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Sheet1

Hospital Min %
Operational Min Ooclinics Min Doctor ooclinics
Number Procedures Cost Share Share Share
1 Therapeutic ul 50000 3000 3000 15
2 Therapeutic ul 50000 3000 3000 15
3 Therapeutic ul 50000 3000 3000 15
4 Other therapeu 50000 3000 3000 15
5 Implantation 50000 3000 3000 15
6 Infusion of dro 50000 3000 3000 15
7 Administration 50000 3000 3000 15
8 Injection or in 50000 3000 3000 15
9 Injection or in 50000 3000 3000 15
10 High-dose infus 50000 3000 3000 15
11 Pressurized tr 50000 3000 3000 15
12 Infusion of va 50000 3000 3000 15
13 Infusion of i 50000 3000 3000 15
14 Disruption of 50000 3000 3000 15
15 Intravascular 50000 3000 3000 15
16 Intravascular 50000 3000 3000 15
17 Intravascular 50000 3000 3000 15
18 Intravascular 50000 3000 3000 15
19 Intravascular 50000 3000 3000 15
20 Intravascular 50000 3000 3000 15
21 Intravascular 50000 3000 3000 15
22 Computer assi 50000 3000 3000 15
23 Computer assi 50000 3000 3000 15
24 Computer assi 50000 3000 3000 15
25 Imageless com 50000 3000 3000 15
26 Computer assis 50000 3000 3000 15
27 Other compute 50000 3000 3000 15
28 Procedure on 50000 3000 3000 15
29 Procedure on 50000 3000 3000 15
30 Procedure on 50000 3000 3000 15
31 Procedure on 50000 3000 3000 15
32 Procedure on v 50000 3000 3000 15
33 Insertion of o 50000 3000 3000 15
34 Insertion of t 50000 3000 3000 15
35 Insertion of th 50000 3000 3000 15
36 Insertion of f 50000 3000 3000 15
37 Supersaturate 50000 3000 3000 15
38 Implantation o 50000 3000 3000 15
39 Implantation o 50000 3000 3000 15
40 Implantation o 50000 3000 3000 15
41 Implantation o 50000 3000 3000 15
42 Implantation o 50000 3000 3000 15
43 Insertion of dr 50000 3000 3000 15
44 Insertion or r 50000 3000 3000 15
45 Implantation o 50000 3000 3000 15
46 Insertion of i 50000 3000 3000 15

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47 Intravascular 50000 3000 3000 15
48 Insertion of dr 50000 3000 3000 15
49 Percutaneous a 50000 3000 3000 15
50 Percutaneous a 50000 3000 3000 15
51 Percutaneous i 50000 3000 3000 15
52 Percutaneous i 50000 3000 3000 15
53 Percutaneous i 50000 3000 3000 15
54 Percutaneous 50000 3000 3000 15
55 Intravascular 50000 3000 3000 15
56 Intravascular 50000 3000 3000 15
57 Intravascular 50000 3000 3000 15
58 Revision of h 50000 3000 3000 15
59 Revision of h 50000 3000 3000 15
60 Revision of h 50000 3000 3000 15
61 Revision of hi 50000 3000 3000 15
62 Hip bearing su 50000 3000 3000 15
63 Hip bearing su 50000 3000 3000 15
64 Hip bearing su 50000 3000 3000 15
65 Hip bearing su 50000 3000 3000 15
66 Revision of kn 50000 3000 3000 15
67 Revision of kn 50000 3000 3000 15
68 Revision of k 50000 3000 3000 15
69 Revision of k 50000 3000 3000 15
70 Revision of tot 50000 3000 3000 15
71 Resurfacing hi 50000 3000 3000 15
72 Resurfacing hi 50000 3000 3000 15
73 Resurfacing hi 50000 3000 3000 15
74 Transplant fro 50000 3000 3000 15
75 Transplant fro 50000 3000 3000 15
76 Transplant fr 50000 3000 3000 15
77 Intra-operativ 50000 3000 3000 15
78 Cisternal punc 50000 3000 3000 15
79 Ventriculopunc 50000 3000 3000 15
80 Other cranial 50000 3000 3000 15
81 Intracranial p 50000 3000 3000 15
82 Closed [percut 50000 3000 3000 15
83 Open biopsy o 50000 3000 3000 15
84 Closed [percut 50000 3000 3000 15
85 Open biopsy o 50000 3000 3000 15
86 Biopsy of skull 50000 3000 3000 15
87 Intracranial o 50000 3000 3000 15
88 Brain tempera 50000 3000 3000 15
89 Other diagnos 50000 3000 3000 15
90 Other diagnost 50000 3000 3000 15
91 Cranial implan 50000 3000 3000 15
92 Incision and d 50000 3000 3000 15
93 Removal of int 50000 3000 3000 15
94 Reopening of 50000 3000 3000 15
95 Other craniot 50000 3000 3000 15

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96 Other craniec 50000 3000 3000 15
97 Insertion of ca 50000 3000 3000 15
98 Removal of cat 50000 3000 3000 15
99 Placement of i 50000 3000 3000 15
100 Removal of cra 50000 3000 3000 15
101 Incision of ce 50000 3000 3000 15
102 Lobotomy and 50000 3000 3000 15
103 Other incision 50000 3000 3000 15
104 Operations on 50000 3000 3000 15
105 Operations on 50000 3000 3000 15
106 Excision of le 50000 3000 3000 15
107 Hemispherect 50000 3000 3000 15
108 Lobectomy of 50000 3000 3000 15
109 Other excision 50000 3000 3000 15
110 Excision of les 50000 3000 3000 15
111 Opening of cra 50000 3000 3000 15
112 Elevation of s 50000 3000 3000 15
113 Formation of c 50000 3000 3000 15
114 Bone graft to s 50000 3000 3000 15
115 Insertion of sk 50000 3000 3000 15
116 Other cranial 50000 3000 3000 15
117 Removal of sku 50000 3000 3000 15
118 Simple suture 50000 3000 3000 15
119 Other repair o 50000 3000 3000 15
120 Ligation of me 50000 3000 3000 15
121 Choroid plexe 50000 3000 3000 15
122 Insertion or r 50000 3000 3000 15
123 Intracranial v 50000 3000 3000 15
124 Ventricular sh 50000 3000 3000 15
125 Ventricular sh 50000 3000 3000 15
126 Ventricular shu 50000 3000 3000 15
127 Ventricular sh 50000 3000 3000 15
128 Ventricular sh 50000 3000 3000 15
129 Ventricular sh 50000 3000 3000 15
130 Irrigation and 50000 3000 3000 15
131 Replacement of 50000 3000 3000 15
132 Removal of ven 50000 3000 3000 15
133 Lysis of corti 50000 3000 3000 15
134 Repair of brai 50000 3000 3000 15
135 Implantation o 50000 3000 3000 15
136 Insertion or re 50000 3000 3000 15
137 Removal of sku 50000 3000 3000 15
138 Insertion of s 50000 3000 3000 15
139 Other operatio 50000 3000 3000 15
140 Removal of for 50000 3000 3000 15
141 Reopening of 50000 3000 3000 15
142 Other explorat 50000 3000 3000 15
143 Division of int 50000 3000 3000 15
144 Percutaneous 50000 3000 3000 15

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145 Other chordo 50000 3000 3000 15
146 Spinal tap 50000 3000 3000 15
147 Biopsy of spin 50000 3000 3000 15
148 Other diagnost 50000 3000 3000 15
149 Excision or de 50000 3000 3000 15
150 Repair of spin 50000 3000 3000 15
151 Repair of spi 50000 3000 3000 15
152 Repair of verte 50000 3000 3000 15
153 Other repair a 50000 3000 3000 15
154 Lysis of adhes 50000 3000 3000 15
155 Spinal subarac 50000 3000 3000 15
156 Spinal subarac 50000 3000 3000 15
157 Other shunt of 50000 3000 3000 15
158 Injection of de 50000 3000 3000 15
159 Insertion of ca 50000 3000 3000 15
160 Injection of an 50000 3000 3000 15
161 Injection of ot 50000 3000 3000 15
162 Implantation o 50000 3000 3000 15
163 Removal of spi 50000 3000 3000 15
164 Spinal blood p 50000 3000 3000 15
165 Percutaneous 50000 3000 3000 15
166 Revision of sp 50000 3000 3000 15
167 Removal of spi 50000 3000 3000 15
168 Other operatio 50000 3000 3000 15
169 Excision of a 50000 3000 3000 15
170 Division of tri 50000 3000 3000 15
171 Division or cr 50000 3000 3000 15
172 Other incision 50000 3000 3000 15
173 Gasserian gan 50000 3000 3000 15
174 Other cranial 50000 3000 3000 15
175 Other excision 50000 3000 3000 15
176 Closed [percut 50000 3000 3000 15
177 Open biopsy of 50000 3000 3000 15
178 Other diagnost 50000 3000 3000 15
179 Destruction of 50000 3000 3000 15
180 Suture of cran 50000 3000 3000 15
181 Decompression 50000 3000 3000 15
182 Other cranial 50000 3000 3000 15
183 Release of car 50000 3000 3000 15
184 Release of tar 50000 3000 3000 15
185 Other peripher 50000 3000 3000 15
186 Cranial or peri 50000 3000 3000 15
187 Transposition 50000 3000 3000 15
188 Hypoglossal-f 50000 3000 3000 15
189 Accessory-fac 50000 3000 3000 15
190 Accessory-hyp 50000 3000 3000 15
191 Other anastomo 50000 3000 3000 15
192 Revision of pr 50000 3000 3000 15
193 Repair of old 50000 3000 3000 15

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194 Other neuropl 50000 3000 3000 15
195 Peripheral ner 50000 3000 3000 15
196 Injection of an 50000 3000 3000 15
197 Injection of ot 50000 3000 3000 15
198 Neurectasis 50000 3000 3000 15
199 Implantation o 50000 3000 3000 15
200 Removal of per 50000 3000 3000 15
201 Other operatio 50000 3000 3000 15
202 Division of sy 50000 3000 3000 15
203 Biopsy of symp 50000 3000 3000 15
204 Other diagnost 50000 3000 3000 15
205 Sphenopalatin 50000 3000 3000 15
206 Cervical symp 50000 3000 3000 15
207 Lumbar sympa 50000 3000 3000 15
208 Presacral sym 50000 3000 3000 15
209 Periarterial 50000 3000 3000 15
210 Other sympat 50000 3000 3000 15
211 Injection of a 50000 3000 3000 15
212 Injection of n 50000 3000 3000 15
213 Other injectio 50000 3000 3000 15
214 Repair of symp 50000 3000 3000 15
215 Other operatio 50000 3000 3000 15
216 Other operati 50000 3000 3000 15
217 Aspiration of t 50000 3000 3000 15
218 Reopening of w 50000 3000 3000 15
219 Other incision 50000 3000 3000 15
220 Closed [percut 50000 3000 3000 15
221 Open biopsy of 50000 3000 3000 15
222 Biopsy of para 50000 3000 3000 15
223 Other diagnost 50000 3000 3000 15
224 Unilateral thy 50000 3000 3000 15
225 Excision of les 50000 3000 3000 15
226 Other partial 50000 3000 3000 15
227 Complete thyr 50000 3000 3000 15
228 Substernal thy 50000 3000 3000 15
229 Partial subste 50000 3000 3000 15
230 Complete subs 50000 3000 3000 15
231 Excision of lin 50000 3000 3000 15
232 Excision of thy 50000 3000 3000 15
233 Complete para 50000 3000 3000 15
234 Other parathy 50000 3000 3000 15
235 Division of th 50000 3000 3000 15
236 Ligation of thy 50000 3000 3000 15
237 Suture of thyr 50000 3000 3000 15
238 Thyroid tissue 50000 3000 3000 15
239 Parathyroid ti 50000 3000 3000 15
240 Other operatio 50000 3000 3000 15
241 Other operatio 50000 3000 3000 15
242 Exploration of 50000 3000 3000 15

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243 Unilateral expl 50000 3000 3000 15
244 Bilateral explo 50000 3000 3000 15
245 Closed [percut 50000 3000 3000 15
246 Open biopsy o 50000 3000 3000 15
247 Biopsy of pitu 50000 3000 3000 15
248 Biopsy of pitu 50000 3000 3000 15
249 Biopsy of pitu 50000 3000 3000 15
250 Biopsy of thy 50000 3000 3000 15
251 Biopsy of pine 50000 3000 3000 15
252 Other diagnost 50000 3000 3000 15
253 Excision of le 50000 3000 3000 15
254 Unilateral adr 50000 3000 3000 15
255 Other partial 50000 3000 3000 15
256 Bilateral adre 50000 3000 3000 15
257 Incision of ad 50000 3000 3000 15
258 Division of ne 50000 3000 3000 15
259 Ligation of ad 50000 3000 3000 15
260 Repair of adre 50000 3000 3000 15
261 Reimplantation 50000 3000 3000 15
262 Other operatio 50000 3000 3000 15
263 Exploration of 50000 3000 3000 15
264 Incision of pin 50000 3000 3000 15
265 Partial excisio 50000 3000 3000 15
266 Total excision 50000 3000 3000 15
267 Other operatio 50000 3000 3000 15
268 Partial excisio 50000 3000 3000 15
269 Partial excisi 50000 3000 3000 15
270 Partial excisio 50000 3000 3000 15
271 Total excision 50000 3000 3000 15
272 Total excision 50000 3000 3000 15
273 Total excision 50000 3000 3000 15
274 Total excision 50000 3000 3000 15
275 Exploration of 50000 3000 3000 15
276 Incision of pit 50000 3000 3000 15
277 Other operati 50000 3000 3000 15
278 Thymectomy, n 50000 3000 3000 15
279 Other partial 50000 3000 3000 15
280 Other total ex 50000 3000 3000 15
281 Thoracoscopic 50000 3000 3000 15
282 Thoracoscopic 50000 3000 3000 15
283 Exploration of 50000 3000 3000 15
284 Other incision 50000 3000 3000 15
285 Repair of thy 50000 3000 3000 15
286 Transplantatio 50000 3000 3000 15
287 Thoracoscopic 50000 3000 3000 15
288 Other and uns 50000 3000 3000 15
289 Other and uns 50000 3000 3000 15
290 Incision of lid 50000 3000 3000 15
291 Severing of b 50000 3000 3000 15

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292 Other incision 50000 3000 3000 15
293 Biopsy of eyel 50000 3000 3000 15
294 Other diagnost 50000 3000 3000 15
295 Removal of les 50000 3000 3000 15
296 Excision of ch 50000 3000 3000 15
297 Excision of oth 50000 3000 3000 15
298 Excision of maj 50000 3000 3000 15
299 Excision of maj 50000 3000 3000 15
300 Destruction of 50000 3000 3000 15
301 Repair of blep 50000 3000 3000 15
302 Repair of blep 50000 3000 3000 15
303 Repair of blep 50000 3000 3000 15
304 Repair of blep 50000 3000 3000 15
305 Repair of blep 50000 3000 3000 15
306 Repair of blep 50000 3000 3000 15
307 Reduction of o 50000 3000 3000 15
308 Correction of l 50000 3000 3000 15
309 Repair of entr 50000 3000 3000 15
310 Repair of entr 50000 3000 3000 15
311 Repair of entr 50000 3000 3000 15
312 Repair of entro 50000 3000 3000 15
313 Other repair o 50000 3000 3000 15
314 Canthotomy 50000 3000 3000 15
315 Blepharorrhap 50000 3000 3000 15
316 Other adjustme 50000 3000 3000 15
317 Reconstruction 50000 3000 3000 15
318 Reconstruction 50000 3000 3000 15
319 Reconstruction 50000 3000 3000 15
320 Reconstruction 50000 3000 3000 15
321 Other reconstru 50000 3000 3000 15
322 Reconstruction 50000 3000 3000 15
323 Reconstruction 50000 3000 3000 15
324 Other reconstru 50000 3000 3000 15
325 Reconstruction 50000 3000 3000 15
326 Other reconstru 50000 3000 3000 15
327 Linear repair 50000 3000 3000 15
328 Repair of lacer 50000 3000 3000 15
329 Other repair of 50000 3000 3000 15
330 Repair of lacer 50000 3000 3000 15
331 Other repair of 50000 3000 3000 15
332 Lower eyelid 50000 3000 3000 15
333 Upper eyelid 50000 3000 3000 15
334 Other eyelid r 50000 3000 3000 15
335 Electrosurgical 50000 3000 3000 15
336 Cryosurgical ep 50000 3000 3000 15
337 Other epilation 50000 3000 3000 15
338 Other operatio 50000 3000 3000 15
339 Incision of lac 50000 3000 3000 15
340 Biopsy of lacr 50000 3000 3000 15

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341 Biopsy of lacr 50000 3000 3000 15
342 Other diagnost 50000 3000 3000 15
343 Excision of la 50000 3000 3000 15
344 Excision of les 50000 3000 3000 15
345 Other partial 50000 3000 3000 15
346 Total dacryoa 50000 3000 3000 15
347 Other operatio 50000 3000 3000 15
348 Probing of lac 50000 3000 3000 15
349 Probing of lacr 50000 3000 3000 15
350 Probing of nas 50000 3000 3000 15
351 Intubation of 50000 3000 3000 15
352 Other manipula 50000 3000 3000 15
353 Incision of la 50000 3000 3000 15
354 Incision of lac 50000 3000 3000 15
355 Incision of lac 50000 3000 3000 15
356 Other incision 50000 3000 3000 15
357 Excision of la 50000 3000 3000 15
358 Correction of 50000 3000 3000 15
359 Other repair o 50000 3000 3000 15
360 Repair of cana 50000 3000 3000 15
361 Dacryocystorh 50000 3000 3000 15
362 Conjunctivocy 50000 3000 3000 15
363 Conjunctivorhi 50000 3000 3000 15
364 Obliteration o 50000 3000 3000 15
365 Other operatio 50000 3000 3000 15
366 Removal of em 50000 3000 3000 15
367 Other incision 50000 3000 3000 15
368 Biopsy of conj 50000 3000 3000 15
369 Other diagnost 50000 3000 3000 15
370 Excision of les 50000 3000 3000 15
371 Destruction of 50000 3000 3000 15
372 Other destruct 50000 3000 3000 15
373 Repair of symb 50000 3000 3000 15
374 Reconstruction 50000 3000 3000 15
375 Other reconstr 50000 3000 3000 15
376 Other free graf 50000 3000 3000 15
377 Other conjunct 50000 3000 3000 15
378 Lysis of adhes 50000 3000 3000 15
379 Repair of lace 50000 3000 3000 15
380 Subconjunctiva 50000 3000 3000 15
381 Other operatio 50000 3000 3000 15
382 Magnetic remo 50000 3000 3000 15
383 Incision of co 50000 3000 3000 15
384 Scraping of co 50000 3000 3000 15
385 Biopsy of cor 50000 3000 3000 15
386 Other diagnos 50000 3000 3000 15
387 Transposition 50000 3000 3000 15
388 Excision of pt 50000 3000 3000 15
389 Other excision 50000 3000 3000 15

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390 Mechanical rem 50000 3000 3000 15
391 Thermocauteriz 50000 3000 3000 15
392 Cryotherapy of 50000 3000 3000 15
393 Other removal 50000 3000 3000 15
394 Suture of corn 50000 3000 3000 15
395 Repair of pos 50000 3000 3000 15
396 Repair of corn 50000 3000 3000 15
397 Other repair o 50000 3000 3000 15
398 Corneal transp 50000 3000 3000 15
399 Lamellar kerat 50000 3000 3000 15
400 Other lamellar 50000 3000 3000 15
401 Penetrating ke 50000 3000 3000 15
402 Other penetrat 50000 3000 3000 15
403 Other corneal 50000 3000 3000 15
404 Keratomileusi 50000 3000 3000 15
405 Keratophakia 50000 3000 3000 15
406 Keratoprosthe 50000 3000 3000 15
407 Thermokeratop 50000 3000 3000 15
408 Radial kerato 50000 3000 3000 15
409 Epikeratophak 50000 3000 3000 15
410 Other reconstr 50000 3000 3000 15
411 Tattooing of c 50000 3000 3000 15
412 Removal of art 50000 3000 3000 15
413 Other operati 50000 3000 3000 15
414 Removal of int 50000 3000 3000 15
415 Removal of int 50000 3000 3000 15
416 Removal of int 50000 3000 3000 15
417 Iridotomy with 50000 3000 3000 15
418 Other iridotom 50000 3000 3000 15
419 Excision of pro 50000 3000 3000 15
420 Other iridecto 50000 3000 3000 15
421 Diagnostic asp 50000 3000 3000 15
422 Biopsy of iris 50000 3000 3000 15
423 Other diagnost 50000 3000 3000 15
424 Lysis of gonio 50000 3000 3000 15
425 Lysis of other 50000 3000 3000 15
426 Lysis of poste 50000 3000 3000 15
427 Lysis of corne 50000 3000 3000 15
428 Coreoplasty 50000 3000 3000 15
429 Other iridoplas 50000 3000 3000 15
430 Removal of les 50000 3000 3000 15
431 Destruction of 50000 3000 3000 15
432 Excision of lesi 50000 3000 3000 15
433 Destruction of 50000 3000 3000 15
434 Excision of les 50000 3000 3000 15
435 Goniopuncture 50000 3000 3000 15
436 Goniotomy wit 50000 3000 3000 15
437 Goniotomy wit 50000 3000 3000 15
438 Trabeculotomy 50000 3000 3000 15

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439 Cyclodialysis 50000 3000 3000 15
440 Other facilitat 50000 3000 3000 15
441 Trephination o 50000 3000 3000 15
442 Thermocauteriz 50000 3000 3000 15
443 Iridencleisis a 50000 3000 3000 15
444 Trabeculectom 50000 3000 3000 15
445 Other scleral f 50000 3000 3000 15
446 Postoperative r 50000 3000 3000 15
447 Insertion of a 50000 3000 3000 15
448 Other scleral f 50000 3000 3000 15
449 Cyclodiatherm 50000 3000 3000 15
450 Cyclocryother 50000 3000 3000 15
451 Cyclophotocoa 50000 3000 3000 15
452 Diminution of c 50000 3000 3000 15
453 Other glaucom 50000 3000 3000 15
454 Suture of lacer 50000 3000 3000 15
455 Repair of scler 50000 3000 3000 15
456 Revision of op 50000 3000 3000 15
457 Excision or des 50000 3000 3000 15
458 Repair of scle 50000 3000 3000 15
459 Other repair o 50000 3000 3000 15
460 Scleral reinfo 50000 3000 3000 15
461 Other scleral 50000 3000 3000 15
462 Other operatio 50000 3000 3000 15
463 Therapeutic ev 50000 3000 3000 15
464 Injection into 50000 3000 3000 15
465 Removal or des 50000 3000 3000 15
466 Other operatio 50000 3000 3000 15
467 Other operatio 50000 3000 3000 15
468 Other operati 50000 3000 3000 15
469 Removal of for 50000 3000 3000 15
470 Removal of for 50000 3000 3000 15
471 Removal of for 50000 3000 3000 15
472 Intracapsular e 50000 3000 3000 15
473 Other intracap 50000 3000 3000 15
474 Extracapsular 50000 3000 3000 15
475 Extracapsular 50000 3000 3000 15
476 Phacoemulsific 50000 3000 3000 15
477 Mechanical pha 50000 3000 3000 15
478 Mechanical pha 50000 3000 3000 15
479 Extracapsular 50000 3000 3000 15
480 Other extracap 50000 3000 3000 15
481 Discission of 50000 3000 3000 15
482 Excision of se 50000 3000 3000 15
483 Mechanical fr 50000 3000 3000 15
484 Other cataract 50000 3000 3000 15
485 Insertion of p 50000 3000 3000 15
486 Insertion of in 50000 3000 3000 15
487 Secondary inse 50000 3000 3000 15

