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Sept updated schedule final Powered By Docstoc
					                           DMAP Fee For Service Fee Schedule
                                   September 2009
Proc Code   Description                      Modifier 1 Modifier 2 ASC   Price    Effective Date
00100       ANESTH, SALIVARY GLAND                                       $24.19     20080101
00102       ANESTH, REPAIR OF CLEFT LIP                                  $24.19     20080101
00103       ANESTH, BLEPHAROPLASTY                                       $24.19     20080101
00104       ANESTH, ELECTROSHOCK                                         $24.19     20080101
00120       ANESTH, EAR SURGERY                                          $24.19     20080101
00124       ANESTH, EAR EXAM                                             $24.19     20080101
00126       ANESTH, TYMPANOTOMY                                          $24.19     20080101
00140       ANESTH, PROCEDURES ON EYE                                    $24.19     20080101
00142       ANESTH, LENS SURGERY                                         $24.19     20080101
00144       ANESTH, CORNEAL TRANSPLANT                                   $24.19     20080101
00145       ANESTH, VITREORETINAL SURG                                   $24.19     20080101
00147       ANESTH, IRIDECTOMY                                           $24.19     20080101
00148       ANESTH, EYE EXAM                                             $24.19     20080101
00160       ANESTH, NOSE/SINUS SURGERY                                   $24.19     20080101
00162       ANESTH, NOSE/SINUS SURGERY                                   $24.19     20080101
00164       ANESTH, BIOPSY OF NOSE                                       $24.19     20080101
00170       ANESTH, PROCEDURE ON MOUTH                                   $24.19     20080101
00172       ANESTH, CLEFT PALATE REPAIR                                  $24.19     20080101
00174       ANESTH, PHARYNGEAL SURGERY                                   $24.19     20080101
00176       ANESTH, PHARYNGEAL SURGERY                                   $24.19     20080101
00190       ANESTH, FACE/SKULL BONE SURG                                 $24.19     20080101
00192       ANESTH, FACIAL BONE SURGERY                                  $24.19     20080101
00210       ANESTH, CRANIAL SURG NOS                                     $24.19     20080101
00211       ANESTH, CRAN SURG, HEMOTOMA                                  $24.19     20090101
00212       ANESTH, SKULL DRAINAGE                                       $24.19     20080101
00214       ANESTH, SKULL DRAINAGE                                       $24.19     20080101
00215       ANESTH, SKULL REPAIR/FRACT                                   $24.19     20080101
00216       ANESTH, HEAD VESSEL SURGERY                                  $24.19     20080101
00218       ANESTH, SPECIAL HEAD SURGERY                                 $24.19     20080101
00220       ANESTH, INTRCRN NERVE                                        $24.19     20080101
00222       ANESTH, HEAD NERVE SURGERY                                   $24.19     20080101
00300       ANESTH, HEAD/NECK/PTRUNK                                     $24.19     20080101
00320       ANESTH, NECK ORGAN, 1 & OVER                                 $24.19     20080101
00322       ANESTH, BIOPSY OF THYROID                                    $24.19     20080101
00326       ANESTH, LARYNX/TRACH, < 1 YR                                 $24.19     20080101
00350       ANESTH, NECK VESSEL SURGERY                                  $24.19     20080101
00352       ANESTH, NECK VESSEL SURGERY                                  $24.19     20080101
00400       ANESTH, SKIN, EXT/PER/ATRUNK                                 $24.19     20080101
00402       ANESTH, SURGERY OF BREAST                                    $24.19     20080101
00404       ANESTH, SURGERY OF BREAST                                    $24.19     20080101
00406       ANESTH, SURGERY OF BREAST                                    $24.19     20080101
00410       ANESTH, CORRECT HEART RHYTHM                                 $24.19     20080101
00450       ANESTH, SURGERY OF SHOULDER                                  $24.19     20080101


                                           Page 1
Proc Code   Description                      Modifier 1 Modifier 2 ASC   Price    Effective Date
00452       ANESTH, SURGERY OF SHOULDER                                  $24.19     20080101
00454       ANESTH, COLLAR BONE BIOPSY                                   $24.19     20080101
00470       ANESTH, REMOVAL OF RIB                                       $24.19     20080101
00472       ANESTH, CHEST WALL REPAIR                                    $24.19     20080101
00474       ANESTH, SURGERY OF RIB(S)                                    $24.19     20080101
00500       ANESTH, ESOPHAGEAL SURGERY                                   $24.19     20080101
00520       ANESTH, CHEST PROCEDURE                                      $24.19     20080101
00522       ANESTH, CHEST LINING BIOPSY                                  $24.19     20080101
00524       ANESTH, CHEST DRAINAGE                                       $24.19     20080101
00528       ANESTH, CHEST PARTITION VIEW                                 $24.19     20080101
00529       ANESTH, CHEST PARTITION VIEW                                 $24.19     20080101
00530       ANESTH, PACEMAKER INSERTION                                  $24.19     20080101
00532       ANESTH, VASCULAR ACCESS                                      $24.19     20080101
00534       ANESTH, CARDIOVERTER/DEFIB                                   $24.19     20080101
00537       ANESTH, CARDIAC ELECTROPHYS                                  $24.19     20080101
00539       ANESTH, TRACH-BRONCH RECONST                                 $24.19     20080101
00540       ANESTH, CHEST SURGERY                                        $24.19     20080101
00541       ANESTH, ONE LUNG VENTILATION                                 $24.19     20080101
00542       ANESTH, RELEASE OF LUNG                                      $24.19     20080101
00546       ANESTH, LUNG,CHEST WALL SURG                                 $24.19     20080101
00548       ANESTH, TRACHEA,BRONCHI SURG                                 $24.19     20080101
00550       ANESTH, STERNAL DEBRIDEMENT                                  $24.19     20080101
00560       ANESTH, HEART SURG W/O PUMP                                  $24.19     20080101
00561       ANESTH, HEART SURG < AGE 1                                   $24.19     20080101
00562       ANESTH HRT SURG W/PMP AGE 1+                                 $24.19     20080101
00563       ANESTH, HEART SURG W/ARREST                                  $24.19     20080101
00566       ANESTH, CABG W/O PUMP                                        $24.19     20080101
00567       ANESTH, CABG W/PUMP                                          $24.19     20090101
00580       ANESTH, HEART/LUNG TRANSPLNT                                 $24.19     20080101
00600       ANESTH, SPINE, CORD SURGERY                                  $24.19     20080101
00604       ANESTH, SITTING PROCEDURE                                    $24.19     20080101
00620       ANESTH, SPINE, CORD SURGERY                                  $24.19     20080101
00622       ANESTH, REMOVAL OF NERVES                                    $24.19     20080101
00625       ANES SPINE TRANTHOR W/O VENT                                 $24.19     20080101
00626       ANES, SPINE TRANSTHOR W/VENT                                 $24.19     20080101
00630       ANESTH, SPINE, CORD SURGERY                                  $24.19     20080101
00632       ANESTH, REMOVAL OF NERVES                                    $24.19     20080101
00634       ANESTH FOR CHEMONUCLEOLYSIS                                  $24.19     20080101
00635       ANESTH, LUMBAR PUNCTURE                                      $24.19     20080101
00640       ANESTH, SPINE MANIPULATION                                   $24.19     20080101
00670       ANESTH, SPINE, CORD SURGERY                                  $24.19     20080101
00700       ANESTH, ABDOMINAL WALL SURG                                  $24.19     20080101
00702       ANESTH, FOR LIVER BIOPSY                                     $24.19     20080101
00730       ANESTH, ABDOMINAL WALL SURG                                  $24.19     20080101
00740       ANESTH, UPPER GI VISUALIZE                                   $24.19     20080101


                                           Page 2
Proc Code   Description                      Modifier 1 Modifier 2 ASC   Price    Effective Date
00750       ANESTH, REPAIR OF HERNIA                                     $24.19     20080101
00752       ANESTH, REPAIR OF HERNIA                                     $24.19     20080101
00754       ANESTH, REPAIR OF HERNIA                                     $24.19     20080101
00756       ANESTH, REPAIR OF HERNIA                                     $24.19     20080101
00770       ANESTH, BLOOD VESSEL REPAIR                                  $24.19     20080101
00790       ANESTH, SURG UPPER ABDOMEN                                   $24.19     20080101
00792       ANESTH, HEMORR/EXCISE LIVER                                  $24.19     20080101
00794       ANESTH, PANCREAS REMOVAL                                     $24.19     20080101
00796       ANESTH, FOR LIVER TRANSPLANT                                 $24.19     20080101
00797       ANESTH, SURGERY FOR OBESITY                                  $24.19     20080101
00800       ANESTH, ABDOMINAL WALL SURG                                  $24.19     20080101
00810       ANESTH, LOW INTESTINE SCOPE                                  $24.19     20080101
00820       ANESTH, ABDOMINAL WALL SURG                                  $24.19     20080101
00830       ANESTH, REPAIR OF HERNIA                                     $24.19     20080101
00832       ANESTH, REPAIR OF HERNIA                                     $24.19     20080101
00834       ANESTH, HERNIA REPAIR< 1 YR                                  $24.19     20080101
00836       ANESTH HERNIA REPAIR PREEMIE                                 $24.19     20080101
00840       ANESTH, SURG LOWER ABDOMEN                                   $24.19     20080101
00842       ANESTH, AMNIOCENTESIS                                        $24.19     20080101
00844       ANESTH, PELVIS SURGERY                                       $24.19     20080101
00846       ANESTH, HYSTERECTOMY                                         $24.19     20080101
00848       ANESTH, PELVIC ORGAN SURG                                    $24.19     20080101
00851       ANESTH, TUBAL LIGATION                                       $24.19     20080101
00860       ANESTH, SURGERY OF ABDOMEN                                   $24.19     20080101
00862       ANESTH, KIDNEY/URETER SURG                                   $24.19     20080101
00864       ANESTH, REMOVAL OF BLADDER                                   $24.19     20080101
00865       ANESTH, REMOVAL OF PROSTATE                                  $24.19     20080101
00866       ANESTH, REMOVAL OF ADRENAL                                   $24.19     20080101
00868       ANESTH, KIDNEY TRANSPLANT                                    $24.19     20080101
00870       ANESTH, BLADDER STONE SURG                                   $24.19     20080101
00872       ANESTH KIDNEY STONE DESTRUCT                                 $24.19     20080101
00873       ANESTH KIDNEY STONE DESTRUCT                                 $24.19     20080101
00880       ANESTH, ABDOMEN VESSEL SURG                                  $24.19     20080101
00882       ANESTH, MAJOR VEIN LIGATION                                  $24.19     20080101
00902       ANESTH, ANORECTAL SURGERY                                    $24.19     20080101
00904       ANESTH, PERINEAL SURGERY                                     $24.19     20080101
00906       ANESTH, REMOVAL OF VULVA                                     $24.19     20080101
00908       ANESTH, REMOVAL OF PROSTATE                                  $24.19     20080101
00910       ANESTH, BLADDER SURGERY                                      $24.19     20080101
00912       ANESTH, BLADDER TUMOR SURG                                   $24.19     20080101
00914       ANESTH, REMOVAL OF PROSTATE                                  $24.19     20080101
00916       ANESTH, BLEEDING CONTROL                                     $24.19     20080101
00918       ANESTH, STONE REMOVAL                                        $24.19     20080101
00920       ANESTH, GENITALIA SURGERY                                    $24.19     20080101
00921       ANESTH, VASECTOMY                                            $24.19     20080101


                                           Page 3
Proc Code   Description                      Modifier 1 Modifier 2 ASC   Price    Effective Date
00922       ANESTH, SPERM DUCT SURGERY                                   $24.19     20080101
00924       ANESTH, TESTIS EXPLORATION                                   $24.19     20080101
00926       ANESTH, REMOVAL OF TESTIS                                    $24.19     20080101
00928       ANESTH, REMOVAL OF TESTIS                                    $24.19     20080101
00930       ANESTH, TESTIS SUSPENSION                                    $24.19     20080101
00932       ANESTH, AMPUTATION OF PENIS                                  $24.19     20080101
00934       ANESTH, PENIS, NODES REMOVAL                                 $24.19     20080101
00936       ANESTH, PENIS, NODES REMOVAL                                 $24.19     20080101
00938       ANESTH, INSERT PENIS DEVICE                                  $24.19     20080101
00940       ANESTH, VAGINAL PROCEDURES                                   $24.19     20080101
00942       ANESTH, SURG ON VAG/URETHRAL                                 $24.19     20080101
00944       ANESTH, VAGINAL HYSTERECTOMY                                 $24.19     20080101
00948       ANESTH, REPAIR OF CERVIX                                     $24.19     20080101
00950       ANESTH, VAGINAL ENDOSCOPY                                    $24.19     20080101
00952       ANESTH, HYSTEROSCOPE/GRAPH                                   $24.19     20080101
01112       ANESTH, BONE ASPIRATE/BX                                     $24.19     20080101
01120       ANESTH, PELVIS SURGERY                                       $24.19     20080101
01130       ANESTH, BODY CAST PROCEDURE                                  $24.19     20080101
01140       ANESTH, AMPUTATION AT PELVIS                                 $24.19     20080101
01150       ANESTH, PELVIC TUMOR SURGERY                                 $24.19     20080101
01160       ANESTH, PELVIS PROCEDURE                                     $24.19     20080101
01170       ANESTH, PELVIS SURGERY                                       $24.19     20080101
01173       ANESTH, FX REPAIR, PELVIS                                    $24.19     20080101
01180       ANESTH, PELVIS NERVE REMOVAL                                 $24.19     20080101
01190       ANESTH, PELVIS NERVE REMOVAL                                 $24.19     20080101
01200       ANESTH, HIP JOINT PROCEDURE                                  $24.19     20080101
01202       ANESTH, ARTHROSCOPY OF HIP                                   $24.19     20080101
01210       ANESTH, HIP JOINT SURGERY                                    $24.19     20080101
01212       ANESTH, HIP DISARTICULATION                                  $24.19     20080101
01214       ANESTH, HIP ARTHROPLASTY                                     $24.19     20080101
01215       ANESTH, REVISE HIP REPAIR                                    $24.19     20080101
01220       ANESTH, PROCEDURE ON FEMUR                                   $24.19     20080101
01230       ANESTH, SURGERY OF FEMUR                                     $24.19     20080101
01232       ANESTH, AMPUTATION OF FEMUR                                  $24.19     20080101
01234       ANESTH, RADICAL FEMUR SURG                                   $24.19     20080101
01250       ANESTH, UPPER LEG SURGERY                                    $24.19     20080101
01260       ANESTH, UPPER LEG VEINS SURG                                 $24.19     20080101
01270       ANESTH, THIGH ARTERIES SURG                                  $24.19     20080101
01272       ANESTH, FEMORAL ARTERY SURG                                  $24.19     20080101
01274       ANESTH, FEMORAL EMBOLECTOMY                                  $24.19     20080101
01320       ANESTH, KNEE AREA SURGERY                                    $24.19     20080101
01340       ANESTH, KNEE AREA PROCEDURE                                  $24.19     20080101
01360       ANESTH, KNEE AREA SURGERY                                    $24.19     20080101
01380       ANESTH, KNEE JOINT PROCEDURE                                 $24.19     20080101
01382       ANESTH, DX KNEE ARTHROSCOPY                                  $24.19     20080101


                                           Page 4
Proc Code   Description                      Modifier 1 Modifier 2 ASC   Price    Effective Date
01390       ANESTH, KNEE AREA PROCEDURE                                  $24.19     20080101
01392       ANESTH, KNEE AREA SURGERY                                    $24.19     20080101
01400       ANESTH, KNEE JOINT SURGERY                                   $24.19     20080101
01402       ANESTH, KNEE ARTHROPLASTY                                    $24.19     20080101
01404       ANESTH, AMPUTATION AT KNEE                                   $24.19     20080101
01420       ANESTH, KNEE JOINT CASTING                                   $24.19     20080101
01430       ANESTH, KNEE VEINS SURGERY                                   $24.19     20080101
01432       ANESTH, KNEE VESSEL SURG                                     $24.19     20080101
01440       ANESTH, KNEE ARTERIES SURG                                   $24.19     20080101
01442       ANESTH, KNEE ARTERY SURG                                     $24.19     20080101
01444       ANESTH, KNEE ARTERY REPAIR                                   $24.19     20080101
01462       ANESTH, LOWER LEG PROCEDURE                                  $24.19     20080101
01464       ANESTH, ANKLE/FT ARTHROSCOPY                                 $24.19     20080101
01470       ANESTH, LOWER LEG SURGERY                                    $24.19     20080101
01472       ANESTH, ACHILLES TENDON SURG                                 $24.19     20080101
01474       ANESTH, LOWER LEG SURGERY                                    $24.19     20080101
01480       ANESTH, LOWER LEG BONE SURG                                  $24.19     20080101
01482       ANESTH, RADICAL LEG SURGERY                                  $24.19     20080101
01484       ANESTH, LOWER LEG REVISION                                   $24.19     20080101
01486       ANESTH, ANKLE REPLACEMENT                                    $24.19     20080101
01490       ANESTH, LOWER LEG CASTING                                    $24.19     20080101
01500       ANESTH, LEG ARTERIES SURG                                    $24.19     20080101
01502       ANESTH, LWR LEG EMBOLECTOMY                                  $24.19     20080101
01520       ANESTH, LOWER LEG VEIN SURG                                  $24.19     20080101
01522       ANESTH, LOWER LEG VEIN SURG                                  $24.19     20080101
01610       ANESTH, SURGERY OF SHOULDER                                  $24.19     20080101
01620       ANESTH, SHOULDER PROCEDURE                                   $24.19     20080101
01622       ANES DX SHOULDER ARTHROSCOPY                                 $24.19     20080101
01630       ANESTH, SURGERY OF SHOULDER                                  $24.19     20080101
01632       ANESTH, SURGERY OF SHOULDER                                  $24.19     20080101
01634       ANESTH, SHOULDER JOINT AMPUT                                 $24.19     20080101
01636       ANESTH, FOREQUARTER AMPUT                                    $24.19     20080101
01638       ANESTH, SHOULDER REPLACEMENT                                 $24.19     20080101
01650       ANESTH, SHOULDER ARTERY SURG                                 $24.19     20080101
01652       ANESTH, SHOULDER VESSEL SURG                                 $24.19     20080101
01654       ANESTH, SHOULDER VESSEL SURG                                 $24.19     20080101
01656       ANESTH, ARM-LEG VESSEL SURG                                  $24.19     20080101
01670       ANESTH, SHOULDER VEIN SURG                                   $24.19     20080101
01680       ANESTH, SHOULDER CASTING                                     $24.19     20080101
01682       ANESTH, AIRPLANE CAST                                        $24.19     20080101
01710       ANESTH, ELBOW AREA SURGERY                                   $24.19     20080101
01712       ANESTH, UPPR ARM TENDON SURG                                 $24.19     20080101
01714       ANESTH, UPPR ARM TENDON SURG                                 $24.19     20080101
01716       ANESTH, BICEPS TENDON REPAIR                                 $24.19     20080101
01730       ANESTH, UPPR ARM PROCEDURE                                   $24.19     20080101


                                           Page 5
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
01732       ANESTH, DX ELBOW ARTHROSCOPY                                 $24.19      20080101
01740       ANESTH, UPPER ARM SURGERY                                    $24.19      20080101
01742       ANESTH, HUMERUS SURGERY                                      $24.19      20080101
01744       ANESTH, HUMERUS REPAIR                                       $24.19      20080101
01756       ANESTH, RADICAL HUMERUS SURG                                 $24.19      20080101
01758       ANESTH, HUMERAL LESION SURG                                  $24.19      20080101
01760       ANESTH, ELBOW REPLACEMENT                                    $24.19      20080101
01770       ANESTH, UPPR ARM ARTERY SURG                                 $24.19      20080101
01772       ANESTH, UPPR ARM EMBOLECTOMY                                 $24.19      20080101
01780       ANESTH, UPPER ARM VEIN SURG                                  $24.19      20080101
01782       ANESTH, UPPR ARM VEIN REPAIR                                 $24.19      20080101
01810       ANESTH, LOWER ARM SURGERY                                    $24.19      20080101
01820       ANESTH, LOWER ARM PROCEDURE                                  $24.19      20080101
01829       ANESTH, DX WRIST ARTHROSCOPY                                 $24.19      20080101
01830       ANESTH, LOWER ARM SURGERY                                    $24.19      20080101
01832       ANESTH, WRIST REPLACEMENT                                    $24.19      20080101
01840       ANESTH, LWR ARM ARTERY SURG                                  $24.19      20080101
01842       ANESTH, LWR ARM EMBOLECTOMY                                  $24.19      20080101
01844       ANESTH, VASCULAR SHUNT SURG                                  $24.19      20080101
01850       ANESTH, LOWER ARM VEIN SURG                                  $24.19      20080101
01852       ANESTH, LWR ARM VEIN REPAIR                                  $24.19      20080101
01860       ANESTH, LOWER ARM CASTING                                    $24.19      20080101
01916       ANESTH, DX ARTERIOGRAPHY                                     $24.19      20080101
01920       ANESTH, CATHETERIZE HEART                                    $24.19      20080101
01922       ANESTH, CAT OR MRI SCAN                                      $24.19      20080101
01924       ANES, THER INTERVEN RAD, ART                                 $24.19      20080101
01925       ANES, THER INTERVEN RAD, CAR                                 $24.19      20080101
01926       ANES, TX INTERV RAD HRT/CRAN                                 $24.19      20080101
01930       ANES, THER INTERVEN RAD, VEI                                 $24.19      20080101
01931       ANES, THER INTERVEN RAD, TIP                                 $24.19      20080101
01932       ANES, TX INTERV RAD, TH VEIN                                 $24.19      20080101
01933       ANES, TX INTERV RAD, CRAN V                                  $24.19      20080101
01935       ANESTH, PERC IMG DX SP PROC                                  $24.19      20080101
01936       ANESTH, PERC IMG TX SP PROC                                  $24.19      20080101
01951       ANESTH, BURN, LESS 4 PERCENT                                 $24.19      20080101
01952       ANESTH, BURN, 4-9 PERCENT                                    $24.19      20080101
01953       ANESTH, BURN, EACH 9 PERCENT                                 $24.19      20080101
01958       ANESTH, ANTEPARTUM MANIPUL                                   $24.19      20080101
01960       ANESTH, VAGINAL DELIVERY                                     $24.19      20080101
01961       ANESTH, CS DELIVERY                                          $24.19      20080101
01962       ANESTH, EMER HYSTERECTOMY                                    $24.19      20080101
01963       ANESTH, CS HYSTERECTOMY                                      $24.19      20080101
01965       ANESTH, INC/MISSED AB PROC                                   $24.19      20080101
01966       ANESTH, INDUCED AB PROCEDURE                                 $24.19      20080101
01967       ANESTH/ANALG, VAG DELIVERY                                   $338.67     20080101


                                           Page 6
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
01968       ANES/ANALG CS DELIVER ADD-ON                                 $24.19      20080101
01969       ANESTH/ANALG CS HYST ADD-ON                                  $24.19      20080101
01990       SUPPORT FOR ORGAN DONOR                                      $24.19      20080101
01991       ANESTH, NERVE BLOCK/INJ                                      $24.19      20080101
01992       ANESTH, N BLOCK/INJ, PRONE                                   $24.19      20080101
01996       HOSP MANAGE CONT DRUG ADMIN                                  $24.19      20080101
10021       FNA W/O IMAGE                                                $98.48      20090101
10022       FNA W/IMAGE                                                  $102.94     20090101
10040       ACNE SURGERY                                                 $67.05      20090101
10060       DRAINAGE OF SKIN ABSCESS                                     $74.28      20090101
10061       DRAINAGE OF SKIN ABSCESS                                     $128.81     20090101
10080       DRAINAGE OF PILONIDAL CYST                                   $116.57     20090101
10081       DRAINAGE OF PILONIDAL CYST                                   $180.56     20090101
10120       REMOVE FOREIGN BODY                                          $94.87      20090101
10121       REMOVE FOREIGN BODY                                          $182.22     20090101
10121       REMOVE FOREIGN BODY                                  Y       $400.91     20081209
10140       DRAINAGE OF HEMATOMA/FLUID                                   $104.61     20090101
10160       PUNCTURE DRAINAGE OF LESION                                  $85.69      20090101
10180       COMPLEX DRAINAGE, WOUND                                      $159.69     20090101
10180       COMPLEX DRAINAGE, WOUND                              Y       $419.29     20081209
11000       DEBRIDE INFECTED SKIN                                        $36.72      20090101
11001       DEBRIDE INFECTED SKIN ADD-ON                                 $15.86      20090101
11004       DEBRIDE GENITALIA & PERINEUM                                 $417.87     20090101
11005       DEBRIDE ABDOM WALL               80                          $110.56     20090101
11005       DEBRIDE ABDOM WALL               81                          $110.56     20090101
11005       DEBRIDE ABDOM WALL               82                          $110.56     20090101
11005       DEBRIDE ABDOM WALL               AS                          $110.56     20090101
11005       DEBRIDE ABDOM WALL                                           $552.79     20090101
11006       DEBRIDE GENIT/PER/ABDOM WALL                                 $522.48     20090101
11008       REMOVE MESH FROM ABD WALL        80                          $40.45      20090101
11008       REMOVE MESH FROM ABD WALL        81                          $40.45      20090101
11008       REMOVE MESH FROM ABD WALL        82                          $40.45      20090101
11008       REMOVE MESH FROM ABD WALL        AS                           $40.45     20090101
11008       REMOVE MESH FROM ABD WALL                                    $202.24     20090101
11010       DEBRIDE SKIN, FX                 80                           $65.05     20090101
11010       DEBRIDE SKIN, FX                 81                           $65.05     20090101
11010       DEBRIDE SKIN, FX                 82                           $65.05     20090101
11010       DEBRIDE SKIN, FX                 AS                           $65.05     20090101
11010       DEBRIDE SKIN, FX                                     Y       $186.55     20081209
11010       DEBRIDE SKIN, FX                                             $325.25     20090101
11011       DEBRIDE SKIN/MUSCLE, FX          80                          $73.89      20090101
11011       DEBRIDE SKIN/MUSCLE, FX          81                          $73.89      20090101
11011       DEBRIDE SKIN/MUSCLE, FX          82                          $73.89      20090101
11011       DEBRIDE SKIN/MUSCLE, FX          AS                           $73.89     20090101
11011       DEBRIDE SKIN/MUSCLE, FX                                      $369.44     20090101


                                           Page 7
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
11011       DEBRIDE SKIN/MUSCLE, FX                              Y       $186.55     20081209
11012       DEBRIDE SKIN/MUSCLE/BONE, FX     80                          $103.44     20090101
11012       DEBRIDE SKIN/MUSCLE/BONE, FX     81                          $103.44     20090101
11012       DEBRIDE SKIN/MUSCLE/BONE, FX     82                          $103.44     20090101
11012       DEBRIDE SKIN/MUSCLE/BONE, FX     AS                          $103.44     20090101
11012       DEBRIDE SKIN/MUSCLE/BONE, FX                         Y       $186.55     20081209
11012       DEBRIDE SKIN/MUSCLE/BONE, FX                                 $517.19     20090101
11040       DEBRIDE SKIN, PARTIAL                                        $32.27      20090101
11041       DEBRIDE SKIN, FULL                                           $38.67      20090101
11042       DEBRIDE SKIN/TISSUE                                  Y       $120.68     20081209
11042       DEBRIDE SKIN/TISSUE                                          $52.58      20090101
11043       DEBRIDE TISSUE/MUSCLE                                        $189.18     20090101
11043       DEBRIDE TISSUE/MUSCLE                                Y       $120.68     20081209
11044       DEBRIDE TISSUE/MUSCLE/BONE                                   $255.68     20090101
11044       DEBRIDE TISSUE/MUSCLE/BONE                           Y       $310.84     20081209
11055       TRIM SKIN LESION                                             $32.27      20090101
11056       TRIM SKIN LESIONS, 2 TO 4                                    $40.06      20090101
11057       TRIM SKIN LESIONS, OVER 4                                    $48.69      20090101
11100       BIOPSY, SKIN LESION                                          $66.77      20090101
11101       BIOPSY, SKIN ADD-ON                                          $22.25      20090101
11300       SHAVE SKIN LESION                                            $45.34      20090101
11301       SHAVE SKIN LESION                                            $61.21      20090101
11302       SHAVE SKIN LESION                                            $73.16      20090101
11303       SHAVE SKIN LESION                                            $86.81      20090101
11305       SHAVE SKIN LESION                                            $47.30      20090101
11306       SHAVE SKIN LESION                                            $64.54      20090101
11307       SHAVE SKIN LESION                                            $75.12      20090101
11308       SHAVE SKIN LESION                                            $86.81      20090101
11310       SHAVE SKIN LESION                                            $56.20      20090101
11311       SHAVE SKIN LESION                                            $70.39      20090101
11312       SHAVE SKIN LESION                                            $81.52      20090101
11313       SHAVE SKIN LESION                                            $103.49     20090101
11400       EXC TR-EXT B9+MARG 0.5 < CM                                  $79.85      20090101
11401       EXC TR-EXT B9+MARG 0.6-1 CM                                  $96.53      20090101
11402       EXC TR-EXT B9+MARG 1.1-2 CM                                  $107.39     20090101
11403       EXC TR-EXT B9+MARG 2.1-3 CM                                  $124.08     20090101
11404       EXC TR-EXT B9+MARG 3.1-4 CM                                  $141.05     20090101
11404       EXC TR-EXT B9+MARG 3.1-4 CM                          Y       $333.11     20081209
11406       EXC TR-EXT B9+MARG > 4.0 CM                                  $197.25     20090101
11406       EXC TR-EXT B9+MARG > 4.0 CM                          Y       $400.91     20081209
11420       EXC H-F-NK-SP B9+MARG 0.5 <                                  $80.40      20090101
11421       EXC H-F-NK-SP B9+MARG 0.6-1                                  $103.21     20090101
11422       EXC H-F-NK-SP B9+MARG 1.1-2                                  $115.73     20090101
11423       EXC H-F-NK-SP B9+MARG 2.1-3                                  $135.21     20090101
11424       EXC H-F-NK-SP B9+MARG 3.1-4                                  $155.52     20090101


                                           Page 8
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
11424       EXC H-F-NK-SP B9+MARG 3.1-4                          Y       $400.91     20081209
11426       EXC H-F-NK-SP B9+MARG > 4 CM                         Y       $442.39     20081209
11426       EXC H-F-NK-SP B9+MARG > 4 CM                                 $223.13     20090101
11440       EXC FACE-MM B9+MARG 0.5 < CM                                 $89.03      20090101
11441       EXC FACE-MM B9+MARG 0.6-1 CM                                 $111.00     20090101
11442       EXC FACE-MM B9+MARG 1.1-2 CM                                 $124.91     20090101
11443       EXC FACE-MM B9+MARG 2.1-3 CM                                 $151.07     20090101
11444       EXC FACE-MM B9+MARG 3.1-4 CM                                 $190.85     20090101
11444       EXC FACE-MM B9+MARG 3.1-4 CM                         Y       $271.71     20081209
11446       EXC FACE-MM B9+MARG > 4 CM                                   $257.34     20090101
11446       EXC FACE-MM B9+MARG > 4 CM                           Y       $442.39     20081209
11450       REMOVAL, SWEAT GLAND LESION                          Y       $442.39     20081209
11450       REMOVAL, SWEAT GLAND LESION                                  $238.14     20090101
11451       REMOVAL, SWEAT GLAND LESION                                  $316.33     20090101
11451       REMOVAL, SWEAT GLAND LESION                          Y       $442.39     20081209
11462       REMOVAL, SWEAT GLAND LESION                          Y       $442.39     20081209
11462       REMOVAL, SWEAT GLAND LESION                                  $235.36     20090101
11463       REMOVAL, SWEAT GLAND LESION                          Y       $442.39     20081209
11463       REMOVAL, SWEAT GLAND LESION                                  $321.89     20090101
11470       REMOVAL, SWEAT GLAND LESION                                  $259.57     20090101
11470       REMOVAL, SWEAT GLAND LESION                          Y       $442.39     20081209
11471       REMOVAL, SWEAT GLAND LESION                                  $333.85     20090101
11471       REMOVAL, SWEAT GLAND LESION                          Y       $442.39     20081209
11600       EXC TR-EXT MLG+MARG 0.5 < CM                                 $121.58     20090101
11601       EXC TR-EXT MLG+MARG 0.6-1 CM                                 $144.94     20090101
11602       EXC TR-EXT MLG+MARG 1.1-2 CM                                 $158.02     20090101
11603       EXC TR-EXT MLG+MARG 2.1-3 CM                                 $180.56     20090101
11604       EXC TR-EXT MLG+MARG 3.1-4 CM                         Y       $323.01     20081209
11604       EXC TR-EXT MLG+MARG 3.1-4 CM                                 $199.76     20090101
11606       EXC TR-EXT MLG+MARG > 4 CM                           Y       $400.91     20081209
11606       EXC TR-EXT MLG+MARG > 4 CM                                   $281.27     20090101
11620       EXC H-F-NK-SP MLG+MARG 0.5 <                                 $122.41     20090101
11621       EXC H-F-NK-SP MLG+MARG 0.6-1                                 $146.06     20090101
11622       EXC H-F-NK-SP MLG+MARG 1.1-2                                 $164.98     20090101
11623       EXC H-F-NK-SP MLG+MARG 2.1-3                                 $194.47     20090101
11624       EXC H-F-NK-SP MLG+MARG 3.1-4                                 $220.62     20090101
11624       EXC H-F-NK-SP MLG+MARG 3.1-4                         Y       $400.91     20081209
11626       EXC H-F-NK-SP MLG+MAR > 4 CM                                 $272.92     20090101
11626       EXC H-F-NK-SP MLG+MAR > 4 CM                         Y       $442.39     20081209
11640       EXC FACE-MM MALIG+MARG 0.5 <                                 $127.70     20090101
11641       EXC FACE-MM MALIG+MARG 0.6-1                                 $156.08     20090101
11642       EXC FACE-MM MALIG+MARG 1.1-2                                 $180.28     20090101
11643       EXC FACE-MM MALIG+MARG 2.1-3                                 $213.39     20090101
11644       EXC FACE-MM MALIG+MARG 3.1-4                                 $265.42     20090101
11644       EXC FACE-MM MALIG+MARG 3.1-4                         Y       $400.91     20081209


                                           Page 9
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
11646       EXC FACE-MM MLG+MARG > 4 CM                                  $351.93     20090101
11646       EXC FACE-MM MLG+MARG > 4 CM                          Y       $442.39     20081209
11719       TRIM NAIL(S)                                                  $13.91     20090101
11720       DEBRIDE NAIL, 1-5                                             $21.15     20090101
11721       DEBRIDE NAIL, 6 OR MORE                                       $30.60     20090101
11730       REMOVAL OF NAIL PLATE                                         $67.33     20090101
11732       REMOVE NAIL PLATE, ADD-ON                                     $31.43     20090101
11740       DRAIN BLOOD FROM UNDER NAIL                                   $30.05     20090101
11750       REMOVAL OF NAIL BED                                          $144.11     20090101
11752       REMOVE NAIL BED/FINGER TIP                                   $204.76     20090101
11755       BIOPSY, NAIL UNIT                                             $90.42     20090101
11760       REPAIR OF NAIL BED                                           $134.09     20090101
11762       RECONSTRUCTION OF NAIL BED                                   $182.50     20090101
11765       EXCISION OF NAIL FOLD, TOE                                    $84.02     20090101
11770       REMOVAL OF PILONIDAL LESION                                  $178.89     20090101
11770       REMOVAL OF PILONIDAL LESION                          Y       $480.79     20081209
11771       REMOVAL OF PILONIDAL LESION                          Y       $480.79     20081209
11771       REMOVAL OF PILONIDAL LESION                                  $357.78     20090101
11772       REMOVAL OF PILONIDAL LESION                                  $442.07     20090101
11772       REMOVAL OF PILONIDAL LESION                          Y       $480.79     20081209
11900       INJECTION INTO SKIN LESIONS                                   $36.72     20090101
11901       ADDED SKIN LESIONS INJECTION                                  $46.18     20090101
11960       INSERT TISSUE EXPANDER(S)                                    $634.59     20090101
11960       INSERT TISSUE EXPANDER(S)                            Y       $434.92     20081209
11970       REPLACE TISSUE EXPANDER                                      $418.98     20090101
11970       REPLACE TISSUE EXPANDER                              Y       $661.93     20081209
11971       REMOVE TISSUE EXPANDER(S)                                    $328.01     20090101
11971       REMOVE TISSUE EXPANDER(S)                            Y       $374.59     20081209
11975       INSERT CONTRACEPTIVE CAP                                      $87.07     20090101
11976       REMOVAL OF CONTRACEPTIVE CAP                                 $103.21     20090101
11977       REMOVAL/REINSERT CONTRA CAP                                  $161.36     20090101
11980       IMPLANT HORMONE PELLET(S)                                     $74.84     20090101
11981       INSERT DRUG IMPLANT DEVICE                                    $94.59     20090101
11982       REMOVE DRUG IMPLANT DEVICE                                   $109.34     20090101
11983       REMOVE/INSERT DRUG IMPLANT                                   $166.65     20090101
12001       REPAIR SUPERFICIAL WOUND(S)                                  $103.77     20090101
12002       REPAIR SUPERFICIAL WOUND(S)                                  $110.44     20090101
12004       REPAIR SUPERFICIAL WOUND(S)                                  $129.92     20090101
12005       REPAIR SUPERFICIAL WOUND(S)                                  $161.92     20090101
12005       REPAIR SUPERFICIAL WOUND(S)                          Y        $65.34     20081209
12006       REPAIR SUPERFICIAL WOUND(S)                                  $201.98     20090101
12006       REPAIR SUPERFICIAL WOUND(S)                          Y        $65.34     20081209
12007       REPAIR SUPERFICIAL WOUND(S)                          Y        $65.34     20081209
12007       REPAIR SUPERFICIAL WOUND(S)                                  $227.30     20090101
12011       REPAIR SUPERFICIAL WOUND(S)                                  $110.17     20090101


                                           Page 10
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
12013       REPAIR SUPERFICIAL WOUND(S)                                 $121.30     20090101
12014       REPAIR SUPERFICIAL WOUND(S)                                 $143.00     20090101
12015       REPAIR SUPERFICIAL WOUND(S)                                 $179.72     20090101
12016       REPAIR SUPERFICIAL WOUND(S)                                 $213.39     20090101
12016       REPAIR SUPERFICIAL WOUND(S)                         Y       $65.34      20081209
12017       REPAIR SUPERFICIAL WOUND(S)                                 $191.96     20090101
12017       REPAIR SUPERFICIAL WOUND(S)                         Y       $65.34      20081209
12018       REPAIR SUPERFICIAL WOUND(S)     80                          $46.02      20090101
12018       REPAIR SUPERFICIAL WOUND(S)     81                          $46.02      20090101
12018       REPAIR SUPERFICIAL WOUND(S)     82                          $46.02      20090101
12018       REPAIR SUPERFICIAL WOUND(S)     AS                           $46.02     20090101
12018       REPAIR SUPERFICIAL WOUND(S)                                 $230.08     20090101
12018       REPAIR SUPERFICIAL WOUND(S)                         Y       $65.34      20081209
12020       CLOSURE OF SPLIT WOUND                              Y        $92.22     20081209
12020       CLOSURE OF SPLIT WOUND                                      $186.40     20090101
12021       CLOSURE OF SPLIT WOUND                              Y        $92.22     20081209
12021       CLOSURE OF SPLIT WOUND                                      $109.62     20090101
12031       INTMD WND REPAIR S/TR/EXT                                   $151.07     20090101
12032       INTMD WND REPAIR S/TR/EXT                                   $199.76     20090101
12034       INTMD WND REPAIR S/TR/EXT                                   $197.25     20090101
12034       INTMD WND REPAIR S/TR/EXT                           Y        $72.18     20081209
12035       INTMD WND REPAIR S/TR/EXT                                   $252.61     20090101
12035       INTMD WND REPAIR S/TR/EXT                           Y        $72.18     20081209
12036       INTMD WND REPAIR S/TR/EXT                                   $280.71     20090101
12036       INTMD WND REPAIR S/TR/EXT                           Y        $72.18     20081209
12037       INTMD WND REPAIR S/TR/EXT                                   $316.60     20090101
12037       INTMD WND REPAIR S/TR/EXT                           Y       $211.40     20081209
12041       INTMD WND REPAIR N-HF/GENIT                                 $161.09     20090101
12042       INTMD WND REPAIR N-HG/GENIT                                 $189.46     20090101
12044       INTMD WND REPAIR N-HG/GENIT                                 $215.33     20090101
12044       INTMD WND REPAIR N-HG/GENIT                         Y        $72.18     20081209
12045       INTMD WND REPAIR N-HG/GENIT                                 $256.22     20090101
12045       INTMD WND REPAIR N-HG/GENIT                         Y        $72.18     20081209
12046       INTMD WND REPAIR N-HG/GENIT                                 $302.69     20090101
12046       INTMD WND REPAIR N-HG/GENIT                         Y        $72.18     20081209
12047       INTMD WND REPAIR N-HG/GENIT     80                           $64.87     20090101
12047       INTMD WND REPAIR N-HG/GENIT     81                           $64.87     20090101
12047       INTMD WND REPAIR N-HG/GENIT     82                           $64.87     20090101
12047       INTMD WND REPAIR N-HG/GENIT     AS                           $64.87     20090101
12047       INTMD WND REPAIR N-HG/GENIT                                 $324.37     20090101
12047       INTMD WND REPAIR N-HG/GENIT                         Y       $211.40     20081209
12051       INTMD WND REPAIR FACE/MM                                    $177.49     20090101
12052       INTMD WND REPAIR FACE/MM                                    $195.30     20090101
12053       INTMD WND REPAIR FACE/MM                                    $213.94     20090101
12054       INTMD WND REPAIR, FACE/MM                                   $230.08     20090101


                                          Page 11
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
12054       INTMD WND REPAIR, FACE/MM                          Y        $72.18     20081209
12055       INTMD WND REPAIR FACE/MM                                   $282.10     20090101
12055       INTMD WND REPAIR FACE/MM                           Y        $72.18     20081209
12056       INTMD WND REPAIR FACE/MM                                   $347.76     20090101
12056       INTMD WND REPAIR FACE/MM                           Y        $72.18     20081209
12057       INTMD WND REPAIR FACE/MM       80                          $75.01      20090101
12057       INTMD WND REPAIR FACE/MM       81                          $75.01      20090101
12057       INTMD WND REPAIR FACE/MM       82                          $75.01      20090101
12057       INTMD WND REPAIR FACE/MM       AS                           $75.01     20090101
12057       INTMD WND REPAIR FACE/MM                           Y       $211.40     20081209
12057       INTMD WND REPAIR FACE/MM                                   $375.03     20090101
13100       REPAIR OF WOUND OR LESION                                  $212.55     20090101
13100       REPAIR OF WOUND OR LESION                          Y       $231.45     20081209
13101       REPAIR OF WOUND OR LESION                          Y       $231.45     20081209
13101       REPAIR OF WOUND OR LESION                                  $264.02     20090101
13102       REPAIR WOUND/LESION ADD-ON                                 $73.16      20090101
13120       REPAIR OF WOUND OR LESION                                  $220.90     20090101
13120       REPAIR OF WOUND OR LESION                          Y        $72.18     20081209
13121       REPAIR OF WOUND OR LESION                          Y        $92.22     20081209
13121       REPAIR OF WOUND OR LESION                                  $289.05     20090101
13122       REPAIR WOUND/LESION ADD-ON                                 $84.30      20090101
13131       REPAIR OF WOUND OR LESION                          Y        $92.22     20081209
13131       REPAIR OF WOUND OR LESION                                  $243.43     20090101
13132       REPAIR OF WOUND OR LESION                                  $381.15     20090101
13132       REPAIR OF WOUND OR LESION                          Y        $92.22     20081209
13133       REPAIR WOUND/LESION ADD-ON                                 $115.17     20090101
13150       REPAIR OF WOUND OR LESION                                  $249.27     20090101
13150       REPAIR OF WOUND OR LESION                          Y       $231.45     20081209
13151       REPAIR OF WOUND OR LESION                                  $276.26     20090101
13151       REPAIR OF WOUND OR LESION                          Y       $231.45     20081209
13152       REPAIR OF WOUND OR LESION                                  $376.42     20090101
13152       REPAIR OF WOUND OR LESION                          Y       $231.45     20081209
13153       REPAIR WOUND/LESION ADD-ON                                 $128.26     20090101
13160       LATE CLOSURE OF WOUND                                      $569.49     20090101
13160       LATE CLOSURE OF WOUND                              Y       $434.92     20081209
14000       SKIN TISSUE REARRANGEMENT                                  $440.12     20090101
14000       SKIN TISSUE REARRANGEMENT                          Y       $392.18     20081209
14001       SKIN TISSUE REARRANGEMENT                                  $574.22     20090101
14001       SKIN TISSUE REARRANGEMENT                          Y       $430.58     20081209
14020       SKIN TISSUE REARRANGEMENT                          Y       $430.58     20081209
14020       SKIN TISSUE REARRANGEMENT                                  $490.21     20090101
14021       SKIN TISSUE REARRANGEMENT                                  $646.00     20090101
14021       SKIN TISSUE REARRANGEMENT                          Y       $430.58     20081209
14040       SKIN TISSUE REARRANGEMENT                          Y       $392.18     20081209
14040       SKIN TISSUE REARRANGEMENT                                  $516.35     20090101


                                         Page 12
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
14041       SKIN TISSUE REARRANGEMENT                                    $709.15     20090101
14041       SKIN TISSUE REARRANGEMENT                            Y       $430.58     20081209
14060       SKIN TISSUE REARRANGEMENT                                    $528.32     20090101
14060       SKIN TISSUE REARRANGEMENT                            Y       $430.58     20081209
14061       SKIN TISSUE REARRANGEMENT                                    $769.24     20090101
14061       SKIN TISSUE REARRANGEMENT                            Y       $430.58     20081209
14300       SKIN TISSUE REARRANGEMENT                                    $744.21     20090101
14300       SKIN TISSUE REARRANGEMENT                            Y       $545.32     20081209
14350       SKIN TISSUE REARRANGEMENT                                    $533.60     20090101
14350       SKIN TISSUE REARRANGEMENT                            Y       $473.32     20081209
15002       WOUND PREP, TRK/ARM/LEG                              Y       $231.45     20081209
15002       WOUND PREP, TRK/ARM/LEG                                      $232.59     20090101
15003       WOUND PREP, ADDL 100 CM                              Y       $231.45     20081209
15003       WOUND PREP, ADDL 100 CM                                      $50.35      20090101
15004       WOUND PREP, F/N/HF/G                                         $280.43     20090101
15004       WOUND PREP, F/N/HF/G                                 Y       $231.45     20081209
15005       WND PREP, F/N/HF/G, ADDL CM                                  $85.13      20090101
15005       WND PREP, F/N/HF/G, ADDL CM                          Y       $231.45     20081209
15040       HARVEST CULTURED SKIN GRAFT                                  $180.56     20090101
15040       HARVEST CULTURED SKIN GRAFT                          Y        $72.18     20081209
15050       SKIN PINCH GRAFT                                             $367.51     20090101
15050       SKIN PINCH GRAFT                                     Y       $231.45     20081209
15100       SKIN SPLT GRFT, TRNK/ARM/LEG     80                          $123.53     20090101
15100       SKIN SPLT GRFT, TRNK/ARM/LEG     81                          $123.53     20090101
15100       SKIN SPLT GRFT, TRNK/ARM/LEG     82                          $123.53     20090101
15100       SKIN SPLT GRFT, TRNK/ARM/LEG     AS                          $123.53     20090101
15100       SKIN SPLT GRFT, TRNK/ARM/LEG                         Y       $434.92     20081209
15100       SKIN SPLT GRFT, TRNK/ARM/LEG                                 $617.64     20090101
15101       SKIN SPLT GRFT T/A/L, ADD-ON     80                           $28.15     20090101
15101       SKIN SPLT GRFT T/A/L, ADD-ON     81                           $28.15     20090101
15101       SKIN SPLT GRFT T/A/L, ADD-ON     82                           $28.15     20090101
15101       SKIN SPLT GRFT T/A/L, ADD-ON     AS                           $28.15     20090101
15101       SKIN SPLT GRFT T/A/L, ADD-ON                                 $140.76     20090101
15101       SKIN SPLT GRFT T/A/L, ADD-ON                         Y       $473.32     20081209
15110       EPIDRM AUTOGRFT TRNK/ARM/LEG                                 $609.27     20090101
15110       EPIDRM AUTOGRFT TRNK/ARM/LEG                         Y       $305.08     20081209
15111       EPIDRM AUTOGRFT T/A/L ADD-ON                         Y       $237.28     20081209
15111       EPIDRM AUTOGRFT T/A/L ADD-ON                                 $88.75      20090101
15115       EPIDRM A-GRFT FACE/NCK/HF/G                                  $600.09     20090101
15115       EPIDRM A-GRFT FACE/NCK/HF/G                          Y       $305.08     20081209
15116       EPIDRM A-GRFT F/N/HF/G ADDL                          Y       $237.28     20081209
15116       EPIDRM A-GRFT F/N/HF/G ADDL                                  $117.40     20090101
15120       SKN SPLT A-GRFT FAC/NCK/HF/G     80                          $128.87     20090101
15120       SKN SPLT A-GRFT FAC/NCK/HF/G     81                          $128.87     20090101
15120       SKN SPLT A-GRFT FAC/NCK/HF/G     82                          $128.87     20090101


                                           Page 13
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
15120       SKN SPLT A-GRFT FAC/NCK/HF/G     AS                          $128.87     20090101
15120       SKN SPLT A-GRFT FAC/NCK/HF/G                                 $644.34     20090101
15120       SKN SPLT A-GRFT FAC/NCK/HF/G                         Y       $434.92     20081209
15121       SKN SPLT A-GRFT F/N/HF/G ADD     80                           $38.95     20090101
15121       SKN SPLT A-GRFT F/N/HF/G ADD     81                           $38.95     20090101
15121       SKN SPLT A-GRFT F/N/HF/G ADD     82                           $38.95     20090101
15121       SKN SPLT A-GRFT F/N/HF/G ADD     AS                           $38.95     20090101
15121       SKN SPLT A-GRFT F/N/HF/G ADD                                 $194.74     20090101
15121       SKN SPLT A-GRFT F/N/HF/G ADD                         Y       $473.32     20081209
15130       DERM AUTOGRAFT, TRNK/ARM/LEG                                 $481.03     20090101
15130       DERM AUTOGRAFT, TRNK/ARM/LEG                         Y       $392.18     20081209
15131       DERM AUTOGRAFT T/A/L ADD-ON                                  $71.50      20090101
15131       DERM AUTOGRAFT T/A/L ADD-ON                          Y       $324.38     20081209
15135       DERM AUTOGRAFT FACE/NCK/HF/G                                 $607.05     20090101
15135       DERM AUTOGRAFT FACE/NCK/HF/G                         Y       $392.18     20081209
15136       DERM AUTOGRAFT, F/N/HF/G ADD                                 $68.71      20090101
15136       DERM AUTOGRAFT, F/N/HF/G ADD                         Y       $324.38     20081209
15150       CULT EPIDERM GRFT T/ARM/LEG                                  $506.06     20090101
15150       CULT EPIDERM GRFT T/ARM/LEG                          Y       $305.08     20081209
15151       CULT EPIDERM GRFT T/A/L ADDL                                 $93.76      20090101
15151       CULT EPIDERM GRFT T/A/L ADDL                         Y       $237.28     20081209
15152       CULT EPIDERM GRAFT T/A/L +%                                  $115.45     20090101
15152       CULT EPIDERM GRAFT T/A/L +%                          Y       $237.28     20081209
15155       CULT EPIDERM GRAFT, F/N/HF/G                                 $524.14     20090101
15155       CULT EPIDERM GRAFT, F/N/HF/G                         Y       $305.08     20081209
15156       CULT EPIDRM GRFT F/N/HFG ADD                         Y       $237.28     20081209
15156       CULT EPIDRM GRFT F/N/HFG ADD                                 $124.08     20090101
15157       CULT EPIDERM GRFT F/N/HFG +%                                 $137.72     20090101
15157       CULT EPIDERM GRFT F/N/HFG +%                         Y       $237.28     20081209
15170       ACELL GRAFT TRUNK/ARMS/LEGS                                  $291.00     20090101
15171       ACELL GRAFT T/ARM/LEG ADD-ON                                 $66.21      20090101
15175       ACELLULAR GRAFT, F/N/HF/G                                    $382.82     20090101
15176       ACELL GRAFT, F/N/HF/G ADD-ON                                 $105.99     20090101
15200       SKIN FULL GRAFT, TRUNK                                       $545.57     20090101
15200       SKIN FULL GRAFT, TRUNK                               Y       $430.58     20081209
15201       SKIN FULL GRAFT TRUNK ADD-ON                                 $105.71     20090101
15201       SKIN FULL GRAFT TRUNK ADD-ON                         Y       $318.55     20081209
15220       SKIN FULL GRAFT SCLP/ARM/LEG                                 $518.03     20090101
15220       SKIN FULL GRAFT SCLP/ARM/LEG                         Y       $392.18     20081209
15221       SKIN FULL GRAFT ADD-ON                               Y       $231.45     20081209
15221       SKIN FULL GRAFT ADD-ON                                       $97.65      20090101
15240       SKIN FULL GRFT FACE/GENIT/HF                         Y       $430.58     20081209
15240       SKIN FULL GRFT FACE/GENIT/HF                                 $617.35     20090101
15241       SKIN FULL GRAFT ADD-ON                                       $127.42     20090101
15241       SKIN FULL GRAFT ADD-ON                               Y       $231.45     20081209


                                           Page 14
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
15260       SKIN FULL GRAFT EEN & LIPS                           Y       $392.18     20081209
15260       SKIN FULL GRAFT EEN & LIPS                                   $659.36     20090101
15261       SKIN FULL GRAFT ADD-ON                               Y       $318.55     20081209
15261       SKIN FULL GRAFT ADD-ON                                       $146.90     20090101
15300       APPLY SKINALLOGRFT, T/ARM/LG                         Y       $231.45     20081209
15300       APPLY SKINALLOGRFT, T/ARM/LG                                 $235.36     20090101
15301       APPLY SKNALLOGRFT T/A/L ADDL                                  $44.52     20090101
15301       APPLY SKNALLOGRFT T/A/L ADDL                         Y       $231.45     20081209
15320       APPLY SKIN ALLOGRFT F/N/HF/G                                 $268.19     20090101
15320       APPLY SKIN ALLOGRFT F/N/HF/G                         Y       $231.45     20081209
15321       APLY SKNALLOGRFT F/N/HFG ADD                         Y       $231.45     20081209
15321       APLY SKNALLOGRFT F/N/HFG ADD                                  $66.77     20090101
15330       APLY ACELL ALOGRFT T/ARM/LEG                                 $217.56     20090101
15330       APLY ACELL ALOGRFT T/ARM/LEG                         Y       $231.45     20081209
15331       APLY ACELL GRFT T/A/L ADD-ON                                  $44.79     20090101
15331       APLY ACELL GRFT T/A/L ADD-ON                         Y       $231.45     20081209
15335       APPLY ACELL GRAFT, F/N/HF/G                                  $235.09     20090101
15335       APPLY ACELL GRAFT, F/N/HF/G                          Y       $231.45     20081209
15336       APLY ACELL GRFT F/N/HF/G ADD                                  $65.10     20090101
15336       APLY ACELL GRFT F/N/HF/G ADD                         Y       $231.45     20081209
15340       APPLY CULT SKIN SUBSTITUTE                                   $222.85     20090101
15341       APPLY CULT SKIN SUB ADD-ON                                    $32.83     20090101
15360       APPLY CULT DERM SUB, T/A/L                                   $250.95     20090101
15361       APLY CULT DERM SUB T/A/L ADD                                  $50.91     20090101
15365       APPLY CULT DERM SUB F/N/HF/G                                 $251.77     20090101
15366       APPLY CULT DERM F/HF/G ADD                                    $63.98     20090101
15400       APPLY SKIN XENOGRAFT, T/A/L                                  $260.13     20090101
15400       APPLY SKIN XENOGRAFT, T/A/L                          Y       $231.45     20081209
15401       APPLY SKN XENOGRFT T/A/L ADD                                  $72.06     20090101
15401       APPLY SKN XENOGRFT T/A/L ADD                         Y       $231.45     20081209
15420       APPLY SKIN XGRAFT, F/N/HF/G                                  $292.68     20090101
15420       APPLY SKIN XGRAFT, F/N/HF/G                          Y       $231.45     20081209
15421       APPLY SKN XGRFT F/N/HF/G ADD                                  $82.08     20090101
15421       APPLY SKN XGRFT F/N/HF/G ADD                         Y       $231.45     20081209
15430       APPLY ACELLULAR XENOGRAFT                                    $371.41     20090101
15430       APPLY ACELLULAR XENOGRAFT                            Y       $231.45     20081209
15431       APPLY ACELLULAR XGRAFT ADD                           Y       $231.45     20081209
15570       FORM SKIN PEDICLE FLAP                               Y       $473.32     20081209
15570       FORM SKIN PEDICLE FLAP                                       $613.18     20090101
15572       FORM SKIN PEDICLE FLAP                               Y       $473.32     20081209
15572       FORM SKIN PEDICLE FLAP                                       $578.12     20090101
15574       FORM SKIN PEDICLE FLAP                                       $621.52     20090101
15574       FORM SKIN PEDICLE FLAP                               Y       $473.32     20081209
15576       FORM SKIN PEDICLE FLAP                                       $551.69     20090101
15576       FORM SKIN PEDICLE FLAP                               Y       $473.32     20081209


                                           Page 15
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
15600       SKIN GRAFT                                           Y        $473.32      20081209
15600       SKIN GRAFT                                                    $241.49      20090101
15610       SKIN GRAFT                                           Y        $473.32      20081209
15610       SKIN GRAFT                                                    $220.90      20090101
15620       SKIN GRAFT                                           Y        $545.32      20081209
15620       SKIN GRAFT                                                    $308.81      20090101
15630       SKIN GRAFT                                                    $315.77      20090101
15630       SKIN GRAFT                                           Y        $473.32      20081209
15650       TRANSFER SKIN PEDICLE FLAP                                    $341.36      20090101
15650       TRANSFER SKIN PEDICLE FLAP                           Y        $597.52      20081209
15731       FOREHEAD FLAP W/VASC PEDICLE                                  $759.50      20090101
15731       FOREHEAD FLAP W/VASC PEDICLE                         Y        $473.32      20081209
15732       MUSCLE-SKIN GRAFT, HEAD/NECK     80                           $211.77      20090101
15732       MUSCLE-SKIN GRAFT, HEAD/NECK     81                           $211.77      20090101
15732       MUSCLE-SKIN GRAFT, HEAD/NECK     82                           $211.77      20090101
15732       MUSCLE-SKIN GRAFT, HEAD/NECK     AS                           $211.77      20090101
15732       MUSCLE-SKIN GRAFT, HEAD/NECK                         Y        $473.32      20081209
15732       MUSCLE-SKIN GRAFT, HEAD/NECK                                 $1,058.86     20090101
15734       MUSCLE-SKIN GRAFT, TRUNK         80                           $217.84      20090101
15734       MUSCLE-SKIN GRAFT, TRUNK         81                           $217.84      20090101
15734       MUSCLE-SKIN GRAFT, TRUNK         82                           $217.84      20090101
15734       MUSCLE-SKIN GRAFT, TRUNK         AS                           $217.84      20090101
15734       MUSCLE-SKIN GRAFT, TRUNK                                     $1,089.18     20090101
15734       MUSCLE-SKIN GRAFT, TRUNK                             Y        $473.32      20081209
15736       MUSCLE-SKIN GRAFT, ARM           80                           $195.86      20090101
15736       MUSCLE-SKIN GRAFT, ARM           81                           $195.86      20090101
15736       MUSCLE-SKIN GRAFT, ARM           82                           $195.86      20090101
15736       MUSCLE-SKIN GRAFT, ARM           AS                           $195.86      20090101
15736       MUSCLE-SKIN GRAFT, ARM                               Y        $473.32      20081209
15736       MUSCLE-SKIN GRAFT, ARM                                        $979.32      20090101
15738       MUSCLE-SKIN GRAFT, LEG           80                           $208.43      20090101
15738       MUSCLE-SKIN GRAFT, LEG           81                           $208.43      20090101
15738       MUSCLE-SKIN GRAFT, LEG           82                           $208.43      20090101
15738       MUSCLE-SKIN GRAFT, LEG           AS                           $208.43      20090101
15738       MUSCLE-SKIN GRAFT, LEG                               Y        $473.32      20081209
15738       MUSCLE-SKIN GRAFT, LEG                                       $1,042.14     20090101
15740       ISLAND PEDICLE FLAP GRAFT                            Y        $392.18      20081209
15740       ISLAND PEDICLE FLAP GRAFT                                     $669.37      20090101
15750       NEUROVASCULAR PEDICLE GRAFT      80                           $128.54      20090101
15750       NEUROVASCULAR PEDICLE GRAFT      81                           $128.54      20090101
15750       NEUROVASCULAR PEDICLE GRAFT      82                           $128.54      20090101
15750       NEUROVASCULAR PEDICLE GRAFT      AS                           $128.54      20090101
15750       NEUROVASCULAR PEDICLE GRAFT                          Y        $434.92      20081209
15750       NEUROVASCULAR PEDICLE GRAFT                                   $642.68      20090101
15756       FREE MYO/SKIN FLAP MICROVASC     80                           $339.02      20090101


                                           Page 16
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
15756       FREE MYO/SKIN FLAP MICROVASC     81                           $339.02      20090101
15756       FREE MYO/SKIN FLAP MICROVASC     82                           $339.02      20090101
15756       FREE MYO/SKIN FLAP MICROVASC     AS                           $339.02      20090101
15756       FREE MYO/SKIN FLAP MICROVASC                                 $1,695.12     20090101
15757       FREE SKIN FLAP, MICROVASC        80                           $337.13      20090101
15757       FREE SKIN FLAP, MICROVASC        81                           $337.13      20090101
15757       FREE SKIN FLAP, MICROVASC        82                           $337.13      20090101
15757       FREE SKIN FLAP, MICROVASC        AS                           $337.13      20090101
15757       FREE SKIN FLAP, MICROVASC                                    $1,685.65     20090101
15758       FREE FASCIAL FLAP, MICROVASC     80                           $336.75      20090101
15758       FREE FASCIAL FLAP, MICROVASC     81                           $336.75      20090101
15758       FREE FASCIAL FLAP, MICROVASC     82                           $336.75      20090101
15758       FREE FASCIAL FLAP, MICROVASC     AS                           $336.75      20090101
15758       FREE FASCIAL FLAP, MICROVASC                                 $1,683.74     20090101
15760       COMPOSITE SKIN GRAFT                                          $577.56      20090101
15760       COMPOSITE SKIN GRAFT                                 Y        $434.92      20081209
15770       DERMA-FAT-FASCIA GRAFT           80                            $91.47      20090101
15770       DERMA-FAT-FASCIA GRAFT           81                            $91.47      20090101
15770       DERMA-FAT-FASCIA GRAFT           82                            $91.47      20090101
15770       DERMA-FAT-FASCIA GRAFT           AS                            $91.47      20090101
15770       DERMA-FAT-FASCIA GRAFT                                        $457.37      20090101
15770       DERMA-FAT-FASCIA GRAFT                               Y        $473.32      20081209
15822       REVISION OF UPPER EYELID                             Y        $473.32      20081209
15822       REVISION OF UPPER EYELID                                      $289.61      20090101
15823       REVISION OF UPPER EYELID                                      $451.81      20090101
15823       REVISION OF UPPER EYELID                             Y        $597.52      20081209
15836       EXCISE EXCESSIVE SKIN TISSUE     80                           $103.27      20090101
15836       EXCISE EXCESSIVE SKIN TISSUE     81                           $103.27      20090101
15836       EXCISE EXCESSIVE SKIN TISSUE     82                           $103.27      20090101
15836       EXCISE EXCESSIVE SKIN TISSUE     AS                           $103.27      20090101
15836       EXCISE EXCESSIVE SKIN TISSUE                                  $516.36      20090101
15840       GRAFT FOR FACE NERVE PALSY                           Y        $545.32      20081209
15840       GRAFT FOR FACE NERVE PALSY                                    $710.27      20090101
15841       GRAFT FOR FACE NERVE PALSY       80                           $236.53      20090101
15841       GRAFT FOR FACE NERVE PALSY       81                           $236.53      20090101
15841       GRAFT FOR FACE NERVE PALSY       82                           $236.53      20090101
15841       GRAFT FOR FACE NERVE PALSY       AS                           $236.53      20090101
15841       GRAFT FOR FACE NERVE PALSY                                   $1,182.64     20090101
15841       GRAFT FOR FACE NERVE PALSY                           Y        $545.32      20081209
15842       FLAP FOR FACE NERVE PALSY        80                           $375.75      20090101
15842       FLAP FOR FACE NERVE PALSY        81                           $375.75      20090101
15842       FLAP FOR FACE NERVE PALSY        82                           $375.75      20090101
15842       FLAP FOR FACE NERVE PALSY        AS                           $375.75      20090101
15842       FLAP FOR FACE NERVE PALSY                            Y        $669.27      20081209
15842       FLAP FOR FACE NERVE PALSY                                    $1,878.73     20090101


                                           Page 17
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
15845       SKIN AND MUSCLE REPAIR, FACE     80                          $131.82     20090101
15845       SKIN AND MUSCLE REPAIR, FACE     81                          $131.82     20090101
15845       SKIN AND MUSCLE REPAIR, FACE     82                          $131.82     20090101
15845       SKIN AND MUSCLE REPAIR, FACE     AS                          $131.82     20090101
15845       SKIN AND MUSCLE REPAIR, FACE                                 $659.09     20090101
15845       SKIN AND MUSCLE REPAIR, FACE                         Y       $545.32     20081209
15850       REMOVAL OF SUTURES                                           $61.48      20090101
15851       REMOVAL OF SUTURES                                           $67.61      20090101
15852       DRESSING CHANGE NOT FOR BURN                                 $34.50      20090101
15860       TEST FOR BLOOD FLOW IN GRAFT                                 $81.52      20090101
15920       REMOVAL OF TAIL BONE ULCER                                   $407.29     20090101
15920       REMOVAL OF TAIL BONE ULCER                           Y       $186.55     20081209
15922       REMOVAL OF TAIL BONE ULCER       80                          $104.82     20090101
15922       REMOVAL OF TAIL BONE ULCER       81                          $104.82     20090101
15922       REMOVAL OF TAIL BONE ULCER       82                          $104.82     20090101
15922       REMOVAL OF TAIL BONE ULCER       AS                          $104.82     20090101
15922       REMOVAL OF TAIL BONE ULCER                           Y       $545.32     20081209
15922       REMOVAL OF TAIL BONE ULCER                                   $524.12     20090101
15931       REMOVE SACRUM PRESSURE SORE                                  $468.50     20090101
15931       REMOVE SACRUM PRESSURE SORE                          Y       $480.79     20081209
15933       REMOVE SACRUM PRESSURE SORE                                  $575.89     20090101
15933       REMOVE SACRUM PRESSURE SORE                          Y       $480.79     20081209
15934       REMOVE SACRUM PRESSURE SORE                          Y       $473.32     20081209
15934       REMOVE SACRUM PRESSURE SORE                                  $645.72     20090101
15935       REMOVE SACRUM PRESSURE SORE      80                          $152.62     20090101
15935       REMOVE SACRUM PRESSURE SORE      81                          $152.62     20090101
15935       REMOVE SACRUM PRESSURE SORE      82                          $152.62     20090101
15935       REMOVE SACRUM PRESSURE SORE      AS                          $152.62     20090101
15935       REMOVE SACRUM PRESSURE SORE                          Y       $545.32     20081209
15935       REMOVE SACRUM PRESSURE SORE                                  $763.11     20090101
15936       REMOVE SACRUM PRESSURE SORE      80                          $125.92     20090101
15936       REMOVE SACRUM PRESSURE SORE      81                          $125.92     20090101
15936       REMOVE SACRUM PRESSURE SORE      82                          $125.92     20090101
15936       REMOVE SACRUM PRESSURE SORE      AS                          $125.92     20090101
15936       REMOVE SACRUM PRESSURE SORE                          Y       $502.58     20081209
15936       REMOVE SACRUM PRESSURE SORE                                  $629.59     20090101
15937       REMOVE SACRUM PRESSURE SORE      80                          $147.18     20090101
15937       REMOVE SACRUM PRESSURE SORE      81                          $147.18     20090101
15937       REMOVE SACRUM PRESSURE SORE      82                          $147.18     20090101
15937       REMOVE SACRUM PRESSURE SORE      AS                          $147.18     20090101
15937       REMOVE SACRUM PRESSURE SORE                          Y       $545.32     20081209
15937       REMOVE SACRUM PRESSURE SORE                                  $735.89     20090101
15940       REMOVE HIP PRESSURE SORE                                     $484.36     20090101
15940       REMOVE HIP PRESSURE SORE                             Y       $480.79     20081209
15941       REMOVE HIP PRESSURE SORE                             Y       $480.79     20081209


                                           Page 18
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
15941       REMOVE HIP PRESSURE SORE                                    $635.43      20090101
15944       REMOVE HIP PRESSURE SORE                           Y        $473.32      20081209
15944       REMOVE HIP PRESSURE SORE                                    $620.13      20090101
15945       REMOVE HIP PRESSURE SORE                                    $685.78      20090101
15945       REMOVE HIP PRESSURE SORE                           Y        $545.32      20081209
15946       REMOVE HIP PRESSURE SORE       80                           $228.19      20090101
15946       REMOVE HIP PRESSURE SORE       81                           $228.19      20090101
15946       REMOVE HIP PRESSURE SORE       82                           $228.19      20090101
15946       REMOVE HIP PRESSURE SORE       AS                           $228.19      20090101
15946       REMOVE HIP PRESSURE SORE                                   $1,140.93     20090101
15946       REMOVE HIP PRESSURE SORE                           Y        $545.32      20081209
15950       REMOVE THIGH PRESSURE SORE     80                           $79.90       20090101
15950       REMOVE THIGH PRESSURE SORE     81                           $79.90       20090101
15950       REMOVE THIGH PRESSURE SORE     82                           $79.90       20090101
15950       REMOVE THIGH PRESSURE SORE     AS                            $79.90      20090101
15950       REMOVE THIGH PRESSURE SORE                         Y        $480.79      20081209
15950       REMOVE THIGH PRESSURE SORE                                  $399.51      20090101
15951       REMOVE THIGH PRESSURE SORE     80                           $114.07      20090101
15951       REMOVE THIGH PRESSURE SORE     81                           $114.07      20090101
15951       REMOVE THIGH PRESSURE SORE     82                           $114.07      20090101
15951       REMOVE THIGH PRESSURE SORE     AS                           $114.07      20090101
15951       REMOVE THIGH PRESSURE SORE                                  $570.34      20090101
15951       REMOVE THIGH PRESSURE SORE                         Y        $552.79      20081209
15952       REMOVE THIGH PRESSURE SORE     80                           $118.80      20090101
15952       REMOVE THIGH PRESSURE SORE     81                           $118.80      20090101
15952       REMOVE THIGH PRESSURE SORE     82                           $118.80      20090101
15952       REMOVE THIGH PRESSURE SORE     AS                           $118.80      20090101
15952       REMOVE THIGH PRESSURE SORE                         Y        $430.58      20081209
15952       REMOVE THIGH PRESSURE SORE                                  $593.99      20090101
15953       REMOVE THIGH PRESSURE SORE     80                           $132.48      20090101
15953       REMOVE THIGH PRESSURE SORE     81                           $132.48      20090101
15953       REMOVE THIGH PRESSURE SORE     82                           $132.48      20090101
15953       REMOVE THIGH PRESSURE SORE     AS                           $132.48      20090101
15953       REMOVE THIGH PRESSURE SORE                         Y        $502.58      20081209
15953       REMOVE THIGH PRESSURE SORE                                  $662.40      20090101
15956       REMOVE THIGH PRESSURE SORE     80                           $161.19      20090101
15956       REMOVE THIGH PRESSURE SORE     81                           $161.19      20090101
15956       REMOVE THIGH PRESSURE SORE     82                           $161.19      20090101
15956       REMOVE THIGH PRESSURE SORE     AS                           $161.19      20090101
15956       REMOVE THIGH PRESSURE SORE                                  $805.95      20090101
15956       REMOVE THIGH PRESSURE SORE                         Y        $430.58      20081209
15958       REMOVE THIGH PRESSURE SORE     80                           $164.42      20090101
15958       REMOVE THIGH PRESSURE SORE     81                           $164.42      20090101
15958       REMOVE THIGH PRESSURE SORE     82                           $164.42      20090101
15958       REMOVE THIGH PRESSURE SORE     AS                           $164.42      20090101


