEDICARE – VANTAGE | $2,449 |
| 28104 | Removal of foot lesion | $8,245 | MEDICARE -PEOPLES | $2,449 |
| 28104 | Removal of foot lesion | $8,245 | MEDICARE- HUMANA | $2,400 |
| 28104 | Removal of foot lesion | $8,245 | HUMANA | $3,673 |
| 28104 | Removal of foot lesion | $8,245 | VANTAGE | $4,163 |
| 28104 | Removal of foot lesion | $8,245 | MEDICAID | $466 |
| 28104 | Removal of foot lesion | $8,245 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 28104 | Removal of foot lesion | $8,245 | MEDICAID – UNITED | $466 |
| 28104 | Removal of foot lesion | $8,245 | MEDICAID – HEALTHY BLUE | $466 |
| 28104 | Removal of foot lesion | $8,245 | MEDICAID – AMERIHEALTH | $466 |
| 28104 | Removal of foot lesion | $8,245 | UNITED | $2,188 |
| 28104 | Removal of foot lesion | $8,245 | AETNA | $1,000 |
| 28104 | Removal of foot lesion | $8,245 | CIGNA | $1,102 |
| 28104 | Removal of foot lesion | $8,245 | LWCC | $6,296 |
| 28104 | Removal of foot lesion | $8,245 | PPOPLUS | $5,588 |
| 28104 | Removal of foot lesion | $8,245 | GILSBAR | $4,489 |
| 28104 | Removal of foot lesion | $8,245 | LSU | $4,000 |
| 28104 | Removal of foot lesion | $8,245 | VERITY | $3,386 |
| 28104 | Removal of foot lesion | $8,245 | MULTIPLAN | $3,386 |
| 28104 | Removal of foot lesion | $8,245 | LA WORK COMP | $8,245 |
| 28104 | Removal of foot lesion | $8,245 | | |
| 20525 | Removal of foreign body | $5,975 | Private Pay | $6,639 |
| 20525 | Removal of foreign body | $5,975 | BC PPO | $2,831 |
| 20525 | Removal of foreign body | $5,975 | BC HMO | $2,484 |
| 20525 | Removal of foreign body | $5,975 | BC FMOL | $2,508 |
| 20525 | Removal of foreign body | $5,975 | MEDICARE | $2,074 |
| 20525 | Removal of foreign body | $5,975 | MEDICARE – BLUE CROSS | $2,074 |
| 20525 | Removal of foreign body | $5,975 | MEDICARE – UNITED | $2,074 |
| 20525 | Removal of foreign body | $5,975 | MEDICARE – COVENTRY | $2,074 |
| 20525 | Removal of foreign body | $5,975 | MEDICARE – VANTAGE | $2,074 |
| 20525 | Removal of foreign body | $5,975 | MEDICARE -PEOPLES | $2,074 |
| 20525 | Removal of foreign body | $5,975 | MEDICARE- HUMANA | $2,033 |
| 20525 | Removal of foreign body | $5,975 | HUMANA | $3,111 |
| 20525 | Removal of foreign body | $5,975 | VANTAGE | $3,526 |
| 20525 | Removal of foreign body | $5,975 | MEDICAID | $533 |
| 20525 | Removal of foreign body | $5,975 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 20525 | Removal of foreign body | $5,975 | MEDICAID – UNITED | $533 |
| 20525 | Removal of foreign body | $5,975 | MEDICAID – HEALTHY BLUE | $533 |
| 20525 | Removal of foreign body | $5,975 | MEDICAID – AMERIHEALTH | $533 |
| 20525 | Removal of foreign body | $5,975 | UNITED | $2,188 |
| 20525 | Removal of foreign body | $5,975 | AETNA | $1,200 |
| 20525 | Removal of foreign body | $5,975 | CIGNA | $1,102 |
| 20525 | Removal of foreign body | $5,975 | LWCC | $5,333 |
| 20525 | Removal of foreign body | $5,975 | PPOPLUS | $4,050 |
| 20525 | Removal of foreign body | $5,975 | GILSBAR | $3,253 |
| 20525 | Removal of foreign body | $5,975 | LSU | $4,000 |
| 20525 | Removal of foreign body | $5,975 | VERITY | $2,976 |
| 20525 | Removal of foreign body | $5,975 | MULTIPLAN | $2,976 |
| 20525 | Removal of foreign body | $5,975 | LA WORK COMP | $5,975 |
| 20525 | Removal of foreign body | $5,975 | | |
| 55040 | Removal of hydrocele | $8,579 | Private Pay | $9,194 |
| 55040 | Removal of hydrocele | $8,579 | BC PPO | $3,545 |
| 55040 | Removal of hydrocele | $8,579 | BC HMO | $3,111 |
| 55040 | Removal of hydrocele | $8,579 | BC FMOL | $3,140 |
| 55040 | Removal of hydrocele | $8,579 | MEDICARE | $2,781 |
| 55040 | Removal of hydrocele | $8,579 | MEDICARE – BLUE CROSS | $2,781 |
| 55040 | Removal of hydrocele | $8,579 | MEDICARE – UNITED | $2,781 |
| 55040 | Removal of hydrocele | $8,579 | MEDICARE – COVENTRY | $2,781 |
| 55040 | Removal of hydrocele | $8,579 | MEDICARE – VANTAGE | $2,781 |
| 55040 | Removal of hydrocele | $8,579 | MEDICARE -PEOPLES | $2,781 |
| 55040 | Removal of hydrocele | $8,579 | MEDICARE- HUMANA | $2,726 |
| 55040 | Removal of hydrocele | $8,579 | HUMANA | $4,172 |
| 55040 | Removal of hydrocele | $8,579 | VANTAGE | $4,728 |
| 55040 | Removal of hydrocele | $8,579 | MEDICAID | $533 |
| 55040 | Removal of hydrocele | $8,579 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 55040 | Removal of hydrocele | $8,579 | MEDICAID – UNITED | $533 |
| 55040 | Removal of hydrocele | $8,579 | MEDICAID – HEALTHY BLUE | $533 |
| 55040 | Removal of hydrocele | $8,579 | MEDICAID – AMERIHEALTH | $533 |
| 55040 | Removal of hydrocele | $8,579 | UNITED | $2,923 |
| 55040 | Removal of hydrocele | $8,579 | AETNA | $1,535 |
| 55040 | Removal of hydrocele | $8,579 | CIGNA | $1,323 |
| 55040 | Removal of hydrocele | $8,579 | LWCC | $7,151 |
| 55040 | Removal of hydrocele | $8,579 | PPOPLUS | $5,608 |
| 55040 | Removal of hydrocele | $8,579 | GILSBAR | $4,560 |
| 55040 | Removal of hydrocele | $8,579 | LSU | $4,396 |
| 55040 | Removal of hydrocele | $8,579 | VERITY | $3,726 |
| 55040 | Removal of hydrocele | $8,579 | MULTIPLAN | $3,726 |
| 55040 | Removal of hydrocele | $8,579 | LA WORK COMP | $8,579 |
| 55040 | Removal of hydrocele | $8,579 | | |
| 55041 | Removal of hydroceles | $8,194 | Private Pay | $9,104 |
| 55041 | Removal of hydroceles | $8,194 | BC PPO | $3,696 |
| 55041 | Removal of hydroceles | $8,194 | BC HMO | $3,243 |
| 55041 | Removal of hydroceles | $8,194 | BC FMOL | $3,274 |
| 55041 | Removal of hydroceles | $8,194 | MEDICARE | $2,781 |
| 55041 | Removal of hydroceles | $8,194 | MEDICARE – BLUE CROSS | $2,781 |
| 55041 | Removal of hydroceles | $8,194 | MEDICARE – UNITED | $2,781 |
| 55041 | Removal of hydroceles | $8,194 | MEDICARE – COVENTRY | $2,781 |
| 55041 | Removal of hydroceles | $8,194 | MEDICARE – VANTAGE | $2,781 |
| 55041 | Removal of hydroceles | $8,194 | MEDICARE -PEOPLES | $2,781 |
| 55041 | Removal of hydroceles | $8,194 | MEDICARE- HUMANA | $2,726 |
| 55041 | Removal of hydroceles | $8,194 | HUMANA | $4,172 |
| 55041 | Removal of hydroceles | $8,194 | VANTAGE | $4,728 |
| 55041 | Removal of hydroceles | $8,194 | MEDICAID | $750 |
| 55041 | Removal of hydroceles | $8,194 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 55041 | Removal of hydroceles | $8,194 | MEDICAID – UNITED | $750 |
| 55041 | Removal of hydroceles | $8,194 | MEDICAID – HEALTHY BLUE | $750 |
| 55041 | Removal of hydroceles | $8,194 | MEDICAID – AMERIHEALTH | $750 |
| 55041 | Removal of hydroceles | $8,194 | UNITED | $2,923 |
| 55041 | Removal of hydroceles | $8,194 | AETNA | $1,650 |
| 55041 | Removal of hydroceles | $8,194 | CIGNA | $634 |
| 55041 | Removal of hydroceles | $8,194 | LWCC | $7,151 |
| 55041 | Removal of hydroceles | $8,194 | PPOPLUS | $5,554 |
| 55041 | Removal of hydroceles | $8,194 | GILSBAR | $4,461 |
| 55041 | Removal of hydroceles | $8,194 | LSU | $4,000 |
| 55041 | Removal of hydroceles | $8,194 | VERITY | $3,726 |
| 55041 | Removal of hydroceles | $8,194 | MULTIPLAN | $3,726 |
| 55041 | Removal of hydroceles | $8,194 | LA WORK COMP | $8,194 |
| 55041 | Removal of hydroceles | $8,194 | | |
| 27340 | Removal of kneecap bursa | $8,859 | Private Pay | $9,843 |
| 27340 | Removal of kneecap bursa | $8,859 | BC PPO | $3,221 |
| 27340 | Removal of kneecap bursa | $8,859 | BC HMO | $2,826 |
| 27340 | Removal of kneecap bursa | $8,859 | BC FMOL | $2,853 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICARE | $2,449 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICARE – BLUE CROSS | $2,449 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICARE – UNITED | $2,449 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICARE – COVENTRY | $2,449 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICARE – VANTAGE | $2,449 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICARE -PEOPLES | $2,449 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICARE- HUMANA | $2,400 |
| 27340 | Removal of kneecap bursa | $8,859 | HUMANA | $3,673 |
| 27340 | Removal of kneecap bursa | $8,859 | VANTAGE | $4,163 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICAID | $533 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICAID – UNITED | $533 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICAID – HEALTHY BLUE | $533 |
| 27340 | Removal of kneecap bursa | $8,859 | MEDICAID – AMERIHEALTH | $533 |
| 27340 | Removal of kneecap bursa | $8,859 | UNITED | $2,188 |
| 27340 | Removal of kneecap bursa | $8,859 | AETNA | $1,200 |
| 27340 | Removal of kneecap bursa | $8,859 | CIGNA | $1,102 |
| 27340 | Removal of kneecap bursa | $8,859 | LWCC | $6,296 |
| 27340 | Removal of kneecap bursa | $8,859 | PPOPLUS | $6,004 |