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488 Removal of im 50000 3000 3000 15
489 Operation on l 50000 3000 3000 15
490 Implantation o 50000 3000 3000 15
491 Removal of for 50000 3000 3000 15
492 Removal of for 50000 3000 3000 15
493 Removal of for 50000 3000 3000 15
494 Diagnostic asp 50000 3000 3000 15
495 Other diagnost 50000 3000 3000 15
496 Destruction of 50000 3000 3000 15
497 Destruction of 50000 3000 3000 15
498 Destruction of 50000 3000 3000 15
499 Destruction of 50000 3000 3000 15
500 Destruction of 50000 3000 3000 15
501 Destruction of 50000 3000 3000 15
502 Destruction of 50000 3000 3000 15
503 Other destructi 50000 3000 3000 15
504 Repair of reti 50000 3000 3000 15
505 Repair of reti 50000 3000 3000 15
506 Repair of reti 50000 3000 3000 15
507 Repair of reti 50000 3000 3000 15
508 Repair of reti 50000 3000 3000 15
509 Other repair of 50000 3000 3000 15
510 Scleral buckli 50000 3000 3000 15
511 Other scleral 50000 3000 3000 15
512 Repair of reti 50000 3000 3000 15
513 Repair of reti 50000 3000 3000 15
514 Repair of reti 50000 3000 3000 15
515 Repair of reti 50000 3000 3000 15
516 Repair of reti 50000 3000 3000 15
517 Other repair o 50000 3000 3000 15
518 Removal of sur 50000 3000 3000 15
519 Removal of vit 50000 3000 3000 15
520 Other removal 50000 3000 3000 15
521 Mechanical vit 50000 3000 3000 15
522 Other mechani 50000 3000 3000 15
523 Injection of vi 50000 3000 3000 15
524 Other operatio 50000 3000 3000 15
525 Other operatio 50000 3000 3000 15
526 Biopsy of extr 50000 3000 3000 15
527 Other diagnos 50000 3000 3000 15
528 Recession of 50000 3000 3000 15
529 Advancement o 50000 3000 3000 15
530 Resection of 50000 3000 3000 15
531 Other operati 50000 3000 3000 15
532 Lengthening p 50000 3000 3000 15
533 Shortening pr 50000 3000 3000 15
534 Other operati 50000 3000 3000 15
535 Operations on 50000 3000 3000 15
536 Other operatio 50000 3000 3000 15

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537 Transposition 50000 3000 3000 15
538 Revision of ex 50000 3000 3000 15
539 Repair of inju 50000 3000 3000 15
540 Other operati 50000 3000 3000 15
541 Orbitotomy wit 50000 3000 3000 15
542 Orbitotomy with 50000 3000 3000 15
543 Other orbitot 50000 3000 3000 15
544 Removal of pen 50000 3000 3000 15
545 Ophthalmosco 50000 3000 3000 15
546 Diagnostic aspi 50000 3000 3000 15
547 Biopsy of eyeb 50000 3000 3000 15
548 Other diagnost 50000 3000 3000 15
549 Removal of ocu 50000 3000 3000 15
550 Other eviscera 50000 3000 3000 15
551 Enucleation of 50000 3000 3000 15
552 Enucleation of 50000 3000 3000 15
553 Other enucleat 50000 3000 3000 15
554 Exenteration o 50000 3000 3000 15
555 Exenteration o 50000 3000 3000 15
556 Other exentera 50000 3000 3000 15
557 Secondary inse 50000 3000 3000 15
558 Revision and r 50000 3000 3000 15
559 Revision of en 50000 3000 3000 15
560 Other revision 50000 3000 3000 15
561 Secondary graf 50000 3000 3000 15
562 Other revision 50000 3000 3000 15
563 Other secondar 50000 3000 3000 15
564 Removal of oc 50000 3000 3000 15
565 Removal of orb 50000 3000 3000 15
566 Repair of woun 50000 3000 3000 15
567 Repair of rupt 50000 3000 3000 15
568 Other repair of 50000 3000 3000 15
569 Retrobulbar in 50000 3000 3000 15
570 Excision of les 50000 3000 3000 15
571 Excision of les 50000 3000 3000 15
572 Other operatio 50000 3000 3000 15
573 Other operatio 50000 3000 3000 15
574 Laparoscopic re 50000 3000 3000 15
575 Laparoscopic re 50000 3000 3000 15
576 Laparoscopic r 50000 3000 3000 15
577 Laparoscopic bi 50000 3000 3000 15
578 Laparoscopic bi 50000 3000 3000 15
579 Laparoscopic bi 50000 3000 3000 15
580 Laparoscopic bi 50000 3000 3000 15
581 Laparoscopic m 50000 3000 3000 15
582 Laparoscopic 50000 3000 3000 15
583 Laparoscopic 50000 3000 3000 15
584 Laparoscopic r 50000 3000 3000 15
585 Laparoscopic 50000 3000 3000 15

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586 Laparoscopic 50000 3000 3000 15
587 Other laparosco 50000 3000 3000 15
588 Open robotic 50000 3000 3000 15
589 Laparoscopic r 50000 3000 3000 15
590 Percutaneous 50000 3000 3000 15
591 Endoscopic ro 50000 3000 3000 15
592 Thoracoscopic 50000 3000 3000 15
593 Other and unsp 50000 3000 3000 15
594 Implantation o 50000 3000 3000 15
595 Implantation o 50000 3000 3000 15
596 Percutaneous a 50000 3000 3000 15
597 Percutaneous a 50000 3000 3000 15
598 Transluminal 50000 3000 3000 15
599 Atherectomy of 50000 3000 3000 15
600 Laser interstit 50000 3000 3000 15
601 Laser intersti 50000 3000 3000 15
602 Laser interstit 50000 3000 3000 15
603 Laser interstit 50000 3000 3000 15
604 Intravenous in 50000 3000 3000 15
605 Non-coronary i 50000 3000 3000 15
606 Insertion of a 50000 3000 3000 15
607 Piercing of ea 50000 3000 3000 15
608 Incision of ext 50000 3000 3000 15
609 Other incision 50000 3000 3000 15
610 Otoscopy 50000 3000 3000 15
611 Biopsy of exte 50000 3000 3000 15
612 Other diagnost 50000 3000 3000 15
613 Excision of pr 50000 3000 3000 15
614 Excision or des 50000 3000 3000 15
615 Radical excisio 50000 3000 3000 15
616 Other excision 50000 3000 3000 15
617 Suture of lacer 50000 3000 3000 15
618 Surgical corre 50000 3000 3000 15
619 Reconstruction 50000 3000 3000 15
620 Construction of 50000 3000 3000 15
621 Reattachment 50000 3000 3000 15
622 Other plastic r 50000 3000 3000 15
623 Other operatio 50000 3000 3000 15
624 Stapes mobiliz 50000 3000 3000 15
625 Stapedectomy 50000 3000 3000 15
626 Other staped 50000 3000 3000 15
627 Revision of s 50000 3000 3000 15
628 Other revisio 50000 3000 3000 15
629 Other operatio 50000 3000 3000 15
630 Myringoplasty 50000 3000 3000 15
631 Type II tympa 50000 3000 3000 15
632 Type III tympa 50000 3000 3000 15
633 Type IV tympa 50000 3000 3000 15
634 Type V tympan 50000 3000 3000 15

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635 Revision of t 50000 3000 3000 15
636 Other repair o 50000 3000 3000 15
637 Myringotomy wi 50000 3000 3000 15
638 Other myringo 50000 3000 3000 15
639 Removal of t 50000 3000 3000 15
640 Incision of ma 50000 3000 3000 15
641 Incision of pet 50000 3000 3000 15
642 Incision of mi 50000 3000 3000 15
643 Electrocochle 50000 3000 3000 15
644 Biopsy of midd 50000 3000 3000 15
645 Other diagnost 50000 3000 3000 15
646 Simple masto 50000 3000 3000 15
647 Radical masto 50000 3000 3000 15
648 Other mastoi 50000 3000 3000 15
649 Excision of le 50000 3000 3000 15
650 Other excision 50000 3000 3000 15
651 Fenestration of 50000 3000 3000 15
652 Revision of fen 50000 3000 3000 15
653 Endolymphatic 50000 3000 3000 15
654 Injection into 50000 3000 3000 15
655 Other incision, 50000 3000 3000 15
656 Operations on 50000 3000 3000 15
657 Tympanosymp 50000 3000 3000 15
658 Revision of m 50000 3000 3000 15
659 Repair of ova 50000 3000 3000 15
660 Injection of 50000 3000 3000 15
661 Implantation o 50000 3000 3000 15
662 Implantation o 50000 3000 3000 15
663 Implantation o 50000 3000 3000 15
664 Implantation o 50000 3000 3000 15
665 Other operatio 50000 3000 3000 15
666 Control of epis 50000 3000 3000 15
667 Control of epi 50000 3000 3000 15
668 Control of epi 50000 3000 3000 15
669 Control of epi 50000 3000 3000 15
670 Control of epis 50000 3000 3000 15
671 Control of epis 50000 3000 3000 15
672 Control of epis 50000 3000 3000 15
673 Control of epi 50000 3000 3000 15
674 Control of epi 50000 3000 3000 15
675 Incision of no 50000 3000 3000 15
676 Rhinoscopy 50000 3000 3000 15
677 Biopsy of nos 50000 3000 3000 15
678 Other diagnos 50000 3000 3000 15
679 Excision or de 50000 3000 3000 15
680 Local excision 50000 3000 3000 15
681 Local excision 50000 3000 3000 15
682 Resection of 50000 3000 3000 15
683 Submucous res 50000 3000 3000 15

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684 Turbinectomy 50000 3000 3000 15
685 Fracture of th 50000 3000 3000 15
686 Other turbine 50000 3000 3000 15
687 Closed reducti 50000 3000 3000 15
688 Open reduction 50000 3000 3000 15
689 Suture of lace 50000 3000 3000 15
690 Closure of nasa 50000 3000 3000 15
691 Total nasal re 50000 3000 3000 15
692 Revision rhino 50000 3000 3000 15
693 Augmentation 50000 3000 3000 15
694 Limited rhinop 50000 3000 3000 15
695 Other rhinopla 50000 3000 3000 15
696 Other septopla 50000 3000 3000 15
697 Other repair a 50000 3000 3000 15
698 Lysis of adhes 50000 3000 3000 15
699 Other operati 50000 3000 3000 15
700 Aspiration and 50000 3000 3000 15
701 Puncture of na 50000 3000 3000 15
702 Aspiration or 50000 3000 3000 15
703 Closed [endosc 50000 3000 3000 15
704 Open biopsy o 50000 3000 3000 15
705 Other diagnos 50000 3000 3000 15
706 Intranasal ant 50000 3000 3000 15
707 Radical maxill 50000 3000 3000 15
708 Other external 50000 3000 3000 15
709 Frontal sinus 50000 3000 3000 15
710 Frontal sinus 50000 3000 3000 15
711 Sinusotomy, no 50000 3000 3000 15
712 Ethmoidotomy 50000 3000 3000 15
713 Sphenoidotom 50000 3000 3000 15
714 Incision of mul 50000 3000 3000 15
715 Sinusectomy, n 50000 3000 3000 15
716 Excision of le 50000 3000 3000 15
717 Excision of le 50000 3000 3000 15
718 Ethmoidectom 50000 3000 3000 15
719 Sphenoidecto 50000 3000 3000 15
720 Closure of nasa 50000 3000 3000 15
721 Other repair o 50000 3000 3000 15
722 Other operatio 50000 3000 3000 15
723 Extraction of 50000 3000 3000 15
724 Extraction of o 50000 3000 3000 15
725 Removal of res 50000 3000 3000 15
726 Other surgical 50000 3000 3000 15
727 Restoration of 50000 3000 3000 15
728 Restoration of 50000 3000 3000 15
729 Application of 50000 3000 3000 15
730 Insertion of fi 50000 3000 3000 15
731 Insertion of r 50000 3000 3000 15
732 Other dental r 50000 3000 3000 15

Page 15
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733 Implantation o 50000 3000 3000 15
734 Prosthetic den 50000 3000 3000 15
735 Root canal, no 50000 3000 3000 15
736 Root canal ther 50000 3000 3000 15
737 Root canal th 50000 3000 3000 15
738 Apicoectomy 50000 3000 3000 15
739 Incision of gu 50000 3000 3000 15
740 Biopsy of gum 50000 3000 3000 15
741 Biopsy of alve 50000 3000 3000 15
742 Other diagnost 50000 3000 3000 15
743 Gingivoplasty 50000 3000 3000 15
744 Excision of le 50000 3000 3000 15
745 Suture of lace 50000 3000 3000 15
746 Other operati 50000 3000 3000 15
747 Excision of den 50000 3000 3000 15
748 Alveoloplasty 50000 3000 3000 15
749 Exposure of t 50000 3000 3000 15
750 Application of 50000 3000 3000 15
751 Other orthodon 50000 3000 3000 15
752 Extension or d 50000 3000 3000 15
753 Other dental o 50000 3000 3000 15
754 Closed [needle 50000 3000 3000 15
755 Open biopsy o 50000 3000 3000 15
756 Other diagnos 50000 3000 3000 15
757 Excision or des 50000 3000 3000 15
758 Partial glosse 50000 3000 3000 15
759 Complete glo 50000 3000 3000 15
760 Radical gloss 50000 3000 3000 15
761 Suture of lace 50000 3000 3000 15
762 Other repair a 50000 3000 3000 15
763 Lingual freno 50000 3000 3000 15
764 Lingual frene 50000 3000 3000 15
765 Lysis of adhes 50000 3000 3000 15
766 Other glossot 50000 3000 3000 15
767 Other operati 50000 3000 3000 15
768 Incision of sal 50000 3000 3000 15
769 Closed [needle 50000 3000 3000 15
770 Open biopsy of 50000 3000 3000 15
771 Other diagnost 50000 3000 3000 15
772 Marsupializati 50000 3000 3000 15
773 Other excision 50000 3000 3000 15
774 Sialoadenectom 50000 3000 3000 15
775 Partial sialo 50000 3000 3000 15
776 Complete sia 50000 3000 3000 15
777 Suture of lacer 50000 3000 3000 15
778 Closure of sali 50000 3000 3000 15
779 Other repair a 50000 3000 3000 15
780 Probing of sal 50000 3000 3000 15
781 Other operatio 50000 3000 3000 15

Page 16
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782 Drainage of fa 50000 3000 3000 15
783 Incision of pal 50000 3000 3000 15
784 Biopsy of bony 50000 3000 3000 15
785 Biopsy of uvul 50000 3000 3000 15
786 Biopsy of lip 50000 3000 3000 15
787 Biopsy of mout 50000 3000 3000 15
788 Other diagnost 50000 3000 3000 15
789 Local excision 50000 3000 3000 15
790 Wide excision 50000 3000 3000 15
791 Labial frenec 50000 3000 3000 15
792 Wide excision o 50000 3000 3000 15
793 Other excision 50000 3000 3000 15
794 Other excision 50000 3000 3000 15
795 Suture of lacer 50000 3000 3000 15
796 Suture of lace 50000 3000 3000 15
797 Closure of fis 50000 3000 3000 15
798 Repair of cleft 50000 3000 3000 15
799 Full-thickness 50000 3000 3000 15
800 Other skin gra 50000 3000 3000 15
801 Attachment of 50000 3000 3000 15
802 Other plastic 50000 3000 3000 15
803 Suture of lacer 50000 3000 3000 15
804 Correction of c 50000 3000 3000 15
805 Revision of cle 50000 3000 3000 15
806 Insertion of pa 50000 3000 3000 15
807 Other plastic r 50000 3000 3000 15
808 Incision of uvu 50000 3000 3000 15
809 Excision of uv 50000 3000 3000 15
810 Repair of uvul 50000 3000 3000 15
811 Other operatio 50000 3000 3000 15
812 Labial frenot 50000 3000 3000 15
813 Incision of mo 50000 3000 3000 15
814 Other operatio 50000 3000 3000 15
815 Incision and dr 50000 3000 3000 15
816 Biopsy of tons 50000 3000 3000 15
817 Other diagnost 50000 3000 3000 15
818 Tonsillectomy 50000 3000 3000 15
819 Tonsillectomy 50000 3000 3000 15
820 Excision of ton 50000 3000 3000 15
821 Excision of lin 50000 3000 3000 15
822 Adenoidectomy 50000 3000 3000 15
823 Control of he 50000 3000 3000 15
824 Removal of for 50000 3000 3000 15
825 Excision of le 50000 3000 3000 15
826 Other operatio 50000 3000 3000 15
827 Pharyngotomy 50000 3000 3000 15
828 Pharyngoscop 50000 3000 3000 15
829 Pharyngeal bi 50000 3000 3000 15
830 Other diagnos 50000 3000 3000 15

Page 17
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831 Excision of bra 50000 3000 3000 15
832 Cricopharyng 50000 3000 3000 15
833 Pharyngeal di 50000 3000 3000 15
834 Pharyngectomy 50000 3000 3000 15
835 Other excision 50000 3000 3000 15
836 Plastic operat 50000 3000 3000 15
837 Suture of lace 50000 3000 3000 15
838 Closure of bran 50000 3000 3000 15
839 Closure of othe 50000 3000 3000 15
840 Lysis of phar 50000 3000 3000 15
841 Other repair o 50000 3000 3000 15
842 Dilation of ph 50000 3000 3000 15
843 Division of gl 50000 3000 3000 15
844 Other operati 50000 3000 3000 15
845 Marsupializati 50000 3000 3000 15
846 Other excision 50000 3000 3000 15
847 Hemilaryngec 50000 3000 3000 15
848 Epiglottidecto 50000 3000 3000 15
849 Vocal cordect 50000 3000 3000 15
850 Other partial 50000 3000 3000 15
851 Complete lary 50000 3000 3000 15
852 Radical laryn 50000 3000 3000 15
853 Injection of la 50000 3000 3000 15
854 Temporary tra 50000 3000 3000 15
855 Mediastinal t 50000 3000 3000 15
856 Other permane 50000 3000 3000 15
857 Other incision 50000 3000 3000 15
858 Tracheoscopy t 50000 3000 3000 15
859 Laryngoscopy 50000 3000 3000 15
860 Closed [endosc 50000 3000 3000 15
861 Closed [endosc 50000 3000 3000 15
862 Open biopsy of 50000 3000 3000 15
863 Other diagnost 50000 3000 3000 15
864 Other diagnos 50000 3000 3000 15
865 Local excision 50000 3000 3000 15
866 Suture of lacer 50000 3000 3000 15
867 Closure of fist 50000 3000 3000 15
868 Revision of l 50000 3000 3000 15
869 Repair of lary 50000 3000 3000 15
870 Other repair of 50000 3000 3000 15
871 Suture of lace 50000 3000 3000 15
872 Closure of exte 50000 3000 3000 15
873 Closure of othe 50000 3000 3000 15
874 Revision of t 50000 3000 3000 15
875 Reconstruction 50000 3000 3000 15
876 Other repair a 50000 3000 3000 15
877 Division of la 50000 3000 3000 15
878 Lysis of adhes 50000 3000 3000 15
879 Replacement of 50000 3000 3000 15

Page 18
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880 Injection of lo 50000 3000 3000 15
881 Tracheoesophag 50000 3000 3000 15
882 Other operatio 50000 3000 3000 15
883 Other operati 50000 3000 3000 15
884 Endoscopic exc 50000 3000 3000 15
885 Other local exc 50000 3000 3000 15
886 Other excision 50000 3000 3000 15
887 Thoracoscopic 50000 3000 3000 15
888 Plication of 50000 3000 3000 15
889 Lung volume r 50000 3000 3000 15
890 Open ablation 50000 3000 3000 15
891 Percutaneous a 50000 3000 3000 15
892 Thoracoscopic 50000 3000 3000 15
893 Other and unsp 50000 3000 3000 15
894 Bronchoscopic 50000 3000 3000 15
895 Endoscopic exc 50000 3000 3000 15
896 Other local exc 50000 3000 3000 15
897 Thoracoscopic 50000 3000 3000 15
898 Other and unsp 50000 3000 3000 15
899 Thoracoscopic 50000 3000 3000 15
900 Other lobecto 50000 3000 3000 15
901 Thoracoscopi 50000 3000 3000 15
902 Other and uns 50000 3000 3000 15
903 Radical dissec 50000 3000 3000 15
904 Other excision 50000 3000 3000 15
905 Incision of br 50000 3000 3000 15
906 Incision of lun 50000 3000 3000 15
907 Thoracoscopic 50000 3000 3000 15
908 Bronchoscopy t 50000 3000 3000 15
909 Fiber-optic b 50000 3000 3000 15
910 Other bronch 50000 3000 3000 15
911 Closed [endos 50000 3000 3000 15
912 Open biopsy o 50000 3000 3000 15
913 Closed [percut 50000 3000 3000 15
914 Closed endosc 50000 3000 3000 15
915 Open biopsy o 50000 3000 3000 15
916 Other diagnos 50000 3000 3000 15
917 Destruction of 50000 3000 3000 15
918 Artificial pneu 50000 3000 3000 15
919 Pneumoperiton 50000 3000 3000 15
920 Thoracoplasty 50000 3000 3000 15
921 Other surgical 50000 3000 3000 15
922 Suture of lace 50000 3000 3000 15
923 Closure of bron 50000 3000 3000 15
924 Closure of lac 50000 3000 3000 15
925 Other repair a 50000 3000 3000 15
926 Other repair a 50000 3000 3000 15
927 Lung transplan 50000 3000 3000 15
928 Unilateral lung 50000 3000 3000 15

Page 19
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929 Bilateral lung 50000 3000 3000 15
930 Combined hear 50000 3000 3000 15
931 Endoscopic ins 50000 3000 3000 15
932 Endoscopic pu 50000 3000 3000 15
933 Endoscopic ins 50000 3000 3000 15
934 Endoscopic rem 50000 3000 3000 15
935 Endoscopic ins 50000 3000 3000 15
936 Bronchial dilat 50000 3000 3000 15
937 Ligation of br 50000 3000 3000 15
938 Puncture of lu 50000 3000 3000 15
939 Other operati 50000 3000 3000 15
940 Other operatio 50000 3000 3000 15
941 Incision of che 50000 3000 3000 15
942 Exploratory t 50000 3000 3000 15
943 Reopening of 50000 3000 3000 15
944 Insertion of in 50000 3000 3000 15
945 Creation of pl 50000 3000 3000 15
946 Thoracoscopic 50000 3000 3000 15
947 Other incision 50000 3000 3000 15
948 Incision of me 50000 3000 3000 15
949 Thoracoscopic 50000 3000 3000 15
950 Transpleural 50000 3000 3000 15
951 Mediastinosco 50000 3000 3000 15
952 Biopsy of ches 50000 3000 3000 15
953 Other pleural 50000 3000 3000 15
954 Closed [percu 50000 3000 3000 15
955 Open mediasti 50000 3000 3000 15
956 Biopsy of dia 50000 3000 3000 15
957 Other diagnost 50000 3000 3000 15
958 Other diagnos 50000 3000 3000 15
959 Excision or de 50000 3000 3000 15
960 Excision or des 50000 3000 3000 15
961 Decortication 50000 3000 3000 15
962 Thoracoscopic 50000 3000 3000 15
963 Other excision 50000 3000 3000 15
964 Scarification o 50000 3000 3000 15
965 Suture of lacer 50000 3000 3000 15
966 Closure of th 50000 3000 3000 15
967 Closure of othe 50000 3000 3000 15
968 Repair of pect 50000 3000 3000 15
969 Other repair of 50000 3000 3000 15
970 Excision of le 50000 3000 3000 15
971 Suture of lace 50000 3000 3000 15
972 Closure of fis 50000 3000 3000 15
973 Other repair o 50000 3000 3000 15
974 Implantation 50000 3000 3000 15
975 Other operati 50000 3000 3000 15
976 Thoracentesis 50000 3000 3000 15
977 Injection into 50000 3000 3000 15

Page 20
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978 Repair of pleu 50000 3000 3000 15
979 Other operatio 50000 3000 3000 15
980 Closed heart v 50000 3000 3000 15
981 Closed heart v 50000 3000 3000 15
982 Closed heart v 50000 3000 3000 15
983 Closed heart 50000 3000 3000 15
984 Closed heart v 50000 3000 3000 15
985 Endovascular r 50000 3000 3000 15
986 Transapical re 50000 3000 3000 15
987 Endovascular 50000 3000 3000 15
988 Transapical r 50000 3000 3000 15
989 Endovascular r 50000 3000 3000 15
990 Open heart val 50000 3000 3000 15
991 Open heart val 50000 3000 3000 15
992 Open heart val 50000 3000 3000 15
993 Open heart val 50000 3000 3000 15
994 Open heart val 50000 3000 3000 15
995 Open and other 50000 3000 3000 15
996 Open and other 50000 3000 3000 15
997 Open and other 50000 3000 3000 15
998 Open and other 50000 3000 3000 15
999 Open and other 50000 3000 3000 15
1000 Open and other 50000 3000 3000 15
1001 Open and othe 50000 3000 3000 15
1002 Open and other 50000 3000 3000 15
1003 Open and other 50000 3000 3000 15
1004 Operations on 50000 3000 3000 15
1005 Operations on 50000 3000 3000 15
1006 Annuloplasty 50000 3000 3000 15
1007 Infundibulect 50000 3000 3000 15
1008 Operations on 50000 3000 3000 15
1009 Operations on 50000 3000 3000 15
1010 Enlargement of 50000 3000 3000 15
1011 Creation of sep 50000 3000 3000 15
1012 Repair of unsp 50000 3000 3000 15
1013 Repair of atri 50000 3000 3000 15
1014 Repair of atria 50000 3000 3000 15
1015 Repair of vent 50000 3000 3000 15
1016 Repair of endo 50000 3000 3000 15
1017 Repair of vent 50000 3000 3000 15
1018 Repair of unspe 50000 3000 3000 15
1019 Repair of atria 50000 3000 3000 15
1020 Repair of ventr 50000 3000 3000 15
1021 Repair of endo 50000 3000 3000 15
1022 Other and unsp 50000 3000 3000 15
1023 Other and unspe 50000 3000 3000 15
1024 Other and unsp 50000 3000 3000 15
1025 Other and unsp 50000 3000 3000 15
1026 Total repair of 50000 3000 3000 15