                                         Page 19
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
15958       REMOVE THIGH PRESSURE SORE                                   $822.10     20090101
15958       REMOVE THIGH PRESSURE SORE                           Y       $502.58     20081209
16000       INITIAL TREATMENT OF BURN(S)                                 $48.97      20090101
16020       DRESS/DEBRID P-THICK BURN, S                                 $57.87      20090101
16025       DRESS/DEBRID P-THICK BURN, M                         Y        $62.30     20081209
16025       DRESS/DEBRID P-THICK BURN, M                                 $103.21     20090101
16030       DRESS/DEBRID P-THICK BURN, L                                 $123.81     20090101
16030       DRESS/DEBRID P-THICK BURN, L                         Y        $81.93     20081209
16035       INCISION OF BURN SCAB, INITI                                 $155.80     20090101
16035       INCISION OF BURN SCAB, INITI                         Y        $88.11     20081209
16036       ESCHAROTOMY; ADD?L INCISION                                  $62.04      20090101
17000       DESTRUCT PREMALG LESION                                      $51.19      20090101
17003       DESTRUCT PREMALG LES, 2-14                                     $5.29     20090101
17004       DESTROY PREMLG LESIONS 15+                                   $119.63     20090101
17106       DESTRUCTION OF SKIN LESIONS                                  $267.64     20090101
17107       DESTRUCTION OF SKIN LESIONS                                  $470.45     20090101
17108       DESTRUCTION OF SKIN LESIONS                                  $635.15     20090101
17110       DESTRUCT B9 LESION, 1-14                                     $67.33      20090101
17111       DESTRUCT LESION, 15 OR MORE                                  $82.08      20090101
17250       CHEMICAL CAUTERY, TISSUE                                     $50.91      20090101
17260       DESTRUCTION OF SKIN LESIONS                                  $64.26      20090101
17261       DESTRUCTION OF SKIN LESIONS                                  $91.54      20090101
17262       DESTRUCTION OF SKIN LESIONS                                  $111.84     20090101
17263       DESTRUCTION OF SKIN LESIONS                                  $123.53     20090101
17264       DESTRUCTION OF SKIN LESIONS                                  $133.27     20090101
17266       DESTRUCTION OF SKIN LESIONS                                  $151.63     20090101
17270       DESTRUCTION OF SKIN LESIONS                                  $96.26      20090101
17271       DESTRUCTION OF SKIN LESIONS                                  $105.45     20090101
17272       DESTRUCTION OF SKIN LESIONS                                  $121.02     20090101
17273       DESTRUCTION OF SKIN LESIONS                                  $135.21     20090101
17274       DESTRUCTION OF SKIN LESIONS                                  $161.36     20090101
17276       DESTRUCTION OF SKIN LESIONS                                  $189.18     20090101
17280       DESTRUCTION OF SKIN LESIONS                                  $89.86      20090101
17281       DESTRUCTION OF SKIN LESIONS                                  $114.90     20090101
17282       DESTRUCTION OF SKIN LESIONS                                  $133.27     20090101
17283       DESTRUCTION OF SKIN LESIONS                                  $161.92     20090101
17284       DESTRUCTION OF SKIN LESIONS                                  $189.46     20090101
17286       DESTRUCTION OF SKIN LESIONS                                  $243.15     20090101
17311       MOHS, 1 STAGE, H/N/HF/G                                      $477.12     20090101
17312       MOHS ADDL STAGE                                              $287.11     20090101
17313       MOHS, 1 STAGE, T/A/L                                         $435.67     20090101
17314       MOHS, ADDL STAGE, T/A/L                                      $265.68     20090101
17315       MOHS SURG, ADDL BLOCK                                        $56.76      20090101
17340       CRYOTHERAPY OF SKIN                                          $32.55      20090101
17360       SKIN PEEL THERAPY                                            $87.63      20090101


                                           Page 20
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
19000       DRAINAGE OF BREAST LESION                                      $79.85      20090101
19001       DRAIN BREAST LESION ADD-ON                                     $19.75      20090101
19020       INCISION OF BREAST LESION                                     $296.85      20090101
19020       INCISION OF BREAST LESION                            Y        $419.29      20081209
19030       INJECTION FOR BREAST X-RAY                                    $122.13      20090101
19100       BX BREAST PERCUT W/O IMAGE                                     $97.65      20090101
19100       BX BREAST PERCUT W/O IMAGE                           Y        $179.83      20081209
19101       BIOPSY OF BREAST, OPEN                                        $223.40      20090101
19101       BIOPSY OF BREAST, OPEN                               Y        $438.52      20081209
19102       BX BREAST PERCUT W/IMAGE                             Y        $202.91      20081209
19102       BX BREAST PERCUT W/IMAGE                                      $161.09      20090101
19103       BX BREAST PERCUT W/DEVICE                            Y        $349.88      20081209
19103       BX BREAST PERCUT W/DEVICE                                     $411.47      20090101
19105       CRYOSURG ABLATE FA, EACH                                     $1,404.91     20090101
19110       NIPPLE EXPLORATION                                            $301.86      20090101
19110       NIPPLE EXPLORATION                                   Y        $438.52      20081209
19112       EXCISE BREAST DUCT FISTULA                                    $287.95      20090101
19112       EXCISE BREAST DUCT FISTULA                           Y        $476.92      20081209
19120       REMOVAL OF BREAST LESION                                      $316.60      20090101
19120       REMOVAL OF BREAST LESION                             Y        $476.92      20081209
19125       EXCISION, BREAST LESION                                       $349.43      20090101
19125       EXCISION, BREAST LESION                              Y        $476.92      20081209
19126       EXCISION, ADDL BREAST LESION                                  $116.29      20090101
19126       EXCISION, ADDL BREAST LESION                         Y        $476.92      20081209
19260       REMOVAL OF CHEST WALL LESION     80                           $169.10      20090101
19260       REMOVAL OF CHEST WALL LESION     81                           $169.10      20090101
19260       REMOVAL OF CHEST WALL LESION     82                           $169.10      20090101
19260       REMOVAL OF CHEST WALL LESION     AS                           $169.10      20090101
19260       REMOVAL OF CHEST WALL LESION                                  $845.49      20090101
19271       REVISION OF CHEST WALL           80                           $230.30      20090101
19271       REVISION OF CHEST WALL           81                           $230.30      20090101
19271       REVISION OF CHEST WALL           82                           $230.30      20090101
19271       REVISION OF CHEST WALL           AS                           $230.30      20090101
19271       REVISION OF CHEST WALL                                       $1,151.49     20090101
19272       EXTENSIVE CHEST WALL SURGERY     80                           $254.67      20090101
19272       EXTENSIVE CHEST WALL SURGERY     81                           $254.67      20090101
19272       EXTENSIVE CHEST WALL SURGERY     82                           $254.67      20090101
19272       EXTENSIVE CHEST WALL SURGERY     AS                           $254.67      20090101
19272       EXTENSIVE CHEST WALL SURGERY                                 $1,273.36     20090101
19290       PLACE NEEDLE WIRE, BREAST                                     $117.12      20090101
19291       PLACE NEEDLE WIRE, BREAST                                      $51.19      20090101
19295       PLACE BREAST CLIP, PERCUT                                      $69.55      20090101
19296       PLACE PO BREAST CATH FOR RAD     80                           $610.61      20090101
19296       PLACE PO BREAST CATH FOR RAD     81                           $610.61      20090101
19296       PLACE PO BREAST CATH FOR RAD     82                           $610.61      20090101


                                           Page 21
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
19296       PLACE PO BREAST CATH FOR RAD     AS                           $610.61      20090101
19296       PLACE PO BREAST CATH FOR RAD                         Y       $1,271.87     20081209
19296       PLACE PO BREAST CATH FOR RAD                                 $3,053.04     20090101
19297       PLACE BREAST CATH FOR RAD                                     $67.61       20090101
19298       PLACE BREAST RAD TUBE/CATHS      80                           $214.39      20090101
19298       PLACE BREAST RAD TUBE/CATHS      81                           $214.39      20090101
19298       PLACE BREAST RAD TUBE/CATHS      82                           $214.39      20090101
19298       PLACE BREAST RAD TUBE/CATHS      AS                           $214.39      20090101
19298       PLACE BREAST RAD TUBE/CATHS                                  $1,071.95     20090101
19298       PLACE BREAST RAD TUBE/CATHS                          Y       $1,271.87     20081209
19301       PARTICAL MASTECTOMY                                           $412.02      20090101
19301       PARTICAL MASTECTOMY                                  Y        $476.92      20081209
19302       P-MASTECTOMY W/LN REMOVAL                            Y        $926.71      20081209
19302       P-MASTECTOMY W/LN REMOVAL                                     $609.83      20090101
19303       MAST, SIMPLE, COMPLETE                               Y        $640.59      20081209
19303       MAST, SIMPLE, COMPLETE                                        $635.99      20090101
19304       MAST, SUBQ                                                    $381.15      20090101
19304       MAST, SUBQ                                           Y        $640.59      20081209
19305       MAST, RADICAL                    80                           $151.35      20090101
19305       MAST, RADICAL                    81                           $151.35      20090101
19305       MAST, RADICAL                    82                           $151.35      20090101
19305       MAST, RADICAL                    AS                           $151.35      20090101
19305       MAST, RADICAL                                                 $756.73      20090101
19306       MAST, RAD, URBAN TYPE            80                           $158.08      20090101
19306       MAST, RAD, URBAN TYPE            81                           $158.08      20090101
19306       MAST, RAD, URBAN TYPE            82                           $158.08      20090101
19306       MAST, RAD, URBAN TYPE            AS                           $158.08      20090101
19306       MAST, RAD, URBAN TYPE                                         $790.39      20090101
19307       MAST, MOD RAD                    80                           $158.97      20090101
19307       MAST, MOD RAD                    81                           $158.97      20090101
19307       MAST, MOD RAD                    82                           $158.97      20090101
19307       MAST, MOD RAD                    AS                           $158.97      20090101
19307       MAST, MOD RAD                                                 $794.84      20090101
19318       REDUCTION OF LARGE BREAST        80                           $163.48      20090101
19318       REDUCTION OF LARGE BREAST        81                           $163.48      20090101
19318       REDUCTION OF LARGE BREAST        82                           $163.48      20090101
19318       REDUCTION OF LARGE BREAST        AS                           $163.48      20090101
19318       REDUCTION OF LARGE BREAST                                     $817.39      20090101
19318       REDUCTION OF LARGE BREAST                            Y        $707.71      20081209
19324       ENLARGE BREAST                                                $338.58      20090101
19324       ENLARGE BREAST                                       Y        $707.71      20081209
19325       ENLARGE BREAST WITH IMPLANT                                   $454.03      20090101
19325       ENLARGE BREAST WITH IMPLANT                          Y       $1,271.87     20081209
19328       REMOVAL OF BREAST IMPLANT                                     $341.36      20090101
19328       REMOVAL OF BREAST IMPLANT                            Y        $462.39      20081209


                                           Page 22
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
19330       REMOVAL OF IMPLANT MATERIAL                         Y        $462.39      20081209
19330       REMOVAL OF IMPLANT MATERIAL                                  $435.39      20090101
19340       IMMEDIATE BREAST PROSTHESIS                                  $287.67      20090101
19340       IMMEDIATE BREAST PROSTHESIS                         Y        $597.31      20081209
19342       DELAYED BREAST PROSTHESIS                                    $644.61      20090101
19342       DELAYED BREAST PROSTHESIS                           Y        $774.47      20081209
19350       BREAST RECONSTRUCTION                                        $619.57      20090101
19350       BREAST RECONSTRUCTION                               Y        $548.92      20081209
19355       CORRECT INVERTED NIPPLE(S)                                   $504.12      20090101
19355       CORRECT INVERTED NIPPLE(S)                          Y        $640.59      20081209
19357       BREAST RECONSTRUCTION           80                           $217.11      20090101
19357       BREAST RECONSTRUCTION           81                           $217.11      20090101
19357       BREAST RECONSTRUCTION           82                           $217.11      20090101
19357       BREAST RECONSTRUCTION           AS                           $217.11      20090101
19357       BREAST RECONSTRUCTION                                       $1,085.56     20090101
19357       BREAST RECONSTRUCTION                               Y        $898.67      20081209
19361       BREAST RECONSTR W/LAT FLAP      80                           $226.57      20090101
19361       BREAST RECONSTR W/LAT FLAP      81                           $226.57      20090101
19361       BREAST RECONSTR W/LAT FLAP      82                           $226.57      20090101
19361       BREAST RECONSTR W/LAT FLAP      AS                           $226.57      20090101
19361       BREAST RECONSTR W/LAT FLAP                                  $1,132.86     20090101
19364       BREAST RECONSTRUCTION           80                           $397.90      20090101
19364       BREAST RECONSTRUCTION           81                           $397.90      20090101
19364       BREAST RECONSTRUCTION           82                           $397.90      20090101
19364       BREAST RECONSTRUCTION           AS                           $397.90      20090101
19364       BREAST RECONSTRUCTION                                       $1,989.48     20090101
19366       BREAST RECONSTRUCTION           80                           $198.64      20090101
19366       BREAST RECONSTRUCTION           81                           $198.64      20090101
19366       BREAST RECONSTRUCTION           82                           $198.64      20090101
19366       BREAST RECONSTRUCTION           AS                           $198.64      20090101
19366       BREAST RECONSTRUCTION                                        $993.19      20090101
19366       BREAST RECONSTRUCTION                               Y        $692.79      20081209
19367       BREAST RECONSTRUCTION           80                           $259.17      20090101
19367       BREAST RECONSTRUCTION           81                           $259.17      20090101
19367       BREAST RECONSTRUCTION           82                           $259.17      20090101
19367       BREAST RECONSTRUCTION           AS                           $259.17      20090101
19367       BREAST RECONSTRUCTION                                       $1,295.87     20090101
19368       BREAST RECONSTRUCTION           80                           $320.66      20090101
19368       BREAST RECONSTRUCTION           81                           $320.66      20090101
19368       BREAST RECONSTRUCTION           82                           $320.66      20090101
19368       BREAST RECONSTRUCTION           AS                           $320.66      20090101
19368       BREAST RECONSTRUCTION                                       $1,603.32     20090101
19369       BREAST RECONSTRUCTION           80                           $294.34      20090101
19369       BREAST RECONSTRUCTION           81                           $294.34      20090101
19369       BREAST RECONSTRUCTION           82                           $294.34      20090101


                                          Page 23
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
19369       BREAST RECONSTRUCTION            AS                           $294.34      20090101
19369       BREAST RECONSTRUCTION                                        $1,471.72     20090101
19371       REMOVAL OF BREAST CAPSULE                                     $550.85      20090101
19371       REMOVAL OF BREAST CAPSULE                            Y        $640.59      20081209
19380       REVISE BREAST RECONSTRUCTION                                  $537.22      20090101
19380       REVISE BREAST RECONSTRUCTION                         Y        $759.91      20081209
20000       INCISION OF ABSCESS                                           $142.72      20090101
20005       INCISION OF DEEP ABSCESS                                      $211.16      20090101
20005       INCISION OF DEEP ABSCESS                             Y        $443.71      20081209
20100       EXPLORE WOUND, NECK              80                            $86.58      20090101
20100       EXPLORE WOUND, NECK              81                            $86.58      20090101
20100       EXPLORE WOUND, NECK              82                            $86.58      20090101
20100       EXPLORE WOUND, NECK              AS                            $86.58      20090101
20100       EXPLORE WOUND, NECK                                           $432.89      20090101
20101       EXPLORE WOUND, CHEST             80                            $55.20      20090101
20101       EXPLORE WOUND, CHEST             81                            $55.20      20090101
20101       EXPLORE WOUND, CHEST             82                            $55.20      20090101
20101       EXPLORE WOUND, CHEST             AS                            $55.20      20090101
20101       EXPLORE WOUND, CHEST                                          $275.98      20090101
20102       EXPLORE WOUND, ABDOMEN           80                            $64.82      20090101
20102       EXPLORE WOUND, ABDOMEN           81                            $64.82      20090101
20102       EXPLORE WOUND, ABDOMEN           82                            $64.82      20090101
20102       EXPLORE WOUND, ABDOMEN           AS                            $64.82      20090101
20102       EXPLORE WOUND, ABDOMEN                                        $324.11      20090101
20103       EXPLORE WOUND, EXTREMITY         80                            $79.34      20090101
20103       EXPLORE WOUND, EXTREMITY         81                            $79.34      20090101
20103       EXPLORE WOUND, EXTREMITY         82                            $79.34      20090101
20103       EXPLORE WOUND, EXTREMITY         AS                            $79.34      20090101
20103       EXPLORE WOUND, EXTREMITY                                      $396.72      20090101
20150       EXCISE EPIPHYSEAL BAR            80                           $133.43      20090101
20150       EXCISE EPIPHYSEAL BAR            81                           $133.43      20090101
20150       EXCISE EPIPHYSEAL BAR            82                           $133.43      20090101
20150       EXCISE EPIPHYSEAL BAR            AS                           $133.43      20090101
20150       EXCISE EPIPHYSEAL BAR                                         $667.16      20090101
20200       MUSCLE BIOPSY                                                 $132.15      20090101
20200       MUSCLE BIOPSY                                        Y        $400.91      20081209
20205       DEEP MUSCLE BIOPSY                                            $181.95      20090101
20205       DEEP MUSCLE BIOPSY                                   Y        $439.31      20081209
20206       NEEDLE BIOPSY, MUSCLE                                         $192.52      20090101
20206       NEEDLE BIOPSY, MUSCLE                                Y        $202.91      20081209
20220       BONE BIOPSY, TROCAR/NEEDLE                                    $138.55      20090101
20220       BONE BIOPSY, TROCAR/NEEDLE                           Y        $222.82      20081209
20225       BONE BIOPSY, TROCAR/NEEDLE                                    $565.32      20090101
20225       BONE BIOPSY, TROCAR/NEEDLE                           Y        $323.01      20081209
20240       BONE BIOPSY, EXCISIONAL                                       $166.37      20090101


                                           Page 24
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
20240       BONE BIOPSY, EXCISIONAL                              Y       $442.39     20081209
20245       BONE BIOPSY, EXCISIONAL          80                          $90.37      20090101
20245       BONE BIOPSY, EXCISIONAL          81                          $90.37      20090101
20245       BONE BIOPSY, EXCISIONAL          82                          $90.37      20090101
20245       BONE BIOPSY, EXCISIONAL          AS                           $90.37     20090101
20245       BONE BIOPSY, EXCISIONAL                                      $451.83     20090101
20245       BONE BIOPSY, EXCISIONAL                              Y       $480.79     20081209
20250       OPEN BONE BIOPSY                                     Y       $482.11     20081209
20250       OPEN BONE BIOPSY                                             $271.25     20090101
20251       OPEN BONE BIOPSY                 80                          $60.32      20090101
20251       OPEN BONE BIOPSY                 81                          $60.32      20090101
20251       OPEN BONE BIOPSY                 82                          $60.32      20090101
20251       OPEN BONE BIOPSY                 AS                           $60.32     20090101
20251       OPEN BONE BIOPSY                                     Y       $482.11     20081209
20251       OPEN BONE BIOPSY                                             $301.60     20090101
20500       INJECTION OF SINUS TRACT                                     $88.19      20090101
20501       INJECT SINUS TRACT FOR X-RAY                                 $95.71      20090101
20520       REMOVAL OF FOREIGN BODY                                      $134.65     20090101
20525       REMOVAL OF FOREIGN BODY                              Y       $480.79     20081209
20525       REMOVAL OF FOREIGN BODY                                      $338.02     20090101
20526       THER INJECTION, CARP TUNNEL                                  $54.52      20090101
20550       INJ TENDON SHEATH/LIGAMENT                                   $42.01      20090101
20551       INJ TENDON ORIGIN/INSERTION                                  $41.45      20090101
20555       PLACE NDL MUSC/TIS FOR RT                                    $239.54     20090101
20600       DRAIN/INJECT, JOINT/BURSA                                    $38.95      20090101
20605       DRAIN/INJECT, JOINT/BURSA                                    $42.01      20090101
20610       DRAIN/INJECT, JOINT/BURSA                                    $53.14      20090101
20615       TREATMENT OF BONE CYST                                       $156.08     20090101
20650       INSERT AND REMOVE BONE PIN       80                          $27.66      20090101
20650       INSERT AND REMOVE BONE PIN       81                          $27.66      20090101
20650       INSERT AND REMOVE BONE PIN       82                          $27.66      20090101
20650       INSERT AND REMOVE BONE PIN       AS                           $27.66     20090101
20650       INSERT AND REMOVE BONE PIN                                   $138.28     20090101
20650       INSERT AND REMOVE BONE PIN                           Y       $482.11     20081209
20660       APPLY, REM FIXATION DEVICE                                   $191.13     20090101
20661       APPLICATION OF HEAD BRACE                                    $327.17     20090101
20662       APPLICATION OF PELVIS BRACE                                  $333.57     20090101
20662       APPLICATION OF PELVIS BRACE                          Y       $704.44     20081209
20663       APPLICATION OF THIGH BRACE                                   $317.16     20090101
20663       APPLICATION OF THIGH BRACE                           Y       $704.44     20081209
20664       HALO BRACE APPLICATION                                       $529.71     20090101
20665       REMOVAL OF FIXATION DEVICE                           Y       $20.90      20081209
20665       REMOVAL OF FIXATION DEVICE                                   $91.26      20090101
20670       REMOVAL OF SUPPORT IMPLANT                           Y       $333.11     20081209
20670       REMOVAL OF SUPPORT IMPLANT                                   $309.37     20090101


                                           Page 25
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
20680       REMOVAL OF SUPPORT IMPLANT       80                            $83.07      20090101
20680       REMOVAL OF SUPPORT IMPLANT       81                            $83.07      20090101
20680       REMOVAL OF SUPPORT IMPLANT       82                            $83.07      20090101
20680       REMOVAL OF SUPPORT IMPLANT       AS                            $83.07      20090101
20680       REMOVAL OF SUPPORT IMPLANT                           Y        $480.79      20081209
20680       REMOVAL OF SUPPORT IMPLANT                                    $415.35      20090101
20690       APPLY BONE FIXATION DEVICE                           Y        $509.30      20081209
20690       APPLY BONE FIXATION DEVICE                                    $360.28      20090101
20692       APPLY BONE FIXATION DEVICE       80                           $132.65      20090101
20692       APPLY BONE FIXATION DEVICE       81                           $132.65      20090101
20692       APPLY BONE FIXATION DEVICE       82                           $132.65      20090101
20692       APPLY BONE FIXATION DEVICE       AS                           $132.65      20090101
20692       APPLY BONE FIXATION DEVICE                           Y        $547.70      20081209
20692       APPLY BONE FIXATION DEVICE                                    $663.23      20090101
20693       ADJUST BONE FIXATION DEVICE                                   $331.62      20090101
20693       ADJUST BONE FIXATION DEVICE                          Y        $482.11      20081209
20694       REMOVE BONE FIXATION DEVICE                                   $309.92      20090101
20694       REMOVE BONE FIXATION DEVICE                          Y        $375.91      20081209
20802       REPLANTATION, ARM, COMPLETE      80                           $351.77      20090101
20802       REPLANTATION, ARM, COMPLETE      81                           $351.77      20090101
20802       REPLANTATION, ARM, COMPLETE      82                           $351.77      20090101
20802       REPLANTATION, ARM, COMPLETE      AS                           $351.77      20090101
20802       REPLANTATION, ARM, COMPLETE                                  $1,758.83     20090101
20805       REPLANT FOREARM, COMPLETE        80                           $457.10      20090101
20805       REPLANT FOREARM, COMPLETE        81                           $457.10      20090101
20805       REPLANT FOREARM, COMPLETE        82                           $457.10      20090101
20805       REPLANT FOREARM, COMPLETE        AS                           $457.10      20090101
20805       REPLANT FOREARM, COMPLETE                                    $2,285.49     20090101
20808       REPLANTATION HAND, COMPLETE      80                           $589.46      20090101
20808       REPLANTATION HAND, COMPLETE      81                           $589.46      20090101
20808       REPLANTATION HAND, COMPLETE      82                           $589.46      20090101
20808       REPLANTATION HAND, COMPLETE      AS                           $589.46      20090101
20808       REPLANTATION HAND, COMPLETE                                  $2,947.32     20090101
20816       REPLANTATION DIGIT, COMPLETE     80                           $352.54      20090101
20816       REPLANTATION DIGIT, COMPLETE     81                           $352.54      20090101
20816       REPLANTATION DIGIT, COMPLETE     82                           $352.54      20090101
20816       REPLANTATION DIGIT, COMPLETE     AS                           $352.54      20090101
20816       REPLANTATION DIGIT, COMPLETE                                 $1,762.71     20090101
20822       REPLANTATION DIGIT, COMPLETE     80                           $308.53      20090101
20822       REPLANTATION DIGIT, COMPLETE     81                           $308.53      20090101
20822       REPLANTATION DIGIT, COMPLETE     82                           $308.53      20090101
20822       REPLANTATION DIGIT, COMPLETE     AS                           $308.53      20090101
20822       REPLANTATION DIGIT, COMPLETE                                 $1,542.67     20090101
20824       REPLANTATION THUMB, COMPLETE     80                           $349.15      20090101
20824       REPLANTATION THUMB, COMPLETE     81                           $349.15      20090101


                                           Page 26
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
20824       REPLANTATION THUMB, COMPLETE     82                           $349.15      20090101
20824       REPLANTATION THUMB, COMPLETE     AS                           $349.15      20090101
20824       REPLANTATION THUMB, COMPLETE                                 $1,745.73     20090101
20827       REPLANTATION THUMB, COMPLETE     80                           $314.55      20090101
20827       REPLANTATION THUMB, COMPLETE     81                           $314.55      20090101
20827       REPLANTATION THUMB, COMPLETE     82                           $314.55      20090101
20827       REPLANTATION THUMB, COMPLETE     AS                           $314.55      20090101
20827       REPLANTATION THUMB, COMPLETE                                 $1,572.73     20090101
20838       REPLANTATION FOOT, COMPLETE      80                           $344.09      20090101
20838       REPLANTATION FOOT, COMPLETE      81                           $344.09      20090101
20838       REPLANTATION FOOT, COMPLETE      82                           $344.09      20090101
20838       REPLANTATION FOOT, COMPLETE      AS                           $344.09      20090101
20838       REPLANTATION FOOT, COMPLETE                                  $1,720.43     20090101
20900       REMOVAL OF BONE FOR GRAFT        80                            $86.46      20090101
20900       REMOVAL OF BONE FOR GRAFT        81                            $86.46      20090101
20900       REMOVAL OF BONE FOR GRAFT        82                            $86.46      20090101
20900       REMOVAL OF BONE FOR GRAFT        AS                            $86.46      20090101
20900       REMOVAL OF BONE FOR GRAFT                                     $432.32      20090101
20900       REMOVAL OF BONE FOR GRAFT                            Y        $547.70      20081209
20902       REMOVAL OF BONE FOR GRAFT        80                            $87.42      20090101
20902       REMOVAL OF BONE FOR GRAFT        81                            $87.42      20090101
20902       REMOVAL OF BONE FOR GRAFT        82                            $87.42      20090101
20902       REMOVAL OF BONE FOR GRAFT        AS                            $87.42      20090101
20902       REMOVAL OF BONE FOR GRAFT                            Y        $619.70      20081209
20902       REMOVAL OF BONE FOR GRAFT                                     $437.08      20090101
20910       REMOVE CARTILAGE FOR GRAFT                                    $306.03      20090101
20910       REMOVE CARTILAGE FOR GRAFT                           Y        $473.32      20081209
20912       REMOVE CARTILAGE FOR GRAFT                           Y        $473.32      20081209
20912       REMOVE CARTILAGE FOR GRAFT                                    $347.20      20090101
20920       REMOVAL OF FASCIA FOR GRAFT      80                            $57.65      20090101
20920       REMOVAL OF FASCIA FOR GRAFT      81                            $57.65      20090101
20920       REMOVAL OF FASCIA FOR GRAFT      82                            $57.65      20090101
20920       REMOVAL OF FASCIA FOR GRAFT      AS                            $57.65      20090101
20920       REMOVAL OF FASCIA FOR GRAFT                                   $288.25      20090101
20920       REMOVAL OF FASCIA FOR GRAFT                          Y        $502.58      20081209
20922       REMOVAL OF FASCIA FOR GRAFT      80                            $83.96      20090101
20922       REMOVAL OF FASCIA FOR GRAFT      81                            $83.96      20090101
20922       REMOVAL OF FASCIA FOR GRAFT      82                            $83.96      20090101
20922       REMOVAL OF FASCIA FOR GRAFT      AS                            $83.96      20090101
20922       REMOVAL OF FASCIA FOR GRAFT                                   $419.80      20090101
20922       REMOVAL OF FASCIA FOR GRAFT                          Y        $430.58      20081209
20924       REMOVAL OF TENDON FOR GRAFT      80                            $72.67      20090101
20924       REMOVAL OF TENDON FOR GRAFT      81                            $72.67      20090101
20924       REMOVAL OF TENDON FOR GRAFT      82                            $72.67      20090101
20924       REMOVAL OF TENDON FOR GRAFT      AS                            $72.67      20090101


                                           Page 27
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
20924       REMOVAL OF TENDON FOR GRAFT                                   $363.34      20090101
20924       REMOVAL OF TENDON FOR GRAFT                          Y        $619.70      20081209
20926       REMOVAL OF TISSUE FOR GRAFT                                   $311.32      20090101
20930       SP BONE ALGRFT MORSEL ADD-ON                                  $56.58       20080101
20931       SP BONE ALGRFT STRUCT ADD-ON     80                           $16.91       20090101
20931       SP BONE ALGRFT STRUCT ADD-ON     81                           $16.91       20090101
20931       SP BONE ALGRFT STRUCT ADD-ON     82                           $16.91       20090101
20931       SP BONE ALGRFT STRUCT ADD-ON     AS                            $16.91      20090101
20931       SP BONE ALGRFT STRUCT ADD-ON                                  $84.56       20090101
20936       SP BONE AGRFT LOCAL ADD-ON       80                           $25.49       20090101
20936       SP BONE AGRFT LOCAL ADD-ON       81                           $25.49       20090101
20936       SP BONE AGRFT LOCAL ADD-ON       82                           $25.49       20090101
20936       SP BONE AGRFT LOCAL ADD-ON       AS                            $25.49      20090101
20936       SP BONE AGRFT LOCAL ADD-ON                                    $127.43      20090101
20937       SP BONE AGRFT MORSEL ADD-ON      80                           $25.54       20090101
20937       SP BONE AGRFT MORSEL ADD-ON      81                           $25.54       20090101
20937       SP BONE AGRFT MORSEL ADD-ON      82                           $25.54       20090101
20937       SP BONE AGRFT MORSEL ADD-ON      AS                            $25.54      20090101
20937       SP BONE AGRFT MORSEL ADD-ON                                   $127.72      20090101
20938       SP BONE AGRFT STRUCT ADD-ON      80                           $27.87       20090101
20938       SP BONE AGRFT STRUCT ADD-ON      81                           $27.87       20090101
20938       SP BONE AGRFT STRUCT ADD-ON      82                           $27.87       20090101
20938       SP BONE AGRFT STRUCT ADD-ON      AS                            $27.87      20090101
20938       SP BONE AGRFT STRUCT ADD-ON                                   $139.36      20090101
20950       FLUID PRESSURE, MUSCLE                                        $194.75      20090101
20955       FIBULA BONE GRAFT, MICROVASC     80                           $369.12      20090101
20955       FIBULA BONE GRAFT, MICROVASC     81                           $369.12      20090101
20955       FIBULA BONE GRAFT, MICROVASC     82                           $369.12      20090101
20955       FIBULA BONE GRAFT, MICROVASC     AS                           $369.12      20090101
20955       FIBULA BONE GRAFT, MICROVASC                                 $1,845.61     20090101
20956       ILIAC BONE GRAFT, MICROVASC      80                           $392.33      20090101
20956       ILIAC BONE GRAFT, MICROVASC      81                           $392.33      20090101
20956       ILIAC BONE GRAFT, MICROVASC      82                           $392.33      20090101
20956       ILIAC BONE GRAFT, MICROVASC      AS                           $392.33      20090101
20956       ILIAC BONE GRAFT, MICROVASC                                  $1,961.64     20090101
20957       MT BONE GRAFT, MICROVASC         80                           $371.79      20090101
20957       MT BONE GRAFT, MICROVASC         81                           $371.79      20090101
20957       MT BONE GRAFT, MICROVASC         82                           $371.79      20090101
20957       MT BONE GRAFT, MICROVASC         AS                           $371.79      20090101
20957       MT BONE GRAFT, MICROVASC                                     $1,858.96     20090101
20962       OTHER BONE GRAFT, MICROVASC      80                           $387.88      20090101
20962       OTHER BONE GRAFT, MICROVASC      81                           $387.88      20090101
20962       OTHER BONE GRAFT, MICROVASC      82                           $387.88      20090101
20962       OTHER BONE GRAFT, MICROVASC      AS                           $387.88      20090101
20962       OTHER BONE GRAFT, MICROVASC                                  $1,939.38     20090101


                                           Page 28
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
20969       BONE/SKIN GRAFT, MICROVASC       80                           $410.58      20090101
20969       BONE/SKIN GRAFT, MICROVASC       81                           $410.58      20090101
20969       BONE/SKIN GRAFT, MICROVASC       82                           $410.58      20090101
20969       BONE/SKIN GRAFT, MICROVASC       AS                           $410.58      20090101
20969       BONE/SKIN GRAFT, MICROVASC                                   $2,052.92     20090101
20970       BONE/SKIN GRAFT, ILIAC CREST     80                           $411.97      20090101
20970       BONE/SKIN GRAFT, ILIAC CREST     81                           $411.97      20090101
20970       BONE/SKIN GRAFT, ILIAC CREST     82                           $411.97      20090101
20970       BONE/SKIN GRAFT, ILIAC CREST     AS                           $411.97      20090101
20970       BONE/SKIN GRAFT, ILIAC CREST                                 $2,059.86     20090101
20972       BONE/SKIN GRAFT, METATARSAL      80                           $374.30      20090101
20972       BONE/SKIN GRAFT, METATARSAL      81                           $374.30      20090101
20972       BONE/SKIN GRAFT, METATARSAL      82                           $374.30      20090101
20972       BONE/SKIN GRAFT, METATARSAL      AS                           $374.30      20090101
20972       BONE/SKIN GRAFT, METATARSAL                                  $1,871.49     20090101
20972       BONE/SKIN GRAFT, METATARSAL                          Y       $1,466.22     20081209
20973       BONE/SKIN GRAFT, GREAT TOE       80                           $401.62      20090101
20973       BONE/SKIN GRAFT, GREAT TOE       81                           $401.62      20090101
20973       BONE/SKIN GRAFT, GREAT TOE       82                           $401.62      20090101
20973       BONE/SKIN GRAFT, GREAT TOE       AS                           $401.62      20090101
20973       BONE/SKIN GRAFT, GREAT TOE                           Y       $1,466.22     20081209
20973       BONE/SKIN GRAFT, GREAT TOE                                   $2,008.11     20090101
20974       ELECTRICAL BONE STIMULATION                                   $43.40       20090101
20975       ELECTRICAL BONE STIMULATION      80                            $26.09      20090101
20975       ELECTRICAL BONE STIMULATION      81                            $26.09      20090101
20975       ELECTRICAL BONE STIMULATION      82                            $26.09      20090101
20975       ELECTRICAL BONE STIMULATION      AS                            $26.09      20090101
20975       ELECTRICAL BONE STIMULATION                                   $130.46      20090101
20979       US BONE STIMULATION                                           $39.51       20090101
20982       ABLATE, BONE TUMOR(S) PERQ                                    $300.18      20090101
21010       INCISION OF JAW JOINT                                Y        $466.13      20081209
21010       INCISION OF JAW JOINT                                         $520.25      20090101
21015       RESECTION OF FACIAL TUMOR                            Y        $441.21      20081209
21015       RESECTION OF FACIAL TUMOR                                     $304.64      20090101
21025       EXCISION OF BONE, LOWER JAW                                   $689.68      20090101
21025       EXCISION OF BONE, LOWER JAW                          Y        $597.79      20081209
21026       EXCISION OF FACIAL BONE(S)                                    $403.12      20090101
21026       EXCISION OF FACIAL BONE(S)                           Y        $597.79      20081209
21029       CONTOUR OF FACE BONE LESION                                   $519.41      20090101
21029       CONTOUR OF FACE BONE LESION                          Y        $597.79      20081209
21030       EXCISE MAX/ZYGOMA B9 TUMOR                                    $336.63      20090101
21031       REMOVE EXOSTOSIS, MANDIBLE                                    $258.18      20090101
21032       REMOVE EXOSTOSIS, MAXILLA                                     $262.91      20090101
21034       EXCISE MAX/ZYGOMA MLG TUMOR      80                           $188.24      20090101
21034       EXCISE MAX/ZYGOMA MLG TUMOR      81                           $188.24      20090101


                                           Page 29
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
21034       EXCISE MAX/ZYGOMA MLG TUMOR      82                          $188.24     20090101
21034       EXCISE MAX/ZYGOMA MLG TUMOR      AS                          $188.24     20090101
21034       EXCISE MAX/ZYGOMA MLG TUMOR                                  $941.18     20090101
21034       EXCISE MAX/ZYGOMA MLG TUMOR                          Y       $636.19     20081209
21040       EXCISE MANDIBLE LESION                                       $337.74     20090101
21040       EXCISE MANDIBLE LESION                               Y       $466.13     20081209
21044       REMOVAL OF JAW BONE LESION       80                          $125.03     20090101
21044       REMOVAL OF JAW BONE LESION       81                          $125.03     20090101
21044       REMOVAL OF JAW BONE LESION       82                          $125.03     20090101
21044       REMOVAL OF JAW BONE LESION       AS                          $125.03     20090101
21044       REMOVAL OF JAW BONE LESION                           Y       $597.79     20081209
21044       REMOVAL OF JAW BONE LESION                                   $625.14     20090101
21045       EXTENSIVE JAW SURGERY            80                          $173.77     20090101
21045       EXTENSIVE JAW SURGERY            81                          $173.77     20090101
21045       EXTENSIVE JAW SURGERY            82                          $173.77     20090101
21045       EXTENSIVE JAW SURGERY            AS                          $173.77     20090101
21045       EXTENSIVE JAW SURGERY                                        $868.83     20090101
21046       REMOVE MANDIBLE CYST COMPLEX     80                          $153.18     20090101
21046       REMOVE MANDIBLE CYST COMPLEX     81                          $153.18     20090101
21046       REMOVE MANDIBLE CYST COMPLEX     82                          $153.18     20090101
21046       REMOVE MANDIBLE CYST COMPLEX     AS                          $153.18     20090101
21046       REMOVE MANDIBLE CYST COMPLEX                                 $765.90     20090101
21046       REMOVE MANDIBLE CYST COMPLEX                         Y       $597.79     20081209
21047       EXCISE LWR JAW CYST W/REPAIR     80                          $188.02     20090101
21047       EXCISE LWR JAW CYST W/REPAIR     81                          $188.02     20090101
21047       EXCISE LWR JAW CYST W/REPAIR     82                          $188.02     20090101
21047       EXCISE LWR JAW CYST W/REPAIR     AS                          $188.02     20090101
21047       EXCISE LWR JAW CYST W/REPAIR                         Y       $597.79     20081209
21047       EXCISE LWR JAW CYST W/REPAIR                                 $940.09     20090101
21048       REMOVE MAXILLA CYST COMPLEX      80                          $155.85     20090101
21048       REMOVE MAXILLA CYST COMPLEX      81                          $155.85     20090101
21048       REMOVE MAXILLA CYST COMPLEX      82                          $155.85     20090101
21048       REMOVE MAXILLA CYST COMPLEX      AS                          $155.85     20090101
21048       REMOVE MAXILLA CYST COMPLEX                                  $779.25     20090101
21049       EXCIS UPPR JAW CYST W/REPAIR     80                          $179.89     20090101
21049       EXCIS UPPR JAW CYST W/REPAIR     81                          $179.89     20090101
21049       EXCIS UPPR JAW CYST W/REPAIR     82                          $179.89     20090101
21049       EXCIS UPPR JAW CYST W/REPAIR     AS                          $179.89     20090101
21049       EXCIS UPPR JAW CYST W/REPAIR                                 $899.47     20090101
21050       REMOVAL OF JAW JOINT                                         $607.61     20090101
21050       REMOVAL OF JAW JOINT                                 Y       $636.19     20081209
21060       REMOVE JAW JOINT CARTILAGE       80                          $112.34     20090101
21060       REMOVE JAW JOINT CARTILAGE       81                          $112.34     20090101
21060       REMOVE JAW JOINT CARTILAGE       82                          $112.34     20090101
21060       REMOVE JAW JOINT CARTILAGE       AS                          $112.34     20090101


                                           Page 30
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
21060       REMOVE JAW JOINT CARTILAGE                           Y        $597.79      20081209
21060       REMOVE JAW JOINT CARTILAGE                                    $561.69      20090101
21070       REMOVE CORONOID PROCESS                                       $457.93      20090101
21070       REMOVE CORONOID PROCESS                              Y        $636.19      20081209
21076       PREPARE FACE/ORAL PROSTHESIS                                  $711.94      20090101
21077       PREPARE FACE/ORAL PROSTHESIS                                 $1,756.88     20090101
21079       PREPARE FACE/ORAL PROSTHESIS                                 $1,202.13     20090101
21080       PREPARE FACE/ORAL PROSTHESIS                                 $1,367.11     20090101
21081       PREPARE FACE/ORAL PROSTHESIS                                 $1,244.42     20090101
21082       PREPARE FACE/ORAL PROSTHESIS                                 $1,143.16     20090101
21083       PREPARE FACE/ORAL PROSTHESIS                                 $1,085.57     20090101
21084       PREPARE FACE/ORAL PROSTHESIS                                 $1,233.02     20090101
21085       PREPARE FACE/ORAL PROSTHESIS                                  $497.16      20090101
21086       PREPARE FACE/ORAL PROSTHESIS                                 $1,305.91     20090101
21087       PREPARE FACE/ORAL PROSTHESIS                                 $1,293.67     20090101
21100       MAXILLOFACIAL FIXATION                                        $503.56      20090101
21100       MAXILLOFACIAL FIXATION                               Y        $597.79      20081209
21110       INTERDENTAL FIXATION                                          $496.04      20090101
21116       INJECTION, JAW JOINT X-RAY                                    $119.36      20090101
21120       RECONSTRUCTION OF CHIN                                        $437.06      20090101
21120       RECONSTRUCTION OF CHIN                               Y        $795.53      20081209
21121       RECONSTRUCTION OF CHIN           80                           $104.56      20090101
21121       RECONSTRUCTION OF CHIN           81                           $104.56      20090101
21121       RECONSTRUCTION OF CHIN           82                           $104.56      20090101
21121       RECONSTRUCTION OF CHIN           AS                           $104.56      20090101
21121       RECONSTRUCTION OF CHIN                                        $522.78      20090101
21121       RECONSTRUCTION OF CHIN                               Y        $795.53      20081209
21137       REDUCTION OF FOREHEAD            80                           $105.89      20090101
21137       REDUCTION OF FOREHEAD            81                           $105.89      20090101
21137       REDUCTION OF FOREHEAD            82                           $105.89      20090101
21137       REDUCTION OF FOREHEAD            AS                           $105.89      20090101
21137       REDUCTION OF FOREHEAD                                         $529.45      20090101
21138       REDUCTION OF FOREHEAD            80                           $128.75      20090101
21138       REDUCTION OF FOREHEAD            81                           $128.75      20090101
21138       REDUCTION OF FOREHEAD            82                           $128.75      20090101
21138       REDUCTION OF FOREHEAD            AS                           $128.75      20090101
21138       REDUCTION OF FOREHEAD                                         $643.77      20090101
21139       REDUCTION OF FOREHEAD            80                           $139.71      20090101
21139       REDUCTION OF FOREHEAD            81                           $139.71      20090101
21139       REDUCTION OF FOREHEAD            82                           $139.71      20090101
21139       REDUCTION OF FOREHEAD            AS                           $139.71      20090101
21139       REDUCTION OF FOREHEAD                                         $698.57      20090101
21141       RECONSTRUCT MIDFACE, LEFORT      80                           $191.35      20090101
21141       RECONSTRUCT MIDFACE, LEFORT      81                           $191.35      20090101
21141       RECONSTRUCT MIDFACE, LEFORT      82                           $191.35      20090101


                                           Page 31
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
21141       RECONSTRUCT MIDFACE, LEFORT     AS                           $191.35      20090101
21141       RECONSTRUCT MIDFACE, LEFORT                                  $956.75      20090101
21142       RECONSTRUCT MIDFACE, LEFORT     80                           $188.24      20090101
21142       RECONSTRUCT MIDFACE, LEFORT     81                           $188.24      20090101
21142       RECONSTRUCT MIDFACE, LEFORT     82                           $188.24      20090101
21142       RECONSTRUCT MIDFACE, LEFORT     AS                           $188.24      20090101
21142       RECONSTRUCT MIDFACE, LEFORT                                  $941.18      20090101
21143       RECONSTRUCT MIDFACE, LEFORT     80                           $197.36      20090101
21143       RECONSTRUCT MIDFACE, LEFORT     81                           $197.36      20090101
21143       RECONSTRUCT MIDFACE, LEFORT     82                           $197.36      20090101
21143       RECONSTRUCT MIDFACE, LEFORT     AS                           $197.36      20090101
21143       RECONSTRUCT MIDFACE, LEFORT                                  $986.82      20090101
21145       RECONSTRUCT MIDFACE, LEFORT     80                           $222.17      20090101
21145       RECONSTRUCT MIDFACE, LEFORT     81                           $222.17      20090101
21145       RECONSTRUCT MIDFACE, LEFORT     82                           $222.17      20090101
21145       RECONSTRUCT MIDFACE, LEFORT     AS                           $222.17      20090101
21145       RECONSTRUCT MIDFACE, LEFORT                                 $1,110.87     20090101
21146       RECONSTRUCT MIDFACE, LEFORT     80                           $222.01      20090101
21146       RECONSTRUCT MIDFACE, LEFORT     81                           $222.01      20090101
21146       RECONSTRUCT MIDFACE, LEFORT     82                           $222.01      20090101
21146       RECONSTRUCT MIDFACE, LEFORT     AS                           $222.01      20090101
21146       RECONSTRUCT MIDFACE, LEFORT                                 $1,110.04     20090101
21147       RECONSTRUCT MIDFACE, LEFORT     80                           $237.42      20090101
21147       RECONSTRUCT MIDFACE, LEFORT     81                           $237.42      20090101
21147       RECONSTRUCT MIDFACE, LEFORT     82                           $237.42      20090101
21147       RECONSTRUCT MIDFACE, LEFORT     AS                           $237.42      20090101
21147       RECONSTRUCT MIDFACE, LEFORT                                 $1,187.09     20090101
21150       RECONSTRUCT MIDFACE, LEFORT     80                           $251.44      20090101
21150       RECONSTRUCT MIDFACE, LEFORT     81                           $251.44      20090101
21150       RECONSTRUCT MIDFACE, LEFORT     82                           $251.44      20090101
21150       RECONSTRUCT MIDFACE, LEFORT     AS                           $251.44      20090101
21150       RECONSTRUCT MIDFACE, LEFORT                                 $1,257.21     20090101
21151       RECONSTRUCT MIDFACE, LEFORT     80                           $269.52      20090101
21151       RECONSTRUCT MIDFACE, LEFORT     81                           $269.52      20090101
21151       RECONSTRUCT MIDFACE, LEFORT     82                           $269.52      20090101
21151       RECONSTRUCT MIDFACE, LEFORT     AS                           $269.52      20090101
21151       RECONSTRUCT MIDFACE, LEFORT                                 $1,347.62     20090101
21154       RECONSTRUCT MIDFACE, LEFORT     80                           $300.80      20090101
21154       RECONSTRUCT MIDFACE, LEFORT     81                           $300.80      20090101
21154       RECONSTRUCT MIDFACE, LEFORT     82                           $300.80      20090101
21154       RECONSTRUCT MIDFACE, LEFORT     AS                           $300.80      20090101
21154       RECONSTRUCT MIDFACE, LEFORT                                 $1,504.01     20090101
21155       RECONSTRUCT MIDFACE, LEFORT     80                           $348.76      20090101
21155       RECONSTRUCT MIDFACE, LEFORT     81                           $348.76      20090101
21155       RECONSTRUCT MIDFACE, LEFORT     82                           $348.76      20090101


                                          Page 32
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
21155       RECONSTRUCT MIDFACE, LEFORT     AS                           $348.76      20090101
21155       RECONSTRUCT MIDFACE, LEFORT                                 $1,743.82     20090101
21159       RECONSTRUCT MIDFACE, LEFORT     80                           $407.41      20090101
21159       RECONSTRUCT MIDFACE, LEFORT     81                           $407.41      20090101
21159       RECONSTRUCT MIDFACE, LEFORT     82                           $407.41      20090101
21159       RECONSTRUCT MIDFACE, LEFORT     AS                           $407.41      20090101
21159       RECONSTRUCT MIDFACE, LEFORT                                 $2,037.04     20090101
21160       RECONSTRUCT MIDFACE, LEFORT     80                           $425.44      20090101
21160       RECONSTRUCT MIDFACE, LEFORT     81                           $425.44      20090101
21160       RECONSTRUCT MIDFACE, LEFORT     82                           $425.44      20090101
21160       RECONSTRUCT MIDFACE, LEFORT     AS                           $425.44      20090101
21160       RECONSTRUCT MIDFACE, LEFORT                                 $2,127.18     20090101
21172       RECONSTRUCT ORBIT/FOREHEAD      80                           $252.50      20090101
21172       RECONSTRUCT ORBIT/FOREHEAD      81                           $252.50      20090101
21172       RECONSTRUCT ORBIT/FOREHEAD      82                           $252.50      20090101
21172       RECONSTRUCT ORBIT/FOREHEAD      AS                           $252.50      20090101
21172       RECONSTRUCT ORBIT/FOREHEAD                                  $1,262.49     20090101
21175       RECONSTRUCT ORBIT/FOREHEAD      80                           $300.13      20090101
21175       RECONSTRUCT ORBIT/FOREHEAD      81                           $300.13      20090101
21175       RECONSTRUCT ORBIT/FOREHEAD      82                           $300.13      20090101
21175       RECONSTRUCT ORBIT/FOREHEAD      AS                           $300.13      20090101
21175       RECONSTRUCT ORBIT/FOREHEAD                                  $1,500.65     20090101
21179       RECONSTRUCT ENTIRE FOREHEAD     80                           $211.55      20090101
21179       RECONSTRUCT ENTIRE FOREHEAD     81                           $211.55      20090101
21179       RECONSTRUCT ENTIRE FOREHEAD     82                           $211.55      20090101
21179       RECONSTRUCT ENTIRE FOREHEAD     AS                           $211.55      20090101
21179       RECONSTRUCT ENTIRE FOREHEAD                                 $1,057.77     20090101
21180       RECONSTRUCT ENTIRE FOREHEAD     80                           $240.04      20090101
21180       RECONSTRUCT ENTIRE FOREHEAD     81                           $240.04      20090101
21180       RECONSTRUCT ENTIRE FOREHEAD     82                           $240.04      20090101
21180       RECONSTRUCT ENTIRE FOREHEAD     AS                           $240.04      20090101
21180       RECONSTRUCT ENTIRE FOREHEAD                                 $1,200.19     20090101
21181       CONTOUR CRANIAL BONE LESION                                  $518.86      20090101
21181       CONTOUR CRANIAL BONE LESION                         Y        $795.53      20081209
21182       RECONSTRUCT CRANIAL BONE        80                           $291.89      20090101
21182       RECONSTRUCT CRANIAL BONE        81                           $291.89      20090101
21182       RECONSTRUCT CRANIAL BONE        82                           $291.89      20090101
21182       RECONSTRUCT CRANIAL BONE        AS                           $291.89      20090101
21182       RECONSTRUCT CRANIAL BONE                                    $1,459.45     20090101
21183       RECONSTRUCT CRANIAL BONE        80                           $334.29      20090101
21183       RECONSTRUCT CRANIAL BONE        81                           $334.29      20090101
21183       RECONSTRUCT CRANIAL BONE        82                           $334.29      20090101
21183       RECONSTRUCT CRANIAL BONE        AS                           $334.29      20090101
21183       RECONSTRUCT CRANIAL BONE                                    $1,671.47     20090101
21184       RECONSTRUCT CRANIAL BONE        80                           $350.54      20090101


                                          Page 33
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
21184       RECONSTRUCT CRANIAL BONE         81                           $350.54      20090101
21184       RECONSTRUCT CRANIAL BONE         82                           $350.54      20090101
21184       RECONSTRUCT CRANIAL BONE         AS                           $350.54      20090101
21184       RECONSTRUCT CRANIAL BONE                                     $1,752.72     20090101
21188       RECONSTRUCTION OF MIDFACE        80                           $233.36      20090101
21188       RECONSTRUCTION OF MIDFACE        81                           $233.36      20090101
21188       RECONSTRUCTION OF MIDFACE        82                           $233.36      20090101
21188       RECONSTRUCTION OF MIDFACE        AS                           $233.36      20090101
21188       RECONSTRUCTION OF MIDFACE                                    $1,166.81     20090101
21193       RECONST LWR JAW W/O GRAFT        80                           $178.78      20090101
21193       RECONST LWR JAW W/O GRAFT        81                           $178.78      20090101
21193       RECONST LWR JAW W/O GRAFT        82                           $178.78      20090101
21193       RECONST LWR JAW W/O GRAFT        AS                           $178.78      20090101
21193       RECONST LWR JAW W/O GRAFT                                     $893.88      20090101
21194       RECONST LWR JAW W/GRAFT          80                           $203.20      20090101
21194       RECONST LWR JAW W/GRAFT          81                           $203.20      20090101
21194       RECONST LWR JAW W/GRAFT          82                           $203.20      20090101
21194       RECONST LWR JAW W/GRAFT          AS                           $203.20      20090101
21194       RECONST LWR JAW W/GRAFT                                      $1,016.01     20090101
21195       RECONST LWR JAW W/O FIXATION     80                           $191.80      20090101
21195       RECONST LWR JAW W/O FIXATION     81                           $191.80      20090101
21195       RECONST LWR JAW W/O FIXATION     82                           $191.80      20090101
21195       RECONST LWR JAW W/O FIXATION     AS                           $191.80      20090101
21195       RECONST LWR JAW W/O FIXATION                                  $958.98      20090101
21196       RECONST LWR JAW W/FIXATION       80                           $208.43      20090101
21196       RECONST LWR JAW W/FIXATION       81                           $208.43      20090101
21196       RECONST LWR JAW W/FIXATION       82                           $208.43      20090101
21196       RECONST LWR JAW W/FIXATION       AS                           $208.43      20090101
21196       RECONST LWR JAW W/FIXATION                                   $1,042.14     20090101
21198       RECONSTR LWR JAW SEGMENT         80                           $162.59      20090101
21198       RECONSTR LWR JAW SEGMENT         81                           $162.59      20090101
21198       RECONSTR LWR JAW SEGMENT         82                           $162.59      20090101
21198       RECONSTR LWR JAW SEGMENT         AS                           $162.59      20090101
21198       RECONSTR LWR JAW SEGMENT                                      $812.94      20090101
21199       RECONSTR LWR JAW W/ADVANCE       80                           $146.67      20090101
21199       RECONSTR LWR JAW W/ADVANCE       81                           $146.67      20090101
21199       RECONSTR LWR JAW W/ADVANCE       82                           $146.67      20090101
21199       RECONSTR LWR JAW W/ADVANCE       AS                           $146.67      20090101
21199       RECONSTR LWR JAW W/ADVANCE                                    $733.35      20090101
21206       RECONSTRUCT UPPER JAW BONE       80                           $158.36      20090101
21206       RECONSTRUCT UPPER JAW BONE       81                           $158.36      20090101
21206       RECONSTRUCT UPPER JAW BONE       82                           $158.36      20090101
21206       RECONSTRUCT UPPER JAW BONE       AS                           $158.36      20090101
21206       RECONSTRUCT UPPER JAW BONE                                    $791.78      20090101
21206       RECONSTRUCT UPPER JAW BONE                           Y        $760.39      20081209


                                           Page 34
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
21208       AUGMENTATION OF FACIAL BONES                                 $1,112.83     20090101
21208       AUGMENTATION OF FACIAL BONES                         Y        $927.19      20081209
21209       REDUCTION OF FACIAL BONES        80                           $111.17      20090101
21209       REDUCTION OF FACIAL BONES        81                           $111.17      20090101
21209       REDUCTION OF FACIAL BONES        82                           $111.17      20090101
21209       REDUCTION OF FACIAL BONES        AS                           $111.17      20090101
21209       REDUCTION OF FACIAL BONES                            Y        $760.39      20081209
21209       REDUCTION OF FACIAL BONES                                     $555.85      20090101
21210       FACE BONE GRAFT                                      Y        $927.19      20081209
21210       FACE BONE GRAFT                                              $1,304.51     20090101
21215       LOWER JAW BONE GRAFT                                 Y        $927.19      20081209
21215       LOWER JAW BONE GRAFT                                          $615.93      20090101
21230       RIB CARTILAGE GRAFT                                  Y        $927.19      20081209
21230       RIB CARTILAGE GRAFT                                           $553.07      20090101
21235       EAR CARTILAGE GRAFT                                  Y        $795.53      20081209
21235       EAR CARTILAGE GRAFT                                           $497.99      20090101
21240       RECONSTRUCTION OF JAW JOINT      80                           $160.08      20090101
21240       RECONSTRUCTION OF JAW JOINT      81                           $160.08      20090101
21240       RECONSTRUCTION OF JAW JOINT      82                           $160.08      20090101
21240       RECONSTRUCTION OF JAW JOINT      AS                           $160.08      20090101
21240       RECONSTRUCTION OF JAW JOINT                          Y        $708.19      20081209
21240       RECONSTRUCTION OF JAW JOINT                                   $800.42      20090101
21242       RECONSTRUCTION OF JAW JOINT      80                           $146.78      20090101
21242       RECONSTRUCTION OF JAW JOINT      81                           $146.78      20090101
21242       RECONSTRUCTION OF JAW JOINT      82                           $146.78      20090101
21242       RECONSTRUCTION OF JAW JOINT      AS                           $146.78      20090101
21242       RECONSTRUCTION OF JAW JOINT                                   $733.92      20090101
21242       RECONSTRUCTION OF JAW JOINT                          Y        $760.39      20081209
21243       RECONSTRUCTION OF JAW JOINT      80                           $239.76      20090101
21243       RECONSTRUCTION OF JAW JOINT      81                           $239.76      20090101
21243       RECONSTRUCTION OF JAW JOINT      82                           $239.76      20090101
21243       RECONSTRUCTION OF JAW JOINT      AS                           $239.76      20090101
21243       RECONSTRUCTION OF JAW JOINT                                  $1,198.79     20090101
21243       RECONSTRUCTION OF JAW JOINT                          Y        $760.39      20081209
21244       RECONSTRUCTION OF LOWER JAW      80                           $146.95      20090101
21244       RECONSTRUCTION OF LOWER JAW      81                           $146.95      20090101
21244       RECONSTRUCTION OF LOWER JAW      82                           $146.95      20090101
21244       RECONSTRUCTION OF LOWER JAW      AS                           $146.95      20090101
21244       RECONSTRUCTION OF LOWER JAW                                   $734.75      20090101
21244       RECONSTRUCTION OF LOWER JAW                          Y        $927.19      20081209
21245       RECONSTRUCTION OF JAW            80                           $157.91      20090101
21245       RECONSTRUCTION OF JAW            81                           $157.91      20090101
21245       RECONSTRUCTION OF JAW            82                           $157.91      20090101
21245       RECONSTRUCTION OF JAW            AS                           $157.91      20090101
21245       RECONSTRUCTION OF JAW                                         $789.55      20090101


                                           Page 35
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
21245       RECONSTRUCTION OF JAW                              Y        $927.19      20081209
21246       RECONSTRUCTION OF JAW          80                           $124.47      20090101
21246       RECONSTRUCTION OF JAW          81                           $124.47      20090101
21246       RECONSTRUCTION OF JAW          82                           $124.47      20090101
21246       RECONSTRUCTION OF JAW          AS                           $124.47      20090101
21246       RECONSTRUCTION OF JAW                              Y        $927.19      20081209
21246       RECONSTRUCTION OF JAW                                       $622.35      20090101
21247       RECONSTRUCT LOWER JAW BONE     80                           $233.25      20090101
21247       RECONSTRUCT LOWER JAW BONE     81                           $233.25      20090101
21247       RECONSTRUCT LOWER JAW BONE     82                           $233.25      20090101
21247       RECONSTRUCT LOWER JAW BONE     AS                           $233.25      20090101
21247       RECONSTRUCT LOWER JAW BONE                                 $1,166.24     20090101
21248       RECONSTRUCTION OF JAW                              Y        $927.19      20081209
21248       RECONSTRUCTION OF JAW                                       $736.41      20090101
21249       RECONSTRUCTION OF JAW                              Y        $927.19      20081209
21249       RECONSTRUCTION OF JAW                                      $1,037.71     20090101
21255       RECONSTRUCT LOWER JAW BONE     80                           $198.25      20090101
21255       RECONSTRUCT LOWER JAW BONE     81                           $198.25      20090101
21255       RECONSTRUCT LOWER JAW BONE     82                           $198.25      20090101
21255       RECONSTRUCT LOWER JAW BONE     AS                           $198.25      20090101
21255       RECONSTRUCT LOWER JAW BONE                                  $991.27      20090101
21256       RECONSTRUCTION OF ORBIT        80                           $164.81      20090101
21256       RECONSTRUCTION OF ORBIT        81                           $164.81      20090101
21256       RECONSTRUCTION OF ORBIT        82                           $164.81      20090101
21256       RECONSTRUCTION OF ORBIT        AS                           $164.81      20090101
21256       RECONSTRUCTION OF ORBIT                                     $824.07      20090101
21260       REVISE EYE SOCKETS             80                           $175.71      20090101
21260       REVISE EYE SOCKETS             81                           $175.71      20090101
21260       REVISE EYE SOCKETS             82                           $175.71      20090101
21260       REVISE EYE SOCKETS             AS                           $175.71      20090101
21260       REVISE EYE SOCKETS                                          $878.56      20090101
21261       REVISE EYE SOCKETS             80                           $315.54      20090101
21261       REVISE EYE SOCKETS             81                           $315.54      20090101
21261       REVISE EYE SOCKETS             82                           $315.54      20090101
21261       REVISE EYE SOCKETS             AS                           $315.54      20090101
21261       REVISE EYE SOCKETS                                         $1,577.70     20090101
21263       REVISE EYE SOCKETS             80                           $277.76      20090101
21263       REVISE EYE SOCKETS             81                           $277.76      20090101
21263       REVISE EYE SOCKETS             82                           $277.76      20090101
21263       REVISE EYE SOCKETS             AS                           $277.76      20090101
21263       REVISE EYE SOCKETS                                         $1,388.81     20090101
21267       REVISE EYE SOCKETS             80                           $223.01      20090101
21267       REVISE EYE SOCKETS             81                           $223.01      20090101
21267       REVISE EYE SOCKETS             82                           $223.01      20090101
21267       REVISE EYE SOCKETS             AS                           $223.01      20090101


                                         Page 36
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
21267       REVISE EYE SOCKETS                                           $1,115.06     20090101
21267       REVISE EYE SOCKETS                                   Y        $927.19      20081209
21268       REVISE EYE SOCKETS               80                           $262.19      20090101
21268       REVISE EYE SOCKETS               81                           $262.19      20090101
21268       REVISE EYE SOCKETS               82                           $262.19      20090101
21268       REVISE EYE SOCKETS               AS                           $262.19      20090101
21268       REVISE EYE SOCKETS                                           $1,310.93     20090101
21270       AUGMENTATION, CHEEK BONE         80                           $126.03      20090101
21270       AUGMENTATION, CHEEK BONE         81                           $126.03      20090101
21270       AUGMENTATION, CHEEK BONE         82                           $126.03      20090101
21270       AUGMENTATION, CHEEK BONE         AS                           $126.03      20090101
21270       AUGMENTATION, CHEEK BONE                             Y        $760.39      20081209
21270       AUGMENTATION, CHEEK BONE                                      $630.16      20090101
21275       REVISION, ORBITOFACIAL BONES     80                           $114.63      20090101
21275       REVISION, ORBITOFACIAL BONES     81                           $114.63      20090101
21275       REVISION, ORBITOFACIAL BONES     82                           $114.63      20090101
21275       REVISION, ORBITOFACIAL BONES     AS                           $114.63      20090101
21275       REVISION, ORBITOFACIAL BONES                         Y        $927.19      20081209
21275       REVISION, ORBITOFACIAL BONES                                  $573.13      20090101
21280       REVISION OF EYELID                                            $365.28      20090101
21280       REVISION OF EYELID                                   Y        $760.39      20081209
21282       REVISION OF EYELID                                            $241.77      20090101
21282       REVISION OF EYELID                                   Y        $565.41      20081209
21295       REVISION OF JAW MUSCLE/BONE                                   $121.30      20090101
21295       REVISION OF JAW MUSCLE/BONE                          Y        $261.46      20081209
21296       REVISION OF JAW MUSCLE/BONE                          Y        $398.33      20081209
21296       REVISION OF JAW MUSCLE/BONE                                   $283.22      20090101
21310       TREATMENT OF NOSE FRACTURE                                     $77.07      20090101
21310       TREATMENT OF NOSE FRACTURE                           Y        $111.14      20081209
21315       TREATMENT OF NOSE FRACTURE                                    $178.05      20090101
21315       TREATMENT OF NOSE FRACTURE                           Y        $111.14      20081209
21320       TREATMENT OF NOSE FRACTURE                                    $171.10      20090101
21320       TREATMENT OF NOSE FRACTURE                           Y        $402.81      20081209
21325       TREATMENT OF NOSE FRACTURE                                    $338.86      20090101
21325       TREATMENT OF NOSE FRACTURE                           Y        $576.53      20081209
21330       TREATMENT OF NOSE FRACTURE                                    $414.81      20090101
21330       TREATMENT OF NOSE FRACTURE                           Y        $628.73      20081209
21335       TREATMENT OF NOSE FRACTURE                                    $520.25      20090101
21335       TREATMENT OF NOSE FRACTURE                           Y        $795.53      20081209
21336       TREAT NASAL SEPTAL FRACTURE                          Y        $594.61      20081209
21336       TREAT NASAL SEPTAL FRACTURE                                   $452.09      20090101
21337       TREAT NASAL SEPTAL FRACTURE                                   $269.31      20090101
21337       TREAT NASAL SEPTAL FRACTURE                          Y        $402.81      20081209
21338       TREAT NASOETHMOID FRACTURE                                    $544.17      20090101
21338       TREAT NASOETHMOID FRACTURE                           Y        $576.53      20081209


                                           Page 37
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
21339       TREAT NASOETHMOID FRACTURE      80                           $118.07      20090101
21339       TREAT NASOETHMOID FRACTURE      81                           $118.07      20090101
21339       TREAT NASOETHMOID FRACTURE      82                           $118.07      20090101
21339       TREAT NASOETHMOID FRACTURE      AS                           $118.07      20090101
21339       TREAT NASOETHMOID FRACTURE                                   $590.36      20090101
21339       TREAT NASOETHMOID FRACTURE                          Y        $628.73      20081209
21340       TREATMENT OF NOSE FRACTURE                                   $565.04      20090101
21340       TREATMENT OF NOSE FRACTURE                          Y        $708.19      20081209
21343       TREATMENT OF SINUS FRACTURE     80                           $165.36      20090101
21343       TREATMENT OF SINUS FRACTURE     81                           $165.36      20090101
21343       TREATMENT OF SINUS FRACTURE     82                           $165.36      20090101
21343       TREATMENT OF SINUS FRACTURE     AS                           $165.36      20090101
21343       TREATMENT OF SINUS FRACTURE                                  $826.81      20090101
21344       TREATMENT OF SINUS FRACTURE     80                           $214.72      20090101
21344       TREATMENT OF SINUS FRACTURE     81                           $214.72      20090101
21344       TREATMENT OF SINUS FRACTURE     82                           $214.72      20090101
21344       TREATMENT OF SINUS FRACTURE     AS                           $214.72      20090101
21344       TREATMENT OF SINUS FRACTURE                                 $1,073.61     20090101
21345       TREAT NOSE/JAW FRACTURE                                      $555.30      20090101
21345       TREAT NOSE/JAW FRACTURE                             Y        $795.53      20081209
21346       TREAT NOSE/JAW FRACTURE                                      $668.26      20090101
21347       TREAT NOSE/JAW FRACTURE         80                           $160.30      20090101
21347       TREAT NOSE/JAW FRACTURE         81                           $160.30      20090101
21347       TREAT NOSE/JAW FRACTURE         82                           $160.30      20090101
21347       TREAT NOSE/JAW FRACTURE         AS                           $160.30      20090101
21347       TREAT NOSE/JAW FRACTURE                                      $801.50      20090101
21348       TREAT NOSE/JAW FRACTURE         80                           $171.99      20090101
21348       TREAT NOSE/JAW FRACTURE         81                           $171.99      20090101
21348       TREAT NOSE/JAW FRACTURE         82                           $171.99      20090101
21348       TREAT NOSE/JAW FRACTURE         AS                           $171.99      20090101
21348       TREAT NOSE/JAW FRACTURE                                      $859.93      20090101
21355       TREAT CHEEK BONE FRACTURE                                    $298.51      20090101
21355       TREAT CHEEK BONE FRACTURE                           Y        $636.19      20081209
21356       TREAT CHEEK BONE FRACTURE                                    $339.69      20090101
21360       TREAT CHEEK BONE FRACTURE       80                            $74.78      20090101
21360       TREAT CHEEK BONE FRACTURE       81                            $74.78      20090101
21360       TREAT CHEEK BONE FRACTURE       82                            $74.78      20090101
21360       TREAT CHEEK BONE FRACTURE       AS                            $74.78      20090101
21360       TREAT CHEEK BONE FRACTURE                           Y        $794.12      20081209
21360       TREAT CHEEK BONE FRACTURE                                    $373.89      20090101
21365       TREAT CHEEK BONE FRACTURE       80                           $156.85      20090101
21365       TREAT CHEEK BONE FRACTURE       81                           $156.85      20090101
21365       TREAT CHEEK BONE FRACTURE       82                           $156.85      20090101
21365       TREAT CHEEK BONE FRACTURE       AS                           $156.85      20090101
21365       TREAT CHEEK BONE FRACTURE                                    $784.27      20090101