| 27340 | Removal of kneecap bursa | $8,859 | GILSBAR | $4,823 |
| 27340 | Removal of kneecap bursa | $8,859 | LSU | $4,000 |
| 27340 | Removal of kneecap bursa | $8,859 | VERITY | $3,386 |
| 27340 | Removal of kneecap bursa | $8,859 | MULTIPLAN | $3,386 |
| 27340 | Removal of kneecap bursa | $8,859 | LA WORK COMP | $8,859 |
| 27340 | Removal of kneecap bursa | $8,859 | | |
| 11750 | Removal of nail bed | $7,107 | Private Pay | $7,897 |
| 11750 | Removal of nail bed | $7,107 | BC PPO | $403 |
| 11750 | Removal of nail bed | $7,107 | BC HMO | $353 |
| 11750 | Removal of nail bed | $7,107 | BC FMOL | $357 |
| 11750 | Removal of nail bed | $7,107 | MEDICARE | $286 |
| 11750 | Removal of nail bed | $7,107 | MEDICARE – BLUE CROSS | $286 |
| 11750 | Removal of nail bed | $7,107 | MEDICARE – UNITED | $286 |
| 11750 | Removal of nail bed | $7,107 | MEDICARE – COVENTRY | $286 |
| 11750 | Removal of nail bed | $7,107 | MEDICARE – VANTAGE | $286 |
| 11750 | Removal of nail bed | $7,107 | MEDICARE -PEOPLES | $286 |
| 11750 | Removal of nail bed | $7,107 | MEDICARE- HUMANA | $280 |
| 11750 | Removal of nail bed | $7,107 | HUMANA | $429 |
| 11750 | Removal of nail bed | $7,107 | VANTAGE | $486 |
| 11750 | Removal of nail bed | $7,107 | MEDICAID | $348 |
| 11750 | Removal of nail bed | $7,107 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 11750 | Removal of nail bed | $7,107 | MEDICAID – UNITED | $348 |
| 11750 | Removal of nail bed | $7,107 | MEDICAID – HEALTHY BLUE | $348 |
| 11750 | Removal of nail bed | $7,107 | MEDICAID – AMERIHEALTH | $348 |
| 11750 | Removal of nail bed | $7,107 | UNITED | $392 |
| 11750 | Removal of nail bed | $7,107 | AETNA | $750 |
| 11750 | Removal of nail bed | $7,107 | CIGNA | $854 |
| 11750 | Removal of nail bed | $7,107 | LWCC | $735 |
| 11750 | Removal of nail bed | $7,107 | PPOPLUS | $4,817 |
| 11750 | Removal of nail bed | $7,107 | GILSBAR | $3,869 |
| 11750 | Removal of nail bed | $7,107 | LSU | $4,000 |
| 11750 | Removal of nail bed | $7,107 | VERITY | $398 |
| 11750 | Removal of nail bed | $7,107 | MULTIPLAN | $398 |
| 11750 | Removal of nail bed | $7,107 | LA WORK COMP | $7,107 |
| 11750 | Removal of nail bed | $7,107 | | |
| 26170 | Removal of palm tendon each | $6,076 | Private Pay | $6,751 |
| 26170 | Removal of palm tendon each | $6,076 | BC PPO | $1,329 |
| 26170 | Removal of palm tendon each | $6,076 | BC HMO | $1,166 |
| 26170 | Removal of palm tendon each | $6,076 | BC FMOL | $1,177 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICARE | $1,212 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICARE – BLUE CROSS | $1,212 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICARE – UNITED | $1,212 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICARE – COVENTRY | $1,212 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICARE – VANTAGE | $1,212 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICARE -PEOPLES | $1,212 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICARE- HUMANA | $1,188 |
| 26170 | Removal of palm tendon each | $6,076 | HUMANA | $1,819 |
| 26170 | Removal of palm tendon each | $6,076 | VANTAGE | $2,061 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICAID | $533 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICAID – UNITED | $533 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICAID – HEALTHY BLUE | $533 |
| 26170 | Removal of palm tendon each | $6,076 | MEDICAID – AMERIHEALTH | $533 |
| 26170 | Removal of palm tendon each | $6,076 | UNITED | $734 |
| 26170 | Removal of palm tendon each | $6,076 | AETNA | $1,200 |
| 26170 | Removal of palm tendon each | $6,076 | CIGNA | $1,102 |
| 26170 | Removal of palm tendon each | $6,076 | LWCC | $3,117 |
| 26170 | Removal of palm tendon each | $6,076 | PPOPLUS | $4,118 |
| 26170 | Removal of palm tendon each | $6,076 | GILSBAR | $3,308 |
| 26170 | Removal of palm tendon each | $6,076 | LSU | $4,000 |
| 26170 | Removal of palm tendon each | $6,076 | VERITY | $1,728 |
| 26170 | Removal of palm tendon each | $6,076 | MULTIPLAN | $1,728 |
| 26170 | Removal of palm tendon each | $6,076 | LA WORK COMP | $6,076 |
| 26170 | Removal of palm tendon each | $6,076 | | |
| 28315 | Removal of sesamoid bone | $11,788 | Private Pay | $12,711 |
| 28315 | Removal of sesamoid bone | $11,788 | BC PPO | $3,221 |
| 28315 | Removal of sesamoid bone | $11,788 | BC HMO | $2,826 |
| 28315 | Removal of sesamoid bone | $11,788 | BC FMOL | $2,853 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICARE | $2,449 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICARE – BLUE CROSS | $2,449 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICARE – UNITED | $2,449 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICARE – COVENTRY | $2,449 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICARE – VANTAGE | $2,449 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICARE -PEOPLES | $2,449 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICARE- HUMANA | $2,400 |
| 28315 | Removal of sesamoid bone | $11,788 | HUMANA | $3,673 |
| 28315 | Removal of sesamoid bone | $11,788 | VANTAGE | $4,163 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICAID | $659 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICAID – UNITED | $659 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICAID – HEALTHY BLUE | $659 |
| 28315 | Removal of sesamoid bone | $11,788 | MEDICAID – AMERIHEALTH | $659 |
| 28315 | Removal of sesamoid bone | $11,788 | UNITED | $2,188 |
| 28315 | Removal of sesamoid bone | $11,788 | AETNA | $1,857 |
| 28315 | Removal of sesamoid bone | $11,788 | CIGNA | $854 |
| 28315 | Removal of sesamoid bone | $11,788 | LWCC | $6,296 |
| 28315 | Removal of sesamoid bone | $11,788 | PPOPLUS | $7,754 |
| 28315 | Removal of sesamoid bone | $11,788 | GILSBAR | $6,291 |
| 28315 | Removal of sesamoid bone | $11,788 | LSU | $4,452 |
| 28315 | Removal of sesamoid bone | $11,788 | VERITY | $3,386 |
| 28315 | Removal of sesamoid bone | $11,788 | MULTIPLAN | $3,386 |
| 28315 | Removal of sesamoid bone | $11,788 | LA WORK COMP | $11,788 |
| 28315 | Removal of sesamoid bone | $11,788 | | |
| 20680 | Removal of support implant | $8,488 | Private Pay | $9,122 |
| 20680 | Removal of support implant | $8,488 | BC PPO | $3,012 |
| 20680 | Removal of support implant | $8,488 | BC HMO | $2,643 |
| 20680 | Removal of support implant | $8,488 | BC FMOL | $2,668 |
| 20680 | Removal of support implant | $8,488 | MEDICARE | $2,074 |
| 20680 | Removal of support implant | $8,488 | MEDICARE – BLUE CROSS | $2,074 |
| 20680 | Removal of support implant | $8,488 | MEDICARE – UNITED | $2,074 |
| 20680 | Removal of support implant | $8,488 | MEDICARE – COVENTRY | $2,074 |
| 20680 | Removal of support implant | $8,488 | MEDICARE – VANTAGE | $2,074 |
| 20680 | Removal of support implant | $8,488 | MEDICARE -PEOPLES | $2,074 |
| 20680 | Removal of support implant | $8,488 | MEDICARE- HUMANA | $2,033 |
| 20680 | Removal of support implant | $8,488 | HUMANA | $3,111 |
| 20680 | Removal of support implant | $8,488 | VANTAGE | $3,526 |
| 20680 | Removal of support implant | $8,488 | MEDICAID | $533 |
| 20680 | Removal of support implant | $8,488 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 20680 | Removal of support implant | $8,488 | MEDICAID – UNITED | $533 |
| 20680 | Removal of support implant | $8,488 | MEDICAID – HEALTHY BLUE | $533 |
| 20680 | Removal of support implant | $8,488 | MEDICAID – AMERIHEALTH | $533 |
| 20680 | Removal of support implant | $8,488 | UNITED | $2,188 |
| 20680 | Removal of support implant | $8,488 | AETNA | $1,506 |
| 20680 | Removal of support implant | $8,488 | CIGNA | $1,359 |
| 20680 | Removal of support implant | $8,488 | LWCC | $5,333 |
| 20680 | Removal of support implant | $8,488 | PPOPLUS | $5,564 |
| 20680 | Removal of support implant | $8,488 | GILSBAR | $4,520 |
| 20680 | Removal of support implant | $8,488 | LSU | $4,362 |
| 20680 | Removal of support implant | $8,488 | VERITY | $2,570 |
| 20680 | Removal of support implant | $8,488 | MULTIPLAN | $2,570 |
| 20680 | Removal of support implant | $8,488 | LA WORK COMP | $8,488 |
| 20680 | Removal of support implant | $8,488 | | |
| 27630 | Removal of tendon lesion | $9,117 | Private Pay | $10,130 |
| 27630 | Removal of tendon lesion | $9,117 | BC PPO | $3,358 |
| 27630 | Removal of tendon lesion | $9,117 | BC HMO | $2,947 |
