|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,981.25
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,064.30
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,916.96
|
|
Excision breast lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,694.96
|
|
Excision floor mouth lesion 41116
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,819.23
|
|
Excision graft extremity
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,982.97
|
|
Excision gum each quadrant
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision hand/finger tendon
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,594.44
|
|
Excision lesion mouth roof
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,600.75
|
|
Excision lesion mouth roof
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,413.19
|
|
Excision nasal polyp(s) simple 30110
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,639.57
|
|
Excision of anal lesion(s)
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,245.23
|
|
Excision of gum flap
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,752.89
|
|
Excision of gum lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,752.89
|
|
Excision of gum lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,339.00
|
|
Excision of gum lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision of gum lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,148.70
|
|
Excision of gum lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,752.89
|
|
Excision of gum lesion 41825
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,920.70
|
|
Excision of lingual tonsil
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,881.00
|
|
Excision of mouth lesion complex 40816
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision of neck cyst
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,591.74
|
|
Excision of neck cyst confined 42810
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,786.00
|
|
Excision of penis lesion(s) 54060
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,371.50
|
|
Excision of rectal lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,229.60
|
|
Excision of rectal stricture
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,395.28
|
|
Excision of salivary cyst
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision of tongue lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,819.23
|
|
Excision of tongue lesion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision of tongue lesion w/closure 41113
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision of tonsil tags
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision of umbilicus 49250
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,856.84
|
|
Excision of uvula
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,589.62
|
|
Excision of vaginal septum 57130
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,762.53
|
|
Excision olecranon bursa
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,591.33
|
|
Excision radial head
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,839.54
|
|
Excision tongue lesion without closure 41110
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Excision tumor soft tissue back/flank subcutaneous >= 3 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,255.75
|
|
Excis partial tal calc
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,594.44
|
|
Excis uppr jaw cyst w/repair
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,855.00
|
|
Exc leg/ankle tum dep 5 cm/ > 27634
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc leg/ankle tum subfasc<5cm 27619
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc les conjunctiva <1 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,760.73
|
|
Exc les conjunctiva >1 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,760.73
|
|
Exc les conjunctiva adj scl
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,760.73
|
|
Exc les/mucos/sub/ves mouth/no rpr 40810
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,401.25
|
|
Exc malig feenl <0.5cm 11640
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,206.78
|
|
Exc malig feenl 1.1-2 11642
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,113.60
|
|
Exc malig feenl 3.1-4.0 11644
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,070.30
|
|
Exc malig feenl >4cm 11646
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc malig snhfg 0.5cm or less 11620
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,273.80
|
|
Exc malig snhfg 0.6-1.0 cm 11621
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$973.71
|
|
Exc malig snhfg 2.1-3 cm 11623
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,917.33
|
|
Exc malig tal <0.5cm 11600
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$894.66
|
|
Exc malig tal 0.6-1.0cm 11601
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$828.59
|
|
Exc mal+marg tal 1.1-2 cm 11602
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$932.35
|
|
Exc mal+marg tal 2.1-3 cm 11603
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,246.00
|
|
Exc mal+marg tal 3.1-4 cm 11604
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,322.10
|
|
Exc mandible 21025
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,876.98
|
|
Exc neck tum deep < 5 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc neck tum deep 5 cm/>
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,294.00
|
|
Exc of facial bones/osteomy/abcess 21026
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,555.73
|
|
Exc of residual cervix via aginal approach 57550
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,913.60
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,588.30
|
|
Exc prtl bn phlnx toe
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,752.25
|
|
Exc rect tum transanal full
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,229.60
|
|
Exc rect tum transanal part
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,997.10
|
|
Exc sac pr ulc prim str ostc
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc sac pr ulc skn flp ostc
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,055.70
|
|
Exc sacral pr ulc prim sutr
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc sacral pr ulc skn flap
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,054.55
|
|
Exc shoulder tum deep < 5 cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc skn hdrdnt ax complex
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc skn hdrdnt ax smpl/ntrm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,170.64
|
|
Exc skn hdrdnt ing complex
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,329.08
|
|
Exc snhfg mal+mrg 3.1-4 11624
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,171.00
|
|
Exc snhfg mal+mrg >4 cm 11626
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,370.52
|
|
Exc sq tum/leg or ankle area <3 cm 27618
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,310.40
|
|
Exc sq tum/neck/ant thorax 3cm/> 21552
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,295.90
|
|
Exc sq tum/neck or ant thorax <3cm 21555
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,271.01
|
|
Exc sq tumor/foot or toe < 1.5 cm 28039
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,480.43
|
|
Exc sq tumor/forearm/wrist/<3cm 25075
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,473.60
|
|
Exc sq tumor/leg/ankle 3cm/> 27632
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc sq tumor/shoulder area 3cm/> 23071
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,271.01
|
|
Exc sq tumor/thigh/knee area 3cm/> 27337
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,370.52
|
|
Exc sq tum/vasc malform/hand/fngr 26111
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,908.09
|
|
Exc subq tum/sft tis/pel/hip 3cm/> 27043
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc tendon sheath or cap lesion 26160
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,650.53
|
|
Exc thigh/knee les sc<3cm 27327
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,369.60
|
|
Exc thigh/knee tum deep <5cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,170.64
|
|
Exc thigh/knee tum dep 5cm/>
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,700.80
|
|
Exc thrombosed hemorrhoid 46320
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,491.20
|
|
Exc tmr sft tiss shldr subq <3cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,271.01
|
|
Exc torus mandibularis 21031
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,786.00
|
|
Exc trchntric pr ulcer w/prim sutr w/ostectomy 15951
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,386.84
|
|
Exc trchntr pr ulc flp clsr
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,164.64
|
|
Exc trchntr pr ulc flp ostc
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,129.78
|
|
Exc trchntr pr ulc prep flap
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,872.80
|
|
Exc trchntr pr ulc prep ostc
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,055.70
|