                                          Page 38
Proc Code   Description                   Modifier 1 Modifier 2 ASC     Price     Effective Date
21366       TREAT CHEEK BONE FRACTURE     80                           $177.27      20090101
21366       TREAT CHEEK BONE FRACTURE     81                           $177.27      20090101
21366       TREAT CHEEK BONE FRACTURE     82                           $177.27      20090101
21366       TREAT CHEEK BONE FRACTURE     AS                           $177.27      20090101
21366       TREAT CHEEK BONE FRACTURE                                  $886.37      20090101
21385       TREAT EYE SOCKET FRACTURE     80                           $100.93      20090101
21385       TREAT EYE SOCKET FRACTURE     81                           $100.93      20090101
21385       TREAT EYE SOCKET FRACTURE     82                           $100.93      20090101
21385       TREAT EYE SOCKET FRACTURE     AS                           $100.93      20090101
21385       TREAT EYE SOCKET FRACTURE                                  $504.67      20090101
21386       TREAT EYE SOCKET FRACTURE     80                           $94.42       20090101
21386       TREAT EYE SOCKET FRACTURE     81                           $94.42       20090101
21386       TREAT EYE SOCKET FRACTURE     82                           $94.42       20090101
21386       TREAT EYE SOCKET FRACTURE     AS                            $94.42      20090101
21386       TREAT EYE SOCKET FRACTURE                                  $472.12      20090101
21387       TREAT EYE SOCKET FRACTURE     80                           $107.33      20090101
21387       TREAT EYE SOCKET FRACTURE     81                           $107.33      20090101
21387       TREAT EYE SOCKET FRACTURE     82                           $107.33      20090101
21387       TREAT EYE SOCKET FRACTURE     AS                           $107.33      20090101
21387       TREAT EYE SOCKET FRACTURE                                  $536.65      20090101
21390       TREAT EYE SOCKET FRACTURE     80                           $107.84      20090101
21390       TREAT EYE SOCKET FRACTURE     81                           $107.84      20090101
21390       TREAT EYE SOCKET FRACTURE     82                           $107.84      20090101
21390       TREAT EYE SOCKET FRACTURE     AS                           $107.84      20090101
21390       TREAT EYE SOCKET FRACTURE                         Y       $1,320.78     20081209
21390       TREAT EYE SOCKET FRACTURE                                  $539.18      20090101
21395       TREAT EYE SOCKET FRACTURE     80                           $137.72      20090101
21395       TREAT EYE SOCKET FRACTURE     81                           $137.72      20090101
21395       TREAT EYE SOCKET FRACTURE     82                           $137.72      20090101
21395       TREAT EYE SOCKET FRACTURE     AS                           $137.72      20090101
21395       TREAT EYE SOCKET FRACTURE                                  $688.59      20090101
21400       TREAT EYE SOCKET FRACTURE                         Y        $329.26      20081209
21400       TREAT EYE SOCKET FRACTURE                                  $118.24      20090101
21401       TREAT EYE SOCKET FRACTURE     80                           $63.82       20090101
21401       TREAT EYE SOCKET FRACTURE     81                           $63.82       20090101
21401       TREAT EYE SOCKET FRACTURE     82                           $63.82       20090101
21401       TREAT EYE SOCKET FRACTURE     AS                            $63.82      20090101
21401       TREAT EYE SOCKET FRACTURE                                  $319.09      20090101
21401       TREAT EYE SOCKET FRACTURE                         Y        $441.21      20081209
21406       TREAT EYE SOCKET FRACTURE     80                           $76.39       20090101
21406       TREAT EYE SOCKET FRACTURE     81                           $76.39       20090101
21406       TREAT EYE SOCKET FRACTURE     82                           $76.39       20090101
21406       TREAT EYE SOCKET FRACTURE     AS                            $76.39      20090101
21406       TREAT EYE SOCKET FRACTURE                                  $381.97      20090101
21406       TREAT EYE SOCKET FRACTURE                         Y       $1,320.78     20081209


                                        Page 39
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
21407       TREAT EYE SOCKET FRACTURE       80                           $90.37       20090101
21407       TREAT EYE SOCKET FRACTURE       81                           $90.37       20090101
21407       TREAT EYE SOCKET FRACTURE       82                           $90.37       20090101
21407       TREAT EYE SOCKET FRACTURE       AS                            $90.37      20090101
21407       TREAT EYE SOCKET FRACTURE                                    $451.83      20090101
21407       TREAT EYE SOCKET FRACTURE                           Y       $1,320.78     20081209
21408       TREAT EYE SOCKET FRACTURE       80                           $123.97      20090101
21408       TREAT EYE SOCKET FRACTURE       81                           $123.97      20090101
21408       TREAT EYE SOCKET FRACTURE       82                           $123.97      20090101
21408       TREAT EYE SOCKET FRACTURE       AS                           $123.97      20090101
21408       TREAT EYE SOCKET FRACTURE                                    $619.86      20090101
21421       TREAT MOUTH ROOF FRACTURE                                    $484.92      20090101
21421       TREAT MOUTH ROOF FRACTURE                           Y        $576.53      20081209
21422       TREAT MOUTH ROOF FRACTURE       80                            $95.54      20090101
21422       TREAT MOUTH ROOF FRACTURE       81                            $95.54      20090101
21422       TREAT MOUTH ROOF FRACTURE       82                            $95.54      20090101
21422       TREAT MOUTH ROOF FRACTURE       AS                            $95.54      20090101
21422       TREAT MOUTH ROOF FRACTURE                                    $477.70      20090101
21423       TREAT MOUTH ROOF FRACTURE       80                           $113.23      20090101
21423       TREAT MOUTH ROOF FRACTURE       81                           $113.23      20090101
21423       TREAT MOUTH ROOF FRACTURE       82                           $113.23      20090101
21423       TREAT MOUTH ROOF FRACTURE       AS                           $113.23      20090101
21423       TREAT MOUTH ROOF FRACTURE                                    $566.15      20090101
21431       TREAT CRANIOFACIAL FRACTURE     80                           $103.66      20090101
21431       TREAT CRANIOFACIAL FRACTURE     81                           $103.66      20090101
21431       TREAT CRANIOFACIAL FRACTURE     82                           $103.66      20090101
21431       TREAT CRANIOFACIAL FRACTURE     AS                           $103.66      20090101
21431       TREAT CRANIOFACIAL FRACTURE                                  $518.28      20090101
21432       TREAT CRANIOFACIAL FRACTURE     80                           $94.65       20090101
21432       TREAT CRANIOFACIAL FRACTURE     81                           $94.65       20090101
21432       TREAT CRANIOFACIAL FRACTURE     82                           $94.65       20090101
21432       TREAT CRANIOFACIAL FRACTURE     AS                            $94.65      20090101
21432       TREAT CRANIOFACIAL FRACTURE                                  $473.25      20090101
21433       TREAT CRANIOFACIAL FRACTURE     80                           $240.37      20090101
21433       TREAT CRANIOFACIAL FRACTURE     81                           $240.37      20090101
21433       TREAT CRANIOFACIAL FRACTURE     82                           $240.37      20090101
21433       TREAT CRANIOFACIAL FRACTURE     AS                           $240.37      20090101
21433       TREAT CRANIOFACIAL FRACTURE                                 $1,201.84     20090101
21435       TREAT CRANIOFACIAL FRACTURE     80                           $188.68      20090101
21435       TREAT CRANIOFACIAL FRACTURE     81                           $188.68      20090101
21435       TREAT CRANIOFACIAL FRACTURE     82                           $188.68      20090101
21435       TREAT CRANIOFACIAL FRACTURE     AS                           $188.68      20090101
21435       TREAT CRANIOFACIAL FRACTURE                                  $943.40      20090101
21436       TREAT CRANIOFACIAL FRACTURE     80                           $271.53      20090101
21436       TREAT CRANIOFACIAL FRACTURE     81                           $271.53      20090101


                                          Page 40
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
21436       TREAT CRANIOFACIAL FRACTURE     82                           $271.53      20090101
21436       TREAT CRANIOFACIAL FRACTURE     AS                           $271.53      20090101
21436       TREAT CRANIOFACIAL FRACTURE                                 $1,357.66     20090101
21440       TREAT DENTAL RIDGE FRACTURE                                  $340.80      20090101
21440       TREAT DENTAL RIDGE FRACTURE                         Y        $261.74      20081209
21445       TREAT DENTAL RIDGE FRACTURE     80                            $99.27      20090101
21445       TREAT DENTAL RIDGE FRACTURE     81                            $99.27      20090101
21445       TREAT DENTAL RIDGE FRACTURE     82                            $99.27      20090101
21445       TREAT DENTAL RIDGE FRACTURE     AS                            $99.27      20090101
21445       TREAT DENTAL RIDGE FRACTURE                                  $496.33      20090101
21445       TREAT DENTAL RIDGE FRACTURE                         Y        $576.53      20081209
21450       TREAT LOWER JAW FRACTURE                                     $356.94      20090101
21450       TREAT LOWER JAW FRACTURE                            Y        $111.14      20081209
21451       TREAT LOWER JAW FRACTURE                                     $480.19      20090101
21451       TREAT LOWER JAW FRACTURE                            Y        $340.16      20081209
21452       TREAT LOWER JAW FRACTURE                                     $420.10      20090101
21452       TREAT LOWER JAW FRACTURE                            Y        $402.81      20081209
21453       TREAT LOWER JAW FRACTURE                                     $554.19      20090101
21453       TREAT LOWER JAW FRACTURE                            Y        $636.19      20081209
21454       TREAT LOWER JAW FRACTURE        80                           $77.84       20090101
21454       TREAT LOWER JAW FRACTURE        81                           $77.84       20090101
21454       TREAT LOWER JAW FRACTURE        82                           $77.84       20090101
21454       TREAT LOWER JAW FRACTURE        AS                            $77.84      20090101
21454       TREAT LOWER JAW FRACTURE                            Y        $628.73      20081209
21454       TREAT LOWER JAW FRACTURE                                     $389.21      20090101
21461       TREAT LOWER JAW FRACTURE        80                           $126.81      20090101
21461       TREAT LOWER JAW FRACTURE        81                           $126.81      20090101
21461       TREAT LOWER JAW FRACTURE        82                           $126.81      20090101
21461       TREAT LOWER JAW FRACTURE        AS                           $126.81      20090101
21461       TREAT LOWER JAW FRACTURE                                     $634.02      20090101
21461       TREAT LOWER JAW FRACTURE                            Y        $708.19      20081209
21462       TREAT LOWER JAW FRACTURE        80                           $139.72      20090101
21462       TREAT LOWER JAW FRACTURE        81                           $139.72      20090101
21462       TREAT LOWER JAW FRACTURE        82                           $139.72      20090101
21462       TREAT LOWER JAW FRACTURE        AS                           $139.72      20090101
21462       TREAT LOWER JAW FRACTURE                                     $698.56      20090101
21462       TREAT LOWER JAW FRACTURE                            Y        $760.39      20081209
21465       TREAT LOWER JAW FRACTURE        80                           $129.92      20090101
21465       TREAT LOWER JAW FRACTURE        81                           $129.92      20090101
21465       TREAT LOWER JAW FRACTURE        82                           $129.92      20090101
21465       TREAT LOWER JAW FRACTURE        AS                           $129.92      20090101
21465       TREAT LOWER JAW FRACTURE                                     $649.62      20090101
21465       TREAT LOWER JAW FRACTURE                            Y        $708.19      20081209
21470       TREAT LOWER JAW FRACTURE        80                           $168.65      20090101
21470       TREAT LOWER JAW FRACTURE        81                           $168.65      20090101


                                          Page 41
Proc Code   Description                   Modifier 1 Modifier 2 ASC    Price    Effective Date
21470       TREAT LOWER JAW FRACTURE      82                          $168.65     20090101
21470       TREAT LOWER JAW FRACTURE      AS                          $168.65     20090101
21470       TREAT LOWER JAW FRACTURE                                  $843.27     20090101
21480       RESET DISLOCATED JAW                                      $64.54      20090101
21480       RESET DISLOCATED JAW                              Y       $111.14     20081209
21485       RESET DISLOCATED JAW                              Y       $402.81     20081209
21485       RESET DISLOCATED JAW                                      $424.27     20090101
21490       REPAIR DISLOCATED JAW         80                          $131.26     20090101
21490       REPAIR DISLOCATED JAW         81                          $131.26     20090101
21490       REPAIR DISLOCATED JAW         82                          $131.26     20090101
21490       REPAIR DISLOCATED JAW         AS                          $131.26     20090101
21490       REPAIR DISLOCATED JAW                                     $656.29     20090101
21490       REPAIR DISLOCATED JAW                             Y       $636.19     20081209
21495       TREAT HYOID BONE FRACTURE     80                          $91.59      20090101
21495       TREAT HYOID BONE FRACTURE     81                          $91.59      20090101
21495       TREAT HYOID BONE FRACTURE     82                          $91.59      20090101
21495       TREAT HYOID BONE FRACTURE     AS                           $91.59     20090101
21495       TREAT HYOID BONE FRACTURE                                 $457.94     20090101
21495       TREAT HYOID BONE FRACTURE                         Y       $540.82     20081209
21497       INTERDENTAL WIRING                                Y       $402.81     20081209
21497       INTERDENTAL WIRING                                        $425.39     20090101
21501       DRAIN NECK/CHEST LESION                                   $300.19     20090101
21501       DRAIN NECK/CHEST LESION                           Y       $419.29     20081209
21502       DRAIN CHEST LESION            80                           $75.12     20090101
21502       DRAIN CHEST LESION            81                           $75.12     20090101
21502       DRAIN CHEST LESION            82                           $75.12     20090101
21502       DRAIN CHEST LESION            AS                           $75.12     20090101
21502       DRAIN CHEST LESION                                        $375.60     20090101
21502       DRAIN CHEST LESION                                Y       $443.71     20081209
21510       DRAINAGE OF BONE LESION                                   $336.63     20090101
21550       BIOPSY OF NECK/CHEST                              Y       $287.66     20081209
21550       BIOPSY OF NECK/CHEST                                      $172.76     20090101
21555       REMOVE LESION, NECK/CHEST                         Y       $442.39     20081209
21555       REMOVE LESION, NECK/CHEST                                 $295.18     20090101
21556       REMOVE LESION, NECK/CHEST                                 $289.33     20090101
21556       REMOVE LESION, NECK/CHEST                         Y       $442.39     20081209
21557       REMOVE TUMOR, NECK/CHEST      80                          $83.07      20090101
21557       REMOVE TUMOR, NECK/CHEST      81                          $83.07      20090101
21557       REMOVE TUMOR, NECK/CHEST      82                          $83.07      20090101
21557       REMOVE TUMOR, NECK/CHEST      AS                           $83.07     20090101
21557       REMOVE TUMOR, NECK/CHEST                                  $415.35     20090101
21600       PARTIAL REMOVAL OF RIB        80                          $77.79      20090101
21600       PARTIAL REMOVAL OF RIB        81                          $77.79      20090101
21600       PARTIAL REMOVAL OF RIB        82                          $77.79      20090101
21600       PARTIAL REMOVAL OF RIB        AS                           $77.79     20090101


                                        Page 42
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
21600       PARTIAL REMOVAL OF RIB                                      $388.95     20090101
21600       PARTIAL REMOVAL OF RIB                              Y       $509.30     20081209
21610       PARTIAL REMOVAL OF RIB          80                          $154.30     20090101
21610       PARTIAL REMOVAL OF RIB          81                          $154.30     20090101
21610       PARTIAL REMOVAL OF RIB          82                          $154.30     20090101
21610       PARTIAL REMOVAL OF RIB          AS                          $154.30     20090101
21610       PARTIAL REMOVAL OF RIB                              Y       $509.30     20081209
21610       PARTIAL REMOVAL OF RIB                                      $771.49     20090101
21615       REMOVAL OF RIB                  80                          $98.43      20090101
21615       REMOVAL OF RIB                  81                          $98.43      20090101
21615       REMOVAL OF RIB                  82                          $98.43      20090101
21615       REMOVAL OF RIB                  AS                           $98.43     20090101
21615       REMOVAL OF RIB                                              $492.14     20090101
21616       REMOVAL OF RIB AND NERVES       80                          $120.63     20090101
21616       REMOVAL OF RIB AND NERVES       81                          $120.63     20090101
21616       REMOVAL OF RIB AND NERVES       82                          $120.63     20090101
21616       REMOVAL OF RIB AND NERVES       AS                          $120.63     20090101
21616       REMOVAL OF RIB AND NERVES                                   $603.15     20090101
21620       PARTIAL REMOVAL OF STERNUM      80                          $75.17      20090101
21620       PARTIAL REMOVAL OF STERNUM      81                          $75.17      20090101
21620       PARTIAL REMOVAL OF STERNUM      82                          $75.17      20090101
21620       PARTIAL REMOVAL OF STERNUM      AS                           $75.17     20090101
21620       PARTIAL REMOVAL OF STERNUM                                  $375.86     20090101
21627       STERNAL DEBRIDEMENT             80                          $78.62      20090101
21627       STERNAL DEBRIDEMENT             81                          $78.62      20090101
21627       STERNAL DEBRIDEMENT             82                          $78.62      20090101
21627       STERNAL DEBRIDEMENT             AS                           $78.62     20090101
21627       STERNAL DEBRIDEMENT                                         $393.09     20090101
21630       EXTENSIVE STERNUM SURGERY       80                          $181.95     20090101
21630       EXTENSIVE STERNUM SURGERY       81                          $181.95     20090101
21630       EXTENSIVE STERNUM SURGERY       82                          $181.95     20090101
21630       EXTENSIVE STERNUM SURGERY       AS                          $181.95     20090101
21630       EXTENSIVE STERNUM SURGERY                                   $909.77     20090101
21632       EXTENSIVE STERNUM SURGERY       80                          $180.50     20090101
21632       EXTENSIVE STERNUM SURGERY       81                          $180.50     20090101
21632       EXTENSIVE STERNUM SURGERY       82                          $180.50     20090101
21632       EXTENSIVE STERNUM SURGERY       AS                          $180.50     20090101
21632       EXTENSIVE STERNUM SURGERY                                   $902.52     20090101
21700       REVISION OF NECK MUSCLE         80                           $61.03     20090101
21700       REVISION OF NECK MUSCLE         81                           $61.03     20090101
21700       REVISION OF NECK MUSCLE         82                           $61.03     20090101
21700       REVISION OF NECK MUSCLE         AS                           $61.03     20090101
21700       REVISION OF NECK MUSCLE                             Y       $443.71     20081209
21700       REVISION OF NECK MUSCLE                                     $305.17     20090101
21705       REVISION OF NECK MUSCLE/RIB     80                           $90.30     20090101


                                          Page 43
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
21705       REVISION OF NECK MUSCLE/RIB      81                           $90.30     20090101
21705       REVISION OF NECK MUSCLE/RIB      82                           $90.30     20090101
21705       REVISION OF NECK MUSCLE/RIB      AS                           $90.30     20090101
21705       REVISION OF NECK MUSCLE/RIB                                  $451.52     20090101
21720       REVISION OF NECK MUSCLE          80                           $55.20     20090101
21720       REVISION OF NECK MUSCLE          81                           $55.20     20090101
21720       REVISION OF NECK MUSCLE          82                           $55.20     20090101
21720       REVISION OF NECK MUSCLE          AS                           $55.20     20090101
21720       REVISION OF NECK MUSCLE                              Y       $482.11     20081209
21720       REVISION OF NECK MUSCLE                                      $275.98     20090101
21725       REVISION OF NECK MUSCLE          80                           $75.73     20090101
21725       REVISION OF NECK MUSCLE          81                           $75.73     20090101
21725       REVISION OF NECK MUSCLE          82                           $75.73     20090101
21725       REVISION OF NECK MUSCLE          AS                           $75.73     20090101
21725       REVISION OF NECK MUSCLE                                      $378.65     20090101
21725       REVISION OF NECK MUSCLE                              Y        $64.72     20081209
21740       RECONSTRUCTION OF STERNUM        80                          $156.91     20090101
21740       RECONSTRUCTION OF STERNUM        81                          $156.91     20090101
21740       RECONSTRUCTION OF STERNUM        82                          $156.91     20090101
21740       RECONSTRUCTION OF STERNUM        AS                          $156.91     20090101
21740       RECONSTRUCTION OF STERNUM                                    $784.53     20090101
21750       REPAIR OF STERNUM SEPARATION     80                          $104.05     20090101
21750       REPAIR OF STERNUM SEPARATION     81                          $104.05     20090101
21750       REPAIR OF STERNUM SEPARATION     82                          $104.05     20090101
21750       REPAIR OF STERNUM SEPARATION     AS                          $104.05     20090101
21750       REPAIR OF STERNUM SEPARATION                                 $520.24     20090101
21800       TREATMENT OF RIB FRACTURE                            Y        $76.82     20081209
21800       TREATMENT OF RIB FRACTURE                                    $67.33      20090101
21805       TREATMENT OF RIB FRACTURE                                    $178.61     20090101
21805       TREATMENT OF RIB FRACTURE                            Y       $484.21     20081209
21810       TREATMENT OF RIB FRACTURE(S)     80                           $72.50     20090101
21810       TREATMENT OF RIB FRACTURE(S)     81                           $72.50     20090101
21810       TREATMENT OF RIB FRACTURE(S)     82                           $72.50     20090101
21810       TREATMENT OF RIB FRACTURE(S)     AS                           $72.50     20090101
21810       TREATMENT OF RIB FRACTURE(S)                                 $362.51     20090101
21820       TREAT STERNUM FRACTURE                                       $91.80      20090101
21820       TREAT STERNUM FRACTURE                               Y        $76.82     20081209
21825       TREAT STERNUM FRACTURE           80                           $81.52     20090101
21825       TREAT STERNUM FRACTURE           81                           $81.52     20090101
21825       TREAT STERNUM FRACTURE           82                           $81.52     20090101
21825       TREAT STERNUM FRACTURE           AS                           $81.52     20090101
21825       TREAT STERNUM FRACTURE                                       $407.58     20090101
21920       BIOPSY SOFT TISSUE OF BACK                                   $169.15     20090101
21920       BIOPSY SOFT TISSUE OF BACK                           Y       $117.62     20081209
21925       BIOPSY SOFT TISSUE OF BACK                                   $289.33     20090101


                                           Page 44
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
21925       BIOPSY SOFT TISSUE OF BACK                           Y        $442.39      20081209
21930       REMOVE LESION, BACK OR FLANK                                  $322.72      20090101
21930       REMOVE LESION, BACK OR FLANK                         Y        $442.39      20081209
21935       REMOVE TUMOR, BACK                                   Y        $480.79      20081209
21935       REMOVE TUMOR, BACK                                            $831.84      20090101
22010       I&D, P-SPINE, C/T/CERV-THOR                                   $637.93      20090101
22015       I&D, P-SPINE, L/S/LS                                          $633.48      20090101
22100       REMOVE PART OF NECK VERTEBRA     80                           $115.79      20090101
22100       REMOVE PART OF NECK VERTEBRA     81                           $115.79      20090101
22100       REMOVE PART OF NECK VERTEBRA     82                           $115.79      20090101
22100       REMOVE PART OF NECK VERTEBRA     AS                           $115.79      20090101
22100       REMOVE PART OF NECK VERTEBRA                                  $578.93      20090101
22101       REMOVE PART, THORAX VERTEBRA     80                           $115.34      20090101
22101       REMOVE PART, THORAX VERTEBRA     81                           $115.34      20090101
22101       REMOVE PART, THORAX VERTEBRA     82                           $115.34      20090101
22101       REMOVE PART, THORAX VERTEBRA     AS                           $115.34      20090101
22101       REMOVE PART, THORAX VERTEBRA                                  $576.70      20090101
22102       REMOVE PART, LUMBAR VERTEBRA     80                           $115.62      20090101
22102       REMOVE PART, LUMBAR VERTEBRA     81                           $115.62      20090101
22102       REMOVE PART, LUMBAR VERTEBRA     82                           $115.62      20090101
22102       REMOVE PART, LUMBAR VERTEBRA     AS                           $115.62      20090101
22102       REMOVE PART, LUMBAR VERTEBRA                                  $578.10      20090101
22102       REMOVE PART, LUMBAR VERTEBRA                         Y       $1,549.14     20081209
22103       REMOVE EXTRA SPINE SEGMENT       80                            $21.31      20090101
22103       REMOVE EXTRA SPINE SEGMENT       81                            $21.31      20090101
22103       REMOVE EXTRA SPINE SEGMENT       82                            $21.31      20090101
22103       REMOVE EXTRA SPINE SEGMENT       AS                            $21.31      20090101
22103       REMOVE EXTRA SPINE SEGMENT                                    $106.55      20090101
22103       REMOVE EXTRA SPINE SEGMENT                           Y       $1,549.14     20081209
22110       REMOVE PART OF NECK VERTEBRA     80                           $143.11      20090101
22110       REMOVE PART OF NECK VERTEBRA     81                           $143.11      20090101
22110       REMOVE PART OF NECK VERTEBRA     82                           $143.11      20090101
22110       REMOVE PART OF NECK VERTEBRA     AS                           $143.11      20090101
22110       REMOVE PART OF NECK VERTEBRA                                  $715.55      20090101
22112       REMOVE PART, THORAX VERTEBRA     80                           $142.22      20090101
22112       REMOVE PART, THORAX VERTEBRA     81                           $142.22      20090101
22112       REMOVE PART, THORAX VERTEBRA     82                           $142.22      20090101
22112       REMOVE PART, THORAX VERTEBRA     AS                           $142.22      20090101
22112       REMOVE PART, THORAX VERTEBRA                                  $711.10      20090101
22114       REMOVE PART, LUMBAR VERTEBRA     80                           $142.72      20090101
22114       REMOVE PART, LUMBAR VERTEBRA     81                           $142.72      20090101
22114       REMOVE PART, LUMBAR VERTEBRA     82                           $142.72      20090101
22114       REMOVE PART, LUMBAR VERTEBRA     AS                           $142.72      20090101
22114       REMOVE PART, LUMBAR VERTEBRA                                  $713.58      20090101
22116       REMOVE EXTRA SPINE SEGMENT       80                            $21.42      20090101


                                           Page 45
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
22116       REMOVE EXTRA SPINE SEGMENT       81                           $21.42       20090101
22116       REMOVE EXTRA SPINE SEGMENT       82                           $21.42       20090101
22116       REMOVE EXTRA SPINE SEGMENT       AS                            $21.42      20090101
22116       REMOVE EXTRA SPINE SEGMENT                                    $107.12      20090101
22210       REVISION OF NECK SPINE           80                           $253.62      20090101
22210       REVISION OF NECK SPINE           81                           $253.62      20090101
22210       REVISION OF NECK SPINE           82                           $253.62      20090101
22210       REVISION OF NECK SPINE           AS                           $253.62      20090101
22210       REVISION OF NECK SPINE                                       $1,268.08     20090101
22212       REVISION OF THORAX SPINE                                     $1,043.84     20090101
22214       REVISION OF LUMBAR SPINE         80                           $210.72      20090101
22214       REVISION OF LUMBAR SPINE         81                           $210.72      20090101
22214       REVISION OF LUMBAR SPINE         82                           $210.72      20090101
22214       REVISION OF LUMBAR SPINE         AS                           $210.72      20090101
22214       REVISION OF LUMBAR SPINE                                     $1,053.58     20090101
22216       REVISE, EXTRA SPINE SEGMENT      80                           $55.92       20090101
22216       REVISE, EXTRA SPINE SEGMENT      81                           $55.92       20090101
22216       REVISE, EXTRA SPINE SEGMENT      82                           $55.92       20090101
22216       REVISE, EXTRA SPINE SEGMENT      AS                            $55.92      20090101
22216       REVISE, EXTRA SPINE SEGMENT                                   $279.61      20090101
22220       REVISION OF NECK SPINE           80                           $229.64      20090101
22220       REVISION OF NECK SPINE           81                           $229.64      20090101
22220       REVISION OF NECK SPINE           82                           $229.64      20090101
22220       REVISION OF NECK SPINE           AS                           $229.64      20090101
22220       REVISION OF NECK SPINE                                       $1,148.18     20090101
22222       REVISION OF THORAX SPINE         80                           $210.16      20090101
22222       REVISION OF THORAX SPINE         81                           $210.16      20090101
22222       REVISION OF THORAX SPINE         82                           $210.16      20090101
22222       REVISION OF THORAX SPINE         AS                           $210.16      20090101
22222       REVISION OF THORAX SPINE                                     $1,050.78     20090101
22224       REVISION OF LUMBAR SPINE         80                           $225.91      20090101
22224       REVISION OF LUMBAR SPINE         81                           $225.91      20090101
22224       REVISION OF LUMBAR SPINE         82                           $225.91      20090101
22224       REVISION OF LUMBAR SPINE         AS                           $225.91      20090101
22224       REVISION OF LUMBAR SPINE                                     $1,129.55     20090101
22226       REVISE, EXTRA SPINE SEGMENT      80                           $55.69       20090101
22226       REVISE, EXTRA SPINE SEGMENT      81                           $55.69       20090101
22226       REVISE, EXTRA SPINE SEGMENT      82                           $55.69       20090101
22226       REVISE, EXTRA SPINE SEGMENT      AS                            $55.69      20090101
22226       REVISE, EXTRA SPINE SEGMENT                                   $278.47      20090101
22305       TREAT SPINE PROCESS FRACTURE                                  $130.76      20090101
22305       TREAT SPINE PROCESS FRACTURE                         Y        $76.82       20081209
22310       TREAT SPINE FRACTURE                                 Y         $76.82      20081209
22310       TREAT SPINE FRACTURE                                          $197.25      20090101
22315       TREAT SPINE FRACTURE                                          $599.81      20090101


                                           Page 46
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
22315       TREAT SPINE FRACTURE                                Y         $76.82      20081209
22318       TREAT ODONTOID FX W/O GRAFT     80                           $229.08      20090101
22318       TREAT ODONTOID FX W/O GRAFT     81                           $229.08      20090101
22318       TREAT ODONTOID FX W/O GRAFT     82                           $229.08      20090101
22318       TREAT ODONTOID FX W/O GRAFT     AS                           $229.08      20090101
22318       TREAT ODONTOID FX W/O GRAFT                                 $1,145.38     20090101
22319       TREAT ODONTOID FX W/GRAFT       80                           $252.00      20090101
22319       TREAT ODONTOID FX W/GRAFT       81                           $252.00      20090101
22319       TREAT ODONTOID FX W/GRAFT       82                           $252.00      20090101
22319       TREAT ODONTOID FX W/GRAFT       AS                           $252.00      20090101
22319       TREAT ODONTOID FX W/GRAFT                                   $1,260.01     20090101
22325       TREAT SPINE FRACTURE            80                           $198.19      20090101
22325       TREAT SPINE FRACTURE            81                           $198.19      20090101
22325       TREAT SPINE FRACTURE            82                           $198.19      20090101
22325       TREAT SPINE FRACTURE            AS                           $198.19      20090101
22325       TREAT SPINE FRACTURE                                         $990.96      20090101
22326       TREAT NECK SPINE FRACTURE       80                           $208.32      20090101
22326       TREAT NECK SPINE FRACTURE       81                           $208.32      20090101
22326       TREAT NECK SPINE FRACTURE       82                           $208.32      20090101
22326       TREAT NECK SPINE FRACTURE       AS                           $208.32      20090101
22326       TREAT NECK SPINE FRACTURE                                   $1,041.62     20090101
22327       TREAT THORAX SPINE FRACTURE     80                           $205.15      20090101
22327       TREAT THORAX SPINE FRACTURE     81                           $205.15      20090101
22327       TREAT THORAX SPINE FRACTURE     82                           $205.15      20090101
22327       TREAT THORAX SPINE FRACTURE     AS                           $205.15      20090101
22327       TREAT THORAX SPINE FRACTURE                                 $1,025.74     20090101
22328       TREAT EACH ADD SPINE FX         80                           $42.01       20090101
22328       TREAT EACH ADD SPINE FX         81                           $42.01       20090101
22328       TREAT EACH ADD SPINE FX         82                           $42.01       20090101
22328       TREAT EACH ADD SPINE FX         AS                            $42.01      20090101
22328       TREAT EACH ADD SPINE FX                                      $210.05      20090101
22505       MANIPULATION OF SPINE                                        $90.42       20090101
22505       MANIPULATION OF SPINE                               Y        $389.86      20081209
22520       PERCUT VERTEBROPLASTY THOR                                   $437.61      20090101
22521       PERCUT VERTEBROPLASTY LUMB                                   $413.13      20090101
22522       PERCUT VERTEBROPLASTY ADD?L                                  $186.67      20090101
22532       LAT THORAX SPINE FUSION         80                           $247.44      20090101
22532       LAT THORAX SPINE FUSION         81                           $247.44      20090101
22532       LAT THORAX SPINE FUSION         82                           $247.44      20090101
22532       LAT THORAX SPINE FUSION         AS                           $247.44      20090101
22532       LAT THORAX SPINE FUSION                                     $1,237.19     20090101
22533       LAT LUMBAR SPINE FUSION         80                           $230.13      20090101
22533       LAT LUMBAR SPINE FUSION         81                           $230.13      20090101
22533       LAT LUMBAR SPINE FUSION         82                           $230.13      20090101
22533       LAT LUMBAR SPINE FUSION         AS                           $230.13      20090101


                                          Page 47
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
22533       LAT LUMBAR SPINE FUSION                                     $1,150.66     20090101
22534       LAT THOR/LUMB, ADD?L SEG        80                           $55.08       20090101
22534       LAT THOR/LUMB, ADD?L SEG        81                           $55.08       20090101
22534       LAT THOR/LUMB, ADD?L SEG        82                           $55.08       20090101
22534       LAT THOR/LUMB, ADD?L SEG        AS                            $55.08      20090101
22534       LAT THOR/LUMB, ADD?L SEG                                     $275.41      20090101
22548       NECK SPINE FUSION               80                           $266.24      20090101
22548       NECK SPINE FUSION               81                           $266.24      20090101
22548       NECK SPINE FUSION               82                           $266.24      20090101
22548       NECK SPINE FUSION               AS                           $266.24      20090101
22548       NECK SPINE FUSION                                           $1,331.22     20090101
22554       NECK SPINE FUSION               80                           $186.40      20090101
22554       NECK SPINE FUSION               81                           $186.40      20090101
22554       NECK SPINE FUSION               82                           $186.40      20090101
22554       NECK SPINE FUSION               AS                           $186.40      20090101
22554       NECK SPINE FUSION                                            $932.02      20090101
22556       THORAX SPINE FUSION             80                           $237.59      20090101
22556       THORAX SPINE FUSION             81                           $237.59      20090101
22556       THORAX SPINE FUSION             82                           $237.59      20090101
22556       THORAX SPINE FUSION             AS                           $237.59      20090101
22556       THORAX SPINE FUSION                                         $1,187.97     20090101
22558       LUMBAR SPINE FUSION             80                           $216.22      20090101
22558       LUMBAR SPINE FUSION             81                           $216.22      20090101
22558       LUMBAR SPINE FUSION             82                           $216.22      20090101
22558       LUMBAR SPINE FUSION             AS                           $216.22      20090101
22558       LUMBAR SPINE FUSION                                         $1,081.11     20090101
22585       ADDITIONAL SPINAL FUSION        80                            $51.19      20090101
22585       ADDITIONAL SPINAL FUSION        81                            $51.19      20090101
22585       ADDITIONAL SPINAL FUSION        82                            $51.19      20090101
22585       ADDITIONAL SPINAL FUSION        AS                            $51.19      20090101
22585       ADDITIONAL SPINAL FUSION                                     $255.96      20090101
22590       SPINE & SKULL SPINAL FUSION     80                           $220.11      20090101
22590       SPINE & SKULL SPINAL FUSION     81                           $220.11      20090101
22590       SPINE & SKULL SPINAL FUSION     82                           $220.11      20090101
22590       SPINE & SKULL SPINAL FUSION     AS                           $220.11      20090101
22590       SPINE & SKULL SPINAL FUSION                                 $1,100.57     20090101
22595       NECK SPINAL FUSION              80                           $209.21      20090101
22595       NECK SPINAL FUSION              81                           $209.21      20090101
22595       NECK SPINAL FUSION              82                           $209.21      20090101
22595       NECK SPINAL FUSION              AS                           $209.21      20090101
22595       NECK SPINAL FUSION                                          $1,046.07     20090101
22600       NECK SPINE FUSION               80                           $178.78      20090101
22600       NECK SPINE FUSION               81                           $178.78      20090101
22600       NECK SPINE FUSION               82                           $178.78      20090101
22600       NECK SPINE FUSION               AS                           $178.78      20090101


                                          Page 48
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
22600       NECK SPINE FUSION                                            $893.88      20090101
22610       THORAX SPINE FUSION             80                           $176.55      20090101
22610       THORAX SPINE FUSION             81                           $176.55      20090101
22610       THORAX SPINE FUSION             82                           $176.55      20090101
22610       THORAX SPINE FUSION             AS                           $176.55      20090101
22610       THORAX SPINE FUSION                                          $882.75      20090101
22612       LUMBAR SPINE FUSION             80                           $229.29      20090101
22612       LUMBAR SPINE FUSION             81                           $229.29      20090101
22612       LUMBAR SPINE FUSION             82                           $229.29      20090101
22612       LUMBAR SPINE FUSION             AS                           $229.29      20090101
22612       LUMBAR SPINE FUSION                                         $1,146.47     20090101
22614       SPINE FUSION, EXTRA SEGMENT     80                           $59.60       20090101
22614       SPINE FUSION, EXTRA SEGMENT     81                           $59.60       20090101
22614       SPINE FUSION, EXTRA SEGMENT     82                           $59.60       20090101
22614       SPINE FUSION, EXTRA SEGMENT     AS                            $59.60      20090101
22614       SPINE FUSION, EXTRA SEGMENT                                  $297.98      20090101
22630       LUMBAR SPINE FUSION             80                           $220.90      20090101
22630       LUMBAR SPINE FUSION             81                           $220.90      20090101
22630       LUMBAR SPINE FUSION             82                           $220.90      20090101
22630       LUMBAR SPINE FUSION             AS                           $220.90      20090101
22630       LUMBAR SPINE FUSION                                         $1,104.50     20090101
22632       SPINE FUSION, EXTRA SEGMENT     80                           $48.46       20090101
22632       SPINE FUSION, EXTRA SEGMENT     81                           $48.46       20090101
22632       SPINE FUSION, EXTRA SEGMENT     82                           $48.46       20090101
22632       SPINE FUSION, EXTRA SEGMENT     AS                            $48.46      20090101
22632       SPINE FUSION, EXTRA SEGMENT                                  $242.29      20090101
22800       FUSION OF SPINE                 80                           $194.91      20090101
22800       FUSION OF SPINE                 81                           $194.91      20090101
22800       FUSION OF SPINE                 82                           $194.91      20090101
22800       FUSION OF SPINE                 AS                           $194.91      20090101
22800       FUSION OF SPINE                                              $974.56      20090101
22802       FUSION OF SPINE                 80                           $310.92      20090101
22802       FUSION OF SPINE                 81                           $310.92      20090101
22802       FUSION OF SPINE                 82                           $310.92      20090101
22802       FUSION OF SPINE                 AS                           $310.92      20090101
22802       FUSION OF SPINE                                             $1,554.62     20090101
22804       FUSION OF SPINE                 80                           $360.11      20090101
22804       FUSION OF SPINE                 81                           $360.11      20090101
22804       FUSION OF SPINE                 82                           $360.11      20090101
22804       FUSION OF SPINE                 AS                           $360.11      20090101
22804       FUSION OF SPINE                                             $1,800.54     20090101
22808       FUSION OF SPINE                 80                           $263.90      20090101
22808       FUSION OF SPINE                 81                           $263.90      20090101
22808       FUSION OF SPINE                 82                           $263.90      20090101
22808       FUSION OF SPINE                 AS                           $263.90      20090101


                                          Page 49
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
22808       FUSION OF SPINE                                              $1,319.52     20090101
22810       FUSION OF SPINE                  80                           $295.40      20090101
22810       FUSION OF SPINE                  81                           $295.40      20090101
22810       FUSION OF SPINE                  82                           $295.40      20090101
22810       FUSION OF SPINE                  AS                           $295.40      20090101
22810       FUSION OF SPINE                                              $1,477.00     20090101
22812       FUSION OF SPINE                  80                           $322.89      20090101
22812       FUSION OF SPINE                  81                           $322.89      20090101
22812       FUSION OF SPINE                  82                           $322.89      20090101
22812       FUSION OF SPINE                  AS                           $322.89      20090101
22812       FUSION OF SPINE                                              $1,614.45     20090101
22818       KYPHECTOMY, 1-2 SEGMENTS         80                           $324.95      20090101
22818       KYPHECTOMY, 1-2 SEGMENTS         81                           $324.95      20090101
22818       KYPHECTOMY, 1-2 SEGMENTS         82                           $324.95      20090101
22818       KYPHECTOMY, 1-2 SEGMENTS         AS                           $324.95      20090101
22818       KYPHECTOMY, 1-2 SEGMENTS                                     $1,624.74     20090101
22819       KYPHECTOMY, 3 OR MORE            80                           $369.02      20090101
22819       KYPHECTOMY, 3 OR MORE            81                           $369.02      20090101
22819       KYPHECTOMY, 3 OR MORE            82                           $369.02      20090101
22819       KYPHECTOMY, 3 OR MORE            AS                           $369.02      20090101
22819       KYPHECTOMY, 3 OR MORE                                        $1,845.09     20090101
22830       EXPLORATION OF SPINAL FUSION     80                           $116.51      20090101
22830       EXPLORATION OF SPINAL FUSION     81                           $116.51      20090101
22830       EXPLORATION OF SPINAL FUSION     82                           $116.51      20090101
22830       EXPLORATION OF SPINAL FUSION     AS                           $116.51      20090101
22830       EXPLORATION OF SPINAL FUSION                                  $582.55      20090101
22840       INSERT SPINE FIXATION DEVICE     80                           $116.57      20090101
22840       INSERT SPINE FIXATION DEVICE     81                           $116.57      20090101
22840       INSERT SPINE FIXATION DEVICE     82                           $116.57      20090101
22840       INSERT SPINE FIXATION DEVICE     AS                           $116.57      20090101
22840       INSERT SPINE FIXATION DEVICE                                  $582.86      20090101
22842       INSERT SPINE FIXATION DEVICE     80                           $116.62      20090101
22842       INSERT SPINE FIXATION DEVICE     81                           $116.62      20090101
22842       INSERT SPINE FIXATION DEVICE     82                           $116.62      20090101
22842       INSERT SPINE FIXATION DEVICE     AS                           $116.62      20090101
22842       INSERT SPINE FIXATION DEVICE                                  $583.12      20090101
22843       INSERT SPINE FIXATION DEVICE     80                           $123.41      20090101
22843       INSERT SPINE FIXATION DEVICE     81                           $123.41      20090101
22843       INSERT SPINE FIXATION DEVICE     82                           $123.41      20090101
22843       INSERT SPINE FIXATION DEVICE     AS                           $123.41      20090101
22843       INSERT SPINE FIXATION DEVICE                                  $617.07      20090101
22844       INSERT SPINE FIXATION DEVICE     80                           $151.29      20090101
22844       INSERT SPINE FIXATION DEVICE     81                           $151.29      20090101
22844       INSERT SPINE FIXATION DEVICE     82                           $151.29      20090101
22844       INSERT SPINE FIXATION DEVICE     AS                           $151.29      20090101


                                           Page 50
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
22844       INSERT SPINE FIXATION DEVICE                                 $756.43     20090101
22845       INSERT SPINE FIXATION DEVICE     80                          $111.73     20090101
22845       INSERT SPINE FIXATION DEVICE     81                          $111.73     20090101
22845       INSERT SPINE FIXATION DEVICE     82                          $111.73     20090101
22845       INSERT SPINE FIXATION DEVICE     AS                          $111.73     20090101
22845       INSERT SPINE FIXATION DEVICE                                 $558.64     20090101
22846       INSERT SPINE FIXATION DEVICE     80                          $116.06     20090101
22846       INSERT SPINE FIXATION DEVICE     81                          $116.06     20090101
22846       INSERT SPINE FIXATION DEVICE     82                          $116.06     20090101
22846       INSERT SPINE FIXATION DEVICE     AS                          $116.06     20090101
22846       INSERT SPINE FIXATION DEVICE                                 $580.32     20090101
22847       INSERT SPINE FIXATION DEVICE     80                          $127.37     20090101
22847       INSERT SPINE FIXATION DEVICE     81                          $127.37     20090101
22847       INSERT SPINE FIXATION DEVICE     82                          $127.37     20090101
22847       INSERT SPINE FIXATION DEVICE     AS                          $127.37     20090101
22847       INSERT SPINE FIXATION DEVICE                                 $636.84     20090101
22848       INSERT PELV FIXATION DEVICE      80                          $55.08      20090101
22848       INSERT PELV FIXATION DEVICE      81                          $55.08      20090101
22848       INSERT PELV FIXATION DEVICE      82                          $55.08      20090101
22848       INSERT PELV FIXATION DEVICE      AS                           $55.08     20090101
22848       INSERT PELV FIXATION DEVICE                                  $275.41     20090101
22849       REINSERT SPINAL FIXATION         80                          $188.79     20090101
22849       REINSERT SPINAL FIXATION         81                          $188.79     20090101
22849       REINSERT SPINAL FIXATION         82                          $188.79     20090101
22849       REINSERT SPINAL FIXATION         AS                          $188.79     20090101
22849       REINSERT SPINAL FIXATION                                     $943.97     20090101
22850       REMOVE SPINE FIXATION DEVICE     80                          $102.88     20090101
22850       REMOVE SPINE FIXATION DEVICE     81                          $102.88     20090101
22850       REMOVE SPINE FIXATION DEVICE     82                          $102.88     20090101
22850       REMOVE SPINE FIXATION DEVICE     AS                          $102.88     20090101
22850       REMOVE SPINE FIXATION DEVICE                                 $514.40     20090101
22851       APPLY SPINE PROSTH DEVICE        80                          $61.99      20090101
22851       APPLY SPINE PROSTH DEVICE        81                          $61.99      20090101
22851       APPLY SPINE PROSTH DEVICE        82                          $61.99      20090101
22851       APPLY SPINE PROSTH DEVICE        AS                           $61.99     20090101
22851       APPLY SPINE PROSTH DEVICE                                    $309.93     20090101
22852       REMOVE SPINE FIXATION DEVICE     80                          $98.38      20090101
22852       REMOVE SPINE FIXATION DEVICE     81                          $98.38      20090101
22852       REMOVE SPINE FIXATION DEVICE     82                          $98.38      20090101
22852       REMOVE SPINE FIXATION DEVICE     AS                           $98.38     20090101
22852       REMOVE SPINE FIXATION DEVICE                                 $491.88     20090101
22855       REMOVE SPINE FIXATION DEVICE     80                          $159.80     20090101
22855       REMOVE SPINE FIXATION DEVICE     81                          $159.80     20090101
22855       REMOVE SPINE FIXATION DEVICE     82                          $159.80     20090101
22855       REMOVE SPINE FIXATION DEVICE     AS                          $159.80     20090101


                                           Page 51
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
22855       REMOVE SPINE FIXATION DEVICE                                 $799.02     20090101
22900       REMOVE ABDOMINAL WALL LESION     80                           $57.20     20090101
22900       REMOVE ABDOMINAL WALL LESION     81                           $57.20     20090101
22900       REMOVE ABDOMINAL WALL LESION     82                           $57.20     20090101
22900       REMOVE ABDOMINAL WALL LESION     AS                           $57.20     20090101
22900       REMOVE ABDOMINAL WALL LESION                                 $286.02     20090101
22900       REMOVE ABDOMINAL WALL LESION                         Y       $552.79     20081209
23000       REMOVAL OF CALCIUM DEPOSITS      80                           $73.95     20090101
23000       REMOVAL OF CALCIUM DEPOSITS      81                           $73.95     20090101
23000       REMOVAL OF CALCIUM DEPOSITS      82                           $73.95     20090101
23000       REMOVAL OF CALCIUM DEPOSITS      AS                           $73.95     20090101
23000       REMOVAL OF CALCIUM DEPOSITS                                  $369.75     20090101
23000       REMOVAL OF CALCIUM DEPOSITS                          Y       $400.91     20081209
23020       RELEASE SHOULDER JOINT           80                           $99.04     20090101
23020       RELEASE SHOULDER JOINT           81                           $99.04     20090101
23020       RELEASE SHOULDER JOINT           82                           $99.04     20090101
23020       RELEASE SHOULDER JOINT           AS                           $99.04     20090101
23020       RELEASE SHOULDER JOINT                                       $495.20     20090101
23020       RELEASE SHOULDER JOINT                               Y       $623.53     20081209
23030       DRAIN SHOULDER LESION                                        $301.86     20090101
23030       DRAIN SHOULDER LESION                                Y       $351.49     20081209
23031       DRAIN SHOULDER BURSA                                         $289.61     20090101
23031       DRAIN SHOULDER BURSA                                 Y       $457.69     20081209
23035       DRAIN SHOULDER BONE LESION       80                           $99.43     20090101
23035       DRAIN SHOULDER BONE LESION       81                           $99.43     20090101
23035       DRAIN SHOULDER BONE LESION       82                           $99.43     20090101
23035       DRAIN SHOULDER BONE LESION       AS                           $99.43     20090101
23035       DRAIN SHOULDER BONE LESION                                   $497.16     20090101
23035       DRAIN SHOULDER BONE LESION                           Y       $482.11     20081209
23040       EXPLORATORY SHOULDER SURGERY     80                          $103.16     20090101
23040       EXPLORATORY SHOULDER SURGERY     81                          $103.16     20090101
23040       EXPLORATORY SHOULDER SURGERY     82                          $103.16     20090101
23040       EXPLORATORY SHOULDER SURGERY     AS                          $103.16     20090101
23040       EXPLORATORY SHOULDER SURGERY                                 $515.79     20090101
23040       EXPLORATORY SHOULDER SURGERY                         Y       $547.70     20081209
23044       EXPLORATORY SHOULDER SURGERY     80                           $81.80     20090101
23044       EXPLORATORY SHOULDER SURGERY     81                           $81.80     20090101
23044       EXPLORATORY SHOULDER SURGERY     82                           $81.80     20090101
23044       EXPLORATORY SHOULDER SURGERY     AS                           $81.80     20090101
23044       EXPLORATORY SHOULDER SURGERY                         Y       $619.70     20081209
23044       EXPLORATORY SHOULDER SURGERY                                 $408.98     20090101
23065       BIOPSY SHOULDER TISSUES                                      $144.67     20090101
23065       BIOPSY SHOULDER TISSUES                              Y        $82.88     20081209
23066       BIOPSY SHOULDER TISSUES                                      $349.43     20090101
23066       BIOPSY SHOULDER TISSUES                              Y       $442.39     20081209


                                           Page 52
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
23075       REMOVAL OF SHOULDER LESION                           Y       $400.91     20081209
23075       REMOVAL OF SHOULDER LESION                                   $178.89     20090101
23076       REMOVAL OF SHOULDER LESION                                   $398.95     20090101
23076       REMOVAL OF SHOULDER LESION                           Y       $442.39     20081209
23077       REMOVE TUMOR OF SHOULDER         80                          $168.82     20090101
23077       REMOVE TUMOR OF SHOULDER         81                          $168.82     20090101
23077       REMOVE TUMOR OF SHOULDER         82                          $168.82     20090101
23077       REMOVE TUMOR OF SHOULDER         AS                          $168.82     20090101
23077       REMOVE TUMOR OF SHOULDER                             Y       $480.79     20081209
23077       REMOVE TUMOR OF SHOULDER                                     $844.09     20090101
23100       BIOPSY OF SHOULDER JOINT         80                           $69.32     20090101
23100       BIOPSY OF SHOULDER JOINT         81                           $69.32     20090101
23100       BIOPSY OF SHOULDER JOINT         82                           $69.32     20090101
23100       BIOPSY OF SHOULDER JOINT         AS                           $69.32     20090101
23100       BIOPSY OF SHOULDER JOINT                                     $346.62     20090101
23100       BIOPSY OF SHOULDER JOINT                             Y       $443.71     20081209
23101       SHOULDER JOINT SURGERY           80                           $64.16     20090101
23101       SHOULDER JOINT SURGERY           81                           $64.16     20090101
23101       SHOULDER JOINT SURGERY           82                           $64.16     20090101
23101       SHOULDER JOINT SURGERY           AS                           $64.16     20090101
23101       SHOULDER JOINT SURGERY                               Y       $838.70     20081209
23101       SHOULDER JOINT SURGERY                                       $320.80     20090101
23105       REMOVE SHOULDER JOINT LINING     80                           $91.19     20090101
23105       REMOVE SHOULDER JOINT LINING     81                           $91.19     20090101
23105       REMOVE SHOULDER JOINT LINING     82                           $91.19     20090101
23105       REMOVE SHOULDER JOINT LINING     AS                           $91.19     20090101
23105       REMOVE SHOULDER JOINT LINING                                 $455.97     20090101
23105       REMOVE SHOULDER JOINT LINING                         Y       $619.70     20081209
23106       INCISION OF COLLARBONE JOINT     80                           $68.22     20090101
23106       INCISION OF COLLARBONE JOINT     81                           $68.22     20090101
23106       INCISION OF COLLARBONE JOINT     82                           $68.22     20090101
23106       INCISION OF COLLARBONE JOINT     AS                           $68.22     20090101
23106       INCISION OF COLLARBONE JOINT                                 $341.08     20090101
23106       INCISION OF COLLARBONE JOINT                         Y       $619.70     20081209
23107       EXPLORE TREAT SHOULDER JOINT     80                           $94.98     20090101
23107       EXPLORE TREAT SHOULDER JOINT     81                           $94.98     20090101
23107       EXPLORE TREAT SHOULDER JOINT     82                           $94.98     20090101
23107       EXPLORE TREAT SHOULDER JOINT     AS                           $94.98     20090101
23107       EXPLORE TREAT SHOULDER JOINT                                 $474.91     20090101
23107       EXPLORE TREAT SHOULDER JOINT                         Y       $619.70     20081209
23120       PARTIAL REMOVAL, COLLAR BONE     80                           $80.30     20090101
23120       PARTIAL REMOVAL, COLLAR BONE     81                           $80.30     20090101
23120       PARTIAL REMOVAL, COLLAR BONE     82                           $80.30     20090101
23120       PARTIAL REMOVAL, COLLAR BONE     AS                           $80.30     20090101
23120       PARTIAL REMOVAL, COLLAR BONE                                 $401.48     20090101


                                           Page 53
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
23120       PARTIAL REMOVAL, COLLAR BONE                         Y       $671.90     20081209
23125       REMOVAL OF COLLAR BONE           80                          $100.82     20090101
23125       REMOVAL OF COLLAR BONE           81                          $100.82     20090101
23125       REMOVAL OF COLLAR BONE           82                          $100.82     20090101
23125       REMOVAL OF COLLAR BONE           AS                          $100.82     20090101
23125       REMOVAL OF COLLAR BONE                                       $504.10     20090101
23125       REMOVAL OF COLLAR BONE                               Y       $671.90     20081209
23130       REMOVE SHOULDER BONE, PART       80                           $86.46     20090101
23130       REMOVE SHOULDER BONE, PART       81                           $86.46     20090101
23130       REMOVE SHOULDER BONE, PART       82                           $86.46     20090101
23130       REMOVE SHOULDER BONE, PART       AS                           $86.46     20090101
23130       REMOVE SHOULDER BONE, PART                           Y       $786.13     20081209
23130       REMOVE SHOULDER BONE, PART                                   $432.32     20090101
23140       REMOVAL OF BONE LESION                               Y       $554.11     20081209
23140       REMOVAL OF BONE LESION                                       $366.12     20090101
23145       REMOVAL OF BONE LESION           80                           $98.71     20090101
23145       REMOVAL OF BONE LESION           81                           $98.71     20090101
23145       REMOVAL OF BONE LESION           82                           $98.71     20090101
23145       REMOVAL OF BONE LESION           AS                           $98.71     20090101
23145       REMOVAL OF BONE LESION                               Y       $671.90     20081209
23145       REMOVAL OF BONE LESION                                       $493.54     20090101
23146       REMOVAL OF BONE LESION                                       $440.40     20090101
23146       REMOVAL OF BONE LESION                               Y       $671.90     20081209
23150       REMOVAL OF HUMERUS LESION        80                           $92.92     20090101
23150       REMOVAL OF HUMERUS LESION        81                           $92.92     20090101
23150       REMOVAL OF HUMERUS LESION        82                           $92.92     20090101
23150       REMOVAL OF HUMERUS LESION        AS                           $92.92     20090101
23150       REMOVAL OF HUMERUS LESION                                    $464.61     20090101
23150       REMOVAL OF HUMERUS LESION                            Y       $619.70     20081209
23155       REMOVAL OF HUMERUS LESION        80                          $113.06     20090101
23155       REMOVAL OF HUMERUS LESION        81                          $113.06     20090101
23155       REMOVAL OF HUMERUS LESION        82                          $113.06     20090101
23155       REMOVAL OF HUMERUS LESION        AS                          $113.06     20090101
23155       REMOVAL OF HUMERUS LESION                            Y       $671.90     20081209
23155       REMOVAL OF HUMERUS LESION                                    $565.32     20090101
23156       REMOVAL OF HUMERUS LESION        80                           $96.43     20090101
23156       REMOVAL OF HUMERUS LESION        81                           $96.43     20090101
23156       REMOVAL OF HUMERUS LESION        82                           $96.43     20090101
23156       REMOVAL OF HUMERUS LESION        AS                           $96.43     20090101
23156       REMOVAL OF HUMERUS LESION                            Y       $671.90     20081209
23156       REMOVAL OF HUMERUS LESION                                    $482.15     20090101
23170       REMOVE COLLAR BONE LESION        80                           $76.39     20090101
23170       REMOVE COLLAR BONE LESION        81                           $76.39     20090101
23170       REMOVE COLLAR BONE LESION        82                           $76.39     20090101
23170       REMOVE COLLAR BONE LESION        AS                           $76.39     20090101


                                           Page 54
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
23170       REMOVE COLLAR BONE LESION                            Y       $509.30     20081209
23170       REMOVE COLLAR BONE LESION                                    $381.97     20090101
23172       REMOVE SHOULDER BLADE LESION     80                           $78.52     20090101
23172       REMOVE SHOULDER BLADE LESION     81                           $78.52     20090101
23172       REMOVE SHOULDER BLADE LESION     82                           $78.52     20090101
23172       REMOVE SHOULDER BLADE LESION     AS                           $78.52     20090101
23172       REMOVE SHOULDER BLADE LESION                         Y       $509.30     20081209
23172       REMOVE SHOULDER BLADE LESION                                 $392.58     20090101
23174       REMOVE HUMERUS LESION            80                          $107.50     20090101
23174       REMOVE HUMERUS LESION            81                          $107.50     20090101
23174       REMOVE HUMERUS LESION            82                          $107.50     20090101
23174       REMOVE HUMERUS LESION            AS                          $107.50     20090101
23174       REMOVE HUMERUS LESION                                Y       $509.30     20081209
23174       REMOVE HUMERUS LESION                                        $537.48     20090101
23180       REMOVE COLLAR BONE LESION        80                          $100.32     20090101
23180       REMOVE COLLAR BONE LESION        81                          $100.32     20090101
23180       REMOVE COLLAR BONE LESION        82                          $100.32     20090101
23180       REMOVE COLLAR BONE LESION        AS                          $100.32     20090101
23180       REMOVE COLLAR BONE LESION                            Y       $619.70     20081209
23180       REMOVE COLLAR BONE LESION                                    $501.61     20090101
23182       REMOVE SHOULDER BLADE LESION     80                           $96.43     20090101
23182       REMOVE SHOULDER BLADE LESION     81                           $96.43     20090101
23182       REMOVE SHOULDER BLADE LESION     82                           $96.43     20090101
23182       REMOVE SHOULDER BLADE LESION     AS                           $96.43     20090101
23182       REMOVE SHOULDER BLADE LESION                         Y       $619.70     20081209
23182       REMOVE SHOULDER BLADE LESION                                 $482.15     20090101
23184       REMOVE HUMERUS LESION            80                          $108.56     20090101
23184       REMOVE HUMERUS LESION            81                          $108.56     20090101
23184       REMOVE HUMERUS LESION            82                          $108.56     20090101
23184       REMOVE HUMERUS LESION            AS                          $108.56     20090101
23184       REMOVE HUMERUS LESION                                Y       $619.70     20081209
23184       REMOVE HUMERUS LESION                                        $542.81     20090101
23190       PARTIAL REMOVAL OF SCAPULA       80                           $79.41     20090101
23190       PARTIAL REMOVAL OF SCAPULA       81                           $79.41     20090101
23190       PARTIAL REMOVAL OF SCAPULA       82                           $79.41     20090101
23190       PARTIAL REMOVAL OF SCAPULA       AS                           $79.41     20090101
23190       PARTIAL REMOVAL OF SCAPULA                                   $397.03     20090101
23190       PARTIAL REMOVAL OF SCAPULA                           Y       $619.70     20081209
23195       REMOVAL OF HEAD OF HUMERUS       80                          $107.28     20090101
23195       REMOVAL OF HEAD OF HUMERUS       81                          $107.28     20090101
23195       REMOVAL OF HEAD OF HUMERUS       82                          $107.28     20090101
23195       REMOVAL OF HEAD OF HUMERUS       AS                          $107.28     20090101
23195       REMOVAL OF HEAD OF HUMERUS                                   $536.39     20090101
23195       REMOVAL OF HEAD OF HUMERUS                           Y       $671.90     20081209
23200       REMOVAL OF COLLAR BONE           80                          $125.47     20090101


                                           Page 55
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
23200       REMOVAL OF COLLAR BONE           81                           $125.47      20090101
23200       REMOVAL OF COLLAR BONE           82                           $125.47      20090101
23200       REMOVAL OF COLLAR BONE           AS                           $125.47      20090101
23200       REMOVAL OF COLLAR BONE                                        $627.37      20090101
23210       REMOVAL OF SHOULDER BLADE        80                           $131.31      20090101
23210       REMOVAL OF SHOULDER BLADE        81                           $131.31      20090101
23210       REMOVAL OF SHOULDER BLADE        82                           $131.31      20090101
23210       REMOVAL OF SHOULDER BLADE        AS                           $131.31      20090101
23210       REMOVAL OF SHOULDER BLADE                                     $656.55      20090101
23220       PARTIAL REMOVAL OF HUMERUS       80                           $154.91      20090101
23220       PARTIAL REMOVAL OF HUMERUS       81                           $154.91      20090101
23220       PARTIAL REMOVAL OF HUMERUS       82                           $154.91      20090101
23220       PARTIAL REMOVAL OF HUMERUS       AS                           $154.91      20090101
23220       PARTIAL REMOVAL OF HUMERUS                                    $774.54      20090101
23221       PARTIAL REMOVAL OF HUMERUS       80                           $181.61      20090101
23221       PARTIAL REMOVAL OF HUMERUS       81                           $181.61      20090101
23221       PARTIAL REMOVAL OF HUMERUS       82                           $181.61      20090101
23221       PARTIAL REMOVAL OF HUMERUS       AS                           $181.61      20090101
23221       PARTIAL REMOVAL OF HUMERUS                                    $908.06      20090101
23222       PARTIAL REMOVAL OF HUMERUS       80                           $244.60      20090101
23222       PARTIAL REMOVAL OF HUMERUS       81                           $244.60      20090101
23222       PARTIAL REMOVAL OF HUMERUS       82                           $244.60      20090101
23222       PARTIAL REMOVAL OF HUMERUS       AS                           $244.60      20090101
23222       PARTIAL REMOVAL OF HUMERUS                                   $1,223.01     20090101
23330       REMOVE SHOULDER FOREIGN BODY                                  $156.63      20090101
23330       REMOVE SHOULDER FOREIGN BODY                         Y        $271.71      20081209
23331       REMOVE SHOULDER FOREIGN BODY                                  $420.10      20090101
23331       REMOVE SHOULDER FOREIGN BODY                         Y        $374.59      20081209
23332       REMOVE SHOULDER FOREIGN BODY     80                           $127.47      20090101
23332       REMOVE SHOULDER FOREIGN BODY     81                           $127.47      20090101
23332       REMOVE SHOULDER FOREIGN BODY     82                           $127.47      20090101
23332       REMOVE SHOULDER FOREIGN BODY     AS                           $127.47      20090101
23332       REMOVE SHOULDER FOREIGN BODY                                  $637.35      20090101
23350       INJECTION FOR SHOULDER X-RAY                                  $115.73      20090101
23395       MUSCLE TRANSFER,SHOULDER/ARM     80                           $185.12      20090101
23395       MUSCLE TRANSFER,SHOULDER/ARM     81                           $185.12      20090101
23395       MUSCLE TRANSFER,SHOULDER/ARM     82                           $185.12      20090101
23395       MUSCLE TRANSFER,SHOULDER/ARM     AS                           $185.12      20090101
23395       MUSCLE TRANSFER,SHOULDER/ARM                         Y        $786.13      20081209
23395       MUSCLE TRANSFER,SHOULDER/ARM                                  $925.60      20090101
23397       MUSCLE TRANSFERS                 80                           $165.98      20090101
23397       MUSCLE TRANSFERS                 81                           $165.98      20090101
23397       MUSCLE TRANSFERS                 82                           $165.98      20090101
23397       MUSCLE TRANSFERS                 AS                           $165.98      20090101
23397       MUSCLE TRANSFERS                                              $829.91      20090101


                                           Page 56
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
23397       MUSCLE TRANSFERS                                     Y       $1,254.65     20081209
23400       FIXATION OF SHOULDER BLADE       80                           $141.00      20090101
23400       FIXATION OF SHOULDER BLADE       81                           $141.00      20090101
23400       FIXATION OF SHOULDER BLADE       82                           $141.00      20090101
23400       FIXATION OF SHOULDER BLADE       AS                           $141.00      20090101
23400       FIXATION OF SHOULDER BLADE                                    $704.99      20090101
23400       FIXATION OF SHOULDER BLADE                           Y        $838.70      20081209
23405       INCISION OF TENDON & MUSCLE      80                            $90.70      20090101
23405       INCISION OF TENDON & MUSCLE      81                            $90.70      20090101
23405       INCISION OF TENDON & MUSCLE      82                            $90.70      20090101
23405       INCISION OF TENDON & MUSCLE      AS                            $90.70      20090101
23405       INCISION OF TENDON & MUSCLE                          Y        $509.30      20081209
23405       INCISION OF TENDON & MUSCLE                                   $453.49      20090101
23406       INCISE TENDON(S) & MUSCLE(S)     80                           $113.56      20090101
23406       INCISE TENDON(S) & MUSCLE(S)     81                           $113.56      20090101
23406       INCISE TENDON(S) & MUSCLE(S)     82                           $113.56      20090101
23406       INCISE TENDON(S) & MUSCLE(S)     AS                           $113.56      20090101
23406       INCISE TENDON(S) & MUSCLE(S)                         Y        $509.30      20081209
23406       INCISE TENDON(S) & MUSCLE(S)                                  $567.80      20090101
23410       REPAIR ROTATOR CUFF, ACUTE       80                           $130.20      20090101
23410       REPAIR ROTATOR CUFF, ACUTE       81                           $130.20      20090101
23410       REPAIR ROTATOR CUFF, ACUTE       82                           $130.20      20090101
23410       REPAIR ROTATOR CUFF, ACUTE       AS                           $130.20      20090101
23410       REPAIR ROTATOR CUFF, ACUTE                                    $651.02      20090101
23410       REPAIR ROTATOR CUFF, ACUTE                           Y        $786.13      20081209
23412       REPAIR ROTATOR CUFF, CHRONIC     80                           $138.55      20090101
23412       REPAIR ROTATOR CUFF, CHRONIC     81                           $138.55      20090101
23412       REPAIR ROTATOR CUFF, CHRONIC     82                           $138.55      20090101
23412       REPAIR ROTATOR CUFF, CHRONIC     AS                           $138.55      20090101
23412       REPAIR ROTATOR CUFF, CHRONIC                         Y        $952.93      20081209
23412       REPAIR ROTATOR CUFF, CHRONIC                                  $692.73      20090101
23415       RELEASE OF SHOULDER LIGAMENT     80                           $106.39      20090101
23415       RELEASE OF SHOULDER LIGAMENT     81                           $106.39      20090101
23415       RELEASE OF SHOULDER LIGAMENT     82                           $106.39      20090101
23415       RELEASE OF SHOULDER LIGAMENT     AS                           $106.39      20090101
23415       RELEASE OF SHOULDER LIGAMENT                         Y        $786.13      20081209
23415       RELEASE OF SHOULDER LIGAMENT                                  $531.94      20090101
23420       REPAIR OF SHOULDER               80                           $152.18      20090101
23420       REPAIR OF SHOULDER               81                           $152.18      20090101
23420       REPAIR OF SHOULDER               82                           $152.18      20090101
23420       REPAIR OF SHOULDER               AS                           $152.18      20090101
23420       REPAIR OF SHOULDER                                   Y        $952.93      20081209
23420       REPAIR OF SHOULDER                                            $760.88      20090101
23430       REPAIR BICEPS TENDON             80                           $107.00      20090101
23430       REPAIR BICEPS TENDON             81                           $107.00      20090101


                                           Page 57
Proc Code   Description                  Modifier 1 Modifier 2 ASC     Price     Effective Date
23430       REPAIR BICEPS TENDON         82                           $107.00      20090101
23430       REPAIR BICEPS TENDON         AS                           $107.00      20090101
23430       REPAIR BICEPS TENDON                             Y        $733.93      20081209
23430       REPAIR BICEPS TENDON                                      $534.99      20090101
23440       REMOVE/TRANSPLANT TENDON     80                           $110.61      20090101
23440       REMOVE/TRANSPLANT TENDON     81                           $110.61      20090101
23440       REMOVE/TRANSPLANT TENDON     82                           $110.61      20090101
23440       REMOVE/TRANSPLANT TENDON     AS                           $110.61      20090101
23440       REMOVE/TRANSPLANT TENDON                         Y        $733.93      20081209
23440       REMOVE/TRANSPLANT TENDON                                  $553.05      20090101
23450       REPAIR SHOULDER CAPSULE      80                           $138.71      20090101
23450       REPAIR SHOULDER CAPSULE      81                           $138.71      20090101
23450       REPAIR SHOULDER CAPSULE      82                           $138.71      20090101
23450       REPAIR SHOULDER CAPSULE      AS                           $138.71      20090101
23450       REPAIR SHOULDER CAPSULE                                   $693.55      20090101
23450       REPAIR SHOULDER CAPSULE                          Y       $1,087.85     20081209
23455       REPAIR SHOULDER CAPSULE      80                           $147.73      20090101
23455       REPAIR SHOULDER CAPSULE      81                           $147.73      20090101
23455       REPAIR SHOULDER CAPSULE      82                           $147.73      20090101
23455       REPAIR SHOULDER CAPSULE      AS                           $147.73      20090101
23455       REPAIR SHOULDER CAPSULE                                   $738.63      20090101
23455       REPAIR SHOULDER CAPSULE                          Y       $1,254.65     20081209
23460       REPAIR SHOULDER CAPSULE      80                           $159.80      20090101
23460       REPAIR SHOULDER CAPSULE      81                           $159.80      20090101
23460       REPAIR SHOULDER CAPSULE      82                           $159.80      20090101
23460       REPAIR SHOULDER CAPSULE      AS                           $159.80      20090101
23460       REPAIR SHOULDER CAPSULE                                   $799.02      20090101
23460       REPAIR SHOULDER CAPSULE                          Y       $1,087.85     20081209
23462       REPAIR SHOULDER CAPSULE      80                           $156.46      20090101
23462       REPAIR SHOULDER CAPSULE      81                           $156.46      20090101
23462       REPAIR SHOULDER CAPSULE      82                           $156.46      20090101
23462       REPAIR SHOULDER CAPSULE      AS                           $156.46      20090101
23462       REPAIR SHOULDER CAPSULE                                   $782.30      20090101
23462       REPAIR SHOULDER CAPSULE                          Y        $952.93      20081209
23465       REPAIR SHOULDER CAPSULE      80                           $162.87      20090101
23465       REPAIR SHOULDER CAPSULE      81                           $162.87      20090101
23465       REPAIR SHOULDER CAPSULE      82                           $162.87      20090101
23465       REPAIR SHOULDER CAPSULE      AS                           $162.87      20090101
23465       REPAIR SHOULDER CAPSULE                          Y       $1,087.85     20081209
23465       REPAIR SHOULDER CAPSULE                                   $814.34      20090101
23466       REPAIR SHOULDER CAPSULE      80                           $159.74      20090101
23466       REPAIR SHOULDER CAPSULE      81                           $159.74      20090101
23466       REPAIR SHOULDER CAPSULE      82                           $159.74      20090101
23466       REPAIR SHOULDER CAPSULE      AS                           $159.74      20090101
23466       REPAIR SHOULDER CAPSULE                                   $798.71      20090101