| 27630 | Removal of tendon lesion | $9,117 | BC FMOL | $2,975 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICARE | $2,449 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICARE – BLUE CROSS | $2,449 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICARE – UNITED | $2,449 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICARE – COVENTRY | $2,449 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICARE – VANTAGE | $2,449 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICARE -PEOPLES | $2,449 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICARE- HUMANA | $2,400 |
| 27630 | Removal of tendon lesion | $9,117 | HUMANA | $3,673 |
| 27630 | Removal of tendon lesion | $9,117 | VANTAGE | $4,163 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICAID | $533 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICAID – UNITED | $533 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICAID – HEALTHY BLUE | $533 |
| 27630 | Removal of tendon lesion | $9,117 | MEDICAID – AMERIHEALTH | $533 |
| 27630 | Removal of tendon lesion | $9,117 | UNITED | $2,188 |
| 27630 | Removal of tendon lesion | $9,117 | AETNA | $1,200 |
| 27630 | Removal of tendon lesion | $9,117 | CIGNA | $634 |
| 27630 | Removal of tendon lesion | $9,117 | LWCC | $6,296 |
| 27630 | Removal of tendon lesion | $9,117 | PPOPLUS | $6,180 |
| 27630 | Removal of tendon lesion | $9,117 | GILSBAR | $4,964 |
| 27630 | Removal of tendon lesion | $9,117 | LSU | $4,000 |
| 27630 | Removal of tendon lesion | $9,117 | VERITY | $3,386 |
| 27630 | Removal of tendon lesion | $9,117 | MULTIPLAN | $3,386 |
| 27630 | Removal of tendon lesion | $9,117 | LA WORK COMP | $9,117 |
| 27630 | Removal of tendon lesion | $9,117 | | |
| 60240 | Removal of thyroid | $20,842 | Private Pay | $22,930 |
| 60240 | Removal of thyroid | $20,842 | BC PPO | $5,698 |
| 60240 | Removal of thyroid | $20,842 | BC HMO | $5,000 |
| 60240 | Removal of thyroid | $20,842 | BC FMOL | $5,048 |
| 60240 | Removal of thyroid | $20,842 | MEDICARE | $4,324 |
| 60240 | Removal of thyroid | $20,842 | MEDICARE – BLUE CROSS | $4,324 |
| 60240 | Removal of thyroid | $20,842 | MEDICARE – UNITED | $4,324 |
| 60240 | Removal of thyroid | $20,842 | MEDICARE – COVENTRY | $4,324 |
| 60240 | Removal of thyroid | $20,842 | MEDICARE – VANTAGE | $4,324 |
| 60240 | Removal of thyroid | $20,842 | MEDICARE -PEOPLES | $4,324 |
| 60240 | Removal of thyroid | $20,842 | MEDICARE- HUMANA | $4,237 |
| 60240 | Removal of thyroid | $20,842 | HUMANA | $6,486 |
| 60240 | Removal of thyroid | $20,842 | VANTAGE | $7,351 |
| 60240 | Removal of thyroid | $20,842 | MEDICAID | $1,400 |
| 60240 | Removal of thyroid | $20,842 | MEDICAID – AETNA BETTER HEALTH | $1,400 |
| 60240 | Removal of thyroid | $20,842 | MEDICAID – UNITED | $1,400 |
| 60240 | Removal of thyroid | $20,842 | MEDICAID – HEALTHY BLUE | $1,400 |
| 60240 | Removal of thyroid | $20,842 | MEDICAID – AMERIHEALTH | $1,400 |
| 60240 | Removal of thyroid | $20,842 | UNITED | $4,460 |
| 60240 | Removal of thyroid | $20,842 | AETNA | $2,325 |
| 60240 | Removal of thyroid | $20,842 | CIGNA | $634 |
| 60240 | Removal of thyroid | $20,842 | LWCC | $11,118 |
| 60240 | Removal of thyroid | $20,842 | PPOPLUS | $13,987 |
| 60240 | Removal of thyroid | $20,842 | GILSBAR | $11,273 |
| 60240 | Removal of thyroid | $20,842 | LSU | $4,266 |
| 60240 | Removal of thyroid | $20,842 | VERITY | $5,745 |
| 60240 | Removal of thyroid | $20,842 | MULTIPLAN | $5,745 |
| 60240 | Removal of thyroid | $20,842 | LA WORK COMP | $20,842 |
| 60240 | Removal of thyroid | $20,842 | | |
| 28092 | Removal of toe lesions | $6,371 | Private Pay | $7,079 |
| 28092 | Removal of toe lesions | $6,371 | BC PPO | $1,329 |
| 28092 | Removal of toe lesions | $6,371 | BC HMO | $1,166 |
| 28092 | Removal of toe lesions | $6,371 | BC FMOL | $1,177 |
| 28092 | Removal of toe lesions | $6,371 | MEDICARE | $1,212 |
| 28092 | Removal of toe lesions | $6,371 | MEDICARE – BLUE CROSS | $1,212 |
| 28092 | Removal of toe lesions | $6,371 | MEDICARE – UNITED | $1,212 |
| 28092 | Removal of toe lesions | $6,371 | MEDICARE – COVENTRY | $1,212 |
| 28092 | Removal of toe lesions | $6,371 | MEDICARE – VANTAGE | $1,212 |
| 28092 | Removal of toe lesions | $6,371 | MEDICARE -PEOPLES | $1,212 |
| 28092 | Removal of toe lesions | $6,371 | MEDICARE- HUMANA | $1,188 |
| 28092 | Removal of toe lesions | $6,371 | HUMANA | $1,819 |
| 28092 | Removal of toe lesions | $6,371 | VANTAGE | $2,061 |
| 28092 | Removal of toe lesions | $6,371 | MEDICAID | $533 |
| 28092 | Removal of toe lesions | $6,371 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 28092 | Removal of toe lesions | $6,371 | MEDICAID – UNITED | $533 |
| 28092 | Removal of toe lesions | $6,371 | MEDICAID – HEALTHY BLUE | $533 |
| 28092 | Removal of toe lesions | $6,371 | MEDICAID – AMERIHEALTH | $533 |
| 28092 | Removal of toe lesions | $6,371 | UNITED | $2,188 |
| 28092 | Removal of toe lesions | $6,371 | AETNA | $1,200 |
| 28092 | Removal of toe lesions | $6,371 | CIGNA | $1,102 |
| 28092 | Removal of toe lesions | $6,371 | LWCC | $3,117 |
| 28092 | Removal of toe lesions | $6,371 | PPOPLUS | $4,318 |
| 28092 | Removal of toe lesions | $6,371 | GILSBAR | $3,469 |
| 28092 | Removal of toe lesions | $6,371 | LSU | $4,000 |
| 28092 | Removal of toe lesions | $6,371 | VERITY | $1,728 |
| 28092 | Removal of toe lesions | $6,371 | MULTIPLAN | $1,728 |
| 28092 | Removal of toe lesions | $6,371 | LA WORK COMP | $6,371 |
| 28092 | Removal of toe lesions | $6,371 | | |
| 42825 | Removal of tonsils | $11,156 | Private Pay | $7,203 |
| 42825 | Removal of tonsils | $11,156 | BC PPO | $5,283 |
| 42825 | Removal of tonsils | $11,156 | BC HMO | $4,636 |
| 42825 | Removal of tonsils | $11,156 | BC FMOL | $4,680 |
| 42825 | Removal of tonsils | $11,156 | MEDICARE | $4,339 |
| 42825 | Removal of tonsils | $11,156 | MEDICARE – BLUE CROSS | $4,339 |
| 42825 | Removal of tonsils | $11,156 | MEDICARE – UNITED | $4,339 |
| 42825 | Removal of tonsils | $11,156 | MEDICARE – COVENTRY | $4,339 |
| 42825 | Removal of tonsils | $11,156 | MEDICARE – VANTAGE | $4,339 |
| 42825 | Removal of tonsils | $11,156 | MEDICARE -PEOPLES | $4,339 |
| 42825 | Removal of tonsils | $11,156 | MEDICARE- HUMANA | $4,252 |
| 42825 | Removal of tonsils | $11,156 | HUMANA | $6,508 |
| 42825 | Removal of tonsils | $11,156 | VANTAGE | $7,376 |
| 42825 | Removal of tonsils | $11,156 | MEDICAID | $659 |
| 42825 | Removal of tonsils | $11,156 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 42825 | Removal of tonsils | $11,156 | MEDICAID – UNITED | $659 |
| 42825 | Removal of tonsils | $11,156 | MEDICAID – HEALTHY BLUE | $659 |
| 42825 | Removal of tonsils | $11,156 | MEDICAID – AMERIHEALTH | $659 |
| 42825 | Removal of tonsils | $11,156 | UNITED | $2,188 |
| 42825 | Removal of tonsils | $11,156 | AETNA | $1,527 |
| 42825 | Removal of tonsils | $11,156 | CIGNA | $634 |
| 42825 | Removal of tonsils | $11,156 | LWCC | $11,156 |
| 42825 | Removal of tonsils | $11,156 | PPOPLUS | $4,394 |
| 42825 | Removal of tonsils | $11,156 | GILSBAR | $3,538 |
| 42825 | Removal of tonsils | $11,156 | LSU | $4,061 |
| 42825 | Removal of tonsils | $11,156 | VERITY | $5,553 |
| 42825 | Removal of tonsils | $11,156 | MULTIPLAN | $5,553 |
| 42825 | Removal of tonsils | $11,156 | LA WORK COMP | $6,530 |
| 42825 | Removal of tonsils | $11,156 | | |
| 42826 | Removal of tonsils | $7,259 | Private Pay | $7,914 |
| 42826 | Removal of tonsils | $7,259 | BC PPO | $2,792 |
| 42826 | Removal of tonsils | $7,259 | BC HMO | $2,450 |
| 42826 | Removal of tonsils | $7,259 | BC FMOL | $2,473 |
| 42826 | Removal of tonsils | $7,259 | MEDICARE | $2,343 |
| 42826 | Removal of tonsils | $7,259 | MEDICARE – BLUE CROSS | $2,343 |
| 42826 | Removal of tonsils | $7,259 | MEDICARE – UNITED | $2,343 |
| 42826 | Removal of tonsils | $7,259 | MEDICARE – COVENTRY | $2,343 |
| 42826 | Removal of tonsils | $7,259 | MEDICARE – VANTAGE | $2,343 |
| 42826 | Removal of tonsils | $7,259 | MEDICARE -PEOPLES | $2,343 |
| 42826 | Removal of tonsils | $7,259 | MEDICARE- HUMANA | $2,296 |
| 42826 | Removal of tonsils | $7,259 | HUMANA | $3,515 |
| 42826 | Removal of tonsils | $7,259 | VANTAGE | $3,983 |
| 42826 | Removal of tonsils | $7,259 | MEDICAID | $659 |
| 42826 | Removal of tonsils | $7,259 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 42826 | Removal of tonsils | $7,259 | MEDICAID – UNITED | $659 |
| 42826 | Removal of tonsils | $7,259 | MEDICAID – HEALTHY BLUE | $659 |
| 42826 | Removal of tonsils | $7,259 | MEDICAID – AMERIHEALTH | $659 |
| 42826 | Removal of tonsils | $7,259 | UNITED | $2,188 |
| 42826 | Removal of tonsils | $7,259 | AETNA | $1,625 |
| 42826 | Removal of tonsils | $7,259 | CIGNA | $1,102 |
| 42826 | Removal of tonsils | $7,259 | LWCC | $6,024 |
| 42826 | Removal of tonsils | $7,259 | PPOPLUS | $4,828 |