Page 21
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1027 Total repair o 50000 3000 3000 15
1028 Total repair of 50000 3000 3000 15
1029 Total correctio 50000 3000 3000 15
1030 Interatrial tra 50000 3000 3000 15
1031 Creation of co 50000 3000 3000 15
1032 Creation of co 50000 3000 3000 15
1033 Creation of co 50000 3000 3000 15
1034 Revision of co 50000 3000 3000 15
1035 Percutaneous 50000 3000 3000 15
1036 Percutaneous m 50000 3000 3000 15
1037 Other operatio 50000 3000 3000 15
1038 Other operatio 50000 3000 3000 15
1039 Open chest cor 50000 3000 3000 15
1040 Intracoronary 50000 3000 3000 15
1041 Insertion of no 50000 3000 3000 15
1042 Insertion of dr 50000 3000 3000 15
1043 Other removal 50000 3000 3000 15
1044 Aortocoronary 50000 3000 3000 15
1045 (Aorto)coronar 50000 3000 3000 15
1046 (Aorto)coronar 50000 3000 3000 15
1047 (Aorto)coronar 50000 3000 3000 15
1048 (Aorto)coronar 50000 3000 3000 15
1049 Single intern 50000 3000 3000 15
1050 Double intern 50000 3000 3000 15
1051 Abdominal-cor 50000 3000 3000 15
1052 Other bypass a 50000 3000 3000 15
1053 Heart revascula 50000 3000 3000 15
1054 Open chest tra 50000 3000 3000 15
1055 Other transmyo 50000 3000 3000 15
1056 Endoscopic tra 50000 3000 3000 15
1057 Percutaneous 50000 3000 3000 15
1058 Other heart re 50000 3000 3000 15
1059 Repair of ane 50000 3000 3000 15
1060 Other operatio 50000 3000 3000 15
1061 Pericardiocent 50000 3000 3000 15
1062 Incision of hea 50000 3000 3000 15
1063 Cardiotomy 50000 3000 3000 15
1064 Pericardiotom 50000 3000 3000 15
1065 Noninvasive pr 50000 3000 3000 15
1066 Right heart ca 50000 3000 3000 15
1067 Left heart card 50000 3000 3000 15
1068 Combined right 50000 3000 3000 15
1069 Biopsy of peri 50000 3000 3000 15
1070 Biopsy of hear 50000 3000 3000 15
1071 Catheter based 50000 3000 3000 15
1072 Cardiac mapp 50000 3000 3000 15
1073 Intracardiac 50000 3000 3000 15
1074 Other diagnost 50000 3000 3000 15
1075 Pericardiecto 50000 3000 3000 15

Page 22
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1076 Excision of an 50000 3000 3000 15
1077 Excision or de 50000 3000 3000 15
1078 Excision or de 50000 3000 3000 15
1079 Partial ventri 50000 3000 3000 15
1080 Excision, dest 50000 3000 3000 15
1081 Excision or de 50000 3000 3000 15
1082 Implantation o 50000 3000 3000 15
1083 Other repair o 50000 3000 3000 15
1084 Heart transpla 50000 3000 3000 15
1085 Implantation o 50000 3000 3000 15
1086 Replacement or 50000 3000 3000 15
1087 Replacement or 50000 3000 3000 15
1088 Removal of int 50000 3000 3000 15
1089 Implantation or 50000 3000 3000 15
1090 Implant of pul 50000 3000 3000 15
1091 Insertion of t 50000 3000 3000 15
1092 Repair of hear 50000 3000 3000 15
1093 Removal of ext 50000 3000 3000 15
1094 Implant of sin 50000 3000 3000 15
1095 Insertion of i 50000 3000 3000 15
1096 Implantation o 50000 3000 3000 15
1097 Insertion of p 50000 3000 3000 15
1098 Initial inserti 50000 3000 3000 15
1099 Initial inserti 50000 3000 3000 15
1100 Initial inserti 50000 3000 3000 15
1101 Initial inserti 50000 3000 3000 15
1102 Insertion or r 50000 3000 3000 15
1103 Revision of le 50000 3000 3000 15
1104 Replacement of 50000 3000 3000 15
1105 Removal of lea 50000 3000 3000 15
1106 Insertion of 50000 3000 3000 15
1107 Revision or re 50000 3000 3000 15
1108 Insertion of p 50000 3000 3000 15
1109 Initial inserti 50000 3000 3000 15
1110 Initial inserti 50000 3000 3000 15
1111 Initial inserti 50000 3000 3000 15
1112 Replacement of 50000 3000 3000 15
1113 Replacement o 50000 3000 3000 15
1114 Replacement o 50000 3000 3000 15
1115 Revision or r 50000 3000 3000 15
1116 Insertion of le 50000 3000 3000 15
1117 Open chest ca 50000 3000 3000 15
1118 Injection of t 50000 3000 3000 15
1119 Injection of t 50000 3000 3000 15
1120 Implantation o 50000 3000 3000 15
1121 Implantation of 50000 3000 3000 15
1122 Implantation of 50000 3000 3000 15
1123 Replacement of 50000 3000 3000 15
1124 Replacement of 50000 3000 3000 15

Page 23
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1125 Other operatio 50000 3000 3000 15
1126 Incision of ves 50000 3000 3000 15
1127 Incision of ves 50000 3000 3000 15
1128 Incision of ve 50000 3000 3000 15
1129 Incision of ve 50000 3000 3000 15
1130 Incision of ves 50000 3000 3000 15
1131 Incision of ves 50000 3000 3000 15
1132 Incision of ve 50000 3000 3000 15
1133 Incision of ve 50000 3000 3000 15
1134 Incision of ves 50000 3000 3000 15
1135 Incision of ves 50000 3000 3000 15
1136 Endarterectomy 50000 3000 3000 15
1137 Endarterectomy 50000 3000 3000 15
1138 Endarterectom 50000 3000 3000 15
1139 Endarterectom 50000 3000 3000 15
1140 Endarterectom 50000 3000 3000 15
1141 Endarterectomy 50000 3000 3000 15
1142 Endarterectom 50000 3000 3000 15
1143 Endarterectomy 50000 3000 3000 15
1144 Biopsy of bloo 50000 3000 3000 15
1145 Percutaneous 50000 3000 3000 15
1146 Intravascular 50000 3000 3000 15
1147 Intravascular 50000 3000 3000 15
1148 Intravascular 50000 3000 3000 15
1149 Insertion of i 50000 3000 3000 15
1150 Other diagnos 50000 3000 3000 15
1151 Resection of v 50000 3000 3000 15
1152 Resection of v 50000 3000 3000 15
1153 Resection of v 50000 3000 3000 15
1154 Resection of v 50000 3000 3000 15
1155 Resection of v 50000 3000 3000 15
1156 Resection of v 50000 3000 3000 15
1157 Resection of v 50000 3000 3000 15
1158 Resection of v 50000 3000 3000 15
1159 Resection of v 50000 3000 3000 15
1160 Resection of v 50000 3000 3000 15
1161 Resection of v 50000 3000 3000 15
1162 Resection of v 50000 3000 3000 15
1163 Resection of v 50000 3000 3000 15
1164 Resection of v 50000 3000 3000 15
1165 Resection of v 50000 3000 3000 15
1166 Resection of v 50000 3000 3000 15
1167 Resection of v 50000 3000 3000 15
1168 Resection of v 50000 3000 3000 15
1169 Resection of v 50000 3000 3000 15
1170 Resection of v 50000 3000 3000 15
1171 Ligation and st 50000 3000 3000 15
1172 Ligation and st 50000 3000 3000 15
1173 Ligation and s 50000 3000 3000 15

Page 24
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1174 Ligation and s 50000 3000 3000 15
1175 Ligation and s 50000 3000 3000 15
1176 Ligation and s 50000 3000 3000 15
1177 Ligation and s 50000 3000 3000 15
1178 Other excision 50000 3000 3000 15
1179 Other excision 50000 3000 3000 15
1180 Other excision 50000 3000 3000 15
1181 Other excision 50000 3000 3000 15
1182 Other excision 50000 3000 3000 15
1183 Other excision 50000 3000 3000 15
1184 Other excision 50000 3000 3000 15
1185 Other excision 50000 3000 3000 15
1186 Other excision 50000 3000 3000 15
1187 Other excision 50000 3000 3000 15
1188 Interruption o 50000 3000 3000 15
1189 Other surgical 50000 3000 3000 15
1190 Other surgical 50000 3000 3000 15
1191 Other surgical 50000 3000 3000 15
1192 Other surgical 50000 3000 3000 15
1193 Other surgical 50000 3000 3000 15
1194 Other surgical 50000 3000 3000 15
1195 Other surgical 50000 3000 3000 15
1196 Other surgical 50000 3000 3000 15
1197 Other surgical 50000 3000 3000 15
1198 Other surgical 50000 3000 3000 15
1199 Arterial cathet 50000 3000 3000 15
1200 Umbilical vein 50000 3000 3000 15
1201 Venous cathete 50000 3000 3000 15
1202 Venous cutdo 50000 3000 3000 15
1203 Venous cathete 50000 3000 3000 15
1204 Central venou 50000 3000 3000 15
1205 Other puncture 50000 3000 3000 15
1206 Other puncture 50000 3000 3000 15
1207 Systemic to pu 50000 3000 3000 15
1208 Intra-abdomin 50000 3000 3000 15
1209 Caval-pulmona 50000 3000 3000 15
1210 Aorta-subclavi 50000 3000 3000 15
1211 Other intratho 50000 3000 3000 15
1212 Aorta-renal b 50000 3000 3000 15
1213 Aorta-iliac-fe 50000 3000 3000 15
1214 Other intra-ab 50000 3000 3000 15
1215 Arteriovenosto 50000 3000 3000 15
1216 Extracranial-i 50000 3000 3000 15
1217 Other (periphe 50000 3000 3000 15
1218 Suture of unsp 50000 3000 3000 15
1219 Suture of arte 50000 3000 3000 15
1220 Suture of vein 50000 3000 3000 15
1221 Control of hem 50000 3000 3000 15
1222 Revision of ar 50000 3000 3000 15

Page 25
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1223 Removal of art 50000 3000 3000 15
1224 Other revision 50000 3000 3000 15
1225 Angioplasty of 50000 3000 3000 15
1226 Clipping of a 50000 3000 3000 15
1227 Other repair 50000 3000 3000 15
1228 Repair of arte 50000 3000 3000 15
1229 Re-entry opera 50000 3000 3000 15
1230 Reimplantation 50000 3000 3000 15
1231 Repair of bloo 50000 3000 3000 15
1232 Repair of bloo 50000 3000 3000 15
1233 Repair of bloo 50000 3000 3000 15
1234 Other repair o 50000 3000 3000 15
1235 Extracorporeal 50000 3000 3000 15
1236 Hypothermia (s 50000 3000 3000 15
1237 Cardioplegia 50000 3000 3000 15
1238 Intraoperativ 50000 3000 3000 15
1239 Extracorpore 50000 3000 3000 15
1240 Percutaneous 50000 3000 3000 15
1241 Endovascular i 50000 3000 3000 15
1242 Endovascular ( 50000 3000 3000 15
1243 Endovascular i 50000 3000 3000 15
1244 Endovascular 50000 3000 3000 15
1245 Endovascular e 50000 3000 3000 15
1246 Endovascular e 50000 3000 3000 15
1247 Temporary (par 50000 3000 3000 15
1248 Endovascular i 50000 3000 3000 15
1249 Other endovas 50000 3000 3000 15
1250 Implantation o 50000 3000 3000 15
1251 Implantation o 50000 3000 3000 15
1252 Implantation o 50000 3000 3000 15
1253 Revision of car 50000 3000 3000 15
1254 Revision of ca 50000 3000 3000 15
1255 Removal of car 50000 3000 3000 15
1256 Removal of car 50000 3000 3000 15
1257 Removal of car 50000 3000 3000 15
1258 Other operatio 50000 3000 3000 15
1259 Insertion of n 50000 3000 3000 15
1260 Freeing of ves 50000 3000 3000 15
1261 Injection of sc 50000 3000 3000 15
1262 Insertion of v 50000 3000 3000 15
1263 Replacement o 50000 3000 3000 15
1264 Hemodialysis 50000 3000 3000 15
1265 Total body per 50000 3000 3000 15
1266 Other perfusio 50000 3000 3000 15
1267 Control of hem 50000 3000 3000 15
1268 Other operati 50000 3000 3000 15
1269 Incision of lym 50000 3000 3000 15
1270 Biopsy of lymp 50000 3000 3000 15
1271 Other diagnost 50000 3000 3000 15

Page 26
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1272 Excision of de 50000 3000 3000 15
1273 Excision of i 50000 3000 3000 15
1274 Excision of ax 50000 3000 3000 15
1275 Excision of in 50000 3000 3000 15
1276 Simple excisio 50000 3000 3000 15
1277 Regional lymp 50000 3000 3000 15
1278 Radical neck d 50000 3000 3000 15
1279 Radical neck d 50000 3000 3000 15
1280 Radical neck di 50000 3000 3000 15
1281 Radical excisi 50000 3000 3000 15
1282 Radical excisi 50000 3000 3000 15
1283 Radical excisi 50000 3000 3000 15
1284 Radical excisi 50000 3000 3000 15
1285 Radical groin 50000 3000 3000 15
1286 Radical excisi 50000 3000 3000 15
1287 Cannulation of 50000 3000 3000 15
1288 Fistulization o 50000 3000 3000 15
1289 Closure of fist 50000 3000 3000 15
1290 Ligation of tho 50000 3000 3000 15
1291 Other operatio 50000 3000 3000 15
1292 Other operatio 50000 3000 3000 15
1293 Bone marrow tr 50000 3000 3000 15
1294 Autologous bo 50000 3000 3000 15
1295 Allogeneic bon 50000 3000 3000 15
1296 Allogeneic bon 50000 3000 3000 15
1297 Autologous hem 50000 3000 3000 15
1298 Allogeneic hem 50000 3000 3000 15
1299 Cord blood ste 50000 3000 3000 15
1300 Autologous hem 50000 3000 3000 15
1301 Allogeneic hem 50000 3000 3000 15
1302 Autologous bo 50000 3000 3000 15
1303 Puncture of s 50000 3000 3000 15
1304 Splenotomy 50000 3000 3000 15
1305 Biopsy of bon 50000 3000 3000 15
1306 Closed [aspira 50000 3000 3000 15
1307 Open biopsy o 50000 3000 3000 15
1308 Other diagnos 50000 3000 3000 15
1309 Other diagnos 50000 3000 3000 15
1310 Marsupializati 50000 3000 3000 15
1311 Excision of les 50000 3000 3000 15
1312 Partial splene 50000 3000 3000 15
1313 Total splenec 50000 3000 3000 15
1314 Aspiration of 50000 3000 3000 15
1315 Injection into 50000 3000 3000 15
1316 Excision of ac 50000 3000 3000 15
1317 Transplantatio 50000 3000 3000 15
1318 Repair and pla 50000 3000 3000 15
1319 Other operati 50000 3000 3000 15
1320 Other operati 50000 3000 3000 15

Page 27
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1321 Incision of e 50000 3000 3000 15
1322 Other incision 50000 3000 3000 15
1323 Esophagostomy 50000 3000 3000 15
1324 Cervical esop 50000 3000 3000 15
1325 Exteriorizatio 50000 3000 3000 15
1326 Other external 50000 3000 3000 15
1327 Operative eso 50000 3000 3000 15
1328 Esophagoscopy 50000 3000 3000 15
1329 Other esopha 50000 3000 3000 15
1330 Closed [endos 50000 3000 3000 15
1331 Open biopsy o 50000 3000 3000 15
1332 Other diagnos 50000 3000 3000 15
1333 Local excision 50000 3000 3000 15
1334 Local excision 50000 3000 3000 15
1335 Endoscopic exc 50000 3000 3000 15
1336 Other destruct 50000 3000 3000 15
1337 Esophagectomy 50000 3000 3000 15
1338 Partial esoph 50000 3000 3000 15
1339 Total esophag 50000 3000 3000 15
1340 Intrathoracic 50000 3000 3000 15
1341 Intrathoracic 50000 3000 3000 15
1342 Intrathoracic 50000 3000 3000 15
1343 Other intrath 50000 3000 3000 15
1344 Intrathoracic 50000 3000 3000 15
1345 Other intrath 50000 3000 3000 15
1346 Intrathoracic 50000 3000 3000 15
1347 Other intrath 50000 3000 3000 15
1348 Antesternal 50000 3000 3000 15
1349 Antesternal e 50000 3000 3000 15
1350 Antesternal es 50000 3000 3000 15
1351 Other anteste 50000 3000 3000 15
1352 Antesternal es 50000 3000 3000 15
1353 Other anteste 50000 3000 3000 15
1354 Other antester 50000 3000 3000 15
1355 Other anteste 50000 3000 3000 15
1356 Esophagomyo 50000 3000 3000 15
1357 Insertion of p 50000 3000 3000 15
1358 Suture of lace 50000 3000 3000 15
1359 Closure of es 50000 3000 3000 15
1360 Repair of esop 50000 3000 3000 15
1361 Repair of esop 50000 3000 3000 15
1362 Production of 50000 3000 3000 15
1363 Other graft o 50000 3000 3000 15
1364 Other repair 50000 3000 3000 15
1365 Ligation of es 50000 3000 3000 15
1366 Dilation of es 50000 3000 3000 15
1367 Other operati 50000 3000 3000 15
1368 Gastrotomy 50000 3000 3000 15
1369 Percutaneous 50000 3000 3000 15

Page 28
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1370 Other gastros 50000 3000 3000 15
1371 Pyloromyotom 50000 3000 3000 15
1372 Endoscopic exc 50000 3000 3000 15
1373 Local excision 50000 3000 3000 15
1374 Other destruct 50000 3000 3000 15
1375 Partial gastr 50000 3000 3000 15
1376 Partial gastr 50000 3000 3000 15
1377 Partial gastre 50000 3000 3000 15
1378 Partial gastre 50000 3000 3000 15
1379 Laparoscopic v 50000 3000 3000 15
1380 Open and othe 50000 3000 3000 15
1381 Total gastrecto 50000 3000 3000 15
1382 Other total ga 50000 3000 3000 15
1383 Vagotomy, not 50000 3000 3000 15
1384 Truncal vagot 50000 3000 3000 15
1385 Highly select 50000 3000 3000 15
1386 Other selecti 50000 3000 3000 15
1387 Transabdomina 50000 3000 3000 15
1388 Gastroscopy th 50000 3000 3000 15
1389 Other gastros 50000 3000 3000 15
1390 Closed [endos 50000 3000 3000 15
1391 Open biopsy o 50000 3000 3000 15
1392 Other diagnos 50000 3000 3000 15
1393 Dilation of pyl 50000 3000 3000 15
1394 Endoscopic dil 50000 3000 3000 15
1395 Other pyloropl 50000 3000 3000 15
1396 High gastric b 50000 3000 3000 15
1397 Percutaneous 50000 3000 3000 15
1398 Laparoscopic 50000 3000 3000 15
1399 Other gastroe 50000 3000 3000 15
1400 Suture of pepti 50000 3000 3000 15
1401 Suture of gastr 50000 3000 3000 15
1402 Suture of duod 50000 3000 3000 15
1403 Endoscopic con 50000 3000 3000 15
1404 Transcatheter 50000 3000 3000 15
1405 Other control 50000 3000 3000 15
1406 Revision of ga 50000 3000 3000 15
1407 Suture of lace 50000 3000 3000 15
1408 Closure of ga 50000 3000 3000 15
1409 Closure of othe 50000 3000 3000 15
1410 Gastropexy 50000 3000 3000 15
1411 Esophagogastr 50000 3000 3000 15
1412 Other procedur 50000 3000 3000 15
1413 Laparoscopic 50000 3000 3000 15
1414 Laparoscopic 50000 3000 3000 15
1415 Other repair o 50000 3000 3000 15
1416 Ligation of gas 50000 3000 3000 15
1417 Intraoperative 50000 3000 3000 15
1418 Insertion of ga 50000 3000 3000 15

Page 29
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1419 Removal of gas 50000 3000 3000 15
1420 Laparoscopic g 50000 3000 3000 15
1421 Laparoscopic r 50000 3000 3000 15
1422 Laparoscopic r 50000 3000 3000 15
1423 (Laparoscopic) 50000 3000 3000 15
1424 Other operati 50000 3000 3000 15
1425 Incision of int 50000 3000 3000 15
1426 Incision of d 50000 3000 3000 15
1427 Other incision 50000 3000 3000 15
1428 Incision of lar 50000 3000 3000 15
1429 Transabdomina 50000 3000 3000 15
1430 Endoscopy of s 50000 3000 3000 15
1431 Other endoscop 50000 3000 3000 15
1432 Closed [endosc 50000 3000 3000 15
1433 Open biopsy of 50000 3000 3000 15
1434 Esophagogastr 50000 3000 3000 15
1435 Other diagnost 50000 3000 3000 15
1436 Transabdomina 50000 3000 3000 15
1437 Endoscopy of l 50000 3000 3000 15
1438 Colonoscopy 50000 3000 3000 15
1439 Flexible sigm 50000 3000 3000 15
1440 Closed [endosc 50000 3000 3000 15
1441 Open biopsy of 50000 3000 3000 15
1442 Intestinal biop 50000 3000 3000 15
1443 Other diagnost 50000 3000 3000 15
1444 Other diagnost 50000 3000 3000 15
1445 Endoscopic exc 50000 3000 3000 15
1446 Other local ex 50000 3000 3000 15
1447 Other destruct 50000 3000 3000 15
1448 Local excision 50000 3000 3000 15
1449 Other destruct 50000 3000 3000 15
1450 Excision of les 50000 3000 3000 15
1451 Endoscopic pol 50000 3000 3000 15
1452 Endoscopic dest 50000 3000 3000 15
1453 Other destructi 50000 3000 3000 15
1454 Isolation of in 50000 3000 3000 15
1455 Isolation of se 50000 3000 3000 15
1456 Isolation of se 50000 3000 3000 15
1457 Multiple segme 50000 3000 3000 15
1458 Other partial r 50000 3000 3000 15
1459 Total removal o 50000 3000 3000 15
1460 Open and other 50000 3000 3000 15
1461 Open and oth 50000 3000 3000 15
1462 Open and othe 50000 3000 3000 15
1463 Open and other 50000 3000 3000 15
1464 Open and othe 50000 3000 3000 15
1465 Open and othe 50000 3000 3000 15
1466 Other and unspe 50000 3000 3000 15
1467 Laparoscopic t 50000 3000 3000 15

Page 30
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1468 Open total int 50000 3000 3000 15
1469 Other and unsp 50000 3000 3000 15
1470 Intestinal ana 50000 3000 3000 15
1471 Small-to-small 50000 3000 3000 15
1472 Anastomosis of 50000 3000 3000 15
1473 Other small-to 50000 3000 3000 15
1474 Large-to-large 50000 3000 3000 15
1475 Anastomosis t 50000 3000 3000 15
1476 Exteriorization 50000 3000 3000 15
1477 Resection of e 50000 3000 3000 15
1478 Exteriorization 50000 3000 3000 15
1479 Resection of e 50000 3000 3000 15
1480 Colostomy, not 50000 3000 3000 15
1481 Temporary col 50000 3000 3000 15
1482 Permanent co 50000 3000 3000 15
1483 Delayed openi 50000 3000 3000 15
1484 Ileostomy, not 50000 3000 3000 15
1485 Temporary ile 50000 3000 3000 15
1486 Continent ile 50000 3000 3000 15
1487 Other permane 50000 3000 3000 15
1488 Delayed openi 50000 3000 3000 15
1489 Delayed openi 50000 3000 3000 15
1490 Percutaneous 50000 3000 3000 15
1491 Other enteros 50000 3000 3000 15
1492 Revision of in 50000 3000 3000 15
1493 Revision of st 50000 3000 3000 15
1494 Repair of peri 50000 3000 3000 15
1495 Other revision 50000 3000 3000 15
1496 Closure of int 50000 3000 3000 15
1497 Closure of sto 50000 3000 3000 15
1498 Closure of sto 50000 3000 3000 15
1499 Fixation of int 50000 3000 3000 15
1500 Fixation of sma 50000 3000 3000 15
1501 Other fixation 50000 3000 3000 15
1502 Fixation of lar 50000 3000 3000 15
1503 Other fixation 50000 3000 3000 15
1504 Suture of lac 50000 3000 3000 15
1505 Closure of fis 50000 3000 3000 15
1506 Suture of lace 50000 3000 3000 15
1507 Closure of fis 50000 3000 3000 15
1508 Suture of lacer 50000 3000 3000 15
1509 Closure of fist 50000 3000 3000 15
1510 Other repair of 50000 3000 3000 15
1511 Intra-abdomina 50000 3000 3000 15
1512 Intra-abdomina 50000 3000 3000 15
1513 Intra-abdomina 50000 3000 3000 15
1514 Dilation of int 50000 3000 3000 15
1515 Endoscopic ins 50000 3000 3000 15
1516 Other insertion 50000 3000 3000 15