                                       Page 58
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
23466       REPAIR SHOULDER CAPSULE                            Y        $952.93      20081209
23470       RECONSTRUCT SHOULDER JOINT     80                           $177.67      20090101
23470       RECONSTRUCT SHOULDER JOINT     81                           $177.67      20090101
23470       RECONSTRUCT SHOULDER JOINT     82                           $177.67      20090101
23470       RECONSTRUCT SHOULDER JOINT     AS                           $177.67      20090101
23470       RECONSTRUCT SHOULDER JOINT                                  $888.34      20090101
23472       RECONSTRUCT SHOULDER JOINT     80                           $219.34      20090101
23472       RECONSTRUCT SHOULDER JOINT     81                           $219.34      20090101
23472       RECONSTRUCT SHOULDER JOINT     82                           $219.34      20090101
23472       RECONSTRUCT SHOULDER JOINT     AS                           $219.34      20090101
23472       RECONSTRUCT SHOULDER JOINT                                 $1,096.69     20090101
23480       REVISION OF COLLAR BONE        80                           $119.13      20090101
23480       REVISION OF COLLAR BONE        81                           $119.13      20090101
23480       REVISION OF COLLAR BONE        82                           $119.13      20090101
23480       REVISION OF COLLAR BONE        AS                           $119.13      20090101
23480       REVISION OF COLLAR BONE                                     $595.64      20090101
23480       REVISION OF COLLAR BONE                            Y        $733.93      20081209
23485       REVISION OF COLLAR BONE        80                           $140.11      20090101
23485       REVISION OF COLLAR BONE        81                           $140.11      20090101
23485       REVISION OF COLLAR BONE        82                           $140.11      20090101
23485       REVISION OF COLLAR BONE        AS                           $140.11      20090101
23485       REVISION OF COLLAR BONE                                     $700.54      20090101
23485       REVISION OF COLLAR BONE                            Y       $1,254.65     20081209
23490       REINFORCE CLAVICLE             80                           $118.19      20090101
23490       REINFORCE CLAVICLE             81                           $118.19      20090101
23490       REINFORCE CLAVICLE             82                           $118.19      20090101
23490       REINFORCE CLAVICLE             AS                           $118.19      20090101
23490       REINFORCE CLAVICLE                                          $590.93      20090101
23490       REINFORCE CLAVICLE                                 Y        $661.93      20081209
23491       REINFORCE SHOULDER BONES       80                           $147.95      20090101
23491       REINFORCE SHOULDER BONES       81                           $147.95      20090101
23491       REINFORCE SHOULDER BONES       82                           $147.95      20090101
23491       REINFORCE SHOULDER BONES       AS                           $147.95      20090101
23491       REINFORCE SHOULDER BONES                                    $739.77      20090101
23491       REINFORCE SHOULDER BONES                           Y        $963.65      20081209
23500       TREAT CLAVICLE FRACTURE                            Y         $76.82      20081209
23500       TREAT CLAVICLE FRACTURE                                     $144.39      20090101
23505       TREAT CLAVICLE FRACTURE                                     $238.14      20090101
23505       TREAT CLAVICLE FRACTURE                            Y         $76.82      20081209
23515       TREAT CLAVICLE FRACTURE        80                            $97.87      20090101
23515       TREAT CLAVICLE FRACTURE        81                            $97.87      20090101
23515       TREAT CLAVICLE FRACTURE        82                            $97.87      20090101
23515       TREAT CLAVICLE FRACTURE        AS                            $97.87      20090101
23515       TREAT CLAVICLE FRACTURE                            Y        $796.38      20081209
23515       TREAT CLAVICLE FRACTURE                                     $489.35      20090101


                                         Page 59
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
23520       TREAT CLAVICLE DISLOCATION                         Y        $76.82     20081209
23520       TREAT CLAVICLE DISLOCATION                                 $149.12     20090101
23525       TREAT CLAVICLE DISLOCATION                                 $235.92     20090101
23525       TREAT CLAVICLE DISLOCATION                         Y        $76.82     20081209
23530       TREAT CLAVICLE DISLOCATION     80                          $78.96      20090101
23530       TREAT CLAVICLE DISLOCATION     81                          $78.96      20090101
23530       TREAT CLAVICLE DISLOCATION     82                          $78.96      20090101
23530       TREAT CLAVICLE DISLOCATION     AS                           $78.96     20090101
23530       TREAT CLAVICLE DISLOCATION                         Y       $646.39     20081209
23530       TREAT CLAVICLE DISLOCATION                                 $394.80     20090101
23532       TREAT CLAVICLE DISLOCATION     80                          $88.80      20090101
23532       TREAT CLAVICLE DISLOCATION     81                          $88.80      20090101
23532       TREAT CLAVICLE DISLOCATION     82                          $88.80      20090101
23532       TREAT CLAVICLE DISLOCATION     AS                           $88.80     20090101
23532       TREAT CLAVICLE DISLOCATION                         Y       $594.61     20081209
23532       TREAT CLAVICLE DISLOCATION                                 $444.02     20090101
23540       TREAT CLAVICLE DISLOCATION                         Y        $76.82     20081209
23540       TREAT CLAVICLE DISLOCATION                                 $148.56     20090101
23545       TREAT CLAVICLE DISLOCATION                                 $212.55     20090101
23545       TREAT CLAVICLE DISLOCATION                         Y        $76.82     20081209
23550       TREAT CLAVICLE DISLOCATION     80                          $81.73      20090101
23550       TREAT CLAVICLE DISLOCATION     81                          $81.73      20090101
23550       TREAT CLAVICLE DISLOCATION     82                          $81.73      20090101
23550       TREAT CLAVICLE DISLOCATION     AS                           $81.73     20090101
23550       TREAT CLAVICLE DISLOCATION                                 $408.67     20090101
23550       TREAT CLAVICLE DISLOCATION                         Y       $646.39     20081209
23552       TREAT CLAVICLE DISLOCATION     80                          $94.31      20090101
23552       TREAT CLAVICLE DISLOCATION     81                          $94.31      20090101
23552       TREAT CLAVICLE DISLOCATION     82                          $94.31      20090101
23552       TREAT CLAVICLE DISLOCATION     AS                           $94.31     20090101
23552       TREAT CLAVICLE DISLOCATION                                 $471.55     20090101
23552       TREAT CLAVICLE DISLOCATION                         Y       $718.39     20081209
23570       TREAT SHOULDER BLADE FX                                    $154.13     20090101
23570       TREAT SHOULDER BLADE FX                            Y        $76.82     20081209
23575       TREAT SHOULDER BLADE FX                            Y        $76.82     20081209
23575       TREAT SHOULDER BLADE FX                                    $262.91     20090101
23585       TREAT SCAPULA FRACTURE         80                          $131.82     20090101
23585       TREAT SCAPULA FRACTURE         81                          $131.82     20090101
23585       TREAT SCAPULA FRACTURE         82                          $131.82     20090101
23585       TREAT SCAPULA FRACTURE         AS                          $131.82     20090101
23585       TREAT SCAPULA FRACTURE                                     $659.09     20090101
23585       TREAT SCAPULA FRACTURE                             Y       $796.38     20081209
23600       TREAT HUMERUS FRACTURE                                     $216.73     20090101
23600       TREAT HUMERUS FRACTURE                             Y        $58.57     20081209
23605       TREAT HUMERUS FRACTURE                                     $321.33     20090101


                                         Page 60
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
23615       TREAT HUMERUS FRACTURE         80                          $123.47     20090101
23615       TREAT HUMERUS FRACTURE         81                          $123.47     20090101
23615       TREAT HUMERUS FRACTURE         82                          $123.47     20090101
23615       TREAT HUMERUS FRACTURE         AS                          $123.47     20090101
23615       TREAT HUMERUS FRACTURE                             Y       $868.38     20081209
23615       TREAT HUMERUS FRACTURE                                     $617.33     20090101
23616       TREAT HUMERUS FRACTURE         80                          $190.24     20090101
23616       TREAT HUMERUS FRACTURE         81                          $190.24     20090101
23616       TREAT HUMERUS FRACTURE         82                          $190.24     20090101
23616       TREAT HUMERUS FRACTURE         AS                          $190.24     20090101
23616       TREAT HUMERUS FRACTURE                                     $951.22     20090101
23616       TREAT HUMERUS FRACTURE                             Y       $868.38     20081209
23620       TREAT HUMERUS FRACTURE                                     $177.22     20090101
23625       TREAT HUMERUS FRACTURE                                     $260.13     20090101
23625       TREAT HUMERUS FRACTURE                             Y        $76.82     20081209
23630       TREAT HUMERUS FRACTURE         80                          $103.83     20090101
23630       TREAT HUMERUS FRACTURE         81                          $103.83     20090101
23630       TREAT HUMERUS FRACTURE         82                          $103.83     20090101
23630       TREAT HUMERUS FRACTURE         AS                          $103.83     20090101
23630       TREAT HUMERUS FRACTURE                             Y       $920.58     20081209
23630       TREAT HUMERUS FRACTURE                                     $519.16     20090101
23650       TREAT SHOULDER DISLOCATION                                 $202.26     20090101
23650       TREAT SHOULDER DISLOCATION                         Y        $76.82     20081209
23655       TREAT SHOULDER DISLOCATION                                 $264.02     20090101
23655       TREAT SHOULDER DISLOCATION                         Y       $322.06     20081209
23660       TREAT SHOULDER DISLOCATION     80                           $82.79     20090101
23660       TREAT SHOULDER DISLOCATION     81                           $82.79     20090101
23660       TREAT SHOULDER DISLOCATION     82                           $82.79     20090101
23660       TREAT SHOULDER DISLOCATION     AS                           $82.79     20090101
23660       TREAT SHOULDER DISLOCATION                         Y       $646.39     20081209
23660       TREAT SHOULDER DISLOCATION                                 $413.95     20090101
23665       TREAT DISLOCATION/FRACTURE                                 $287.67     20090101
23665       TREAT DISLOCATION/FRACTURE                         Y        $76.82     20081209
23670       TREAT DISLOCATION/FRACTURE     80                          $116.06     20090101
23670       TREAT DISLOCATION/FRACTURE     81                          $116.06     20090101
23670       TREAT DISLOCATION/FRACTURE     82                          $116.06     20090101
23670       TREAT DISLOCATION/FRACTURE     AS                          $116.06     20090101
23670       TREAT DISLOCATION/FRACTURE                                 $580.32     20090101
23670       TREAT DISLOCATION/FRACTURE                         Y       $796.38     20081209
23675       TREAT DISLOCATION/FRACTURE                                 $378.92     20090101
23675       TREAT DISLOCATION/FRACTURE                         Y        $76.82     20081209
23680       TREAT DISLOCATION/FRACTURE     80                          $127.53     20090101
23680       TREAT DISLOCATION/FRACTURE     81                          $127.53     20090101
23680       TREAT DISLOCATION/FRACTURE     82                          $127.53     20090101
23680       TREAT DISLOCATION/FRACTURE     AS                          $127.53     20090101


                                         Page 61
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
23680       TREAT DISLOCATION/FRACTURE                           Y        $646.39      20081209
23680       TREAT DISLOCATION/FRACTURE                                    $637.66      20090101
23700       FIXATION OF SHOULDER                                 Y        $322.06      20081209
23700       FIXATION OF SHOULDER                                          $139.66      20090101
23800       FUSION OF SHOULDER JOINT         80                           $147.95      20090101
23800       FUSION OF SHOULDER JOINT         81                           $147.95      20090101
23800       FUSION OF SHOULDER JOINT         82                           $147.95      20090101
23800       FUSION OF SHOULDER JOINT         AS                           $147.95      20090101
23800       FUSION OF SHOULDER JOINT                             Y       $1,035.65     20081209
23800       FUSION OF SHOULDER JOINT                                      $739.77      20090101
23802       FUSION OF SHOULDER JOINT         80                           $175.71      20090101
23802       FUSION OF SHOULDER JOINT         81                           $175.71      20090101
23802       FUSION OF SHOULDER JOINT         82                           $175.71      20090101
23802       FUSION OF SHOULDER JOINT         AS                           $175.71      20090101
23802       FUSION OF SHOULDER JOINT                             Y        $952.93      20081209
23802       FUSION OF SHOULDER JOINT                                      $878.56      20090101
23900       AMPUTATION OF ARM & GIRDLE       80                           $193.80      20090101
23900       AMPUTATION OF ARM & GIRDLE       81                           $193.80      20090101
23900       AMPUTATION OF ARM & GIRDLE       82                           $193.80      20090101
23900       AMPUTATION OF ARM & GIRDLE       AS                           $193.80      20090101
23900       AMPUTATION OF ARM & GIRDLE                                    $969.02      20090101
23920       AMPUTATION AT SHOULDER JOINT     80                           $156.24      20090101
23920       AMPUTATION AT SHOULDER JOINT     81                           $156.24      20090101
23920       AMPUTATION AT SHOULDER JOINT     82                           $156.24      20090101
23920       AMPUTATION AT SHOULDER JOINT     AS                           $156.24      20090101
23920       AMPUTATION AT SHOULDER JOINT                                  $781.22      20090101
23921       AMPUTATION FOLLOW-UP SURGERY     80                            $63.21      20090101
23921       AMPUTATION FOLLOW-UP SURGERY     81                            $63.21      20090101
23921       AMPUTATION FOLLOW-UP SURGERY     82                            $63.21      20090101
23921       AMPUTATION FOLLOW-UP SURGERY     AS                            $63.21      20090101
23921       AMPUTATION FOLLOW-UP SURGERY                                  $316.04      20090101
23921       AMPUTATION FOLLOW-UP SURGERY                         Y        $318.55      20081209
23930       DRAINAGE OF ARM LESION                                        $251.51      20090101
23930       DRAINAGE OF ARM LESION                               Y        $351.49      20081209
23931       DRAINAGE OF ARM BURSA                                         $201.14      20090101
23931       DRAINAGE OF ARM BURSA                                Y        $419.29      20081209
23935       DRAIN ARM/ELBOW BONE LESION                                   $356.94      20090101
23935       DRAIN ARM/ELBOW BONE LESION                          Y        $443.71      20081209
24000       EXPLORATORY ELBOW SURGERY                                     $334.97      20090101
24000       EXPLORATORY ELBOW SURGERY                            Y        $619.70      20081209
24006       RELEASE ELBOW JOINT              80                           $101.82      20090101
24006       RELEASE ELBOW JOINT              81                           $101.82      20090101
24006       RELEASE ELBOW JOINT              82                           $101.82      20090101
24006       RELEASE ELBOW JOINT              AS                           $101.82      20090101
24006       RELEASE ELBOW JOINT                                  Y        $619.70      20081209


                                           Page 62
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
24006       RELEASE ELBOW JOINT                                          $509.12     20090101
24065       BIOPSY ARM/ELBOW SOFT TISSUE                         Y       $112.13     20081209
24065       BIOPSY ARM/ELBOW SOFT TISSUE                                 $165.54     20090101
24066       BIOPSY ARM/ELBOW SOFT TISSUE                         Y       $400.91     20081209
24066       BIOPSY ARM/ELBOW SOFT TISSUE                                 $408.13     20090101
24075       REMOVE ARM/ELBOW LESION                              Y       $400.91     20081209
24075       REMOVE ARM/ELBOW LESION                                      $328.01     20090101
24076       REMOVE ARM/ELBOW LESION                              Y       $442.39     20081209
24076       REMOVE ARM/ELBOW LESION                                      $334.69     20090101
24077       REMOVE TUMOR OF ARM/ELBOW        80                          $116.74     20090101
24077       REMOVE TUMOR OF ARM/ELBOW        81                          $116.74     20090101
24077       REMOVE TUMOR OF ARM/ELBOW        82                          $116.74     20090101
24077       REMOVE TUMOR OF ARM/ELBOW        AS                          $116.74     20090101
24077       REMOVE TUMOR OF ARM/ELBOW                            Y       $480.79     20081209
24077       REMOVE TUMOR OF ARM/ELBOW                                    $583.69     20090101
24100       BIOPSY ELBOW JOINT LINING        80                           $56.42     20090101
24100       BIOPSY ELBOW JOINT LINING        81                           $56.42     20090101
24100       BIOPSY ELBOW JOINT LINING        82                           $56.42     20090101
24100       BIOPSY ELBOW JOINT LINING        AS                           $56.42     20090101
24100       BIOPSY ELBOW JOINT LINING                                    $282.09     20090101
24100       BIOPSY ELBOW JOINT LINING                            Y       $375.91     20081209
24101       EXPLORE/TREAT ELBOW JOINT        80                           $70.72     20090101
24101       EXPLORE/TREAT ELBOW JOINT        81                           $70.72     20090101
24101       EXPLORE/TREAT ELBOW JOINT        82                           $70.72     20090101
24101       EXPLORE/TREAT ELBOW JOINT        AS                           $70.72     20090101
24101       EXPLORE/TREAT ELBOW JOINT                                    $353.61     20090101
24101       EXPLORE/TREAT ELBOW JOINT                            Y       $619.70     20081209
24102       REMOVE ELBOW JOINT LINING        80                           $88.03     20090101
24102       REMOVE ELBOW JOINT LINING        81                           $88.03     20090101
24102       REMOVE ELBOW JOINT LINING        82                           $88.03     20090101
24102       REMOVE ELBOW JOINT LINING        AS                           $88.03     20090101
24102       REMOVE ELBOW JOINT LINING                                    $440.13     20090101
24102       REMOVE ELBOW JOINT LINING                            Y       $619.70     20081209
24105       REMOVAL OF ELBOW BURSA                                       $236.20     20090101
24105       REMOVAL OF ELBOW BURSA                               Y       $482.11     20081209
24110       REMOVE HUMERUS LESION                                        $414.53     20090101
24110       REMOVE HUMERUS LESION                                Y       $443.71     20081209
24115       REMOVE/GRAFT BONE LESION         80                           $97.09     20090101
24115       REMOVE/GRAFT BONE LESION         81                           $97.09     20090101
24115       REMOVE/GRAFT BONE LESION         82                           $97.09     20090101
24115       REMOVE/GRAFT BONE LESION         AS                           $97.09     20090101
24115       REMOVE/GRAFT BONE LESION                             Y       $547.70     20081209
24115       REMOVE/GRAFT BONE LESION                                     $485.47     20090101
24116       REMOVE/GRAFT BONE LESION         80                          $125.47     20090101
24116       REMOVE/GRAFT BONE LESION         81                          $125.47     20090101


                                           Page 63
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
24116       REMOVE/GRAFT BONE LESION        82                          $125.47     20090101
24116       REMOVE/GRAFT BONE LESION        AS                          $125.47     20090101
24116       REMOVE/GRAFT BONE LESION                                    $627.37     20090101
24116       REMOVE/GRAFT BONE LESION                            Y       $547.70     20081209
24120       REMOVE ELBOW LESION                                         $371.69     20090101
24120       REMOVE ELBOW LESION                                 Y       $482.11     20081209
24125       REMOVE/GRAFT BONE LESION        80                           $84.35     20090101
24125       REMOVE/GRAFT BONE LESION        81                           $84.35     20090101
24125       REMOVE/GRAFT BONE LESION        82                           $84.35     20090101
24125       REMOVE/GRAFT BONE LESION        AS                           $84.35     20090101
24125       REMOVE/GRAFT BONE LESION                            Y       $547.70     20081209
24125       REMOVE/GRAFT BONE LESION                                    $421.76     20090101
24126       REMOVE/GRAFT BONE LESION        80                           $90.02     20090101
24126       REMOVE/GRAFT BONE LESION        81                           $90.02     20090101
24126       REMOVE/GRAFT BONE LESION        82                           $90.02     20090101
24126       REMOVE/GRAFT BONE LESION        AS                           $90.02     20090101
24126       REMOVE/GRAFT BONE LESION                            Y       $547.70     20081209
24126       REMOVE/GRAFT BONE LESION                                    $450.12     20090101
24130       REMOVAL OF HEAD OF RADIUS       80                           $71.94     20090101
24130       REMOVAL OF HEAD OF RADIUS       81                           $71.94     20090101
24130       REMOVAL OF HEAD OF RADIUS       82                           $71.94     20090101
24130       REMOVAL OF HEAD OF RADIUS       AS                           $71.94     20090101
24130       REMOVAL OF HEAD OF RADIUS                           Y       $547.70     20081209
24130       REMOVAL OF HEAD OF RADIUS                                   $359.71     20090101
24134       REMOVAL OF ARM BONE LESION      80                          $109.17     20090101
24134       REMOVAL OF ARM BONE LESION      81                          $109.17     20090101
24134       REMOVAL OF ARM BONE LESION      82                          $109.17     20090101
24134       REMOVAL OF ARM BONE LESION      AS                          $109.17     20090101
24134       REMOVAL OF ARM BONE LESION                          Y       $509.30     20081209
24134       REMOVAL OF ARM BONE LESION                                  $545.86     20090101
24136       REMOVE RADIUS BONE LESION       80                           $89.97     20090101
24136       REMOVE RADIUS BONE LESION       81                           $89.97     20090101
24136       REMOVE RADIUS BONE LESION       82                           $89.97     20090101
24136       REMOVE RADIUS BONE LESION       AS                           $89.97     20090101
24136       REMOVE RADIUS BONE LESION                                   $449.86     20090101
24136       REMOVE RADIUS BONE LESION                           Y       $509.30     20081209
24138       REMOVE ELBOW BONE LESION        80                           $93.53     20090101
24138       REMOVE ELBOW BONE LESION        81                           $93.53     20090101
24138       REMOVE ELBOW BONE LESION        82                           $93.53     20090101
24138       REMOVE ELBOW BONE LESION        AS                           $93.53     20090101
24138       REMOVE ELBOW BONE LESION                            Y       $509.30     20081209
24138       REMOVE ELBOW BONE LESION                                    $467.66     20090101
24140       PARTIAL REMOVAL OF ARM BONE     80                          $104.49     20090101
24140       PARTIAL REMOVAL OF ARM BONE     81                          $104.49     20090101
24140       PARTIAL REMOVAL OF ARM BONE     82                          $104.49     20090101


                                          Page 64
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
24140       PARTIAL REMOVAL OF ARM BONE     AS                           $104.49      20090101
24140       PARTIAL REMOVAL OF ARM BONE                         Y        $547.70      20081209
24140       PARTIAL REMOVAL OF ARM BONE                                  $522.47      20090101
24145       PARTIAL REMOVAL OF RADIUS       80                           $87.91       20090101
24145       PARTIAL REMOVAL OF RADIUS       81                           $87.91       20090101
24145       PARTIAL REMOVAL OF RADIUS       82                           $87.91       20090101
24145       PARTIAL REMOVAL OF RADIUS       AS                            $87.91      20090101
24145       PARTIAL REMOVAL OF RADIUS                                    $439.56      20090101
24145       PARTIAL REMOVAL OF RADIUS                           Y        $547.70      20081209
24147       PARTIAL REMOVAL OF ELBOW                            Y        $509.30      20081209
24147       PARTIAL REMOVAL OF ELBOW                                     $457.10      20090101
24149       RADICAL RESECTION OF ELBOW      80                           $163.98      20090101
24149       RADICAL RESECTION OF ELBOW      81                           $163.98      20090101
24149       RADICAL RESECTION OF ELBOW      82                           $163.98      20090101
24149       RADICAL RESECTION OF ELBOW      AS                           $163.98      20090101
24149       RADICAL RESECTION OF ELBOW                                   $819.88      20090101
24150       EXTENSIVE HUMERUS SURGERY       80                           $140.67      20090101
24150       EXTENSIVE HUMERUS SURGERY       81                           $140.67      20090101
24150       EXTENSIVE HUMERUS SURGERY       82                           $140.67      20090101
24150       EXTENSIVE HUMERUS SURGERY       AS                           $140.67      20090101
24150       EXTENSIVE HUMERUS SURGERY                                    $703.33      20090101
24151       EXTENSIVE HUMERUS SURGERY       80                           $162.97      20090101
24151       EXTENSIVE HUMERUS SURGERY       81                           $162.97      20090101
24151       EXTENSIVE HUMERUS SURGERY       82                           $162.97      20090101
24151       EXTENSIVE HUMERUS SURGERY       AS                           $162.97      20090101
24151       EXTENSIVE HUMERUS SURGERY                                    $814.86      20090101
24152       EXTENSIVE RADIUS SURGERY        80                           $103.88      20090101
24152       EXTENSIVE RADIUS SURGERY        81                           $103.88      20090101
24152       EXTENSIVE RADIUS SURGERY        82                           $103.88      20090101
24152       EXTENSIVE RADIUS SURGERY        AS                           $103.88      20090101
24152       EXTENSIVE RADIUS SURGERY                                     $519.41      20090101
24152       EXTENSIVE RADIUS SURGERY                            Y       $1,423.70     20081209
24153       EXTENSIVE RADIUS SURGERY                            Y       $2,630.60     20081209
24153       EXTENSIVE RADIUS SURGERY                                     $492.15      20090101
24155       REMOVAL OF ELBOW JOINT          80                           $121.35      20090101
24155       REMOVAL OF ELBOW JOINT          81                           $121.35      20090101
24155       REMOVAL OF ELBOW JOINT          82                           $121.35      20090101
24155       REMOVAL OF ELBOW JOINT          AS                           $121.35      20090101
24155       REMOVAL OF ELBOW JOINT                              Y        $661.93      20081209
24155       REMOVAL OF ELBOW JOINT                                       $606.77      20090101
24160       REMOVE ELBOW JOINT IMPLANT      80                            $86.53      20090101
24160       REMOVE ELBOW JOINT IMPLANT      81                            $86.53      20090101
24160       REMOVE ELBOW JOINT IMPLANT      82                            $86.53      20090101
24160       REMOVE ELBOW JOINT IMPLANT      AS                            $86.53      20090101
24160       REMOVE ELBOW JOINT IMPLANT                                   $432.63      20090101


                                          Page 65
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
24160       REMOVE ELBOW JOINT IMPLANT                          Y       $509.30     20081209
24164       REMOVE RADIUS HEAD IMPLANT      80                           $70.72     20090101
24164       REMOVE RADIUS HEAD IMPLANT      81                           $70.72     20090101
24164       REMOVE RADIUS HEAD IMPLANT      82                           $70.72     20090101
24164       REMOVE RADIUS HEAD IMPLANT      AS                           $70.72     20090101
24164       REMOVE RADIUS HEAD IMPLANT                                  $353.61     20090101
24164       REMOVE RADIUS HEAD IMPLANT                          Y       $547.70     20081209
24200       REMOVAL OF ARM FOREIGN BODY                                 $140.77     20090101
24201       REMOVAL OF ARM FOREIGN BODY                                 $393.38     20090101
24201       REMOVAL OF ARM FOREIGN BODY                         Y       $400.91     20081209
24220       INJECTION FOR ELBOW X-RAY                                   $126.31     20090101
24300       MANIPULATE ELBOW W/ANESTH                                   $276.82     20090101
24301       MUSCLE/TENDON TRANSFER          80                          $108.12     20090101
24301       MUSCLE/TENDON TRANSFER          81                          $108.12     20090101
24301       MUSCLE/TENDON TRANSFER          82                          $108.12     20090101
24301       MUSCLE/TENDON TRANSFER          AS                          $108.12     20090101
24301       MUSCLE/TENDON TRANSFER                                      $540.58     20090101
24301       MUSCLE/TENDON TRANSFER                              Y       $619.70     20081209
24305       ARM TENDON LENGTHENING                                      $413.14     20090101
24305       ARM TENDON LENGTHENING                              Y       $619.70     20081209
24310       REVISION OF ARM TENDON                                      $338.02     20090101
24310       REVISION OF ARM TENDON                              Y       $482.11     20081209
24320       REPAIR OF ARM TENDON            80                          $109.95     20090101
24320       REPAIR OF ARM TENDON            81                          $109.95     20090101
24320       REPAIR OF ARM TENDON            82                          $109.95     20090101
24320       REPAIR OF ARM TENDON            AS                          $109.95     20090101
24320       REPAIR OF ARM TENDON                                Y       $661.93     20081209
24320       REPAIR OF ARM TENDON                                        $549.74     20090101
24330       REVISION OF ARM MUSCLES         80                          $103.11     20090101
24330       REVISION OF ARM MUSCLES         81                          $103.11     20090101
24330       REVISION OF ARM MUSCLES         82                          $103.11     20090101
24330       REVISION OF ARM MUSCLES         AS                          $103.11     20090101
24330       REVISION OF ARM MUSCLES                             Y       $963.65     20081209
24330       REVISION OF ARM MUSCLES                                     $515.53     20090101
24331       REVISION OF ARM MUSCLES         80                          $113.67     20090101
24331       REVISION OF ARM MUSCLES         81                          $113.67     20090101
24331       REVISION OF ARM MUSCLES         82                          $113.67     20090101
24331       REVISION OF ARM MUSCLES         AS                          $113.67     20090101
24331       REVISION OF ARM MUSCLES                             Y       $661.93     20081209
24331       REVISION OF ARM MUSCLES                                     $568.37     20090101
24332       TENOLYSIS, TRICEPS                                          $427.05     20090101
24340       REPAIR OF BICEPS TENDON         80                           $87.86     20090101
24340       REPAIR OF BICEPS TENDON         81                           $87.86     20090101
24340       REPAIR OF BICEPS TENDON         82                           $87.86     20090101
24340       REPAIR OF BICEPS TENDON         AS                           $87.86     20090101


                                          Page 66
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
24340       REPAIR OF BICEPS TENDON                              Y        $661.93      20081209
24340       REPAIR OF BICEPS TENDON                                       $439.31      20090101
24341       REPAIR ARM TENDON/MUSCLE         80                           $101.94      20090101
24341       REPAIR ARM TENDON/MUSCLE         81                           $101.94      20090101
24341       REPAIR ARM TENDON/MUSCLE         82                           $101.94      20090101
24341       REPAIR ARM TENDON/MUSCLE         AS                           $101.94      20090101
24341       REPAIR ARM TENDON/MUSCLE                             Y        $661.93      20081209
24341       REPAIR ARM TENDON/MUSCLE                                      $509.69      20090101
24342       REPAIR OF RUPTURED TENDON        80                           $113.46      20090101
24342       REPAIR OF RUPTURED TENDON        81                           $113.46      20090101
24342       REPAIR OF RUPTURED TENDON        82                           $113.46      20090101
24342       REPAIR OF RUPTURED TENDON        AS                           $113.46      20090101
24342       REPAIR OF RUPTURED TENDON                                     $567.28      20090101
24342       REPAIR OF RUPTURED TENDON                            Y        $661.93      20081209
24343       REPR ELBOW LAT LIGMNT W/TISS                                  $500.49      20090101
24344       RECONSTRUCT ELBOW LAT LIGMNT                                  $781.21      20090101
24345       REPR ELBW MED LIGMNT W/TISSU                                  $498.27      20090101
24345       REPR ELBW MED LIGMNT W/TISSU                         Y        $509.30      20081209
24346       RECONSTRUCT ELBOW MED LIGMNT                                  $778.98      20090101
24360       RECONSTRUCT ELBOW JOINT          80                           $129.36      20090101
24360       RECONSTRUCT ELBOW JOINT          81                           $129.36      20090101
24360       RECONSTRUCT ELBOW JOINT          82                           $129.36      20090101
24360       RECONSTRUCT ELBOW JOINT          AS                           $129.36      20090101
24360       RECONSTRUCT ELBOW JOINT                                       $646.82      20090101
24360       RECONSTRUCT ELBOW JOINT                              Y        $727.50      20081209
24361       RECONSTRUCT ELBOW JOINT          80                           $145.39      20090101
24361       RECONSTRUCT ELBOW JOINT          81                           $145.39      20090101
24361       RECONSTRUCT ELBOW JOINT          82                           $145.39      20090101
24361       RECONSTRUCT ELBOW JOINT          AS                           $145.39      20090101
24361       RECONSTRUCT ELBOW JOINT                                       $726.93      20090101
24361       RECONSTRUCT ELBOW JOINT                              Y       $1,442.09     20081209
24362       RECONSTRUCT ELBOW JOINT          80                           $142.89      20090101
24362       RECONSTRUCT ELBOW JOINT          81                           $142.89      20090101
24362       RECONSTRUCT ELBOW JOINT          82                           $142.89      20090101
24362       RECONSTRUCT ELBOW JOINT          AS                           $142.89      20090101
24362       RECONSTRUCT ELBOW JOINT                                       $714.46      20090101
24362       RECONSTRUCT ELBOW JOINT                              Y        $851.56      20081209
24363       REPLACE ELBOW JOINT              80                           $213.88      20090101
24363       REPLACE ELBOW JOINT              81                           $213.88      20090101
24363       REPLACE ELBOW JOINT              82                           $213.88      20090101
24363       REPLACE ELBOW JOINT              AS                           $213.88      20090101
24363       REPLACE ELBOW JOINT                                          $1,069.41     20090101
24363       REPLACE ELBOW JOINT                                  Y       $1,608.89     20081209
24365       RECONSTRUCT HEAD OF RADIUS       80                            $91.87      20090101
24365       RECONSTRUCT HEAD OF RADIUS       81                            $91.87      20090101


                                           Page 67
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
24365       RECONSTRUCT HEAD OF RADIUS     82                            $91.87      20090101
24365       RECONSTRUCT HEAD OF RADIUS     AS                            $91.87      20090101
24365       RECONSTRUCT HEAD OF RADIUS                                  $459.33      20090101
24365       RECONSTRUCT HEAD OF RADIUS                         Y        $727.50      20081209
24366       RECONSTRUCT HEAD OF RADIUS     80                            $98.49      20090101
24366       RECONSTRUCT HEAD OF RADIUS     81                            $98.49      20090101
24366       RECONSTRUCT HEAD OF RADIUS     82                            $98.49      20090101
24366       RECONSTRUCT HEAD OF RADIUS     AS                            $98.49      20090101
24366       RECONSTRUCT HEAD OF RADIUS                         Y       $1,442.09     20081209
24366       RECONSTRUCT HEAD OF RADIUS                                  $492.45      20090101
24400       REVISION OF HUMERUS            80                           $118.52      20090101
24400       REVISION OF HUMERUS            81                           $118.52      20090101
24400       REVISION OF HUMERUS            82                           $118.52      20090101
24400       REVISION OF HUMERUS            AS                           $118.52      20090101
24400       REVISION OF HUMERUS                                         $592.59      20090101
24400       REVISION OF HUMERUS                                Y        $619.70      20081209
24410       REVISION OF HUMERUS            80                           $152.01      20090101
24410       REVISION OF HUMERUS            81                           $152.01      20090101
24410       REVISION OF HUMERUS            82                           $152.01      20090101
24410       REVISION OF HUMERUS            AS                           $152.01      20090101
24410       REVISION OF HUMERUS                                Y        $619.70      20081209
24410       REVISION OF HUMERUS                                         $760.05      20090101
24420       REVISION OF HUMERUS            80                           $140.72      20090101
24420       REVISION OF HUMERUS            81                           $140.72      20090101
24420       REVISION OF HUMERUS            82                           $140.72      20090101
24420       REVISION OF HUMERUS            AS                           $140.72      20090101
24420       REVISION OF HUMERUS                                Y        $661.93      20081209
24420       REVISION OF HUMERUS                                         $703.59      20090101
24430       REPAIR OF HUMERUS              80                           $149.01      20090101
24430       REPAIR OF HUMERUS              81                           $149.01      20090101
24430       REPAIR OF HUMERUS              82                           $149.01      20090101
24430       REPAIR OF HUMERUS              AS                           $149.01      20090101
24430       REPAIR OF HUMERUS                                           $745.04      20090101
24430       REPAIR OF HUMERUS                                  Y        $963.65      20081209
24435       REPAIR HUMERUS WITH GRAFT      80                           $152.29      20090101
24435       REPAIR HUMERUS WITH GRAFT      81                           $152.29      20090101
24435       REPAIR HUMERUS WITH GRAFT      82                           $152.29      20090101
24435       REPAIR HUMERUS WITH GRAFT      AS                           $152.29      20090101
24435       REPAIR HUMERUS WITH GRAFT                          Y       $1,035.65     20081209
24435       REPAIR HUMERUS WITH GRAFT                                   $761.45      20090101
24470       REVISION OF ELBOW JOINT        80                           $94.47       20090101
24470       REVISION OF ELBOW JOINT        81                           $94.47       20090101
24470       REVISION OF ELBOW JOINT        82                           $94.47       20090101
24470       REVISION OF ELBOW JOINT        AS                            $94.47      20090101
24470       REVISION OF ELBOW JOINT                                     $472.37      20090101


                                         Page 68
Proc Code   Description                  Modifier 1 Modifier 2 ASC    Price    Effective Date
24470       REVISION OF ELBOW JOINT                          Y       $661.93     20081209
24495       DECOMPRESSION OF FOREARM                         Y       $509.30     20081209
24495       DECOMPRESSION OF FOREARM                                 $474.62     20090101
24498       REINFORCE HUMERUS            80                          $126.31     20090101
24498       REINFORCE HUMERUS            81                          $126.31     20090101
24498       REINFORCE HUMERUS            82                          $126.31     20090101
24498       REINFORCE HUMERUS            AS                          $126.31     20090101
24498       REINFORCE HUMERUS                                Y       $963.65     20081209
24498       REINFORCE HUMERUS                                        $631.56     20090101
24500       TREAT HUMERUS FRACTURE                           Y        $76.82     20081209
24500       TREAT HUMERUS FRACTURE                                   $234.81     20090101
24505       TREAT HUMERUS FRACTURE                                   $343.87     20090101
24505       TREAT HUMERUS FRACTURE                           Y        $76.82     20081209
24515       TREAT HUMERUS FRACTURE       80                          $126.41     20090101
24515       TREAT HUMERUS FRACTURE       81                          $126.41     20090101
24515       TREAT HUMERUS FRACTURE       82                          $126.41     20090101
24515       TREAT HUMERUS FRACTURE       AS                          $126.41     20090101
24515       TREAT HUMERUS FRACTURE                                   $632.07     20090101
24515       TREAT HUMERUS FRACTURE                           Y       $868.38     20081209
24516       TREAT HUMERUS FRACTURE       80                          $125.08     20090101
24516       TREAT HUMERUS FRACTURE       81                          $125.08     20090101
24516       TREAT HUMERUS FRACTURE       82                          $125.08     20090101
24516       TREAT HUMERUS FRACTURE       AS                          $125.08     20090101
24516       TREAT HUMERUS FRACTURE                           Y       $868.38     20081209
24516       TREAT HUMERUS FRACTURE                                   $625.40     20090101
24530       TREAT HUMERUS FRACTURE                           Y        $76.82     20081209
24530       TREAT HUMERUS FRACTURE                                   $253.45     20090101
24535       TREAT HUMERUS FRACTURE                                   $430.38     20090101
24535       TREAT HUMERUS FRACTURE                           Y        $76.82     20081209
24538       TREAT HUMERUS FRACTURE       80                          $106.95     20090101
24538       TREAT HUMERUS FRACTURE       81                          $106.95     20090101
24538       TREAT HUMERUS FRACTURE       82                          $106.95     20090101
24538       TREAT HUMERUS FRACTURE       AS                          $106.95     20090101
24538       TREAT HUMERUS FRACTURE                           Y       $484.21     20081209
24538       TREAT HUMERUS FRACTURE                                   $534.73     20090101
24545       TREAT HUMERUS FRACTURE       80                          $129.03     20090101
24545       TREAT HUMERUS FRACTURE       81                          $129.03     20090101
24545       TREAT HUMERUS FRACTURE       82                          $129.03     20090101
24545       TREAT HUMERUS FRACTURE       AS                          $129.03     20090101
24545       TREAT HUMERUS FRACTURE                                   $645.17     20090101
24545       TREAT HUMERUS FRACTURE                           Y       $868.38     20081209
24546       TREAT HUMERUS FRACTURE       80                          $154.07     20090101
24546       TREAT HUMERUS FRACTURE       81                          $154.07     20090101
24546       TREAT HUMERUS FRACTURE       82                          $154.07     20090101
24546       TREAT HUMERUS FRACTURE       AS                          $154.07     20090101


                                       Page 69
Proc Code   Description                 Modifier 1 Modifier 2 ASC    Price    Effective Date
24546       TREAT HUMERUS FRACTURE                          Y       $920.58     20081209
24546       TREAT HUMERUS FRACTURE                                  $770.35     20090101
24560       TREAT HUMERUS FRACTURE                                  $211.72     20090101
24560       TREAT HUMERUS FRACTURE                          Y        $76.82     20081209
24565       TREAT HUMERUS FRACTURE      80                           $71.50     20090101
24565       TREAT HUMERUS FRACTURE      81                           $71.50     20090101
24565       TREAT HUMERUS FRACTURE      82                           $71.50     20090101
24565       TREAT HUMERUS FRACTURE      AS                           $71.50     20090101
24565       TREAT HUMERUS FRACTURE                                  $357.49     20090101
24565       TREAT HUMERUS FRACTURE                          Y        $76.82     20081209
24566       TREAT HUMERUS FRACTURE                                  $490.76     20090101
24566       TREAT HUMERUS FRACTURE                          Y       $484.21     20081209
24575       TREAT HUMERUS FRACTURE      80                          $106.22     20090101
24575       TREAT HUMERUS FRACTURE      81                          $106.22     20090101
24575       TREAT HUMERUS FRACTURE      82                          $106.22     20090101
24575       TREAT HUMERUS FRACTURE      AS                          $106.22     20090101
24575       TREAT HUMERUS FRACTURE                                  $531.11     20090101
24575       TREAT HUMERUS FRACTURE                          Y       $796.38     20081209
24576       TREAT HUMERUS FRACTURE                                  $222.29     20090101
24576       TREAT HUMERUS FRACTURE                          Y        $76.82     20081209
24577       TREAT HUMERUS FRACTURE                                  $370.29     20090101
24577       TREAT HUMERUS FRACTURE                          Y        $76.82     20081209
24579       TREAT HUMERUS FRACTURE      80                          $120.07     20090101
24579       TREAT HUMERUS FRACTURE      81                          $120.07     20090101
24579       TREAT HUMERUS FRACTURE      82                          $120.07     20090101
24579       TREAT HUMERUS FRACTURE      AS                          $120.07     20090101
24579       TREAT HUMERUS FRACTURE                                  $600.35     20090101
24579       TREAT HUMERUS FRACTURE                          Y       $796.38     20081209
24582       TREAT HUMERUS FRACTURE                                  $556.97     20090101
24582       TREAT HUMERUS FRACTURE                          Y       $484.21     20081209
24586       TREAT ELBOW FRACTURE        80                          $158.97     20090101
24586       TREAT ELBOW FRACTURE        81                          $158.97     20090101
24586       TREAT ELBOW FRACTURE        82                          $158.97     20090101
24586       TREAT ELBOW FRACTURE        AS                          $158.97     20090101
24586       TREAT ELBOW FRACTURE                                    $794.83     20090101
24586       TREAT ELBOW FRACTURE                            Y       $868.38     20081209
24587       TREAT ELBOW FRACTURE        80                          $157.74     20090101
24587       TREAT ELBOW FRACTURE        81                          $157.74     20090101
24587       TREAT ELBOW FRACTURE        82                          $157.74     20090101
24587       TREAT ELBOW FRACTURE        AS                          $157.74     20090101
24587       TREAT ELBOW FRACTURE                                    $788.72     20090101
24587       TREAT ELBOW FRACTURE                            Y       $920.58     20081209
24600       TREAT ELBOW DISLOCATION                         Y        $76.82     20081209
24600       TREAT ELBOW DISLOCATION                                 $254.28     20090101
24605       TREAT ELBOW DISLOCATION                                 $320.78     20090101


                                      Page 70
Proc Code   Description                 Modifier 1 Modifier 2 ASC    Price    Effective Date
24605       TREAT ELBOW DISLOCATION                         Y       $389.86     20081209
24615       TREAT ELBOW DISLOCATION     80                          $102.99     20090101
24615       TREAT ELBOW DISLOCATION     81                          $102.99     20090101
24615       TREAT ELBOW DISLOCATION     82                          $102.99     20090101
24615       TREAT ELBOW DISLOCATION     AS                          $102.99     20090101
24615       TREAT ELBOW DISLOCATION                                 $514.96     20090101
24615       TREAT ELBOW DISLOCATION                         Y       $796.38     20081209
24620       TREAT ELBOW FRACTURE                                    $389.77     20090101
24620       TREAT ELBOW FRACTURE                            Y        $76.82     20081209
24635       TREAT ELBOW FRACTURE        80                          $118.19     20090101
24635       TREAT ELBOW FRACTURE        81                          $118.19     20090101
24635       TREAT ELBOW FRACTURE        82                          $118.19     20090101
24635       TREAT ELBOW FRACTURE        AS                          $118.19     20090101
24635       TREAT ELBOW FRACTURE                            Y       $796.38     20081209
24635       TREAT ELBOW FRACTURE                                    $590.93     20090101
24640       TREAT ELBOW DISLOCATION                                 $84.30      20090101
24650       TREAT RADIUS FRACTURE                                   $171.65     20090101
24655       TREAT RADIUS FRACTURE                           Y        $76.82     20081209
24655       TREAT RADIUS FRACTURE                                   $299.07     20090101
24665       TREAT RADIUS FRACTURE       80                           $92.59     20090101
24665       TREAT RADIUS FRACTURE       81                           $92.59     20090101
24665       TREAT RADIUS FRACTURE       82                           $92.59     20090101
24665       TREAT RADIUS FRACTURE       AS                           $92.59     20090101
24665       TREAT RADIUS FRACTURE                           Y       $718.39     20081209
24665       TREAT RADIUS FRACTURE                                   $462.96     20090101
24666       TREAT RADIUS FRACTURE       80                          $105.00     20090101
24666       TREAT RADIUS FRACTURE       81                          $105.00     20090101
24666       TREAT RADIUS FRACTURE       82                          $105.00     20090101
24666       TREAT RADIUS FRACTURE       AS                          $105.00     20090101
24666       TREAT RADIUS FRACTURE                           Y       $868.38     20081209
24666       TREAT RADIUS FRACTURE                                   $525.00     20090101
24670       TREAT ULNAR FRACTURE                                    $192.80     20090101
24670       TREAT ULNAR FRACTURE                            Y        $76.82     20081209
24675       TREAT ULNAR FRACTURE                            Y        $76.82     20081209
24675       TREAT ULNAR FRACTURE                                    $314.10     20090101
24685       TREAT ULNAR FRACTURE        80                          $93.20      20090101
24685       TREAT ULNAR FRACTURE        81                          $93.20      20090101
24685       TREAT ULNAR FRACTURE        82                          $93.20      20090101
24685       TREAT ULNAR FRACTURE        AS                           $93.20     20090101
24685       TREAT ULNAR FRACTURE                            Y       $646.39     20081209
24685       TREAT ULNAR FRACTURE                                    $466.01     20090101
24800       FUSION OF ELBOW JOINT       80                          $115.29     20090101
24800       FUSION OF ELBOW JOINT       81                          $115.29     20090101
24800       FUSION OF ELBOW JOINT       82                          $115.29     20090101
24800       FUSION OF ELBOW JOINT       AS                          $115.29     20090101


                                      Page 71
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
24800       FUSION OF ELBOW JOINT                                        $576.44     20090101
24800       FUSION OF ELBOW JOINT                                Y       $733.93     20081209
24802       FUSION/GRAFT OF ELBOW JOINT      80                          $143.39     20090101
24802       FUSION/GRAFT OF ELBOW JOINT      81                          $143.39     20090101
24802       FUSION/GRAFT OF ELBOW JOINT      82                          $143.39     20090101
24802       FUSION/GRAFT OF ELBOW JOINT      AS                          $143.39     20090101
24802       FUSION/GRAFT OF ELBOW JOINT                                  $716.94     20090101
24802       FUSION/GRAFT OF ELBOW JOINT                          Y       $786.13     20081209
24900       AMPUTATION OF UPPER ARM          80                          $101.88     20090101
24900       AMPUTATION OF UPPER ARM          81                          $101.88     20090101
24900       AMPUTATION OF UPPER ARM          82                          $101.88     20090101
24900       AMPUTATION OF UPPER ARM          AS                          $101.88     20090101
24900       AMPUTATION OF UPPER ARM                                      $509.38     20090101
24920       AMPUTATION OF UPPER ARM          80                          $100.82     20090101
24920       AMPUTATION OF UPPER ARM          81                          $100.82     20090101
24920       AMPUTATION OF UPPER ARM          82                          $100.82     20090101
24920       AMPUTATION OF UPPER ARM          AS                          $100.82     20090101
24920       AMPUTATION OF UPPER ARM                                      $504.10     20090101
24925       AMPUTATION FOLLOW-UP SURGERY     80                           $77.07     20090101
24925       AMPUTATION FOLLOW-UP SURGERY     81                           $77.07     20090101
24925       AMPUTATION FOLLOW-UP SURGERY     82                           $77.07     20090101
24925       AMPUTATION FOLLOW-UP SURGERY     AS                           $77.07     20090101
24925       AMPUTATION FOLLOW-UP SURGERY                         Y       $482.11     20081209
24925       AMPUTATION FOLLOW-UP SURGERY                                 $385.33     20090101
24930       AMPUTATION FOLLOW-UP SURGERY     80                          $106.39     20090101
24930       AMPUTATION FOLLOW-UP SURGERY     81                          $106.39     20090101
24930       AMPUTATION FOLLOW-UP SURGERY     82                          $106.39     20090101
24930       AMPUTATION FOLLOW-UP SURGERY     AS                          $106.39     20090101
24930       AMPUTATION FOLLOW-UP SURGERY                                 $531.94     20090101
24931       AMPUTATE UPPER ARM & IMPLANT     80                          $114.73     20090101
24931       AMPUTATE UPPER ARM & IMPLANT     81                          $114.73     20090101
24931       AMPUTATE UPPER ARM & IMPLANT     82                          $114.73     20090101
24931       AMPUTATE UPPER ARM & IMPLANT     AS                          $114.73     20090101
24931       AMPUTATE UPPER ARM & IMPLANT                                 $573.65     20090101
24935       REVISION OF AMPUTATION                                       $770.36     20090101
24940       REVISION OF UPPER ARM            80                          $180.59     20090101
24940       REVISION OF UPPER ARM            81                          $180.59     20090101
24940       REVISION OF UPPER ARM            82                          $180.59     20090101
24940       REVISION OF UPPER ARM            AS                          $180.59     20090101
24940       REVISION OF UPPER ARM                                        $902.93     20090101
25000       INCISION OF TENDON SHEATH                            Y       $482.11     20081209
25000       INCISION OF TENDON SHEATH                                    $262.07     20090101
25001       INCISE FLEXOR CARPI RADIALIS                                 $231.47     20090101
25020       DECOMPRESS FOREARM 1 SPACE                                   $421.76     20090101
25020       DECOMPRESS FOREARM 1 SPACE                           Y       $482.11     20081209


                                           Page 72
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
25023       DECOMPRESS FOREARM 1 SPACE                                   $803.19     20090101
25023       DECOMPRESS FOREARM 1 SPACE                           Y       $547.70     20081209
25024       DECOMPRESS FOREARM 2 SPACES                                  $535.83     20090101
25024       DECOMPRESS FOREARM 2 SPACES                          Y       $547.70     20081209
25025       DECOMPRESS FOREARM 2 SPACES                                  $819.05     20090101
25025       DECOMPRESS FOREARM 2 SPACES                          Y       $547.70     20081209
25028       DRAINAGE OF FOREARM LESION                                   $369.74     20090101
25028       DRAINAGE OF FOREARM LESION                           Y       $375.91     20081209
25031       DRAINAGE OF FOREARM BURSA                            Y       $443.71     20081209
25031       DRAINAGE OF FOREARM BURSA                                    $292.68     20090101
25035       TREAT FOREARM BONE LESION                            Y       $443.71     20081209
25035       TREAT FOREARM BONE LESION                                    $511.62     20090101
25040       EXPLORE/TREAT WRIST JOINT                                    $414.81     20090101
25040       EXPLORE/TREAT WRIST JOINT                            Y       $671.90     20081209
25065       BIOPSY FOREARM SOFT TISSUES                                  $165.26     20090101
25065       BIOPSY FOREARM SOFT TISSUES                          Y       $115.18     20081209
25066       BIOPSY FOREARM SOFT TISSUES                                  $285.72     20090101
25066       BIOPSY FOREARM SOFT TISSUES                          Y       $442.39     20081209
25075       REMOVAL FOREARM LESION SUBCU                                 $248.44     20090101
25075       REMOVAL FOREARM LESION SUBCU                         Y       $400.91     20081209
25076       REMOVAL FOREARM LESION DEEP                          Y       $480.79     20081209
25076       REMOVAL FOREARM LESION DEEP                                  $348.88     20090101
25077       REMOVE TUMOR, FOREARM/WRIST                                  $569.21     20090101
25077       REMOVE TUMOR, FOREARM/WRIST                          Y       $480.79     20081209
25085       INCISION OF WRIST CAPSULE        80                           $68.27     20090101
25085       INCISION OF WRIST CAPSULE        81                           $68.27     20090101
25085       INCISION OF WRIST CAPSULE        82                           $68.27     20090101
25085       INCISION OF WRIST CAPSULE        AS                           $68.27     20090101
25085       INCISION OF WRIST CAPSULE                                    $341.34     20090101
25085       INCISION OF WRIST CAPSULE                            Y       $482.11     20081209
25100       BIOPSY OF WRIST JOINT                                        $252.05     20090101
25100       BIOPSY OF WRIST JOINT                                Y       $443.71     20081209
25101       EXPLORE/TREAT WRIST JOINT                            Y       $547.70     20081209
25101       EXPLORE/TREAT WRIST JOINT                                    $295.18     20090101
25105       REMOVE WRIST JOINT LINING                                    $360.83     20090101
25105       REMOVE WRIST JOINT LINING                            Y       $619.70     20081209
25107       REMOVE WRIST JOINT CARTILAGE     80                           $87.80     20090101
25107       REMOVE WRIST JOINT CARTILAGE     81                           $87.80     20090101
25107       REMOVE WRIST JOINT CARTILAGE     82                           $87.80     20090101
25107       REMOVE WRIST JOINT CARTILAGE     AS                           $87.80     20090101
25107       REMOVE WRIST JOINT CARTILAGE                         Y       $547.70     20081209
25107       REMOVE WRIST JOINT CARTILAGE                                 $439.00     20090101
25109       EXCISE TENDON FOREARM/WRIST                                  $361.95     20090101
25110       REMOVE WRIST TENDON LESION                                   $275.98     20090101
25110       REMOVE WRIST TENDON LESION                           Y       $482.11     20081209


                                           Page 73
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
25111       REMOVE WRIST TENDON LESION                                   $226.18     20090101
25111       REMOVE WRIST TENDON LESION                           Y       $442.32     20081209
25112       REREMOVE WRIST TENDON LESION                                 $276.82     20090101
25112       REREMOVE WRIST TENDON LESION                         Y       $514.32     20081209
25115       REMOVE WRIST/FOREARM LESION                          Y       $554.11     20081209
25115       REMOVE WRIST/FOREARM LESION                                  $608.99     20090101
25116       REMOVE WRIST/FOREARM LESION                                  $505.22     20090101
25116       REMOVE WRIST/FOREARM LESION                          Y       $554.11     20081209
25118       EXCISE WRIST TENDON SHEATH                                   $279.59     20090101
25118       EXCISE WRIST TENDON SHEATH                           Y       $509.30     20081209
25119       PARTIAL REMOVAL OF ULNA          80                           $74.50     20090101
25119       PARTIAL REMOVAL OF ULNA          81                           $74.50     20090101
25119       PARTIAL REMOVAL OF ULNA          82                           $74.50     20090101
25119       PARTIAL REMOVAL OF ULNA          AS                           $74.50     20090101
25119       PARTIAL REMOVAL OF ULNA                              Y       $547.70     20081209
25119       PARTIAL REMOVAL OF ULNA                                      $372.50     20090101
25120       REMOVAL OF FOREARM LESION                                    $438.46     20090101
25120       REMOVAL OF FOREARM LESION                            Y       $547.70     20081209
25125       REMOVE/GRAFT FOREARM LESION                                  $497.43     20090101
25125       REMOVE/GRAFT FOREARM LESION                          Y       $547.70     20081209
25126       REMOVE/GRAFT FOREARM LESION      80                          $101.99     20090101
25126       REMOVE/GRAFT FOREARM LESION      81                          $101.99     20090101
25126       REMOVE/GRAFT FOREARM LESION      82                          $101.99     20090101
25126       REMOVE/GRAFT FOREARM LESION      AS                          $101.99     20090101
25126       REMOVE/GRAFT FOREARM LESION                          Y       $547.70     20081209
25126       REMOVE/GRAFT FOREARM LESION                                  $509.94     20090101
25130       REMOVAL OF WRIST LESION                                      $325.51     20090101
25130       REMOVAL OF WRIST LESION                              Y       $547.70     20081209
25135       REMOVE & GRAFT WRIST LESION      80                           $80.96     20090101
25135       REMOVE & GRAFT WRIST LESION      81                           $80.96     20090101
25135       REMOVE & GRAFT WRIST LESION      82                           $80.96     20090101
25135       REMOVE & GRAFT WRIST LESION      AS                           $80.96     20090101
25135       REMOVE & GRAFT WRIST LESION                                  $404.79     20090101
25135       REMOVE & GRAFT WRIST LESION                          Y       $547.70     20081209
25136       REMOVE & GRAFT WRIST LESION      80                           $71.83     20090101
25136       REMOVE & GRAFT WRIST LESION      81                           $71.83     20090101
25136       REMOVE & GRAFT WRIST LESION      82                           $71.83     20090101
25136       REMOVE & GRAFT WRIST LESION      AS                           $71.83     20090101
25136       REMOVE & GRAFT WRIST LESION                          Y       $547.70     20081209
25136       REMOVE & GRAFT WRIST LESION                                  $359.15     20090101
25145       REMOVE FOREARM BONE LESION       80                           $89.48     20090101
25145       REMOVE FOREARM BONE LESION       81                           $89.48     20090101
25145       REMOVE FOREARM BONE LESION       82                           $89.48     20090101
25145       REMOVE FOREARM BONE LESION       AS                           $89.48     20090101
25145       REMOVE FOREARM BONE LESION                                   $447.38     20090101


                                           Page 74
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
25145       REMOVE FOREARM BONE LESION                           Y       $509.30     20081209
25150       PARTIAL REMOVAL OF ULNA                                      $425.11     20090101
25150       PARTIAL REMOVAL OF ULNA                              Y       $509.30     20081209
25151       PARTIAL REMOVAL OF RADIUS        80                           $99.83     20090101
25151       PARTIAL REMOVAL OF RADIUS        81                           $99.83     20090101
25151       PARTIAL REMOVAL OF RADIUS        82                           $99.83     20090101
25151       PARTIAL REMOVAL OF RADIUS        AS                           $99.83     20090101
25151       PARTIAL REMOVAL OF RADIUS                                    $499.13     20090101
25151       PARTIAL REMOVAL OF RADIUS                            Y       $509.30     20081209
25170       EXTENSIVE FOREARM SURGERY        80                          $135.66     20090101
25170       EXTENSIVE FOREARM SURGERY        81                          $135.66     20090101
25170       EXTENSIVE FOREARM SURGERY        82                          $135.66     20090101
25170       EXTENSIVE FOREARM SURGERY        AS                          $135.66     20090101
25170       EXTENSIVE FOREARM SURGERY                                    $678.29     20090101
25210       REMOVAL OF WRIST BONE                                        $356.38     20090101
25210       REMOVAL OF WRIST BONE                                Y       $523.86     20081209
25215       REMOVAL OF WRIST BONES           80                           $92.43     20090101
25215       REMOVAL OF WRIST BONES           81                           $92.43     20090101
25215       REMOVAL OF WRIST BONES           82                           $92.43     20090101
25215       REMOVAL OF WRIST BONES           AS                           $92.43     20090101
25215       REMOVAL OF WRIST BONES                               Y       $595.86     20081209
25215       REMOVAL OF WRIST BONES                                       $462.13     20090101
25230       PARTIAL REMOVAL OF RADIUS                                    $316.88     20090101
25230       PARTIAL REMOVAL OF RADIUS                            Y       $619.70     20081209
25240       PARTIAL REMOVAL OF ULNA                              Y       $619.70     20081209
25240       PARTIAL REMOVAL OF ULNA                                      $326.61     20090101
25246       INJECTION FOR WRIST X-RAY                                    $128.81     20090101
25248       REMOVE FOREARM FOREIGN BODY                                  $339.69     20090101
25248       REMOVE FOREARM FOREIGN BODY                          Y       $443.71     20081209
25250       REMOVAL OF WRIST PROSTHESIS      80                           $74.33     20090101
25250       REMOVAL OF WRIST PROSTHESIS      81                           $74.33     20090101
25250       REMOVAL OF WRIST PROSTHESIS      82                           $74.33     20090101
25250       REMOVAL OF WRIST PROSTHESIS      AS                           $74.33     20090101
25250       REMOVAL OF WRIST PROSTHESIS                          Y       $441.50     20081209
25250       REMOVAL OF WRIST PROSTHESIS                                  $371.67     20090101
25251       REMOVAL OF WRIST PROSTHESIS      80                          $101.77     20090101
25251       REMOVAL OF WRIST PROSTHESIS      81                          $101.77     20090101
25251       REMOVAL OF WRIST PROSTHESIS      82                          $101.77     20090101
25251       REMOVAL OF WRIST PROSTHESIS      AS                          $101.77     20090101
25251       REMOVAL OF WRIST PROSTHESIS                                  $508.86     20090101
25251       REMOVAL OF WRIST PROSTHESIS                          Y       $441.50     20081209
25259       MANIPULATE WRIST W/ANESTHES                                  $275.98     20090101
25260       REPAIR FOREARM TENDON/MUSCLE                                 $526.65     20090101
25260       REPAIR FOREARM TENDON/MUSCLE                         Y       $619.70     20081209
25263       REPAIR FOREARM TENDON/MUSCLE     80                          $104.38     20090101


                                           Page 75
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
25263       REPAIR FOREARM TENDON/MUSCLE     81                          $104.38     20090101
25263       REPAIR FOREARM TENDON/MUSCLE     82                          $104.38     20090101
25263       REPAIR FOREARM TENDON/MUSCLE     AS                          $104.38     20090101
25263       REPAIR FOREARM TENDON/MUSCLE                                 $521.90     20090101
25263       REPAIR FOREARM TENDON/MUSCLE                         Y       $509.30     20081209
25265       REPAIR FOREARM TENDON/MUSCLE     80                          $123.19     20090101
25265       REPAIR FOREARM TENDON/MUSCLE     81                          $123.19     20090101
25265       REPAIR FOREARM TENDON/MUSCLE     82                          $123.19     20090101
25265       REPAIR FOREARM TENDON/MUSCLE     AS                          $123.19     20090101
25265       REPAIR FOREARM TENDON/MUSCLE                         Y       $547.70     20081209
25265       REPAIR FOREARM TENDON/MUSCLE                                 $615.93     20090101
25270       REPAIR FOREARM TENDON/MUSCLE                                 $431.50     20090101
25270       REPAIR FOREARM TENDON/MUSCLE                         Y       $619.70     20081209
25272       REPAIR FOREARM TENDON/MUSCLE                                 $482.69     20090101
25272       REPAIR FOREARM TENDON/MUSCLE                         Y       $547.70     20081209
25274       REPAIR FOREARM TENDON/MUSCLE                                 $561.43     20090101
25274       REPAIR FOREARM TENDON/MUSCLE                         Y       $619.70     20081209
25275       REPAIR FOREARM TENDON SHEATH                                 $477.40     20090101
25275       REPAIR FOREARM TENDON SHEATH                         Y       $619.70     20081209
25280       REVISE WRIST/FOREARM TENDON                          Y       $619.70     20081209
25280       REVISE WRIST/FOREARM TENDON                                  $485.75     20090101
25290       INCISE WRIST/FOREARM TENDON                                  $442.63     20090101
25290       INCISE WRIST/FOREARM TENDON                          Y       $547.70     20081209
25295       RELEASE WRIST/FOREARM TENDON                                 $454.59     20090101
25295       RELEASE WRIST/FOREARM TENDON                         Y       $482.11     20081209
25300       FUSION OF TENDONS AT WRIST       80                           $98.49     20090101
25300       FUSION OF TENDONS AT WRIST       81                           $98.49     20090101
25300       FUSION OF TENDONS AT WRIST       82                           $98.49     20090101
25300       FUSION OF TENDONS AT WRIST       AS                           $98.49     20090101
25300       FUSION OF TENDONS AT WRIST                                   $492.45     20090101
25300       FUSION OF TENDONS AT WRIST                           Y       $547.70     20081209
25301       FUSION OF TENDONS AT WRIST       80                           $93.98     20090101
25301       FUSION OF TENDONS AT WRIST       81                           $93.98     20090101
25301       FUSION OF TENDONS AT WRIST       82                           $93.98     20090101
25301       FUSION OF TENDONS AT WRIST       AS                           $93.98     20090101
25301       FUSION OF TENDONS AT WRIST                                   $469.89     20090101
25301       FUSION OF TENDONS AT WRIST                           Y       $547.70     20081209
25310       TRANSPLANT FOREARM TENDON        80                          $105.50     20090101
25310       TRANSPLANT FOREARM TENDON        81                          $105.50     20090101
25310       TRANSPLANT FOREARM TENDON        82                          $105.50     20090101
25310       TRANSPLANT FOREARM TENDON        AS                          $105.50     20090101
25310       TRANSPLANT FOREARM TENDON                                    $527.49     20090101
25310       TRANSPLANT FOREARM TENDON                            Y       $661.93     20081209
25312       TRANSPLANT FOREARM TENDON        80                          $119.29     20090101
25312       TRANSPLANT FOREARM TENDON        81                          $119.29     20090101


                                           Page 76
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
25312       TRANSPLANT FOREARM TENDON       82                          $119.29     20090101
25312       TRANSPLANT FOREARM TENDON       AS                          $119.29     20090101
25312       TRANSPLANT FOREARM TENDON                                   $596.47     20090101
25312       TRANSPLANT FOREARM TENDON                           Y       $733.93     20081209
25315       REVISE PALSY HAND TENDON(S)     80                          $127.42     20090101
25315       REVISE PALSY HAND TENDON(S)     81                          $127.42     20090101
25315       REVISE PALSY HAND TENDON(S)     82                          $127.42     20090101
25315       REVISE PALSY HAND TENDON(S)     AS                          $127.42     20090101
25315       REVISE PALSY HAND TENDON(S)                         Y       $661.93     20081209
25315       REVISE PALSY HAND TENDON(S)                                 $637.09     20090101
25316       REVISE PALSY HAND TENDON(S)     80                          $147.67     20090101
25316       REVISE PALSY HAND TENDON(S)     81                          $147.67     20090101
25316       REVISE PALSY HAND TENDON(S)     82                          $147.67     20090101
25316       REVISE PALSY HAND TENDON(S)     AS                          $147.67     20090101
25316       REVISE PALSY HAND TENDON(S)                                 $738.37     20090101
25316       REVISE PALSY HAND TENDON(S)                         Y       $963.65     20081209
25320       REPAIR/REVISE WRIST JOINT       80                          $136.99     20090101
25320       REPAIR/REVISE WRIST JOINT       81                          $136.99     20090101
25320       REPAIR/REVISE WRIST JOINT       82                          $136.99     20090101
25320       REPAIR/REVISE WRIST JOINT       AS                          $136.99     20090101
25320       REPAIR/REVISE WRIST JOINT                                   $684.96     20090101
25320       REPAIR/REVISE WRIST JOINT                           Y       $661.93     20081209
25332       REVISE WRIST JOINT              80                          $121.52     20090101
25332       REVISE WRIST JOINT              81                          $121.52     20090101
25332       REVISE WRIST JOINT              82                          $121.52     20090101
25332       REVISE WRIST JOINT              AS                          $121.52     20090101
25332       REVISE WRIST JOINT                                          $607.60     20090101
25332       REVISE WRIST JOINT                                  Y       $727.50     20081209
25335       REALIGNMENT OF HAND             80                          $139.83     20090101
25335       REALIGNMENT OF HAND             81                          $139.83     20090101
25335       REALIGNMENT OF HAND             82                          $139.83     20090101
25335       REALIGNMENT OF HAND             AS                          $139.83     20090101
25335       REALIGNMENT OF HAND                                 Y       $661.93     20081209
25335       REALIGNMENT OF HAND                                         $699.14     20090101
25337       RECONSTRUCT ULNA/RADIOULNAR     80                          $127.47     20090101
25337       RECONSTRUCT ULNA/RADIOULNAR     81                          $127.47     20090101
25337       RECONSTRUCT ULNA/RADIOULNAR     82                          $127.47     20090101
25337       RECONSTRUCT ULNA/RADIOULNAR     AS                          $127.47     20090101
25337       RECONSTRUCT ULNA/RADIOULNAR                                 $637.35     20090101
25337       RECONSTRUCT ULNA/RADIOULNAR                         Y       $786.13     20081209
25350       REVISION OF RADIUS              80                          $114.63     20090101
25350       REVISION OF RADIUS              81                          $114.63     20090101
25350       REVISION OF RADIUS              82                          $114.63     20090101
25350       REVISION OF RADIUS              AS                          $114.63     20090101
25350       REVISION OF RADIUS                                  Y       $963.65     20081209


                                          Page 77
Proc Code   Description                 Modifier 1 Modifier 2 ASC    Price    Effective Date
25350       REVISION OF RADIUS                                      $573.13     20090101
25355       REVISION OF RADIUS          80                          $127.03     20090101
25355       REVISION OF RADIUS          81                          $127.03     20090101
25355       REVISION OF RADIUS          82                          $127.03     20090101
25355       REVISION OF RADIUS          AS                          $127.03     20090101
25355       REVISION OF RADIUS                              Y       $661.93     20081209
25355       REVISION OF RADIUS                                      $635.13     20090101
25360       REVISION OF ULNA            80                          $111.78     20090101
25360       REVISION OF ULNA            81                          $111.78     20090101
25360       REVISION OF ULNA            82                          $111.78     20090101
25360       REVISION OF ULNA            AS                          $111.78     20090101
25360       REVISION OF ULNA                                        $558.90     20090101
25360       REVISION OF ULNA                                Y       $547.70     20081209
25365       REVISE RADIUS & ULNA        80                          $149.40     20090101
25365       REVISE RADIUS & ULNA        81                          $149.40     20090101
25365       REVISE RADIUS & ULNA        82                          $149.40     20090101
25365       REVISE RADIUS & ULNA        AS                          $149.40     20090101
25365       REVISE RADIUS & ULNA                                    $747.01     20090101
25365       REVISE RADIUS & ULNA                            Y       $547.70     20081209
25370       REVISE RADIUS OR ULNA       80                          $160.08     20090101
25370       REVISE RADIUS OR ULNA       81                          $160.08     20090101
25370       REVISE RADIUS OR ULNA       82                          $160.08     20090101
25370       REVISE RADIUS OR ULNA       AS                          $160.08     20090101
25370       REVISE RADIUS OR ULNA                           Y       $661.93     20081209
25370       REVISE RADIUS OR ULNA                                   $800.42     20090101
25375       REVISE RADIUS & ULNA        80                          $156.24     20090101
25375       REVISE RADIUS & ULNA        81                          $156.24     20090101
25375       REVISE RADIUS & ULNA        82                          $156.24     20090101
25375       REVISE RADIUS & ULNA        AS                          $156.24     20090101
25375       REVISE RADIUS & ULNA                                    $781.22     20090101
25375       REVISE RADIUS & ULNA                            Y       $733.93     20081209
25390       SHORTEN RADIUS OR ULNA      80                          $128.31     20090101
25390       SHORTEN RADIUS OR ULNA      81                          $128.31     20090101
25390       SHORTEN RADIUS OR ULNA      82                          $128.31     20090101
25390       SHORTEN RADIUS OR ULNA      AS                          $128.31     20090101
25390       SHORTEN RADIUS OR ULNA                                  $641.54     20090101
25390       SHORTEN RADIUS OR ULNA                          Y       $547.70     20081209
25391       LENGTHEN RADIUS OR ULNA     80                          $161.25     20090101
25391       LENGTHEN RADIUS OR ULNA     81                          $161.25     20090101
25391       LENGTHEN RADIUS OR ULNA     82                          $161.25     20090101
25391       LENGTHEN RADIUS OR ULNA     AS                          $161.25     20090101
25391       LENGTHEN RADIUS OR ULNA                         Y       $733.93     20081209
25391       LENGTHEN RADIUS OR ULNA                                 $806.27     20090101
25392       SHORTEN RADIUS & ULNA       80                          $161.30     20090101
25392       SHORTEN RADIUS & ULNA       81                          $161.30     20090101