| 42826 | Removal of tonsils | $7,259 | GILSBAR | $3,903 |
| 42826 | Removal of tonsils | $7,259 | LSU | $4,177 |
| 42826 | Removal of tonsils | $7,259 | VERITY | $2,815 |
| 42826 | Removal of tonsils | $7,259 | MULTIPLAN | $2,815 |
| 42826 | Removal of tonsils | $7,259 | LA WORK COMP | $7,259 |
| 42826 | Removal of tonsils | $7,259 | | |
| 25210 | Removal of wrist bone | $8,075 | Private Pay | $8,583 |
| 25210 | Removal of wrist bone | $8,075 | BC PPO | $2,913 |
| 25210 | Removal of wrist bone | $8,075 | BC HMO | $2,556 |
| 25210 | Removal of wrist bone | $8,075 | BC FMOL | $2,580 |
| 25210 | Removal of wrist bone | $8,075 | MEDICARE | $2,449 |
| 25210 | Removal of wrist bone | $8,075 | MEDICARE – BLUE CROSS | $2,449 |
| 25210 | Removal of wrist bone | $8,075 | MEDICARE – UNITED | $2,449 |
| 25210 | Removal of wrist bone | $8,075 | MEDICARE – COVENTRY | $2,449 |
| 25210 | Removal of wrist bone | $8,075 | MEDICARE – VANTAGE | $2,449 |
| 25210 | Removal of wrist bone | $8,075 | MEDICARE -PEOPLES | $2,449 |
| 25210 | Removal of wrist bone | $8,075 | MEDICARE- HUMANA | $2,400 |
| 25210 | Removal of wrist bone | $8,075 | HUMANA | $3,673 |
| 25210 | Removal of wrist bone | $8,075 | VANTAGE | $4,163 |
| 25210 | Removal of wrist bone | $8,075 | MEDICAID | $533 |
| 25210 | Removal of wrist bone | $8,075 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 25210 | Removal of wrist bone | $8,075 | MEDICAID – UNITED | $533 |
| 25210 | Removal of wrist bone | $8,075 | MEDICAID – HEALTHY BLUE | $533 |
| 25210 | Removal of wrist bone | $8,075 | MEDICAID – AMERIHEALTH | $533 |
| 25210 | Removal of wrist bone | $8,075 | UNITED | $2,923 |
| 25210 | Removal of wrist bone | $8,075 | AETNA | $1,586 |
| 25210 | Removal of wrist bone | $8,075 | CIGNA | $1,102 |
| 25210 | Removal of wrist bone | $8,075 | LWCC | $6,296 |
| 25210 | Removal of wrist bone | $8,075 | PPOPLUS | $5,235 |
| 25210 | Removal of wrist bone | $8,075 | GILSBAR | $4,269 |
| 25210 | Removal of wrist bone | $8,075 | LSU | $4,456 |
| 25210 | Removal of wrist bone | $8,075 | VERITY | $3,386 |
| 25210 | Removal of wrist bone | $8,075 | MULTIPLAN | $3,386 |
| 25210 | Removal of wrist bone | $8,075 | LA WORK COMP | $8,075 |
| 25210 | Removal of wrist bone | $8,075 | | |
| 25215 | Removal of wrist bones | $8,456 | Private Pay | $9,005 |
| 25215 | Removal of wrist bones | $8,456 | BC PPO | $2,913 |
| 25215 | Removal of wrist bones | $8,456 | BC HMO | $2,556 |
| 25215 | Removal of wrist bones | $8,456 | BC FMOL | $2,580 |
| 25215 | Removal of wrist bones | $8,456 | MEDICARE | $2,449 |
| 25215 | Removal of wrist bones | $8,456 | MEDICARE – BLUE CROSS | $2,449 |
| 25215 | Removal of wrist bones | $8,456 | MEDICARE – UNITED | $2,449 |
| 25215 | Removal of wrist bones | $8,456 | MEDICARE – COVENTRY | $2,449 |
| 25215 | Removal of wrist bones | $8,456 | MEDICARE – VANTAGE | $2,449 |
| 25215 | Removal of wrist bones | $8,456 | MEDICARE -PEOPLES | $2,449 |
| 25215 | Removal of wrist bones | $8,456 | MEDICARE- HUMANA | $2,400 |
| 25215 | Removal of wrist bones | $8,456 | HUMANA | $3,673 |
| 25215 | Removal of wrist bones | $8,456 | VANTAGE | $4,163 |
| 25215 | Removal of wrist bones | $8,456 | MEDICAID | $659 |
| 25215 | Removal of wrist bones | $8,456 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 25215 | Removal of wrist bones | $8,456 | MEDICAID – UNITED | $659 |
| 25215 | Removal of wrist bones | $8,456 | MEDICAID – HEALTHY BLUE | $659 |
| 25215 | Removal of wrist bones | $8,456 | MEDICAID – AMERIHEALTH | $659 |
| 25215 | Removal of wrist bones | $8,456 | UNITED | $2,923 |
| 25215 | Removal of wrist bones | $8,456 | AETNA | $1,861 |
| 25215 | Removal of wrist bones | $8,456 | CIGNA | $1,323 |
| 25215 | Removal of wrist bones | $8,456 | LWCC | $6,296 |
| 25215 | Removal of wrist bones | $8,456 | PPOPLUS | $5,493 |
| 25215 | Removal of wrist bones | $8,456 | GILSBAR | $4,476 |
| 25215 | Removal of wrist bones | $8,456 | LSU | $4,456 |
| 25215 | Removal of wrist bones | $8,456 | VERITY | $3,386 |
| 25215 | Removal of wrist bones | $8,456 | MULTIPLAN | $3,386 |
| 25215 | Removal of wrist bones | $8,456 | LA WORK COMP | $8,456 |
| 25215 | Removal of wrist bones | $8,456 | | |
| 52317 | Remove bladder stone | $10,680 | Private Pay | $11,251 |
| 52317 | Remove bladder stone | $10,680 | BC PPO | $2,969 |
| 52317 | Remove bladder stone | $10,680 | BC HMO | $2,606 |
| 52317 | Remove bladder stone | $10,680 | BC FMOL | $2,630 |
| 52317 | Remove bladder stone | $10,680 | MEDICARE | $2,700 |
| 52317 | Remove bladder stone | $10,680 | MEDICARE – BLUE CROSS | $2,700 |
| 52317 | Remove bladder stone | $10,680 | MEDICARE – UNITED | $2,700 |
| 52317 | Remove bladder stone | $10,680 | MEDICARE – COVENTRY | $2,700 |
| 52317 | Remove bladder stone | $10,680 | MEDICARE – VANTAGE | $2,700 |
| 52317 | Remove bladder stone | $10,680 | MEDICARE -PEOPLES | $2,700 |
| 52317 | Remove bladder stone | $10,680 | MEDICARE- HUMANA | $2,646 |
| 52317 | Remove bladder stone | $10,680 | HUMANA | $4,050 |
| 52317 | Remove bladder stone | $10,680 | VANTAGE | $4,590 |
| 52317 | Remove bladder stone | $10,680 | MEDICAID | $348 |
| 52317 | Remove bladder stone | $10,680 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 52317 | Remove bladder stone | $10,680 | MEDICAID – UNITED | $348 |
| 52317 | Remove bladder stone | $10,680 | MEDICAID – HEALTHY BLUE | $348 |
| 52317 | Remove bladder stone | $10,680 | MEDICAID – AMERIHEALTH | $348 |
| 52317 | Remove bladder stone | $10,680 | UNITED | $2,188 |
| 52317 | Remove bladder stone | $10,680 | AETNA | $1,360 |
| 52317 | Remove bladder stone | $10,680 | CIGNA | $1,323 |
| 52317 | Remove bladder stone | $10,680 | LWCC | $6,943 |
| 52317 | Remove bladder stone | $10,680 | PPOPLUS | $6,863 |
| 52317 | Remove bladder stone | $10,680 | GILSBAR | $5,613 |
| 52317 | Remove bladder stone | $10,680 | LSU | $4,721 |
| 52317 | Remove bladder stone | $10,680 | VERITY | $3,452 |
| 52317 | Remove bladder stone | $10,680 | MULTIPLAN | $3,452 |
| 52317 | Remove bladder stone | $10,680 | LA WORK COMP | $10,680 |
| 52317 | Remove bladder stone | $10,680 | | |
| 52318 | Remove bladder stone | $12,015 | Private Pay | $13,011 |
| 52318 | Remove bladder stone | $12,015 | BC PPO | $4,081 |
| 52318 | Remove bladder stone | $12,015 | BC HMO | $3,581 |
| 52318 | Remove bladder stone | $12,015 | BC FMOL | $3,615 |
| 52318 | Remove bladder stone | $12,015 | MEDICARE | $2,700 |
| 52318 | Remove bladder stone | $12,015 | MEDICARE – BLUE CROSS | $2,700 |
| 52318 | Remove bladder stone | $12,015 | MEDICARE – UNITED | $2,700 |
| 52318 | Remove bladder stone | $12,015 | MEDICARE – COVENTRY | $2,700 |
| 52318 | Remove bladder stone | $12,015 | MEDICARE – VANTAGE | $2,700 |
| 52318 | Remove bladder stone | $12,015 | MEDICARE -PEOPLES | $2,700 |
| 52318 | Remove bladder stone | $12,015 | MEDICARE- HUMANA | $2,646 |
| 52318 | Remove bladder stone | $12,015 | HUMANA | $4,050 |
| 52318 | Remove bladder stone | $12,015 | VANTAGE | $4,590 |
| 52318 | Remove bladder stone | $12,015 | MEDICAID | $466 |
| 52318 | Remove bladder stone | $12,015 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 52318 | Remove bladder stone | $12,015 | MEDICAID – UNITED | $466 |
| 52318 | Remove bladder stone | $12,015 | MEDICAID – HEALTHY BLUE | $466 |
| 52318 | Remove bladder stone | $12,015 | MEDICAID – AMERIHEALTH | $466 |
| 52318 | Remove bladder stone | $12,015 | UNITED | $2,188 |
| 52318 | Remove bladder stone | $12,015 | AETNA | $1,335 |
| 52318 | Remove bladder stone | $12,015 | CIGNA | $854 |
| 52318 | Remove bladder stone | $12,015 | LWCC | $6,943 |
| 52318 | Remove bladder stone | $12,015 | PPOPLUS | $7,937 |
| 52318 | Remove bladder stone | $12,015 | GILSBAR | $6,430 |
| 52318 | Remove bladder stone | $12,015 | LSU | $4,396 |
| 52318 | Remove bladder stone | $12,015 | VERITY | $4,743 |
| 52318 | Remove bladder stone | $12,015 | MULTIPLAN | $4,743 |
| 52318 | Remove bladder stone | $12,015 | LA WORK COMP | $12,015 |
| 52318 | Remove bladder stone | $12,015 | | |
| 20694 | Remove bone fixation device | $8,322 | Private Pay | $9,247 |
| 20694 | Remove bone fixation device | $8,322 | BC PPO | $1,749 |
| 20694 | Remove bone fixation device | $8,322 | BC HMO | $1,534 |
| 20694 | Remove bone fixation device | $8,322 | BC FMOL | $1,549 |
| 20694 | Remove bone fixation device | $8,322 | MEDICARE | $1,212 |
| 20694 | Remove bone fixation device | $8,322 | MEDICARE – BLUE CROSS | $1,212 |
| 20694 | Remove bone fixation device | $8,322 | MEDICARE – UNITED | $1,212 |
| 20694 | Remove bone fixation device | $8,322 | MEDICARE – COVENTRY | $1,212 |