Page 31
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1517 Myotomy of si 50000 3000 3000 15
1518 Myotomy of oth 50000 3000 3000 15
1519 Revision of an 50000 3000 3000 15
1520 Revision of an 50000 3000 3000 15
1521 Local perfusion 50000 3000 3000 15
1522 Local perfusion 50000 3000 3000 15
1523 Transplant of i 50000 3000 3000 15
1524 Other operatio 50000 3000 3000 15
1525 Laparoscopic 50000 3000 3000 15
1526 Other append 50000 3000 3000 15
1527 Laparoscopic 50000 3000 3000 15
1528 Other inciden 50000 3000 3000 15
1529 Drainage of a 50000 3000 3000 15
1530 Appendicosto 50000 3000 3000 15
1531 Closure of app 50000 3000 3000 15
1532 Other operati 50000 3000 3000 15
1533 Proctotomy 50000 3000 3000 15
1534 Proctostomy 50000 3000 3000 15
1535 Transabdomina 50000 3000 3000 15
1536 Proctosigmoido 50000 3000 3000 15
1537 Rigid proctos 50000 3000 3000 15
1538 Closed [endos 50000 3000 3000 15
1539 Open biopsy o 50000 3000 3000 15
1540 Biopsy of perir 50000 3000 3000 15
1541 Other diagnost 50000 3000 3000 15
1542 Radical electro 50000 3000 3000 15
1543 Other electroco 50000 3000 3000 15
1544 Destruction of 50000 3000 3000 15
1545 Destruction of 50000 3000 3000 15
1546 Local excision 50000 3000 3000 15
1547 [Endoscopic] 50000 3000 3000 15
1548 Pull-through r 50000 3000 3000 15
1549 Soave submuco 50000 3000 3000 15
1550 Laparoscopic p 50000 3000 3000 15
1551 Open pull-thro 50000 3000 3000 15
1552 Other pull-thr 50000 3000 3000 15
1553 Abdominoperine 50000 3000 3000 15
1554 Laparoscopic 50000 3000 3000 15
1555 Open abdomino 50000 3000 3000 15
1556 Other abdomino 50000 3000 3000 15
1557 Transsacral r 50000 3000 3000 15
1558 Anterior resec 50000 3000 3000 15
1559 Other anterior 50000 3000 3000 15
1560 Posterior rese 50000 3000 3000 15
1561 Duhamel resec 50000 3000 3000 15
1562 Other resectio 50000 3000 3000 15
1563 Suture of lace 50000 3000 3000 15
1564 Closure of pr 50000 3000 3000 15
1565 Closure of othe 50000 3000 3000 15

Page 32
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1566 Rectorectosto 50000 3000 3000 15
1567 Abdominal pro 50000 3000 3000 15
1568 Other proctop 50000 3000 3000 15
1569 Other repair o 50000 3000 3000 15
1570 Incision of per 50000 3000 3000 15
1571 Excision of per 50000 3000 3000 15
1572 Incision of rect 50000 3000 3000 15
1573 Anorectal my 50000 3000 3000 15
1574 Repair of perir 50000 3000 3000 15
1575 Other operatio 50000 3000 3000 15
1576 Incision of pe 50000 3000 3000 15
1577 Other incision 50000 3000 3000 15
1578 Excision of pe 50000 3000 3000 15
1579 Other excision 50000 3000 3000 15
1580 Anal fistuloto 50000 3000 3000 15
1581 Anal fistulect 50000 3000 3000 15
1582 Anoscopy 50000 3000 3000 15
1583 Biopsy of peri 50000 3000 3000 15
1584 Biopsy of anu 50000 3000 3000 15
1585 Other diagnost 50000 3000 3000 15
1586 Endoscopic exc 50000 3000 3000 15
1587 Other local exc 50000 3000 3000 15
1588 Reduction of 50000 3000 3000 15
1589 Injection of h 50000 3000 3000 15
1590 Cauterization 50000 3000 3000 15
1591 Destruction of 50000 3000 3000 15
1592 Ligation of he 50000 3000 3000 15
1593 Excision of h 50000 3000 3000 15
1594 Evacuation of 50000 3000 3000 15
1595 Other procedu 50000 3000 3000 15
1596 Left lateral a 50000 3000 3000 15
1597 Posterior anal 50000 3000 3000 15
1598 Other anal sp 50000 3000 3000 15
1599 Excision of an 50000 3000 3000 15
1600 Suture of lace 50000 3000 3000 15
1601 Anal cerclage 50000 3000 3000 15
1602 Closure of anal 50000 3000 3000 15
1603 Gracilis muscl 50000 3000 3000 15
1604 Implantation or 50000 3000 3000 15
1605 Removal of arti 50000 3000 3000 15
1606 Other repair o 50000 3000 3000 15
1607 Incision of an 50000 3000 3000 15
1608 Insertion of s 50000 3000 3000 15
1609 Other incision 50000 3000 3000 15
1610 Reduction of a 50000 3000 3000 15
1611 Control of (po 50000 3000 3000 15
1612 Other operati 50000 3000 3000 15
1613 Hepatotomy 50000 3000 3000 15
1614 Closed (percut 50000 3000 3000 15

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1615 Open biopsy of 50000 3000 3000 15
1616 Transjugular l 50000 3000 3000 15
1617 Laparoscopic l 50000 3000 3000 15
1618 Other diagnost 50000 3000 3000 15
1619 Marsupializatio 50000 3000 3000 15
1620 Partial hepat 50000 3000 3000 15
1621 Open ablation o 50000 3000 3000 15
1622 Percutaneous ab 50000 3000 3000 15
1623 Laparoscopic ab 50000 3000 3000 15
1624 Other and unspe 50000 3000 3000 15
1625 Other destructi 50000 3000 3000 15
1626 Lobectomy of l 50000 3000 3000 15
1627 Total hepatec 50000 3000 3000 15
1628 Auxiliary liver 50000 3000 3000 15
1629 Other transplan 50000 3000 3000 15
1630 Closure of lace 50000 3000 3000 15
1631 Other repair of 50000 3000 3000 15
1632 Percutaneous a 50000 3000 3000 15
1633 Extracorporeal 50000 3000 3000 15
1634 Localized perfu 50000 3000 3000 15
1635 Other injection 50000 3000 3000 15
1636 Other operatio 50000 3000 3000 15
1637 Percutaneous a 50000 3000 3000 15
1638 Trocar cholec 50000 3000 3000 15
1639 Other cholecy 50000 3000 3000 15
1640 Other cholecy 50000 3000 3000 15
1641 Endoscopic re 50000 3000 3000 15
1642 Endoscopic re 50000 3000 3000 15
1643 Percutaneous b 50000 3000 3000 15
1644 Open biopsy of 50000 3000 3000 15
1645 Other closed [ 50000 3000 3000 15
1646 Pressure meas 50000 3000 3000 15
1647 Other diagnost 50000 3000 3000 15
1648 Other partial 50000 3000 3000 15
1649 Cholecystect 50000 3000 3000 15
1650 Laparoscopic 50000 3000 3000 15
1651 Laparoscopic 50000 3000 3000 15
1652 Anastomosis of 50000 3000 3000 15
1653 Anastomosis of 50000 3000 3000 15
1654 Anastomosis of 50000 3000 3000 15
1655 Anastomosis o 50000 3000 3000 15
1656 Other gallbla 50000 3000 3000 15
1657 Choledochoen 50000 3000 3000 15
1658 Anastomosis of 50000 3000 3000 15
1659 Other bile duc 50000 3000 3000 15
1660 Common duct ex 50000 3000 3000 15
1661 Common duct ex 50000 3000 3000 15
1662 Insertion of c 50000 3000 3000 15
1663 Incision of oth 50000 3000 3000 15

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1664 Exploration o 50000 3000 3000 15
1665 Other incision 50000 3000 3000 15
1666 Excision of cy 50000 3000 3000 15
1667 Excision of am 50000 3000 3000 15
1668 Other excisio 50000 3000 3000 15
1669 Endoscopic exci 50000 3000 3000 15
1670 Excision of oth 50000 3000 3000 15
1671 Simple suture 50000 3000 3000 15
1672 Choledochopla 50000 3000 3000 15
1673 Repair of other 50000 3000 3000 15
1674 Dilation of sph 50000 3000 3000 15
1675 Pancreatic sp 50000 3000 3000 15
1676 Pancreatic sph 50000 3000 3000 15
1677 Endoscopic dil 50000 3000 3000 15
1678 Endoscopic sp 50000 3000 3000 15
1679 Endoscopic ins 50000 3000 3000 15
1680 Endoscopic inse 50000 3000 3000 15
1681 Endoscopic rem 50000 3000 3000 15
1682 Other operatio 50000 3000 3000 15
1683 Repair of lacer 50000 3000 3000 15
1684 Closure of ch 50000 3000 3000 15
1685 Closure of othe 50000 3000 3000 15
1686 Revision of ana 50000 3000 3000 15
1687 Removal of pro 50000 3000 3000 15
1688 Percutaneous 50000 3000 3000 15
1689 Other percutan 50000 3000 3000 15
1690 Other operation 50000 3000 3000 15
1691 Drainage of pa 50000 3000 3000 15
1692 Other pancrea 50000 3000 3000 15
1693 Closed [aspira 50000 3000 3000 15
1694 Open biopsy o 50000 3000 3000 15
1695 Endoscopic re 50000 3000 3000 15
1696 Closed [endosc 50000 3000 3000 15
1697 Other diagnos 50000 3000 3000 15
1698 Endoscopic exc 50000 3000 3000 15
1699 Other excision 50000 3000 3000 15
1700 Marsupializati 50000 3000 3000 15
1701 Internal drain 50000 3000 3000 15
1702 Proximal panc 50000 3000 3000 15
1703 Distal pancre 50000 3000 3000 15
1704 Radical subto 50000 3000 3000 15
1705 Other partial 50000 3000 3000 15
1706 Total pancrea 50000 3000 3000 15
1707 Radical pancr 50000 3000 3000 15
1708 Pancreatic tra 50000 3000 3000 15
1709 Reimplantation 50000 3000 3000 15
1710 Homotransplan 50000 3000 3000 15
1711 Heterotranspla 50000 3000 3000 15
1712 Autotransplant 50000 3000 3000 15

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1713 Allotransplanta 50000 3000 3000 15
1714 Transplantatio 50000 3000 3000 15
1715 Cannulation of 50000 3000 3000 15
1716 Endoscopic ins 50000 3000 3000 15
1717 Endoscopic rem 50000 3000 3000 15
1718 Other repair o 50000 3000 3000 15
1719 Anastomosis o 50000 3000 3000 15
1720 Endoscopic ins 50000 3000 3000 15
1721 Endoscopic dil 50000 3000 3000 15
1722 Other operati 50000 3000 3000 15
1723 Unilateral repa 50000 3000 3000 15
1724 Other and open 50000 3000 3000 15
1725 Other and open 50000 3000 3000 15
1726 Other and open 50000 3000 3000 15
1727 Other and open 50000 3000 3000 15
1728 Repair of ingui 50000 3000 3000 15
1729 Bilateral repai 50000 3000 3000 15
1730 Other and open 50000 3000 3000 15
1731 Other and open 50000 3000 3000 15
1732 Other and open 50000 3000 3000 15
1733 Other and open 50000 3000 3000 15
1734 Other and open 50000 3000 3000 15
1735 Other and open 50000 3000 3000 15
1736 Bilateral ingui 50000 3000 3000 15
1737 Unilateral repa 50000 3000 3000 15
1738 Other unilater 50000 3000 3000 15
1739 Bilateral repai 50000 3000 3000 15
1740 Other bilatera 50000 3000 3000 15
1741 Other and open 50000 3000 3000 15
1742 Laparoscopic r 50000 3000 3000 15
1743 Other laparosc 50000 3000 3000 15
1744 Other open umb 50000 3000 3000 15
1745 Incisional hern 50000 3000 3000 15
1746 Repair of othe 50000 3000 3000 15
1747 Other open inci 50000 3000 3000 15
1748 Laparoscopic i 50000 3000 3000 15
1749 Other laparosc 50000 3000 3000 15
1750 Other and open 50000 3000 3000 15
1751 Laparoscopic 50000 3000 3000 15
1752 Other and ope 50000 3000 3000 15
1753 Repair of diap 50000 3000 3000 15
1754 Repair of diap 50000 3000 3000 15
1755 Plication of t 50000 3000 3000 15
1756 Repair of para 50000 3000 3000 15
1757 Laparoscopic r 50000 3000 3000 15
1758 Other and open 50000 3000 3000 15
1759 Other hernia r 50000 3000 3000 15
1760 Incision of ab 50000 3000 3000 15
1761 Exploratory l 50000 3000 3000 15

Page 36
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1762 Reopening of r 50000 3000 3000 15
1763 Other laparot 50000 3000 3000 15
1764 Laparoscopy 50000 3000 3000 15
1765 Biopsy of abdo 50000 3000 3000 15
1766 Biopsy of per 50000 3000 3000 15
1767 Closed [percut 50000 3000 3000 15
1768 Peritoneal lav 50000 3000 3000 15
1769 Other diagnos 50000 3000 3000 15
1770 Excision or de 50000 3000 3000 15
1771 Excision or des 50000 3000 3000 15
1772 Laparoscopic l 50000 3000 3000 15
1773 Other lysis of 50000 3000 3000 15
1774 Reclosure of p 50000 3000 3000 15
1775 Delayed closu 50000 3000 3000 15
1776 Other suture o 50000 3000 3000 15
1777 Suture of per 50000 3000 3000 15
1778 Repair of gast 50000 3000 3000 15
1779 Other repair o 50000 3000 3000 15
1780 Other repair o 50000 3000 3000 15
1781 Other repair 50000 3000 3000 15
1782 Other repair o 50000 3000 3000 15
1783 Percutaneous 50000 3000 3000 15
1784 Removal of for 50000 3000 3000 15
1785 Creation of cu 50000 3000 3000 15
1786 Creation of pe 50000 3000 3000 15
1787 Incision of pe 50000 3000 3000 15
1788 Injection of ai 50000 3000 3000 15
1789 Injection of lo 50000 3000 3000 15
1790 Peritoneal dial 50000 3000 3000 15
1791 Other operatio 50000 3000 3000 15
1792 Nephrotomy 50000 3000 3000 15
1793 Nephrostomy 50000 3000 3000 15
1794 Percutaneous 50000 3000 3000 15
1795 Percutaneous 50000 3000 3000 15
1796 Pyelotomy 50000 3000 3000 15
1797 Pyelostomy 50000 3000 3000 15
1798 Nephroscopy 50000 3000 3000 15
1799 Pyeloscopy 50000 3000 3000 15
1800 Closed [percut 50000 3000 3000 15
1801 Open biopsy o 50000 3000 3000 15
1802 Other diagnos 50000 3000 3000 15
1803 Marsupializati 50000 3000 3000 15
1804 Open ablation 50000 3000 3000 15
1805 Percutaneous a 50000 3000 3000 15
1806 Laparoscopic a 50000 3000 3000 15
1807 Other and unsp 50000 3000 3000 15
1808 Other local des 50000 3000 3000 15
1809 Partial nephr 50000 3000 3000 15
1810 Nephroureter 50000 3000 3000 15

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1811 Nephrectomy o 50000 3000 3000 15
1812 Removal of tra 50000 3000 3000 15
1813 Bilateral neph 50000 3000 3000 15
1814 Renal autotran 50000 3000 3000 15
1815 Other kidney t 50000 3000 3000 15
1816 Nephropexy 50000 3000 3000 15
1817 Suture of lace 50000 3000 3000 15
1818 Closure of ne 50000 3000 3000 15
1819 Closure of othe 50000 3000 3000 15
1820 Reduction of t 50000 3000 3000 15
1821 Symphysiotomy 50000 3000 3000 15
1822 Anastomosis o 50000 3000 3000 15
1823 Correction of 50000 3000 3000 15
1824 Other repair o 50000 3000 3000 15
1825 Decapsulation 50000 3000 3000 15
1826 Percutaneous a 50000 3000 3000 15
1827 Replacement o 50000 3000 3000 15
1828 Replacement o 50000 3000 3000 15
1829 Local perfusio 50000 3000 3000 15
1830 Other injectio 50000 3000 3000 15
1831 Implantation o 50000 3000 3000 15
1832 Removal of me 50000 3000 3000 15
1833 Other operati 50000 3000 3000 15
1834 Transurethral 50000 3000 3000 15
1835 Ureteral meat 50000 3000 3000 15
1836 Ureterotomy 50000 3000 3000 15
1837 Ureteroscopy 50000 3000 3000 15
1838 Closed percut 50000 3000 3000 15
1839 Closed endosco 50000 3000 3000 15
1840 Open biopsy of 50000 3000 3000 15
1841 Endoscopy (cys 50000 3000 3000 15
1842 Other diagnost 50000 3000 3000 15
1843 Ureterectomy, 50000 3000 3000 15
1844 Partial ureter 50000 3000 3000 15
1845 Total ureterec 50000 3000 3000 15
1846 Formation of 50000 3000 3000 15
1847 Revision of cu 50000 3000 3000 15
1848 Formation of 50000 3000 3000 15
1849 Revision of o 50000 3000 3000 15
1850 Urinary diversi 50000 3000 3000 15
1851 Revision of ur 50000 3000 3000 15
1852 Nephrocystana 50000 3000 3000 15
1853 Ureteroneocys 50000 3000 3000 15
1854 Transureterou 50000 3000 3000 15
1855 Other anastomo 50000 3000 3000 15
1856 Lysis of intra 50000 3000 3000 15
1857 Suture of lacer 50000 3000 3000 15
1858 Closure of ur 50000 3000 3000 15
1859 Closure of othe 50000 3000 3000 15

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1860 Ureteropexy 50000 3000 3000 15
1861 Removal of lig 50000 3000 3000 15
1862 Other repair of 50000 3000 3000 15
1863 Dilation of ur 50000 3000 3000 15
1864 Implantation of 50000 3000 3000 15
1865 Replacement of 50000 3000 3000 15
1866 Removal of ele 50000 3000 3000 15
1867 Ligation of ure 50000 3000 3000 15
1868 Other operatio 50000 3000 3000 15
1869 Transurethral 50000 3000 3000 15
1870 Percutaneous a 50000 3000 3000 15
1871 Lysis of intral 50000 3000 3000 15
1872 Percutaneous 50000 3000 3000 15
1873 Other suprapu 50000 3000 3000 15
1874 Other cystoto 50000 3000 3000 15
1875 Vesicostomy 50000 3000 3000 15
1876 Revision or cl 50000 3000 3000 15
1877 Cystoscopy thr 50000 3000 3000 15
1878 Other cystosc 50000 3000 3000 15
1879 Closed [transu 50000 3000 3000 15
1880 Open biopsy o 50000 3000 3000 15
1881 Other diagnos 50000 3000 3000 15
1882 Transurethral 50000 3000 3000 15
1883 Other transuret 50000 3000 3000 15
1884 Excision of ur 50000 3000 3000 15
1885 Open excision 50000 3000 3000 15
1886 Partial cystec 50000 3000 3000 15
1887 Radical cyste 50000 3000 3000 15
1888 Other total cy 50000 3000 3000 15
1889 Suture of lace 50000 3000 3000 15
1890 Closure of cy 50000 3000 3000 15
1891 Repair of fistu 50000 3000 3000 15
1892 Repair of other 50000 3000 3000 15
1893 Cystourethropl 50000 3000 3000 15
1894 Repair of blad 50000 3000 3000 15
1895 Reconstruction 50000 3000 3000 15
1896 Other anastom 50000 3000 3000 15
1897 Other repair o 50000 3000 3000 15
1898 Sphincterotom 50000 3000 3000 15
1899 Dilation of bl 50000 3000 3000 15
1900 Control of (po 50000 3000 3000 15
1901 Insertion of in 50000 3000 3000 15
1902 Replacement of 50000 3000 3000 15
1903 Implantation o 50000 3000 3000 15
1904 Replacement of 50000 3000 3000 15
1905 Removal of ele 50000 3000 3000 15
1906 Other operati 50000 3000 3000 15
1907 Urethrotomy 50000 3000 3000 15
1908 Urethral meat 50000 3000 3000 15

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1909 Perineal uret 50000 3000 3000 15
1910 Other urethro 50000 3000 3000 15
1911 Biopsy of uret 50000 3000 3000 15
1912 Biopsy of periu 50000 3000 3000 15
1913 Other diagnost 50000 3000 3000 15
1914 Endoscopic exc 50000 3000 3000 15
1915 Other local exc 50000 3000 3000 15
1916 Suture of lacer 50000 3000 3000 15
1917 Closure of ur 50000 3000 3000 15
1918 Closure of othe 50000 3000 3000 15
1919 Reanastomosis 50000 3000 3000 15
1920 Repair of hyp 50000 3000 3000 15
1921 Other reconstr 50000 3000 3000 15
1922 Urethral meato 50000 3000 3000 15
1923 Other repair o 50000 3000 3000 15
1924 Release of uret 50000 3000 3000 15
1925 Dilation of ure 50000 3000 3000 15
1926 Incision of per 50000 3000 3000 15
1927 Excision of per 50000 3000 3000 15
1928 Implantation of 50000 3000 3000 15
1929 Other operatio 50000 3000 3000 15
1930 Retroperitonea 50000 3000 3000 15
1931 Other lysis of 50000 3000 3000 15
1932 Laparoscopic l 50000 3000 3000 15
1933 Other incision 50000 3000 3000 15
1934 Other lysis of 50000 3000 3000 15
1935 Laparoscopic l 50000 3000 3000 15
1936 Other incision 50000 3000 3000 15
1937 Biopsy of perir 50000 3000 3000 15
1938 Other diagnost 50000 3000 3000 15
1939 Plication of ur 50000 3000 3000 15
1940 Suprapubic sli 50000 3000 3000 15
1941 Retropubic ur 50000 3000 3000 15
1942 Paraurethral 50000 3000 3000 15
1943 Levator muscle 50000 3000 3000 15
1944 Injection of i 50000 3000 3000 15
1945 Other repair o 50000 3000 3000 15
1946 Ureteral cathe 50000 3000 3000 15
1947 Excision of per 50000 3000 3000 15
1948 Other operatio 50000 3000 3000 15
1949 Replacement o 50000 3000 3000 15
1950 Replacement o 50000 3000 3000 15
1951 Ultrasonic fra 50000 3000 3000 15
1952 Other operatio 50000 3000 3000 15
1953 Incision of pro 50000 3000 3000 15
1954 Closed [percut 50000 3000 3000 15
1955 Open biopsy o 50000 3000 3000 15
1956 Closed [percut 50000 3000 3000 15
1957 Open biopsy of 50000 3000 3000 15