                                      Page 78
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
25392       SHORTEN RADIUS & ULNA           82                           $161.30      20090101
25392       SHORTEN RADIUS & ULNA           AS                           $161.30      20090101
25392       SHORTEN RADIUS & ULNA                                        $806.52      20090101
25392       SHORTEN RADIUS & ULNA                               Y        $547.70      20081209
25393       LENGTHEN RADIUS & ULNA          80                           $182.34      20090101
25393       LENGTHEN RADIUS & ULNA          81                           $182.34      20090101
25393       LENGTHEN RADIUS & ULNA          82                           $182.34      20090101
25393       LENGTHEN RADIUS & ULNA          AS                           $182.34      20090101
25393       LENGTHEN RADIUS & ULNA                              Y        $733.93      20081209
25393       LENGTHEN RADIUS & ULNA                                       $911.68      20090101
25394       REPAIR CARPAL BONE, SHORTEN                                  $551.13      20090101
25400       REPAIR RADIUS OR ULNA           80                           $134.77      20090101
25400       REPAIR RADIUS OR ULNA           81                           $134.77      20090101
25400       REPAIR RADIUS OR ULNA           82                           $134.77      20090101
25400       REPAIR RADIUS OR ULNA           AS                           $134.77      20090101
25400       REPAIR RADIUS OR ULNA                                        $673.84      20090101
25400       REPAIR RADIUS OR ULNA                               Y        $963.65      20081209
25405       REPAIR/GRAFT RADIUS OR ULNA     80                           $168.65      20090101
25405       REPAIR/GRAFT RADIUS OR ULNA     81                           $168.65      20090101
25405       REPAIR/GRAFT RADIUS OR ULNA     82                           $168.65      20090101
25405       REPAIR/GRAFT RADIUS OR ULNA     AS                           $168.65      20090101
25405       REPAIR/GRAFT RADIUS OR ULNA                                  $843.27      20090101
25405       REPAIR/GRAFT RADIUS OR ULNA                         Y       $1,035.65     20081209
25415       REPAIR RADIUS & ULNA            80                           $158.58      20090101
25415       REPAIR RADIUS & ULNA            81                           $158.58      20090101
25415       REPAIR RADIUS & ULNA            82                           $158.58      20090101
25415       REPAIR RADIUS & ULNA            AS                           $158.58      20090101
25415       REPAIR RADIUS & ULNA                                         $792.91      20090101
25415       REPAIR RADIUS & ULNA                                Y        $963.65      20081209
25420       REPAIR/GRAFT RADIUS & ULNA      80                           $187.07      20090101
25420       REPAIR/GRAFT RADIUS & ULNA      81                           $187.07      20090101
25420       REPAIR/GRAFT RADIUS & ULNA      82                           $187.07      20090101
25420       REPAIR/GRAFT RADIUS & ULNA      AS                           $187.07      20090101
25420       REPAIR/GRAFT RADIUS & ULNA                                   $935.33      20090101
25420       REPAIR/GRAFT RADIUS & ULNA                          Y       $1,035.65     20081209
25425       REPAIR/GRAFT RADIUS OR ULNA     80                           $170.32      20090101
25425       REPAIR/GRAFT RADIUS OR ULNA     81                           $170.32      20090101
25425       REPAIR/GRAFT RADIUS OR ULNA     82                           $170.32      20090101
25425       REPAIR/GRAFT RADIUS OR ULNA     AS                           $170.32      20090101
25425       REPAIR/GRAFT RADIUS OR ULNA                         Y        $661.93      20081209
25425       REPAIR/GRAFT RADIUS OR ULNA                                  $851.60      20090101
25426       REPAIR/GRAFT RADIUS & ULNA      80                           $176.60      20090101
25426       REPAIR/GRAFT RADIUS & ULNA      81                           $176.60      20090101
25426       REPAIR/GRAFT RADIUS & ULNA      82                           $176.60      20090101
25426       REPAIR/GRAFT RADIUS & ULNA      AS                           $176.60      20090101


                                          Page 79
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
25426       REPAIR/GRAFT RADIUS & ULNA                          Y        $733.93      20081209
25426       REPAIR/GRAFT RADIUS & ULNA                                   $883.01      20090101
25430       VASC GRAFT INTO CARPAL BONE                                  $501.61      20090101
25431       REPAIR NONUNION CARPAL BONE                                  $568.66      20090101
25440       REPAIR/GRAFT WRIST BONE         80                           $113.18      20090101
25440       REPAIR/GRAFT WRIST BONE         81                           $113.18      20090101
25440       REPAIR/GRAFT WRIST BONE         82                           $113.18      20090101
25440       REPAIR/GRAFT WRIST BONE         AS                           $113.18      20090101
25440       REPAIR/GRAFT WRIST BONE                                      $565.89      20090101
25440       REPAIR/GRAFT WRIST BONE                             Y       $1,035.65     20081209
25441       RECONSTRUCT WRIST JOINT         80                           $135.15      20090101
25441       RECONSTRUCT WRIST JOINT         81                           $135.15      20090101
25441       RECONSTRUCT WRIST JOINT         82                           $135.15      20090101
25441       RECONSTRUCT WRIST JOINT         AS                           $135.15      20090101
25441       RECONSTRUCT WRIST JOINT                             Y       $1,442.09     20081209
25441       RECONSTRUCT WRIST JOINT                                      $675.75      20090101
25442       RECONSTRUCT WRIST JOINT         80                           $115.24      20090101
25442       RECONSTRUCT WRIST JOINT         81                           $115.24      20090101
25442       RECONSTRUCT WRIST JOINT         82                           $115.24      20090101
25442       RECONSTRUCT WRIST JOINT         AS                           $115.24      20090101
25442       RECONSTRUCT WRIST JOINT                             Y       $1,442.09     20081209
25442       RECONSTRUCT WRIST JOINT                                      $576.18      20090101
25443       RECONSTRUCT WRIST JOINT         80                           $110.67      20090101
25443       RECONSTRUCT WRIST JOINT         81                           $110.67      20090101
25443       RECONSTRUCT WRIST JOINT         82                           $110.67      20090101
25443       RECONSTRUCT WRIST JOINT         AS                           $110.67      20090101
25443       RECONSTRUCT WRIST JOINT                             Y        $851.56      20081209
25443       RECONSTRUCT WRIST JOINT                                      $553.36      20090101
25444       RECONSTRUCT WRIST JOINT         80                           $118.19      20090101
25444       RECONSTRUCT WRIST JOINT         81                           $118.19      20090101
25444       RECONSTRUCT WRIST JOINT         82                           $118.19      20090101
25444       RECONSTRUCT WRIST JOINT         AS                           $118.19      20090101
25444       RECONSTRUCT WRIST JOINT                                      $590.93      20090101
25444       RECONSTRUCT WRIST JOINT                             Y        $851.56      20081209
25445       RECONSTRUCT WRIST JOINT         80                           $103.83      20090101
25445       RECONSTRUCT WRIST JOINT         81                           $103.83      20090101
25445       RECONSTRUCT WRIST JOINT         82                           $103.83      20090101
25445       RECONSTRUCT WRIST JOINT         AS                           $103.83      20090101
25445       RECONSTRUCT WRIST JOINT                             Y        $851.56      20081209
25445       RECONSTRUCT WRIST JOINT                                      $519.16      20090101
25446       WRIST REPLACEMENT               80                           $170.27      20090101
25446       WRIST REPLACEMENT               81                           $170.27      20090101
25446       WRIST REPLACEMENT               82                           $170.27      20090101
25446       WRIST REPLACEMENT               AS                           $170.27      20090101
25446       WRIST REPLACEMENT                                   Y       $1,608.89     20081209


                                          Page 80
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
25446       WRIST REPLACEMENT                                          $851.34     20090101
25447       REPAIR WRIST JOINT(S)          80                          $115.90     20090101
25447       REPAIR WRIST JOINT(S)          81                          $115.90     20090101
25447       REPAIR WRIST JOINT(S)          82                          $115.90     20090101
25447       REPAIR WRIST JOINT(S)          AS                          $115.90     20090101
25447       REPAIR WRIST JOINT(S)                                      $579.50     20090101
25447       REPAIR WRIST JOINT(S)                              Y       $727.50     20081209
25449       REMOVE WRIST JOINT IMPLANT     80                          $149.34     20090101
25449       REMOVE WRIST JOINT IMPLANT     81                          $149.34     20090101
25449       REMOVE WRIST JOINT IMPLANT     82                          $149.34     20090101
25449       REMOVE WRIST JOINT IMPLANT     AS                          $149.34     20090101
25449       REMOVE WRIST JOINT IMPLANT                                 $746.70     20090101
25449       REMOVE WRIST JOINT IMPLANT                         Y       $727.50     20081209
25450       REVISION OF WRIST JOINT        80                           $90.81     20090101
25450       REVISION OF WRIST JOINT        81                           $90.81     20090101
25450       REVISION OF WRIST JOINT        82                           $90.81     20090101
25450       REVISION OF WRIST JOINT        AS                           $90.81     20090101
25450       REVISION OF WRIST JOINT                                    $454.05     20090101
25450       REVISION OF WRIST JOINT                            Y       $661.93     20081209
25455       REVISION OF WRIST JOINT        80                          $107.89     20090101
25455       REVISION OF WRIST JOINT        81                          $107.89     20090101
25455       REVISION OF WRIST JOINT        82                          $107.89     20090101
25455       REVISION OF WRIST JOINT        AS                          $107.89     20090101
25455       REVISION OF WRIST JOINT                                    $539.44     20090101
25455       REVISION OF WRIST JOINT                            Y       $661.93     20081209
25490       REINFORCE RADIUS               80                          $117.96     20090101
25490       REINFORCE RADIUS               81                          $117.96     20090101
25490       REINFORCE RADIUS               82                          $117.96     20090101
25490       REINFORCE RADIUS               AS                          $117.96     20090101
25490       REINFORCE RADIUS                                           $589.79     20090101
25490       REINFORCE RADIUS                                   Y       $661.93     20081209
25491       REINFORCE ULNA                 80                          $123.86     20090101
25491       REINFORCE ULNA                 81                          $123.86     20090101
25491       REINFORCE ULNA                 82                          $123.86     20090101
25491       REINFORCE ULNA                 AS                          $123.86     20090101
25491       REINFORCE ULNA                                             $619.29     20090101
25491       REINFORCE ULNA                                     Y       $661.93     20081209
25492       REINFORCE RADIUS AND ULNA      80                          $147.39     20090101
25492       REINFORCE RADIUS AND ULNA      81                          $147.39     20090101
25492       REINFORCE RADIUS AND ULNA      82                          $147.39     20090101
25492       REINFORCE RADIUS AND ULNA      AS                          $147.39     20090101
25492       REINFORCE RADIUS AND ULNA                          Y       $661.93     20081209
25492       REINFORCE RADIUS AND ULNA                                  $736.97     20090101
25500       TREAT FRACTURE OF RADIUS                                   $175.27     20090101
25505       TREAT FRACTURE OF RADIUS                                   $344.70     20090101


                                         Page 81
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
25505       TREAT FRACTURE OF RADIUS                             Y        $76.82     20081209
25515       TREAT FRACTURE OF RADIUS         80                           $95.71     20090101
25515       TREAT FRACTURE OF RADIUS         81                           $95.71     20090101
25515       TREAT FRACTURE OF RADIUS         82                           $95.71     20090101
25515       TREAT FRACTURE OF RADIUS         AS                           $95.71     20090101
25515       TREAT FRACTURE OF RADIUS                             Y       $646.39     20081209
25515       TREAT FRACTURE OF RADIUS                                     $478.53     20090101
25520       TREAT FRACTURE OF RADIUS                                     $381.42     20090101
25520       TREAT FRACTURE OF RADIUS                             Y        $76.82     20081209
25525       TREAT FRACTURE OF RADIUS         80                          $118.01     20090101
25525       TREAT FRACTURE OF RADIUS         81                          $118.01     20090101
25525       TREAT FRACTURE OF RADIUS         82                          $118.01     20090101
25525       TREAT FRACTURE OF RADIUS         AS                          $118.01     20090101
25525       TREAT FRACTURE OF RADIUS                                     $590.05     20090101
25525       TREAT FRACTURE OF RADIUS                             Y       $718.39     20081209
25526       TREAT FRACTURE OF RADIUS         80                          $146.11     20090101
25526       TREAT FRACTURE OF RADIUS         81                          $146.11     20090101
25526       TREAT FRACTURE OF RADIUS         82                          $146.11     20090101
25526       TREAT FRACTURE OF RADIUS         AS                          $146.11     20090101
25526       TREAT FRACTURE OF RADIUS                             Y       $770.59     20081209
25526       TREAT FRACTURE OF RADIUS                                     $730.55     20090101
25530       TREAT FRACTURE OF ULNA                                       $169.99     20090101
25535       TREAT FRACTURE OF ULNA                                       $331.07     20090101
25535       TREAT FRACTURE OF ULNA                               Y        $76.82     20081209
25545       TREAT FRACTURE OF ULNA           80                           $90.47     20090101
25545       TREAT FRACTURE OF ULNA           81                           $90.47     20090101
25545       TREAT FRACTURE OF ULNA           82                           $90.47     20090101
25545       TREAT FRACTURE OF ULNA           AS                           $90.47     20090101
25545       TREAT FRACTURE OF ULNA                               Y       $646.39     20081209
25545       TREAT FRACTURE OF ULNA                                       $452.35     20090101
25560       TREAT FRACTURE RADIUS & ULNA                                 $177.49     20090101
25565       TREAT FRACTURE RADIUS & ULNA                                 $360.28     20090101
25565       TREAT FRACTURE RADIUS & ULNA                         Y        $76.82     20081209
25574       TREAT FRACTURE RADIUS & ULNA     80                           $93.09     20090101
25574       TREAT FRACTURE RADIUS & ULNA     81                           $93.09     20090101
25574       TREAT FRACTURE RADIUS & ULNA     82                           $93.09     20090101
25574       TREAT FRACTURE RADIUS & ULNA     AS                           $93.09     20090101
25574       TREAT FRACTURE RADIUS & ULNA                         Y       $796.38     20081209
25574       TREAT FRACTURE RADIUS & ULNA                                 $465.44     20090101
25575       TREAT FRACTURE RADIUS/ULNA       80                          $127.20     20090101
25575       TREAT FRACTURE RADIUS/ULNA       81                          $127.20     20090101
25575       TREAT FRACTURE RADIUS/ULNA       82                          $127.20     20090101
25575       TREAT FRACTURE RADIUS/ULNA       AS                          $127.20     20090101
25575       TREAT FRACTURE RADIUS/ULNA                                   $636.01     20090101
25575       TREAT FRACTURE RADIUS/ULNA                           Y       $796.38     20081209


                                           Page 82
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
25600       TREAT FRACTURE RADIUS/ULNA                                   $194.75     20090101
25605       TREAT FRACTURE RADIUS/ULNA                                   $419.26     20090101
25605       TREAT FRACTURE RADIUS/ULNA                           Y        $76.82     20081209
25606       TREAT FX DISTAL RADIAL                                       $478.24     20090101
25606       TREAT FX DISTAL RADIAL                               Y       $522.61     20081209
25607       TREAT FX RAD EXTRA-ARTICUL                           Y       $920.58     20081209
25607       TREAT FX RAD EXTRA-ARTICUL                                   $498.27     20090101
25608       TREAT FX RAD INTRA-ARTICUL                                   $570.33     20090101
25608       TREAT FX RAD INTRA-ARTICUL                           Y       $920.58     20081209
25609       TREAT FX RADIAL 3+ FRAG                                      $727.79     20090101
25609       TREAT FX RADIAL 3+ FRAG                              Y       $920.58     20081209
25622       TREAT WRIST BONE FRACTURE                                    $199.76     20090101
25624       TREAT WRIST BONE FRACTURE                            Y        $76.82     20081209
25624       TREAT WRIST BONE FRACTURE                                    $315.77     20090101
25628       TREAT WRIST BONE FRACTURE        80                          $101.38     20090101
25628       TREAT WRIST BONE FRACTURE        81                          $101.38     20090101
25628       TREAT WRIST BONE FRACTURE        82                          $101.38     20090101
25628       TREAT WRIST BONE FRACTURE        AS                          $101.38     20090101
25628       TREAT WRIST BONE FRACTURE                                    $506.89     20090101
25628       TREAT WRIST BONE FRACTURE                            Y       $646.39     20081209
25630       TREAT WRIST BONE FRACTURE                                    $204.76     20090101
25635       TREAT WRIST BONE FRACTURE                            Y        $76.82     20081209
25635       TREAT WRIST BONE FRACTURE                                    $298.79     20090101
25645       TREAT WRIST BONE FRACTURE        80                           $81.29     20090101
25645       TREAT WRIST BONE FRACTURE        81                           $81.29     20090101
25645       TREAT WRIST BONE FRACTURE        82                           $81.29     20090101
25645       TREAT WRIST BONE FRACTURE        AS                           $81.29     20090101
25645       TREAT WRIST BONE FRACTURE                                    $406.44     20090101
25645       TREAT WRIST BONE FRACTURE                            Y       $646.39     20081209
25650       TREAT WRIST BONE FRACTURE                                    $212.83     20090101
25651       PIN ULNAR STYLOID FRACTURE                                   $329.96     20090101
25652       TREAT FRACTURE ULNAR STYLOID                                 $437.06     20090101
25660       TREAT WRIST DISLOCATION                              Y        $76.82     20081209
25660       TREAT WRIST DISLOCATION                                      $276.54     20090101
25670       TREAT WRIST DISLOCATION          80                           $87.19     20090101
25670       TREAT WRIST DISLOCATION          81                           $87.19     20090101
25670       TREAT WRIST DISLOCATION          82                           $87.19     20090101
25670       TREAT WRIST DISLOCATION          AS                           $87.19     20090101
25670       TREAT WRIST DISLOCATION                              Y       $522.61     20081209
25670       TREAT WRIST DISLOCATION                                      $435.94     20090101
25671       PIN RADIOULNAR DISLOCATION                                   $366.40     20090101
25671       PIN RADIOULNAR DISLOCATION                           Y       $416.41     20081209
25675       TREAT WRIST DISLOCATION                              Y        $76.82     20081209
25675       TREAT WRIST DISLOCATION                                      $293.78     20090101
25676       TREAT WRIST DISLOCATION          80                           $90.30     20090101


                                           Page 83
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
25676       TREAT WRIST DISLOCATION         81                            $90.30      20090101
25676       TREAT WRIST DISLOCATION         82                            $90.30      20090101
25676       TREAT WRIST DISLOCATION         AS                            $90.30      20090101
25676       TREAT WRIST DISLOCATION                                      $451.52      20090101
25676       TREAT WRIST DISLOCATION                             Y        $484.21      20081209
25680       TREAT WRIST FRACTURE                                         $317.71      20090101
25680       TREAT WRIST FRACTURE                                Y         $76.82      20081209
25685       TREAT WRIST FRACTURE            80                           $104.49      20090101
25685       TREAT WRIST FRACTURE            81                           $104.49      20090101
25685       TREAT WRIST FRACTURE            82                           $104.49      20090101
25685       TREAT WRIST FRACTURE            AS                           $104.49      20090101
25685       TREAT WRIST FRACTURE                                         $522.47      20090101
25685       TREAT WRIST FRACTURE                                Y        $522.61      20081209
25690       TREAT WRIST DISLOCATION                                      $323.83      20090101
25690       TREAT WRIST DISLOCATION                             Y         $76.82      20081209
25695       TREAT WRIST DISLOCATION         80                            $90.53      20090101
25695       TREAT WRIST DISLOCATION         81                            $90.53      20090101
25695       TREAT WRIST DISLOCATION         82                            $90.53      20090101
25695       TREAT WRIST DISLOCATION         AS                            $90.53      20090101
25695       TREAT WRIST DISLOCATION                             Y        $484.21      20081209
25695       TREAT WRIST DISLOCATION                                      $452.66      20090101
25800       FUSION OF WRIST JOINT           80                           $108.33      20090101
25800       FUSION OF WRIST JOINT           81                           $108.33      20090101
25800       FUSION OF WRIST JOINT           82                           $108.33      20090101
25800       FUSION OF WRIST JOINT           AS                           $108.33      20090101
25800       FUSION OF WRIST JOINT                                        $541.67      20090101
25800       FUSION OF WRIST JOINT                               Y       $1,035.65     20081209
25805       FUSION/GRAFT OF WRIST JOINT     80                           $124.47      20090101
25805       FUSION/GRAFT OF WRIST JOINT     81                           $124.47      20090101
25805       FUSION/GRAFT OF WRIST JOINT     82                           $124.47      20090101
25805       FUSION/GRAFT OF WRIST JOINT     AS                           $124.47      20090101
25805       FUSION/GRAFT OF WRIST JOINT                                  $622.35      20090101
25805       FUSION/GRAFT OF WRIST JOINT                         Y        $786.13      20081209
25810       FUSION/GRAFT OF WRIST JOINT     80                           $124.70      20090101
25810       FUSION/GRAFT OF WRIST JOINT     81                           $124.70      20090101
25810       FUSION/GRAFT OF WRIST JOINT     82                           $124.70      20090101
25810       FUSION/GRAFT OF WRIST JOINT     AS                           $124.70      20090101
25810       FUSION/GRAFT OF WRIST JOINT                                  $623.48      20090101
25810       FUSION/GRAFT OF WRIST JOINT                         Y       $1,087.85     20081209
25820       FUSION OF HAND BONES            80                            $88.31      20090101
25820       FUSION OF HAND BONES            81                            $88.31      20090101
25820       FUSION OF HAND BONES            82                            $88.31      20090101
25820       FUSION OF HAND BONES            AS                            $88.31      20090101
25820       FUSION OF HAND BONES                                         $441.53      20090101
25820       FUSION OF HAND BONES                                Y        $514.32      20081209


                                          Page 84
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
25825       FUSE HAND BONES WITH GRAFT       80                           $107.94      20090101
25825       FUSE HAND BONES WITH GRAFT       81                           $107.94      20090101
25825       FUSE HAND BONES WITH GRAFT       82                           $107.94      20090101
25825       FUSE HAND BONES WITH GRAFT       AS                           $107.94      20090101
25825       FUSE HAND BONES WITH GRAFT                                    $539.70      20090101
25825       FUSE HAND BONES WITH GRAFT                           Y       $1,087.85     20081209
25830       FUSION, RADIOULNAR JNT/ULNA      80                           $137.66      20090101
25830       FUSION, RADIOULNAR JNT/ULNA      81                           $137.66      20090101
25830       FUSION, RADIOULNAR JNT/ULNA      82                           $137.66      20090101
25830       FUSION, RADIOULNAR JNT/ULNA      AS                           $137.66      20090101
25830       FUSION, RADIOULNAR JNT/ULNA                          Y       $1,087.85     20081209
25830       FUSION, RADIOULNAR JNT/ULNA                                   $688.28      20090101
25900       AMPUTATION OF FOREARM            80                           $113.62      20090101
25900       AMPUTATION OF FOREARM            81                           $113.62      20090101
25900       AMPUTATION OF FOREARM            82                           $113.62      20090101
25900       AMPUTATION OF FOREARM            AS                           $113.62      20090101
25900       AMPUTATION OF FOREARM                                         $568.11      20090101
25905       AMPUTATION OF FOREARM            80                           $111.68      20090101
25905       AMPUTATION OF FOREARM            81                           $111.68      20090101
25905       AMPUTATION OF FOREARM            82                           $111.68      20090101
25905       AMPUTATION OF FOREARM            AS                           $111.68      20090101
25905       AMPUTATION OF FOREARM                                         $558.38      20090101
25907       AMPUTATION FOLLOW-UP SURGERY     80                            $99.32      20090101
25907       AMPUTATION FOLLOW-UP SURGERY     81                            $99.32      20090101
25907       AMPUTATION FOLLOW-UP SURGERY     82                            $99.32      20090101
25907       AMPUTATION FOLLOW-UP SURGERY     AS                            $99.32      20090101
25907       AMPUTATION FOLLOW-UP SURGERY                         Y        $482.11      20081209
25907       AMPUTATION FOLLOW-UP SURGERY                                  $496.59      20090101
25909       AMPUTATION FOLLOW-UP SURGERY     80                           $111.00      20090101
25909       AMPUTATION FOLLOW-UP SURGERY     81                           $111.00      20090101
25909       AMPUTATION FOLLOW-UP SURGERY     82                           $111.00      20090101
25909       AMPUTATION FOLLOW-UP SURGERY     AS                           $111.00      20090101
25909       AMPUTATION FOLLOW-UP SURGERY                                  $555.02      20090101
25915       AMPUTATION OF FOREARM            80                           $182.22      20090101
25915       AMPUTATION OF FOREARM            81                           $182.22      20090101
25915       AMPUTATION OF FOREARM            82                           $182.22      20090101
25915       AMPUTATION OF FOREARM            AS                           $182.22      20090101
25915       AMPUTATION OF FOREARM                                         $911.11      20090101
25920       AMPUTATE HAND AT WRIST           80                            $97.32      20090101
25920       AMPUTATE HAND AT WRIST           81                            $97.32      20090101
25920       AMPUTATE HAND AT WRIST           82                            $97.32      20090101
25920       AMPUTATE HAND AT WRIST           AS                            $97.32      20090101
25920       AMPUTATE HAND AT WRIST                                        $486.61      20090101
25922       AMPUTATE HAND AT WRIST           80                            $85.29      20090101
25922       AMPUTATE HAND AT WRIST           81                            $85.29      20090101


                                           Page 85
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
25922       AMPUTATE HAND AT WRIST           82                           $85.29     20090101
25922       AMPUTATE HAND AT WRIST           AS                           $85.29     20090101
25922       AMPUTATE HAND AT WRIST                               Y       $482.11     20081209
25922       AMPUTATE HAND AT WRIST                                       $426.47     20090101
25924       AMPUTATION FOLLOW-UP SURGERY     80                           $95.31     20090101
25924       AMPUTATION FOLLOW-UP SURGERY     81                           $95.31     20090101
25924       AMPUTATION FOLLOW-UP SURGERY     82                           $95.31     20090101
25924       AMPUTATION FOLLOW-UP SURGERY     AS                           $95.31     20090101
25924       AMPUTATION FOLLOW-UP SURGERY                                 $476.57     20090101
25927       AMPUTATION OF HAND                                           $568.10     20090101
25929       AMPUTATION FOLLOW-UP SURGERY     80                           $81.35     20090101
25929       AMPUTATION FOLLOW-UP SURGERY     81                           $81.35     20090101
25929       AMPUTATION FOLLOW-UP SURGERY     82                           $81.35     20090101
25929       AMPUTATION FOLLOW-UP SURGERY     AS                           $81.35     20090101
25929       AMPUTATION FOLLOW-UP SURGERY                                 $406.76     20090101
25929       AMPUTATION FOLLOW-UP SURGERY                         Y       $430.58     20081209
25931       AMPUTATION FOLLOW-UP SURGERY     80                          $105.61     20090101
25931       AMPUTATION FOLLOW-UP SURGERY     81                          $105.61     20090101
25931       AMPUTATION FOLLOW-UP SURGERY     82                          $105.61     20090101
25931       AMPUTATION FOLLOW-UP SURGERY     AS                          $105.61     20090101
25931       AMPUTATION FOLLOW-UP SURGERY                                 $528.06     20090101
26010       DRAINAGE OF FINGER ABSCESS                                   $182.22     20090101
26011       DRAINAGE OF FINGER ABSCESS                                   $280.43     20090101
26011       DRAINAGE OF FINGER ABSCESS                           Y       $295.51     20081209
26020       DRAIN HAND TENDON SHEATH                                     $299.07     20090101
26020       DRAIN HAND TENDON SHEATH                             Y       $403.92     20081209
26025       DRAINAGE OF PALM BURSA                                       $293.24     20090101
26025       DRAINAGE OF PALM BURSA                               Y       $336.12     20081209
26030       DRAINAGE OF PALM BURSA(S)                                    $346.09     20090101
26030       DRAINAGE OF PALM BURSA(S)                            Y       $403.92     20081209
26034       TREAT HAND BONE LESION                               Y       $403.92     20081209
26034       TREAT HAND BONE LESION                                       $374.74     20090101
26035       DECOMPRESS FINGERS/HAND                                      $573.39     20090101
26035       DECOMPRESS FINGERS/HAND                              Y       $545.29     20081209
26037       DECOMPRESS FINGERS/HAND                                      $403.96     20090101
26040       RELEASE PALM CONTRACTURE                                     $215.33     20090101
26040       RELEASE PALM CONTRACTURE                             Y       $595.86     20081209
26045       RELEASE PALM CONTRACTURE                                     $328.84     20090101
26045       RELEASE PALM CONTRACTURE                             Y       $523.86     20081209
26055       INCISE FINGER TENDON SHEATH                                  $420.92     20090101
26055       INCISE FINGER TENDON SHEATH                          Y       $403.92     20081209
26060       INCISION OF FINGER TENDON                            Y       $403.92     20081209
26060       INCISION OF FINGER TENDON                                    $183.06     20090101
26070       EXPLORE/TREAT HAND JOINT                             Y       $403.92     20081209
26070       EXPLORE/TREAT HAND JOINT                                     $206.43     20090101


                                           Page 86
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26075       EXPLORE/TREAT FINGER JOINT                           Y       $514.32     20081209
26075       EXPLORE/TREAT FINGER JOINT                                   $220.90     20090101
26080       EXPLORE/TREAT FINGER JOINT                                   $267.36     20090101
26080       EXPLORE/TREAT FINGER JOINT                           Y       $514.32     20081209
26100       BIOPSY HAND JOINT LINING                                     $226.74     20090101
26100       BIOPSY HAND JOINT LINING                             Y       $403.92     20081209
26105       BIOPSY FINGER JOINT LINING                                   $230.91     20090101
26105       BIOPSY FINGER JOINT LINING                           Y       $336.12     20081209
26110       BIOPSY FINGER JOINT LINING                                   $220.62     20090101
26110       BIOPSY FINGER JOINT LINING                           Y       $336.12     20081209
26115       REMOVAL HAND LESION SUBCUT                                   $444.57     20090101
26115       REMOVAL HAND LESION SUBCUT                           Y       $442.39     20081209
26116       REMOVAL HAND LESION, DEEP                                    $336.91     20090101
26116       REMOVAL HAND LESION, DEEP                            Y       $442.39     20081209
26117       REMOVE TUMOR, HAND/FINGER                                    $459.32     20090101
26117       REMOVE TUMOR, HAND/FINGER                            Y       $480.79     20081209
26121       RELEASE PALM CONTRACTURE                                     $423.71     20090101
26121       RELEASE PALM CONTRACTURE                             Y       $595.86     20081209
26123       RELEASE PALM CONTRACTURE                                     $573.11     20090101
26123       RELEASE PALM CONTRACTURE                             Y       $595.86     20081209
26125       RELEASE PALM CONTRACTURE                                     $207.54     20090101
26125       RELEASE PALM CONTRACTURE                             Y       $514.32     20081209
26130       REMOVE WRIST JOINT LINING                                    $321.06     20090101
26130       REMOVE WRIST JOINT LINING                            Y       $442.32     20081209
26135       REVISE FINGER JOINT, EACH                            Y       $595.86     20081209
26135       REVISE FINGER JOINT, EACH                                    $391.16     20090101
26140       REVISE FINGER JOINT, EACH                                    $354.99     20090101
26140       REVISE FINGER JOINT, EACH                            Y       $403.92     20081209
26145       TENDON EXCISION, PALM/FINGER                                 $360.83     20090101
26145       TENDON EXCISION, PALM/FINGER                         Y       $442.32     20081209
26160       REMOVE TENDON SHEATH LESION                          Y       $442.32     20081209
26160       REMOVE TENDON SHEATH LESION                                  $407.85     20090101
26170       REMOVAL OF PALM TENDON, EACH                                 $282.94     20090101
26170       REMOVAL OF PALM TENDON, EACH                         Y       $442.32     20081209
26180       REMOVAL OF FINGER TENDON                                     $308.25     20090101
26180       REMOVAL OF FINGER TENDON                             Y       $442.32     20081209
26185       REMOVE FINGER BONE               80                           $72.45     20090101
26185       REMOVE FINGER BONE               81                           $72.45     20090101
26185       REMOVE FINGER BONE               82                           $72.45     20090101
26185       REMOVE FINGER BONE               AS                           $72.45     20090101
26185       REMOVE FINGER BONE                                           $362.25     20090101
26185       REMOVE FINGER BONE                                   Y       $514.32     20081209
26200       REMOVE HAND BONE LESION                                      $317.16     20090101
26200       REMOVE HAND BONE LESION                              Y       $403.92     20081209
26205       REMOVE/GRAFT BONE LESION                                     $428.16     20090101


                                           Page 87
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26205       REMOVE/GRAFT BONE LESION                             Y       $523.86     20081209
26210       REMOVAL OF FINGER LESION                                     $308.25     20090101
26210       REMOVAL OF FINGER LESION                             Y       $403.92     20081209
26215       REMOVE/GRAFT FINGER LESION       80                           $78.29     20090101
26215       REMOVE/GRAFT FINGER LESION       81                           $78.29     20090101
26215       REMOVE/GRAFT FINGER LESION       82                           $78.29     20090101
26215       REMOVE/GRAFT FINGER LESION       AS                           $78.29     20090101
26215       REMOVE/GRAFT FINGER LESION                           Y       $442.32     20081209
26215       REMOVE/GRAFT FINGER LESION                                   $391.44     20090101
26230       PARTIAL REMOVAL OF HAND BONE                         Y       $732.10     20081209
26230       PARTIAL REMOVAL OF HAND BONE                                 $356.66     20090101
26235       PARTIAL REMOVAL, FINGER BONE                         Y       $442.32     20081209
26235       PARTIAL REMOVAL, FINGER BONE                                 $349.71     20090101
26236       PARTIAL REMOVAL, FINGER BONE                                 $309.64     20090101
26236       PARTIAL REMOVAL, FINGER BONE                         Y       $442.32     20081209
26250       EXTENSIVE HAND SURGERY                                       $410.64     20090101
26250       EXTENSIVE HAND SURGERY                               Y       $442.32     20081209
26255       EXTENSIVE HAND SURGERY           80                          $129.76     20090101
26255       EXTENSIVE HAND SURGERY           81                          $129.76     20090101
26255       EXTENSIVE HAND SURGERY           82                          $129.76     20090101
26255       EXTENSIVE HAND SURGERY           AS                          $129.76     20090101
26255       EXTENSIVE HAND SURGERY                                       $648.79     20090101
26255       EXTENSIVE HAND SURGERY                               Y       $523.86     20081209
26260       EXTENSIVE FINGER SURGERY         80                           $77.51     20090101
26260       EXTENSIVE FINGER SURGERY         81                           $77.51     20090101
26260       EXTENSIVE FINGER SURGERY         82                           $77.51     20090101
26260       EXTENSIVE FINGER SURGERY         AS                           $77.51     20090101
26260       EXTENSIVE FINGER SURGERY                                     $387.56     20090101
26260       EXTENSIVE FINGER SURGERY                             Y       $442.32     20081209
26261       EXTENSIVE FINGER SURGERY         80                           $93.86     20090101
26261       EXTENSIVE FINGER SURGERY         81                           $93.86     20090101
26261       EXTENSIVE FINGER SURGERY         82                           $93.86     20090101
26261       EXTENSIVE FINGER SURGERY         AS                           $93.86     20090101
26261       EXTENSIVE FINGER SURGERY                             Y       $442.32     20081209
26261       EXTENSIVE FINGER SURGERY                                     $469.32     20090101
26262       PARTIAL REMOVAL OF FINGER        80                           $64.77     20090101
26262       PARTIAL REMOVAL OF FINGER        81                           $64.77     20090101
26262       PARTIAL REMOVAL OF FINGER        82                           $64.77     20090101
26262       PARTIAL REMOVAL OF FINGER        AS                           $64.77     20090101
26262       PARTIAL REMOVAL OF FINGER                            Y       $403.92     20081209
26262       PARTIAL REMOVAL OF FINGER                                    $323.85     20090101
26320       REMOVAL OF IMPLANT FROM HAND                                 $240.93     20090101
26320       REMOVAL OF IMPLANT FROM HAND                         Y       $400.91     20081209
26340       MANIPULATE FINGER W/ANESTH                                   $215.61     20090101
26350       REPAIR FINGER/HAND TENDON                            Y       $417.66     20081209


                                           Page 88
Proc Code   Description                   Modifier 1 Modifier 2 ASC    Price    Effective Date
26350       REPAIR FINGER/HAND TENDON                                 $530.82     20090101
26352       REPAIR/GRAFT HAND TENDON      80                          $120.18     20090101
26352       REPAIR/GRAFT HAND TENDON      81                          $120.18     20090101
26352       REPAIR/GRAFT HAND TENDON      82                          $120.18     20090101
26352       REPAIR/GRAFT HAND TENDON      AS                          $120.18     20090101
26352       REPAIR/GRAFT HAND TENDON                                  $600.92     20090101
26352       REPAIR/GRAFT HAND TENDON                          Y       $595.86     20081209
26356       REPAIR FINGER/HAND TENDON                                 $764.51     20090101
26356       REPAIR FINGER/HAND TENDON                         Y       $595.86     20081209
26357       REPAIR FINGER/HAND TENDON     80                          $127.86     20090101
26357       REPAIR FINGER/HAND TENDON     81                          $127.86     20090101
26357       REPAIR FINGER/HAND TENDON     82                          $127.86     20090101
26357       REPAIR FINGER/HAND TENDON     AS                          $127.86     20090101
26357       REPAIR FINGER/HAND TENDON                         Y       $595.86     20081209
26357       REPAIR FINGER/HAND TENDON                                 $639.32     20090101
26358       REPAIR/GRAFT HAND TENDON      80                          $135.82     20090101
26358       REPAIR/GRAFT HAND TENDON      81                          $135.82     20090101
26358       REPAIR/GRAFT HAND TENDON      82                          $135.82     20090101
26358       REPAIR/GRAFT HAND TENDON      AS                          $135.82     20090101
26358       REPAIR/GRAFT HAND TENDON                                  $679.12     20090101
26358       REPAIR/GRAFT HAND TENDON                          Y       $595.86     20081209
26370       REPAIR FINGER/HAND TENDON                                 $573.11     20090101
26370       REPAIR FINGER/HAND TENDON                         Y       $595.86     20081209
26372       REPAIR/GRAFT HAND TENDON      80                          $132.59     20090101
26372       REPAIR/GRAFT HAND TENDON      81                          $132.59     20090101
26372       REPAIR/GRAFT HAND TENDON      82                          $132.59     20090101
26372       REPAIR/GRAFT HAND TENDON      AS                          $132.59     20090101
26372       REPAIR/GRAFT HAND TENDON                          Y       $595.86     20081209
26372       REPAIR/GRAFT HAND TENDON                                  $662.97     20090101
26373       REPAIR FINGER/HAND TENDON     80                          $125.92     20090101
26373       REPAIR FINGER/HAND TENDON     81                          $125.92     20090101
26373       REPAIR FINGER/HAND TENDON     82                          $125.92     20090101
26373       REPAIR FINGER/HAND TENDON     AS                          $125.92     20090101
26373       REPAIR FINGER/HAND TENDON                                 $629.59     20090101
26373       REPAIR FINGER/HAND TENDON                         Y       $523.86     20081209
26390       REVISE HAND/FINGER TENDON     80                          $122.19     20090101
26390       REVISE HAND/FINGER TENDON     81                          $122.19     20090101
26390       REVISE HAND/FINGER TENDON     82                          $122.19     20090101
26390       REVISE HAND/FINGER TENDON     AS                          $122.19     20090101
26390       REVISE HAND/FINGER TENDON                         Y       $595.86     20081209
26390       REVISE HAND/FINGER TENDON                                 $610.96     20090101
26392       REPAIR/GRAFT HAND TENDON      80                          $144.11     20090101
26392       REPAIR/GRAFT HAND TENDON      81                          $144.11     20090101
26392       REPAIR/GRAFT HAND TENDON      82                          $144.11     20090101
26392       REPAIR/GRAFT HAND TENDON      AS                          $144.11     20090101


                                        Page 89
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26392       REPAIR/GRAFT HAND TENDON                                     $720.57     20090101
26392       REPAIR/GRAFT HAND TENDON                             Y       $523.86     20081209
26410       REPAIR HAND TENDON                                           $422.88     20090101
26410       REPAIR HAND TENDON                                   Y       $442.32     20081209
26412       REPAIR/GRAFT HAND TENDON         80                          $101.77     20090101
26412       REPAIR/GRAFT HAND TENDON         81                          $101.77     20090101
26412       REPAIR/GRAFT HAND TENDON         82                          $101.77     20090101
26412       REPAIR/GRAFT HAND TENDON         AS                          $101.77     20090101
26412       REPAIR/GRAFT HAND TENDON                             Y       $523.86     20081209
26412       REPAIR/GRAFT HAND TENDON                                     $508.86     20090101
26415       EXCISION, HAND/FINGER TENDON                                 $528.87     20090101
26415       EXCISION, HAND/FINGER TENDON                         Y       $595.86     20081209
26416       GRAFT HAND OR FINGER TENDON      80                          $122.74     20090101
26416       GRAFT HAND OR FINGER TENDON      81                          $122.74     20090101
26416       GRAFT HAND OR FINGER TENDON      82                          $122.74     20090101
26416       GRAFT HAND OR FINGER TENDON      AS                          $122.74     20090101
26416       GRAFT HAND OR FINGER TENDON                          Y       $523.86     20081209
26416       GRAFT HAND OR FINGER TENDON                                  $613.70     20090101
26418       REPAIR FINGER TENDON                                         $423.99     20090101
26418       REPAIR FINGER TENDON                                 Y       $514.32     20081209
26420       REPAIR/GRAFT FINGER TENDON       80                          $106.39     20090101
26420       REPAIR/GRAFT FINGER TENDON       81                          $106.39     20090101
26420       REPAIR/GRAFT FINGER TENDON       82                          $106.39     20090101
26420       REPAIR/GRAFT FINGER TENDON       AS                          $106.39     20090101
26420       REPAIR/GRAFT FINGER TENDON                                   $531.94     20090101
26420       REPAIR/GRAFT FINGER TENDON                           Y       $595.86     20081209
26426       REPAIR FINGER/HAND TENDON        80                          $90.70      20090101
26426       REPAIR FINGER/HAND TENDON        81                          $90.70      20090101
26426       REPAIR FINGER/HAND TENDON        82                          $90.70      20090101
26426       REPAIR FINGER/HAND TENDON        AS                           $90.70     20090101
26426       REPAIR FINGER/HAND TENDON                            Y       $523.86     20081209
26426       REPAIR FINGER/HAND TENDON                                    $453.49     20090101
26428       REPAIR/GRAFT FINGER TENDON                                   $554.75     20090101
26428       REPAIR/GRAFT FINGER TENDON                           Y       $523.86     20081209
26432       REPAIR FINGER TENDON                                 Y       $442.32     20081209
26432       REPAIR FINGER TENDON                                         $368.35     20090101
26433       REPAIR FINGER TENDON                                 Y       $442.32     20081209
26433       REPAIR FINGER TENDON                                         $396.17     20090101
26434       REPAIR/GRAFT FINGER TENDON       80                          $93.58      20090101
26434       REPAIR/GRAFT FINGER TENDON       81                          $93.58      20090101
26434       REPAIR/GRAFT FINGER TENDON       82                          $93.58      20090101
26434       REPAIR/GRAFT FINGER TENDON       AS                           $93.58     20090101
26434       REPAIR/GRAFT FINGER TENDON                           Y       $523.86     20081209
26434       REPAIR/GRAFT FINGER TENDON                                   $467.92     20090101
26437       REALIGNMENT OF TENDONS                                       $457.93     20090101


                                           Page 90
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26437       REALIGNMENT OF TENDONS                               Y       $442.32     20081209
26440       RELEASE PALM/FINGER TENDON                                   $467.12     20090101
26440       RELEASE PALM/FINGER TENDON                           Y       $442.32     20081209
26442       RELEASE PALM & FINGER TENDON                         Y       $523.86     20081209
26442       RELEASE PALM & FINGER TENDON                                 $684.11     20090101
26445       RELEASE HAND/FINGER TENDON                                   $436.79     20090101
26445       RELEASE HAND/FINGER TENDON                           Y       $442.32     20081209
26449       RELEASE FOREARM/HAND TENDON                                  $582.29     20090101
26449       RELEASE FOREARM/HAND TENDON                          Y       $523.86     20081209
26450       INCISION OF PALM TENDON                              Y       $442.32     20081209
26450       INCISION OF PALM TENDON                                      $293.78     20090101
26455       INCISION OF FINGER TENDON                                    $291.56     20090101
26455       INCISION OF FINGER TENDON                            Y       $442.32     20081209
26460       INCISE HAND/FINGER TENDON                                    $283.22     20090101
26460       INCISE HAND/FINGER TENDON                            Y       $442.32     20081209
26471       FUSION OF FINGER TENDONS                                     $450.42     20090101
26471       FUSION OF FINGER TENDONS                             Y       $403.92     20081209
26474       FUSION OF FINGER TENDONS         80                           $87.02     20090101
26474       FUSION OF FINGER TENDONS         81                           $87.02     20090101
26474       FUSION OF FINGER TENDONS         82                           $87.02     20090101
26474       FUSION OF FINGER TENDONS         AS                           $87.02     20090101
26474       FUSION OF FINGER TENDONS                             Y       $403.92     20081209
26474       FUSION OF FINGER TENDONS                                     $435.11     20090101
26476       TENDON LENGTHENING               80                           $84.47     20090101
26476       TENDON LENGTHENING               81                           $84.47     20090101
26476       TENDON LENGTHENING               82                           $84.47     20090101
26476       TENDON LENGTHENING               AS                           $84.47     20090101
26476       TENDON LENGTHENING                                   Y       $336.12     20081209
26476       TENDON LENGTHENING                                           $422.33     20090101
26477       TENDON SHORTENING                                            $426.77     20090101
26477       TENDON SHORTENING                                    Y       $336.12     20081209
26478       LENGTHENING OF HAND TENDON                                   $460.99     20090101
26478       LENGTHENING OF HAND TENDON                           Y       $336.12     20081209
26479       SHORTENING OF HAND TENDON        80                           $91.09     20090101
26479       SHORTENING OF HAND TENDON        81                           $91.09     20090101
26479       SHORTENING OF HAND TENDON        82                           $91.09     20090101
26479       SHORTENING OF HAND TENDON        AS                           $91.09     20090101
26479       SHORTENING OF HAND TENDON                            Y       $336.12     20081209
26479       SHORTENING OF HAND TENDON                                    $455.45     20090101
26480       TRANSPLANT HAND TENDON           80                          $112.06     20090101
26480       TRANSPLANT HAND TENDON           81                          $112.06     20090101
26480       TRANSPLANT HAND TENDON           82                          $112.06     20090101
26480       TRANSPLANT HAND TENDON           AS                          $112.06     20090101
26480       TRANSPLANT HAND TENDON                                       $560.30     20090101
26480       TRANSPLANT HAND TENDON                               Y       $523.86     20081209


                                           Page 91
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26483       TRANSPLANT/GRAFT HAND TENDON     80                          $125.14     20090101
26483       TRANSPLANT/GRAFT HAND TENDON     81                          $125.14     20090101
26483       TRANSPLANT/GRAFT HAND TENDON     82                          $125.14     20090101
26483       TRANSPLANT/GRAFT HAND TENDON     AS                          $125.14     20090101
26483       TRANSPLANT/GRAFT HAND TENDON                                 $625.71     20090101
26483       TRANSPLANT/GRAFT HAND TENDON                         Y       $523.86     20081209
26485       TRANSPLANT PALM TENDON           80                          $120.46     20090101
26485       TRANSPLANT PALM TENDON           81                          $120.46     20090101
26485       TRANSPLANT PALM TENDON           82                          $120.46     20090101
26485       TRANSPLANT PALM TENDON           AS                          $120.46     20090101
26485       TRANSPLANT PALM TENDON                                       $602.32     20090101
26485       TRANSPLANT PALM TENDON                               Y       $485.46     20081209
26489       TRANSPLANT/GRAFT PALM TENDON                         Y       $523.86     20081209
26489       TRANSPLANT/GRAFT PALM TENDON                                 $624.58     20090101
26490       REVISE THUMB TENDON                                          $571.71     20090101
26490       REVISE THUMB TENDON                                  Y       $523.86     20081209
26492       TENDON TRANSFER WITH GRAFT       80                          $126.97     20090101
26492       TENDON TRANSFER WITH GRAFT       81                          $126.97     20090101
26492       TENDON TRANSFER WITH GRAFT       82                          $126.97     20090101
26492       TENDON TRANSFER WITH GRAFT       AS                          $126.97     20090101
26492       TENDON TRANSFER WITH GRAFT                           Y       $523.86     20081209
26492       TENDON TRANSFER WITH GRAFT                                   $634.87     20090101
26494       HAND TENDON/MUSCLE TRANSFER      80                          $116.46     20090101
26494       HAND TENDON/MUSCLE TRANSFER      81                          $116.46     20090101
26494       HAND TENDON/MUSCLE TRANSFER      82                          $116.46     20090101
26494       HAND TENDON/MUSCLE TRANSFER      AS                          $116.46     20090101
26494       HAND TENDON/MUSCLE TRANSFER                                  $582.29     20090101
26494       HAND TENDON/MUSCLE TRANSFER                          Y       $523.86     20081209
26496       REVISE THUMB TENDON                                          $626.53     20090101
26496       REVISE THUMB TENDON                                  Y       $523.86     20081209
26497       FINGER TENDON TRANSFER           80                          $125.80     20090101
26497       FINGER TENDON TRANSFER           81                          $125.80     20090101
26497       FINGER TENDON TRANSFER           82                          $125.80     20090101
26497       FINGER TENDON TRANSFER           AS                          $125.80     20090101
26497       FINGER TENDON TRANSFER                                       $629.02     20090101
26497       FINGER TENDON TRANSFER                               Y       $523.86     20081209
26498       FINGER TENDON TRANSFER           80                          $167.48     20090101
26498       FINGER TENDON TRANSFER           81                          $167.48     20090101
26498       FINGER TENDON TRANSFER           82                          $167.48     20090101
26498       FINGER TENDON TRANSFER           AS                          $167.48     20090101
26498       FINGER TENDON TRANSFER                                       $837.42     20090101
26498       FINGER TENDON TRANSFER                               Y       $595.86     20081209
26499       REVISION OF FINGER               80                          $118.80     20090101
26499       REVISION OF FINGER               81                          $118.80     20090101
26499       REVISION OF FINGER               82                          $118.80     20090101


                                           Page 92
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
26499       REVISION OF FINGER              AS                           $118.80      20090101
26499       REVISION OF FINGER                                           $593.99      20090101
26499       REVISION OF FINGER                                  Y        $523.86      20081209
26500       HAND TENDON RECONSTRUCTION                          Y        $514.32      20081209
26500       HAND TENDON RECONSTRUCTION                                   $459.60      20090101
26502       HAND TENDON RECONSTRUCTION      80                           $102.99      20090101
26502       HAND TENDON RECONSTRUCTION      81                           $102.99      20090101
26502       HAND TENDON RECONSTRUCTION      82                           $102.99      20090101
26502       HAND TENDON RECONSTRUCTION      AS                           $102.99      20090101
26502       HAND TENDON RECONSTRUCTION                          Y        $595.86      20081209
26502       HAND TENDON RECONSTRUCTION                                   $514.96      20090101
26508       RELEASE THUMB CONTRACTURE                                    $467.12      20090101
26508       RELEASE THUMB CONTRACTURE                           Y        $442.32      20081209
26510       THUMB TENDON TRANSFER                                        $438.74      20090101
26510       THUMB TENDON TRANSFER                               Y        $523.86      20081209
26516       FUSION OF KNUCKLE JOINT                                      $517.19      20090101
26516       FUSION OF KNUCKLE JOINT                             Y        $417.66      20081209
26517       FUSION OF KNUCKLE JOINTS        80                           $120.35      20090101
26517       FUSION OF KNUCKLE JOINTS        81                           $120.35      20090101
26517       FUSION OF KNUCKLE JOINTS        82                           $120.35      20090101
26517       FUSION OF KNUCKLE JOINTS        AS                           $120.35      20090101
26517       FUSION OF KNUCKLE JOINTS                            Y        $523.86      20081209
26517       FUSION OF KNUCKLE JOINTS                                     $601.75      20090101
26518       FUSION OF KNUCKLE JOINTS        80                           $120.63      20090101
26518       FUSION OF KNUCKLE JOINTS        81                           $120.63      20090101
26518       FUSION OF KNUCKLE JOINTS        82                           $120.63      20090101
26518       FUSION OF KNUCKLE JOINTS        AS                           $120.63      20090101
26518       FUSION OF KNUCKLE JOINTS                            Y        $523.86      20081209
26518       FUSION OF KNUCKLE JOINTS                                     $603.15      20090101
26520       RELEASE KNUCKLE CONTRACTURE                         Y        $442.32      20081209
26520       RELEASE KNUCKLE CONTRACTURE                                  $488.25      20090101
26525       RELEASE FINGER CONTRACTURE                                   $490.76      20090101
26525       RELEASE FINGER CONTRACTURE                          Y        $442.32      20081209
26530       REVISE KNUCKLE JOINT            80                            $75.57      20090101
26530       REVISE KNUCKLE JOINT            81                            $75.57      20090101
26530       REVISE KNUCKLE JOINT            82                            $75.57      20090101
26530       REVISE KNUCKLE JOINT            AS                            $75.57      20090101
26530       REVISE KNUCKLE JOINT                                         $377.83      20090101
26530       REVISE KNUCKLE JOINT                                Y        $603.30      20081209
26531       REVISE KNUCKLE WITH IMPLANT     80                           $87.96       20090101
26531       REVISE KNUCKLE WITH IMPLANT     81                           $87.96       20090101
26531       REVISE KNUCKLE WITH IMPLANT     82                           $87.96       20090101
26531       REVISE KNUCKLE WITH IMPLANT     AS                            $87.96      20090101
26531       REVISE KNUCKLE WITH IMPLANT                         Y       $1,018.36     20081209
26531       REVISE KNUCKLE WITH IMPLANT                                  $439.82      20090101


                                          Page 93
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
26535       REVISE FINGER JOINT                                           $276.26      20090101
26535       REVISE FINGER JOINT                                  Y        $727.50      20081209
26536       REVISE/IMPLANT FINGER JOINT      80                           $93.76       20090101
26536       REVISE/IMPLANT FINGER JOINT      81                           $93.76       20090101
26536       REVISE/IMPLANT FINGER JOINT      82                           $93.76       20090101
26536       REVISE/IMPLANT FINGER JOINT      AS                            $93.76      20090101
26536       REVISE/IMPLANT FINGER JOINT                                   $468.80      20090101
26536       REVISE/IMPLANT FINGER JOINT                          Y        $851.56      20081209
26540       REPAIR HAND JOINT                                    Y        $514.32      20081209
26540       REPAIR HAND JOINT                                             $485.48      20090101
26541       REPAIR HAND JOINT WITH GRAFT     80                           $118.12      20090101
26541       REPAIR HAND JOINT WITH GRAFT     81                           $118.12      20090101
26541       REPAIR HAND JOINT WITH GRAFT     82                           $118.12      20090101
26541       REPAIR HAND JOINT WITH GRAFT     AS                           $118.12      20090101
26541       REPAIR HAND JOINT WITH GRAFT                         Y        $814.86      20081209
26541       REPAIR HAND JOINT WITH GRAFT                                  $590.62      20090101
26542       REPAIR HAND JOINT WITH GRAFT                                  $500.22      20090101
26542       REPAIR HAND JOINT WITH GRAFT                         Y        $514.32      20081209
26545       RECONSTRUCT FINGER JOINT                             Y        $595.86      20081209
26545       RECONSTRUCT FINGER JOINT                                      $510.23      20090101
26546       REPAIR NONUNION HAND             80                           $140.27      20090101
26546       REPAIR NONUNION HAND             81                           $140.27      20090101
26546       REPAIR NONUNION HAND             82                           $140.27      20090101
26546       REPAIR NONUNION HAND             AS                           $140.27      20090101
26546       REPAIR NONUNION HAND                                 Y        $595.86      20081209
26546       REPAIR NONUNION HAND                                          $701.37      20090101
26548       RECONSTRUCT FINGER JOINT                                      $560.03      20090101
26548       RECONSTRUCT FINGER JOINT                             Y        $595.86      20081209
26550       CONSTRUCT THUMB REPLACEMENT      80                           $222.96      20090101
26550       CONSTRUCT THUMB REPLACEMENT      81                           $222.96      20090101
26550       CONSTRUCT THUMB REPLACEMENT      82                           $222.96      20090101
26550       CONSTRUCT THUMB REPLACEMENT      AS                           $222.96      20090101
26550       CONSTRUCT THUMB REPLACEMENT                                  $1,114.80     20090101
26550       CONSTRUCT THUMB REPLACEMENT                          Y        $485.46      20081209
26551       GREAT TOE-HAND TRANSFER          80                           $450.87      20090101
26551       GREAT TOE-HAND TRANSFER          81                           $450.87      20090101
26551       GREAT TOE-HAND TRANSFER          82                           $450.87      20090101
26551       GREAT TOE-HAND TRANSFER          AS                           $450.87      20090101
26551       GREAT TOE-HAND TRANSFER                                      $2,254.33     20090101
26553       SINGLE TRANSFER, TOE-HAND        80                           $419.42      20090101
26553       SINGLE TRANSFER, TOE-HAND        81                           $419.42      20090101
26553       SINGLE TRANSFER, TOE-HAND        82                           $419.42      20090101
26553       SINGLE TRANSFER, TOE-HAND        AS                           $419.42      20090101
26553       SINGLE TRANSFER, TOE-HAND                                    $2,097.12     20090101
26554       DOUBLE TRANSFER, TOE-HAND        80                           $572.33      20090101


                                           Page 94
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
26554       DOUBLE TRANSFER, TOE-HAND       81                           $572.33      20090101
26554       DOUBLE TRANSFER, TOE-HAND       82                           $572.33      20090101
26554       DOUBLE TRANSFER, TOE-HAND       AS                           $572.33      20090101
26554       DOUBLE TRANSFER, TOE-HAND                                   $2,861.67     20090101
26555       POSITIONAL CHANGE OF FINGER     80                           $197.70      20090101
26555       POSITIONAL CHANGE OF FINGER     81                           $197.70      20090101
26555       POSITIONAL CHANGE OF FINGER     82                           $197.70      20090101
26555       POSITIONAL CHANGE OF FINGER     AS                           $197.70      20090101
26555       POSITIONAL CHANGE OF FINGER                                  $988.48      20090101
26555       POSITIONAL CHANGE OF FINGER                         Y        $523.86      20081209
26556       TOE JOINT TRANSFER              80                           $432.39      20090101
26556       TOE JOINT TRANSFER              81                           $432.39      20090101
26556       TOE JOINT TRANSFER              82                           $432.39      20090101
26556       TOE JOINT TRANSFER              AS                           $432.39      20090101
26556       TOE JOINT TRANSFER                                          $2,161.96     20090101
26560       REPAIR OF WEB FINGER            80                            $80.74      20090101
26560       REPAIR OF WEB FINGER            81                            $80.74      20090101
26560       REPAIR OF WEB FINGER            82                            $80.74      20090101
26560       REPAIR OF WEB FINGER            AS                            $80.74      20090101
26560       REPAIR OF WEB FINGER                                Y        $403.92      20081209
26560       REPAIR OF WEB FINGER                                         $403.70      20090101
26561       REPAIR OF WEB FINGER            80                           $129.98      20090101
26561       REPAIR OF WEB FINGER            81                           $129.98      20090101
26561       REPAIR OF WEB FINGER            82                           $129.98      20090101
26561       REPAIR OF WEB FINGER            AS                           $129.98      20090101
26561       REPAIR OF WEB FINGER                                Y        $523.86      20081209
26561       REPAIR OF WEB FINGER                                         $649.88      20090101
26562       REPAIR OF WEB FINGER            80                           $175.83      20090101
26562       REPAIR OF WEB FINGER            81                           $175.83      20090101
26562       REPAIR OF WEB FINGER            82                           $175.83      20090101
26562       REPAIR OF WEB FINGER            AS                           $175.83      20090101
26562       REPAIR OF WEB FINGER                                Y        $595.86      20081209
26562       REPAIR OF WEB FINGER                                         $879.13      20090101
26565       CORRECT METACARPAL FLAW         80                            $99.48      20090101
26565       CORRECT METACARPAL FLAW         81                            $99.48      20090101
26565       CORRECT METACARPAL FLAW         82                            $99.48      20090101
26565       CORRECT METACARPAL FLAW         AS                            $99.48      20090101
26565       CORRECT METACARPAL FLAW                                      $497.42      20090101
26565       CORRECT METACARPAL FLAW                             Y        $648.06      20081209
26567       CORRECT FINGER DEFORMITY                                     $499.66      20090101
26567       CORRECT FINGER DEFORMITY                            Y        $648.06      20081209
26568       LENGTHEN METACARPAL/FINGER      80                           $131.92      20090101
26568       LENGTHEN METACARPAL/FINGER      81                           $131.92      20090101
26568       LENGTHEN METACARPAL/FINGER      82                           $131.92      20090101
26568       LENGTHEN METACARPAL/FINGER      AS                           $131.92      20090101


                                          Page 95
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26568       LENGTHEN METACARPAL/FINGER                           Y       $523.86     20081209
26568       LENGTHEN METACARPAL/FINGER                                   $659.61     20090101
26580       REPAIR HAND DEFORMITY            80                          $186.34     20090101
26580       REPAIR HAND DEFORMITY            81                          $186.34     20090101
26580       REPAIR HAND DEFORMITY            82                          $186.34     20090101
26580       REPAIR HAND DEFORMITY            AS                          $186.34     20090101
26580       REPAIR HAND DEFORMITY                                        $931.71     20090101
26580       REPAIR HAND DEFORMITY                                Y       $566.52     20081209
26587       RECONSTRUCT EXTRA FINGER         80                          $136.38     20090101
26587       RECONSTRUCT EXTRA FINGER         81                          $136.38     20090101
26587       RECONSTRUCT EXTRA FINGER         82                          $136.38     20090101
26587       RECONSTRUCT EXTRA FINGER         AS                          $136.38     20090101
26587       RECONSTRUCT EXTRA FINGER                                     $681.91     20090101
26587       RECONSTRUCT EXTRA FINGER                             Y       $566.52     20081209
26590       REPAIR FINGER DEFORMITY          80                          $191.85     20090101
26590       REPAIR FINGER DEFORMITY          81                          $191.85     20090101
26590       REPAIR FINGER DEFORMITY          82                          $191.85     20090101
26590       REPAIR FINGER DEFORMITY          AS                          $191.85     20090101
26590       REPAIR FINGER DEFORMITY                              Y       $566.52     20081209
26590       REPAIR FINGER DEFORMITY                                      $959.24     20090101
26591       REPAIR MUSCLES OF HAND                               Y       $523.86     20081209
26591       REPAIR MUSCLES OF HAND                                       $325.51     20090101
26593       RELEASE MUSCLES OF HAND                                      $434.83     20090101
26593       RELEASE MUSCLES OF HAND                              Y       $442.32     20081209
26596       EXCISION CONSTRICTING TISSUE     80                          $103.55     20090101
26596       EXCISION CONSTRICTING TISSUE     81                          $103.55     20090101
26596       EXCISION CONSTRICTING TISSUE     82                          $103.55     20090101
26596       EXCISION CONSTRICTING TISSUE     AS                          $103.55     20090101
26596       EXCISION CONSTRICTING TISSUE                         Y       $403.92     20081209
26596       EXCISION CONSTRICTING TISSUE                                 $517.76     20090101
26600       TREAT METACARPAL FRACTURE                                    $181.11     20090101
26605       TREAT METACARPAL FRACTURE                                    $215.05     20090101
26605       TREAT METACARPAL FRACTURE                            Y        $76.82     20081209
26607       TREAT METACARPAL FRACTURE                                    $329.68     20090101
26607       TREAT METACARPAL FRACTURE                            Y        $76.82     20081209
26608       TREAT METACARPAL FRACTURE                            Y       $594.61     20081209
26608       TREAT METACARPAL FRACTURE                                    $335.24     20090101
26615       TREAT METACARPAL FRACTURE                                    $373.64     20090101
26615       TREAT METACARPAL FRACTURE                            Y       $718.39     20081209
26641       TREAT THUMB DISLOCATION                                      $242.05     20090101
26645       TREAT THUMB FRACTURE                                         $279.05     20090101
26645       TREAT THUMB FRACTURE                                 Y        $76.82     20081209
26650       TREAT THUMB FRACTURE                                 Y       $484.21     20081209
26650       TREAT THUMB FRACTURE                                         $331.62     20090101
26665       TREAT THUMB FRACTURE             80                           $84.30     20090101


                                           Page 96
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
26665       TREAT THUMB FRACTURE            81                          $84.30      20090101
26665       TREAT THUMB FRACTURE            82                          $84.30      20090101
26665       TREAT THUMB FRACTURE            AS                           $84.30     20090101
26665       TREAT THUMB FRACTURE                                Y       $718.39     20081209
26665       TREAT THUMB FRACTURE                                        $421.50     20090101
26670       TREAT HAND DISLOCATION                                      $224.51     20090101
26675       TREAT HAND DISLOCATION                                      $301.86     20090101
26675       TREAT HAND DISLOCATION                              Y        $76.82     20081209
26676       PIN HAND DISLOCATION            80                          $70.33      20090101
26676       PIN HAND DISLOCATION            81                          $70.33      20090101
26676       PIN HAND DISLOCATION            82                          $70.33      20090101
26676       PIN HAND DISLOCATION            AS                           $70.33     20090101
26676       PIN HAND DISLOCATION                                        $351.64     20090101
26676       PIN HAND DISLOCATION                                Y       $484.21     20081209
26685       TREAT HAND DISLOCATION          80                          $78.24      20090101
26685       TREAT HAND DISLOCATION          81                          $78.24      20090101
26685       TREAT HAND DISLOCATION          82                          $78.24      20090101
26685       TREAT HAND DISLOCATION          AS                           $78.24     20090101
26685       TREAT HAND DISLOCATION                                      $391.18     20090101
26685       TREAT HAND DISLOCATION                              Y       $522.61     20081209
26686       TREAT HAND DISLOCATION          80                          $87.86      20090101
26686       TREAT HAND DISLOCATION          81                          $87.86      20090101
26686       TREAT HAND DISLOCATION          82                          $87.86      20090101
26686       TREAT HAND DISLOCATION          AS                           $87.86     20090101
26686       TREAT HAND DISLOCATION                              Y       $796.38     20081209
26686       TREAT HAND DISLOCATION                                      $439.31     20090101
26700       TREAT KNUCKLE DISLOCATION                                   $212.00     20090101
26705       TREAT KNUCKLE DISLOCATION                                   $277.09     20090101
26705       TREAT KNUCKLE DISLOCATION                           Y        $76.82     20081209
26706       PIN KNUCKLE DISLOCATION         80                          $60.65      20090101
26706       PIN KNUCKLE DISLOCATION         81                          $60.65      20090101
26706       PIN KNUCKLE DISLOCATION         82                          $60.65      20090101
26706       PIN KNUCKLE DISLOCATION         AS                           $60.65     20090101
26706       PIN KNUCKLE DISLOCATION                             Y        $76.82     20081209
26706       PIN KNUCKLE DISLOCATION                                     $303.26     20090101
26715       TREAT KNUCKLE DISLOCATION                                   $376.70     20090101
26715       TREAT KNUCKLE DISLOCATION                           Y       $594.61     20081209
26720       TREAT FINGER FRACTURE, EACH                                 $128.54     20090101
26725       TREAT FINGER FRACTURE, EACH                                 $232.31     20090101
26727       TREAT FINGER FRACTURE, EACH                                 $329.68     20090101
26727       TREAT FINGER FRACTURE, EACH                         Y       $813.61     20081209
26735       TREAT FINGER FRACTURE, EACH                         Y       $594.61     20081209
26735       TREAT FINGER FRACTURE, EACH                                 $390.88     20090101
26740       TREAT FINGER FRACTURE, EACH                                 $149.40     20090101
26742       TREAT FINGER FRACTURE, EACH                                 $253.45     20090101


                                          Page 97
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26742       TREAT FINGER FRACTURE, EACH                          Y        $76.82     20081209
26746       TREAT FINGER FRACTURE, EACH                                  $469.61     20090101
26746       TREAT FINGER FRACTURE, EACH                          Y       $646.81     20081209
26750       TREAT FINGER FRACTURE, EACH                                  $120.46     20090101
26755       TREAT FINGER FRACTURE, EACH                                  $212.83     20090101
26756       PIN FINGER FRACTURE, EACH                                    $291.00     20090101
26756       PIN FINGER FRACTURE, EACH                            Y       $484.21     20081209
26765       TREAT FINGER FRACTURE, EACH                                  $314.10     20090101
26765       TREAT FINGER FRACTURE, EACH                          Y       $594.61     20081209
26770       TREAT FINGER DISLOCATION                                     $181.39     20090101
26775       TREAT FINGER DISLOCATION                                     $256.78     20090101
26776       PIN FINGER DISLOCATION                                       $309.92     20090101
26776       PIN FINGER DISLOCATION                               Y       $484.21     20081209
26785       TREAT FINGER DISLOCATION                             Y       $484.21     20081209
26785       TREAT FINGER DISLOCATION                                     $341.36     20090101
26820       THUMB FUSION WITH GRAFT          80                          $115.40     20090101
26820       THUMB FUSION WITH GRAFT          81                          $115.40     20090101
26820       THUMB FUSION WITH GRAFT          82                          $115.40     20090101
26820       THUMB FUSION WITH GRAFT          AS                          $115.40     20090101
26820       THUMB FUSION WITH GRAFT                              Y       $648.06     20081209
26820       THUMB FUSION WITH GRAFT                                      $577.01     20090101
26841       FUSION OF THUMB                                              $539.44     20090101
26841       FUSION OF THUMB                                      Y       $595.86     20081209
26842       THUMB FUSION WITH GRAFT          80                          $116.23     20090101
26842       THUMB FUSION WITH GRAFT          81                          $116.23     20090101
26842       THUMB FUSION WITH GRAFT          82                          $116.23     20090101
26842       THUMB FUSION WITH GRAFT          AS                          $116.23     20090101
26842       THUMB FUSION WITH GRAFT                                      $581.15     20090101
26842       THUMB FUSION WITH GRAFT                              Y       $595.86     20081209
26843       FUSION OF HAND JOINT             80                          $107.28     20090101
26843       FUSION OF HAND JOINT             81                          $107.28     20090101
26843       FUSION OF HAND JOINT             82                          $107.28     20090101
26843       FUSION OF HAND JOINT             AS                          $107.28     20090101
26843       FUSION OF HAND JOINT                                 Y       $523.86     20081209
26843       FUSION OF HAND JOINT                                         $536.39     20090101
26844       FUSION/GRAFT OF HAND JOINT       80                          $119.41     20090101
26844       FUSION/GRAFT OF HAND JOINT       81                          $119.41     20090101
26844       FUSION/GRAFT OF HAND JOINT       82                          $119.41     20090101
26844       FUSION/GRAFT OF HAND JOINT       AS                          $119.41     20090101
26844       FUSION/GRAFT OF HAND JOINT                           Y       $523.86     20081209
26844       FUSION/GRAFT OF HAND JOINT                                   $597.04     20090101
26850       FUSION OF KNUCKLE                                    Y       $595.86     20081209
26850       FUSION OF KNUCKLE                                            $509.95     20090101
26852       FUSION OF KNUCKLE WITH GRAFT     80                          $115.90     20090101
26852       FUSION OF KNUCKLE WITH GRAFT     81                          $115.90     20090101