| 20694 | Remove bone fixation device | $8,322 | MEDICARE – VANTAGE | $1,212 |
| 20694 | Remove bone fixation device | $8,322 | MEDICARE -PEOPLES | $1,212 |
| 20694 | Remove bone fixation device | $8,322 | MEDICARE- HUMANA | $1,188 |
| 20694 | Remove bone fixation device | $8,322 | HUMANA | $1,819 |
| 20694 | Remove bone fixation device | $8,322 | VANTAGE | $2,061 |
| 20694 | Remove bone fixation device | $8,322 | MEDICAID | $348 |
| 20694 | Remove bone fixation device | $8,322 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 20694 | Remove bone fixation device | $8,322 | MEDICAID – UNITED | $348 |
| 20694 | Remove bone fixation device | $8,322 | MEDICAID – HEALTHY BLUE | $348 |
| 20694 | Remove bone fixation device | $8,322 | MEDICAID – AMERIHEALTH | $348 |
| 20694 | Remove bone fixation device | $8,322 | UNITED | $734 |
| 20694 | Remove bone fixation device | $8,322 | AETNA | $750 |
| 20694 | Remove bone fixation device | $8,322 | CIGNA | $1,433 |
| 20694 | Remove bone fixation device | $8,322 | LWCC | $3,117 |
| 20694 | Remove bone fixation device | $8,322 | PPOPLUS | $5,640 |
| 20694 | Remove bone fixation device | $8,322 | GILSBAR | $4,531 |
| 20694 | Remove bone fixation device | $8,322 | LSU | $4,000 |
| 20694 | Remove bone fixation device | $8,322 | VERITY | $2,677 |
| 20694 | Remove bone fixation device | $8,322 | MULTIPLAN | $2,677 |
| 20694 | Remove bone fixation device | $8,322 | LA WORK COMP | $8,322 |
| 20694 | Remove bone fixation device | $8,322 | | |
| 24120 | Remove elbow lesion | $8,270 | Private Pay | $9,189 |
| 24120 | Remove elbow lesion | $8,270 | BC PPO | $3,358 |
| 24120 | Remove elbow lesion | $8,270 | BC HMO | $2,947 |
| 24120 | Remove elbow lesion | $8,270 | BC FMOL | $2,975 |
| 24120 | Remove elbow lesion | $8,270 | MEDICARE | $2,449 |
| 24120 | Remove elbow lesion | $8,270 | MEDICARE – BLUE CROSS | $2,449 |
| 24120 | Remove elbow lesion | $8,270 | MEDICARE – UNITED | $2,449 |
| 24120 | Remove elbow lesion | $8,270 | MEDICARE – COVENTRY | $2,449 |
| 24120 | Remove elbow lesion | $8,270 | MEDICARE – VANTAGE | $2,449 |
| 24120 | Remove elbow lesion | $8,270 | MEDICARE -PEOPLES | $2,449 |
| 24120 | Remove elbow lesion | $8,270 | MEDICARE- HUMANA | $2,400 |
| 24120 | Remove elbow lesion | $8,270 | HUMANA | $3,673 |
| 24120 | Remove elbow lesion | $8,270 | VANTAGE | $4,163 |
| 24120 | Remove elbow lesion | $8,270 | MEDICAID | $533 |
| 24120 | Remove elbow lesion | $8,270 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 24120 | Remove elbow lesion | $8,270 | MEDICAID – UNITED | $533 |
| 24120 | Remove elbow lesion | $8,270 | MEDICAID – HEALTHY BLUE | $533 |
| 24120 | Remove elbow lesion | $8,270 | MEDICAID – AMERIHEALTH | $533 |
| 24120 | Remove elbow lesion | $8,270 | UNITED | $2,188 |
| 24120 | Remove elbow lesion | $8,270 | AETNA | $1,200 |
| 24120 | Remove elbow lesion | $8,270 | CIGNA | $1,102 |
| 24120 | Remove elbow lesion | $8,270 | LWCC | $6,296 |
| 24120 | Remove elbow lesion | $8,270 | PPOPLUS | $5,605 |
| 24120 | Remove elbow lesion | $8,270 | GILSBAR | $4,503 |
| 24120 | Remove elbow lesion | $8,270 | LSU | $4,000 |
| 24120 | Remove elbow lesion | $8,270 | VERITY | $3,386 |
| 24120 | Remove elbow lesion | $8,270 | MULTIPLAN | $3,386 |
| 24120 | Remove elbow lesion | $8,270 | LA WORK COMP | $8,270 |
| 24120 | Remove elbow lesion | $8,270 | | |
| 54840 | Remove epididymis lesion | $8,064 | Private Pay | $8,960 |
| 54840 | Remove epididymis lesion | $8,064 | BC PPO | $1,867 |
| 54840 | Remove epididymis lesion | $8,064 | BC HMO | $1,638 |
| 54840 | Remove epididymis lesion | $8,064 | BC FMOL | $1,654 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICARE | $1,585 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICARE – BLUE CROSS | $1,585 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICARE – UNITED | $1,585 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICARE – COVENTRY | $1,585 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICARE – VANTAGE | $1,585 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICARE -PEOPLES | $1,585 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICARE- HUMANA | $1,553 |
| 54840 | Remove epididymis lesion | $8,064 | HUMANA | $2,377 |
| 54840 | Remove epididymis lesion | $8,064 | VANTAGE | $2,694 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICAID | $659 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICAID – UNITED | $659 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICAID – HEALTHY BLUE | $659 |
| 54840 | Remove epididymis lesion | $8,064 | MEDICAID – AMERIHEALTH | $659 |
| 54840 | Remove epididymis lesion | $8,064 | UNITED | $2,188 |
| 54840 | Remove epididymis lesion | $8,064 | AETNA | $1,475 |
| 54840 | Remove epididymis lesion | $8,064 | CIGNA | $1,433 |
| 54840 | Remove epididymis lesion | $8,064 | LWCC | $4,075 |
| 54840 | Remove epididymis lesion | $8,064 | PPOPLUS | $5,466 |
| 54840 | Remove epididymis lesion | $8,064 | GILSBAR | $4,390 |
| 54840 | Remove epididymis lesion | $8,064 | LSU | $4,000 |
| 54840 | Remove epididymis lesion | $8,064 | VERITY | $2,170 |
| 54840 | Remove epididymis lesion | $8,064 | MULTIPLAN | $2,170 |
| 54840 | Remove epididymis lesion | $8,064 | LA WORK COMP | $8,064 |
| 54840 | Remove epididymis lesion | $8,064 | | |
| 10120 | Remove foreign body | $5,505 | Private Pay | $6,117 |
| 10120 | Remove foreign body | $5,505 | BC PPO | $403 |
| 10120 | Remove foreign body | $5,505 | BC HMO | $353 |
| 10120 | Remove foreign body | $5,505 | BC FMOL | $357 |
| 10120 | Remove foreign body | $5,505 | MEDICARE | $286 |
| 10120 | Remove foreign body | $5,505 | MEDICARE – BLUE CROSS | $286 |
| 10120 | Remove foreign body | $5,505 | MEDICARE – UNITED | $286 |
| 10120 | Remove foreign body | $5,505 | MEDICARE – COVENTRY | $286 |
| 10120 | Remove foreign body | $5,505 | MEDICARE – VANTAGE | $286 |
| 10120 | Remove foreign body | $5,505 | MEDICARE -PEOPLES | $286 |
| 10120 | Remove foreign body | $5,505 | MEDICARE- HUMANA | $280 |
| 10120 | Remove foreign body | $5,505 | HUMANA | $429 |
| 10120 | Remove foreign body | $5,505 | VANTAGE | $486 |
| 10120 | Remove foreign body | $5,505 | MEDICAID | $348 |
| 10120 | Remove foreign body | $5,505 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 10120 | Remove foreign body | $5,505 | MEDICAID – UNITED | $348 |
| 10120 | Remove foreign body | $5,505 | MEDICAID – HEALTHY BLUE | $348 |
| 10120 | Remove foreign body | $5,505 | MEDICAID – AMERIHEALTH | $348 |
| 10120 | Remove foreign body | $5,505 | UNITED | $392 |
| 10120 | Remove foreign body | $5,505 | AETNA | $750 |
| 10120 | Remove foreign body | $5,505 | CIGNA | $854 |
| 10120 | Remove foreign body | $5,505 | LWCC | $735 |
| 10120 | Remove foreign body | $5,505 | PPOPLUS | $3,731 |
| 10120 | Remove foreign body | $5,505 | GILSBAR | $2,997 |
| 10120 | Remove foreign body | $5,505 | LSU | $4,000 |
| 10120 | Remove foreign body | $5,505 | VERITY | $496 |
| 10120 | Remove foreign body | $5,505 | MULTIPLAN | $496 |
| 10120 | Remove foreign body | $5,505 | LA WORK COMP | $5,505 |
| 10120 | Remove foreign body | $5,505 | | |
| 10121 | Remove foreign body | $5,386 | Private Pay | $5,984 |
| 10121 | Remove foreign body | $5,386 | BC PPO | $1,484 |
| 10121 | Remove foreign body | $5,386 | BC HMO | $1,302 |
| 10121 | Remove foreign body | $5,386 | BC FMOL | $1,315 |
| 10121 | Remove foreign body | $5,386 | MEDICARE | $1,228 |
| 10121 | Remove foreign body | $5,386 | MEDICARE – BLUE CROSS | $1,228 |
| 10121 | Remove foreign body | $5,386 | MEDICARE – UNITED | $1,228 |
| 10121 | Remove foreign body | $5,386 | MEDICARE – COVENTRY | $1,228 |
| 10121 | Remove foreign body | $5,386 | MEDICARE – VANTAGE | $1,228 |
| 10121 | Remove foreign body | $5,386 | MEDICARE -PEOPLES | $1,228 |
| 10121 | Remove foreign body | $5,386 | MEDICARE- HUMANA | $1,203 |
| 10121 | Remove foreign body | $5,386 | HUMANA | $1,842 |
| 10121 | Remove foreign body | $5,386 | VANTAGE | $2,087 |
| 10121 | Remove foreign body | $5,386 | MEDICAID | $466 |
| 10121 | Remove foreign body | $5,386 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 10121 | Remove foreign body | $5,386 | MEDICAID – UNITED | $466 |
| 10121 | Remove foreign body | $5,386 | MEDICAID – HEALTHY BLUE | $466 |
| 10121 | Remove foreign body | $5,386 | MEDICAID – AMERIHEALTH | $466 |
| 10121 | Remove foreign body | $5,386 | UNITED | $734 |
| 10121 | Remove foreign body | $5,386 | AETNA | $1,000 |
| 10121 | Remove foreign body | $5,386 | CIGNA | $1,102 |
| 10121 | Remove foreign body | $5,386 | LWCC | $3,157 |
| 10121 | Remove foreign body | $5,386 | PPOPLUS | $3,650 |
| 10121 | Remove foreign body | $5,386 | GILSBAR | $2,932 |