Page 40
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1958 Biopsy of perip 50000 3000 3000 15
1959 Other diagnost 50000 3000 3000 15
1960 Other diagnost 50000 3000 3000 15
1961 Transurethral 50000 3000 3000 15
1962 Other transure 50000 3000 3000 15
1963 Suprapubic pr 50000 3000 3000 15
1964 Retropubic pr 50000 3000 3000 15
1965 Radical prost 50000 3000 3000 15
1966 Local excision 50000 3000 3000 15
1967 Perineal pros 50000 3000 3000 15
1968 Other prostat 50000 3000 3000 15
1969 Percutaneous a 50000 3000 3000 15
1970 Incision of sem 50000 3000 3000 15
1971 Excision of se 50000 3000 3000 15
1972 Other operatio 50000 3000 3000 15
1973 Incision of per 50000 3000 3000 15
1974 Excision of per 50000 3000 3000 15
1975 Percutaneous a 50000 3000 3000 15
1976 Injection into 50000 3000 3000 15
1977 Repair of pros 50000 3000 3000 15
1978 Control of (po 50000 3000 3000 15
1979 Transurethral b 50000 3000 3000 15
1980 Transurethral 50000 3000 3000 15
1981 Other transure 50000 3000 3000 15
1982 Other operatio 50000 3000 3000 15
1983 Incision and d 50000 3000 3000 15
1984 Biopsy of scro 50000 3000 3000 15
1985 Other diagnost 50000 3000 3000 15
1986 Excision of hyd 50000 3000 3000 15
1987 Excision or des 50000 3000 3000 15
1988 Suture of lace 50000 3000 3000 15
1989 Repair of scrot 50000 3000 3000 15
1990 Other repair o 50000 3000 3000 15
1991 Percutaneous a 50000 3000 3000 15
1992 Excision of le 50000 3000 3000 15
1993 Other operatio 50000 3000 3000 15
1994 Incision of test 50000 3000 3000 15
1995 Closed [percut 50000 3000 3000 15
1996 Open biopsy of 50000 3000 3000 15
1997 Other diagnost 50000 3000 3000 15
1998 Excision or des 50000 3000 3000 15
1999 Unilateral orc 50000 3000 3000 15
2000 Removal of bo 50000 3000 3000 15
2001 Removal of rem 50000 3000 3000 15
2002 Orchiopexy 50000 3000 3000 15
2003 Suture of lacer 50000 3000 3000 15
2004 Other repair of 50000 3000 3000 15
2005 Insertion of te 50000 3000 3000 15
2006 Aspiration of t 50000 3000 3000 15

Page 41
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2007 Injection of th 50000 3000 3000 15
2008 Other operatio 50000 3000 3000 15
2009 Biopsy of sper 50000 3000 3000 15
2010 Other diagnost 50000 3000 3000 15
2011 Excision of va 50000 3000 3000 15
2012 Excision of cy 50000 3000 3000 15
2013 Excision of ot 50000 3000 3000 15
2014 Epididymecto 50000 3000 3000 15
2015 Suture of lace 50000 3000 3000 15
2016 Reduction of t 50000 3000 3000 15
2017 Transplantatio 50000 3000 3000 15
2018 Other repair o 50000 3000 3000 15
2019 Vasotomy 50000 3000 3000 15
2020 Male steriliza 50000 3000 3000 15
2021 Ligation of va 50000 3000 3000 15
2022 Ligation of sp 50000 3000 3000 15
2023 Vasectomy 50000 3000 3000 15
2024 Suture of lace 50000 3000 3000 15
2025 Reconstruction 50000 3000 3000 15
2026 Epididymovas 50000 3000 3000 15
2027 Removal of lig 50000 3000 3000 15
2028 Removal of va 50000 3000 3000 15
2029 Other repair o 50000 3000 3000 15
2030 Aspiration of 50000 3000 3000 15
2031 Epididymotom 50000 3000 3000 15
2032 Incision of sp 50000 3000 3000 15
2033 Lysis of adhes 50000 3000 3000 15
2034 Insertion of v 50000 3000 3000 15
2035 Other operatio 50000 3000 3000 15
2036 Circumcision 50000 3000 3000 15
2037 Biopsy of peni 50000 3000 3000 15
2038 Other diagnos 50000 3000 3000 15
2039 Local excision 50000 3000 3000 15
2040 Amputation of 50000 3000 3000 15
2041 Suture of lace 50000 3000 3000 15
2042 Release of ch 50000 3000 3000 15
2043 Construction o 50000 3000 3000 15
2044 Reconstruction 50000 3000 3000 15
2045 Replantation o 50000 3000 3000 15
2046 Other repair o 50000 3000 3000 15
2047 Operations for 50000 3000 3000 15
2048 Dorsal or later 50000 3000 3000 15
2049 Incision of pen 50000 3000 3000 15
2050 Division of pe 50000 3000 3000 15
2051 Fitting of exte 50000 3000 3000 15
2052 Insertion or r 50000 3000 3000 15
2053 Removal of int 50000 3000 3000 15
2054 Insertion or re 50000 3000 3000 15
2055 Other operatio 50000 3000 3000 15

Page 42
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2056 Other operatio 50000 3000 3000 15
2057 Laparoscopic 50000 3000 3000 15
2058 Other oophor 50000 3000 3000 15
2059 Aspiration bio 50000 3000 3000 15
2060 Other biopsy o 50000 3000 3000 15
2061 Laparoscopic 50000 3000 3000 15
2062 Other laparosc 50000 3000 3000 15
2063 Other diagnost 50000 3000 3000 15
2064 Marsupializati 50000 3000 3000 15
2065 Wedge resecti 50000 3000 3000 15
2066 Laparoscopic m 50000 3000 3000 15
2067 Laparoscopic 50000 3000 3000 15
2068 Other laparosc 50000 3000 3000 15
2069 Other local ex 50000 3000 3000 15
2070 Laparoscopic 50000 3000 3000 15
2071 Other unilate 50000 3000 3000 15
2072 Laparoscopic 50000 3000 3000 15
2073 Other unilater 50000 3000 3000 15
2074 Other removal 50000 3000 3000 15
2075 Other removal 50000 3000 3000 15
2076 Laparoscopic 50000 3000 3000 15
2077 Laparoscopic 50000 3000 3000 15
2078 Other removal 50000 3000 3000 15
2079 Other removal 50000 3000 3000 15
2080 Laparoscopic 50000 3000 3000 15
2081 Laparoscopic 50000 3000 3000 15
2082 Other simple s 50000 3000 3000 15
2083 Other reimplan 50000 3000 3000 15
2084 Other salping 50000 3000 3000 15
2085 Laparoscopic s 50000 3000 3000 15
2086 Laparoscopic r 50000 3000 3000 15
2087 Laparoscopic 50000 3000 3000 15
2088 Other repair o 50000 3000 3000 15
2089 Laparoscopic l 50000 3000 3000 15
2090 Other lysis of 50000 3000 3000 15
2091 Aspiration of 50000 3000 3000 15
2092 Transplantatio 50000 3000 3000 15
2093 Manual rupture 50000 3000 3000 15
2094 Ovarian dener 50000 3000 3000 15
2095 Release of tor 50000 3000 3000 15
2096 Other operati 50000 3000 3000 15
2097 Salpingotomy 50000 3000 3000 15
2098 Salpingostom 50000 3000 3000 15
2099 Biopsy of fall 50000 3000 3000 15
2100 Other diagnost 50000 3000 3000 15
2101 Bilateral endo 50000 3000 3000 15
2102 Bilateral endos 50000 3000 3000 15
2103 Other bilatera 50000 3000 3000 15
2104 Other bilateral 50000 3000 3000 15

Page 43
Sheet1
2105 Other bilateral 50000 3000 3000 15
2106 Other bilateral 50000 3000 3000 15
2107 Total unilater 50000 3000 3000 15
2108 Removal of bot 50000 3000 3000 15
2109 Removal of rem 50000 3000 3000 15
2110 Excision or des 50000 3000 3000 15
2111 Salpingectomy 50000 3000 3000 15
2112 Bilateral parti 50000 3000 3000 15
2113 Other partial 50000 3000 3000 15
2114 Simple suture 50000 3000 3000 15
2115 Salpingo-oop 50000 3000 3000 15
2116 Salpingo-salp 50000 3000 3000 15
2117 Salpingo-uter 50000 3000 3000 15
2118 Other repair of 50000 3000 3000 15
2119 Insufflation of 50000 3000 3000 15
2120 Aspiration of f 50000 3000 3000 15
2121 Unilateral dest 50000 3000 3000 15
2122 Implantation o 50000 3000 3000 15
2123 Removal of pro 50000 3000 3000 15
2124 Insufflation of 50000 3000 3000 15
2125 Dilation of fal 50000 3000 3000 15
2126 Burying of fimb 50000 3000 3000 15
2127 Other operatio 50000 3000 3000 15
2128 Dilation of cer 50000 3000 3000 15
2129 Endocervical 50000 3000 3000 15
2130 Other cervical 50000 3000 3000 15
2131 Other diagnost 50000 3000 3000 15
2132 Conization of 50000 3000 3000 15
2133 Marsupializatio 50000 3000 3000 15
2134 Destruction of 50000 3000 3000 15
2135 Destruction of 50000 3000 3000 15
2136 Other excision 50000 3000 3000 15
2137 Amputation of 50000 3000 3000 15
2138 Transabdominal 50000 3000 3000 15
2139 Other repair of 50000 3000 3000 15
2140 Suture of lacer 50000 3000 3000 15
2141 Repair of fistu 50000 3000 3000 15
2142 Other repair of 50000 3000 3000 15
2143 Hysterotomy 50000 3000 3000 15
2144 Digital examin 50000 3000 3000 15
2145 Hysteroscopy 50000 3000 3000 15
2146 Open biopsy o 50000 3000 3000 15
2147 Open biopsy of 50000 3000 3000 15
2148 Closed biopsy 50000 3000 3000 15
2149 Closed biopsy 50000 3000 3000 15
2150 Other diagnost 50000 3000 3000 15
2151 Division of en 50000 3000 3000 15
2152 Incision or ex 50000 3000 3000 15
2153 Endometrial ab 50000 3000 3000 15

Page 44
Sheet1
2154 Uterine artery 50000 3000 3000 15
2155 Uterine artery 50000 3000 3000 15
2156 Other excision 50000 3000 3000 15
2157 Laparoscopic 50000 3000 3000 15
2158 Other and uns 50000 3000 3000 15
2159 Laparoscopic 50000 3000 3000 15
2160 Other and uns 50000 3000 3000 15
2161 Laparoscopica 50000 3000 3000 15
2162 Other and uns 50000 3000 3000 15
2163 Laparoscopic 50000 3000 3000 15
2164 Other and uns 50000 3000 3000 15
2165 Laparoscopic 50000 3000 3000 15
2166 Other and unsp 50000 3000 3000 15
2167 Pelvic eviscer 50000 3000 3000 15
2168 Other and uns 50000 3000 3000 15
2169 Dilation and c 50000 3000 3000 15
2170 Dilation and cu 50000 3000 3000 15
2171 Other dilation 50000 3000 3000 15
2172 Other excision 50000 3000 3000 15
2173 Interposition 50000 3000 3000 15
2174 Other uterine 50000 3000 3000 15
2175 Vaginal repair 50000 3000 3000 15
2176 Other repair o 50000 3000 3000 15
2177 Paracervical u 50000 3000 3000 15
2178 Suture of lace 50000 3000 3000 15
2179 Closure of fist 50000 3000 3000 15
2180 Other repair o 50000 3000 3000 15
2181 Aspiration cur 50000 3000 3000 15
2182 Aspiration cure 50000 3000 3000 15
2183 Other aspirati 50000 3000 3000 15
2184 Menstrual extr 50000 3000 3000 15
2185 Insertion of in 50000 3000 3000 15
2186 Insertion of th 50000 3000 3000 15
2187 Artificial inse 50000 3000 3000 15
2188 Insertion of la 50000 3000 3000 15
2189 Manual replac 50000 3000 3000 15
2190 Incision of cer 50000 3000 3000 15
2191 Removal of cer 50000 3000 3000 15
2192 Removal of oth 50000 3000 3000 15
2193 Other operatio 50000 3000 3000 15
2194 Other operatio 50000 3000 3000 15
2195 Culdocentesis 50000 3000 3000 15
2196 Hymenotomy 50000 3000 3000 15
2197 Culdotomy 50000 3000 3000 15
2198 Lysis of intra 50000 3000 3000 15
2199 Other vaginot 50000 3000 3000 15
2200 Vaginoscopy 50000 3000 3000 15
2201 Culdoscopy 50000 3000 3000 15
2202 Biopsy of cul- 50000 3000 3000 15

Page 45
Sheet1
2203 Vaginal biopsy 50000 3000 3000 15
2204 Other diagnos 50000 3000 3000 15
2205 Hymenectomy 50000 3000 3000 15
2206 Excision or des 50000 3000 3000 15
2207 Excision or des 50000 3000 3000 15
2208 Obliteration an 50000 3000 3000 15
2209 Repair of cyst 50000 3000 3000 15
2210 Repair of cyst 50000 3000 3000 15
2211 Repair of rect 50000 3000 3000 15
2212 Repair of cyst 50000 3000 3000 15
2213 Repair of cysto 50000 3000 3000 15
2214 Repair of recto 50000 3000 3000 15
2215 Vaginal constr 50000 3000 3000 15
2216 Vaginal recons 50000 3000 3000 15
2217 Vaginal constru 50000 3000 3000 15
2218 Vaginal recons 50000 3000 3000 15
2219 Suture of lace 50000 3000 3000 15
2220 Repair of colov 50000 3000 3000 15
2221 Repair of recto 50000 3000 3000 15
2222 Repair of other 50000 3000 3000 15
2223 Repair of other 50000 3000 3000 15
2224 Hymenorrhap 50000 3000 3000 15
2225 Vaginal suspen 50000 3000 3000 15
2226 Vaginal suspen 50000 3000 3000 15
2227 Other repair o 50000 3000 3000 15
2228 Obliteration of 50000 3000 3000 15
2229 Other operati 50000 3000 3000 15
2230 Other operatio 50000 3000 3000 15
2231 Other operatio 50000 3000 3000 15
2232 Insertion of bi 50000 3000 3000 15
2233 Insertion of sy 50000 3000 3000 15
2234 Lysis of vulva 50000 3000 3000 15
2235 Other incision 50000 3000 3000 15
2236 Biopsy of vulv 50000 3000 3000 15
2237 Other diagnost 50000 3000 3000 15
2238 Percutaneous a 50000 3000 3000 15
2239 Incision of Bar 50000 3000 3000 15
2240 Marsupializatio 50000 3000 3000 15
2241 Excision or oth 50000 3000 3000 15
2242 Other operatio 50000 3000 3000 15
2243 Other local ex 50000 3000 3000 15
2244 Operations on c 50000 3000 3000 15
2245 Radical vulve 50000 3000 3000 15
2246 Unilateral vul 50000 3000 3000 15
2247 Bilateral vulv 50000 3000 3000 15
2248 Suture of lace 50000 3000 3000 15
2249 Repair of fist 50000 3000 3000 15
2250 Other repair o 50000 3000 3000 15
2251 Other operatio 50000 3000 3000 15

Page 46
Sheet1
2252 Other operatio 50000 3000 3000 15
2253 Low forceps o 50000 3000 3000 15
2254 Low forceps op 50000 3000 3000 15
2255 Mid forceps op 50000 3000 3000 15
2256 Other mid forc 50000 3000 3000 15
2257 High forceps o 50000 3000 3000 15
2258 Other high for 50000 3000 3000 15
2259 Forceps rotati 50000 3000 3000 15
2260 Partial breech 50000 3000 3000 15
2261 Other partial 50000 3000 3000 15
2262 Total breech e 50000 3000 3000 15
2263 Other total br 50000 3000 3000 15
2264 Forceps applic 50000 3000 3000 15
2265 Vacuum extrac 50000 3000 3000 15
2266 Other vacuum 50000 3000 3000 15
2267 Other specifie 50000 3000 3000 15
2268 Unspecified in 50000 3000 3000 15
2269 Induction of l 50000 3000 3000 15
2270 Other artifici 50000 3000 3000 15
2271 Other surgical 50000 3000 3000 15
2272 Internal and c 50000 3000 3000 15
2273 Internal and c 50000 3000 3000 15
2274 Failed forceps 50000 3000 3000 15
2275 Medical induct 50000 3000 3000 15
2276 Manual rotatio 50000 3000 3000 15
2277 Other manually 50000 3000 3000 15
2278 Episiotomy 50000 3000 3000 15
2279 Operations on f 50000 3000 3000 15
2280 External versi 50000 3000 3000 15
2281 Replacement o 50000 3000 3000 15
2282 Incision of cer 50000 3000 3000 15
2283 Pubiotomy to a 50000 3000 3000 15
2284 Other operatio 50000 3000 3000 15
2285 Classical cesa 50000 3000 3000 15
2286 Low cervical c 50000 3000 3000 15
2287 Extraperitonea 50000 3000 3000 15
2288 Removal of ex 50000 3000 3000 15
2289 Cesarean secti 50000 3000 3000 15
2290 Hysterotomy t 50000 3000 3000 15
2291 Other cesarean 50000 3000 3000 15
2292 Intra-amniotic 50000 3000 3000 15
2293 Diagnostic am 50000 3000 3000 15
2294 Intrauterine tr 50000 3000 3000 15
2295 Amnioscopy 50000 3000 3000 15
2296 Fetal EKG (sc 50000 3000 3000 15
2297 Fetal blood s 50000 3000 3000 15
2298 Other fetal mo 50000 3000 3000 15
2299 Other diagnos 50000 3000 3000 15
2300 Correction of f 50000 3000 3000 15

Page 47
Sheet1
2301 Amnioinfusion 50000 3000 3000 15
2302 Fetal pulse ox 50000 3000 3000 15
2303 Manual remova 50000 3000 3000 15
2304 Repair of curre 50000 3000 3000 15
2305 Repair of curre 50000 3000 3000 15
2306 Repair of curre 50000 3000 3000 15
2307 Repair of curr 50000 3000 3000 15
2308 Repair of curr 50000 3000 3000 15
2309 Repair of other 50000 3000 3000 15
2310 Manual explora 50000 3000 3000 15
2311 Obstetric tamp 50000 3000 3000 15
2312 Evacuation of 50000 3000 3000 15
2313 Evacuation of 50000 3000 3000 15
2314 Surgical corre 50000 3000 3000 15
2315 Immediate pos 50000 3000 3000 15
2316 Other obstetri 50000 3000 3000 15
2317 Sequestrectom 50000 3000 3000 15
2318 Other incision 50000 3000 3000 15
2319 Biopsy of faci 50000 3000 3000 15
2320 Other diagnost 50000 3000 3000 15
2321 Local excision 50000 3000 3000 15
2322 Partial mandi 50000 3000 3000 15
2323 Partial ostect 50000 3000 3000 15
2324 Total mandibu 50000 3000 3000 15
2325 Other total m 50000 3000 3000 15
2326 Other reconstr 50000 3000 3000 15
2327 Total ostectom 50000 3000 3000 15
2328 Other total os 50000 3000 3000 15
2329 Other reconstr 50000 3000 3000 15
2330 Temporomandib 50000 3000 3000 15
2331 Closed osteop 50000 3000 3000 15
2332 Open osteopla 50000 3000 3000 15
2333 Osteoplasty [o 50000 3000 3000 15
2334 Other orthogn 50000 3000 3000 15
2335 Segmental oste 50000 3000 3000 15
2336 Total osteopla 50000 3000 3000 15
2337 Reduction gen 50000 3000 3000 15
2338 Augmentation 50000 3000 3000 15
2339 Other facial b 50000 3000 3000 15
2340 Reduction of fa 50000 3000 3000 15
2341 Closed reducti 50000 3000 3000 15
2342 Open reduction 50000 3000 3000 15
2343 Closed reducti 50000 3000 3000 15
2344 Open reduction 50000 3000 3000 15
2345 Closed reducti 50000 3000 3000 15
2346 Open reduction 50000 3000 3000 15
2347 Open reduction 50000 3000 3000 15
2348 Other closed re 50000 3000 3000 15
2349 Other open red 50000 3000 3000 15

Page 48
Sheet1
2350 Bone graft to 50000 3000 3000 15
2351 Insertion of sy 50000 3000 3000 15
2352 Closed reducti 50000 3000 3000 15
2353 Open reductio 50000 3000 3000 15
2354 Other manipula 50000 3000 3000 15
2355 Injection of t 50000 3000 3000 15
2356 Removal of int 50000 3000 3000 15
2357 Other operatio 50000 3000 3000 15
2358 Sequestrectomy 50000 3000 3000 15
2359 Sequestrectomy 50000 3000 3000 15
2360 Sequestrecto 50000 3000 3000 15
2361 Sequestrectom 50000 3000 3000 15
2362 Sequestrectom 50000 3000 3000 15
2363 Sequestrectom 50000 3000 3000 15
2364 Sequestrectom 50000 3000 3000 15
2365 Sequestrectomy 50000 3000 3000 15
2366 Sequestrectom 50000 3000 3000 15
2367 Sequestrectom 50000 3000 3000 15
2368 Other incision 50000 3000 3000 15
2369 Other incision 50000 3000 3000 15
2370 Other incision 50000 3000 3000 15
2371 Other incision 50000 3000 3000 15
2372 Other incision 50000 3000 3000 15
2373 Other incision 50000 3000 3000 15
2374 Other incision 50000 3000 3000 15
2375 Other incision 50000 3000 3000 15
2376 Other incision 50000 3000 3000 15
2377 Other incision 50000 3000 3000 15
2378 Wedge osteoto 50000 3000 3000 15
2379 Wedge osteotom 50000 3000 3000 15
2380 Wedge osteot 50000 3000 3000 15
2381 Wedge osteoto 50000 3000 3000 15
2382 Wedge osteoto 50000 3000 3000 15
2383 Wedge osteot 50000 3000 3000 15
2384 Wedge osteoto 50000 3000 3000 15
2385 Wedge osteotom 50000 3000 3000 15
2386 Wedge osteoto 50000 3000 3000 15
2387 Wedge osteoto 50000 3000 3000 15
2388 Other division 50000 3000 3000 15
2389 Other division 50000 3000 3000 15
2390 Other division 50000 3000 3000 15
2391 Other division 50000 3000 3000 15
2392 Other division 50000 3000 3000 15
2393 Other division 50000 3000 3000 15
2394 Other division 50000 3000 3000 15
2395 Other division 50000 3000 3000 15
2396 Other division 50000 3000 3000 15
2397 Other division 50000 3000 3000 15
2398 Biopsy of bone 50000 3000 3000 15

Page 49
Sheet1
2399 Biopsy of bone 50000 3000 3000 15
2400 Biopsy of bon 50000 3000 3000 15
2401 Biopsy of bone 50000 3000 3000 15
2402 Biopsy of bon 50000 3000 3000 15
2403 Biopsy of bon 50000 3000 3000 15
2404 Biopsy of bone 50000 3000 3000 15
2405 Biopsy of bone, 50000 3000 3000 15
2406 Biopsy of bone 50000 3000 3000 15
2407 Biopsy of bon 50000 3000 3000 15
2408 Bunionectomy w 50000 3000 3000 15
2409 Bunionectomy w 50000 3000 3000 15
2410 Other bunionec 50000 3000 3000 15
2411 Excision or co 50000 3000 3000 15
2412 Repair of ham 50000 3000 3000 15
2413 Repair of claw 50000 3000 3000 15
2414 Other excision 50000 3000 3000 15
2415 Other bunion 50000 3000 3000 15
2416 Local excision 50000 3000 3000 15
2417 Local excision 50000 3000 3000 15
2418 Local excision 50000 3000 3000 15
2419 Local excision 50000 3000 3000 15
2420 Local excision 50000 3000 3000 15
2421 Local excision 50000 3000 3000 15
2422 Local excision 50000 3000 3000 15
2423 Local excision 50000 3000 3000 15
2424 Local excision 50000 3000 3000 15
2425 Local excision 50000 3000 3000 15
2426 Excision of bon 50000 3000 3000 15
2427 Excision of bon 50000 3000 3000 15
2428 Excision of bo 50000 3000 3000 15
2429 Excision of bo 50000 3000 3000 15
2430 Excision of bo 50000 3000 3000 15
2431 Excision of bo 50000 3000 3000 15
2432 Excision of bon 50000 3000 3000 15
2433 Excision of bon 50000 3000 3000 15
2434 Excision of bo 50000 3000 3000 15
2435 Excision of bo 50000 3000 3000 15
2436 Other partial 50000 3000 3000 15
2437 Other partial 50000 3000 3000 15
2438 Other partial 50000 3000 3000 15
2439 Other partial 50000 3000 3000 15
2440 Other partial 50000 3000 3000 15
2441 Other partial 50000 3000 3000 15
2442 Other partial 50000 3000 3000 15
2443 Other partial o 50000 3000 3000 15
2444 Other partial 50000 3000 3000 15
2445 Other partial 50000 3000 3000 15
2446 Total ostectom 50000 3000 3000 15
2447 Total ostectom 50000 3000 3000 15