                                           Page 98
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
26852       FUSION OF KNUCKLE WITH GRAFT     82                          $115.90     20090101
26852       FUSION OF KNUCKLE WITH GRAFT     AS                          $115.90     20090101
26852       FUSION OF KNUCKLE WITH GRAFT                         Y       $595.86     20081209
26852       FUSION OF KNUCKLE WITH GRAFT                                 $579.50     20090101
26860       FUSION OF FINGER JOINT                               Y       $523.86     20081209
26860       FUSION OF FINGER JOINT                                       $413.42     20090101
26861       FUSION OF FINGER JNT, ADD-ON                                 $78.73      20090101
26861       FUSION OF FINGER JNT, ADD-ON                         Y       $485.46     20081209
26862       FUSION/GRAFT OF FINGER JOINT     80                          $105.99     20090101
26862       FUSION/GRAFT OF FINGER JOINT     81                          $105.99     20090101
26862       FUSION/GRAFT OF FINGER JOINT     82                          $105.99     20090101
26862       FUSION/GRAFT OF FINGER JOINT     AS                          $105.99     20090101
26862       FUSION/GRAFT OF FINGER JOINT                                 $529.97     20090101
26862       FUSION/GRAFT OF FINGER JOINT                         Y       $595.86     20081209
26863       FUSE/GRAFT ADDED JOINT           80                           $35.06     20090101
26863       FUSE/GRAFT ADDED JOINT           81                           $35.06     20090101
26863       FUSE/GRAFT ADDED JOINT           82                           $35.06     20090101
26863       FUSE/GRAFT ADDED JOINT           AS                           $35.06     20090101
26863       FUSE/GRAFT ADDED JOINT                               Y       $523.86     20081209
26863       FUSE/GRAFT ADDED JOINT                                       $175.28     20090101
26910       AMPUTATE METACARPAL BONE                                     $516.91     20090101
26910       AMPUTATE METACARPAL BONE                             Y       $523.86     20081209
26951       AMPUTATION OF FINGER/THUMB                                   $440.68     20090101
26951       AMPUTATION OF FINGER/THUMB                           Y       $403.92     20081209
26952       AMPUTATION OF FINGER/THUMB                           Y       $514.32     20081209
26952       AMPUTATION OF FINGER/THUMB                                   $476.02     20090101
26990       DRAINAGE OF PELVIS LESION                            Y       $375.91     20081209
26990       DRAINAGE OF PELVIS LESION                                    $438.74     20090101
26991       DRAINAGE OF PELVIS BURSA                                     $499.94     20090101
26991       DRAINAGE OF PELVIS BURSA                             Y       $375.91     20081209
26992       DRAINAGE OF BONE LESION                                      $693.85     20090101
27000       INCISION OF HIP TENDON           80                          $64.21      20090101
27000       INCISION OF HIP TENDON           81                          $64.21      20090101
27000       INCISION OF HIP TENDON           82                          $64.21      20090101
27000       INCISION OF HIP TENDON           AS                           $64.21     20090101
27000       INCISION OF HIP TENDON                                       $321.06     20090101
27000       INCISION OF HIP TENDON                               Y       $443.71     20081209
27001       INCISION OF HIP TENDON           80                          $77.63      20090101
27001       INCISION OF HIP TENDON           81                          $77.63      20090101
27001       INCISION OF HIP TENDON           82                          $77.63      20090101
27001       INCISION OF HIP TENDON           AS                           $77.63     20090101
27001       INCISION OF HIP TENDON                                       $388.13     20090101
27001       INCISION OF HIP TENDON                               Y       $547.70     20081209
27003       INCISION OF HIP TENDON           80                          $83.07      20090101
27003       INCISION OF HIP TENDON           81                          $83.07      20090101


                                           Page 99
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27003       INCISION OF HIP TENDON            82                          $83.07      20090101
27003       INCISION OF HIP TENDON            AS                           $83.07     20090101
27003       INCISION OF HIP TENDON                                Y       $547.70     20081209
27003       INCISION OF HIP TENDON                                        $415.35     20090101
27005       INCISION OF HIP TENDON            80                          $104.82     20090101
27005       INCISION OF HIP TENDON            81                          $104.82     20090101
27005       INCISION OF HIP TENDON            82                          $104.82     20090101
27005       INCISION OF HIP TENDON            AS                          $104.82     20090101
27005       INCISION OF HIP TENDON                                        $524.12     20090101
27006       INCISION OF HIP TENDONS           80                          $106.06     20090101
27006       INCISION OF HIP TENDONS           81                          $106.06     20090101
27006       INCISION OF HIP TENDONS           82                          $106.06     20090101
27006       INCISION OF HIP TENDONS           AS                          $106.06     20090101
27006       INCISION OF HIP TENDONS                                       $530.28     20090101
27025       INCISION OF HIP/THIGH FASCIA                                  $636.81     20090101
27030       DRAINAGE OF HIP JOINT             80                          $137.16     20090101
27030       DRAINAGE OF HIP JOINT             81                          $137.16     20090101
27030       DRAINAGE OF HIP JOINT             82                          $137.16     20090101
27030       DRAINAGE OF HIP JOINT             AS                          $137.16     20090101
27030       DRAINAGE OF HIP JOINT                                         $685.79     20090101
27033       EXPLORATION OF HIP JOINT          80                          $141.77     20090101
27033       EXPLORATION OF HIP JOINT          81                          $141.77     20090101
27033       EXPLORATION OF HIP JOINT          82                          $141.77     20090101
27033       EXPLORATION OF HIP JOINT          AS                          $141.77     20090101
27033       EXPLORATION OF HIP JOINT                                      $708.87     20090101
27033       EXPLORATION OF HIP JOINT                              Y       $661.93     20081209
27035       DENERVATION OF HIP JOINT          80                          $162.87     20090101
27035       DENERVATION OF HIP JOINT          81                          $162.87     20090101
27035       DENERVATION OF HIP JOINT          82                          $162.87     20090101
27035       DENERVATION OF HIP JOINT          AS                          $162.87     20090101
27035       DENERVATION OF HIP JOINT                              Y       $733.93     20081209
27035       DENERVATION OF HIP JOINT                                      $814.34     20090101
27036       EXCISION OF HIP JOINT/MUSCLE      80                          $144.23     20090101
27036       EXCISION OF HIP JOINT/MUSCLE      81                          $144.23     20090101
27036       EXCISION OF HIP JOINT/MUSCLE      82                          $144.23     20090101
27036       EXCISION OF HIP JOINT/MUSCLE      AS                          $144.23     20090101
27036       EXCISION OF HIP JOINT/MUSCLE                                  $721.14     20090101
27040       BIOPSY OF SOFT TISSUES                                        $233.13     20090101
27040       BIOPSY OF SOFT TISSUES                                Y       $271.71     20081209
27041       BIOPSY OF SOFT TISSUES                                        $489.93     20090101
27041       BIOPSY OF SOFT TISSUES                                Y       $323.01     20081209
27047       REMOVE HIP/PELVIS LESION                                      $434.29     20090101
27047       REMOVE HIP/PELVIS LESION                              Y       $442.39     20081209
27048       REMOVE HIP/PELVIS LESION          80                          $67.10      20090101
27048       REMOVE HIP/PELVIS LESION          81                          $67.10      20090101


                                           Page 100
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
27048       REMOVE HIP/PELVIS LESION         82                          $67.10      20090101
27048       REMOVE HIP/PELVIS LESION         AS                           $67.10     20090101
27048       REMOVE HIP/PELVIS LESION                             Y       $480.79     20081209
27048       REMOVE HIP/PELVIS LESION                                     $335.50     20090101
27049       REMOVE TUMOR, HIP/PELVIS         80                          $142.22     20090101
27049       REMOVE TUMOR, HIP/PELVIS         81                          $142.22     20090101
27049       REMOVE TUMOR, HIP/PELVIS         82                          $142.22     20090101
27049       REMOVE TUMOR, HIP/PELVIS         AS                          $142.22     20090101
27049       REMOVE TUMOR, HIP/PELVIS                                     $711.10     20090101
27049       REMOVE TUMOR, HIP/PELVIS                             Y       $480.79     20081209
27050       BIOPSY OF SACROILIAC JOINT                           Y       $482.11     20081209
27050       BIOPSY OF SACROILIAC JOINT                                   $249.55     20090101
27052       BIOPSY OF HIP JOINT              80                          $78.57      20090101
27052       BIOPSY OF HIP JOINT              81                          $78.57      20090101
27052       BIOPSY OF HIP JOINT              82                          $78.57      20090101
27052       BIOPSY OF HIP JOINT              AS                           $78.57     20090101
27052       BIOPSY OF HIP JOINT                                  Y       $482.11     20081209
27052       BIOPSY OF HIP JOINT                                          $392.83     20090101
27054       REMOVAL OF HIP JOINT LINING      80                          $97.26      20090101
27054       REMOVAL OF HIP JOINT LINING      81                          $97.26      20090101
27054       REMOVAL OF HIP JOINT LINING      82                          $97.26      20090101
27054       REMOVAL OF HIP JOINT LINING      AS                           $97.26     20090101
27054       REMOVAL OF HIP JOINT LINING                                  $486.29     20090101
27060       REMOVAL OF ISCHIAL BURSA         80                          $60.93      20090101
27060       REMOVAL OF ISCHIAL BURSA         81                          $60.93      20090101
27060       REMOVAL OF ISCHIAL BURSA         82                          $60.93      20090101
27060       REMOVAL OF ISCHIAL BURSA         AS                           $60.93     20090101
27060       REMOVAL OF ISCHIAL BURSA                             Y       $606.31     20081209
27060       REMOVAL OF ISCHIAL BURSA                                     $304.65     20090101
27062       REMOVE FEMUR LESION/BURSA        80                          $63.93      20090101
27062       REMOVE FEMUR LESION/BURSA        81                          $63.93      20090101
27062       REMOVE FEMUR LESION/BURSA        82                          $63.93      20090101
27062       REMOVE FEMUR LESION/BURSA        AS                           $63.93     20090101
27062       REMOVE FEMUR LESION/BURSA                            Y       $606.31     20081209
27062       REMOVE FEMUR LESION/BURSA                                    $319.66     20090101
27065       REMOVAL OF HIP BONE LESION       80                          $70.49      20090101
27065       REMOVAL OF HIP BONE LESION       81                          $70.49      20090101
27065       REMOVAL OF HIP BONE LESION       82                          $70.49      20090101
27065       REMOVAL OF HIP BONE LESION       AS                           $70.49     20090101
27065       REMOVAL OF HIP BONE LESION                                   $352.47     20090101
27065       REMOVAL OF HIP BONE LESION                           Y       $606.31     20081209
27066       REMOVAL OF HIP BONE LESION       80                          $115.73     20090101
27066       REMOVAL OF HIP BONE LESION       81                          $115.73     20090101
27066       REMOVAL OF HIP BONE LESION       82                          $115.73     20090101
27066       REMOVAL OF HIP BONE LESION       AS                          $115.73     20090101


                                          Page 101
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27066       REMOVAL OF HIP BONE LESION                            Y        $671.90      20081209
27066       REMOVAL OF HIP BONE LESION                                     $578.67      20090101
27067       REMOVE/GRAFT HIP BONE LESION      80                           $145.67      20090101
27067       REMOVE/GRAFT HIP BONE LESION      81                           $145.67      20090101
27067       REMOVE/GRAFT HIP BONE LESION      82                           $145.67      20090101
27067       REMOVE/GRAFT HIP BONE LESION      AS                           $145.67      20090101
27067       REMOVE/GRAFT HIP BONE LESION                          Y        $671.90      20081209
27067       REMOVE/GRAFT HIP BONE LESION                                   $728.33      20090101
27070       PARTIAL REMOVAL OF HIP BONE       80                           $121.19      20090101
27070       PARTIAL REMOVAL OF HIP BONE       81                           $121.19      20090101
27070       PARTIAL REMOVAL OF HIP BONE       82                           $121.19      20090101
27070       PARTIAL REMOVAL OF HIP BONE       AS                           $121.19      20090101
27070       PARTIAL REMOVAL OF HIP BONE                                    $605.94      20090101
27071       PARTIAL REMOVAL OF HIP BONE       80                           $130.70      20090101
27071       PARTIAL REMOVAL OF HIP BONE       81                           $130.70      20090101
27071       PARTIAL REMOVAL OF HIP BONE       82                           $130.70      20090101
27071       PARTIAL REMOVAL OF HIP BONE       AS                           $130.70      20090101
27071       PARTIAL REMOVAL OF HIP BONE                                    $653.50      20090101
27075       EXTENSIVE HIP SURGERY             80                           $334.46      20090101
27075       EXTENSIVE HIP SURGERY             81                           $334.46      20090101
27075       EXTENSIVE HIP SURGERY             82                           $334.46      20090101
27075       EXTENSIVE HIP SURGERY             AS                           $334.46      20090101
27075       EXTENSIVE HIP SURGERY                                         $1,672.30     20090101
27076       EXTENSIVE HIP SURGERY             80                           $231.70      20090101
27076       EXTENSIVE HIP SURGERY             81                           $231.70      20090101
27076       EXTENSIVE HIP SURGERY             82                           $231.70      20090101
27076       EXTENSIVE HIP SURGERY             AS                           $231.70      20090101
27076       EXTENSIVE HIP SURGERY                                         $1,158.48     20090101
27077       EXTENSIVE HIP SURGERY             80                           $389.44      20090101
27077       EXTENSIVE HIP SURGERY             81                           $389.44      20090101
27077       EXTENSIVE HIP SURGERY             82                           $389.44      20090101
27077       EXTENSIVE HIP SURGERY             AS                           $389.44      20090101
27077       EXTENSIVE HIP SURGERY                                         $1,947.20     20090101
27078       EXTENSIVE HIP SURGERY             80                           $145.50      20090101
27078       EXTENSIVE HIP SURGERY             81                           $145.50      20090101
27078       EXTENSIVE HIP SURGERY             82                           $145.50      20090101
27078       EXTENSIVE HIP SURGERY             AS                           $145.50      20090101
27078       EXTENSIVE HIP SURGERY                                          $727.50      20090101
27079       EXTENSIVE HIP SURGERY             80                           $142.66      20090101
27079       EXTENSIVE HIP SURGERY             81                           $142.66      20090101
27079       EXTENSIVE HIP SURGERY             82                           $142.66      20090101
27079       EXTENSIVE HIP SURGERY             AS                           $142.66      20090101
27079       EXTENSIVE HIP SURGERY                                          $713.32      20090101
27080       REMOVAL OF TAIL BONE              80                           $69.22       20090101
27080       REMOVAL OF TAIL BONE              81                           $69.22       20090101


                                           Page 102
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27080       REMOVAL OF TAIL BONE              82                            $69.22      20090101
27080       REMOVAL OF TAIL BONE              AS                            $69.22      20090101
27080       REMOVAL OF TAIL BONE                                  Y        $509.30      20081209
27080       REMOVAL OF TAIL BONE                                           $346.10      20090101
27086       REMOVE HIP FOREIGN BODY                                        $173.88      20090101
27086       REMOVE HIP FOREIGN BODY                               Y        $271.71      20081209
27087       REMOVE HIP FOREIGN BODY           80                            $90.30      20090101
27087       REMOVE HIP FOREIGN BODY           81                            $90.30      20090101
27087       REMOVE HIP FOREIGN BODY           82                            $90.30      20090101
27087       REMOVE HIP FOREIGN BODY           AS                            $90.30      20090101
27087       REMOVE HIP FOREIGN BODY                                        $451.52      20090101
27087       REMOVE HIP FOREIGN BODY                               Y        $482.11      20081209
27090       REMOVAL OF HIP PROSTHESIS         80                           $120.30      20090101
27090       REMOVAL OF HIP PROSTHESIS         81                           $120.30      20090101
27090       REMOVAL OF HIP PROSTHESIS         82                           $120.30      20090101
27090       REMOVAL OF HIP PROSTHESIS         AS                           $120.30      20090101
27090       REMOVAL OF HIP PROSTHESIS                                      $601.49      20090101
27091       REMOVAL OF HIP PROSTHESIS         80                           $230.69      20090101
27091       REMOVAL OF HIP PROSTHESIS         81                           $230.69      20090101
27091       REMOVAL OF HIP PROSTHESIS         82                           $230.69      20090101
27091       REMOVAL OF HIP PROSTHESIS         AS                           $230.69      20090101
27091       REMOVAL OF HIP PROSTHESIS                                     $1,153.46     20090101
27093       INJECTION FOR HIP X-RAY                                        $145.78      20090101
27095       INJECTION FOR HIP X-RAY                                        $176.94      20090101
27096       INJECT SACROILIAC JOINT                                        $136.88      20090101
27097       REVISION OF HIP TENDON            80                            $95.20      20090101
27097       REVISION OF HIP TENDON            81                            $95.20      20090101
27097       REVISION OF HIP TENDON            82                            $95.20      20090101
27097       REVISION OF HIP TENDON            AS                            $95.20      20090101
27097       REVISION OF HIP TENDON                                         $476.00      20090101
27097       REVISION OF HIP TENDON                                Y        $547.70      20081209
27098       TRANSFER TENDON TO PELVIS         80                            $89.69      20090101
27098       TRANSFER TENDON TO PELVIS         81                            $89.69      20090101
27098       TRANSFER TENDON TO PELVIS         82                            $89.69      20090101
27098       TRANSFER TENDON TO PELVIS         AS                            $89.69      20090101
27098       TRANSFER TENDON TO PELVIS                                      $448.47      20090101
27098       TRANSFER TENDON TO PELVIS                             Y        $547.70      20081209
27100       TRANSFER OF ABDOMINAL MUSCLE      80                           $117.46      20090101
27100       TRANSFER OF ABDOMINAL MUSCLE      81                           $117.46      20090101
27100       TRANSFER OF ABDOMINAL MUSCLE      82                           $117.46      20090101
27100       TRANSFER OF ABDOMINAL MUSCLE      AS                           $117.46      20090101
27100       TRANSFER OF ABDOMINAL MUSCLE                          Y        $733.93      20081209
27100       TRANSFER OF ABDOMINAL MUSCLE                                   $587.31      20090101
27105       TRANSFER OF SPINAL MUSCLE         80                           $121.80      20090101
27105       TRANSFER OF SPINAL MUSCLE         81                           $121.80      20090101


                                           Page 103
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27105       TRANSFER OF SPINAL MUSCLE         82                           $121.80      20090101
27105       TRANSFER OF SPINAL MUSCLE         AS                           $121.80      20090101
27105       TRANSFER OF SPINAL MUSCLE                             Y        $733.93      20081209
27105       TRANSFER OF SPINAL MUSCLE                                      $608.99      20090101
27110       TRANSFER OF ILIOPSOAS MUSCLE      80                           $136.43      20090101
27110       TRANSFER OF ILIOPSOAS MUSCLE      81                           $136.43      20090101
27110       TRANSFER OF ILIOPSOAS MUSCLE      82                           $136.43      20090101
27110       TRANSFER OF ILIOPSOAS MUSCLE      AS                           $136.43      20090101
27110       TRANSFER OF ILIOPSOAS MUSCLE                          Y        $733.93      20081209
27110       TRANSFER OF ILIOPSOAS MUSCLE                                   $682.17      20090101
27111       TRANSFER OF ILIOPSOAS MUSCLE      80                           $128.09      20090101
27111       TRANSFER OF ILIOPSOAS MUSCLE      81                           $128.09      20090101
27111       TRANSFER OF ILIOPSOAS MUSCLE      82                           $128.09      20090101
27111       TRANSFER OF ILIOPSOAS MUSCLE      AS                           $128.09      20090101
27111       TRANSFER OF ILIOPSOAS MUSCLE                                   $640.46      20090101
27111       TRANSFER OF ILIOPSOAS MUSCLE                          Y        $733.93      20081209
27120       RECONSTRUCTION OF HIP SOCKET      80                           $186.51      20090101
27120       RECONSTRUCTION OF HIP SOCKET      81                           $186.51      20090101
27120       RECONSTRUCTION OF HIP SOCKET      82                           $186.51      20090101
27120       RECONSTRUCTION OF HIP SOCKET      AS                           $186.51      20090101
27120       RECONSTRUCTION OF HIP SOCKET                                   $932.54      20090101
27122       RECONSTRUCTION OF HIP SOCKET      80                           $160.30      20090101
27122       RECONSTRUCTION OF HIP SOCKET      81                           $160.30      20090101
27122       RECONSTRUCTION OF HIP SOCKET      82                           $160.30      20090101
27122       RECONSTRUCTION OF HIP SOCKET      AS                           $160.30      20090101
27122       RECONSTRUCTION OF HIP SOCKET                                   $801.50      20090101
27125       PARTIAL HIP REPLACEMENT           80                           $162.03      20090101
27125       PARTIAL HIP REPLACEMENT           81                           $162.03      20090101
27125       PARTIAL HIP REPLACEMENT           82                           $162.03      20090101
27125       PARTIAL HIP REPLACEMENT           AS                           $162.03      20090101
27125       PARTIAL HIP REPLACEMENT                                        $810.15      20090101
27130       TOTAL HIP ARTHROPLASTY            80                           $209.55      20090101
27130       TOTAL HIP ARTHROPLASTY            81                           $209.55      20090101
27130       TOTAL HIP ARTHROPLASTY            82                           $209.55      20090101
27130       TOTAL HIP ARTHROPLASTY            AS                           $209.55      20090101
27130       TOTAL HIP ARTHROPLASTY                                        $1,047.73     20090101
27132       TOTAL HIP ARTHROPLASTY            80                           $245.26      20090101
27132       TOTAL HIP ARTHROPLASTY            81                           $245.26      20090101
27132       TOTAL HIP ARTHROPLASTY            82                           $245.26      20090101
27132       TOTAL HIP ARTHROPLASTY            AS                           $245.26      20090101
27132       TOTAL HIP ARTHROPLASTY                                        $1,226.32     20090101
27134       REVISE HIP JOINT REPLACEMENT      80                           $285.61      20090101
27134       REVISE HIP JOINT REPLACEMENT      81                           $285.61      20090101
27134       REVISE HIP JOINT REPLACEMENT      82                           $285.61      20090101
27134       REVISE HIP JOINT REPLACEMENT      AS                           $285.61      20090101


                                           Page 104
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27134       REVISE HIP JOINT REPLACEMENT                                  $1,428.04     20090101
27137       REVISE HIP JOINT REPLACEMENT      80                           $217.39      20090101
27137       REVISE HIP JOINT REPLACEMENT      81                           $217.39      20090101
27137       REVISE HIP JOINT REPLACEMENT      82                           $217.39      20090101
27137       REVISE HIP JOINT REPLACEMENT      AS                           $217.39      20090101
27137       REVISE HIP JOINT REPLACEMENT                                  $1,086.96     20090101
27138       REVISE HIP JOINT REPLACEMENT      80                           $226.24      20090101
27138       REVISE HIP JOINT REPLACEMENT      81                           $226.24      20090101
27138       REVISE HIP JOINT REPLACEMENT      82                           $226.24      20090101
27138       REVISE HIP JOINT REPLACEMENT      AS                           $226.24      20090101
27138       REVISE HIP JOINT REPLACEMENT                                  $1,131.20     20090101
27140       TRANSPLANT FEMUR RIDGE            80                           $130.37      20090101
27140       TRANSPLANT FEMUR RIDGE            81                           $130.37      20090101
27140       TRANSPLANT FEMUR RIDGE            82                           $130.37      20090101
27140       TRANSPLANT FEMUR RIDGE            AS                           $130.37      20090101
27140       TRANSPLANT FEMUR RIDGE                                         $651.84      20090101
27146       INCISION OF HIP BONE              80                           $184.23      20090101
27146       INCISION OF HIP BONE              81                           $184.23      20090101
27146       INCISION OF HIP BONE              82                           $184.23      20090101
27146       INCISION OF HIP BONE              AS                           $184.23      20090101
27146       INCISION OF HIP BONE                                           $921.15      20090101
27147       REVISION OF HIP BONE              80                           $211.94      20090101
27147       REVISION OF HIP BONE              81                           $211.94      20090101
27147       REVISION OF HIP BONE              82                           $211.94      20090101
27147       REVISION OF HIP BONE              AS                           $211.94      20090101
27147       REVISION OF HIP BONE                                          $1,059.68     20090101
27151       INCISION OF HIP BONES             80                           $212.89      20090101
27151       INCISION OF HIP BONES             81                           $212.89      20090101
27151       INCISION OF HIP BONES             82                           $212.89      20090101
27151       INCISION OF HIP BONES             AS                           $212.89      20090101
27151       INCISION OF HIP BONES                                         $1,064.45     20090101
27156       REVISION OF HIP BONES             80                           $251.23      20090101
27156       REVISION OF HIP BONES             81                           $251.23      20090101
27156       REVISION OF HIP BONES             82                           $251.23      20090101
27156       REVISION OF HIP BONES             AS                           $251.23      20090101
27156       REVISION OF HIP BONES                                         $1,256.13     20090101
27158       REVISION OF PELVIS                80                           $196.47      20090101
27158       REVISION OF PELVIS                81                           $196.47      20090101
27158       REVISION OF PELVIS                82                           $196.47      20090101
27158       REVISION OF PELVIS                AS                           $196.47      20090101
27158       REVISION OF PELVIS                                             $982.37      20090101
27161       INCISION OF NECK OF FEMUR         80                           $177.67      20090101
27161       INCISION OF NECK OF FEMUR         81                           $177.67      20090101
27161       INCISION OF NECK OF FEMUR         82                           $177.67      20090101
27161       INCISION OF NECK OF FEMUR         AS                           $177.67      20090101


                                           Page 105
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27161       INCISION OF NECK OF FEMUR                                     $888.34     20090101
27165       INCISION/FIXATION OF FEMUR        80                          $197.08     20090101
27165       INCISION/FIXATION OF FEMUR        81                          $197.08     20090101
27165       INCISION/FIXATION OF FEMUR        82                          $197.08     20090101
27165       INCISION/FIXATION OF FEMUR        AS                          $197.08     20090101
27165       INCISION/FIXATION OF FEMUR                                    $985.42     20090101
27170       REPAIR/GRAFT FEMUR HEAD/NECK      80                          $171.43     20090101
27170       REPAIR/GRAFT FEMUR HEAD/NECK      81                          $171.43     20090101
27170       REPAIR/GRAFT FEMUR HEAD/NECK      82                          $171.43     20090101
27170       REPAIR/GRAFT FEMUR HEAD/NECK      AS                          $171.43     20090101
27170       REPAIR/GRAFT FEMUR HEAD/NECK                                  $857.14     20090101
27175       TREAT SLIPPED EPIPHYSIS                                       $463.77     20090101
27176       TREAT SLIPPED EPIPHYSIS           80                          $131.37     20090101
27176       TREAT SLIPPED EPIPHYSIS           81                          $131.37     20090101
27176       TREAT SLIPPED EPIPHYSIS           82                          $131.37     20090101
27176       TREAT SLIPPED EPIPHYSIS           AS                          $131.37     20090101
27176       TREAT SLIPPED EPIPHYSIS                                       $656.86     20090101
27177       TREAT SLIPPED EPIPHYSIS           80                          $160.41     20090101
27177       TREAT SLIPPED EPIPHYSIS           81                          $160.41     20090101
27177       TREAT SLIPPED EPIPHYSIS           82                          $160.41     20090101
27177       TREAT SLIPPED EPIPHYSIS           AS                          $160.41     20090101
27177       TREAT SLIPPED EPIPHYSIS                                       $802.07     20090101
27178       TREAT SLIPPED EPIPHYSIS           80                          $128.36     20090101
27178       TREAT SLIPPED EPIPHYSIS           81                          $128.36     20090101
27178       TREAT SLIPPED EPIPHYSIS           82                          $128.36     20090101
27178       TREAT SLIPPED EPIPHYSIS           AS                          $128.36     20090101
27178       TREAT SLIPPED EPIPHYSIS                                       $641.80     20090101
27179       REVISE HEAD/NECK OF FEMUR         80                          $141.22     20090101
27179       REVISE HEAD/NECK OF FEMUR         81                          $141.22     20090101
27179       REVISE HEAD/NECK OF FEMUR         82                          $141.22     20090101
27179       REVISE HEAD/NECK OF FEMUR         AS                          $141.22     20090101
27179       REVISE HEAD/NECK OF FEMUR                                     $706.08     20090101
27181       TREAT SLIPPED EPIPHYSIS           80                          $153.18     20090101
27181       TREAT SLIPPED EPIPHYSIS           81                          $153.18     20090101
27181       TREAT SLIPPED EPIPHYSIS           82                          $153.18     20090101
27181       TREAT SLIPPED EPIPHYSIS           AS                          $153.18     20090101
27181       TREAT SLIPPED EPIPHYSIS                                       $765.90     20090101
27185       REVISION OF FEMUR EPIPHYSIS       80                          $106.55     20090101
27185       REVISION OF FEMUR EPIPHYSIS       81                          $106.55     20090101
27185       REVISION OF FEMUR EPIPHYSIS       82                          $106.55     20090101
27185       REVISION OF FEMUR EPIPHYSIS       AS                          $106.55     20090101
27185       REVISION OF FEMUR EPIPHYSIS                                   $532.77     20090101
27187       REINFORCE HIP BONES               80                          $144.56     20090101
27187       REINFORCE HIP BONES               81                          $144.56     20090101
27187       REINFORCE HIP BONES               82                          $144.56     20090101


                                           Page 106
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
27187       REINFORCE HIP BONES             AS                           $144.56      20090101
27187       REINFORCE HIP BONES                                          $722.79      20090101
27193       TREAT PELVIC RING FRACTURE                                   $328.28      20090101
27193       TREAT PELVIC RING FRACTURE                          Y         $76.82      20081209
27194       TREAT PELVIC RING FRACTURE                                   $524.70      20090101
27194       TREAT PELVIC RING FRACTURE                          Y        $389.86      20081209
27200       TREAT TAIL BONE FRACTURE                                     $119.63      20090101
27202       TREAT TAIL BONE FRACTURE        80                           $106.83      20090101
27202       TREAT TAIL BONE FRACTURE        81                           $106.83      20090101
27202       TREAT TAIL BONE FRACTURE        82                           $106.83      20090101
27202       TREAT TAIL BONE FRACTURE        AS                           $106.83      20090101
27202       TREAT TAIL BONE FRACTURE                            Y        $607.99      20081209
27202       TREAT TAIL BONE FRACTURE                                     $534.16      20090101
27215       TREAT PELVIC FRACTURE(S)        80                           $107.11      20090101
27215       TREAT PELVIC FRACTURE(S)        81                           $107.11      20090101
27215       TREAT PELVIC FRACTURE(S)        82                           $107.11      20090101
27215       TREAT PELVIC FRACTURE(S)        AS                           $107.11      20090101
27215       TREAT PELVIC FRACTURE(S)                                     $535.56      20090101
27216       TREAT PELVIC RING FRACTURE      80                           $154.35      20090101
27216       TREAT PELVIC RING FRACTURE      81                           $154.35      20090101
27216       TREAT PELVIC RING FRACTURE      82                           $154.35      20090101
27216       TREAT PELVIC RING FRACTURE      AS                           $154.35      20090101
27216       TREAT PELVIC RING FRACTURE                                   $771.75      20090101
27217       TREAT PELVIC RING FRACTURE      80                           $147.23      20090101
27217       TREAT PELVIC RING FRACTURE      81                           $147.23      20090101
27217       TREAT PELVIC RING FRACTURE      82                           $147.23      20090101
27217       TREAT PELVIC RING FRACTURE      AS                           $147.23      20090101
27217       TREAT PELVIC RING FRACTURE                                   $736.14      20090101
27218       TREAT PELVIC RING FRACTURE      80                           $199.14      20090101
27218       TREAT PELVIC RING FRACTURE      81                           $199.14      20090101
27218       TREAT PELVIC RING FRACTURE      82                           $199.14      20090101
27218       TREAT PELVIC RING FRACTURE      AS                           $199.14      20090101
27218       TREAT PELVIC RING FRACTURE                                   $995.72      20090101
27220       TREAT HIP SOCKET FRACTURE                                    $369.46      20090101
27222       TREAT HIP SOCKET FRACTURE                                    $707.21      20090101
27226       TREAT HIP WALL FRACTURE         80                           $146.39      20090101
27226       TREAT HIP WALL FRACTURE         81                           $146.39      20090101
27226       TREAT HIP WALL FRACTURE         82                           $146.39      20090101
27226       TREAT HIP WALL FRACTURE         AS                           $146.39      20090101
27226       TREAT HIP WALL FRACTURE                                      $731.95      20090101
27227       TREAT HIP FRACTURE(S)           80                           $242.94      20090101
27227       TREAT HIP FRACTURE(S)           81                           $242.94      20090101
27227       TREAT HIP FRACTURE(S)           82                           $242.94      20090101
27227       TREAT HIP FRACTURE(S)           AS                           $242.94      20090101
27227       TREAT HIP FRACTURE(S)                                       $1,214.68     20090101


                                         Page 107
Proc Code   Description                Modifier 1 Modifier 2 ASC     Price     Effective Date
27228       TREAT HIP FRACTURE(S)      80                           $278.44      20090101
27228       TREAT HIP FRACTURE(S)      81                           $278.44      20090101
27228       TREAT HIP FRACTURE(S)      82                           $278.44      20090101
27228       TREAT HIP FRACTURE(S)      AS                           $278.44      20090101
27228       TREAT HIP FRACTURE(S)                                  $1,392.18     20090101
27230       TREAT THIGH FRACTURE                                    $330.24      20090101
27230       TREAT THIGH FRACTURE                           Y         $76.82      20081209
27232       TREAT THIGH FRACTURE                                    $560.87      20090101
27235       TREAT THIGH FRACTURE       80                           $131.98      20090101
27235       TREAT THIGH FRACTURE       81                           $131.98      20090101
27235       TREAT THIGH FRACTURE       82                           $131.98      20090101
27235       TREAT THIGH FRACTURE       AS                           $131.98      20090101
27235       TREAT THIGH FRACTURE                                    $659.92      20090101
27236       TREAT THIGH FRACTURE       80                           $171.10      20090101
27236       TREAT THIGH FRACTURE       81                           $171.10      20090101
27236       TREAT THIGH FRACTURE       82                           $171.10      20090101
27236       TREAT THIGH FRACTURE       AS                           $171.10      20090101
27236       TREAT THIGH FRACTURE                                    $855.48      20090101
27238       TREAT THIGH FRACTURE                           Y         $76.82      20081209
27238       TREAT THIGH FRACTURE                                    $317.99      20090101
27240       TREAT THIGH FRACTURE                                    $686.34      20090101
27244       TREAT THIGH FRACTURE       80                           $168.71      20090101
27244       TREAT THIGH FRACTURE       81                           $168.71      20090101
27244       TREAT THIGH FRACTURE       82                           $168.71      20090101
27244       TREAT THIGH FRACTURE       AS                           $168.71      20090101
27244       TREAT THIGH FRACTURE                                    $843.53      20090101
27245       TREAT THIGH FRACTURE       80                           $206.82      20090101
27245       TREAT THIGH FRACTURE       81                           $206.82      20090101
27245       TREAT THIGH FRACTURE       82                           $206.82      20090101
27245       TREAT THIGH FRACTURE       AS                           $206.82      20090101
27245       TREAT THIGH FRACTURE                                   $1,034.12     20090101
27246       TREAT THIGH FRACTURE                           Y         $76.82      20081209
27246       TREAT THIGH FRACTURE                                    $270.97      20090101
27248       TREAT THIGH FRACTURE       80                           $109.95      20090101
27248       TREAT THIGH FRACTURE       81                           $109.95      20090101
27248       TREAT THIGH FRACTURE       82                           $109.95      20090101
27248       TREAT THIGH FRACTURE       AS                           $109.95      20090101
27248       TREAT THIGH FRACTURE                                    $549.74      20090101
27250       TREAT HIP DISLOCATION                                   $341.92      20090101
27250       TREAT HIP DISLOCATION                          Y         $76.82      20081209
27252       TREAT HIP DISLOCATION                                   $543.62      20090101
27252       TREAT HIP DISLOCATION                          Y        $389.86      20081209
27253       TREAT HIP DISLOCATION      80                           $137.38      20090101
27253       TREAT HIP DISLOCATION      81                           $137.38      20090101
27253       TREAT HIP DISLOCATION      82                           $137.38      20090101


                                    Page 108
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
27253       TREAT HIP DISLOCATION           AS                           $137.38      20090101
27253       TREAT HIP DISLOCATION                                        $686.88      20090101
27254       TREAT HIP DISLOCATION           80                           $185.07      20090101
27254       TREAT HIP DISLOCATION           81                           $185.07      20090101
27254       TREAT HIP DISLOCATION           82                           $185.07      20090101
27254       TREAT HIP DISLOCATION           AS                           $185.07      20090101
27254       TREAT HIP DISLOCATION                                        $925.34      20090101
27256       TREAT HIP DISLOCATION                                        $215.05      20090101
27257       TREAT HIP DISLOCATION                                        $242.59      20090101
27257       TREAT HIP DISLOCATION                               Y        $428.26      20081209
27258       TREAT HIP DISLOCATION           80                           $160.64      20090101
27258       TREAT HIP DISLOCATION           81                           $160.64      20090101
27258       TREAT HIP DISLOCATION           82                           $160.64      20090101
27258       TREAT HIP DISLOCATION           AS                           $160.64      20090101
27258       TREAT HIP DISLOCATION                                        $803.21      20090101
27259       TREAT HIP DISLOCATION           80                           $223.85      20090101
27259       TREAT HIP DISLOCATION           81                           $223.85      20090101
27259       TREAT HIP DISLOCATION           82                           $223.85      20090101
27259       TREAT HIP DISLOCATION           AS                           $223.85      20090101
27259       TREAT HIP DISLOCATION                                       $1,119.25     20090101
27265       TREAT HIP DISLOCATION                                        $281.55      20090101
27265       TREAT HIP DISLOCATION                               Y         $76.82      20081209
27266       TREAT HIP DISLOCATION                                        $414.25      20090101
27266       TREAT HIP DISLOCATION                               Y        $389.86      20081209
27267       CLTX THIGH FX                                                $296.85      20090101
27267       CLTX THIGH FX                                       Y         $58.57      20080101
27268       CLTX THIGH FX W/MNPJ                                         $366.68      20090101
27269       OPTX THIGH FX                                                $878.28      20080101
27275       MANIPULATION OF HIP JOINT                           Y        $389.86      20081209
27275       MANIPULATION OF HIP JOINT                                    $129.64      20090101
27280       FUSION OF SACROILIAC JOINT      80                           $148.07      20090101
27280       FUSION OF SACROILIAC JOINT      81                           $148.07      20090101
27280       FUSION OF SACROILIAC JOINT      82                           $148.07      20090101
27280       FUSION OF SACROILIAC JOINT      AS                           $148.07      20090101
27280       FUSION OF SACROILIAC JOINT                                   $740.34      20090101
27282       FUSION OF PUBIC BONES           80                           $119.46      20090101
27282       FUSION OF PUBIC BONES           81                           $119.46      20090101
27282       FUSION OF PUBIC BONES           82                           $119.46      20090101
27282       FUSION OF PUBIC BONES           AS                           $119.46      20090101
27282       FUSION OF PUBIC BONES                                        $597.30      20090101
27284       FUSION OF HIP JOINT             80                           $234.98      20090101
27284       FUSION OF HIP JOINT             81                           $234.98      20090101
27284       FUSION OF HIP JOINT             82                           $234.98      20090101
27284       FUSION OF HIP JOINT             AS                           $234.98      20090101
27284       FUSION OF HIP JOINT                                         $1,174.88     20090101


                                         Page 109
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27286       FUSION OF HIP JOINT               80                           $235.42      20090101
27286       FUSION OF HIP JOINT               81                           $235.42      20090101
27286       FUSION OF HIP JOINT               82                           $235.42      20090101
27286       FUSION OF HIP JOINT               AS                           $235.42      20090101
27286       FUSION OF HIP JOINT                                           $1,177.11     20090101
27290       AMPUTATION OF LEG AT HIP          80                           $227.63      20090101
27290       AMPUTATION OF LEG AT HIP          81                           $227.63      20090101
27290       AMPUTATION OF LEG AT HIP          82                           $227.63      20090101
27290       AMPUTATION OF LEG AT HIP          AS                           $227.63      20090101
27290       AMPUTATION OF LEG AT HIP                                      $1,138.14     20090101
27295       AMPUTATION OF LEG AT HIP          80                           $183.34      20090101
27295       AMPUTATION OF LEG AT HIP          81                           $183.34      20090101
27295       AMPUTATION OF LEG AT HIP          82                           $183.34      20090101
27295       AMPUTATION OF LEG AT HIP          AS                           $183.34      20090101
27295       AMPUTATION OF LEG AT HIP                                       $916.70      20090101
27301       DRAIN THIGH/KNEE LESION                               Y        $457.69      20081209
27301       DRAIN THIGH/KNEE LESION                                        $468.78      20090101
27303       DRAINAGE OF BONE LESION           80                            $91.47      20090101
27303       DRAINAGE OF BONE LESION           81                            $91.47      20090101
27303       DRAINAGE OF BONE LESION           82                            $91.47      20090101
27303       DRAINAGE OF BONE LESION           AS                            $91.47      20090101
27303       DRAINAGE OF BONE LESION                                        $457.37      20090101
27305       INCISE THIGH TENDON & FASCIA      80                            $66.93      20090101
27305       INCISE THIGH TENDON & FASCIA      81                            $66.93      20090101
27305       INCISE THIGH TENDON & FASCIA      82                            $66.93      20090101
27305       INCISE THIGH TENDON & FASCIA      AS                            $66.93      20090101
27305       INCISE THIGH TENDON & FASCIA                          Y        $443.71      20081209
27305       INCISE THIGH TENDON & FASCIA                                   $334.67      20090101
27306       INCISION OF THIGH TENDON          80                            $55.14      20090101
27306       INCISION OF THIGH TENDON          81                            $55.14      20090101
27306       INCISION OF THIGH TENDON          82                            $55.14      20090101
27306       INCISION OF THIGH TENDON          AS                            $55.14      20090101
27306       INCISION OF THIGH TENDON                                       $275.72      20090101
27306       INCISION OF THIGH TENDON                              Y        $482.11      20081209
27307       INCISION OF THIGH TENDONS         80                            $67.16      20090101
27307       INCISION OF THIGH TENDONS         81                            $67.16      20090101
27307       INCISION OF THIGH TENDONS         82                            $67.16      20090101
27307       INCISION OF THIGH TENDONS         AS                            $67.16      20090101
27307       INCISION OF THIGH TENDONS                             Y        $482.11      20081209
27307       INCISION OF THIGH TENDONS                                      $335.81      20090101
27310       EXPLORATION OF KNEE JOINT         80                           $103.88      20090101
27310       EXPLORATION OF KNEE JOINT         81                           $103.88      20090101
27310       EXPLORATION OF KNEE JOINT         82                           $103.88      20090101
27310       EXPLORATION OF KNEE JOINT         AS                           $103.88      20090101
27310       EXPLORATION OF KNEE JOINT                                      $519.41      20090101


                                           Page 110
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
27310       EXPLORATION OF KNEE JOINT                           Y       $619.70     20081209
27323       BIOPSY, THIGH SOFT TISSUES                                  $178.05     20090101
27323       BIOPSY, THIGH SOFT TISSUES                          Y       $271.71     20081209
27324       BIOPSY, THIGH SOFT TISSUES                          Y       $374.59     20081209
27324       BIOPSY, THIGH SOFT TISSUES                                  $269.87     20090101
27325       NEURECTOMY, HAMSTRING                                       $365.84     20090101
27325       NEURECTOMY, HAMSTRING                               Y       $417.07     20081209
27326       NEURECTOMY, POPLITEAL                                       $350.54     20090101
27326       NEURECTOMY, POPLITEAL                               Y       $417.07     20081209
27327       REMOVAL OF THIGH LESION                                     $311.04     20090101
27327       REMOVAL OF THIGH LESION                             Y       $442.39     20081209
27328       REMOVAL OF THIGH LESION                                     $297.13     20090101
27328       REMOVAL OF THIGH LESION                             Y       $480.79     20081209
27329       REMOVE TUMOR, THIGH/KNEE        80                          $147.89     20090101
27329       REMOVE TUMOR, THIGH/KNEE        81                          $147.89     20090101
27329       REMOVE TUMOR, THIGH/KNEE        82                          $147.89     20090101
27329       REMOVE TUMOR, THIGH/KNEE        AS                          $147.89     20090101
27329       REMOVE TUMOR, THIGH/KNEE                                    $739.46     20090101
27329       REMOVE TUMOR, THIGH/KNEE                            Y       $552.79     20081209
27330       BIOPSY, KNEE JOINT LINING       80                           $57.31     20090101
27330       BIOPSY, KNEE JOINT LINING       81                           $57.31     20090101
27330       BIOPSY, KNEE JOINT LINING       82                           $57.31     20090101
27330       BIOPSY, KNEE JOINT LINING       AS                           $57.31     20090101
27330       BIOPSY, KNEE JOINT LINING                           Y       $619.70     20081209
27330       BIOPSY, KNEE JOINT LINING                                   $286.54     20090101
27331       EXPLORE/TREAT KNEE JOINT        80                          $67.38      20090101
27331       EXPLORE/TREAT KNEE JOINT        81                          $67.38      20090101
27331       EXPLORE/TREAT KNEE JOINT        82                          $67.38      20090101
27331       EXPLORE/TREAT KNEE JOINT        AS                           $67.38     20090101
27331       EXPLORE/TREAT KNEE JOINT                            Y       $619.70     20081209
27331       EXPLORE/TREAT KNEE JOINT                                    $336.89     20090101
27332       REMOVAL OF KNEE CARTILAGE       80                          $91.19      20090101
27332       REMOVAL OF KNEE CARTILAGE       81                          $91.19      20090101
27332       REMOVAL OF KNEE CARTILAGE       82                          $91.19      20090101
27332       REMOVAL OF KNEE CARTILAGE       AS                           $91.19     20090101
27332       REMOVAL OF KNEE CARTILAGE                                   $455.97     20090101
27332       REMOVAL OF KNEE CARTILAGE                           Y       $619.70     20081209
27333       REMOVAL OF KNEE CARTILAGE       80                          $82.74      20090101
27333       REMOVAL OF KNEE CARTILAGE       81                          $82.74      20090101
27333       REMOVAL OF KNEE CARTILAGE       82                          $82.74      20090101
27333       REMOVAL OF KNEE CARTILAGE       AS                           $82.74     20090101
27333       REMOVAL OF KNEE CARTILAGE                                   $413.69     20090101
27333       REMOVAL OF KNEE CARTILAGE                           Y       $619.70     20081209
27334       REMOVE KNEE JOINT LINING        80                          $97.37      20090101
27334       REMOVE KNEE JOINT LINING        81                          $97.37      20090101


                                         Page 111
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
27334       REMOVE KNEE JOINT LINING       82                          $97.37      20090101
27334       REMOVE KNEE JOINT LINING       AS                           $97.37     20090101
27334       REMOVE KNEE JOINT LINING                           Y       $619.70     20081209
27334       REMOVE KNEE JOINT LINING                                   $486.86     20090101
27335       REMOVE KNEE JOINT LINING       80                          $110.17     20090101
27335       REMOVE KNEE JOINT LINING       81                          $110.17     20090101
27335       REMOVE KNEE JOINT LINING       82                          $110.17     20090101
27335       REMOVE KNEE JOINT LINING       AS                          $110.17     20090101
27335       REMOVE KNEE JOINT LINING                                   $550.83     20090101
27335       REMOVE KNEE JOINT LINING                           Y       $619.70     20081209
27340       REMOVAL OF KNEECAP BURSA                                   $257.34     20090101
27340       REMOVAL OF KNEECAP BURSA                           Y       $482.11     20081209
27345       REMOVAL OF KNEE CYST           80                          $68.10      20090101
27345       REMOVAL OF KNEE CYST           81                          $68.10      20090101
27345       REMOVAL OF KNEE CYST           82                          $68.10      20090101
27345       REMOVAL OF KNEE CYST           AS                           $68.10     20090101
27345       REMOVAL OF KNEE CYST                                       $340.52     20090101
27345       REMOVAL OF KNEE CYST                               Y       $554.11     20081209
27347       REMOVE KNEE CYST               80                          $71.78      20090101
27347       REMOVE KNEE CYST               81                          $71.78      20090101
27347       REMOVE KNEE CYST               82                          $71.78      20090101
27347       REMOVE KNEE CYST               AS                           $71.78     20090101
27347       REMOVE KNEE CYST                                           $358.89     20090101
27347       REMOVE KNEE CYST                                   Y       $554.11     20081209
27350       REMOVAL OF KNEECAP             80                          $92.92      20090101
27350       REMOVAL OF KNEECAP             81                          $92.92      20090101
27350       REMOVAL OF KNEECAP             82                          $92.92      20090101
27350       REMOVAL OF KNEECAP             AS                           $92.92     20090101
27350       REMOVAL OF KNEECAP                                 Y       $619.70     20081209
27350       REMOVAL OF KNEECAP                                         $464.61     20090101
27355       REMOVE FEMUR LESION            80                          $86.25      20090101
27355       REMOVE FEMUR LESION            81                          $86.25      20090101
27355       REMOVE FEMUR LESION            82                          $86.25      20090101
27355       REMOVE FEMUR LESION            AS                           $86.25     20090101
27355       REMOVE FEMUR LESION                                Y       $547.70     20081209
27355       REMOVE FEMUR LESION                                        $431.23     20090101
27356       REMOVE FEMUR LESION/GRAFT      80                          $105.50     20090101
27356       REMOVE FEMUR LESION/GRAFT      81                          $105.50     20090101
27356       REMOVE FEMUR LESION/GRAFT      82                          $105.50     20090101
27356       REMOVE FEMUR LESION/GRAFT      AS                          $105.50     20090101
27356       REMOVE FEMUR LESION/GRAFT                                  $527.49     20090101
27356       REMOVE FEMUR LESION/GRAFT                          Y       $619.70     20081209
27357       REMOVE FEMUR LESION/GRAFT      80                          $117.23     20090101
27357       REMOVE FEMUR LESION/GRAFT      81                          $117.23     20090101
27357       REMOVE FEMUR LESION/GRAFT      82                          $117.23     20090101


                                        Page 112
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27357       REMOVE FEMUR LESION/GRAFT         AS                          $117.23     20090101
27357       REMOVE FEMUR LESION/GRAFT                                     $586.17     20090101
27357       REMOVE FEMUR LESION/GRAFT                             Y       $671.90     20081209
27358       REMOVE FEMUR LESION/FIXATION      80                          $42.95      20090101
27358       REMOVE FEMUR LESION/FIXATION      81                          $42.95      20090101
27358       REMOVE FEMUR LESION/FIXATION      82                          $42.95      20090101
27358       REMOVE FEMUR LESION/FIXATION      AS                           $42.95     20090101
27358       REMOVE FEMUR LESION/FIXATION                          Y       $671.90     20081209
27358       REMOVE FEMUR LESION/FIXATION                                  $214.76     20090101
27360       PARTIAL REMOVAL, LEG BONE(S)      80                          $122.36     20090101
27360       PARTIAL REMOVAL, LEG BONE(S)      81                          $122.36     20090101
27360       PARTIAL REMOVAL, LEG BONE(S)      82                          $122.36     20090101
27360       PARTIAL REMOVAL, LEG BONE(S)      AS                          $122.36     20090101
27360       PARTIAL REMOVAL, LEG BONE(S)                          Y       $671.90     20081209
27360       PARTIAL REMOVAL, LEG BONE(S)                                  $611.79     20090101
27365       EXTENSIVE LEG SURGERY             80                          $176.83     20090101
27365       EXTENSIVE LEG SURGERY             81                          $176.83     20090101
27365       EXTENSIVE LEG SURGERY             82                          $176.83     20090101
27365       EXTENSIVE LEG SURGERY             AS                          $176.83     20090101
27365       EXTENSIVE LEG SURGERY                                         $884.15     20090101
27370       INJECTION FOR KNEE X-RAY                                      $122.41     20090101
27372       REMOVAL OF FOREIGN BODY                                       $421.20     20090101
27372       REMOVAL OF FOREIGN BODY                               Y       $771.79     20081209
27380       REPAIR OF KNEECAP TENDON          80                          $84.85      20090101
27380       REPAIR OF KNEECAP TENDON          81                          $84.85      20090101
27380       REPAIR OF KNEECAP TENDON          82                          $84.85      20090101
27380       REPAIR OF KNEECAP TENDON          AS                           $84.85     20090101
27380       REPAIR OF KNEECAP TENDON                              Y       $375.91     20081209
27380       REPAIR OF KNEECAP TENDON                                      $424.25     20090101
27381       REPAIR/GRAFT KNEECAP TENDON       80                          $115.57     20090101
27381       REPAIR/GRAFT KNEECAP TENDON       81                          $115.57     20090101
27381       REPAIR/GRAFT KNEECAP TENDON       82                          $115.57     20090101
27381       REPAIR/GRAFT KNEECAP TENDON       AS                          $115.57     20090101
27381       REPAIR/GRAFT KNEECAP TENDON                           Y       $482.11     20081209
27381       REPAIR/GRAFT KNEECAP TENDON                                   $577.84     20090101
27385       REPAIR OF THIGH MUSCLE            80                          $90.86      20090101
27385       REPAIR OF THIGH MUSCLE            81                          $90.86      20090101
27385       REPAIR OF THIGH MUSCLE            82                          $90.86      20090101
27385       REPAIR OF THIGH MUSCLE            AS                           $90.86     20090101
27385       REPAIR OF THIGH MUSCLE                                        $454.31     20090101
27385       REPAIR OF THIGH MUSCLE                                Y       $482.11     20081209
27386       REPAIR/GRAFT OF THIGH MUSCLE      80                          $120.02     20090101
27386       REPAIR/GRAFT OF THIGH MUSCLE      81                          $120.02     20090101
27386       REPAIR/GRAFT OF THIGH MUSCLE      82                          $120.02     20090101
27386       REPAIR/GRAFT OF THIGH MUSCLE      AS                          $120.02     20090101


                                           Page 113
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27386       REPAIR/GRAFT OF THIGH MUSCLE                                  $600.09     20090101
27386       REPAIR/GRAFT OF THIGH MUSCLE                          Y       $482.11     20081209
27390       INCISION OF THIGH TENDON          80                           $62.04     20090101
27390       INCISION OF THIGH TENDON          81                           $62.04     20090101
27390       INCISION OF THIGH TENDON          82                           $62.04     20090101
27390       INCISION OF THIGH TENDON          AS                           $62.04     20090101
27390       INCISION OF THIGH TENDON                              Y       $375.91     20081209
27390       INCISION OF THIGH TENDON                                      $310.19     20090101
27391       INCISION OF THIGH TENDONS         80                           $81.63     20090101
27391       INCISION OF THIGH TENDONS         81                           $81.63     20090101
27391       INCISION OF THIGH TENDONS         82                           $81.63     20090101
27391       INCISION OF THIGH TENDONS         AS                           $81.63     20090101
27391       INCISION OF THIGH TENDONS                             Y       $443.71     20081209
27391       INCISION OF THIGH TENDONS                                     $408.15     20090101
27392       INCISION OF THIGH TENDONS         80                          $101.33     20090101
27392       INCISION OF THIGH TENDONS         81                          $101.33     20090101
27392       INCISION OF THIGH TENDONS         82                          $101.33     20090101
27392       INCISION OF THIGH TENDONS         AS                          $101.33     20090101
27392       INCISION OF THIGH TENDONS                                     $506.63     20090101
27392       INCISION OF THIGH TENDONS                             Y       $482.11     20081209
27393       LENGTHENING OF THIGH TENDON       80                           $72.34     20090101
27393       LENGTHENING OF THIGH TENDON       81                           $72.34     20090101
27393       LENGTHENING OF THIGH TENDON       82                           $72.34     20090101
27393       LENGTHENING OF THIGH TENDON       AS                           $72.34     20090101
27393       LENGTHENING OF THIGH TENDON                                   $361.68     20090101
27393       LENGTHENING OF THIGH TENDON                           Y       $509.30     20081209
27394       LENGTHENING OF THIGH TENDONS      80                           $93.70     20090101
27394       LENGTHENING OF THIGH TENDONS      81                           $93.70     20090101
27394       LENGTHENING OF THIGH TENDONS      82                           $93.70     20090101
27394       LENGTHENING OF THIGH TENDONS      AS                           $93.70     20090101
27394       LENGTHENING OF THIGH TENDONS                                  $468.49     20090101
27394       LENGTHENING OF THIGH TENDONS                          Y       $547.70     20081209
27395       LENGTHENING OF THIGH TENDONS      80                          $126.76     20090101
27395       LENGTHENING OF THIGH TENDONS      81                          $126.76     20090101
27395       LENGTHENING OF THIGH TENDONS      82                          $126.76     20090101
27395       LENGTHENING OF THIGH TENDONS      AS                          $126.76     20090101
27395       LENGTHENING OF THIGH TENDONS                                  $633.78     20090101
27395       LENGTHENING OF THIGH TENDONS                          Y       $661.93     20081209
27396       TRANSPLANT OF THIGH TENDON        80                           $87.91     20090101
27396       TRANSPLANT OF THIGH TENDON        81                           $87.91     20090101
27396       TRANSPLANT OF THIGH TENDON        82                           $87.91     20090101
27396       TRANSPLANT OF THIGH TENDON        AS                           $87.91     20090101
27396       TRANSPLANT OF THIGH TENDON                                    $439.56     20090101
27396       TRANSPLANT OF THIGH TENDON                            Y       $547.70     20081209
27397       TRANSPLANTS OF THIGH TENDONS      80                          $127.92     20090101


                                           Page 114
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
27397       TRANSPLANTS OF THIGH TENDONS   81                           $127.92      20090101
27397       TRANSPLANTS OF THIGH TENDONS   82                           $127.92      20090101
27397       TRANSPLANTS OF THIGH TENDONS   AS                           $127.92      20090101
27397       TRANSPLANTS OF THIGH TENDONS                       Y        $661.93      20081209
27397       TRANSPLANTS OF THIGH TENDONS                                $639.58      20090101
27400       REVISE THIGH MUSCLES/TENDONS   80                            $96.81      20090101
27400       REVISE THIGH MUSCLES/TENDONS   81                            $96.81      20090101
27400       REVISE THIGH MUSCLES/TENDONS   82                            $96.81      20090101
27400       REVISE THIGH MUSCLES/TENDONS   AS                            $96.81      20090101
27400       REVISE THIGH MUSCLES/TENDONS                                $484.07      20090101
27400       REVISE THIGH MUSCLES/TENDONS                       Y        $661.93      20081209
27403       REPAIR OF KNEE CARTILAGE       80                            $92.15      20090101
27403       REPAIR OF KNEE CARTILAGE       81                            $92.15      20090101
27403       REPAIR OF KNEE CARTILAGE       82                            $92.15      20090101
27403       REPAIR OF KNEE CARTILAGE       AS                            $92.15      20090101
27403       REPAIR OF KNEE CARTILAGE                                    $460.73      20090101
27403       REPAIR OF KNEE CARTILAGE                           Y        $619.70      20081209
27405       REPAIR OF KNEE LIGAMENT        80                            $96.88      20090101
27405       REPAIR OF KNEE LIGAMENT        81                            $96.88      20090101
27405       REPAIR OF KNEE LIGAMENT        82                            $96.88      20090101
27405       REPAIR OF KNEE LIGAMENT        AS                            $96.88      20090101
27405       REPAIR OF KNEE LIGAMENT                                     $484.38      20090101
27405       REPAIR OF KNEE LIGAMENT                            Y        $733.93      20081209
27407       REPAIR OF KNEE LIGAMENT        80                           $111.73      20090101
27407       REPAIR OF KNEE LIGAMENT        81                           $111.73      20090101
27407       REPAIR OF KNEE LIGAMENT        82                           $111.73      20090101
27407       REPAIR OF KNEE LIGAMENT        AS                           $111.73      20090101
27407       REPAIR OF KNEE LIGAMENT                            Y       $1,035.65     20081209
27407       REPAIR OF KNEE LIGAMENT                                     $558.64      20090101
27409       REPAIR OF KNEE LIGAMENTS       80                           $138.71      20090101
27409       REPAIR OF KNEE LIGAMENTS       81                           $138.71      20090101
27409       REPAIR OF KNEE LIGAMENTS       82                           $138.71      20090101
27409       REPAIR OF KNEE LIGAMENTS       AS                           $138.71      20090101
27409       REPAIR OF KNEE LIGAMENTS                           Y        $733.93      20081209
27409       REPAIR OF KNEE LIGAMENTS                                    $693.55      20090101
27412       AUTOCHONDROCYTE IMPLANT KNEE   80                           $239.92      20090101
27412       AUTOCHONDROCYTE IMPLANT KNEE                               $1,199.60     20080101
27415       OSTEOCHONDRAL KNEE ALLOGRAFT   80                           $202.08      20090101
27415       OSTEOCHONDRAL KNEE ALLOGRAFT                               $1,010.42     20090101
27416       OSTEOCHONDRAL KNEE AUTOGRAFT                                $687.43      20090101
27418       REPAIR DEGENERATED KNEECAP     80                           $120.13      20090101
27418       REPAIR DEGENERATED KNEECAP     81                           $120.13      20090101
27418       REPAIR DEGENERATED KNEECAP     82                           $120.13      20090101
27418       REPAIR DEGENERATED KNEECAP     AS                           $120.13      20090101
27418       REPAIR DEGENERATED KNEECAP                         Y        $661.93      20081209


                                       Page 115
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27418       REPAIR DEGENERATED KNEECAP                                     $600.66      20090101
27420       REVISION OF UNSTABLE KNEECAP      80                           $107.77      20090101
27420       REVISION OF UNSTABLE KNEECAP      81                           $107.77      20090101
27420       REVISION OF UNSTABLE KNEECAP      82                           $107.77      20090101
27420       REVISION OF UNSTABLE KNEECAP      AS                           $107.77      20090101
27420       REVISION OF UNSTABLE KNEECAP                                   $538.87      20090101
27420       REVISION OF UNSTABLE KNEECAP                          Y        $661.93      20081209
27422       REVISION OF UNSTABLE KNEECAP      80                           $107.39      20090101
27422       REVISION OF UNSTABLE KNEECAP      81                           $107.39      20090101
27422       REVISION OF UNSTABLE KNEECAP      82                           $107.39      20090101
27422       REVISION OF UNSTABLE KNEECAP      AS                           $107.39      20090101
27422       REVISION OF UNSTABLE KNEECAP                                   $536.96      20090101
27422       REVISION OF UNSTABLE KNEECAP                          Y        $952.93      20081209
27424       REVISION/REMOVAL OF KNEECAP       80                           $107.56      20090101
27424       REVISION/REMOVAL OF KNEECAP       81                           $107.56      20090101
27424       REVISION/REMOVAL OF KNEECAP       82                           $107.56      20090101
27424       REVISION/REMOVAL OF KNEECAP       AS                           $107.56      20090101
27424       REVISION/REMOVAL OF KNEECAP                           Y        $661.93      20081209
27424       REVISION/REMOVAL OF KNEECAP                                    $537.79      20090101
27425       LAT RETINACULAR RELEASE OPEN      80                            $62.88      20090101
27425       LAT RETINACULAR RELEASE OPEN      81                            $62.88      20090101
27425       LAT RETINACULAR RELEASE OPEN      82                            $62.88      20090101
27425       LAT RETINACULAR RELEASE OPEN      AS                            $62.88      20090101
27425       LAT RETINACULAR RELEASE OPEN                          Y        $838.70      20081209
27425       LAT RETINACULAR RELEASE OPEN                                   $314.38      20090101
27427       RECONSTRUCTION, KNEE              80                           $103.21      20090101
27427       RECONSTRUCTION, KNEE              81                           $103.21      20090101
27427       RECONSTRUCTION, KNEE              82                           $103.21      20090101
27427       RECONSTRUCTION, KNEE              AS                           $103.21      20090101
27427       RECONSTRUCTION, KNEE                                  Y        $661.93      20081209
27427       RECONSTRUCTION, KNEE                                           $516.05      20090101
27428       RECONSTRUCTION, KNEE              80                           $158.08      20090101
27428       RECONSTRUCTION, KNEE              81                           $158.08      20090101
27428       RECONSTRUCTION, KNEE              82                           $158.08      20090101
27428       RECONSTRUCTION, KNEE              AS                           $158.08      20090101
27428       RECONSTRUCTION, KNEE                                  Y       $1,035.65     20081209
27428       RECONSTRUCTION, KNEE                                           $790.38      20090101
27429       RECONSTRUCTION, KNEE              80                           $176.88      20090101
27429       RECONSTRUCTION, KNEE              81                           $176.88      20090101
27429       RECONSTRUCTION, KNEE              82                           $176.88      20090101
27429       RECONSTRUCTION, KNEE              AS                           $176.88      20090101
27429       RECONSTRUCTION, KNEE                                           $884.41      20090101
27429       RECONSTRUCTION, KNEE                                  Y       $1,035.65     20081209
27430       REVISION OF THIGH MUSCLES         80                           $106.61      20090101
27430       REVISION OF THIGH MUSCLES         81                           $106.61      20090101


                                           Page 116
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
27430       REVISION OF THIGH MUSCLES        82                           $106.61      20090101
27430       REVISION OF THIGH MUSCLES        AS                           $106.61      20090101
27430       REVISION OF THIGH MUSCLES                            Y        $733.93      20081209
27430       REVISION OF THIGH MUSCLES                                     $533.03      20090101
27435       INCISION OF KNEE JOINT           80                           $113.62      20090101
27435       INCISION OF KNEE JOINT           81                           $113.62      20090101
27435       INCISION OF KNEE JOINT           82                           $113.62      20090101
27435       INCISION OF KNEE JOINT           AS                           $113.62      20090101
27435       INCISION OF KNEE JOINT                               Y        $733.93      20081209
27435       INCISION OF KNEE JOINT                                        $568.11      20090101
27437       REVISE KNEECAP                   80                            $94.75      20090101
27437       REVISE KNEECAP                   81                            $94.75      20090101
27437       REVISE KNEECAP                   82                            $94.75      20090101
27437       REVISE KNEECAP                   AS                            $94.75      20090101
27437       REVISE KNEECAP                                       Y        $675.30      20081209
27437       REVISE KNEECAP                                                $473.77      20090101
27438       REVISE KNEECAP WITH IMPLANT      80                           $121.02      20090101
27438       REVISE KNEECAP WITH IMPLANT      81                           $121.02      20090101
27438       REVISE KNEECAP WITH IMPLANT      82                           $121.02      20090101
27438       REVISE KNEECAP WITH IMPLANT      AS                           $121.02      20090101
27438       REVISE KNEECAP WITH IMPLANT                          Y        $851.56      20081209
27438       REVISE KNEECAP WITH IMPLANT                                   $605.11      20090101
27440       REVISION OF KNEE JOINT           80                           $107.33      20090101
27440       REVISION OF KNEE JOINT           81                           $107.33      20090101
27440       REVISION OF KNEE JOINT           82                           $107.33      20090101
27440       REVISION OF KNEE JOINT           AS                           $107.33      20090101
27440       REVISION OF KNEE JOINT                                        $536.65      20090101
27440       REVISION OF KNEE JOINT                               Y       $1,189.17     20081209
27441       REVISION OF KNEE JOINT           80                           $113.23      20090101
27441       REVISION OF KNEE JOINT           81                           $113.23      20090101
27441       REVISION OF KNEE JOINT           82                           $113.23      20090101
27441       REVISION OF KNEE JOINT           AS                           $113.23      20090101
27441       REVISION OF KNEE JOINT                                        $566.15      20090101
27441       REVISION OF KNEE JOINT                               Y        $727.50      20081209
27442       REVISION OF KNEE JOINT           80                           $125.92      20090101
27442       REVISION OF KNEE JOINT           81                           $125.92      20090101
27442       REVISION OF KNEE JOINT           82                           $125.92      20090101
27442       REVISION OF KNEE JOINT           AS                           $125.92      20090101
27442       REVISION OF KNEE JOINT                                        $629.59      20090101
27442       REVISION OF KNEE JOINT                               Y        $727.50      20081209
27443       REVISION OF KNEE JOINT           80                           $118.19      20090101
27443       REVISION OF KNEE JOINT           81                           $118.19      20090101
27443       REVISION OF KNEE JOINT           82                           $118.19      20090101
27443       REVISION OF KNEE JOINT           AS                           $118.19      20090101
27443       REVISION OF KNEE JOINT                               Y        $727.50      20081209


                                          Page 117
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
27443       REVISION OF KNEE JOINT                                      $590.93      20090101
27445       REVISION OF KNEE JOINT         80                           $183.62      20090101
27445       REVISION OF KNEE JOINT         81                           $183.62      20090101
27445       REVISION OF KNEE JOINT         82                           $183.62      20090101
27445       REVISION OF KNEE JOINT         AS                           $183.62      20090101
27445       REVISION OF KNEE JOINT                                      $918.10      20090101
27446       REVISION OF KNEE JOINT         80                           $163.31      20090101
27446       REVISION OF KNEE JOINT         81                           $163.31      20090101
27446       REVISION OF KNEE JOINT         82                           $163.31      20090101
27446       REVISION OF KNEE JOINT         AS                           $163.31      20090101
27446       REVISION OF KNEE JOINT                                      $816.56      20090101
27447       TOTAL KNEE ARTHROPLASTY        80                           $224.96      20090101
27447       TOTAL KNEE ARTHROPLASTY        81                           $224.96      20090101
27447       TOTAL KNEE ARTHROPLASTY        82                           $224.96      20090101
27447       TOTAL KNEE ARTHROPLASTY        AS                           $224.96      20090101
27447       TOTAL KNEE ARTHROPLASTY                                    $1,124.79     20090101
27448       INCISION OF THIGH              80                           $119.01      20090101
27448       INCISION OF THIGH              81                           $119.01      20090101
27448       INCISION OF THIGH              82                           $119.01      20090101
27448       INCISION OF THIGH              AS                           $119.01      20090101
27448       INCISION OF THIGH                                           $595.07      20090101
27450       INCISION OF THIGH              80                           $148.07      20090101
27450       INCISION OF THIGH              81                           $148.07      20090101
27450       INCISION OF THIGH              82                           $148.07      20090101
27450       INCISION OF THIGH              AS                           $148.07      20090101
27450       INCISION OF THIGH                                           $740.34      20090101
27454       REALIGNMENT OF THIGH BONE      80                           $187.62      20090101
27454       REALIGNMENT OF THIGH BONE      81                           $187.62      20090101
27454       REALIGNMENT OF THIGH BONE      82                           $187.62      20090101
27454       REALIGNMENT OF THIGH BONE      AS                           $187.62      20090101
27454       REALIGNMENT OF THIGH BONE                                   $938.12      20090101
27455       REALIGNMENT OF KNEE            80                           $136.83      20090101
27455       REALIGNMENT OF KNEE            81                           $136.83      20090101
27455       REALIGNMENT OF KNEE            82                           $136.83      20090101
27455       REALIGNMENT OF KNEE            AS                           $136.83      20090101
27455       REALIGNMENT OF KNEE                                         $684.14      20090101
27457       REALIGNMENT OF KNEE            80                           $141.05      20090101
27457       REALIGNMENT OF KNEE            81                           $141.05      20090101
27457       REALIGNMENT OF KNEE            82                           $141.05      20090101
27457       REALIGNMENT OF KNEE            AS                           $141.05      20090101
27457       REALIGNMENT OF KNEE                                         $705.25      20090101
27465       SHORTENING OF THIGH BONE       80                           $173.49      20090101
27465       SHORTENING OF THIGH BONE       81                           $173.49      20090101
27465       SHORTENING OF THIGH BONE       82                           $173.49      20090101
27465       SHORTENING OF THIGH BONE       AS                           $173.49      20090101