| 10121 | Remove foreign body | $5,386 | LSU | $4,000 |
| 10121 | Remove foreign body | $5,386 | VERITY | $106 |
| 10121 | Remove foreign body | $5,386 | MULTIPLAN | $106 |
| 10121 | Remove foreign body | $5,386 | LA WORK COMP | $5,386 |
| 10121 | Remove foreign body | $5,386 | | |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | Private Pay | $19,783 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | BC PPO | $7,117 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | BC HMO | $6,245 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | BC FMOL | $6,305 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICARE | $5,351 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICARE – BLUE CROSS | $5,351 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICARE – UNITED | $5,351 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICARE – COVENTRY | $5,351 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICARE – VANTAGE | $5,351 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICARE -PEOPLES | $5,351 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICARE- HUMANA | $5,244 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | HUMANA | $8,026 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | VANTAGE | $9,097 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICAID | $- |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICAID – AETNA BETTER HEALTH | $- |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICAID – UNITED | $- |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICAID – HEALTHY BLUE | $- |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MEDICAID – AMERIHEALTH | $- |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | UNITED | $4,460 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | AETNA | $2,843 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | CIGNA | $4,187 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | LWCC | $13,758 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | PPOPLUS | $12,068 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | GILSBAR | $9,889 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | LSU | $5,410 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | VERITY | $7,176 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | MULTIPLAN | $7,176 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | LA WORK COMP | $18,889 |
| 63047 | Remove spine lamina 1 lmbr | $18,889 | | |
| 26160 | Remove tendon sheath lesion | $5,382 | Private Pay | $5,980 |
| 26160 | Remove tendon sheath lesion | $5,382 | BC PPO | $1,644 |
| 26160 | Remove tendon sheath lesion | $5,382 | BC HMO | $1,442 |
| 26160 | Remove tendon sheath lesion | $5,382 | BC FMOL | $1,456 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICARE | $1,212 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICARE – BLUE CROSS | $1,212 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICARE – UNITED | $1,212 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICARE – COVENTRY | $1,212 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICARE – VANTAGE | $1,212 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICARE -PEOPLES | $1,212 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICARE- HUMANA | $1,188 |
| 26160 | Remove tendon sheath lesion | $5,382 | HUMANA | $1,819 |
| 26160 | Remove tendon sheath lesion | $5,382 | VANTAGE | $2,061 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICAID | $533 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICAID – UNITED | $533 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICAID – HEALTHY BLUE | $533 |
| 26160 | Remove tendon sheath lesion | $5,382 | MEDICAID – AMERIHEALTH | $533 |
| 26160 | Remove tendon sheath lesion | $5,382 | UNITED | $734 |
| 26160 | Remove tendon sheath lesion | $5,382 | AETNA | $1,200 |
| 26160 | Remove tendon sheath lesion | $5,382 | CIGNA | $992 |
| 26160 | Remove tendon sheath lesion | $5,382 | LWCC | $3,117 |
| 26160 | Remove tendon sheath lesion | $5,382 | PPOPLUS | $3,648 |
| 26160 | Remove tendon sheath lesion | $5,382 | GILSBAR | $2,930 |
| 26160 | Remove tendon sheath lesion | $5,382 | LSU | $4,000 |
| 26160 | Remove tendon sheath lesion | $5,382 | VERITY | $1,728 |
| 26160 | Remove tendon sheath lesion | $5,382 | MULTIPLAN | $1,728 |
| 26160 | Remove tendon sheath lesion | $5,382 | LA WORK COMP | $5,382 |
| 26160 | Remove tendon sheath lesion | $5,382 | | |
| 42820 | Remove tonsils and adenoids | $11,156 | Private Pay | $7,417 |
| 42820 | Remove tonsils and adenoids | $11,156 | BC PPO | $5,508 |
| 42820 | Remove tonsils and adenoids | $11,156 | BC HMO | $4,833 |
| 42820 | Remove tonsils and adenoids | $11,156 | BC FMOL | $4,879 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICARE | $4,339 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICARE – BLUE CROSS | $4,339 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICARE – UNITED | $4,339 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICARE – COVENTRY | $4,339 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICARE – VANTAGE | $4,339 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICARE -PEOPLES | $4,339 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICARE- HUMANA | $4,252 |
| 42820 | Remove tonsils and adenoids | $11,156 | HUMANA | $6,508 |
| 42820 | Remove tonsils and adenoids | $11,156 | VANTAGE | $7,376 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICAID | $533 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICAID – UNITED | $533 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICAID – HEALTHY BLUE | $533 |
| 42820 | Remove tonsils and adenoids | $11,156 | MEDICAID – AMERIHEALTH | $533 |
| 42820 | Remove tonsils and adenoids | $11,156 | UNITED | $2,188 |
| 42820 | Remove tonsils and adenoids | $11,156 | AETNA | $1,270 |
| 42820 | Remove tonsils and adenoids | $11,156 | CIGNA | $1,076 |
| 42820 | Remove tonsils and adenoids | $11,156 | LWCC | $11,156 |
| 42820 | Remove tonsils and adenoids | $11,156 | PPOPLUS | $4,525 |
| 42820 | Remove tonsils and adenoids | $11,156 | GILSBAR | $3,646 |
| 42820 | Remove tonsils and adenoids | $11,156 | LSU | $4,083 |
| 42820 | Remove tonsils and adenoids | $11,156 | VERITY | $5,553 |
| 42820 | Remove tonsils and adenoids | $11,156 | MULTIPLAN | $5,553 |
| 42820 | Remove tonsils and adenoids | $11,156 | LA WORK COMP | $6,739 |
| 42820 | Remove tonsils and adenoids | $11,156 | | |
| 42821 | Remove tonsils and adenoids | $7,062 | Private Pay | $7,793 |
| 42821 | Remove tonsils and adenoids | $7,062 | BC PPO | $2,792 |
| 42821 | Remove tonsils and adenoids | $7,062 | BC HMO | $2,450 |
| 42821 | Remove tonsils and adenoids | $7,062 | BC FMOL | $2,473 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICARE | $2,343 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICARE – BLUE CROSS | $2,343 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICARE – UNITED | $2,343 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICARE – COVENTRY | $2,343 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICARE – VANTAGE | $2,343 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICARE -PEOPLES | $2,343 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICARE- HUMANA | $2,296 |
| 42821 | Remove tonsils and adenoids | $7,062 | HUMANA | $3,515 |
| 42821 | Remove tonsils and adenoids | $7,062 | VANTAGE | $3,983 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICAID | $750 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICAID – UNITED | $750 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICAID – HEALTHY BLUE | $750 |
| 42821 | Remove tonsils and adenoids | $7,062 | MEDICAID – AMERIHEALTH | $750 |
| 42821 | Remove tonsils and adenoids | $7,062 | UNITED | $2,188 |
| 42821 | Remove tonsils and adenoids | $7,062 | AETNA | $1,703 |
| 42821 | Remove tonsils and adenoids | $7,062 | CIGNA | $1,102 |
| 42821 | Remove tonsils and adenoids | $7,062 | LWCC | $6,024 |
| 42821 | Remove tonsils and adenoids | $7,062 | PPOPLUS | $4,754 |
| 42821 | Remove tonsils and adenoids | $7,062 | GILSBAR | $3,827 |
| 42821 | Remove tonsils and adenoids | $7,062 | LSU | $4,062 |
| 42821 | Remove tonsils and adenoids | $7,062 | VERITY | $2,815 |
| 42821 | Remove tonsils and adenoids | $7,062 | MULTIPLAN | $2,815 |
| 42821 | Remove tonsils and adenoids | $7,062 | LA WORK COMP | $7,062 |
| 42821 | Remove tonsils and adenoids | $7,062 | | |
| 69424 | Remove ventilating tube | $6,024 | Private Pay | $5,325 |
| 69424 | Remove ventilating tube | $6,024 | BC PPO | $2,849 |
| 69424 | Remove ventilating tube | $6,024 | BC HMO | $2,500 |
| 69424 | Remove ventilating tube | $6,024 | BC FMOL | $2,523 |