Page 50
Sheet1
2448 Total ostecto 50000 3000 3000 15
2449 Total ostectom 50000 3000 3000 15
2450 Total ostectom 50000 3000 3000 15
2451 Total ostectom 50000 3000 3000 15
2452 Total ostectom 50000 3000 3000 15
2453 Total ostectomy 50000 3000 3000 15
2454 Total ostectom 50000 3000 3000 15
2455 Total ostectom 50000 3000 3000 15
2456 Bone graft, un 50000 3000 3000 15
2457 Bone graft, sc 50000 3000 3000 15
2458 Bone graft, h 50000 3000 3000 15
2459 Bone graft, ra 50000 3000 3000 15
2460 Bone graft, ca 50000 3000 3000 15
2461 Bone graft, fe 50000 3000 3000 15
2462 Bone graft, pat 50000 3000 3000 15
2463 Bone graft, tib 50000 3000 3000 15
2464 Bone graft, ta 50000 3000 3000 15
2465 Bone graft, ot 50000 3000 3000 15
2466 Application of 50000 3000 3000 15
2467 Application of 50000 3000 3000 15
2468 Application of 50000 3000 3000 15
2469 Application of 50000 3000 3000 15
2470 Application of 50000 3000 3000 15
2471 Application of 50000 3000 3000 15
2472 Application of 50000 3000 3000 15
2473 Application of 50000 3000 3000 15
2474 Application of 50000 3000 3000 15
2475 Application of 50000 3000 3000 15
2476 Limb shortenin 50000 3000 3000 15
2477 Limb shorteni 50000 3000 3000 15
2478 Limb shortenin 50000 3000 3000 15
2479 Limb shorteni 50000 3000 3000 15
2480 Limb shorteni 50000 3000 3000 15
2481 Limb shortenin 50000 3000 3000 15
2482 Limb shortenin 50000 3000 3000 15
2483 Limb shorteni 50000 3000 3000 15
2484 Limb lengtheni 50000 3000 3000 15
2485 Limb lengthen 50000 3000 3000 15
2486 Limb lengthen 50000 3000 3000 15
2487 Limb lengthen 50000 3000 3000 15
2488 Limb lengthen 50000 3000 3000 15
2489 Limb lengtheni 50000 3000 3000 15
2490 Limb lengtheni 50000 3000 3000 15
2491 Limb lengthen 50000 3000 3000 15
2492 Other repair o 50000 3000 3000 15
2493 Other repair o 50000 3000 3000 15
2494 Other repair o 50000 3000 3000 15
2495 Other repair o 50000 3000 3000 15
2496 Other repair o 50000 3000 3000 15

Page 51
Sheet1
2497 Other repair o 50000 3000 3000 15
2498 Other repair o 50000 3000 3000 15
2499 Other repair or 50000 3000 3000 15
2500 Other repair o 50000 3000 3000 15
2501 Other repair o 50000 3000 3000 15
2502 Internal fixati 50000 3000 3000 15
2503 Internal fixati 50000 3000 3000 15
2504 Internal fixat 50000 3000 3000 15
2505 Internal fixati 50000 3000 3000 15
2506 Internal fixat 50000 3000 3000 15
2507 Internal fixati 50000 3000 3000 15
2508 Internal fixati 50000 3000 3000 15
2509 Internal fixati 50000 3000 3000 15
2510 Internal fixati 50000 3000 3000 15
2511 Internal fixati 50000 3000 3000 15
2512 Removal of imp 50000 3000 3000 15
2513 Removal of imp 50000 3000 3000 15
2514 Removal of im 50000 3000 3000 15
2515 Removal of im 50000 3000 3000 15
2516 Removal of im 50000 3000 3000 15
2517 Removal of im 50000 3000 3000 15
2518 Removal of imp 50000 3000 3000 15
2519 Removal of imp 50000 3000 3000 15
2520 Removal of imp 50000 3000 3000 15
2521 Removal of im 50000 3000 3000 15
2522 Osteoclasis, u 50000 3000 3000 15
2523 Osteoclasis, s 50000 3000 3000 15
2524 Osteoclasis, 50000 3000 3000 15
2525 Osteoclasis, r 50000 3000 3000 15
2526 Osteoclasis, 50000 3000 3000 15
2527 Osteoclasis, f 50000 3000 3000 15
2528 Osteoclasis, p 50000 3000 3000 15
2529 Osteoclasis, ti 50000 3000 3000 15
2530 Osteoclasis, t 50000 3000 3000 15
2531 Osteoclasis, o 50000 3000 3000 15
2532 Diagnostic pro 50000 3000 3000 15
2533 Diagnostic pro 50000 3000 3000 15
2534 Diagnostic pro 50000 3000 3000 15
2535 Diagnostic pro 50000 3000 3000 15
2536 Diagnostic pro 50000 3000 3000 15
2537 Diagnostic pro 50000 3000 3000 15
2538 Diagnostic pro 50000 3000 3000 15
2539 Diagnostic pro 50000 3000 3000 15
2540 Diagnostic pro 50000 3000 3000 15
2541 Diagnostic pro 50000 3000 3000 15
2542 Insertion of b 50000 3000 3000 15
2543 Insertion of b 50000 3000 3000 15
2544 Insertion of b 50000 3000 3000 15
2545 Insertion of b 50000 3000 3000 15

Page 52
Sheet1
2546 Insertion of b 50000 3000 3000 15
2547 Insertion of b 50000 3000 3000 15
2548 Insertion of bo 50000 3000 3000 15
2549 Insertion of bo 50000 3000 3000 15
2550 Insertion of b 50000 3000 3000 15
2551 Insertion of b 50000 3000 3000 15
2552 Closed reductio 50000 3000 3000 15
2553 Closed reducti 50000 3000 3000 15
2554 Closed reductio 50000 3000 3000 15
2555 Closed reducti 50000 3000 3000 15
2556 Closed reducti 50000 3000 3000 15
2557 Closed reductio 50000 3000 3000 15
2558 Closed reductio 50000 3000 3000 15
2559 Closed reductio 50000 3000 3000 15
2560 Closed reductio 50000 3000 3000 15
2561 Closed reductio 50000 3000 3000 15
2562 Closed reductio 50000 3000 3000 15
2563 Closed reducti 50000 3000 3000 15
2564 Closed reductio 50000 3000 3000 15
2565 Closed reducti 50000 3000 3000 15
2566 Closed reducti 50000 3000 3000 15
2567 Closed reductio 50000 3000 3000 15
2568 Closed reductio 50000 3000 3000 15
2569 Closed reductio 50000 3000 3000 15
2570 Closed reductio 50000 3000 3000 15
2571 Closed reductio 50000 3000 3000 15
2572 Open reduction 50000 3000 3000 15
2573 Open reduction 50000 3000 3000 15
2574 Open reduction 50000 3000 3000 15
2575 Open reduction 50000 3000 3000 15
2576 Open reduction 50000 3000 3000 15
2577 Open reduction 50000 3000 3000 15
2578 Open reduction 50000 3000 3000 15
2579 Open reduction 50000 3000 3000 15
2580 Open reduction 50000 3000 3000 15
2581 Open reduction 50000 3000 3000 15
2582 Open reduction 50000 3000 3000 15
2583 Open reduction 50000 3000 3000 15
2584 Open reduction 50000 3000 3000 15
2585 Open reduction 50000 3000 3000 15
2586 Open reduction 50000 3000 3000 15
2587 Open reduction 50000 3000 3000 15
2588 Open reduction 50000 3000 3000 15
2589 Open reduction 50000 3000 3000 15
2590 Open reduction 50000 3000 3000 15
2591 Open reduction 50000 3000 3000 15
2592 Closed reducti 50000 3000 3000 15
2593 Closed reduct 50000 3000 3000 15
2594 Closed reducti 50000 3000 3000 15

Page 53
Sheet1
2595 Closed reducti 50000 3000 3000 15
2596 Closed reducti 50000 3000 3000 15
2597 Closed reducti 50000 3000 3000 15
2598 Open reduction 50000 3000 3000 15
2599 Open reductio 50000 3000 3000 15
2600 Open reduction 50000 3000 3000 15
2601 Open reduction 50000 3000 3000 15
2602 Open reduction 50000 3000 3000 15
2603 Open reduction 50000 3000 3000 15
2604 Debridement of 50000 3000 3000 15
2605 Debridement of 50000 3000 3000 15
2606 Debridement of 50000 3000 3000 15
2607 Debridement of 50000 3000 3000 15
2608 Debridement of 50000 3000 3000 15
2609 Debridement of 50000 3000 3000 15
2610 Debridement of 50000 3000 3000 15
2611 Debridement of 50000 3000 3000 15
2612 Debridement of 50000 3000 3000 15
2613 Debridement of 50000 3000 3000 15
2614 Closed reducti 50000 3000 3000 15
2615 Closed reducti 50000 3000 3000 15
2616 Closed reducti 50000 3000 3000 15
2617 Closed reductio 50000 3000 3000 15
2618 Closed reducti 50000 3000 3000 15
2619 Closed reducti 50000 3000 3000 15
2620 Closed reducti 50000 3000 3000 15
2621 Closed reducti 50000 3000 3000 15
2622 Closed reducti 50000 3000 3000 15
2623 Closed reductio 50000 3000 3000 15
2624 Open reduction 50000 3000 3000 15
2625 Open reduction 50000 3000 3000 15
2626 Open reduction 50000 3000 3000 15
2627 Open reduction 50000 3000 3000 15
2628 Open reduction 50000 3000 3000 15
2629 Open reduction 50000 3000 3000 15
2630 Open reduction 50000 3000 3000 15
2631 Open reduction 50000 3000 3000 15
2632 Open reduction 50000 3000 3000 15
2633 Open reduction 50000 3000 3000 15
2634 Unspecified op 50000 3000 3000 15
2635 Unspecified op 50000 3000 3000 15
2636 Unspecified op 50000 3000 3000 15
2637 Unspecified op 50000 3000 3000 15
2638 Unspecified op 50000 3000 3000 15
2639 Unspecified op 50000 3000 3000 15
2640 Unspecified op 50000 3000 3000 15
2641 Unspecified op 50000 3000 3000 15
2642 Unspecified op 50000 3000 3000 15
2643 Unspecified op 50000 3000 3000 15

Page 54
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2644 Arthrotomy for 50000 3000 3000 15
2645 Arthrotomy for 50000 3000 3000 15
2646 Arthrotomy for 50000 3000 3000 15
2647 Arthrotomy for 50000 3000 3000 15
2648 Arthrotomy for 50000 3000 3000 15
2649 Arthrotomy for 50000 3000 3000 15
2650 Arthrotomy for 50000 3000 3000 15
2651 Arthrotomy for 50000 3000 3000 15
2652 Arthrotomy for 50000 3000 3000 15
2653 Arthrotomy for 50000 3000 3000 15
2654 Other arthroto 50000 3000 3000 15
2655 Other arthroto 50000 3000 3000 15
2656 Other arthrot 50000 3000 3000 15
2657 Other arthroto 50000 3000 3000 15
2658 Other arthroto 50000 3000 3000 15
2659 Other arthroto 50000 3000 3000 15
2660 Other arthrot 50000 3000 3000 15
2661 Other arthroto 50000 3000 3000 15
2662 Other arthroto 50000 3000 3000 15
2663 Other arthroto 50000 3000 3000 15
2664 Arthroscopy, u 50000 3000 3000 15
2665 Arthroscopy, s 50000 3000 3000 15
2666 Arthroscopy, 50000 3000 3000 15
2667 Arthroscopy, w 50000 3000 3000 15
2668 Arthroscopy, h 50000 3000 3000 15
2669 Arthroscopy, h 50000 3000 3000 15
2670 Arthroscopy, 50000 3000 3000 15
2671 Arthroscopy, a 50000 3000 3000 15
2672 Arthroscopy, f 50000 3000 3000 15
2673 Arthroscopy, o 50000 3000 3000 15
2674 Biopsy of joint 50000 3000 3000 15
2675 Biopsy of joint 50000 3000 3000 15
2676 Biopsy of joint 50000 3000 3000 15
2677 Biopsy of joint 50000 3000 3000 15
2678 Biopsy of joint 50000 3000 3000 15
2679 Biopsy of joint 50000 3000 3000 15
2680 Biopsy of joint 50000 3000 3000 15
2681 Biopsy of joint 50000 3000 3000 15
2682 Biopsy of joint 50000 3000 3000 15
2683 Biopsy of joint 50000 3000 3000 15
2684 Division of joi 50000 3000 3000 15
2685 Division of joi 50000 3000 3000 15
2686 Division of joi 50000 3000 3000 15
2687 Division of joi 50000 3000 3000 15
2688 Division of joi 50000 3000 3000 15
2689 Division of joi 50000 3000 3000 15
2690 Division of joi 50000 3000 3000 15
2691 Division of joi 50000 3000 3000 15
2692 Division of joi 50000 3000 3000 15

Page 55
Sheet1
2693 Division of joi 50000 3000 3000 15
2694 Excision or des 50000 3000 3000 15
2695 Excision of int 50000 3000 3000 15
2696 Intervertebral 50000 3000 3000 15
2697 Repair of the a 50000 3000 3000 15
2698 Other and unsp 50000 3000 3000 15
2699 Other destructi 50000 3000 3000 15
2700 Excision of se 50000 3000 3000 15
2701 Synovectomy, u 50000 3000 3000 15
2702 Synovectomy, 50000 3000 3000 15
2703 Synovectomy, 50000 3000 3000 15
2704 Synovectomy, 50000 3000 3000 15
2705 Synovectomy, 50000 3000 3000 15
2706 Synovectomy, 50000 3000 3000 15
2707 Synovectomy, 50000 3000 3000 15
2708 Synovectomy, 50000 3000 3000 15
2709 Synovectomy, 50000 3000 3000 15
2710 Synovectomy, o 50000 3000 3000 15
2711 Other local exc 50000 3000 3000 15
2712 Other local exc 50000 3000 3000 15
2713 Other local exc 50000 3000 3000 15
2714 Other local exc 50000 3000 3000 15
2715 Other local exc 50000 3000 3000 15
2716 Other local exc 50000 3000 3000 15
2717 Other local exc 50000 3000 3000 15
2718 Other local exc 50000 3000 3000 15
2719 Other local exc 50000 3000 3000 15
2720 Other local exc 50000 3000 3000 15
2721 Other excision 50000 3000 3000 15
2722 Other excision 50000 3000 3000 15
2723 Other excision 50000 3000 3000 15
2724 Other excision 50000 3000 3000 15
2725 Other excision 50000 3000 3000 15
2726 Other excision 50000 3000 3000 15
2727 Other excision 50000 3000 3000 15
2728 Other excision 50000 3000 3000 15
2729 Other excision 50000 3000 3000 15
2730 Other excision 50000 3000 3000 15
2731 Spinal fusion, 50000 3000 3000 15
2732 Atlas-axis spin 50000 3000 3000 15
2733 Other cervical 50000 3000 3000 15
2734 Other cervical 50000 3000 3000 15
2735 Dorsal and dor 50000 3000 3000 15
2736 Dorsal and dor 50000 3000 3000 15
2737 Lumbar and lum 50000 3000 3000 15
2738 Lumbar and lum 50000 3000 3000 15
2739 Lumbar and lum 50000 3000 3000 15
2740 Ankle fusion 50000 3000 3000 15
2741 Triple arthrode 50000 3000 3000 15

Page 56
Sheet1
2742 Subtalar fusio 50000 3000 3000 15
2743 Midtarsal fusi 50000 3000 3000 15
2744 Tarsometatarsa 50000 3000 3000 15
2745 Metatarsophal 50000 3000 3000 15
2746 Other fusion of 50000 3000 3000 15
2747 Subtalar joint 50000 3000 3000 15
2748 Arthrodesis of 50000 3000 3000 15
2749 Arthrodesis of 50000 3000 3000 15
2750 Arthrodesis of 50000 3000 3000 15
2751 Arthrodesis of 50000 3000 3000 15
2752 Arthrodesis of 50000 3000 3000 15
2753 Carporadial fu 50000 3000 3000 15
2754 Metacarpocarp 50000 3000 3000 15
2755 Metacarpophal 50000 3000 3000 15
2756 Interphalangea 50000 3000 3000 15
2757 Arthrodesis of 50000 3000 3000 15
2758 Refusion of sp 50000 3000 3000 15
2759 Refusion of at 50000 3000 3000 15
2760 Refusion of ot 50000 3000 3000 15
2761 Refusion of ot 50000 3000 3000 15
2762 Refusion of do 50000 3000 3000 15
2763 Refusion of do 50000 3000 3000 15
2764 Refusion of lu 50000 3000 3000 15
2765 Refusion of lu 50000 3000 3000 15
2766 Refusion of lu 50000 3000 3000 15
2767 Refusion of sp 50000 3000 3000 15
2768 Repair of hip, 50000 3000 3000 15
2769 Five-in-one re 50000 3000 3000 15
2770 Triad knee rep 50000 3000 3000 15
2771 Patellar stabil 50000 3000 3000 15
2772 Other repair o 50000 3000 3000 15
2773 Other repair of 50000 3000 3000 15
2774 Other repair o 50000 3000 3000 15
2775 Other repair o 50000 3000 3000 15
2776 Total hip repl 50000 3000 3000 15
2777 Partial hip re 50000 3000 3000 15
2778 Revision of hi 50000 3000 3000 15
2779 Total knee re 50000 3000 3000 15
2780 Revision of kn 50000 3000 3000 15
2781 Total ankle re 50000 3000 3000 15
2782 Replacement of 50000 3000 3000 15
2783 Revision of jo 50000 3000 3000 15
2784 Fusion or refu 50000 3000 3000 15
2785 Fusion or refu 50000 3000 3000 15
2786 Fusion or refu 50000 3000 3000 15
2787 Percutaneous 50000 3000 3000 15
2788 Percutaneous 50000 3000 3000 15
2789 Arthroplasty o 50000 3000 3000 15
2790 Arthroplasty o 50000 3000 3000 15

Page 57
Sheet1
2791 Total wrist re 50000 3000 3000 15
2792 Arthroplasty o 50000 3000 3000 15
2793 Arthroplasty o 50000 3000 3000 15
2794 Other repair of 50000 3000 3000 15
2795 Other total sh 50000 3000 3000 15
2796 Partial should 50000 3000 3000 15
2797 Repair of recu 50000 3000 3000 15
2798 Other repair o 50000 3000 3000 15
2799 Total elbow r 50000 3000 3000 15
2800 Other repair o 50000 3000 3000 15
2801 Reverse total 50000 3000 3000 15
2802 Arthrocentesis 50000 3000 3000 15
2803 Injection of th 50000 3000 3000 15
2804 Suture of caps 50000 3000 3000 15
2805 Suture of caps 50000 3000 3000 15
2806 Suture of caps 50000 3000 3000 15
2807 Other repair of 50000 3000 3000 15
2808 Revision of jo 50000 3000 3000 15
2809 Other diagnost 50000 3000 3000 15
2810 Other operatio 50000 3000 3000 15
2811 Exploration of 50000 3000 3000 15
2812 Myotomy of h 50000 3000 3000 15
2813 Bursotomy of 50000 3000 3000 15
2814 Incision and d 50000 3000 3000 15
2815 Other incision 50000 3000 3000 15
2816 Tenotomy of h 50000 3000 3000 15
2817 Fasciotomy of 50000 3000 3000 15
2818 Other division 50000 3000 3000 15
2819 Excision of le 50000 3000 3000 15
2820 Excision of le 50000 3000 3000 15
2821 Excision of oth 50000 3000 3000 15
2822 Bursectomy of 50000 3000 3000 15
2823 Excision of te 50000 3000 3000 15
2824 Other tenonec 50000 3000 3000 15
2825 Excision of mus 50000 3000 3000 15
2826 Other fasciec 50000 3000 3000 15
2827 Other myectom 50000 3000 3000 15
2828 Other excision 50000 3000 3000 15
2829 Suture of ten 50000 3000 3000 15
2830 Delayed suture 50000 3000 3000 15
2831 Delayed suture 50000 3000 3000 15
2832 Other suture o 50000 3000 3000 15
2833 Other suture o 50000 3000 3000 15
2834 Suture of musc 50000 3000 3000 15
2835 Advancement o 50000 3000 3000 15
2836 Recession of 50000 3000 3000 15
2837 Reattachment 50000 3000 3000 15
2838 Reattachment 50000 3000 3000 15
2839 Other change 50000 3000 3000 15

Page 58
Sheet1
2840 Other hand ten 50000 3000 3000 15
2841 Other hand te 50000 3000 3000 15
2842 Other hand mus 50000 3000 3000 15
2843 Other hand mu 50000 3000 3000 15
2844 Pollicization 50000 3000 3000 15
2845 Other reconstr 50000 3000 3000 15
2846 Tendon pulley 50000 3000 3000 15
2847 Plastic operat 50000 3000 3000 15
2848 Plastic operat 50000 3000 3000 15
2849 Transfer of fi 50000 3000 3000 15
2850 Repair of clef 50000 3000 3000 15
2851 Repair of mac 50000 3000 3000 15
2852 Repair of malle 50000 3000 3000 15
2853 Other tenodes 50000 3000 3000 15
2854 Other tenoplas 50000 3000 3000 15
2855 Other plastic 50000 3000 3000 15
2856 Lysis of adhes 50000 3000 3000 15
2857 Aspiration of 50000 3000 3000 15
2858 Aspiration of o 50000 3000 3000 15
2859 Injection of t 50000 3000 3000 15
2860 Injection of t 50000 3000 3000 15
2861 Other injection 50000 3000 3000 15
2862 Other operatio 50000 3000 3000 15
2863 Exploration of 50000 3000 3000 15
2864 Myotomy 50000 3000 3000 15
2865 Bursotomy 50000 3000 3000 15
2866 Other incision 50000 3000 3000 15
2867 Achillotenoto 50000 3000 3000 15
2868 Adductor teno 50000 3000 3000 15
2869 Other tenotom 50000 3000 3000 15
2870 Fasciotomy 50000 3000 3000 15
2871 Other division 50000 3000 3000 15
2872 Open biopsy of 50000 3000 3000 15
2873 Other diagnost 50000 3000 3000 15
2874 Excision of le 50000 3000 3000 15
2875 Excision of le 50000 3000 3000 15
2876 Excision of les 50000 3000 3000 15
2877 Excision of ten 50000 3000 3000 15
2878 Other tenone 50000 3000 3000 15
2879 Excision of mus 50000 3000 3000 15
2880 Other fasciec 50000 3000 3000 15
2881 Other myecto 50000 3000 3000 15
2882 Other excision 50000 3000 3000 15
2883 Bursectomy 50000 3000 3000 15
2884 Suture of ten 50000 3000 3000 15
2885 Delayed sutur 50000 3000 3000 15
2886 Rotator cuff re 50000 3000 3000 15
2887 Other suture o 50000 3000 3000 15
2888 Other suture o 50000 3000 3000 15

Page 59
Sheet1
2889 Advancement 50000 3000 3000 15
2890 Recession of 50000 3000 3000 15
2891 Reattachment 50000 3000 3000 15
2892 Reattachment 50000 3000 3000 15
2893 Tendon transfe 50000 3000 3000 15
2894 Other tendon t 50000 3000 3000 15
2895 Muscle transfe 50000 3000 3000 15
2896 Other muscle t 50000 3000 3000 15
2897 Tendon graft 50000 3000 3000 15
2898 Graft of muscl 50000 3000 3000 15
2899 Tendon pulley 50000 3000 3000 15
2900 Release of clu 50000 3000 3000 15
2901 Other change 50000 3000 3000 15
2902 Quadricepspla 50000 3000 3000 15
2903 Other plastic 50000 3000 3000 15
2904 Other plastic 50000 3000 3000 15
2905 Other plastic 50000 3000 3000 15
2906 Lysis of adhes 50000 3000 3000 15
2907 Insertion or r 50000 3000 3000 15
2908 Removal of ske 50000 3000 3000 15
2909 Aspiration of 50000 3000 3000 15
2910 Aspiration of o 50000 3000 3000 15
2911 Injection of t 50000 3000 3000 15
2912 Injection of t 50000 3000 3000 15
2913 Injection of lo 50000 3000 3000 15
2914 Other operatio 50000 3000 3000 15
2915 Upper limb amp 50000 3000 3000 15
2916 Amputation and 50000 3000 3000 15
2917 Amputation and 50000 3000 3000 15
2918 Amputation th 50000 3000 3000 15
2919 Disarticulation 50000 3000 3000 15
2920 Amputation th 50000 3000 3000 15
2921 Disarticulation 50000 3000 3000 15
2922 Amputation th 50000 3000 3000 15
2923 Disarticulation 50000 3000 3000 15
2924 Interthoracos 50000 3000 3000 15
2925 Lower limb amp 50000 3000 3000 15
2926 Amputation of 50000 3000 3000 15
2927 Amputation th 50000 3000 3000 15
2928 Disarticulation 50000 3000 3000 15
2929 Amputation of 50000 3000 3000 15
2930 Other amputat 50000 3000 3000 15
2931 Disarticulation 50000 3000 3000 15
2932 Amputation a 50000 3000 3000 15
2933 Disarticulation 50000 3000 3000 15
2934 Abdominopelvi 50000 3000 3000 15
2935 Thumb reatta 50000 3000 3000 15
2936 Finger reatta 50000 3000 3000 15
2937 Forearm, wrist 50000 3000 3000 15