                                        Page 118
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
27465       SHORTENING OF THIGH BONE                                    $867.43     20090101
27466       LENGTHENING OF THIGH BONE       80                          $171.71     20090101
27466       LENGTHENING OF THIGH BONE       81                          $171.71     20090101
27466       LENGTHENING OF THIGH BONE       82                          $171.71     20090101
27466       LENGTHENING OF THIGH BONE       AS                          $171.71     20090101
27466       LENGTHENING OF THIGH BONE                                   $858.53     20090101
27468       SHORTEN/LENGTHEN THIGHS         80                          $194.19     20090101
27468       SHORTEN/LENGTHEN THIGHS         81                          $194.19     20090101
27468       SHORTEN/LENGTHEN THIGHS         82                          $194.19     20090101
27468       SHORTEN/LENGTHEN THIGHS         AS                          $194.19     20090101
27468       SHORTEN/LENGTHEN THIGHS                                     $970.93     20090101
27470       REPAIR OF THIGH                 80                          $171.10     20090101
27470       REPAIR OF THIGH                 81                          $171.10     20090101
27470       REPAIR OF THIGH                 82                          $171.10     20090101
27470       REPAIR OF THIGH                 AS                          $171.10     20090101
27470       REPAIR OF THIGH                                             $855.48     20090101
27472       REPAIR/GRAFT OF THIGH           80                          $185.40     20090101
27472       REPAIR/GRAFT OF THIGH           81                          $185.40     20090101
27472       REPAIR/GRAFT OF THIGH           82                          $185.40     20090101
27472       REPAIR/GRAFT OF THIGH           AS                          $185.40     20090101
27472       REPAIR/GRAFT OF THIGH                                       $927.00     20090101
27475       SURGERY TO STOP LEG GROWTH      80                           $93.98     20090101
27475       SURGERY TO STOP LEG GROWTH      81                           $93.98     20090101
27475       SURGERY TO STOP LEG GROWTH      82                           $93.98     20090101
27475       SURGERY TO STOP LEG GROWTH      AS                           $93.98     20090101
27475       SURGERY TO STOP LEG GROWTH                                  $469.89     20090101
27477       SURGERY TO STOP LEG GROWTH      80                          $105.38     20090101
27477       SURGERY TO STOP LEG GROWTH      81                          $105.38     20090101
27477       SURGERY TO STOP LEG GROWTH      82                          $105.38     20090101
27477       SURGERY TO STOP LEG GROWTH      AS                          $105.38     20090101
27477       SURGERY TO STOP LEG GROWTH                                  $526.92     20090101
27479       SURGERY TO STOP LEG GROWTH      80                          $139.55     20090101
27479       SURGERY TO STOP LEG GROWTH      81                          $139.55     20090101
27479       SURGERY TO STOP LEG GROWTH      82                          $139.55     20090101
27479       SURGERY TO STOP LEG GROWTH      AS                          $139.55     20090101
27479       SURGERY TO STOP LEG GROWTH                                  $697.75     20090101
27485       SURGERY TO STOP LEG GROWTH      80                           $96.60     20090101
27485       SURGERY TO STOP LEG GROWTH      81                           $96.60     20090101
27485       SURGERY TO STOP LEG GROWTH      82                           $96.60     20090101
27485       SURGERY TO STOP LEG GROWTH      AS                           $96.60     20090101
27485       SURGERY TO STOP LEG GROWTH                                  $482.98     20090101
27486       REVISE/REPLACE KNEE JOINT       80                          $205.10     20090101
27486       REVISE/REPLACE KNEE JOINT       81                          $205.10     20090101
27486       REVISE/REPLACE KNEE JOINT       82                          $205.10     20090101
27486       REVISE/REPLACE KNEE JOINT       AS                          $205.10     20090101


                                         Page 119
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
27486       REVISE/REPLACE KNEE JOINT                                    $1,025.48     20090101
27487       REVISE/REPLACE KNEE JOINT        80                           $259.17      20090101
27487       REVISE/REPLACE KNEE JOINT        81                           $259.17      20090101
27487       REVISE/REPLACE KNEE JOINT        82                           $259.17      20090101
27487       REVISE/REPLACE KNEE JOINT        AS                           $259.17      20090101
27487       REVISE/REPLACE KNEE JOINT                                    $1,295.87     20090101
27488       REMOVAL OF KNEE PROSTHESIS       80                           $173.21      20090101
27488       REMOVAL OF KNEE PROSTHESIS       81                           $173.21      20090101
27488       REMOVAL OF KNEE PROSTHESIS       82                           $173.21      20090101
27488       REMOVAL OF KNEE PROSTHESIS       AS                           $173.21      20090101
27488       REMOVAL OF KNEE PROSTHESIS                                    $866.04      20090101
27495       REINFORCE THIGH                  80                           $164.87      20090101
27495       REINFORCE THIGH                  81                           $164.87      20090101
27495       REINFORCE THIGH                  82                           $164.87      20090101
27495       REINFORCE THIGH                  AS                           $164.87      20090101
27495       REINFORCE THIGH                                               $824.33      20090101
27496       DECOMPRESSION OF THIGH/KNEE                          Y        $606.31      20081209
27496       DECOMPRESSION OF THIGH/KNEE                                   $360.00      20090101
27497       DECOMPRESSION OF THIGH/KNEE                                   $391.16      20090101
27497       DECOMPRESSION OF THIGH/KNEE                          Y        $482.11      20081209
27498       DECOMPRESSION OF THIGH/KNEE      80                            $85.41      20090101
27498       DECOMPRESSION OF THIGH/KNEE      81                            $85.41      20090101
27498       DECOMPRESSION OF THIGH/KNEE      82                            $85.41      20090101
27498       DECOMPRESSION OF THIGH/KNEE      AS                            $85.41      20090101
27498       DECOMPRESSION OF THIGH/KNEE                          Y        $482.11      20081209
27498       DECOMPRESSION OF THIGH/KNEE                                   $427.04      20090101
27499       DECOMPRESSION OF THIGH/KNEE      80                            $95.59      20090101
27499       DECOMPRESSION OF THIGH/KNEE      81                            $95.59      20090101
27499       DECOMPRESSION OF THIGH/KNEE      82                            $95.59      20090101
27499       DECOMPRESSION OF THIGH/KNEE      AS                            $95.59      20090101
27499       DECOMPRESSION OF THIGH/KNEE                                   $477.96      20090101
27499       DECOMPRESSION OF THIGH/KNEE                          Y        $482.11      20081209
27500       TREATMENT OF THIGH FRACTURE                                   $361.11      20090101
27500       TREATMENT OF THIGH FRACTURE                          Y         $76.82      20081209
27501       TREATMENT OF THIGH FRACTURE                                   $355.27      20090101
27501       TREATMENT OF THIGH FRACTURE                          Y         $76.82      20081209
27502       TREATMENT OF THIGH FRACTURE                                   $570.89      20090101
27502       TREATMENT OF THIGH FRACTURE                          Y         $76.82      20081209
27503       TREATMENT OF THIGH FRACTURE                          Y         $76.82      20081209
27503       TREATMENT OF THIGH FRACTURE                                   $576.72      20090101
27506       TREATMENT OF THIGH FRACTURE      80                           $192.19      20090101
27506       TREATMENT OF THIGH FRACTURE      81                           $192.19      20090101
27506       TREATMENT OF THIGH FRACTURE      82                           $192.19      20090101
27506       TREATMENT OF THIGH FRACTURE      AS                           $192.19      20090101
27506       TREATMENT OF THIGH FRACTURE                                   $960.95      20090101


                                          Page 120
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
27507       TREATMENT OF THIGH FRACTURE      80                          $143.61     20090101
27507       TREATMENT OF THIGH FRACTURE      81                          $143.61     20090101
27507       TREATMENT OF THIGH FRACTURE      82                          $143.61     20090101
27507       TREATMENT OF THIGH FRACTURE      AS                          $143.61     20090101
27507       TREATMENT OF THIGH FRACTURE                                  $718.03     20090101
27508       TREATMENT OF THIGH FRACTURE                          Y        $76.82     20081209
27508       TREATMENT OF THIGH FRACTURE                                  $365.28     20090101
27509       TREATMENT OF THIGH FRACTURE                                  $462.11     20090101
27509       TREATMENT OF THIGH FRACTURE                          Y       $522.61     20081209
27510       TREATMENT OF THIGH FRACTURE                          Y        $76.82     20081209
27510       TREATMENT OF THIGH FRACTURE                                  $501.05     20090101
27511       TREATMENT OF THIGH FRACTURE      80                          $150.29     20090101
27511       TREATMENT OF THIGH FRACTURE      81                          $150.29     20090101
27511       TREATMENT OF THIGH FRACTURE      82                          $150.29     20090101
27511       TREATMENT OF THIGH FRACTURE      AS                          $150.29     20090101
27511       TREATMENT OF THIGH FRACTURE                                  $751.46     20090101
27513       TREATMENT OF THIGH FRACTURE      80                          $189.52     20090101
27513       TREATMENT OF THIGH FRACTURE      81                          $189.52     20090101
27513       TREATMENT OF THIGH FRACTURE      82                          $189.52     20090101
27513       TREATMENT OF THIGH FRACTURE      AS                          $189.52     20090101
27513       TREATMENT OF THIGH FRACTURE                                  $947.59     20090101
27514       TREATMENT OF THIGH FRACTURE      80                          $156.30     20090101
27514       TREATMENT OF THIGH FRACTURE      81                          $156.30     20090101
27514       TREATMENT OF THIGH FRACTURE      82                          $156.30     20090101
27514       TREATMENT OF THIGH FRACTURE      AS                          $156.30     20090101
27514       TREATMENT OF THIGH FRACTURE                                  $781.48     20090101
27516       TREAT THIGH FX GROWTH PLATE                                  $342.19     20090101
27516       TREAT THIGH FX GROWTH PLATE                          Y        $76.82     20081209
27517       TREAT THIGH FX GROWTH PLATE                                  $476.85     20090101
27517       TREAT THIGH FX GROWTH PLATE                          Y        $76.82     20081209
27519       TREAT THIGH FX GROWTH PLATE      80                          $139.99     20090101
27519       TREAT THIGH FX GROWTH PLATE      81                          $139.99     20090101
27519       TREAT THIGH FX GROWTH PLATE      82                          $139.99     20090101
27519       TREAT THIGH FX GROWTH PLATE      AS                          $139.99     20090101
27519       TREAT THIGH FX GROWTH PLATE                                  $699.97     20090101
27520       TREAT KNEECAP FRACTURE                               Y        $76.82     20081209
27520       TREAT KNEECAP FRACTURE                                       $214.77     20090101
27524       TREAT KNEECAP FRACTURE           80                          $109.01     20090101
27524       TREAT KNEECAP FRACTURE           81                          $109.01     20090101
27524       TREAT KNEECAP FRACTURE           82                          $109.01     20090101
27524       TREAT KNEECAP FRACTURE           AS                          $109.01     20090101
27524       TREAT KNEECAP FRACTURE                                       $545.03     20090101
27530       TREAT KNEE FRACTURE                                          $269.59     20090101
27530       TREAT KNEE FRACTURE                                  Y        $76.82     20081209
27532       TREAT KNEE FRACTURE                                          $433.17     20090101


                                          Page 121
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
27532       TREAT KNEE FRACTURE                                Y        $76.82     20081209
27535       TREAT KNEE FRACTURE            80                          $133.88     20090101
27535       TREAT KNEE FRACTURE            81                          $133.88     20090101
27535       TREAT KNEE FRACTURE            82                          $133.88     20090101
27535       TREAT KNEE FRACTURE            AS                          $133.88     20090101
27535       TREAT KNEE FRACTURE                                        $669.39     20090101
27536       TREAT KNEE FRACTURE            80                          $171.60     20090101
27536       TREAT KNEE FRACTURE            81                          $171.60     20090101
27536       TREAT KNEE FRACTURE            82                          $171.60     20090101
27536       TREAT KNEE FRACTURE            AS                          $171.60     20090101
27536       TREAT KNEE FRACTURE                                        $858.02     20090101
27538       TREAT KNEE FRACTURE(S)                                     $323.28     20090101
27538       TREAT KNEE FRACTURE(S)                             Y        $76.82     20081209
27540       TREAT KNEE FRACTURE            80                          $121.80     20090101
27540       TREAT KNEE FRACTURE            81                          $121.80     20090101
27540       TREAT KNEE FRACTURE            82                          $121.80     20090101
27540       TREAT KNEE FRACTURE            AS                          $121.80     20090101
27540       TREAT KNEE FRACTURE                                        $608.99     20090101
27550       TREAT KNEE DISLOCATION                                     $339.97     20090101
27550       TREAT KNEE DISLOCATION                             Y        $76.82     20081209
27552       TREAT KNEE DISLOCATION                                     $442.91     20090101
27552       TREAT KNEE DISLOCATION                             Y       $322.06     20081209
27556       TREAT KNEE DISLOCATION         80                          $138.16     20090101
27556       TREAT KNEE DISLOCATION         81                          $138.16     20090101
27556       TREAT KNEE DISLOCATION         82                          $138.16     20090101
27556       TREAT KNEE DISLOCATION         AS                          $138.16     20090101
27556       TREAT KNEE DISLOCATION                                     $690.81     20090101
27557       TREAT KNEE DISLOCATION         80                          $164.31     20090101
27557       TREAT KNEE DISLOCATION         81                          $164.31     20090101
27557       TREAT KNEE DISLOCATION         82                          $164.31     20090101
27557       TREAT KNEE DISLOCATION         AS                          $164.31     20090101
27557       TREAT KNEE DISLOCATION                                     $821.53     20090101
27558       TREAT KNEE DISLOCATION         80                          $180.89     20090101
27558       TREAT KNEE DISLOCATION         81                          $180.89     20090101
27558       TREAT KNEE DISLOCATION         82                          $180.89     20090101
27558       TREAT KNEE DISLOCATION         AS                          $180.89     20090101
27558       TREAT KNEE DISLOCATION                                     $904.43     20090101
27560       TREAT KNEECAP DISLOCATION                                  $245.38     20090101
27560       TREAT KNEECAP DISLOCATION                          Y        $76.82     20081209
27562       TREAT KNEECAP DISLOCATION                                  $319.66     20090101
27562       TREAT KNEECAP DISLOCATION                          Y       $322.06     20081209
27566       TREAT KNEECAP DISLOCATION      80                          $129.81     20090101
27566       TREAT KNEECAP DISLOCATION      81                          $129.81     20090101
27566       TREAT KNEECAP DISLOCATION      82                          $129.81     20090101
27566       TREAT KNEECAP DISLOCATION      AS                          $129.81     20090101


                                        Page 122
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27566       TREAT KNEECAP DISLOCATION                                      $649.05      20090101
27566       TREAT KNEECAP DISLOCATION                             Y        $607.99      20081209
27570       FIXATION OF KNEE JOINT                                         $104.61      20090101
27570       FIXATION OF KNEE JOINT                                Y        $322.06      20081209
27580       FUSION OF KNEE                    80                           $210.22      20090101
27580       FUSION OF KNEE                    81                           $210.22      20090101
27580       FUSION OF KNEE                    82                           $210.22      20090101
27580       FUSION OF KNEE                    AS                           $210.22      20090101
27580       FUSION OF KNEE                                                $1,051.09     20090101
27590       AMPUTATE LEG AT THIGH             80                           $119.36      20090101
27590       AMPUTATE LEG AT THIGH             81                           $119.36      20090101
27590       AMPUTATE LEG AT THIGH             82                           $119.36      20090101
27590       AMPUTATE LEG AT THIGH             AS                           $119.36      20090101
27590       AMPUTATE LEG AT THIGH                                          $596.78      20090101
27591       AMPUTATE LEG AT THIGH             80                           $132.71      20090101
27591       AMPUTATE LEG AT THIGH             81                           $132.71      20090101
27591       AMPUTATE LEG AT THIGH             82                           $132.71      20090101
27591       AMPUTATE LEG AT THIGH             AS                           $132.71      20090101
27591       AMPUTATE LEG AT THIGH                                          $663.54      20090101
27592       AMPUTATE LEG AT THIGH             80                           $100.82      20090101
27592       AMPUTATE LEG AT THIGH             81                           $100.82      20090101
27592       AMPUTATE LEG AT THIGH             82                           $100.82      20090101
27592       AMPUTATE LEG AT THIGH             AS                           $100.82      20090101
27592       AMPUTATE LEG AT THIGH                                          $504.10      20090101
27594       AMPUTATION FOLLOW-UP SURGERY                                   $365.56      20090101
27594       AMPUTATION FOLLOW-UP SURGERY                          Y        $482.11      20081209
27596       AMPUTATION FOLLOW-UP SURGERY                                   $531.94      20090101
27598       AMPUTATE LOWER LEG AT KNEE        80                           $107.61      20090101
27598       AMPUTATE LOWER LEG AT KNEE        81                           $107.61      20090101
27598       AMPUTATE LOWER LEG AT KNEE        82                           $107.61      20090101
27598       AMPUTATE LOWER LEG AT KNEE        AS                           $107.61      20090101
27598       AMPUTATE LOWER LEG AT KNEE                                     $538.04      20090101
27600       DECOMPRESSION OF LOWER LEG        80                            $60.98      20090101
27600       DECOMPRESSION OF LOWER LEG        81                            $60.98      20090101
27600       DECOMPRESSION OF LOWER LEG        82                            $60.98      20090101
27600       DECOMPRESSION OF LOWER LEG        AS                            $60.98      20090101
27600       DECOMPRESSION OF LOWER LEG                                     $304.91      20090101
27600       DECOMPRESSION OF LOWER LEG                            Y        $482.11      20081209
27601       DECOMPRESSION OF LOWER LEG        80                            $62.60      20090101
27601       DECOMPRESSION OF LOWER LEG        81                            $62.60      20090101
27601       DECOMPRESSION OF LOWER LEG        82                            $62.60      20090101
27601       DECOMPRESSION OF LOWER LEG        AS                            $62.60      20090101
27601       DECOMPRESSION OF LOWER LEG                                     $312.98      20090101
27601       DECOMPRESSION OF LOWER LEG                            Y        $482.11      20081209
27602       DECOMPRESSION OF LOWER LEG        80                            $75.22      20090101


                                           Page 123
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27602       DECOMPRESSION OF LOWER LEG        81                           $75.22     20090101
27602       DECOMPRESSION OF LOWER LEG        82                           $75.22     20090101
27602       DECOMPRESSION OF LOWER LEG        AS                           $75.22     20090101
27602       DECOMPRESSION OF LOWER LEG                            Y       $482.11     20081209
27602       DECOMPRESSION OF LOWER LEG                                    $376.12     20090101
27603       DRAIN LOWER LEG LESION                                Y       $419.29     20081209
27603       DRAIN LOWER LEG LESION                                        $365.28     20090101
27604       DRAIN LOWER LEG BURSA                                         $319.66     20090101
27604       DRAIN LOWER LEG BURSA                                 Y       $443.71     20081209
27605       INCISION OF ACHILLES TENDON                           Y       $372.26     20081209
27605       INCISION OF ACHILLES TENDON                                   $270.41     20090101
27606       INCISION OF ACHILLES TENDON       80                           $43.56     20090101
27606       INCISION OF ACHILLES TENDON       81                           $43.56     20090101
27606       INCISION OF ACHILLES TENDON       82                           $43.56     20090101
27606       INCISION OF ACHILLES TENDON       AS                           $43.56     20090101
27606       INCISION OF ACHILLES TENDON                           Y       $375.91     20081209
27606       INCISION OF ACHILLES TENDON                                   $217.82     20090101
27607       TREAT LOWER LEG BONE LESION                           Y       $443.71     20081209
27607       TREAT LOWER LEG BONE LESION                                   $438.46     20090101
27610       EXPLORE/TREAT ANKLE JOINT                                     $472.12     20090101
27610       EXPLORE/TREAT ANKLE JOINT                             Y       $509.30     20081209
27612       EXPLORATION OF ANKLE JOINT        80                           $82.24     20090101
27612       EXPLORATION OF ANKLE JOINT        81                           $82.24     20090101
27612       EXPLORATION OF ANKLE JOINT        82                           $82.24     20090101
27612       EXPLORATION OF ANKLE JOINT        AS                           $82.24     20090101
27612       EXPLORATION OF ANKLE JOINT                                    $411.21     20090101
27612       EXPLORATION OF ANKLE JOINT                            Y       $547.70     20081209
27613       BIOPSY LOWER LEG SOFT TISSUE                                  $165.81     20090101
27613       BIOPSY LOWER LEG SOFT TISSUE                          Y       $108.78     20081209
27614       BIOPSY LOWER LEG SOFT TISSUE                                  $387.82     20090101
27614       BIOPSY LOWER LEG SOFT TISSUE                          Y       $442.39     20081209
27615       REMOVE TUMOR, LOWER LEG                               Y       $547.70     20081209
27615       REMOVE TUMOR, LOWER LEG                                       $642.94     20090101
27618       REMOVE LOWER LEG LESION                               Y       $400.91     20081209
27618       REMOVE LOWER LEG LESION                                       $336.35     20090101
27619       REMOVE LOWER LEG LESION                                       $541.95     20090101
27619       REMOVE LOWER LEG LESION                               Y       $480.79     20081209
27620       EXPLORE/TREAT ANKLE JOINT         80                           $66.93     20090101
27620       EXPLORE/TREAT ANKLE JOINT         81                           $66.93     20090101
27620       EXPLORE/TREAT ANKLE JOINT         82                           $66.93     20090101
27620       EXPLORE/TREAT ANKLE JOINT         AS                           $66.93     20090101
27620       EXPLORE/TREAT ANKLE JOINT                                     $334.67     20090101
27620       EXPLORE/TREAT ANKLE JOINT                             Y       $619.70     20081209
27625       REMOVE ANKLE JOINT LINING         80                           $86.97     20090101
27625       REMOVE ANKLE JOINT LINING         81                           $86.97     20090101


                                           Page 124
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27625       REMOVE ANKLE JOINT LINING         82                           $86.97     20090101
27625       REMOVE ANKLE JOINT LINING         AS                           $86.97     20090101
27625       REMOVE ANKLE JOINT LINING                                     $434.86     20090101
27625       REMOVE ANKLE JOINT LINING                             Y       $619.70     20081209
27626       REMOVE ANKLE JOINT LINING         80                           $93.53     20090101
27626       REMOVE ANKLE JOINT LINING         81                           $93.53     20090101
27626       REMOVE ANKLE JOINT LINING         82                           $93.53     20090101
27626       REMOVE ANKLE JOINT LINING         AS                           $93.53     20090101
27626       REMOVE ANKLE JOINT LINING                             Y       $619.70     20081209
27626       REMOVE ANKLE JOINT LINING                                     $467.66     20090101
27630       REMOVAL OF TENDON LESION                                      $371.69     20090101
27630       REMOVAL OF TENDON LESION                              Y       $482.11     20081209
27635       REMOVE LOWER LEG BONE LESION      80                          $85.74      20090101
27635       REMOVE LOWER LEG BONE LESION      81                          $85.74      20090101
27635       REMOVE LOWER LEG BONE LESION      82                          $85.74      20090101
27635       REMOVE LOWER LEG BONE LESION      AS                           $85.74     20090101
27635       REMOVE LOWER LEG BONE LESION                          Y       $547.70     20081209
27635       REMOVE LOWER LEG BONE LESION                                  $428.70     20090101
27637       REMOVE/GRAFT LEG BONE LESION      80                          $108.12     20090101
27637       REMOVE/GRAFT LEG BONE LESION      81                          $108.12     20090101
27637       REMOVE/GRAFT LEG BONE LESION      82                          $108.12     20090101
27637       REMOVE/GRAFT LEG BONE LESION      AS                          $108.12     20090101
27637       REMOVE/GRAFT LEG BONE LESION                          Y       $547.70     20081209
27637       REMOVE/GRAFT LEG BONE LESION                                  $540.58     20090101
27638       REMOVE/GRAFT LEG BONE LESION      80                          $113.46     20090101
27638       REMOVE/GRAFT LEG BONE LESION      81                          $113.46     20090101
27638       REMOVE/GRAFT LEG BONE LESION      82                          $113.46     20090101
27638       REMOVE/GRAFT LEG BONE LESION      AS                          $113.46     20090101
27638       REMOVE/GRAFT LEG BONE LESION                                  $567.28     20090101
27638       REMOVE/GRAFT LEG BONE LESION                          Y       $547.70     20081209
27640       PARTIAL REMOVAL OF TIBIA          80                          $127.31     20090101
27640       PARTIAL REMOVAL OF TIBIA          81                          $127.31     20090101
27640       PARTIAL REMOVAL OF TIBIA          82                          $127.31     20090101
27640       PARTIAL REMOVAL OF TIBIA          AS                          $127.31     20090101
27640       PARTIAL REMOVAL OF TIBIA                              Y       $623.53     20081209
27640       PARTIAL REMOVAL OF TIBIA                                      $636.53     20090101
27641       PARTIAL REMOVAL OF FIBULA         80                          $102.43     20090101
27641       PARTIAL REMOVAL OF FIBULA         81                          $102.43     20090101
27641       PARTIAL REMOVAL OF FIBULA         82                          $102.43     20090101
27641       PARTIAL REMOVAL OF FIBULA         AS                          $102.43     20090101
27641       PARTIAL REMOVAL OF FIBULA                                     $512.17     20090101
27641       PARTIAL REMOVAL OF FIBULA                             Y       $509.30     20081209
27645       EXTENSIVE LOWER LEG SURGERY       80                          $153.57     20090101
27645       EXTENSIVE LOWER LEG SURGERY       81                          $153.57     20090101
27645       EXTENSIVE LOWER LEG SURGERY       82                          $153.57     20090101


                                           Page 125
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27645       EXTENSIVE LOWER LEG SURGERY       AS                          $153.57     20090101
27645       EXTENSIVE LOWER LEG SURGERY                                   $767.87     20090101
27646       EXTENSIVE LOWER LEG SURGERY       80                          $136.93     20090101
27646       EXTENSIVE LOWER LEG SURGERY       81                          $136.93     20090101
27646       EXTENSIVE LOWER LEG SURGERY       82                          $136.93     20090101
27646       EXTENSIVE LOWER LEG SURGERY       AS                          $136.93     20090101
27646       EXTENSIVE LOWER LEG SURGERY                                   $684.65     20090101
27647       EXTENSIVE ANKLE/HEEL SURGERY      80                          $120.69     20090101
27647       EXTENSIVE ANKLE/HEEL SURGERY      81                          $120.69     20090101
27647       EXTENSIVE ANKLE/HEEL SURGERY      82                          $120.69     20090101
27647       EXTENSIVE ANKLE/HEEL SURGERY      AS                          $120.69     20090101
27647       EXTENSIVE ANKLE/HEEL SURGERY                          Y       $661.93     20081209
27647       EXTENSIVE ANKLE/HEEL SURGERY                                  $603.46     20090101
27648       INJECTION FOR ANKLE X-RAY                                     $117.96     20090101
27650       REPAIR ACHILLES TENDON            80                          $102.22     20090101
27650       REPAIR ACHILLES TENDON            81                          $102.22     20090101
27650       REPAIR ACHILLES TENDON            82                          $102.22     20090101
27650       REPAIR ACHILLES TENDON            AS                          $102.22     20090101
27650       REPAIR ACHILLES TENDON                                        $511.08     20090101
27650       REPAIR ACHILLES TENDON                                Y       $661.93     20081209
27652       REPAIR/GRAFT ACHILLES TENDON      80                          $109.06     20090101
27652       REPAIR/GRAFT ACHILLES TENDON      81                          $109.06     20090101
27652       REPAIR/GRAFT ACHILLES TENDON      82                          $109.06     20090101
27652       REPAIR/GRAFT ACHILLES TENDON      AS                          $109.06     20090101
27652       REPAIR/GRAFT ACHILLES TENDON                                  $545.29     20090101
27652       REPAIR/GRAFT ACHILLES TENDON                          Y       $963.65     20081209
27654       REPAIR OF ACHILLES TENDON         80                          $102.77     20090101
27654       REPAIR OF ACHILLES TENDON         81                          $102.77     20090101
27654       REPAIR OF ACHILLES TENDON         82                          $102.77     20090101
27654       REPAIR OF ACHILLES TENDON         AS                          $102.77     20090101
27654       REPAIR OF ACHILLES TENDON                             Y       $661.93     20081209
27654       REPAIR OF ACHILLES TENDON                                     $513.83     20090101
27656       REPAIR LEG FASCIA DEFECT          80                           $75.45     20090101
27656       REPAIR LEG FASCIA DEFECT          81                           $75.45     20090101
27656       REPAIR LEG FASCIA DEFECT          82                           $75.45     20090101
27656       REPAIR LEG FASCIA DEFECT          AS                           $75.45     20090101
27656       REPAIR LEG FASCIA DEFECT                              Y       $443.71     20081209
27656       REPAIR LEG FASCIA DEFECT                                      $377.26     20090101
27658       REPAIR OF LEG TENDON, EACH        80                           $55.87     20090101
27658       REPAIR OF LEG TENDON, EACH        81                           $55.87     20090101
27658       REPAIR OF LEG TENDON, EACH        82                           $55.87     20090101
27658       REPAIR OF LEG TENDON, EACH        AS                           $55.87     20090101
27658       REPAIR OF LEG TENDON, EACH                                    $279.35     20090101
27658       REPAIR OF LEG TENDON, EACH                            Y       $375.91     20081209
27659       REPAIR OF LEG TENDON, EACH        80                           $73.67     20090101


                                           Page 126
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27659       REPAIR OF LEG TENDON, EACH        81                           $73.67     20090101
27659       REPAIR OF LEG TENDON, EACH        82                           $73.67     20090101
27659       REPAIR OF LEG TENDON, EACH        AS                           $73.67     20090101
27659       REPAIR OF LEG TENDON, EACH                            Y       $443.71     20081209
27659       REPAIR OF LEG TENDON, EACH                                    $368.36     20090101
27664       REPAIR OF LEG TENDON, EACH                                    $267.64     20090101
27664       REPAIR OF LEG TENDON, EACH                            Y       $443.71     20081209
27665       REPAIR OF LEG TENDON, EACH        80                           $61.21     20090101
27665       REPAIR OF LEG TENDON, EACH        81                           $61.21     20090101
27665       REPAIR OF LEG TENDON, EACH        82                           $61.21     20090101
27665       REPAIR OF LEG TENDON, EACH        AS                           $61.21     20090101
27665       REPAIR OF LEG TENDON, EACH                            Y       $509.30     20081209
27665       REPAIR OF LEG TENDON, EACH                                    $306.05     20090101
27675       REPAIR LOWER LEG TENDONS          80                           $75.45     20090101
27675       REPAIR LOWER LEG TENDONS          81                           $75.45     20090101
27675       REPAIR LOWER LEG TENDONS          82                           $75.45     20090101
27675       REPAIR LOWER LEG TENDONS          AS                           $75.45     20090101
27675       REPAIR LOWER LEG TENDONS                                      $377.26     20090101
27675       REPAIR LOWER LEG TENDONS                              Y       $443.71     20081209
27676       REPAIR LOWER LEG TENDONS          80                           $90.25     20090101
27676       REPAIR LOWER LEG TENDONS          81                           $90.25     20090101
27676       REPAIR LOWER LEG TENDONS          82                           $90.25     20090101
27676       REPAIR LOWER LEG TENDONS          AS                           $90.25     20090101
27676       REPAIR LOWER LEG TENDONS                                      $451.26     20090101
27676       REPAIR LOWER LEG TENDONS                              Y       $547.70     20081209
27680       RELEASE OF LOWER LEG TENDON       80                           $63.21     20090101
27680       RELEASE OF LOWER LEG TENDON       81                           $63.21     20090101
27680       RELEASE OF LOWER LEG TENDON       82                           $63.21     20090101
27680       RELEASE OF LOWER LEG TENDON       AS                           $63.21     20090101
27680       RELEASE OF LOWER LEG TENDON                           Y       $547.70     20081209
27680       RELEASE OF LOWER LEG TENDON                                   $316.04     20090101
27681       RELEASE OF LOWER LEG TENDONS      80                           $75.67     20090101
27681       RELEASE OF LOWER LEG TENDONS      81                           $75.67     20090101
27681       RELEASE OF LOWER LEG TENDONS      82                           $75.67     20090101
27681       RELEASE OF LOWER LEG TENDONS      AS                           $75.67     20090101
27681       RELEASE OF LOWER LEG TENDONS                                  $378.34     20090101
27681       RELEASE OF LOWER LEG TENDONS                          Y       $509.30     20081209
27685       REVISION OF LOWER LEG TENDON      80                           $86.69     20090101
27685       REVISION OF LOWER LEG TENDON      81                           $86.69     20090101
27685       REVISION OF LOWER LEG TENDON      82                           $86.69     20090101
27685       REVISION OF LOWER LEG TENDON      AS                           $86.69     20090101
27685       REVISION OF LOWER LEG TENDON                          Y       $547.70     20081209
27685       REVISION OF LOWER LEG TENDON                                  $433.46     20090101
27686       REVISE LOWER LEG TENDONS          80                           $82.18     20090101
27686       REVISE LOWER LEG TENDONS          81                           $82.18     20090101


                                           Page 127
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27686       REVISE LOWER LEG TENDONS          82                           $82.18     20090101
27686       REVISE LOWER LEG TENDONS          AS                           $82.18     20090101
27686       REVISE LOWER LEG TENDONS                                      $410.90     20090101
27686       REVISE LOWER LEG TENDONS                              Y       $547.70     20081209
27687       REVISION OF CALF TENDON           80                           $67.89     20090101
27687       REVISION OF CALF TENDON           81                           $67.89     20090101
27687       REVISION OF CALF TENDON           82                           $67.89     20090101
27687       REVISION OF CALF TENDON           AS                           $67.89     20090101
27687       REVISION OF CALF TENDON                                       $339.43     20090101
27687       REVISION OF CALF TENDON                               Y       $547.70     20081209
27690       REVISE LOWER LEG TENDON           80                           $89.86     20090101
27690       REVISE LOWER LEG TENDON           81                           $89.86     20090101
27690       REVISE LOWER LEG TENDON           82                           $89.86     20090101
27690       REVISE LOWER LEG TENDON           AS                           $89.86     20090101
27690       REVISE LOWER LEG TENDON                               Y       $733.93     20081209
27690       REVISE LOWER LEG TENDON                                       $449.29     20090101
27691       REVISE LOWER LEG TENDON           80                          $106.44     20090101
27691       REVISE LOWER LEG TENDON           81                          $106.44     20090101
27691       REVISE LOWER LEG TENDON           82                          $106.44     20090101
27691       REVISE LOWER LEG TENDON           AS                          $106.44     20090101
27691       REVISE LOWER LEG TENDON                               Y       $733.93     20081209
27691       REVISE LOWER LEG TENDON                                       $532.20     20090101
27692       REVISE ADDITIONAL LEG TENDON      80                           $16.75     20090101
27692       REVISE ADDITIONAL LEG TENDON      81                           $16.75     20090101
27692       REVISE ADDITIONAL LEG TENDON      82                           $16.75     20090101
27692       REVISE ADDITIONAL LEG TENDON      AS                           $16.75     20090101
27692       REVISE ADDITIONAL LEG TENDON                                   $83.73     20090101
27692       REVISE ADDITIONAL LEG TENDON                          Y       $661.93     20081209
27695       REPAIR OF ANKLE LIGAMENT          80                           $72.39     20090101
27695       REPAIR OF ANKLE LIGAMENT          81                           $72.39     20090101
27695       REPAIR OF ANKLE LIGAMENT          82                           $72.39     20090101
27695       REPAIR OF ANKLE LIGAMENT          AS                           $72.39     20090101
27695       REPAIR OF ANKLE LIGAMENT                                      $361.94     20090101
27695       REPAIR OF ANKLE LIGAMENT                              Y       $509.30     20081209
27696       REPAIR OF ANKLE LIGAMENTS         80                           $86.74     20090101
27696       REPAIR OF ANKLE LIGAMENTS         81                           $86.74     20090101
27696       REPAIR OF ANKLE LIGAMENTS         82                           $86.74     20090101
27696       REPAIR OF ANKLE LIGAMENTS         AS                           $86.74     20090101
27696       REPAIR OF ANKLE LIGAMENTS                             Y       $509.30     20081209
27696       REPAIR OF ANKLE LIGAMENTS                                     $433.72     20090101
27698       REPAIR OF ANKLE LIGAMENT          80                           $96.65     20090101
27698       REPAIR OF ANKLE LIGAMENT          81                           $96.65     20090101
27698       REPAIR OF ANKLE LIGAMENT          82                           $96.65     20090101
27698       REPAIR OF ANKLE LIGAMENT          AS                           $96.65     20090101
27698       REPAIR OF ANKLE LIGAMENT                              Y       $509.30     20081209


                                           Page 128
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
27698       REPAIR OF ANKLE LIGAMENT                                     $483.24     20090101
27700       REVISION OF ANKLE JOINT          80                           $90.65     20090101
27700       REVISION OF ANKLE JOINT          81                           $90.65     20090101
27700       REVISION OF ANKLE JOINT          82                           $90.65     20090101
27700       REVISION OF ANKLE JOINT          AS                           $90.65     20090101
27700       REVISION OF ANKLE JOINT                                      $453.23     20090101
27700       REVISION OF ANKLE JOINT                              Y       $727.50     20081209
27702       RECONSTRUCT ANKLE JOINT          80                          $145.89     20090101
27702       RECONSTRUCT ANKLE JOINT          81                          $145.89     20090101
27702       RECONSTRUCT ANKLE JOINT          82                          $145.89     20090101
27702       RECONSTRUCT ANKLE JOINT          AS                          $145.89     20090101
27702       RECONSTRUCT ANKLE JOINT                                      $729.47     20090101
27703       RECONSTRUCTION, ANKLE JOINT      80                          $167.32     20090101
27703       RECONSTRUCTION, ANKLE JOINT      81                          $167.32     20090101
27703       RECONSTRUCTION, ANKLE JOINT      82                          $167.32     20090101
27703       RECONSTRUCTION, ANKLE JOINT      AS                          $167.32     20090101
27703       RECONSTRUCTION, ANKLE JOINT                                  $836.59     20090101
27704       REMOVAL OF ANKLE IMPLANT         80                           $81.07     20090101
27704       REMOVAL OF ANKLE IMPLANT         81                           $81.07     20090101
27704       REMOVAL OF ANKLE IMPLANT         82                           $81.07     20090101
27704       REMOVAL OF ANKLE IMPLANT         AS                           $81.07     20090101
27704       REMOVAL OF ANKLE IMPLANT                                     $405.36     20090101
27704       REMOVAL OF ANKLE IMPLANT                             Y       $443.71     20081209
27705       INCISION OF TIBIA                80                          $111.96     20090101
27705       INCISION OF TIBIA                81                          $111.96     20090101
27705       INCISION OF TIBIA                82                          $111.96     20090101
27705       INCISION OF TIBIA                AS                          $111.96     20090101
27705       INCISION OF TIBIA                                    Y       $623.53     20081209
27705       INCISION OF TIBIA                                            $559.78     20090101
27707       INCISION OF FIBULA               80                           $56.42     20090101
27707       INCISION OF FIBULA               81                           $56.42     20090101
27707       INCISION OF FIBULA               82                           $56.42     20090101
27707       INCISION OF FIBULA               AS                           $56.42     20090101
27707       INCISION OF FIBULA                                   Y       $443.71     20081209
27707       INCISION OF FIBULA                                           $282.09     20090101
27709       INCISION OF TIBIA & FIBULA       80                          $156.41     20090101
27709       INCISION OF TIBIA & FIBULA       81                          $156.41     20090101
27709       INCISION OF TIBIA & FIBULA       82                          $156.41     20090101
27709       INCISION OF TIBIA & FIBULA       AS                          $156.41     20090101
27709       INCISION OF TIBIA & FIBULA                                   $782.05     20090101
27709       INCISION OF TIBIA & FIBULA                           Y       $509.30     20081209
27712       REALIGNMENT OF LOWER LEG         80                          $157.19     20090101
27712       REALIGNMENT OF LOWER LEG         81                          $157.19     20090101
27712       REALIGNMENT OF LOWER LEG         82                          $157.19     20090101
27712       REALIGNMENT OF LOWER LEG         AS                          $157.19     20090101


                                          Page 129
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
27712       REALIGNMENT OF LOWER LEG                                    $785.93     20090101
27715       REVISION OF LOWER LEG           80                          $154.52     20090101
27715       REVISION OF LOWER LEG           81                          $154.52     20090101
27715       REVISION OF LOWER LEG           82                          $154.52     20090101
27715       REVISION OF LOWER LEG           AS                          $154.52     20090101
27715       REVISION OF LOWER LEG                                       $772.58     20090101
27720       REPAIR OF TIBIA                 80                          $127.65     20090101
27720       REPAIR OF TIBIA                 81                          $127.65     20090101
27720       REPAIR OF TIBIA                 82                          $127.65     20090101
27720       REPAIR OF TIBIA                 AS                          $127.65     20090101
27720       REPAIR OF TIBIA                                             $638.23     20090101
27722       REPAIR/GRAFT OF TIBIA           80                          $127.31     20090101
27722       REPAIR/GRAFT OF TIBIA           81                          $127.31     20090101
27722       REPAIR/GRAFT OF TIBIA           82                          $127.31     20090101
27722       REPAIR/GRAFT OF TIBIA           AS                          $127.31     20090101
27722       REPAIR/GRAFT OF TIBIA                                       $636.53     20090101
27724       REPAIR/GRAFT OF TIBIA           80                          $187.40     20090101
27724       REPAIR/GRAFT OF TIBIA           81                          $187.40     20090101
27724       REPAIR/GRAFT OF TIBIA           82                          $187.40     20090101
27724       REPAIR/GRAFT OF TIBIA           AS                          $187.40     20090101
27724       REPAIR/GRAFT OF TIBIA                                       $936.99     20090101
27725       REPAIR OF LOWER LEG             80                          $173.16     20090101
27725       REPAIR OF LOWER LEG             81                          $173.16     20090101
27725       REPAIR OF LOWER LEG             82                          $173.16     20090101
27725       REPAIR OF LOWER LEG             AS                          $173.16     20090101
27725       REPAIR OF LOWER LEG                                         $865.78     20090101
27726       REPAIR FIBULA NONUNION                              Y       $866.42     20081209
27726       REPAIR FIBULA NONUNION                                      $648.48     20090101
27727       REPAIR OF LOWER LEG             80                          $149.34     20090101
27727       REPAIR OF LOWER LEG             81                          $149.34     20090101
27727       REPAIR OF LOWER LEG             82                          $149.34     20090101
27727       REPAIR OF LOWER LEG             AS                          $149.34     20090101
27727       REPAIR OF LOWER LEG                                         $746.70     20090101
27730       REPAIR OF TIBIA EPIPHYSIS       80                          $84.52      20090101
27730       REPAIR OF TIBIA EPIPHYSIS       81                          $84.52      20090101
27730       REPAIR OF TIBIA EPIPHYSIS       82                          $84.52      20090101
27730       REPAIR OF TIBIA EPIPHYSIS       AS                           $84.52     20090101
27730       REPAIR OF TIBIA EPIPHYSIS                                   $422.59     20090101
27730       REPAIR OF TIBIA EPIPHYSIS                           Y       $509.30     20081209
27732       REPAIR OF FIBULA EPIPHYSIS      80                          $59.48      20090101
27732       REPAIR OF FIBULA EPIPHYSIS      81                          $59.48      20090101
27732       REPAIR OF FIBULA EPIPHYSIS      82                          $59.48      20090101
27732       REPAIR OF FIBULA EPIPHYSIS      AS                           $59.48     20090101
27732       REPAIR OF FIBULA EPIPHYSIS                                  $297.41     20090101
27732       REPAIR OF FIBULA EPIPHYSIS                          Y       $509.30     20081209


                                         Page 130
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
27734       REPAIR LOWER LEG EPIPHYSES       80                           $90.70     20090101
27734       REPAIR LOWER LEG EPIPHYSES       81                           $90.70     20090101
27734       REPAIR LOWER LEG EPIPHYSES       82                           $90.70     20090101
27734       REPAIR LOWER LEG EPIPHYSES       AS                           $90.70     20090101
27734       REPAIR LOWER LEG EPIPHYSES                                   $453.49     20090101
27734       REPAIR LOWER LEG EPIPHYSES                           Y       $509.30     20081209
27740       REPAIR OF LEG EPIPHYSES          80                          $102.43     20090101
27740       REPAIR OF LEG EPIPHYSES          81                          $102.43     20090101
27740       REPAIR OF LEG EPIPHYSES          82                          $102.43     20090101
27740       REPAIR OF LEG EPIPHYSES          AS                          $102.43     20090101
27740       REPAIR OF LEG EPIPHYSES                                      $512.17     20090101
27740       REPAIR OF LEG EPIPHYSES                              Y       $509.30     20081209
27742       REPAIR OF LEG EPIPHYSES          80                           $96.65     20090101
27742       REPAIR OF LEG EPIPHYSES          81                           $96.65     20090101
27742       REPAIR OF LEG EPIPHYSES          82                           $96.65     20090101
27742       REPAIR OF LEG EPIPHYSES          AS                           $96.65     20090101
27742       REPAIR OF LEG EPIPHYSES                                      $483.24     20090101
27742       REPAIR OF LEG EPIPHYSES                              Y       $623.53     20081209
27745       REINFORCE TIBIA                  80                          $109.67     20090101
27745       REINFORCE TIBIA                  81                          $109.67     20090101
27745       REINFORCE TIBIA                  82                          $109.67     20090101
27745       REINFORCE TIBIA                  AS                          $109.67     20090101
27745       REINFORCE TIBIA                                      Y       $963.65     20081209
27745       REINFORCE TIBIA                                              $548.34     20090101
27750       TREATMENT OF TIBIA FRACTURE                                  $232.31     20090101
27750       TREATMENT OF TIBIA FRACTURE                          Y        $76.82     20081209
27752       TREATMENT OF TIBIA FRACTURE                                  $374.46     20090101
27752       TREATMENT OF TIBIA FRACTURE                          Y        $76.82     20081209
27756       TREATMENT OF TIBIA FRACTURE      80                           $81.29     20090101
27756       TREATMENT OF TIBIA FRACTURE      81                           $81.29     20090101
27756       TREATMENT OF TIBIA FRACTURE      82                           $81.29     20090101
27756       TREATMENT OF TIBIA FRACTURE      AS                           $81.29     20090101
27756       TREATMENT OF TIBIA FRACTURE                          Y       $522.61     20081209
27756       TREATMENT OF TIBIA FRACTURE                                  $406.44     20090101
27758       TREATMENT OF TIBIA FRACTURE      80                          $128.25     20090101
27758       TREATMENT OF TIBIA FRACTURE      81                          $128.26     20090101
27758       TREATMENT OF TIBIA FRACTURE      82                          $128.26     20090101
27758       TREATMENT OF TIBIA FRACTURE      AS                          $128.26     20090101
27758       TREATMENT OF TIBIA FRACTURE                                  $641.25     20090101
27758       TREATMENT OF TIBIA FRACTURE                          Y       $718.39     20091209
27759       TREATMENT OF TIBIA FRACTURE      80                          $145.78     20090101
27759       TREATMENT OF TIBIA FRACTURE      81                          $145.78     20090101
27759       TREATMENT OF TIBIA FRACTURE      82                          $145.78     20090101
27759       TREATMENT OF TIBIA FRACTURE      AS                          $145.78     20090101
27759       TREATMENT OF TIBIA FRACTURE                          Y       $868.38     20081209


                                          Page 131
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27759       TREATMENT OF TIBIA FRACTURE                                    $728.90      20090101
27760       CLTX MEDIAL ANKLE FX                                  Y         $76.82      20081209
27760       CLTX MEDIAL ANKLE FX                                           $223.95      20090101
27762       CLTX MED ANKLE FX W/MNPJ                                       $336.35      20090101
27762       CLTX MED ANKLE FX W/MNPJ                              Y         $76.82      20081209
27766       OPTX MEDIAL ANKLE FX              80                           $88.19       20090101
27766       OPTX MEDIAL ANKLE FX              81                           $88.19       20090101
27766       OPTX MEDIAL ANKLE FX              82                           $88.19       20090101
27766       OPTX MEDIAL ANKLE FX              AS                            $88.19      20090101
27766       OPTX MEDIAL ANKLE FX                                           $440.96      20090101
27766       OPTX MEDIAL ANKLE FX                                  Y        $646.39      20081209
27767       CLTX POST ANKLE FX                                    Y         $56.57      20080101
27767       CLTX POST ANKLE FX                                             $178.61      20090101
27768       CLTX POST ANKLE FX W/MNPJ                                      $280.71      20090101
27768       CLTX POST ANKLE FX W/MNPJ                             Y        $58.57       20080101
27769       OPTX POST ANKLE FX                                    Y       $1,361.57     20080101
27769       OPTX POST ANKLE FX                                             $487.70      20090101
27780       TREATMENT OF FIBULA FRACTURE                          Y         $76.82      20081209
27780       TREATMENT OF FIBULA FRACTURE                                   $198.92      20090101
27781       TREATMENT OF FIBULA FRACTURE                                   $289.05      20090101
27781       TREATMENT OF FIBULA FRACTURE                          Y         $76.82      20081209
27784       TREATMENT OF FIBULA FRACTURE      80                           $96.81       20090101
27784       TREATMENT OF FIBULA FRACTURE      81                           $96.81       20090101
27784       TREATMENT OF FIBULA FRACTURE      82                           $96.81       20090101
27784       TREATMENT OF FIBULA FRACTURE      AS                            $96.81      20090101
27784       TREATMENT OF FIBULA FRACTURE                          Y        $646.39      20081209
27784       TREATMENT OF FIBULA FRACTURE                                   $484.07      20090101
27786       TREATMENT OF ANKLE FRACTURE                                    $212.27      20090101
27786       TREATMENT OF ANKLE FRACTURE                           Y         $76.82      20081209
27788       TREATMENT OF ANKLE FRACTURE                                    $294.06      20090101
27788       TREATMENT OF ANKLE FRACTURE                           Y         $76.82      20081209
27792       TREATMENT OF ANKLE FRACTURE       80                           $98.82       20090101
27792       TREATMENT OF ANKLE FRACTURE       81                           $98.82       20090101
27792       TREATMENT OF ANKLE FRACTURE       82                           $98.82       20090101
27792       TREATMENT OF ANKLE FRACTURE       AS                            $98.82      20090101
27792       TREATMENT OF ANKLE FRACTURE                                    $494.11      20090101
27792       TREATMENT OF ANKLE FRACTURE                           Y        $646.39      20081209
27808       TREATMENT OF ANKLE FRACTURE                                    $221.73      20090101
27808       TREATMENT OF ANKLE FRACTURE                           Y         $76.82      20081209
27810       TREATMENT OF ANKLE FRACTURE                                    $329.68      20090101
27810       TREATMENT OF ANKLE FRACTURE                           Y         $76.82      20081209
27814       TREATMENT OF ANKLE FRACTURE       80                           $112.50      20090101
27814       TREATMENT OF ANKLE FRACTURE       81                           $112.50      20090101
27814       TREATMENT OF ANKLE FRACTURE       82                           $112.50      20090101
27814       TREATMENT OF ANKLE FRACTURE       AS                           $112.50      20090101


                                           Page 132
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
27814       TREATMENT OF ANKLE FRACTURE                          Y       $646.39     20081209
27814       TREATMENT OF ANKLE FRACTURE                                  $562.52     20090101
27816       TREATMENT OF ANKLE FRACTURE                                  $210.88     20090101
27816       TREATMENT OF ANKLE FRACTURE                          Y        $76.82     20081209
27818       TREATMENT OF ANKLE FRACTURE                          Y        $76.82     20081209
27818       TREATMENT OF ANKLE FRACTURE                                  $341.64     20090101
27822       TREATMENT OF ANKLE FRACTURE      80                          $124.52     20090101
27822       TREATMENT OF ANKLE FRACTURE      81                          $124.52     20090101
27822       TREATMENT OF ANKLE FRACTURE      82                          $124.52     20090101
27822       TREATMENT OF ANKLE FRACTURE      AS                          $124.52     20090101
27822       TREATMENT OF ANKLE FRACTURE                                  $622.60     20090101
27822       TREATMENT OF ANKLE FRACTURE                          Y       $646.39     20081209
27823       TREATMENT OF ANKLE FRACTURE      80                          $141.61     20090101
27823       TREATMENT OF ANKLE FRACTURE      81                          $141.61     20090101
27823       TREATMENT OF ANKLE FRACTURE      82                          $141.61     20090101
27823       TREATMENT OF ANKLE FRACTURE      AS                          $141.61     20090101
27823       TREATMENT OF ANKLE FRACTURE                          Y       $796.38     20081209
27823       TREATMENT OF ANKLE FRACTURE                                  $708.04     20090101
27824       TREAT LOWER LEG FRACTURE                             Y        $76.82     20081209
27824       TREAT LOWER LEG FRACTURE                                     $208.94     20090101
27825       TREAT LOWER LEG FRACTURE                                     $384.20     20090101
27825       TREAT LOWER LEG FRACTURE                             Y        $76.82     20081209
27826       TREAT LOWER LEG FRACTURE         80                          $116.34     20090101
27826       TREAT LOWER LEG FRACTURE         81                          $116.34     20090101
27826       TREAT LOWER LEG FRACTURE         82                          $116.34     20090101
27826       TREAT LOWER LEG FRACTURE         AS                          $116.34     20090101
27826       TREAT LOWER LEG FRACTURE                             Y       $646.39     20081209
27826       TREAT LOWER LEG FRACTURE                                     $581.72     20090101
27827       TREAT LOWER LEG FRACTURE         80                          $158.47     20090101
27827       TREAT LOWER LEG FRACTURE         81                          $158.47     20090101
27827       TREAT LOWER LEG FRACTURE         82                          $158.47     20090101
27827       TREAT LOWER LEG FRACTURE         AS                          $158.47     20090101
27827       TREAT LOWER LEG FRACTURE                             Y       $796.38     20081209
27827       TREAT LOWER LEG FRACTURE                                     $792.34     20090101
27828       TREAT LOWER LEG FRACTURE         80                          $187.96     20090101
27828       TREAT LOWER LEG FRACTURE         81                          $187.96     20090101
27828       TREAT LOWER LEG FRACTURE         82                          $187.96     20090101
27828       TREAT LOWER LEG FRACTURE         AS                          $187.96     20090101
27828       TREAT LOWER LEG FRACTURE                             Y       $868.38     20081209
27828       TREAT LOWER LEG FRACTURE                                     $939.78     20090101
27829       TREAT LOWER LEG JOINT            80                          $91.64      20090101
27829       TREAT LOWER LEG JOINT            81                          $91.64      20090101
27829       TREAT LOWER LEG JOINT            82                          $91.64      20090101
27829       TREAT LOWER LEG JOINT            AS                           $91.64     20090101
27829       TREAT LOWER LEG JOINT                                        $458.19     20090101


                                          Page 133
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
27829       TREAT LOWER LEG JOINT                                 Y        $607.99      20081209
27830       TREAT LOWER LEG DISLOCATION                                    $240.09      20090101
27830       TREAT LOWER LEG DISLOCATION                           Y         $76.82      20081209
27831       TREAT LOWER LEG DISLOCATION                           Y         $76.82      20081209
27831       TREAT LOWER LEG DISLOCATION                                    $267.36      20090101
27832       TREAT LOWER LEG DISLOCATION       80                           $97.60       20090101
27832       TREAT LOWER LEG DISLOCATION       81                           $97.60       20090101
27832       TREAT LOWER LEG DISLOCATION       82                           $97.60       20090101
27832       TREAT LOWER LEG DISLOCATION       AS                            $97.60      20090101
27832       TREAT LOWER LEG DISLOCATION                                    $488.00      20090101
27832       TREAT LOWER LEG DISLOCATION                           Y        $607.99      20081209
27840       TREAT ANKLE DISLOCATION                                        $245.38      20090101
27840       TREAT ANKLE DISLOCATION                               Y         $76.82      20081209
27842       TREAT ANKLE DISLOCATION                                        $342.75      20090101
27842       TREAT ANKLE DISLOCATION                               Y        $322.06      20081209
27846       TREAT ANKLE DISLOCATION           80                           $106.95      20090101
27846       TREAT ANKLE DISLOCATION           81                           $106.95      20090101
27846       TREAT ANKLE DISLOCATION           82                           $106.95      20090101
27846       TREAT ANKLE DISLOCATION           AS                           $106.95      20090101
27846       TREAT ANKLE DISLOCATION                               Y        $646.39      20081209
27846       TREAT ANKLE DISLOCATION                                        $534.73      20090101
27848       TREAT ANKLE DISLOCATION           80                           $122.58      20090101
27848       TREAT ANKLE DISLOCATION           81                           $122.58      20090101
27848       TREAT ANKLE DISLOCATION           82                           $122.58      20090101
27848       TREAT ANKLE DISLOCATION           AS                           $122.58      20090101
27848       TREAT ANKLE DISLOCATION                                        $612.88      20090101
27848       TREAT ANKLE DISLOCATION                               Y        $646.39      20081209
27860       FIXATION OF ANKLE JOINT                                        $127.70      20090101
27860       FIXATION OF ANKLE JOINT                               Y        $322.06      20081209
27870       FUSION OF ANKLE JOINT, OPEN       80                           $152.40      20090101
27870       FUSION OF ANKLE JOINT, OPEN       81                           $152.40      20090101
27870       FUSION OF ANKLE JOINT, OPEN       82                           $152.40      20090101
27870       FUSION OF ANKLE JOINT, OPEN       AS                           $152.40      20090101
27870       FUSION OF ANKLE JOINT, OPEN                                    $762.02      20090101
27870       FUSION OF ANKLE JOINT, OPEN                           Y       $1,035.65     20081209
27871       FUSION OF TIBIOFIBULAR JOINT      80                           $100.54      20090101
27871       FUSION OF TIBIOFIBULAR JOINT      81                           $100.54      20090101
27871       FUSION OF TIBIOFIBULAR JOINT      82                           $100.54      20090101
27871       FUSION OF TIBIOFIBULAR JOINT      AS                           $100.54      20090101
27871       FUSION OF TIBIOFIBULAR JOINT                          Y       $1,035.65     20081209
27871       FUSION OF TIBIOFIBULAR JOINT                                   $502.70      20090101
27880       AMPUTATION OF LOWER LEG           80                           $132.93      20090101
27880       AMPUTATION OF LOWER LEG           81                           $132.93      20090101
27880       AMPUTATION OF LOWER LEG           82                           $132.93      20090101
27880       AMPUTATION OF LOWER LEG           AS                           $132.93      20090101


                                           Page 134
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
27880       AMPUTATION OF LOWER LEG                                       $664.63     20090101
27881       AMPUTATION OF LOWER LEG           80                          $130.37     20090101
27881       AMPUTATION OF LOWER LEG           81                          $130.37     20090101
27881       AMPUTATION OF LOWER LEG           82                          $130.37     20090101
27881       AMPUTATION OF LOWER LEG           AS                          $130.37     20090101
27881       AMPUTATION OF LOWER LEG                                       $651.84     20090101
27882       AMPUTATION OF LOWER LEG           80                           $92.69     20090101
27882       AMPUTATION OF LOWER LEG           81                           $92.69     20090101
27882       AMPUTATION OF LOWER LEG           82                           $92.69     20090101
27882       AMPUTATION OF LOWER LEG           AS                           $92.69     20090101
27882       AMPUTATION OF LOWER LEG                                       $463.47     20090101
27884       AMPUTATION FOLLOW-UP SURGERY                                  $425.39     20090101
27884       AMPUTATION FOLLOW-UP SURGERY                          Y       $482.11     20081209
27886       AMPUTATION FOLLOW-UP SURGERY      80                           $96.60     20090101
27886       AMPUTATION FOLLOW-UP SURGERY      81                           $96.60     20090101
27886       AMPUTATION FOLLOW-UP SURGERY      82                           $96.60     20090101
27886       AMPUTATION FOLLOW-UP SURGERY      AS                           $96.60     20090101
27886       AMPUTATION FOLLOW-UP SURGERY                                  $482.98     20090101
27888       AMPUTATION OF FOOT AT ANKLE       80                          $102.94     20090101
27888       AMPUTATION OF FOOT AT ANKLE       81                          $102.94     20090101
27888       AMPUTATION OF FOOT AT ANKLE       82                          $102.94     20090101
27888       AMPUTATION OF FOOT AT ANKLE       AS                          $102.94     20090101
27888       AMPUTATION OF FOOT AT ANKLE                                   $514.71     20090101
27889       AMPUTATION OF FOOT AT ANKLE       80                          $100.93     20090101
27889       AMPUTATION OF FOOT AT ANKLE       81                          $100.93     20090101
27889       AMPUTATION OF FOOT AT ANKLE       82                          $100.93     20090101
27889       AMPUTATION OF FOOT AT ANKLE       AS                          $100.93     20090101
27889       AMPUTATION OF FOOT AT ANKLE                           Y       $547.70     20081209
27889       AMPUTATION OF FOOT AT ANKLE                                   $504.67     20090101
27892       DECOMPRESSION OF LEG                                          $397.01     20090101
27892       DECOMPRESSION OF LEG                                  Y       $482.11     20081209
27893       DECOMPRESSION OF LEG                                          $394.50     20090101
27893       DECOMPRESSION OF LEG                                  Y       $482.11     20081209
27894       DECOMPRESSION OF LEG              80                          $120.35     20090101
27894       DECOMPRESSION OF LEG              81                          $120.35     20090101
27894       DECOMPRESSION OF LEG              82                          $120.35     20090101
27894       DECOMPRESSION OF LEG              AS                          $120.35     20090101
27894       DECOMPRESSION OF LEG                                          $601.75     20090101
27894       DECOMPRESSION OF LEG                                  Y       $482.11     20081209
28001       DRAINAGE OF BURSA OF FOOT                                     $182.78     20090101
28002       TREATMENT OF FOOT INFECTION                                   $339.97     20090101
28002       TREATMENT OF FOOT INFECTION                           Y       $482.11     20081209
28003       TREATMENT OF FOOT INFECTION                                   $475.18     20090101
28003       TREATMENT OF FOOT INFECTION                           Y       $482.11     20081209
28005       TREAT FOOT BONE LESION                                        $452.09     20090101


                                           Page 135
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
28005       TREAT FOOT BONE LESION                                Y       $478.46     20081209
28008       INCISION OF FOOT FASCIA                               Y       $478.46     20081209
28008       INCISION OF FOOT FASCIA                                       $290.17     20090101
28010       INCISION OF TOE TENDON                                        $163.31     20090101
28011       INCISION OF TOE TENDONS                                       $231.75     20090101
28011       INCISION OF TOE TENDONS                               Y       $478.46     20081209
28020       EXPLORATION OF FOOT JOINT         80                           $69.39     20090101
28020       EXPLORATION OF FOOT JOINT         81                           $69.39     20090101
28020       EXPLORATION OF FOOT JOINT         82                           $69.39     20090101
28020       EXPLORATION OF FOOT JOINT         AS                           $69.39     20090101
28020       EXPLORATION OF FOOT JOINT                             Y       $440.06     20081209
28020       EXPLORATION OF FOOT JOINT                                     $346.93     20090101
28022       EXPLORATION OF FOOT JOINT                                     $317.16     20090101
28022       EXPLORATION OF FOOT JOINT                             Y       $440.06     20081209
28024       EXPLORATION OF TOE JOINT                                      $303.24     20090101
28024       EXPLORATION OF TOE JOINT                              Y       $440.06     20081209
28035       DECOMPRESSION OF TIBIA NERVE      80                          $69.06      20090101
28035       DECOMPRESSION OF TIBIA NERVE      81                          $69.06      20090101
28035       DECOMPRESSION OF TIBIA NERVE      82                          $69.06      20090101
28035       DECOMPRESSION OF TIBIA NERVE      AS                           $69.06     20090101
28035       DECOMPRESSION OF TIBIA NERVE                                  $345.28     20090101
28035       DECOMPRESSION OF TIBIA NERVE                          Y       $527.47     20081209
28043       EXCISION OF FOOT LESION                                       $232.03     20090101
28043       EXCISION OF FOOT LESION                               Y       $442.39     20081209
28045       EXCISION OF FOOT LESION                                       $322.72     20090101
28045       EXCISION OF FOOT LESION                               Y       $478.46     20081209
28046       RESECTION OF TUMOR, FOOT                                      $597.59     20090101
28046       RESECTION OF TUMOR, FOOT                              Y       $478.46     20081209
28050       BIOPSY OF FOOT JOINT LINING       80                           $60.21     20090101
28050       BIOPSY OF FOOT JOINT LINING       81                           $60.21     20090101
28050       BIOPSY OF FOOT JOINT LINING       82                           $60.21     20090101
28050       BIOPSY OF FOOT JOINT LINING       AS                           $60.21     20090101
28050       BIOPSY OF FOOT JOINT LINING                           Y       $440.06     20081209
28050       BIOPSY OF FOOT JOINT LINING                                   $301.03     20090101
28052       BIOPSY OF FOOT JOINT LINING                                   $281.55     20090101
28052       BIOPSY OF FOOT JOINT LINING                           Y       $440.06     20081209
28054       BIOPSY OF TOE JOINT LINING                                    $262.63     20090101
28054       BIOPSY OF TOE JOINT LINING                            Y       $440.06     20081209
28055       NEURECTOMY, FOOT                                              $291.84     20090101
28055       NEURECTOMY, FOOT                                      Y       $527.47     20081209
28060       PARTIAL REMOVAL, FOOT FASCIA      80                           $68.27     20090101
28060       PARTIAL REMOVAL, FOOT FASCIA      81                           $68.27     20090101
28060       PARTIAL REMOVAL, FOOT FASCIA      82                           $68.27     20090101
28060       PARTIAL REMOVAL, FOOT FASCIA      AS                           $68.27     20090101
28060       PARTIAL REMOVAL, FOOT FASCIA                          Y       $440.06     20081209


                                           Page 136
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
28060       PARTIAL REMOVAL, FOOT FASCIA                                  $341.34     20090101
28062       REMOVAL OF FOOT FASCIA            80                           $81.12     20090101
28062       REMOVAL OF FOOT FASCIA            81                           $81.12     20090101
28062       REMOVAL OF FOOT FASCIA            82                           $81.12     20090101
28062       REMOVAL OF FOOT FASCIA            AS                           $81.12     20090101
28062       REMOVAL OF FOOT FASCIA                                        $405.62     20090101
28062       REMOVAL OF FOOT FASCIA                                Y       $478.46     20081209
28070       REMOVAL OF FOOT JOINT LINING      80                           $67.72     20090101
28070       REMOVAL OF FOOT JOINT LINING      81                           $67.72     20090101
28070       REMOVAL OF FOOT JOINT LINING      82                           $67.72     20090101
28070       REMOVAL OF FOOT JOINT LINING      AS                           $67.72     20090101
28070       REMOVAL OF FOOT JOINT LINING                                  $338.60     20090101
28070       REMOVAL OF FOOT JOINT LINING                          Y       $478.46     20081209
28072       REMOVAL OF FOOT JOINT LINING      80                           $65.99     20090101
28072       REMOVAL OF FOOT JOINT LINING      81                           $65.99     20090101
28072       REMOVAL OF FOOT JOINT LINING      82                           $65.99     20090101
28072       REMOVAL OF FOOT JOINT LINING      AS                           $65.99     20090101
28072       REMOVAL OF FOOT JOINT LINING                                  $329.96     20090101
28072       REMOVAL OF FOOT JOINT LINING                          Y       $478.46     20081209
28080       REMOVAL OF FOOT LESION                                Y       $478.46     20081209
28080       REMOVAL OF FOOT LESION                                        $320.22     20090101
28086       EXCISE FOOT TENDON SHEATH         80                           $75.22     20090101
28086       EXCISE FOOT TENDON SHEATH         81                           $75.22     20090101
28086       EXCISE FOOT TENDON SHEATH         82                           $75.22     20090101
28086       EXCISE FOOT TENDON SHEATH         AS                           $75.22     20090101
28086       EXCISE FOOT TENDON SHEATH                                     $376.12     20090101
28086       EXCISE FOOT TENDON SHEATH                             Y       $440.06     20081209
28088       EXCISE FOOT TENDON SHEATH                             Y       $440.06     20081209
28088       EXCISE FOOT TENDON SHEATH                                     $302.97     20090101
28090       REMOVAL OF FOOT LESION                                        $306.31     20090101
28090       REMOVAL OF FOOT LESION                                Y       $478.46     20081209
28092       REMOVAL OF TOE LESIONS                                        $278.77     20090101
28092       REMOVAL OF TOE LESIONS                                Y       $478.46     20081209
28100       REMOVAL OF ANKLE/HEEL LESION      80                           $81.07     20090101
28100       REMOVAL OF ANKLE/HEEL LESION      81                           $81.07     20090101
28100       REMOVAL OF ANKLE/HEEL LESION      82                           $81.07     20090101
28100       REMOVAL OF ANKLE/HEEL LESION      AS                           $81.07     20090101
28100       REMOVAL OF ANKLE/HEEL LESION                                  $405.36     20090101
28100       REMOVAL OF ANKLE/HEEL LESION                          Y       $440.06     20081209
28102       REMOVE/GRAFT FOOT LESION          80                           $79.79     20090101
28102       REMOVE/GRAFT FOOT LESION          81                           $79.79     20090101
28102       REMOVE/GRAFT FOOT LESION          82                           $79.79     20090101
28102       REMOVE/GRAFT FOOT LESION          AS                           $79.79     20090101
28102       REMOVE/GRAFT FOOT LESION                                      $398.94     20090101
28102       REMOVE/GRAFT FOOT LESION                              Y       $672.55     20081209