| 69424 | Remove ventilating tube | $6,024 | MEDICARE | $2,343 |
| 69424 | Remove ventilating tube | $6,024 | MEDICARE – BLUE CROSS | $2,343 |
| 69424 | Remove ventilating tube | $6,024 | MEDICARE – UNITED | $2,343 |
| 69424 | Remove ventilating tube | $6,024 | MEDICARE – COVENTRY | $2,343 |
| 69424 | Remove ventilating tube | $6,024 | MEDICARE – VANTAGE | $2,343 |
| 69424 | Remove ventilating tube | $6,024 | MEDICARE -PEOPLES | $2,343 |
| 69424 | Remove ventilating tube | $6,024 | MEDICARE- HUMANA | $2,296 |
| 69424 | Remove ventilating tube | $6,024 | HUMANA | $3,515 |
| 69424 | Remove ventilating tube | $6,024 | VANTAGE | $3,983 |
| 69424 | Remove ventilating tube | $6,024 | MEDICAID | $348 |
| 69424 | Remove ventilating tube | $6,024 | MEDICAID – AETNA BETTER HEALTH | $348 |
| 69424 | Remove ventilating tube | $6,024 | MEDICAID – UNITED | $348 |
| 69424 | Remove ventilating tube | $6,024 | MEDICAID – HEALTHY BLUE | $348 |
| 69424 | Remove ventilating tube | $6,024 | MEDICAID – AMERIHEALTH | $348 |
| 69424 | Remove ventilating tube | $6,024 | UNITED | $2,188 |
| 69424 | Remove ventilating tube | $6,024 | AETNA | $750 |
| 69424 | Remove ventilating tube | $6,024 | CIGNA | $1,433 |
| 69424 | Remove ventilating tube | $6,024 | LWCC | $6,024 |
| 69424 | Remove ventilating tube | $6,024 | PPOPLUS | $3,248 |
| 69424 | Remove ventilating tube | $6,024 | GILSBAR | $2,609 |
| 69424 | Remove ventilating tube | $6,024 | LSU | $4,000 |
| 69424 | Remove ventilating tube | $6,024 | VERITY | $1,064 |
| 69424 | Remove ventilating tube | $6,024 | MULTIPLAN | $1,064 |
| 69424 | Remove ventilating tube | $6,024 | LA WORK COMP | $4,792 |
| 69424 | Remove ventilating tube | $6,024 | | |
| 25107 | Remove wrist joint cartilage | $11,561 | Private Pay | $12,632 |
| 25107 | Remove wrist joint cartilage | $11,561 | BC PPO | $3,221 |
| 25107 | Remove wrist joint cartilage | $11,561 | BC HMO | $2,826 |
| 25107 | Remove wrist joint cartilage | $11,561 | BC FMOL | $2,853 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICARE | $2,449 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICARE – BLUE CROSS | $2,449 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICARE – UNITED | $2,449 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICARE – COVENTRY | $2,449 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICARE – VANTAGE | $2,449 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICARE -PEOPLES | $2,449 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICARE- HUMANA | $2,400 |
| 25107 | Remove wrist joint cartilage | $11,561 | HUMANA | $3,673 |
| 25107 | Remove wrist joint cartilage | $11,561 | VANTAGE | $4,163 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICAID | $533 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICAID – UNITED | $533 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICAID – HEALTHY BLUE | $533 |
| 25107 | Remove wrist joint cartilage | $11,561 | MEDICAID – AMERIHEALTH | $533 |
| 25107 | Remove wrist joint cartilage | $11,561 | UNITED | $2,923 |
| 25107 | Remove wrist joint cartilage | $11,561 | AETNA | $1,411 |
| 25107 | Remove wrist joint cartilage | $11,561 | CIGNA | $1,433 |
| 25107 | Remove wrist joint cartilage | $11,561 | LWCC | $6,296 |
| 25107 | Remove wrist joint cartilage | $11,561 | PPOPLUS | $7,706 |
| 25107 | Remove wrist joint cartilage | $11,561 | GILSBAR | $6,224 |
| 25107 | Remove wrist joint cartilage | $11,561 | LSU | $4,250 |
| 25107 | Remove wrist joint cartilage | $11,561 | VERITY | $3,386 |
| 25107 | Remove wrist joint cartilage | $11,561 | MULTIPLAN | $3,386 |
| 25107 | Remove wrist joint cartilage | $11,561 | LA WORK COMP | $11,561 |
| 25107 | Remove wrist joint cartilage | $11,561 | | |
| 25111 | Remove wrist tendon lesion | $6,507 | Private Pay | $7,230 |
| 25111 | Remove wrist tendon lesion | $6,507 | BC PPO | $1,644 |
| 25111 | Remove wrist tendon lesion | $6,507 | BC HMO | $1,442 |
| 25111 | Remove wrist tendon lesion | $6,507 | BC FMOL | $1,456 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICARE | $1,212 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICARE – BLUE CROSS | $1,212 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICARE – UNITED | $1,212 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICARE – COVENTRY | $1,212 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICARE – VANTAGE | $1,212 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICARE -PEOPLES | $1,212 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICARE- HUMANA | $1,188 |
| 25111 | Remove wrist tendon lesion | $6,507 | HUMANA | $1,819 |
| 25111 | Remove wrist tendon lesion | $6,507 | VANTAGE | $2,061 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICAID | $533 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICAID – UNITED | $533 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICAID – HEALTHY BLUE | $533 |
| 25111 | Remove wrist tendon lesion | $6,507 | MEDICAID – AMERIHEALTH | $533 |
| 25111 | Remove wrist tendon lesion | $6,507 | UNITED | $2,188 |
| 25111 | Remove wrist tendon lesion | $6,507 | AETNA | $1,200 |
| 25111 | Remove wrist tendon lesion | $6,507 | CIGNA | $634 |
| 25111 | Remove wrist tendon lesion | $6,507 | LWCC | $3,117 |
| 25111 | Remove wrist tendon lesion | $6,507 | PPOPLUS | $4,410 |
| 25111 | Remove wrist tendon lesion | $6,507 | GILSBAR | $3,543 |
| 25111 | Remove wrist tendon lesion | $6,507 | LSU | $4,000 |
| 25111 | Remove wrist tendon lesion | $6,507 | VERITY | $1,728 |
| 25111 | Remove wrist tendon lesion | $6,507 | MULTIPLAN | $1,728 |
| 25111 | Remove wrist tendon lesion | $6,507 | LA WORK COMP | $6,507 |
| 25111 | Remove wrist tendon lesion | $6,507 | | |
| 25115 | Remove wrist/forearm lesion | $7,374 | Private Pay | $8,193 |
| 25115 | Remove wrist/forearm lesion | $7,374 | BC PPO | $1,329 |
| 25115 | Remove wrist/forearm lesion | $7,374 | BC HMO | $1,166 |
| 25115 | Remove wrist/forearm lesion | $7,374 | BC FMOL | $1,177 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICARE | $1,212 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICARE – BLUE CROSS | $1,212 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICARE – UNITED | $1,212 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICARE – COVENTRY | $1,212 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICARE – VANTAGE | $1,212 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICARE -PEOPLES | $1,212 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICARE- HUMANA | $1,188 |
| 25115 | Remove wrist/forearm lesion | $7,374 | HUMANA | $1,819 |
| 25115 | Remove wrist/forearm lesion | $7,374 | VANTAGE | $2,061 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICAID | $659 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICAID – UNITED | $659 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICAID – HEALTHY BLUE | $659 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MEDICAID – AMERIHEALTH | $659 |
| 25115 | Remove wrist/forearm lesion | $7,374 | UNITED | $2,188 |
| 25115 | Remove wrist/forearm lesion | $7,374 | AETNA | $1,475 |
| 25115 | Remove wrist/forearm lesion | $7,374 | CIGNA | $1,102 |
| 25115 | Remove wrist/forearm lesion | $7,374 | LWCC | $3,117 |
| 25115 | Remove wrist/forearm lesion | $7,374 | PPOPLUS | $4,998 |
| 25115 | Remove wrist/forearm lesion | $7,374 | GILSBAR | $4,014 |
| 25115 | Remove wrist/forearm lesion | $7,374 | LSU | $4,000 |
| 25115 | Remove wrist/forearm lesion | $7,374 | VERITY | $1,728 |
| 25115 | Remove wrist/forearm lesion | $7,374 | MULTIPLAN | $1,728 |
| 25115 | Remove wrist/forearm lesion | $7,374 | LA WORK COMP | $7,374 |
| 25115 | Remove wrist/forearm lesion | $7,374 | | |
| 27650 | Repair achilles tendon | $13,758 | Private Pay | $13,819 |
| 27650 | Repair achilles tendon | $13,758 | BC PPO | $2,913 |
| 27650 | Repair achilles tendon | $13,758 | BC HMO | $2,556 |
| 27650 | Repair achilles tendon | $13,758 | BC FMOL | $2,580 |
| 27650 | Repair achilles tendon | $13,758 | MEDICARE | $5,351 |
| 27650 | Repair achilles tendon | $13,758 | MEDICARE – BLUE CROSS | $5,351 |
| 27650 | Repair achilles tendon | $13,758 | MEDICARE – UNITED | $5,351 |
| 27650 | Repair achilles tendon | $13,758 | MEDICARE – COVENTRY | $5,351 |
| 27650 | Repair achilles tendon | $13,758 | MEDICARE – VANTAGE | $5,351 |
| 27650 | Repair achilles tendon | $13,758 | MEDICARE -PEOPLES | $5,351 |
| 27650 | Repair achilles tendon | $13,758 | MEDICARE- HUMANA | $5,244 |
| 27650 | Repair achilles tendon | $13,758 | HUMANA | $8,026 |
| 27650 | Repair achilles tendon | $13,758 | VANTAGE | $9,097 |
| 27650 | Repair achilles tendon | $13,758 | MEDICAID | $533 |