Page 60
Sheet1
2938 Upper arm rea 50000 3000 3000 15
2939 Toe reattachm 50000 3000 3000 15
2940 Foot reattach 50000 3000 3000 15
2941 Lower leg or a 50000 3000 3000 15
2942 Thigh reattac 50000 3000 3000 15
2943 Other reattach 50000 3000 3000 15
2944 Revision of a 50000 3000 3000 15
2945 Implantation or 50000 3000 3000 15
2946 Fitting of pro 50000 3000 3000 15
2947 Fitting of pro 50000 3000 3000 15
2948 Fitting of pros 50000 3000 3000 15
2949 Implantation o 50000 3000 3000 15
2950 Fitting of pro 50000 3000 3000 15
2951 Fitting of pro 50000 3000 3000 15
2952 Fitting of pros 50000 3000 3000 15
2953 Implantation of 50000 3000 3000 15
2954 Insertion of in 50000 3000 3000 15
2955 Insertion of r 50000 3000 3000 15
2956 Implantation of 50000 3000 3000 15
2957 Implantation o 50000 3000 3000 15
2958 Insertion of bo 50000 3000 3000 15
2959 Insertion or r 50000 3000 3000 15
2960 Removal of (c 50000 3000 3000 15
2961 Insertion of ot 50000 3000 3000 15
2962 Insertion of sp 50000 3000 3000 15
2963 Insertion of pa 50000 3000 3000 15
2964 Insertion of to 50000 3000 3000 15
2965 Insertion of sp 50000 3000 3000 15
2966 Insertion of pa 50000 3000 3000 15
2967 Insertion of to 50000 3000 3000 15
2968 Revision or rep 50000 3000 3000 15
2969 Revision or rep 50000 3000 3000 15
2970 Revision or rep 50000 3000 3000 15
2971 Revision or rep 50000 3000 3000 15
2972 Application of 50000 3000 3000 15
2973 Application of 50000 3000 3000 15
2974 Application of 50000 3000 3000 15
2975 Insertion or r 50000 3000 3000 15
2976 Revision of in 50000 3000 3000 15
2977 Insertion or r 50000 3000 3000 15
2978 Revision of pe 50000 3000 3000 15
2979 Insertion or r 50000 3000 3000 15
2980 Revision of fa 50000 3000 3000 15
2981 Amputation, no 50000 3000 3000 15
2982 Separation of 50000 3000 3000 15
2983 Separation of 50000 3000 3000 15
2984 Insertion of st 50000 3000 3000 15
2985 Other operati 50000 3000 3000 15
2986 Mastotomy 50000 3000 3000 15

Page 61
Sheet1
2987 Closed [percut 50000 3000 3000 15
2988 Open biopsy o 50000 3000 3000 15
2989 Other diagnost 50000 3000 3000 15
2990 Excision or de 50000 3000 3000 15
2991 Local excision 50000 3000 3000 15
2992 Resection of q 50000 3000 3000 15
2993 Subtotal mast 50000 3000 3000 15
2994 Excision of ec 50000 3000 3000 15
2995 Excision of ni 50000 3000 3000 15
2996 Unilateral re 50000 3000 3000 15
2997 Bilateral red 50000 3000 3000 15
2998 Unilateral su 50000 3000 3000 15
2999 Other unilate 50000 3000 3000 15
3000 Bilateral sub 50000 3000 3000 15
3001 Other bilater 50000 3000 3000 15
3002 Unilateral si 50000 3000 3000 15
3003 Bilateral simp 50000 3000 3000 15
3004 Unilateral ex 50000 3000 3000 15
3005 Bilateral ext 50000 3000 3000 15
3006 Unilateral rad 50000 3000 3000 15
3007 Bilateral radi 50000 3000 3000 15
3008 Unilateral ext 50000 3000 3000 15
3009 Bilateral exte 50000 3000 3000 15
3010 Augmentation 50000 3000 3000 15
3011 Unilateral inje 50000 3000 3000 15
3012 Bilateral injec 50000 3000 3000 15
3013 Unilateral bre 50000 3000 3000 15
3014 Bilateral breas 50000 3000 3000 15
3015 Fat graft to br 50000 3000 3000 15
3016 Mastopexy 50000 3000 3000 15
3017 Total reconstr 50000 3000 3000 15
3018 Latissimus do 50000 3000 3000 15
3019 Transverse re 50000 3000 3000 15
3020 Transverse re 50000 3000 3000 15
3021 Deep inferior e 50000 3000 3000 15
3022 Superficial inf 50000 3000 3000 15
3023 Gluteal artery 50000 3000 3000 15
3024 Other total rec 50000 3000 3000 15
3025 Suture of lace 50000 3000 3000 15
3026 Split-thickness 50000 3000 3000 15
3027 Full-thickness 50000 3000 3000 15
3028 Pedicle graft t 50000 3000 3000 15
3029 Muscle flap gra 50000 3000 3000 15
3030 Transposition 50000 3000 3000 15
3031 Other repair or 50000 3000 3000 15
3032 Other mammop 50000 3000 3000 15
3033 Aspiration of 50000 3000 3000 15
3034 Injection of th 50000 3000 3000 15
3035 Revision of im 50000 3000 3000 15

Page 62
Sheet1
3036 Removal of imp 50000 3000 3000 15
3037 Insertion of b 50000 3000 3000 15
3038 Removal of br 50000 3000 3000 15
3039 Other operatio 50000 3000 3000 15
3040 Aspiration of 50000 3000 3000 15
3041 Injection or ta 50000 3000 3000 15
3042 Incision of pil 50000 3000 3000 15
3043 Other incision 50000 3000 3000 15
3044 Incision with 50000 3000 3000 15
3045 Insertion of t 50000 3000 3000 15
3046 Insertion of t 50000 3000 3000 15
3047 Other incision 50000 3000 3000 15
3048 Closed biopsy 50000 3000 3000 15
3049 Other diagnos 50000 3000 3000 15
3050 Excision of pil 50000 3000 3000 15
3051 Excisional deb 50000 3000 3000 15
3052 Removal of nail 50000 3000 3000 15
3053 Chemosurgery 50000 3000 3000 15
3054 Dermabrasion 50000 3000 3000 15
3055 Ligation of d 50000 3000 3000 15
3056 Debridement of 50000 3000 3000 15
3057 Nonexcisional 50000 3000 3000 15
3058 Other local ex 50000 3000 3000 15
3059 Radical excisio 50000 3000 3000 15
3060 Replantation o 50000 3000 3000 15
3061 Closure of ski 50000 3000 3000 15
3062 Free skin graft 50000 3000 3000 15
3063 Full-thickness 50000 3000 3000 15
3064 Other skin gra 50000 3000 3000 15
3065 Full-thickness 50000 3000 3000 15
3066 Hair transplan 50000 3000 3000 15
3067 Heterograft to 50000 3000 3000 15
3068 Homograft to s 50000 3000 3000 15
3069 Dermal regener 50000 3000 3000 15
3070 Other skin graf 50000 3000 3000 15
3071 Pedicle or flap 50000 3000 3000 15
3072 Cutting and pre 50000 3000 3000 15
3073 Advancement o 50000 3000 3000 15
3074 Attachment of 50000 3000 3000 15
3075 Attachment of p 50000 3000 3000 15
3076 Revision of ped 50000 3000 3000 15
3077 Repair for fac 50000 3000 3000 15
3078 Facial rhytide 50000 3000 3000 15
3079 Size reduction 50000 3000 3000 15
3080 Relaxation of 50000 3000 3000 15
3081 Correction of 50000 3000 3000 15
3082 Onychoplasty 50000 3000 3000 15
3083 Fat graft of s 50000 3000 3000 15
3084 Other repair a 50000 3000 3000 15

Page 63
Sheet1
3085 Extraction of f 50000 3000 3000 15
3086 Excision of ski 50000 3000 3000 15
3087 Electrolysis an 50000 3000 3000 15
3088 Insertion of t 50000 3000 3000 15
3089 Insertion or r 50000 3000 3000 15
3090 Insertion or r 50000 3000 3000 15
3091 Insertion or r 50000 3000 3000 15
3092 Insertion or r 50000 3000 3000 15
3093 Insertion or r 50000 3000 3000 15
3094 Other operati 50000 3000 3000 15
3095 Pneumoencep 50000 3000 3000 15
3096 Other contrast 50000 3000 3000 15
3097 Computerized 50000 3000 3000 15
3098 Other tomogra 50000 3000 3000 15
3099 Contrast dacr 50000 3000 3000 15
3100 Contrast radi 50000 3000 3000 15
3101 Contrast lary 50000 3000 3000 15
3102 Cervical lymp 50000 3000 3000 15
3103 Other soft tis 50000 3000 3000 15
3104 Full-mouth x-r 50000 3000 3000 15
3105 Other dental x 50000 3000 3000 15
3106 Temporomandib 50000 3000 3000 15
3107 Contrast radio 50000 3000 3000 15
3108 Contrast radio 50000 3000 3000 15
3109 Other x-ray of 50000 3000 3000 15
3110 Other x-ray of 50000 3000 3000 15
3111 Contrast myel 50000 3000 3000 15
3112 Other x-ray of 50000 3000 3000 15
3113 Other x-ray of 50000 3000 3000 15
3114 Other x-ray of 50000 3000 3000 15
3115 Other x-ray of 50000 3000 3000 15
3116 Endotracheal 50000 3000 3000 15
3117 Other contras 50000 3000 3000 15
3118 Mediastinal 50000 3000 3000 15
3119 Intrathoracic 50000 3000 3000 15
3120 Contrast radi 50000 3000 3000 15
3121 Xerography of 50000 3000 3000 15
3122 Other mammo 50000 3000 3000 15
3123 Sinogram of ch 50000 3000 3000 15
3124 Other soft tiss 50000 3000 3000 15
3125 Computerized 50000 3000 3000 15
3126 Other tomogra 50000 3000 3000 15
3127 X-ray of ribs, 50000 3000 3000 15
3128 Routine chest 50000 3000 3000 15
3129 Other chest x- 50000 3000 3000 15
3130 Percutaneous 50000 3000 3000 15
3131 Intravenous c 50000 3000 3000 15
3132 Intraoperativ 50000 3000 3000 15
3133 Other cholang 50000 3000 3000 15

Page 64
Sheet1
3134 Other biliary t 50000 3000 3000 15
3135 Barium swallo 50000 3000 3000 15
3136 Upper GI seri 50000 3000 3000 15
3137 Small bowel s 50000 3000 3000 15
3138 Lower GI seri 50000 3000 3000 15
3139 Other x-ray of 50000 3000 3000 15
3140 Contrast panc 50000 3000 3000 15
3141 Other digestive 50000 3000 3000 15
3142 Computerized 50000 3000 3000 15
3143 Other nephro 50000 3000 3000 15
3144 Intravenous p 50000 3000 3000 15
3145 Retrograde py 50000 3000 3000 15
3146 Percutaneous 50000 3000 3000 15
3147 Retrograde cy 50000 3000 3000 15
3148 Other cystogr 50000 3000 3000 15
3149 Ileal conduito 50000 3000 3000 15
3150 Other x-ray of 50000 3000 3000 15
3151 X-ray of gravi 50000 3000 3000 15
3152 Gas contrast 50000 3000 3000 15
3153 Opaque dye co 50000 3000 3000 15
3154 Percutaneous 50000 3000 3000 15
3155 Other x-ray of 50000 3000 3000 15
3156 Other x-ray of 50000 3000 3000 15
3157 Contrast semi 50000 3000 3000 15
3158 Other x-ray of 50000 3000 3000 15
3159 Contrast epid 50000 3000 3000 15
3160 Contrast vaso 50000 3000 3000 15
3161 Other x-ray of 50000 3000 3000 15
3162 Other x-ray of 50000 3000 3000 15
3163 Computerized 50000 3000 3000 15
3164 Other abdome 50000 3000 3000 15
3165 Sinogram of a 50000 3000 3000 15
3166 Abdominal ly 50000 3000 3000 15
3167 Other soft tis 50000 3000 3000 15
3168 Pelvic opaque 50000 3000 3000 15
3169 Pelvic gas con 50000 3000 3000 15
3170 Other periton 50000 3000 3000 15
3171 Retroperitonea 50000 3000 3000 15
3172 Retroperiton 50000 3000 3000 15
3173 Other retroper 50000 3000 3000 15
3174 Other x-ray o 50000 3000 3000 15
3175 Skeletal x-ray 50000 3000 3000 15
3176 Skeletal x-ray 50000 3000 3000 15
3177 Skeletal x-ray 50000 3000 3000 15
3178 Skeletal x-ray 50000 3000 3000 15
3179 Pelvimetry 50000 3000 3000 15
3180 Other skeletal 50000 3000 3000 15
3181 Skeletal x-ray 50000 3000 3000 15
3182 Skeletal x-ray 50000 3000 3000 15

Page 65
Sheet1
3183 Skeletal x-ray 50000 3000 3000 15
3184 Skeletal serie 50000 3000 3000 15
3185 Contrast arth 50000 3000 3000 15
3186 Other skeletal 50000 3000 3000 15
3187 Lymphangiogra 50000 3000 3000 15
3188 Other soft tiss 50000 3000 3000 15
3189 Lymphangiogra 50000 3000 3000 15
3190 Other soft tiss 50000 3000 3000 15
3191 Other compute 50000 3000 3000 15
3192 X-ray, other a 50000 3000 3000 15
3193 Arteriography 50000 3000 3000 15
3194 Arteriography 50000 3000 3000 15
3195 Aortography 50000 3000 3000 15
3196 Arteriography 50000 3000 3000 15
3197 Arteriography 50000 3000 3000 15
3198 Arteriography o 50000 3000 3000 15
3199 Arteriography 50000 3000 3000 15
3200 Arteriography 50000 3000 3000 15
3201 Arteriography 50000 3000 3000 15
3202 Arteriography o 50000 3000 3000 15
3203 Angiocardiogra 50000 3000 3000 15
3204 Angiocardiogr 50000 3000 3000 15
3205 Angiocardiogra 50000 3000 3000 15
3206 Angiocardiogra 50000 3000 3000 15
3207 Combined right 50000 3000 3000 15
3208 Coronary arter 50000 3000 3000 15
3209 Coronary arter 50000 3000 3000 15
3210 Other and unsp 50000 3000 3000 15
3211 Negative-cont 50000 3000 3000 15
3212 Intra-operativ 50000 3000 3000 15
3213 Phlebography u 50000 3000 3000 15
3214 Phlebography o 50000 3000 3000 15
3215 Phlebography o 50000 3000 3000 15
3216 Phlebography o 50000 3000 3000 15
3217 Phlebography o 50000 3000 3000 15
3218 Phlebography o 50000 3000 3000 15
3219 Phlebography o 50000 3000 3000 15
3220 Phlebography o 50000 3000 3000 15
3221 Impedance ph 50000 3000 3000 15
3222 Diagnostic ul 50000 3000 3000 15
3223 Diagnostic ult 50000 3000 3000 15
3224 Diagnostic ult 50000 3000 3000 15
3225 Diagnostic ult 50000 3000 3000 15
3226 Diagnostic ult 50000 3000 3000 15
3227 Diagnostic ul 50000 3000 3000 15
3228 Diagnostic ult 50000 3000 3000 15
3229 Diagnostic ult 50000 3000 3000 15
3230 Other diagnost 50000 3000 3000 15
3231 Cerebral ther 50000 3000 3000 15

Page 66
Sheet1
3232 Ocular thermo 50000 3000 3000 15
3233 Bone thermog 50000 3000 3000 15
3234 Muscle therm 50000 3000 3000 15
3235 Breast thermo 50000 3000 3000 15
3236 Blood vessel 50000 3000 3000 15
3237 Thermography 50000 3000 3000 15
3238 Diagnostic ima 50000 3000 3000 15
3239 Magnetic reso 50000 3000 3000 15
3240 Magnetic reso 50000 3000 3000 15
3241 Magnetic reso 50000 3000 3000 15
3242 Magnetic reso 50000 3000 3000 15
3243 Magnetic reson 50000 3000 3000 15
3244 Other intraop 50000 3000 3000 15
3245 Magnetic reson 50000 3000 3000 15
3246 Bone mineral d 50000 3000 3000 15
3247 Interview and 50000 3000 3000 15
3248 Interview and 50000 3000 3000 15
3249 Interview and 50000 3000 3000 15
3250 Other intervie 50000 3000 3000 15
3251 Diagnostic int 50000 3000 3000 15
3252 Consultation, 50000 3000 3000 15
3253 Consultation, 50000 3000 3000 15
3254 Other consulta 50000 3000 3000 15
3255 Consultation, 50000 3000 3000 15
3256 Intracarotid am 50000 3000 3000 15
3257 Tonometry 50000 3000 3000 15
3258 Nasal function 50000 3000 3000 15
3259 Neurologic ex 50000 3000 3000 15
3260 Electroencep 50000 3000 3000 15
3261 Other nonopera 50000 3000 3000 15
3262 Transilluminat 50000 3000 3000 15
3263 Polysomnogr 50000 3000 3000 15
3264 Other sleep di 50000 3000 3000 15
3265 Video and rad 50000 3000 3000 15
3266 Urinary manom 50000 3000 3000 15
3267 Cystometrogr 50000 3000 3000 15
3268 Urethral sphi 50000 3000 3000 15
3269 Uroflowmetry 50000 3000 3000 15
3270 Urethral press 50000 3000 3000 15
3271 Gynecological 50000 3000 3000 15
3272 Other nonoper 50000 3000 3000 15
3273 Dental examin 50000 3000 3000 15
3274 Esophageal m 50000 3000 3000 15
3275 Digital examin 50000 3000 3000 15
3276 Digital examin 50000 3000 3000 15
3277 Transilluminat 50000 3000 3000 15
3278 Manual examin 50000 3000 3000 15
3279 Vital capacity 50000 3000 3000 15
3280 Other nonoper 50000 3000 3000 15

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3281 Other nonoper 50000 3000 3000 15
3282 Cardiovascular 50000 3000 3000 15
3283 Masters' two-s 50000 3000 3000 15
3284 Cardiovascular 50000 3000 3000 15
3285 Other cardiova 50000 3000 3000 15
3286 Artificial pac 50000 3000 3000 15
3287 Artificial pac 50000 3000 3000 15
3288 Artificial pac 50000 3000 3000 15
3289 Artificial pac 50000 3000 3000 15
3290 Automatic impl 50000 3000 3000 15
3291 Ambulatory ca 50000 3000 3000 15
3292 Rhythm electr 50000 3000 3000 15
3293 Electrocardio 50000 3000 3000 15
3294 Vectorcardiog 50000 3000 3000 15
3295 Electrographic 50000 3000 3000 15
3296 Phonocardiog 50000 3000 3000 15
3297 Carotid pulse 50000 3000 3000 15
3298 Apexcardiogra 50000 3000 3000 15
3299 Plethysmogra 50000 3000 3000 15
3300 Other nonoper 50000 3000 3000 15
3301 Continuous int 50000 3000 3000 15
3302 Systemic arter 50000 3000 3000 15
3303 Central venou 50000 3000 3000 15
3304 Pulmonary art 50000 3000 3000 15
3305 Pulmonary art 50000 3000 3000 15
3306 Measurement o 50000 3000 3000 15
3307 Measurement o 50000 3000 3000 15
3308 Monitoring of 50000 3000 3000 15
3309 Monitoring of 50000 3000 3000 15
3310 Monitoring of 50000 3000 3000 15
3311 General physi 50000 3000 3000 15
3312 Autopsy 50000 3000 3000 15
3313 Microscopic ex 50000 3000 3000 15
3314 Microscopic ex 50000 3000 3000 15
3315 Microscopic ex 50000 3000 3000 15
3316 Microscopic ex 50000 3000 3000 15
3317 Microscopic ex 50000 3000 3000 15
3318 Microscopic ex 50000 3000 3000 15
3319 Microscopic ex 50000 3000 3000 15
3320 Microscopic ex 50000 3000 3000 15
3321 Microscopic ex 50000 3000 3000 15
3322 Microscopic ex 50000 3000 3000 15
3323 Microscopic ex 50000 3000 3000 15
3324 Microscopic ex 50000 3000 3000 15
3325 Microscopic ex 50000 3000 3000 15
3326 Microscopic ex 50000 3000 3000 15
3327 Microscopic e 50000 3000 3000 15
3328 Microscopic ex 50000 3000 3000 15
3329 Microscopic ex 50000 3000 3000 15

Page 68
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3330 Microscopic ex 50000 3000 3000 15
3331 Microscopic ex 50000 3000 3000 15
3332 Microscopic e 50000 3000 3000 15
3333 Microscopic e 50000 3000 3000 15
3334 Microscopic ex 50000 3000 3000 15
3335 Microscopic ex 50000 3000 3000 15
3336 Microscopic ex 50000 3000 3000 15
3337 Microscopic ex 50000 3000 3000 15
3338 Microscopic ex 50000 3000 3000 15
3339 Microscopic ex 50000 3000 3000 15
3340 Microscopic ex 50000 3000 3000 15
3341 Microscopic ex 50000 3000 3000 15
3342 Microscopic ex 50000 3000 3000 15
3343 Microscopic ex 50000 3000 3000 15
3344 Microscopic ex 50000 3000 3000 15
3345 Microscopic ex 50000 3000 3000 15
3346 Microscopic ex 50000 3000 3000 15
3347 Microscopic ex 50000 3000 3000 15
3348 Microscopic ex 50000 3000 3000 15
3349 Microscopic ex 50000 3000 3000 15
3350 Microscopic ex 50000 3000 3000 15
3351 Microscopic ex 50000 3000 3000 15
3352 Microscopic ex 50000 3000 3000 15
3353 Microscopic ex 50000 3000 3000 15
3354 Microscopic ex 50000 3000 3000 15
3355 Microscopic e 50000 3000 3000 15
3356 Microscopic e 50000 3000 3000 15
3357 Microscopic ex 50000 3000 3000 15
3358 Microscopic e 50000 3000 3000 15
3359 Microscopic e 50000 3000 3000 15
3360 Microscopic e 50000 3000 3000 15
3361 Microscopic e 50000 3000 3000 15
3362 Microscopic e 50000 3000 3000 15
3363 Microscopic e 50000 3000 3000 15
3364 Microscopic ex 50000 3000 3000 15
3365 Microscopic e 50000 3000 3000 15
3366 Microscopic e 50000 3000 3000 15
3367 Microscopic e 50000 3000 3000 15
3368 Microscopic e 50000 3000 3000 15
3369 Microscopic ex 50000 3000 3000 15
3370 Microscopic ex 50000 3000 3000 15
3371 Microscopic ex 50000 3000 3000 15
3372 Microscopic ex 50000 3000 3000 15
3373 Microscopic ex 50000 3000 3000 15
3374 Microscopic ex 50000 3000 3000 15
3375 Microscopic ex 50000 3000 3000 15
3376 Microscopic ex 50000 3000 3000 15
3377 Microscopic ex 50000 3000 3000 15
3378 Microscopic ex 50000 3000 3000 15