| 27650 | Repair achilles tendon | $13,758 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 27650 | Repair achilles tendon | $13,758 | MEDICAID – UNITED | $533 |
| 27650 | Repair achilles tendon | $13,758 | MEDICAID – HEALTHY BLUE | $533 |
| 27650 | Repair achilles tendon | $13,758 | MEDICAID – AMERIHEALTH | $533 |
| 27650 | Repair achilles tendon | $13,758 | UNITED | $3,860 |
| 27650 | Repair achilles tendon | $13,758 | AETNA | $1,200 |
| 27650 | Repair achilles tendon | $13,758 | CIGNA | $1,323 |
| 27650 | Repair achilles tendon | $13,758 | LWCC | $13,758 |
| 27650 | Repair achilles tendon | $13,758 | PPOPLUS | $8,430 |
| 27650 | Repair achilles tendon | $13,758 | GILSBAR | $6,772 |
| 27650 | Repair achilles tendon | $13,758 | LSU | $4,000 |
| 27650 | Repair achilles tendon | $13,758 | VERITY | $3,386 |
| 27650 | Repair achilles tendon | $13,758 | MULTIPLAN | $3,386 |
| 27650 | Repair achilles tendon | $13,758 | LA WORK COMP | $12,438 |
| 27650 | Repair achilles tendon | $13,758 | | |
| 24341 | Repair arm tendon/muscle | $16,409 | Private Pay | $16,349 |
| 24341 | Repair arm tendon/muscle | $16,409 | BC PPO | $6,827 |
| 24341 | Repair arm tendon/muscle | $16,409 | BC HMO | $5,990 |
| 24341 | Repair arm tendon/muscle | $16,409 | BC FMOL | $6,047 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICARE | $5,351 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICARE – BLUE CROSS | $5,351 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICARE – UNITED | $5,351 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICARE – COVENTRY | $5,351 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICARE – VANTAGE | $5,351 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICARE -PEOPLES | $5,351 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICARE- HUMANA | $5,244 |
| 24341 | Repair arm tendon/muscle | $16,409 | HUMANA | $8,026 |
| 24341 | Repair arm tendon/muscle | $16,409 | VANTAGE | $9,097 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICAID | $533 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICAID – AETNA BETTER HEALTH | $533 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICAID – UNITED | $533 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICAID – HEALTHY BLUE | $533 |
| 24341 | Repair arm tendon/muscle | $16,409 | MEDICAID – AMERIHEALTH | $533 |
| 24341 | Repair arm tendon/muscle | $16,409 | UNITED | $3,860 |
| 24341 | Repair arm tendon/muscle | $16,409 | AETNA | $3,064 |
| 24341 | Repair arm tendon/muscle | $16,409 | CIGNA | $3,560 |
| 24341 | Repair arm tendon/muscle | $16,409 | LWCC | $13,758 |
| 24341 | Repair arm tendon/muscle | $16,409 | PPOPLUS | $9,973 |
| 24341 | Repair arm tendon/muscle | $16,409 | GILSBAR | $8,316 |
| 24341 | Repair arm tendon/muscle | $16,409 | LSU | $6,203 |
| 24341 | Repair arm tendon/muscle | $16,409 | VERITY | $7,176 |
| 24341 | Repair arm tendon/muscle | $16,409 | MULTIPLAN | $7,176 |
| 24341 | Repair arm tendon/muscle | $16,409 | LA WORK COMP | $16,409 |
| 24341 | Repair arm tendon/muscle | $16,409 | | |
| 64857 | Repair arm/leg nerve | $16,090 | Private Pay | $15,656 |
| 64857 | Repair arm/leg nerve | $16,090 | BC PPO | $4,556 |
| 64857 | Repair arm/leg nerve | $16,090 | BC HMO | $3,998 |
| 64857 | Repair arm/leg nerve | $16,090 | BC FMOL | $4,036 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICARE | $4,928 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICARE – BLUE CROSS | $4,928 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICARE – UNITED | $4,928 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICARE – COVENTRY | $4,928 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICARE – VANTAGE | $4,928 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICARE -PEOPLES | $4,928 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICARE- HUMANA | $4,829 |
| 64857 | Repair arm/leg nerve | $16,090 | HUMANA | $7,392 |
| 64857 | Repair arm/leg nerve | $16,090 | VANTAGE | $8,377 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICAID | $466 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICAID – AETNA BETTER HEALTH | $466 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICAID – UNITED | $466 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICAID – HEALTHY BLUE | $466 |
| 64857 | Repair arm/leg nerve | $16,090 | MEDICAID – AMERIHEALTH | $466 |
| 64857 | Repair arm/leg nerve | $16,090 | UNITED | $3,860 |
| 64857 | Repair arm/leg nerve | $16,090 | AETNA | $3,199 |
| 64857 | Repair arm/leg nerve | $16,090 | CIGNA | $3,962 |
| 64857 | Repair arm/leg nerve | $16,090 | LWCC | $12,671 |
| 64857 | Repair arm/leg nerve | $16,090 | PPOPLUS | $9,550 |
| 64857 | Repair arm/leg nerve | $16,090 | GILSBAR | $8,032 |
| 64857 | Repair arm/leg nerve | $16,090 | LSU | $6,599 |
| 64857 | Repair arm/leg nerve | $16,090 | VERITY | $5,923 |
| 64857 | Repair arm/leg nerve | $16,090 | MULTIPLAN | $5,923 |
| 64857 | Repair arm/leg nerve | $16,090 | LA WORK COMP | $16,090 |
| 64857 | Repair arm/leg nerve | $16,090 | | |
| 23430 | Repair biceps tendon | $20,437 | Private Pay | $20,536 |
| 23430 | Repair biceps tendon | $20,437 | BC PPO | $5,520 |
| 23430 | Repair biceps tendon | $20,437 | BC HMO | $4,843 |
| 23430 | Repair biceps tendon | $20,437 | BC FMOL | $4,889 |
| 23430 | Repair biceps tendon | $20,437 | MEDICARE | $5,351 |
| 23430 | Repair biceps tendon | $20,437 | MEDICARE – BLUE CROSS | $5,351 |
| 23430 | Repair biceps tendon | $20,437 | MEDICARE – UNITED | $5,351 |
| 23430 | Repair biceps tendon | $20,437 | MEDICARE – COVENTRY | $5,351 |
| 23430 | Repair biceps tendon | $20,437 | MEDICARE – VANTAGE | $5,351 |
| 23430 | Repair biceps tendon | $20,437 | MEDICARE -PEOPLES | $5,351 |
| 23430 | Repair biceps tendon | $20,437 | MEDICARE- HUMANA | $5,244 |
| 23430 | Repair biceps tendon | $20,437 | HUMANA | $8,026 |
| 23430 | Repair biceps tendon | $20,437 | VANTAGE | $9,097 |
| 23430 | Repair biceps tendon | $20,437 | MEDICAID | $659 |
| 23430 | Repair biceps tendon | $20,437 | MEDICAID – AETNA BETTER HEALTH | $659 |
| 23430 | Repair biceps tendon | $20,437 | MEDICAID – UNITED | $659 |
| 23430 | Repair biceps tendon | $20,437 | MEDICAID – HEALTHY BLUE | $659 |
| 23430 | Repair biceps tendon | $20,437 | MEDICAID – AMERIHEALTH | $659 |
| 23430 | Repair biceps tendon | $20,437 | UNITED | $3,860 |
| 23430 | Repair biceps tendon | $20,437 | AETNA | $3,625 |
| 23430 | Repair biceps tendon | $20,437 | CIGNA | $3,682 |
| 23430 | Repair biceps tendon | $20,437 | LWCC | $13,758 |
| 23430 | Repair biceps tendon | $20,437 | PPOPLUS | $12,527 |
| 23430 | Repair biceps tendon | $20,437 | GILSBAR | $10,414 |
| 23430 | Repair biceps tendon | $20,437 | LSU | $6,541 |
| 23430 | Repair biceps tendon | $20,437 | VERITY | $7,176 |
| 23430 | Repair biceps tendon | $20,437 | MULTIPLAN | $7,176 |
| 23430 | Repair biceps tendon | $20,437 | LA WORK COMP | $20,437 |
| 23430 | Repair biceps tendon | $20,437 | | |
| 57288 | Repair bladder defect | $18,873 | Private Pay | $18,584 |
| 57288 | Repair bladder defect | $18,873 | BC PPO | $4,048 |
| 57288 | Repair bladder defect | $18,873 | BC HMO | $3,552 |
| 57288 | Repair bladder defect | $18,873 | BC FMOL | $3,586 |
| 57288 | Repair bladder defect | $18,873 | MEDICARE | $3,821 |
| 57288 | Repair bladder defect | $18,873 | MEDICARE – BLUE CROSS | $3,821 |
| 57288 | Repair bladder defect | $18,873 | MEDICARE – UNITED | $3,821 |
| 57288 | Repair bladder defect | $18,873 | MEDICARE – COVENTRY | $3,821 |
| 57288 | Repair bladder defect | $18,873 | MEDICARE – VANTAGE | $3,821 |
| 57288 | Repair bladder defect | $18,873 | MEDICARE -PEOPLES | $3,821 |
| 57288 | Repair bladder defect | $18,873 | MEDICARE- HUMANA | $3,745 |
| 57288 | Repair bladder defect | $18,873 | HUMANA | $5,731 |
| 57288 | Repair bladder defect | $18,873 | VANTAGE | $6,496 |
| 57288 | Repair bladder defect | $18,873 | MEDICAID | $750 |
| 57288 | Repair bladder defect | $18,873 | MEDICAID – AETNA BETTER HEALTH | $750 |
| 57288 | Repair bladder defect | $18,873 | MEDICAID – UNITED | $750 |
| 57288 | Repair bladder defect | $18,873 | MEDICAID – HEALTHY BLUE | $750 |
| 57288 | Repair bladder defect | $18,873 | MEDICAID – AMERIHEALTH | $750 |
| 57288 | Repair bladder defect | $18,873 | UNITED | $3,860 |
| 57288 | Repair bladder defect | $18,873 | AETNA | $4,012 |
| 57288 | Repair bladder defect | $18,873 | CIGNA | $4,267 |
| 57288 | Repair bladder defect | $18,873 | LWCC | $9,825 |
| 57288 | Repair bladder defect | $18,873 | PPOPLUS | $11,336 |
| 57288 | Repair bladder defect | $18,873 | GILSBAR | $9,493 |
| 57288 | Repair bladder defect | $18,873 | LSU | $6,791 |
| 57288 | Repair bladder defect | $18,873 | VERITY |