Page 69
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3379 Microscopic ex 50000 3000 3000 15
3380 Microscopic ex 50000 3000 3000 15
3381 Microscopic ex 50000 3000 3000 15
3382 Microscopic ex 50000 3000 3000 15
3383 Microscopic ex 50000 3000 3000 15
3384 Microscopic ex 50000 3000 3000 15
3385 Microscopic ex 50000 3000 3000 15
3386 Microscopic ex 50000 3000 3000 15
3387 Microscopic ex 50000 3000 3000 15
3388 Microscopic ex 50000 3000 3000 15
3389 Microscopic ex 50000 3000 3000 15
3390 Microscopic ex 50000 3000 3000 15
3391 Microscopic ex 50000 3000 3000 15
3392 Microscopic ex 50000 3000 3000 15
3393 Microscopic ex 50000 3000 3000 15
3394 Microscopic ex 50000 3000 3000 15
3395 Microscopic ex 50000 3000 3000 15
3396 Microscopic ex 50000 3000 3000 15
3397 Microscopic ex 50000 3000 3000 15
3398 Microscopic ex 50000 3000 3000 15
3399 Microscopic ex 50000 3000 3000 15
3400 Microscopic ex 50000 3000 3000 15
3401 Microscopic ex 50000 3000 3000 15
3402 Microscopic ex 50000 3000 3000 15
3403 Microscopic ex 50000 3000 3000 15
3404 Microscopic ex 50000 3000 3000 15
3405 Microscopic ex 50000 3000 3000 15
3406 Microscopic ex 50000 3000 3000 15
3407 Microscopic ex 50000 3000 3000 15
3408 Microscopic ex 50000 3000 3000 15
3409 Microscopic ex 50000 3000 3000 15
3410 Microscopic ex 50000 3000 3000 15
3411 Microscopic ex 50000 3000 3000 15
3412 Microscopic ex 50000 3000 3000 15
3413 Microscopic ex 50000 3000 3000 15
3414 Microscopic ex 50000 3000 3000 15
3415 Microscopic ex 50000 3000 3000 15
3416 Microscopic ex 50000 3000 3000 15
3417 Microscopic ex 50000 3000 3000 15
3418 Microscopic ex 50000 3000 3000 15
3419 Microscopic ex 50000 3000 3000 15
3420 Microscopic ex 50000 3000 3000 15
3421 Microscopic ex 50000 3000 3000 15
3422 Microscopic ex 50000 3000 3000 15
3423 Microscopic ex 50000 3000 3000 15
3424 Microscopic ex 50000 3000 3000 15
3425 Microscopic ex 50000 3000 3000 15
3426 Microscopic ex 50000 3000 3000 15
3427 Microscopic ex 50000 3000 3000 15

Page 70
Sheet1
3428 Microscopic ex 50000 3000 3000 15
3429 Microscopic ex 50000 3000 3000 15
3430 Microscopic e 50000 3000 3000 15
3431 Microscopic ex 50000 3000 3000 15
3432 Microscopic e 50000 3000 3000 15
3433 Microscopic e 50000 3000 3000 15
3434 Microscopic ex 50000 3000 3000 15
3435 Microscopic e 50000 3000 3000 15
3436 Microscopic e 50000 3000 3000 15
3437 Microscopic e 50000 3000 3000 15
3438 Microscopic e 50000 3000 3000 15
3439 Microscopic ex 50000 3000 3000 15
3440 Microscopic ex 50000 3000 3000 15
3441 Microscopic ex 50000 3000 3000 15
3442 Microscopic ex 50000 3000 3000 15
3443 Microscopic ex 50000 3000 3000 15
3444 Microscopic ex 50000 3000 3000 15
3445 Microscopic ex 50000 3000 3000 15
3446 Microscopic ex 50000 3000 3000 15
3447 Microscopic ex 50000 3000 3000 15
3448 Microscopic ex 50000 3000 3000 15
3449 Microscopic ex 50000 3000 3000 15
3450 Microscopic ex 50000 3000 3000 15
3451 Microscopic ex 50000 3000 3000 15
3452 Microscopic ex 50000 3000 3000 15
3453 Thyroid scan a 50000 3000 3000 15
3454 Liver scan and 50000 3000 3000 15
3455 Renal scan and 50000 3000 3000 15
3456 Gastrointestin 50000 3000 3000 15
3457 Cardiovascular 50000 3000 3000 15
3458 Other radioiso 50000 3000 3000 15
3459 Cerebral scan 50000 3000 3000 15
3460 Scan of other 50000 3000 3000 15
3461 Parathyroid s 50000 3000 3000 15
3462 Bone scan 50000 3000 3000 15
3463 Pulmonary sc 50000 3000 3000 15
3464 Scan of lymph 50000 3000 3000 15
3465 Placental sca 50000 3000 3000 15
3466 Total body sc 50000 3000 3000 15
3467 Scan of other 50000 3000 3000 15
3468 Infusion of li 50000 3000 3000 15
3469 Superficial rad 50000 3000 3000 15
3470 Orthovoltage r 50000 3000 3000 15
3471 Radioisotopic 50000 3000 3000 15
3472 Teleradiother 50000 3000 3000 15
3473 Teleradiothera 50000 3000 3000 15
3474 Teleradiotherap 50000 3000 3000 15
3475 Implantation o 50000 3000 3000 15
3476 Injection or in 50000 3000 3000 15

Page 71
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3477 Other radiothe 50000 3000 3000 15
3478 Stereotactic r 50000 3000 3000 15
3479 Single source 50000 3000 3000 15
3480 Multi-source p 50000 3000 3000 15
3481 Particulate ra 50000 3000 3000 15
3482 Stereotactic r 50000 3000 3000 15
3483 Intra-operativ 50000 3000 3000 15
3484 Functional eva 50000 3000 3000 15
3485 Orthotic evalu 50000 3000 3000 15
3486 Prosthetic eva 50000 3000 3000 15
3487 Manual testing 50000 3000 3000 15
3488 Range of motio 50000 3000 3000 15
3489 Measurement o 50000 3000 3000 15
3490 Body measure 50000 3000 3000 15
3491 Electromyogr 50000 3000 3000 15
3492 Other diagnost 50000 3000 3000 15
3493 Assisting exer 50000 3000 3000 15
3494 Other active m 50000 3000 3000 15
3495 Resistive exer 50000 3000 3000 15
3496 Training in jo 50000 3000 3000 15
3497 Mobilization o 50000 3000 3000 15
3498 Mobilization of 50000 3000 3000 15
3499 Other passive 50000 3000 3000 15
3500 Breathing exer 50000 3000 3000 15
3501 Exercise, not 50000 3000 3000 15
3502 Manual and me 50000 3000 3000 15
3503 Ambulation and 50000 3000 3000 15
3504 Fitting of orth 50000 3000 3000 15
3505 Training in use 50000 3000 3000 15
3506 Forced extensi 50000 3000 3000 15
3507 Manual rupture 50000 3000 3000 15
3508 Stretching of 50000 3000 3000 15
3509 Stretching of f 50000 3000 3000 15
3510 Other forcible 50000 3000 3000 15
3511 Assisted exerc 50000 3000 3000 15
3512 Whirlpool trea 50000 3000 3000 15
3513 Other hydroth 50000 3000 3000 15
3514 Diathermy 50000 3000 3000 15
3515 Other heat th 50000 3000 3000 15
3516 Cardiac retrai 50000 3000 3000 15
3517 Prenatal train 50000 3000 3000 15
3518 Combined phys 50000 3000 3000 15
3519 Other physical 50000 3000 3000 15
3520 Spinal traction 50000 3000 3000 15
3521 Other spinal tr 50000 3000 3000 15
3522 Intermittent sk 50000 3000 3000 15
3523 Other skeletal 50000 3000 3000 15
3524 Thomas' splint 50000 3000 3000 15
3525 Other skin trac 50000 3000 3000 15

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3526 Application of 50000 3000 3000 15
3527 Application of 50000 3000 3000 15
3528 Application of 50000 3000 3000 15
3529 Application of 50000 3000 3000 15
3530 Dental wiring 50000 3000 3000 15
3531 Application of 50000 3000 3000 15
3532 Application of 50000 3000 3000 15
3533 Application of 50000 3000 3000 15
3534 Other immobili 50000 3000 3000 15
3535 Osteopathic ma 50000 3000 3000 15
3536 Osteopathic ma 50000 3000 3000 15
3537 Osteopathic ma 50000 3000 3000 15
3538 Osteopathic ma 50000 3000 3000 15
3539 Osteopathic ma 50000 3000 3000 15
3540 Osteopathic ma 50000 3000 3000 15
3541 Other specifie 50000 3000 3000 15
3542 Dyslexia train 50000 3000 3000 15
3543 Dysphasia trai 50000 3000 3000 15
3544 Esophageal sp 50000 3000 3000 15
3545 Speech defect 50000 3000 3000 15
3546 Other speech t 50000 3000 3000 15
3547 Training in use 50000 3000 3000 15
3548 Training in bra 50000 3000 3000 15
3549 Other rehabilit 50000 3000 3000 15
3550 Recreation th 50000 3000 3000 15
3551 Educational t 50000 3000 3000 15
3552 Occupational 50000 3000 3000 15
3553 Music therapy 50000 3000 3000 15
3554 Vocational reha 50000 3000 3000 15
3555 Rehabilitation 50000 3000 3000 15
3556 Non-invasive m 50000 3000 3000 15
3557 Intermittent p 50000 3000 3000 15
3558 Nonmechanical 50000 3000 3000 15
3559 Respiratory me 50000 3000 3000 15
3560 Hyperbaric ox 50000 3000 3000 15
3561 Other oxygen 50000 3000 3000 15
3562 Decompressio 50000 3000 3000 15
3563 Other control 50000 3000 3000 15
3564 Other respirat 50000 3000 3000 15
3565 Administration 50000 3000 3000 15
3566 Administration 50000 3000 3000 15
3567 Character anal 50000 3000 3000 15
3568 Other psycholo 50000 3000 3000 15
3569 Psychologic me 50000 3000 3000 15
3570 Psychiatric me 50000 3000 3000 15
3571 Routine psychia 50000 3000 3000 15
3572 Psychiatric c 50000 3000 3000 15
3573 Other psychiat 50000 3000 3000 15
3574 Narcoanalysis 50000 3000 3000 15

Page 73
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3575 Lithium therap 50000 3000 3000 15
3576 Neuroleptic th 50000 3000 3000 15
3577 Chemical shoc 50000 3000 3000 15
3578 Other psychiat 50000 3000 3000 15
3579 Subconvulsive 50000 3000 3000 15
3580 Other electro 50000 3000 3000 15
3581 Other psychia 50000 3000 3000 15
3582 Psychoanalysi 50000 3000 3000 15
3583 Hypnotherapy 50000 3000 3000 15
3584 Behavior ther 50000 3000 3000 15
3585 Individual the 50000 3000 3000 15
3586 Crisis interven 50000 3000 3000 15
3587 Play psychoth 50000 3000 3000 15
3588 Exploratory v 50000 3000 3000 15
3589 Supportive ve 50000 3000 3000 15
3590 Other individu 50000 3000 3000 15
3591 Group therapy 50000 3000 3000 15
3592 Family therap 50000 3000 3000 15
3593 Psychodrama 50000 3000 3000 15
3594 Other group t 50000 3000 3000 15
3595 Drug addiction 50000 3000 3000 15
3596 Alcoholism co 50000 3000 3000 15
3597 Other counsel 50000 3000 3000 15
3598 Referral for p 50000 3000 3000 15
3599 Referral for ps 50000 3000 3000 15
3600 Referral for al 50000 3000 3000 15
3601 Referral for dr 50000 3000 3000 15
3602 Referral for vo 50000 3000 3000 15
3603 Referral for ot 50000 3000 3000 15
3604 Alcohol rehabil 50000 3000 3000 15
3605 Alcohol detoxif 50000 3000 3000 15
3606 Alcohol rehabil 50000 3000 3000 15
3607 Drug rehabilita 50000 3000 3000 15
3608 Drug detoxific 50000 3000 3000 15
3609 Drug rehabilita 50000 3000 3000 15
3610 Combined alcoh 50000 3000 3000 15
3611 Combined alcoh 50000 3000 3000 15
3612 Combined alcoh 50000 3000 3000 15
3613 Limited eye e 50000 3000 3000 15
3614 Comprehensiv 50000 3000 3000 15
3615 Extended opht 50000 3000 3000 15
3616 Eye examinati 50000 3000 3000 15
3617 Visual field st 50000 3000 3000 15
3618 Color vision s 50000 3000 3000 15
3619 Dark adaptati 50000 3000 3000 15
3620 Eye examinatio 50000 3000 3000 15
3621 Fundus photo 50000 3000 3000 15
3622 Fluorescein a 50000 3000 3000 15
3623 Ultrasound stu 50000 3000 3000 15

Page 74
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3624 X-ray study of 50000 3000 3000 15
3625 Ocular motility 50000 3000 3000 15
3626 P32 and other 50000 3000 3000 15
3627 Electroretino 50000 3000 3000 15
3628 Electro-oculo 50000 3000 3000 15
3629 Visual evoked 50000 3000 3000 15
3630 Electronysta 50000 3000 3000 15
3631 Electromyogra 50000 3000 3000 15
3632 Tonography, pr 50000 3000 3000 15
3633 Fitting and di 50000 3000 3000 15
3634 Prescription, f 50000 3000 3000 15
3635 Dispensing of 50000 3000 3000 15
3636 Ocular prosthe 50000 3000 3000 15
3637 Orthoptic train 50000 3000 3000 15
3638 Ophthalmologic 50000 3000 3000 15
3639 Audiometry 50000 3000 3000 15
3640 Clinical test o 50000 3000 3000 15
3641 Audiological e 50000 3000 3000 15
3642 Clinical vestib 50000 3000 3000 15
3643 Rotation tests 50000 3000 3000 15
3644 Other auditory 50000 3000 3000 15
3645 Hearing examin 50000 3000 3000 15
3646 Fitting of hear 50000 3000 3000 15
3647 Other nonopera 50000 3000 3000 15
3648 Insertion of n 50000 3000 3000 15
3649 Insertion of o 50000 3000 3000 15
3650 Insertion of e 50000 3000 3000 15
3651 Insertion of e 50000 3000 3000 15
3652 Other intubatio 50000 3000 3000 15
3653 Insertion of S 50000 3000 3000 15
3654 Insertion of ot 50000 3000 3000 15
3655 Insertion of (n 50000 3000 3000 15
3656 Insertion of re 50000 3000 3000 15
3657 Packing of ext 50000 3000 3000 15
3658 Vaginal packi 50000 3000 3000 15
3659 Insertion of v 50000 3000 3000 15
3660 Other vaginal d 50000 3000 3000 15
3661 Insertion of v 50000 3000 3000 15
3662 Insertion of o 50000 3000 3000 15
3663 Rectal packin 50000 3000 3000 15
3664 Dilation of fro 50000 3000 3000 15
3665 Dilation of re 50000 3000 3000 15
3666 Dilation of ana 50000 3000 3000 15
3667 Dilation and m 50000 3000 3000 15
3668 Therapeutic di 50000 3000 3000 15
3669 Manual reducti 50000 3000 3000 15
3670 Manual reducti 50000 3000 3000 15
3671 Manual reduct 50000 3000 3000 15
3672 Reduction of i 50000 3000 3000 15

Page 75
Sheet1
3673 Gastric coolin 50000 3000 3000 15
3674 Gastric freezi 50000 3000 3000 15
3675 Gastric lavage 50000 3000 3000 15
3676 Other irrigatio 50000 3000 3000 15
3677 Gastric gavag 50000 3000 3000 15
3678 Irrigation of 50000 3000 3000 15
3679 Proctoclysis 50000 3000 3000 15
3680 Removal of im 50000 3000 3000 15
3681 Other transan 50000 3000 3000 15
3682 Irrigation of 50000 3000 3000 15
3683 Irrigation of p 50000 3000 3000 15
3684 Digestive tract 50000 3000 3000 15
3685 Vaginal douch 50000 3000 3000 15
3686 Irrigation of 50000 3000 3000 15
3687 Irrigation of 50000 3000 3000 15
3688 Irrigation of c 50000 3000 3000 15
3689 Irrigation of o 50000 3000 3000 15
3690 Other genitouri 50000 3000 3000 15
3691 Irrigation of e 50000 3000 3000 15
3692 Irrigation of ea 50000 3000 3000 15
3693 Irrigation of 50000 3000 3000 15
3694 Dental scaling 50000 3000 3000 15
3695 Tracheostomy t 50000 3000 3000 15
3696 Other lavage 50000 3000 3000 15
3697 Irrigation of v 50000 3000 3000 15
3698 Irrigation of 50000 3000 3000 15
3699 Other irrigati 50000 3000 3000 15
3700 Enteral infusi 50000 3000 3000 15
3701 Continuous inv 50000 3000 3000 15
3702 Continuous inv 50000 3000 3000 15
3703 Continuous inv 50000 3000 3000 15
3704 Replacement o 50000 3000 3000 15
3705 Replacement o 50000 3000 3000 15
3706 Replacement of 50000 3000 3000 15
3707 Replacement of 50000 3000 3000 15
3708 Replacement of 50000 3000 3000 15
3709 Replacement o 50000 3000 3000 15
3710 Replacement o 50000 3000 3000 15
3711 Replacement o 50000 3000 3000 15
3712 Replacement of 50000 3000 3000 15
3713 Replacement o 50000 3000 3000 15
3714 Replacement o 50000 3000 3000 15
3715 Replacement o 50000 3000 3000 15
3716 Replacement o 50000 3000 3000 15
3717 Replacement o 50000 3000 3000 15
3718 Replacement an 50000 3000 3000 15
3719 Replacement o 50000 3000 3000 15
3720 Replacement of 50000 3000 3000 15
3721 Other nonoper 50000 3000 3000 15

Page 76
Sheet1
3722 Removal of ey 50000 3000 3000 15
3723 Removal of na 50000 3000 3000 15
3724 Removal of den 50000 3000 3000 15
3725 Removal of de 50000 3000 3000 15
3726 Removal of den 50000 3000 3000 15
3727 Removal of oth 50000 3000 3000 15
3728 Removal of tr 50000 3000 3000 15
3729 Removal of su 50000 3000 3000 15
3730 Removal of ot 50000 3000 3000 15
3731 Removal of tho 50000 3000 3000 15
3732 Removal of med 50000 3000 3000 15
3733 Removal of su 50000 3000 3000 15
3734 Nonoperative r 50000 3000 3000 15
3735 Removal of oth 50000 3000 3000 15
3736 Removal of ga 50000 3000 3000 15
3737 Removal of tub 50000 3000 3000 15
3738 Removal of tub 50000 3000 3000 15
3739 Removal of ch 50000 3000 3000 15
3740 Removal of T-tu 50000 3000 3000 15
3741 Removal of pan 50000 3000 3000 15
3742 Removal of oth 50000 3000 3000 15
3743 Removal of py 50000 3000 3000 15
3744 Removal of ure 50000 3000 3000 15
3745 Removal of cy 50000 3000 3000 15
3746 Removal of oth 50000 3000 3000 15
3747 Removal of ure 50000 3000 3000 15
3748 Removal of oth 50000 3000 3000 15
3749 Removal of int 50000 3000 3000 15
3750 Removal of int 50000 3000 3000 15
3751 Removal of va 50000 3000 3000 15
3752 Removal of ot 50000 3000 3000 15
3753 Removal of vag 50000 3000 3000 15
3754 Removal of oth 50000 3000 3000 15
3755 Removal of ret 50000 3000 3000 15
3756 Removal of pe 50000 3000 3000 15
3757 Removal of ab 50000 3000 3000 15
3758 Removal of sut 50000 3000 3000 15
3759 Removal of pac 50000 3000 3000 15
3760 Removal of ot 50000 3000 3000 15
3761 Removal of oth 50000 3000 3000 15
3762 Removal of ext 50000 3000 3000 15
3763 Removal of oth 50000 3000 3000 15
3764 Removal of int 50000 3000 3000 15
3765 Removal of int 50000 3000 3000 15
3766 Removal of int 50000 3000 3000 15
3767 Removal of int 50000 3000 3000 15
3768 Removal of int 50000 3000 3000 15
3769 Removal of int 50000 3000 3000 15
3770 Removal of int 50000 3000 3000 15

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3771 Removal of int 50000 3000 3000 15
3772 Removal of int 50000 3000 3000 15
3773 Removal of int 50000 3000 3000 15
3774 Removal of int 50000 3000 3000 15
3775 Removal of int 50000 3000 3000 15
3776 Removal of int 50000 3000 3000 15
3777 Removal of int 50000 3000 3000 15
3778 Removal of for 50000 3000 3000 15
3779 Removal of sup 50000 3000 3000 15
3780 Removal of oth 50000 3000 3000 15
3781 Removal of for 50000 3000 3000 15
3782 Removal of for 50000 3000 3000 15
3783 Removal of oth 50000 3000 3000 15
3784 Removal of for 50000 3000 3000 15
3785 Removal of for 50000 3000 3000 15
3786 Removal of for 50000 3000 3000 15
3787 Removal of for 50000 3000 3000 15
3788 Extracorporeal 50000 3000 3000 15
3789 Extracorporeal 50000 3000 3000 15
3790 Extracorporeal 50000 3000 3000 15
3791 Perioperative 50000 3000 3000 15
3792 Exchange tran 50000 3000 3000 15
3793 Transfusion of 50000 3000 3000 15
3794 Other transfus 50000 3000 3000 15
3795 Transfusion of 50000 3000 3000 15
3796 Transfusion of 50000 3000 3000 15
3797 Transfusion of 50000 3000 3000 15
3798 Transfusion of 50000 3000 3000 15
3799 Transfusion o 50000 3000 3000 15
3800 Transfusion of 50000 3000 3000 15
3801 Injection or in 50000 3000 3000 15
3802 Injection of R 50000 3000 3000 15
3803 Immunization f 50000 3000 3000 15
3804 Immunization 50000 3000 3000 15
3805 Injection or i 50000 3000 3000 15
3806 Parenteral inf 50000 3000 3000 15
3807 Injection of an 50000 3000 3000 15
3808 Injection of ins 50000 3000 3000 15
3809 Injection or in 50000 3000 3000 15
3810 Injection of an 50000 3000 3000 15
3811 Injection or inf 50000 3000 3000 15
3812 Injection of ant 50000 3000 3000 15
3813 Injection of ot 50000 3000 3000 15
3814 Injection of st 50000 3000 3000 15
3815 Injection of o 50000 3000 3000 15
3816 Injection or i 50000 3000 3000 15
3817 Injection of tr 50000 3000 3000 15
3818 Iontophoresis 50000 3000 3000 15
3819 Injection or i 50000 3000 3000 15

Page 78
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3820 Injection or i 50000 3000 3000 15
3821 Vaccination ag 50000 3000 3000 15
3822 Vaccination ag 50000 3000 3000 15
3823 Vaccination ag 50000 3000 3000 15
3824 Vaccination ag 50000 3000 3000 15
3825 Vaccination ag 50000 3000 3000 15
3826 Administration 50000 3000 3000 15
3827 Vaccination ag 50000 3000 3000 15
3828 Administration 50000 3000 3000 15
3829 Administration 50000 3000 3000 15
3830 Administration 50000 3000 3000 15
3831 Vaccination ag 50000 3000 3000 15
3832 Vaccination ag 50000 3000 3000 15
3833 Vaccination ag 50000 3000 3000 15
3834 Vaccination a 50000 3000 3000 15
3835 Vaccination a 50000 3000 3000 15
3836 Vaccination ag 50000 3000 3000 15
3837 Administratio 50000 3000 3000 15
3838 Prophylactic v 50000 3000 3000 15
3839 Prophylactic v 50000 3000 3000 15
3840 Prophylactic v 50000 3000 3000 15
3841 Prophylactic v 50000 3000 3000 15
3842 Prophylactic a 50000 3000 3000 15
3843 Administration 50000 3000 3000 15
3844 Administration 50000 3000 3000 15
3845 Administration 50000 3000 3000 15
3846 Other vaccinat 50000 3000 3000 15
3847 Cardiopulmonar 50000 3000 3000 15
3848 Atrial cardiove 50000 3000 3000 15
3849 Other electric 50000 3000 3000 15
3850 Closed chest 50000 3000 3000 15
3851 Carotid sinus 50000 3000 3000 15
3852 Other conversi 50000 3000 3000 15
3853 Therapeutic p 50000 3000 3000 15
3854 Therapeutic l 50000 3000 3000 15
3855 Therapeutic er 50000 3000 3000 15
3856 Therapeutic pl 50000 3000 3000 15
3857 Administration 50000 3000 3000 15
3858 Extracorporea 50000 3000 3000 15
3859 Application or 50000 3000 3000 15
3860 Aquapheresis 50000 3000 3000 15
3861 Other therapeu 50000 3000 3000 15
3862 Hypothermia (c 50000 3000 3000 15
3863 Ultraviolet lig 50000 3000 3000 15
3864 Other phototh 50000 3000 3000 15
3865 Isolation 50000 3000 3000 15
3866 Hyperthermia f 50000 3000 3000 15
3867 Non-invasive 50000 3000 3000 15
3868 Therapeutic p 50000 3000 3000 15

Page 79
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3869 Acupuncture f 50000 3000 3000 15
3870 Other acupunc 50000 3000 3000 15
3871 Rectal massag 50000 3000 3000 15
3872 Prostatic mas 50000 3000 3000 15
3873 Stretching of f 50000 3000 3000 15
3874 Collection of s 50000 3000 3000 15
3875 Fitting of dent 50000 3000 3000 15
3876 Extraction of m 50000 3000 3000 15
3877 Other miscell 50000 3000 3000 15

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