                                           Page 137
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
28103       REMOVE/GRAFT FOOT LESION        80                           $65.60     20090101
28103       REMOVE/GRAFT FOOT LESION        81                           $65.60     20090101
28103       REMOVE/GRAFT FOOT LESION        82                           $65.60     20090101
28103       REMOVE/GRAFT FOOT LESION        AS                           $65.60     20090101
28103       REMOVE/GRAFT FOOT LESION                                    $327.99     20090101
28103       REMOVE/GRAFT FOOT LESION                            Y       $672.55     20081209
28104       REMOVAL OF FOOT LESION          80                           $68.05     20090101
28104       REMOVAL OF FOOT LESION          81                           $68.05     20090101
28104       REMOVAL OF FOOT LESION          82                           $68.05     20090101
28104       REMOVAL OF FOOT LESION          AS                           $68.05     20090101
28104       REMOVAL OF FOOT LESION                              Y       $440.06     20081209
28104       REMOVAL OF FOOT LESION                                      $340.26     20090101
28106       REMOVE/GRAFT FOOT LESION        80                           $69.72     20090101
28106       REMOVE/GRAFT FOOT LESION        81                           $69.72     20090101
28106       REMOVE/GRAFT FOOT LESION        82                           $69.72     20090101
28106       REMOVE/GRAFT FOOT LESION        AS                           $69.72     20090101
28106       REMOVE/GRAFT FOOT LESION                                    $348.59     20090101
28106       REMOVE/GRAFT FOOT LESION                            Y       $672.55     20081209
28107       REMOVE/GRAFT FOOT LESION        80                           $74.94     20090101
28107       REMOVE/GRAFT FOOT LESION        81                           $74.94     20090101
28107       REMOVE/GRAFT FOOT LESION        82                           $74.94     20090101
28107       REMOVE/GRAFT FOOT LESION        AS                           $74.94     20090101
28107       REMOVE/GRAFT FOOT LESION                            Y       $672.55     20081209
28107       REMOVE/GRAFT FOOT LESION                                    $374.72     20090101
28108       REMOVAL OF TOE LESIONS                                      $284.05     20090101
28110       PART REMOVAL OF METATARSAL      80                           $59.76     20090101
28110       PART REMOVAL OF METATARSAL      81                           $59.76     20090101
28110       PART REMOVAL OF METATARSAL      82                           $59.76     20090101
28110       PART REMOVAL OF METATARSAL      AS                           $59.76     20090101
28110       PART REMOVAL OF METATARSAL                                  $298.80     20090101
28110       PART REMOVAL OF METATARSAL                          Y       $478.46     20081209
28111       PART REMOVAL OF METATARSAL      80                           $69.11     20090101
28111       PART REMOVAL OF METATARSAL      81                           $69.11     20090101
28111       PART REMOVAL OF METATARSAL      82                           $69.11     20090101
28111       PART REMOVAL OF METATARSAL      AS                           $69.11     20090101
28111       PART REMOVAL OF METATARSAL                                  $345.53     20090101
28111       PART REMOVAL OF METATARSAL                          Y       $478.46     20081209
28112       PART REMOVAL OF METATARSAL      80                           $64.82     20090101
28112       PART REMOVAL OF METATARSAL      81                           $64.82     20090101
28112       PART REMOVAL OF METATARSAL      82                           $64.82     20090101
28112       PART REMOVAL OF METATARSAL      AS                           $64.82     20090101
28112       PART REMOVAL OF METATARSAL                                  $324.11     20090101
28112       PART REMOVAL OF METATARSAL                          Y       $478.46     20081209
28113       PART REMOVAL OF METATARSAL                          Y       $478.46     20081209
28113       PART REMOVAL OF METATARSAL                                  $381.70     20090101


                                         Page 138
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
28114       REMOVAL OF METATARSAL HEADS       80                          $142.11     20090101
28114       REMOVAL OF METATARSAL HEADS       81                          $142.11     20090101
28114       REMOVAL OF METATARSAL HEADS       82                          $142.11     20090101
28114       REMOVAL OF METATARSAL HEADS       AS                          $142.11     20090101
28114       REMOVAL OF METATARSAL HEADS                                   $710.53     20090101
28114       REMOVAL OF METATARSAL HEADS                           Y       $478.46     20081209
28116       REVISION OF FOOT                                              $503.28     20090101
28116       REVISION OF FOOT                                      Y       $478.46     20081209
28118       REMOVAL OF HEEL BONE              80                           $77.63     20090101
28118       REMOVAL OF HEEL BONE              81                           $77.63     20090101
28118       REMOVAL OF HEEL BONE              82                           $77.63     20090101
28118       REMOVAL OF HEEL BONE              AS                           $77.63     20090101
28118       REMOVAL OF HEEL BONE                                          $388.13     20090101
28118       REMOVAL OF HEEL BONE                                  Y       $550.46     20081209
28119       REMOVAL OF HEEL SPUR              80                           $69.39     20090101
28119       REMOVAL OF HEEL SPUR              81                           $69.39     20090101
28119       REMOVAL OF HEEL SPUR              82                           $69.39     20090101
28119       REMOVAL OF HEEL SPUR              AS                           $69.39     20090101
28119       REMOVAL OF HEEL SPUR                                  Y       $550.46     20081209
28119       REMOVAL OF HEEL SPUR                                          $346.93     20090101
28120       PART REMOVAL OF ANKLE/HEEL                                    $392.28     20090101
28120       PART REMOVAL OF ANKLE/HEEL                            Y       $769.46     20081209
28122       PARTIAL REMOVAL OF FOOT BONE      80                           $90.09     20090101
28122       PARTIAL REMOVAL OF FOOT BONE      81                           $90.09     20090101
28122       PARTIAL REMOVAL OF FOOT BONE      82                           $90.09     20090101
28122       PARTIAL REMOVAL OF FOOT BONE      AS                           $90.09     20090101
28122       PARTIAL REMOVAL OF FOOT BONE                                  $450.43     20090101
28122       PARTIAL REMOVAL OF FOOT BONE                          Y       $478.46     20081209
28124       PARTIAL REMOVAL OF TOE                                        $316.05     20090101
28126       PARTIAL REMOVAL OF TOE                                        $253.17     20090101
28126       PARTIAL REMOVAL OF TOE                                Y       $478.46     20081209
28130       REMOVAL OF ANKLE BONE             80                           $94.59     20090101
28130       REMOVAL OF ANKLE BONE             81                           $94.59     20090101
28130       REMOVAL OF ANKLE BONE             82                           $94.59     20090101
28130       REMOVAL OF ANKLE BONE             AS                           $94.59     20090101
28130       REMOVAL OF ANKLE BONE                                         $472.94     20090101
28130       REMOVAL OF ANKLE BONE                                 Y       $478.46     20081209
28140       REMOVAL OF METATARSAL                                 Y       $478.46     20081209
28140       REMOVAL OF METATARSAL                                         $430.38     20090101
28150       REMOVAL OF TOE                                        Y       $478.46     20081209
28150       REMOVAL OF TOE                                                $285.72     20090101
28153       PARTIAL REMOVAL OF TOE                                        $262.63     20090101
28153       PARTIAL REMOVAL OF TOE                                Y       $478.46     20081209
28160       PARTIAL REMOVAL OF TOE                                        $270.41     20090101
28160       PARTIAL REMOVAL OF TOE                                Y       $478.46     20081209


                                           Page 139
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
28171       EXTENSIVE FOOT SURGERY            80                           $91.92     20090101
28171       EXTENSIVE FOOT SURGERY            81                           $91.92     20090101
28171       EXTENSIVE FOOT SURGERY            82                           $91.92     20090101
28171       EXTENSIVE FOOT SURGERY            AS                           $91.92     20090101
28171       EXTENSIVE FOOT SURGERY                                Y       $478.46     20081209
28171       EXTENSIVE FOOT SURGERY                                        $459.59     20090101
28173       EXTENSIVE FOOT SURGERY                                Y       $478.46     20081209
28173       EXTENSIVE FOOT SURGERY                                        $509.95     20090101
28175       EXTENSIVE FOOT SURGERY                                        $370.85     20090101
28175       EXTENSIVE FOOT SURGERY                                Y       $478.46     20081209
28190       REMOVAL OF FOOT FOREIGN BODY                                  $164.14     20090101
28192       REMOVAL OF FOOT FOREIGN BODY                                  $317.16     20090101
28192       REMOVAL OF FOOT FOREIGN BODY                          Y       $400.91     20081209
28193       REMOVAL OF FOOT FOREIGN BODY                                  $361.39     20090101
28193       REMOVAL OF FOOT FOREIGN BODY                          Y       $323.01     20081209
28200       REPAIR OF FOOT TENDON             80                           $62.60     20090101
28200       REPAIR OF FOOT TENDON             81                           $62.60     20090101
28200       REPAIR OF FOOT TENDON             82                           $62.60     20090101
28200       REPAIR OF FOOT TENDON             AS                           $62.60     20090101
28200       REPAIR OF FOOT TENDON                                 Y       $478.46     20081209
28200       REPAIR OF FOOT TENDON                                         $312.98     20090101
28202       REPAIR/GRAFT OF FOOT TENDON       80                           $85.47     20090101
28202       REPAIR/GRAFT OF FOOT TENDON       81                           $85.47     20090101
28202       REPAIR/GRAFT OF FOOT TENDON       82                           $85.47     20090101
28202       REPAIR/GRAFT OF FOOT TENDON       AS                           $85.47     20090101
28202       REPAIR/GRAFT OF FOOT TENDON                                   $427.35     20090101
28202       REPAIR/GRAFT OF FOOT TENDON                           Y       $478.46     20081209
28208       REPAIR OF FOOT TENDON             80                           $59.81     20090101
28208       REPAIR OF FOOT TENDON             81                           $59.81     20090101
28208       REPAIR OF FOOT TENDON             82                           $59.81     20090101
28208       REPAIR OF FOOT TENDON             AS                           $59.81     20090101
28208       REPAIR OF FOOT TENDON                                         $299.06     20090101
28208       REPAIR OF FOOT TENDON                                 Y       $478.46     20081209
28210       REPAIR/GRAFT OF FOOT TENDON       80                           $78.68     20090101
28210       REPAIR/GRAFT OF FOOT TENDON       81                           $78.68     20090101
28210       REPAIR/GRAFT OF FOOT TENDON       82                           $78.68     20090101
28210       REPAIR/GRAFT OF FOOT TENDON       AS                           $78.68     20090101
28210       REPAIR/GRAFT OF FOOT TENDON                                   $393.40     20090101
28210       REPAIR/GRAFT OF FOOT TENDON                           Y       $672.55     20081209
28220       RELEASE OF FOOT TENDON                                        $297.41     20090101
28222       RELEASE OF FOOT TENDONS                               Y       $372.26     20081209
28222       RELEASE OF FOOT TENDONS                                       $346.37     20090101
28225       RELEASE OF FOOT TENDON                                Y       $372.26     20081209
28225       RELEASE OF FOOT TENDON                                        $259.01     20090101
28226       RELEASE OF FOOT TENDONS                                       $306.03     20090101


                                           Page 140
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
28226       RELEASE OF FOOT TENDONS                              Y       $372.26     20081209
28230       INCISION OF FOOT TENDON(S)                                   $286.55     20090101
28232       INCISION OF TOE TENDON                                       $253.17     20090101
28234       INCISION OF FOOT TENDON                                      $260.13     20090101
28234       INCISION OF FOOT TENDON                              Y       $440.06     20081209
28238       REVISION OF FOOT TENDON          80                           $93.09     20090101
28238       REVISION OF FOOT TENDON          81                           $93.09     20090101
28238       REVISION OF FOOT TENDON          82                           $93.09     20090101
28238       REVISION OF FOOT TENDON          AS                           $93.09     20090101
28238       REVISION OF FOOT TENDON                              Y       $672.55     20081209
28238       REVISION OF FOOT TENDON                                      $465.44     20090101
28240       RELEASE OF BIG TOE                                           $291.28     20090101
28240       RELEASE OF BIG TOE                                   Y       $440.06     20081209
28250       REVISION OF FOOT FASCIA          80                           $74.45     20090101
28250       REVISION OF FOOT FASCIA          81                           $74.45     20090101
28250       REVISION OF FOOT FASCIA          82                           $74.45     20090101
28250       REVISION OF FOOT FASCIA          AS                           $74.45     20090101
28250       REVISION OF FOOT FASCIA                                      $372.24     20090101
28250       REVISION OF FOOT FASCIA                              Y       $478.46     20081209
28260       RELEASE OF MIDFOOT JOINT         80                           $92.43     20090101
28260       RELEASE OF MIDFOOT JOINT         81                           $92.43     20090101
28260       RELEASE OF MIDFOOT JOINT         82                           $92.43     20090101
28260       RELEASE OF MIDFOOT JOINT         AS                           $92.43     20090101
28260       RELEASE OF MIDFOOT JOINT                                     $462.13     20090101
28260       RELEASE OF MIDFOOT JOINT                             Y       $478.46     20081209
28261       REVISION OF FOOT TENDON                                      $671.04     20090101
28261       REVISION OF FOOT TENDON                              Y       $478.46     20081209
28262       REVISION OF FOOT AND ANKLE       80                          $190.07     20090101
28262       REVISION OF FOOT AND ANKLE       81                          $190.07     20090101
28262       REVISION OF FOOT AND ANKLE       82                          $190.07     20090101
28262       REVISION OF FOOT AND ANKLE       AS                          $190.07     20090101
28262       REVISION OF FOOT AND ANKLE                           Y       $550.46     20081209
28262       REVISION OF FOOT AND ANKLE                                   $950.34     20090101
28264       RELEASE OF MIDFOOT JOINT         80                          $117.40     20090101
28264       RELEASE OF MIDFOOT JOINT         81                          $117.40     20090101
28264       RELEASE OF MIDFOOT JOINT         82                          $117.40     20090101
28264       RELEASE OF MIDFOOT JOINT         AS                          $117.40     20090101
28264       RELEASE OF MIDFOOT JOINT                             Y       $566.35     20081209
28264       RELEASE OF MIDFOOT JOINT                                     $587.00     20090101
28270       RELEASE OF FOOT CONTRACTURE                          Y       $478.46     20081209
28270       RELEASE OF FOOT CONTRACTURE                                  $315.49     20090101
28272       RELEASE OF TOE JOINT, EACH                                   $259.01     20090101
28280       FUSION OF TOES                                               $354.44     20090101
28280       FUSION OF TOES                                       Y       $440.06     20081209
28285       REPAIR OF HAMMERTOE              80                           $61.38     20090101


                                          Page 141
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
28285       REPAIR OF HAMMERTOE               81                           $61.38     20090101
28285       REPAIR OF HAMMERTOE               82                           $61.38     20090101
28285       REPAIR OF HAMMERTOE               AS                           $61.38     20090101
28285       REPAIR OF HAMMERTOE                                   Y       $478.46     20081209
28285       REPAIR OF HAMMERTOE                                           $306.88     20090101
28286       REPAIR OF HAMMERTOE                                           $301.58     20090101
28286       REPAIR OF HAMMERTOE                                   Y       $550.46     20081209
28288       PARTIAL REMOVAL OF FOOT BONE                                  $381.98     20090101
28288       PARTIAL REMOVAL OF FOOT BONE                          Y       $478.46     20081209
28289       REPAIR HALLUX RIGIDUS             80                           $99.27     20090101
28289       REPAIR HALLUX RIGIDUS             81                           $99.27     20090101
28289       REPAIR HALLUX RIGIDUS             82                           $99.27     20090101
28289       REPAIR HALLUX RIGIDUS             AS                           $99.27     20090101
28289       REPAIR HALLUX RIGIDUS                                         $496.33     20090101
28289       REPAIR HALLUX RIGIDUS                                 Y       $478.46     20081209
28290       CORRECTION OF BUNION                                  Y       $511.18     20081209
28290       CORRECTION OF BUNION                                          $382.82     20090101
28293       CORRECTION OF BUNION                                  Y       $549.58     20081209
28293       CORRECTION OF BUNION                                          $691.07     20090101
28294       CORRECTION OF BUNION              80                          $101.10     20090101
28294       CORRECTION OF BUNION              81                          $101.10     20090101
28294       CORRECTION OF BUNION              82                          $101.10     20090101
28294       CORRECTION OF BUNION              AS                          $101.10     20090101
28294       CORRECTION OF BUNION                                          $505.49     20090101
28294       CORRECTION OF BUNION                                  Y       $549.58     20081209
28296       CORRECTION OF BUNION              80                          $107.77     20090101
28296       CORRECTION OF BUNION              81                          $107.77     20090101
28296       CORRECTION OF BUNION              82                          $107.77     20090101
28296       CORRECTION OF BUNION              AS                          $107.77     20090101
28296       CORRECTION OF BUNION                                          $538.87     20090101
28296       CORRECTION OF BUNION                                  Y       $549.58     20081209
28297       CORRECTION OF BUNION              80                          $113.18     20090101
28297       CORRECTION OF BUNION              81                          $113.18     20090101
28297       CORRECTION OF BUNION              82                          $113.18     20090101
28297       CORRECTION OF BUNION              AS                          $113.18     20090101
28297       CORRECTION OF BUNION                                          $565.89     20090101
28297       CORRECTION OF BUNION                                  Y       $549.58     20081209
28298       CORRECTION OF BUNION              80                           $96.37     20090101
28298       CORRECTION OF BUNION              81                           $96.37     20090101
28298       CORRECTION OF BUNION              82                           $96.37     20090101
28298       CORRECTION OF BUNION              AS                           $96.37     20090101
28298       CORRECTION OF BUNION                                          $481.84     20090101
28298       CORRECTION OF BUNION                                  Y       $549.58     20081209
28299       CORRECTION OF BUNION              80                          $124.75     20090101
28299       CORRECTION OF BUNION              81                          $124.75     20090101


                                           Page 142
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
28299       CORRECTION OF BUNION            82                          $124.75     20090101
28299       CORRECTION OF BUNION            AS                          $124.75     20090101
28299       CORRECTION OF BUNION                                        $623.74     20090101
28299       CORRECTION OF BUNION                                Y       $673.78     20081209
28300       INCISION OF HEEL BONE           80                           $98.43     20090101
28300       INCISION OF HEEL BONE           81                           $98.43     20090101
28300       INCISION OF HEEL BONE           82                           $98.43     20090101
28300       INCISION OF HEEL BONE           AS                           $98.43     20090101
28300       INCISION OF HEEL BONE                                       $492.14     20090101
28300       INCISION OF HEEL BONE                               Y       $634.15     20081209
28302       INCISION OF ANKLE BONE          80                           $97.87     20090101
28302       INCISION OF ANKLE BONE          81                           $97.87     20090101
28302       INCISION OF ANKLE BONE          82                           $97.87     20090101
28302       INCISION OF ANKLE BONE          AS                           $97.87     20090101
28302       INCISION OF ANKLE BONE                                      $489.35     20090101
28302       INCISION OF ANKLE BONE                              Y       $440.06     20081209
28304       INCISION OF MIDFOOT BONES       80                          $107.44     20090101
28304       INCISION OF MIDFOOT BONES       81                          $107.44     20090101
28304       INCISION OF MIDFOOT BONES       82                          $107.44     20090101
28304       INCISION OF MIDFOOT BONES       AS                          $107.44     20090101
28304       INCISION OF MIDFOOT BONES                           Y       $634.15     20081209
28304       INCISION OF MIDFOOT BONES                                   $537.22     20090101
28305       INCISE/GRAFT MIDFOOT BONES      80                          $101.05     20090101
28305       INCISE/GRAFT MIDFOOT BONES      81                          $101.05     20090101
28305       INCISE/GRAFT MIDFOOT BONES      82                          $101.05     20090101
28305       INCISE/GRAFT MIDFOOT BONES      AS                          $101.05     20090101
28305       INCISE/GRAFT MIDFOOT BONES                          Y       $672.55     20081209
28305       INCISE/GRAFT MIDFOOT BONES                                  $505.24     20090101
28306       INCISION OF METATARSAL          80                           $80.02     20090101
28306       INCISION OF METATARSAL          81                           $80.02     20090101
28306       INCISION OF METATARSAL          82                           $80.02     20090101
28306       INCISION OF METATARSAL          AS                           $80.02     20090101
28306       INCISION OF METATARSAL                                      $400.08     20090101
28306       INCISION OF METATARSAL                              Y       $550.46     20081209
28307       INCISION OF METATARSAL                              Y       $550.46     20081209
28307       INCISION OF METATARSAL                                      $485.20     20090101
28308       INCISION OF METATARSAL          80                           $71.73     20090101
28308       INCISION OF METATARSAL          81                           $71.73     20090101
28308       INCISION OF METATARSAL          82                           $71.73     20090101
28308       INCISION OF METATARSAL          AS                           $71.73     20090101
28308       INCISION OF METATARSAL                                      $358.63     20090101
28308       INCISION OF METATARSAL                              Y       $440.06     20081209
28309       INCISION OF METATARSALS         80                          $132.59     20090101
28309       INCISION OF METATARSALS         81                          $132.59     20090101
28309       INCISION OF METATARSALS         82                          $132.59     20090101


                                         Page 143
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
28309       INCISION OF METATARSALS         AS                          $132.59     20090101
28309       INCISION OF METATARSALS                                     $662.97     20090101
28309       INCISION OF METATARSALS                             Y       $744.55     20081209
28310       REVISION OF BIG TOE             80                           $71.38     20090101
28310       REVISION OF BIG TOE             81                           $71.38     20090101
28310       REVISION OF BIG TOE             82                           $71.38     20090101
28310       REVISION OF BIG TOE             AS                           $71.38     20090101
28310       REVISION OF BIG TOE                                         $356.92     20090101
28310       REVISION OF BIG TOE                                 Y       $478.46     20081209
28312       REVISION OF TOE                 80                           $64.77     20090101
28312       REVISION OF TOE                 81                           $64.77     20090101
28312       REVISION OF TOE                 82                           $64.77     20090101
28312       REVISION OF TOE                 AS                           $64.77     20090101
28312       REVISION OF TOE                                     Y       $478.46     20081209
28312       REVISION OF TOE                                             $323.85     20090101
28313       REPAIR DEFORMITY OF TOE                                     $335.80     20090101
28313       REPAIR DEFORMITY OF TOE                             Y       $440.06     20081209
28315       REMOVAL OF SESAMOID BONE        80                           $63.04     20090101
28315       REMOVAL OF SESAMOID BONE        81                           $63.04     20090101
28315       REMOVAL OF SESAMOID BONE        82                           $63.04     20090101
28315       REMOVAL OF SESAMOID BONE        AS                           $63.04     20090101
28315       REMOVAL OF SESAMOID BONE                            Y       $550.46     20081209
28315       REMOVAL OF SESAMOID BONE                                    $315.21     20090101
28320       REPAIR OF FOOT BONES            80                           $93.93     20090101
28320       REPAIR OF FOOT BONES            81                           $93.93     20090101
28320       REPAIR OF FOOT BONES            82                           $93.93     20090101
28320       REPAIR OF FOOT BONES            AS                           $93.93     20090101
28320       REPAIR OF FOOT BONES                                Y       $744.55     20081209
28320       REPAIR OF FOOT BONES                                        $469.63     20090101
28322       REPAIR OF METATARSALS           80                          $106.50     20090101
28322       REPAIR OF METATARSALS           81                          $106.50     20090101
28322       REPAIR OF METATARSALS           82                          $106.50     20090101
28322       REPAIR OF METATARSALS           AS                          $106.50     20090101
28322       REPAIR OF METATARSALS                                       $532.51     20090101
28322       REPAIR OF METATARSALS                               Y       $744.55     20081209
28340       RESECT ENLARGED TOE TISSUE      80                           $84.30     20090101
28340       RESECT ENLARGED TOE TISSUE      81                           $84.30     20090101
28340       RESECT ENLARGED TOE TISSUE      82                           $84.30     20090101
28340       RESECT ENLARGED TOE TISSUE      AS                           $84.30     20090101
28340       RESECT ENLARGED TOE TISSUE                          Y       $550.46     20081209
28340       RESECT ENLARGED TOE TISSUE                                  $421.50     20090101
28341       RESECT ENLARGED TOE             80                           $96.70     20090101
28341       RESECT ENLARGED TOE             81                           $96.70     20090101
28341       RESECT ENLARGED TOE             82                           $96.70     20090101
28341       RESECT ENLARGED TOE             AS                           $96.70     20090101


                                         Page 144
Proc Code   Description                      Modifier 1 Modifier 2 ASC    Price    Effective Date
28341       RESECT ENLARGED TOE                                          $483.50     20090101
28341       RESECT ENLARGED TOE                                  Y       $550.46     20081209
28344       REPAIR EXTRA TOE(S)              80                           $60.65     20090101
28344       REPAIR EXTRA TOE(S)              81                           $60.65     20090101
28344       REPAIR EXTRA TOE(S)              82                           $60.65     20090101
28344       REPAIR EXTRA TOE(S)              AS                           $60.65     20090101
28344       REPAIR EXTRA TOE(S)                                  Y       $550.46     20081209
28344       REPAIR EXTRA TOE(S)                                          $303.26     20090101
28345       REPAIR WEBBED TOE(S)                                 Y       $550.46     20081209
28345       REPAIR WEBBED TOE(S)                                         $380.87     20090101
28360       RECONSTRUCT CLEFT FOOT           80                          $141.22     20090101
28360       RECONSTRUCT CLEFT FOOT           81                          $141.22     20090101
28360       RECONSTRUCT CLEFT FOOT           82                          $141.22     20090101
28360       RECONSTRUCT CLEFT FOOT           AS                          $141.22     20090101
28360       RECONSTRUCT CLEFT FOOT                                       $706.08     20090101
28400       TREATMENT OF HEEL FRACTURE                                   $168.87     20090101
28400       TREATMENT OF HEEL FRACTURE                           Y        $76.82     20081209
28405       TREATMENT OF HEEL FRACTURE                                   $277.93     20090101
28405       TREATMENT OF HEEL FRACTURE                           Y        $76.82     20081209
28406       TREATMENT OF HEEL FRACTURE                                   $381.98     20090101
28406       TREATMENT OF HEEL FRACTURE                           Y       $484.21     20081209
28415       TREAT HEEL FRACTURE              80                          $169.15     20090101
28415       TREAT HEEL FRACTURE              81                          $169.15     20090101
28415       TREAT HEEL FRACTURE              82                          $169.15     20090101
28415       TREAT HEEL FRACTURE              AS                          $169.15     20090101
28415       TREAT HEEL FRACTURE                                  Y       $796.38     20081209
28415       TREAT HEEL FRACTURE                                          $845.75     20090101
28420       TREAT/GRAFT HEEL FRACTURE        80                          $176.38     20090101
28420       TREAT/GRAFT HEEL FRACTURE        81                          $176.38     20090101
28420       TREAT/GRAFT HEEL FRACTURE        82                          $176.38     20090101
28420       TREAT/GRAFT HEEL FRACTURE        AS                          $176.38     20090101
28420       TREAT/GRAFT HEEL FRACTURE                            Y       $718.39     20081209
28420       TREAT/GRAFT HEEL FRACTURE                                    $881.92     20090101
28430       TREATMENT OF ANKLE FRACTURE                                  $158.85     20090101
28435       TREATMENT OF ANKLE FRACTURE                                  $220.62     20090101
28435       TREATMENT OF ANKLE FRACTURE                          Y        $76.82     20081209
28436       TREATMENT OF ANKLE FRACTURE      80                           $60.76     20090101
28436       TREATMENT OF ANKLE FRACTURE      81                           $60.76     20090101
28436       TREATMENT OF ANKLE FRACTURE      82                           $60.76     20090101
28436       TREATMENT OF ANKLE FRACTURE      AS                           $60.76     20090101
28436       TREATMENT OF ANKLE FRACTURE                          Y       $484.21     20081209
28436       TREATMENT OF ANKLE FRACTURE                                  $303.82     20090101
28445       TREAT ANKLE FRACTURE             80                          $157.91     20090101
28445       TREAT ANKLE FRACTURE             81                          $157.91     20090101
28445       TREAT ANKLE FRACTURE             82                          $157.91     20090101


                                          Page 145
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
28445       TREAT ANKLE FRACTURE           AS                          $157.91     20090101
28445       TREAT ANKLE FRACTURE                                       $789.55     20090101
28445       TREAT ANKLE FRACTURE                               Y       $646.39     20081209
28446       OSTEOCHONDRAL TALUS AUTOGRFT                       Y       $129.92     20090101
28450       TREAT MIDFOOT FRACTURE, EACH                               $146.06     20090101
28455       TREAT MIDFOOT FRACTURE, EACH                               $199.48     20090101
28456       TREAT MIDFOOT FRACTURE         80                           $39.67     20090101
28456       TREAT MIDFOOT FRACTURE         81                           $39.67     20090101
28456       TREAT MIDFOOT FRACTURE         82                           $39.67     20090101
28456       TREAT MIDFOOT FRACTURE         AS                           $39.67     20090101
28456       TREAT MIDFOOT FRACTURE                                     $198.36     20090101
28456       TREAT MIDFOOT FRACTURE                             Y       $484.21     20081209
28465       TREAT MIDFOOT FRACTURE, EACH                       Y       $646.39     20081209
28465       TREAT MIDFOOT FRACTURE, EACH                               $443.19     20090101
28470       TREAT METATARSAL FRACTURE                                  $146.06     20090101
28475       TREAT METATARSAL FRACTURE                                  $184.73     20090101
28476       TREAT METATARSAL FRACTURE                                  $240.65     20090101
28476       TREAT METATARSAL FRACTURE                          Y       $484.21     20081209
28485       TREAT METATARSAL FRACTURE      80                           $75.78     20090101
28485       TREAT METATARSAL FRACTURE      81                           $75.78     20090101
28485       TREAT METATARSAL FRACTURE      82                           $75.78     20090101
28485       TREAT METATARSAL FRACTURE      AS                           $75.78     20090101
28485       TREAT METATARSAL FRACTURE                                  $378.91     20090101
28485       TREAT METATARSAL FRACTURE                          Y       $718.39     20081209
28490       TREAT BIG TOE FRACTURE                                     $92.08      20090101
28495       TREAT BIG TOE FRACTURE                                     $115.17     20090101
28496       TREAT BIG TOE FRACTURE         80                           $58.87     20090101
28496       TREAT BIG TOE FRACTURE         81                           $58.87     20090101
28496       TREAT BIG TOE FRACTURE         82                           $58.87     20090101
28496       TREAT BIG TOE FRACTURE         AS                           $58.87     20090101
28496       TREAT BIG TOE FRACTURE                             Y       $484.21     20081209
28496       TREAT BIG TOE FRACTURE                                     $294.35     20090101
28505       TREAT BIG TOE FRACTURE                                     $448.48     20090101
28505       TREAT BIG TOE FRACTURE                             Y       $522.61     20081209
28510       TREATMENT OF TOE FRACTURE                                  $79.85      20090101
28515       TREATMENT OF TOE FRACTURE                                  $104.05     20090101
28525       TREAT TOE FRACTURE                                         $383.09     20090101
28525       TREAT TOE FRACTURE                                 Y       $522.61     20081209
28530       TREAT SESAMOID BONE FRACTURE                               $76.51      20090101
28531       TREAT SESAMOID BONE FRACTURE                               $271.53     20090101
28531       TREAT SESAMOID BONE FRACTURE                       Y       $522.61     20081209
28540       TREAT FOOT DISLOCATION                                     $137.44     20090101
28545       TREAT FOOT DISLOCATION                             Y       $416.41     20081209
28545       TREAT FOOT DISLOCATION                                     $160.53     20090101
28546       TREAT FOOT DISLOCATION                             Y       $484.21     20081209


                                       Page 146
Proc Code   Description                  Modifier 1 Modifier 2 ASC    Price    Effective Date
28546       TREAT FOOT DISLOCATION                                   $314.10     20090101
28555       REPAIR FOOT DISLOCATION      80                          $116.23     20090101
28555       REPAIR FOOT DISLOCATION      81                          $116.23     20090101
28555       REPAIR FOOT DISLOCATION      82                          $116.23     20090101
28555       REPAIR FOOT DISLOCATION      AS                          $116.23     20090101
28555       REPAIR FOOT DISLOCATION                          Y       $607.99     20081209
28555       REPAIR FOOT DISLOCATION                                  $581.15     20090101
28570       TREAT FOOT DISLOCATION                                   $122.13     20090101
28575       TREAT FOOT DISLOCATION                           Y        $76.82     20081209
28575       TREAT FOOT DISLOCATION                                   $222.85     20090101
28576       TREAT FOOT DISLOCATION                                   $258.46     20090101
28576       TREAT FOOT DISLOCATION                           Y       $522.61     20081209
28585       REPAIR FOOT DISLOCATION      80                          $120.30     20090101
28585       REPAIR FOOT DISLOCATION      81                          $120.30     20090101
28585       REPAIR FOOT DISLOCATION      82                          $120.30     20090101
28585       REPAIR FOOT DISLOCATION      AS                          $120.30     20090101
28585       REPAIR FOOT DISLOCATION                                  $601.49     20090101
28585       REPAIR FOOT DISLOCATION                          Y       $522.61     20081209
28600       TREAT FOOT DISLOCATION                                   $142.72     20090101
28605       TREAT FOOT DISLOCATION                                   $186.12     20090101
28605       TREAT FOOT DISLOCATION                           Y        $76.82     20081209
28606       TREAT FOOT DISLOCATION                           Y       $484.21     20081209
28606       TREAT FOOT DISLOCATION                                   $283.50     20090101
28615       REPAIR FOOT DISLOCATION      80                          $110.44     20090101
28615       REPAIR FOOT DISLOCATION      81                          $110.44     20090101
28615       REPAIR FOOT DISLOCATION      82                          $110.44     20090101
28615       REPAIR FOOT DISLOCATION      AS                          $110.44     20090101
28615       REPAIR FOOT DISLOCATION                                  $552.22     20090101
28615       REPAIR FOOT DISLOCATION                          Y       $646.39     20081209
28630       TREAT TOE DISLOCATION                                    $100.98     20090101
28635       TREAT TOE DISLOCATION                            Y       $322.06     20081209
28635       TREAT TOE DISLOCATION                                    $120.74     20090101
28636       TREAT TOE DISLOCATION                                    $203.93     20090101
28636       TREAT TOE DISLOCATION                            Y       $522.61     20081209
28645       REPAIR TOE DISLOCATION       80                           $80.68     20090101
28645       REPAIR TOE DISLOCATION       81                           $80.68     20090101
28645       REPAIR TOE DISLOCATION       82                           $80.68     20090101
28645       REPAIR TOE DISLOCATION       AS                           $80.68     20090101
28645       REPAIR TOE DISLOCATION                                   $403.39     20090101
28645       REPAIR TOE DISLOCATION                           Y       $522.61     20081209
28660       TREAT TOE DISLOCATION                                    $74.00      20090101
28665       TREAT TOE DISLOCATION                                    $106.55     20090101
28665       TREAT TOE DISLOCATION                            Y       $322.06     20081209
28666       TREAT TOE DISLOCATION                            Y       $522.61     20081209
28666       TREAT TOE DISLOCATION                                    $147.45     20090101


                                      Page 147
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
28675       REPAIR OF TOE DISLOCATION      80                            $75.67      20090101
28675       REPAIR OF TOE DISLOCATION      81                            $75.67      20090101
28675       REPAIR OF TOE DISLOCATION      82                            $75.67      20090101
28675       REPAIR OF TOE DISLOCATION      AS                            $75.67      20090101
28675       REPAIR OF TOE DISLOCATION                                   $378.34      20090101
28675       REPAIR OF TOE DISLOCATION                          Y        $522.61      20081209
28705       FUSION OF FOOT BONES           80                           $193.41      20090101
28705       FUSION OF FOOT BONES           81                           $193.41      20090101
28705       FUSION OF FOOT BONES           82                           $193.41      20090101
28705       FUSION OF FOOT BONES           AS                           $193.41      20090101
28705       FUSION OF FOOT BONES                               Y        $744.55      20081209
28705       FUSION OF FOOT BONES                                        $967.05      20090101
28715       FUSION OF FOOT BONES           80                           $142.94      20090101
28715       FUSION OF FOOT BONES           81                           $142.94      20090101
28715       FUSION OF FOOT BONES           82                           $142.94      20090101
28715       FUSION OF FOOT BONES           AS                           $142.94      20090101
28715       FUSION OF FOOT BONES                                        $714.72      20090101
28715       FUSION OF FOOT BONES                               Y       $1,035.65     20081209
28725       FUSION OF FOOT BONES           80                           $118.91      20090101
28725       FUSION OF FOOT BONES           81                           $118.91      20090101
28725       FUSION OF FOOT BONES           82                           $118.91      20090101
28725       FUSION OF FOOT BONES           AS                           $118.91      20090101
28725       FUSION OF FOOT BONES                               Y        $744.55      20081209
28725       FUSION OF FOOT BONES                                        $594.56      20090101
28730       FUSION OF FOOT BONES           80                           $122.64      20090101
28730       FUSION OF FOOT BONES           81                           $122.64      20090101
28730       FUSION OF FOOT BONES           82                           $122.64      20090101
28730       FUSION OF FOOT BONES           AS                           $122.64      20090101
28730       FUSION OF FOOT BONES                                        $613.19      20090101
28730       FUSION OF FOOT BONES                               Y        $744.55      20081209
28735       FUSION OF FOOT BONES           80                           $117.51      20090101
28735       FUSION OF FOOT BONES           81                           $117.51      20090101
28735       FUSION OF FOOT BONES           82                           $117.51      20090101
28735       FUSION OF FOOT BONES           AS                           $117.51      20090101
28735       FUSION OF FOOT BONES                                        $587.57      20090101
28735       FUSION OF FOOT BONES                               Y        $744.55      20081209
28737       REVISION OF FOOT BONES         80                           $104.28      20090101
28737       REVISION OF FOOT BONES         81                           $104.28      20090101
28737       REVISION OF FOOT BONES         82                           $104.28      20090101
28737       REVISION OF FOOT BONES         AS                           $104.28      20090101
28737       REVISION OF FOOT BONES                             Y        $796.75      20081209
28737       REVISION OF FOOT BONES                                      $521.38      20090101
28740       FUSION OF FOOT BONES           80                           $117.85      20090101
28740       FUSION OF FOOT BONES           81                           $117.85      20090101
28740       FUSION OF FOOT BONES           82                           $117.85      20090101


                                        Page 148
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
28740       FUSION OF FOOT BONES              AS                          $117.85     20090101
28740       FUSION OF FOOT BONES                                          $589.23     20090101
28740       FUSION OF FOOT BONES                                  Y       $744.55     20081209
28750       FUSION OF BIG TOE JOINT                                       $579.79     20090101
28750       FUSION OF BIG TOE JOINT                               Y       $744.55     20081209
28755       FUSION OF BIG TOE JOINT           80                           $67.44     20090101
28755       FUSION OF BIG TOE JOINT           81                           $67.44     20090101
28755       FUSION OF BIG TOE JOINT           82                           $67.44     20090101
28755       FUSION OF BIG TOE JOINT           AS                           $67.44     20090101
28755       FUSION OF BIG TOE JOINT                               Y       $550.46     20081209
28755       FUSION OF BIG TOE JOINT                                       $337.20     20090101
28760       FUSION OF BIG TOE JOINT           80                          $105.22     20090101
28760       FUSION OF BIG TOE JOINT           81                          $105.22     20090101
28760       FUSION OF BIG TOE JOINT           82                          $105.22     20090101
28760       FUSION OF BIG TOE JOINT           AS                          $105.22     20090101
28760       FUSION OF BIG TOE JOINT                                       $526.09     20090101
28760       FUSION OF BIG TOE JOINT                               Y       $744.55     20081209
28800       AMPUTATION OF MIDFOOT             80                           $84.58     20090101
28800       AMPUTATION OF MIDFOOT             81                           $84.58     20090101
28800       AMPUTATION OF MIDFOOT             82                           $84.58     20090101
28800       AMPUTATION OF MIDFOOT             AS                           $84.58     20090101
28800       AMPUTATION OF MIDFOOT                                         $422.90     20090101
28805       AMPUTATION THRU METATARSAL        80                          $108.50     20090101
28805       AMPUTATION THRU METATARSAL        81                          $108.50     20090101
28805       AMPUTATION THRU METATARSAL        82                          $108.50     20090101
28805       AMPUTATION THRU METATARSAL        AS                          $108.50     20090101
28805       AMPUTATION THRU METATARSAL                                    $542.50     20090101
28810       AMPUTATION TOE & METATARSAL                                   $324.11     20090101
28810       AMPUTATION TOE & METATARSAL                           Y       $440.06     20081209
28820       AMPUTATION OF TOE                                     Y       $440.06     20081209
28820       AMPUTATION OF TOE                                             $364.45     20090101
28825       PARTIAL AMPUTATION OF TOE                                     $313.54     20090101
28825       PARTIAL AMPUTATION OF TOE                             Y       $440.06     20081209
29000       APPLICATION OF BODY CAST                                      $171.10     20090101
29010       APPLICATION OF BODY CAST                                      $176.38     20090101
29015       APPLICATION OF BODY CAST                                      $166.37     20090101
29020       APPLICATION OF BODY CAST                                      $163.86     20090101
29025       APPLICATION OF BODY CAST                                      $178.89     20090101
29035       APPLICATION OF BODY CAST                                      $158.85     20090101
29040       APPLICATION OF BODY CAST                                      $151.63     20090101
29044       APPLICATION OF BODY CAST                                      $173.60     20090101
29046       APPLICATION OF BODY CAST                                      $186.12     20090101
29049       APPLICATION OF FIGURE EIGHT                                   $62.04      20090101
29055       APPLICATION OF SHOULDER CAST                                  $138.55     20090101
29058       APPLICATION OF SHOULDER CAST                                  $80.40      20090101


                                           Page 149
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
29065       APPLICATION OF LONG ARM CAST                                  $64.54      20090101
29075       APPLICATION OF FOREARM CAST                                   $59.81      20090101
29085       APPLY HAND/WRIST CAST                                         $63.44      20090101
29086       APPLY FINGER CAST                                             $47.57      20090101
29105       APPLY LONG ARM SPLINT                                         $59.81      20090101
29125       APPLY FOREARM SPLINT                                          $45.90      20090101
29126       APPLY FOREARM SPLINT                                          $54.25      20090101
29130       APPLICATION OF FINGER SPLINT                                  $28.10      20090101
29131       APPLICATION OF FINGER SPLINT                                  $34.50      20090101
29200       STRAPPING OF CHEST                                            $37.56      20090101
29220       STRAPPING OF LOW BACK                                         $38.12      20090101
29240       STRAPPING OF SHOULDER                                         $42.57      20090101
29260       STRAPPING OF ELBOW OR WRIST                                   $36.44      20090101
29280       STRAPPING OF HAND OR FINGER                                   $35.33      20090101
29305       APPLICATION OF HIP CAST                                       $158.30     20090101
29325       APPLICATION OF HIP CASTS                                      $171.10     20090101
29345       APPLICATION OF LONG LEG CAST                                  $93.48      20090101
29355       APPLICATION OF LONG LEG CAST                                  $95.99      20090101
29358       APPLY LONG LEG CAST BRACE                                     $103.49     20090101
29365       APPLICATION OF LONG LEG CAST                                  $83.46      20090101
29405       APPLY SHORT LEG CAST                                          $61.48      20090101
29425       APPLY SHORT LEG CAST                                          $66.49      20090101
29435       APPLY SHORT LEG CAST                                          $81.24      20090101
29440       ADDITION OF WALKER TO CAST                                    $36.72      20090101
29445       APPLY RIGID LEG CAST                                          $103.77     20090101
29450       APPLICATION OF LEG CAST                                       $107.94     20090101
29505       APPLICATION, LONG LEG SPLINT                                  $52.86      20090101
29515       APPLICATION LOWER LEG SPLINT                                  $48.13      20090101
29520       STRAPPING OF HIP                                              $36.72      20090101
29530       STRAPPING OF KNEE                                             $37.28      20090101
29540       STRAPPING OF ANKLE AND/OR FT                                  $29.21      20090101
29550       STRAPPING OF TOES                                             $28.38      20090101
29580       APPLICATION OF PASTE BOOT                                     $36.16      20090101
29590       APPLICATION OF FOOT SPLINT                                    $38.95      20090101
29700       REMOVAL/REVISION OF CAST                                      $43.68      20090101
29705       REMOVAL/REVISION OF CAST                                      $46.74      20090101
29710       REMOVAL/REVISION OF CAST                                      $82.62      20090101
29715       REMOVAL/REVISION OF CAST                                      $61.76      20090101
29720       REPAIR OF BODY CAST                                           $54.52      20090101
29730       WINDOWING OF CAST                                             $45.62      20090101
29740       WEDGING OF CAST                                               $66.49      20090101
29750       WEDGING OF CLUBFOOT CAST                                      $70.39      20090101
29800       JAW ARTHROSCOPY/SURGERY                                       $376.14     20090101
29800       JAW ARTHROSCOPY/SURGERY                               Y       $544.30     20081209
29804       JAW ARTHROSCOPY/SURGERY           80                          $93.20      20090101


                                           Page 150
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
29804       JAW ARTHROSCOPY/SURGERY        81                          $93.20      20090101
29804       JAW ARTHROSCOPY/SURGERY        82                          $93.20      20090101
29804       JAW ARTHROSCOPY/SURGERY        AS                           $93.20     20090101
29804       JAW ARTHROSCOPY/SURGERY                            Y       $544.30     20081209
29804       JAW ARTHROSCOPY/SURGERY                                    $466.01     20090101
29805       SHOULDER ARTHROSCOPY, DX                                   $338.02     20090101
29805       SHOULDER ARTHROSCOPY, DX                           Y       $544.30     20081209
29806       SHOULDER ARTHROSCOPY/SURGERY                       Y       $684.46     20081209
29806       SHOULDER ARTHROSCOPY/SURGERY                               $770.91     20090101
29807       SHOULDER ARTHROSCOPY/SURGERY                       Y       $684.46     20081209
29807       SHOULDER ARTHROSCOPY/SURGERY                               $751.16     20090101
29819       SHOULDER ARTHROSCOPY/SURGERY   80                           $84.63     20090101
29819       SHOULDER ARTHROSCOPY/SURGERY   81                           $84.63     20090101
29819       SHOULDER ARTHROSCOPY/SURGERY   82                           $84.63     20090101
29819       SHOULDER ARTHROSCOPY/SURGERY   AS                           $84.63     20090101
29819       SHOULDER ARTHROSCOPY/SURGERY                               $423.16     20090101
29819       SHOULDER ARTHROSCOPY/SURGERY                       Y       $684.46     20081209
29820       SHOULDER ARTHROSCOPY/SURGERY   80                           $78.12     20090101
29820       SHOULDER ARTHROSCOPY/SURGERY   81                           $78.12     20090101
29820       SHOULDER ARTHROSCOPY/SURGERY   82                           $78.12     20090101
29820       SHOULDER ARTHROSCOPY/SURGERY   AS                           $78.12     20090101
29820       SHOULDER ARTHROSCOPY/SURGERY                               $390.61     20090101
29820       SHOULDER ARTHROSCOPY/SURGERY                       Y       $684.46     20081209
29821       SHOULDER ARTHROSCOPY/SURGERY   80                           $85.36     20090101
29821       SHOULDER ARTHROSCOPY/SURGERY   81                           $85.36     20090101
29821       SHOULDER ARTHROSCOPY/SURGERY   82                           $85.36     20090101
29821       SHOULDER ARTHROSCOPY/SURGERY   AS                           $85.36     20090101
29821       SHOULDER ARTHROSCOPY/SURGERY                               $426.78     20090101
29821       SHOULDER ARTHROSCOPY/SURGERY                       Y       $684.46     20081209
29822       SHOULDER ARTHROSCOPY/SURGERY   80                           $82.97     20090101
29822       SHOULDER ARTHROSCOPY/SURGERY   81                           $82.97     20090101
29822       SHOULDER ARTHROSCOPY/SURGERY   82                           $82.97     20090101
29822       SHOULDER ARTHROSCOPY/SURGERY   AS                           $82.97     20090101
29822       SHOULDER ARTHROSCOPY/SURGERY                               $414.83     20090101
29822       SHOULDER ARTHROSCOPY/SURGERY                       Y       $544.30     20081209
29823       SHOULDER ARTHROSCOPY/SURGERY   80                           $90.65     20090101
29823       SHOULDER ARTHROSCOPY/SURGERY   81                           $90.65     20090101
29823       SHOULDER ARTHROSCOPY/SURGERY   82                           $90.65     20090101
29823       SHOULDER ARTHROSCOPY/SURGERY   AS                           $90.65     20090101
29823       SHOULDER ARTHROSCOPY/SURGERY                       Y       $684.46     20081209
29823       SHOULDER ARTHROSCOPY/SURGERY                               $453.23     20090101
29824       SHOULDER ARTHROSCOPY/SURGERY   80                           $96.09     20090101
29824       SHOULDER ARTHROSCOPY/SURGERY   81                           $96.09     20090101
29824       SHOULDER ARTHROSCOPY/SURGERY   82                           $96.09     20090101
29824       SHOULDER ARTHROSCOPY/SURGERY   AS                           $96.09     20090101


                                       Page 151
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
29824       SHOULDER ARTHROSCOPY/SURGERY                                $480.45      20090101
29824       SHOULDER ARTHROSCOPY/SURGERY                       Y        $668.50      20081209
29825       SHOULDER ARTHROSCOPY/SURGERY   80                            $84.58      20090101
29825       SHOULDER ARTHROSCOPY/SURGERY   81                            $84.58      20090101
29825       SHOULDER ARTHROSCOPY/SURGERY   82                            $84.58      20090101
29825       SHOULDER ARTHROSCOPY/SURGERY   AS                            $84.58      20090101
29825       SHOULDER ARTHROSCOPY/SURGERY                       Y        $684.46      20081209
29825       SHOULDER ARTHROSCOPY/SURGERY                                $422.90      20090101
29826       SHOULDER ARTHROSCOPY/SURGERY   80                            $97.15      20090101
29826       SHOULDER ARTHROSCOPY/SURGERY   81                            $97.15      20090101
29826       SHOULDER ARTHROSCOPY/SURGERY   82                            $97.15      20090101
29826       SHOULDER ARTHROSCOPY/SURGERY   AS                            $97.15      20090101
29826       SHOULDER ARTHROSCOPY/SURGERY                                $485.73      20090101
29826       SHOULDER ARTHROSCOPY/SURGERY                       Y        $684.46      20081209
29827       ARTHROSCOP ROTATOR CUFF REPR   80                           $158.80      20090101
29827       ARTHROSCOP ROTATOR CUFF REPR   81                           $158.80      20090101
29827       ARTHROSCOP ROTATOR CUFF REPR   82                           $158.80      20090101
29827       ARTHROSCOP ROTATOR CUFF REPR   AS                           $158.80      20090101
29827       ARTHROSCOP ROTATOR CUFF REPR                       Y        $808.66      20081209
29827       ARTHROSCOP ROTATOR CUFF REPR                                $794.00      20090101
29828       ARTHROSCOPY BICEPS TENODESIS                                $649.60      20090101
29828       ARTHROSCOPY BICEPS TENODESIS                       Y       $1,513.86     20081209
29830       ELBOW ARTHROSCOPY              80                            $65.15      20090101
29830       ELBOW ARTHROSCOPY              81                            $65.15      20090101
29830       ELBOW ARTHROSCOPY              82                            $65.15      20090101
29830       ELBOW ARTHROSCOPY              AS                            $65.15      20090101
29830       ELBOW ARTHROSCOPY                                           $325.77      20090101
29830       ELBOW ARTHROSCOPY                                  Y        $544.30      20081209
29834       ELBOW ARTHROSCOPY/SURGERY      80                            $71.00      20090101
29834       ELBOW ARTHROSCOPY/SURGERY      81                            $71.00      20090101
29834       ELBOW ARTHROSCOPY/SURGERY      82                            $71.00      20090101
29834       ELBOW ARTHROSCOPY/SURGERY      AS                            $71.00      20090101
29834       ELBOW ARTHROSCOPY/SURGERY                          Y        $544.30      20081209
29834       ELBOW ARTHROSCOPY/SURGERY                                   $355.01      20090101
29835       ELBOW ARTHROSCOPY/SURGERY      80                            $72.83      20090101
29835       ELBOW ARTHROSCOPY/SURGERY      81                            $72.83      20090101
29835       ELBOW ARTHROSCOPY/SURGERY      82                            $72.83      20090101
29835       ELBOW ARTHROSCOPY/SURGERY      AS                            $72.83      20090101
29835       ELBOW ARTHROSCOPY/SURGERY                          Y        $544.30      20081209
29835       ELBOW ARTHROSCOPY/SURGERY                                   $364.16      20090101
29836       ELBOW ARTHROSCOPY/SURGERY      80                            $83.46      20090101
29836       ELBOW ARTHROSCOPY/SURGERY      81                            $83.46      20090101
29836       ELBOW ARTHROSCOPY/SURGERY      82                            $83.46      20090101
29836       ELBOW ARTHROSCOPY/SURGERY      AS                            $83.46      20090101
29836       ELBOW ARTHROSCOPY/SURGERY                                   $417.31      20090101


                                       Page 152
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
29836       ELBOW ARTHROSCOPY/SURGERY                           Y        $544.30      20081209
29837       ELBOW ARTHROSCOPY/SURGERY       80                            $76.28      20090101
29837       ELBOW ARTHROSCOPY/SURGERY       81                            $76.28      20090101
29837       ELBOW ARTHROSCOPY/SURGERY       82                            $76.28      20090101
29837       ELBOW ARTHROSCOPY/SURGERY       AS                            $76.28      20090101
29837       ELBOW ARTHROSCOPY/SURGERY                                    $381.40      20090101
29837       ELBOW ARTHROSCOPY/SURGERY                           Y        $544.30      20081209
29838       ELBOW ARTHROSCOPY/SURGERY                                    $427.05      20090101
29838       ELBOW ARTHROSCOPY/SURGERY                           Y        $544.30      20081209
29840       WRIST ARTHROSCOPY                                            $317.43      20090101
29840       WRIST ARTHROSCOPY                                   Y        $544.30      20081209
29843       WRIST ARTHROSCOPY/SURGERY                                    $339.42      20090101
29843       WRIST ARTHROSCOPY/SURGERY                           Y        $544.30      20081209
29844       WRIST ARTHROSCOPY/SURGERY                           Y        $544.30      20081209
29844       WRIST ARTHROSCOPY/SURGERY                                    $356.38      20090101
29845       WRIST ARTHROSCOPY/SURGERY                                    $406.47      20090101
29845       WRIST ARTHROSCOPY/SURGERY                           Y        $544.30      20081209
29846       WRIST ARTHROSCOPY/SURGERY                                    $374.46      20090101
29846       WRIST ARTHROSCOPY/SURGERY                           Y        $544.30      20081209
29847       WRIST ARTHROSCOPY/SURGERY       80                            $77.63      20090101
29847       WRIST ARTHROSCOPY/SURGERY       81                            $77.63      20090101
29847       WRIST ARTHROSCOPY/SURGERY       82                            $77.63      20090101
29847       WRIST ARTHROSCOPY/SURGERY       AS                            $77.63      20090101
29847       WRIST ARTHROSCOPY/SURGERY                                    $388.13      20090101
29847       WRIST ARTHROSCOPY/SURGERY                           Y        $684.46      20081209
29848       WRIST ENDOSCOPY/SURGERY                             Y       $1,041.70     20081209
29848       WRIST ENDOSCOPY/SURGERY                                      $348.88      20090101
29850       KNEE ARTHROSCOPY/SURGERY                                     $398.11      20090101
29850       KNEE ARTHROSCOPY/SURGERY                            Y        $616.30      20081209
29851       KNEE ARTHROSCOPY/SURGERY        80                           $135.99      20090101
29851       KNEE ARTHROSCOPY/SURGERY        81                           $135.99      20090101
29851       KNEE ARTHROSCOPY/SURGERY        82                           $135.99      20090101
29851       KNEE ARTHROSCOPY/SURGERY        AS                           $135.99      20090101
29851       KNEE ARTHROSCOPY/SURGERY                                     $679.94      20090101
29851       KNEE ARTHROSCOPY/SURGERY                            Y        $756.46      20081209
29855       TIBIAL ARTHROSCOPY/SURGERY      80                           $113.95      20090101
29855       TIBIAL ARTHROSCOPY/SURGERY      81                           $113.95      20090101
29855       TIBIAL ARTHROSCOPY/SURGERY      82                           $113.95      20090101
29855       TIBIAL ARTHROSCOPY/SURGERY      AS                           $113.95      20090101
29855       TIBIAL ARTHROSCOPY/SURGERY                                   $569.77      20090101
29855       TIBIAL ARTHROSCOPY/SURGERY                          Y        $756.46      20081209
29856       TIBIAL ARTHROSCOPY/SURGERY      80                           $145.83      20090101
29856       TIBIAL ARTHROSCOPY/SURGERY      81                           $145.83      20090101
29856       TIBIAL ARTHROSCOPY/SURGERY      82                           $145.83      20090101
29856       TIBIAL ARTHROSCOPY/SURGERY      AS                           $145.83      20090101


                                         Page 153
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
29856       TIBIAL ARTHROSCOPY/SURGERY                                   $729.16      20090101
29856       TIBIAL ARTHROSCOPY/SURGERY                          Y        $756.46      20081209
29860       HIP ARTHROSCOPY, DX                                          $467.66      20090101
29860       HIP ARTHROSCOPY, DX                                 Y        $756.46      20081209
29861       HIP ARTHROSCOPY/SURGERY         80                           $102.43      20090101
29861       HIP ARTHROSCOPY/SURGERY         81                           $102.43      20090101
29861       HIP ARTHROSCOPY/SURGERY         82                           $102.43      20090101
29861       HIP ARTHROSCOPY/SURGERY         AS                           $102.43      20090101
29861       HIP ARTHROSCOPY/SURGERY                                      $512.17      20090101
29861       HIP ARTHROSCOPY/SURGERY                             Y        $756.46      20081209
29862       HIP ARTHROSCOPY/SURGERY         80                           $114.96      20090101
29862       HIP ARTHROSCOPY/SURGERY         81                           $114.96      20090101
29862       HIP ARTHROSCOPY/SURGERY         82                           $114.96      20090101
29862       HIP ARTHROSCOPY/SURGERY         AS                           $114.96      20090101
29862       HIP ARTHROSCOPY/SURGERY                             Y       $1,181.86     20081209
29862       HIP ARTHROSCOPY/SURGERY                                      $574.79      20090101
29863       HIP ARTHROSCOPY/SURGERY         80                           $113.46      20090101
29863       HIP ARTHROSCOPY/SURGERY         81                           $113.46      20090101
29863       HIP ARTHROSCOPY/SURGERY         82                           $113.46      20090101
29863       HIP ARTHROSCOPY/SURGERY         AS                           $113.46      20090101
29863       HIP ARTHROSCOPY/SURGERY                             Y        $756.46      20081209
29863       HIP ARTHROSCOPY/SURGERY                                      $567.28      20090101
29870       KNEE ARTHROSCOPY, DX                                         $291.84      20090101
29870       KNEE ARTHROSCOPY, DX                                Y        $544.30      20081209
29871       KNEE ARTHROSCOPY/DRAINAGE                                    $367.51      20090101
29871       KNEE ARTHROSCOPY/DRAINAGE                           Y        $544.30      20081209
29873       KNEE ARTHROSCOPY/SURGERY                                     $367.79      20090101
29873       KNEE ARTHROSCOPY/SURGERY                            Y        $544.30      20081209
29874       KNEE ARTHROSCOPY/SURGERY        80                            $76.73      20090101
29874       KNEE ARTHROSCOPY/SURGERY        81                            $76.73      20090101
29874       KNEE ARTHROSCOPY/SURGERY        82                            $76.73      20090101
29874       KNEE ARTHROSCOPY/SURGERY        AS                            $76.73      20090101
29874       KNEE ARTHROSCOPY/SURGERY                                     $383.67      20090101
29874       KNEE ARTHROSCOPY/SURGERY                            Y        $544.30      20081209
29875       KNEE ARTHROSCOPY/SURGERY        80                            $71.33      20090101
29875       KNEE ARTHROSCOPY/SURGERY        81                            $71.33      20090101
29875       KNEE ARTHROSCOPY/SURGERY        82                            $71.33      20090101
29875       KNEE ARTHROSCOPY/SURGERY        AS                            $71.33      20090101
29875       KNEE ARTHROSCOPY/SURGERY                                     $356.66      20090101
29875       KNEE ARTHROSCOPY/SURGERY                            Y        $616.30      20081209
29876       KNEE ARTHROSCOPY/SURGERY        80                            $92.92      20090101
29876       KNEE ARTHROSCOPY/SURGERY        81                            $92.92      20090101
29876       KNEE ARTHROSCOPY/SURGERY        82                            $92.92      20090101
29876       KNEE ARTHROSCOPY/SURGERY        AS                            $92.92      20090101
29876       KNEE ARTHROSCOPY/SURGERY                                     $464.61      20090101


                                         Page 154
Proc Code   Description                   Modifier 1 Modifier 2 ASC    Price    Effective Date
29876       KNEE ARTHROSCOPY/SURGERY                          Y       $616.30     20081209
29877       KNEE ARTHROSCOPY/SURGERY      80                           $87.86     20090101
29877       KNEE ARTHROSCOPY/SURGERY      81                           $87.86     20090101
29877       KNEE ARTHROSCOPY/SURGERY      82                           $87.86     20090101
29877       KNEE ARTHROSCOPY/SURGERY      AS                           $87.86     20090101
29877       KNEE ARTHROSCOPY/SURGERY                          Y       $616.30     20081209
29877       KNEE ARTHROSCOPY/SURGERY                                  $439.31     20090101
29879       KNEE ARTHROSCOPY/SURGERY      80                           $94.09     20090101
29879       KNEE ARTHROSCOPY/SURGERY      81                           $94.09     20090101
29879       KNEE ARTHROSCOPY/SURGERY      82                           $94.09     20090101
29879       KNEE ARTHROSCOPY/SURGERY      AS                           $94.09     20090101
29879       KNEE ARTHROSCOPY/SURGERY                                  $470.46     20090101
29879       KNEE ARTHROSCOPY/SURGERY                          Y       $544.30     20081209
29880       KNEE ARTHROSCOPY/SURGERY      80                           $98.31     20090101
29880       KNEE ARTHROSCOPY/SURGERY      81                           $98.31     20090101
29880       KNEE ARTHROSCOPY/SURGERY      82                           $98.31     20090101
29880       KNEE ARTHROSCOPY/SURGERY      AS                           $98.31     20090101
29880       KNEE ARTHROSCOPY/SURGERY                                  $491.57     20090101
29880       KNEE ARTHROSCOPY/SURGERY                          Y       $616.30     20081209
29881       KNEE ARTHROSCOPY/SURGERY      80                           $91.54     20090101
29881       KNEE ARTHROSCOPY/SURGERY      81                           $91.54     20090101
29881       KNEE ARTHROSCOPY/SURGERY      82                           $91.54     20090101
29881       KNEE ARTHROSCOPY/SURGERY      AS                           $91.54     20090101
29881       KNEE ARTHROSCOPY/SURGERY                                  $457.68     20090101
29881       KNEE ARTHROSCOPY/SURGERY                          Y       $616.30     20081209
29882       KNEE ARTHROSCOPY/SURGERY      80                           $99.04     20090101
29882       KNEE ARTHROSCOPY/SURGERY      81                           $99.04     20090101
29882       KNEE ARTHROSCOPY/SURGERY      82                           $99.04     20090101
29882       KNEE ARTHROSCOPY/SURGERY      AS                           $99.04     20090101
29882       KNEE ARTHROSCOPY/SURGERY                          Y       $544.30     20081209
29882       KNEE ARTHROSCOPY/SURGERY                                  $495.20     20090101
29883       KNEE ARTHROSCOPY/SURGERY      80                          $121.68     20090101
29883       KNEE ARTHROSCOPY/SURGERY      81                          $121.68     20090101
29883       KNEE ARTHROSCOPY/SURGERY      82                          $121.68     20090101
29883       KNEE ARTHROSCOPY/SURGERY      AS                          $121.68     20090101
29883       KNEE ARTHROSCOPY/SURGERY                          Y       $544.30     20081209
29883       KNEE ARTHROSCOPY/SURGERY                                  $608.42     20090101
29884       KNEE ARTHROSCOPY/SURGERY      80                           $87.52     20090101
29884       KNEE ARTHROSCOPY/SURGERY      81                           $87.52     20090101
29884       KNEE ARTHROSCOPY/SURGERY      82                           $87.52     20090101
29884       KNEE ARTHROSCOPY/SURGERY      AS                           $87.52     20090101
29884       KNEE ARTHROSCOPY/SURGERY                                  $437.60     20090101
29884       KNEE ARTHROSCOPY/SURGERY                          Y       $544.30     20081209
29885       KNEE ARTHROSCOPY/SURGERY      80                          $106.34     20090101
29885       KNEE ARTHROSCOPY/SURGERY      81                          $106.34     20090101


                                       Page 155
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
29885       KNEE ARTHROSCOPY/SURGERY       82                          $106.34     20090101
29885       KNEE ARTHROSCOPY/SURGERY       AS                          $106.34     20090101
29885       KNEE ARTHROSCOPY/SURGERY                           Y       $684.46     20081209
29885       KNEE ARTHROSCOPY/SURGERY                                   $531.68     20090101
29886       KNEE ARTHROSCOPY/SURGERY       80                           $89.53     20090101
29886       KNEE ARTHROSCOPY/SURGERY       81                           $89.53     20090101
29886       KNEE ARTHROSCOPY/SURGERY       82                           $89.53     20090101
29886       KNEE ARTHROSCOPY/SURGERY       AS                           $89.53     20090101
29886       KNEE ARTHROSCOPY/SURGERY                           Y       $544.30     20081209
29886       KNEE ARTHROSCOPY/SURGERY                                   $447.64     20090101
29887       KNEE ARTHROSCOPY/SURGERY       80                          $105.71     20090101
29887       KNEE ARTHROSCOPY/SURGERY       81                          $105.71     20090101
29887       KNEE ARTHROSCOPY/SURGERY       82                          $105.71     20090101
29887       KNEE ARTHROSCOPY/SURGERY       AS                          $105.71     20090101
29887       KNEE ARTHROSCOPY/SURGERY                                   $528.57     20090101
29887       KNEE ARTHROSCOPY/SURGERY                           Y       $544.30     20081209
29888       KNEE ARTHROSCOPY/SURGERY       80                          $143.55     20090101
29888       KNEE ARTHROSCOPY/SURGERY       81                          $143.55     20090101
29888       KNEE ARTHROSCOPY/SURGERY       82                          $143.55     20090101
29888       KNEE ARTHROSCOPY/SURGERY       AS                          $143.55     20090101
29888       KNEE ARTHROSCOPY/SURGERY                           Y       $684.46     20081209
29888       KNEE ARTHROSCOPY/SURGERY                                   $717.77     20090101
29889       KNEE ARTHROSCOPY/SURGERY       80                          $175.10     20090101
29889       KNEE ARTHROSCOPY/SURGERY       81                          $175.10     20090101
29889       KNEE ARTHROSCOPY/SURGERY       82                          $175.10     20090101
29889       KNEE ARTHROSCOPY/SURGERY       AS                          $175.10     20090101
29889       KNEE ARTHROSCOPY/SURGERY                                   $875.51     20090101
29889       KNEE ARTHROSCOPY/SURGERY                           Y       $684.46     20081209
29891       ANKLE ARTHROSCOPY/SURGERY      80                           $99.83     20090101
29891       ANKLE ARTHROSCOPY/SURGERY      81                           $99.83     20090101
29891       ANKLE ARTHROSCOPY/SURGERY      82                           $99.83     20090101
29891       ANKLE ARTHROSCOPY/SURGERY      AS                           $99.83     20090101
29891       ANKLE ARTHROSCOPY/SURGERY                                  $499.13     20090101
29891       ANKLE ARTHROSCOPY/SURGERY                          Y       $684.46     20081209
29892       ANKLE ARTHROSCOPY/SURGERY      80                          $103.21     20090101
29892       ANKLE ARTHROSCOPY/SURGERY      81                          $103.21     20090101
29892       ANKLE ARTHROSCOPY/SURGERY      82                          $103.21     20090101
29892       ANKLE ARTHROSCOPY/SURGERY      AS                          $103.21     20090101
29892       ANKLE ARTHROSCOPY/SURGERY                                  $516.05     20090101
29892       ANKLE ARTHROSCOPY/SURGERY                          Y       $684.46     20081209
29893       SCOPE, PLANTAR FASCIOTOMY      80                           $79.41     20090101
29893       SCOPE, PLANTAR FASCIOTOMY      81                           $79.41     20090101
29893       SCOPE, PLANTAR FASCIOTOMY      82                           $79.41     20090101
29893       SCOPE, PLANTAR FASCIOTOMY      AS                           $79.41     20090101
29893       SCOPE, PLANTAR FASCIOTOMY                          Y       $925.80     20081209


                                        Page 156
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
29893       SCOPE, PLANTAR FASCIOTOMY                                     $397.03      20090101
29894       ANKLE ARTHROSCOPY/SURGERY        80                            $75.17      20090101
29894       ANKLE ARTHROSCOPY/SURGERY        81                            $75.17      20090101
29894       ANKLE ARTHROSCOPY/SURGERY        82                            $75.17      20090101
29894       ANKLE ARTHROSCOPY/SURGERY        AS                            $75.17      20090101
29894       ANKLE ARTHROSCOPY/SURGERY                                     $375.86      20090101
29894       ANKLE ARTHROSCOPY/SURGERY                            Y        $544.30      20081209
29895       ANKLE ARTHROSCOPY/SURGERY        80                            $73.16      20090101
29895       ANKLE ARTHROSCOPY/SURGERY        81                            $73.16      20090101
29895       ANKLE ARTHROSCOPY/SURGERY        82                            $73.16      20090101
29895       ANKLE ARTHROSCOPY/SURGERY        AS                            $73.16      20090101
29895       ANKLE ARTHROSCOPY/SURGERY                            Y        $544.30      20081209
29895       ANKLE ARTHROSCOPY/SURGERY                                     $365.82      20090101
29897       ANKLE ARTHROSCOPY/SURGERY        80                            $76.51      20090101
29897       ANKLE ARTHROSCOPY/SURGERY        81                            $76.51      20090101
29897       ANKLE ARTHROSCOPY/SURGERY        82                            $76.51      20090101
29897       ANKLE ARTHROSCOPY/SURGERY        AS                            $76.51      20090101
29897       ANKLE ARTHROSCOPY/SURGERY                                     $382.54      20090101
29897       ANKLE ARTHROSCOPY/SURGERY                            Y        $544.30      20081209
29898       ANKLE ARTHROSCOPY/SURGERY        80                            $85.57      20090101
29898       ANKLE ARTHROSCOPY/SURGERY        81                            $85.57      20090101
29898       ANKLE ARTHROSCOPY/SURGERY        82                            $85.57      20090101
29898       ANKLE ARTHROSCOPY/SURGERY        AS                            $85.57      20090101
29898       ANKLE ARTHROSCOPY/SURGERY                            Y        $544.30      20081209
29898       ANKLE ARTHROSCOPY/SURGERY                                     $427.87      20090101
29899       ANKLE ARTHROSCOPY/SURGERY        80                           $153.01      20090101
29899       ANKLE ARTHROSCOPY/SURGERY        81                           $153.01      20090101
29899       ANKLE ARTHROSCOPY/SURGERY        82                           $153.01      20090101
29899       ANKLE ARTHROSCOPY/SURGERY        AS                           $153.01      20090101
29899       ANKLE ARTHROSCOPY/SURGERY                            Y        $684.46      20081209
29899       ANKLE ARTHROSCOPY/SURGERY                                     $765.07      20090101
29900       MCP JOINT ARTHROSCOPY, DX                                     $332.46      20090101
29900       MCP JOINT ARTHROSCOPY, DX                            Y        $544.30      20081209
29901       MCP JOINT ARTHROSCOPY, SURG                                   $366.96      20090101
29901       MCP JOINT ARTHROSCOPY, SURG                          Y        $544.30      20081209
29902       MCP JOINT ARTHROSCOPY, SURG                                   $383.09      20090101
29902       MCP JOINT ARTHROSCOPY, SURG                          Y        $544.30      20081209
29904       SUBTALAR ARTHRO W/FB RMVL                                      $87.02      20090101
29904       SUBTALAR ARTHRO W/FB RMVL                            Y        $953.22      20081209
29905       SUBTALAR ARTHRO W/EXC                                Y        $953.22      20081209
29905       SUBTALAR ARTHRO W/EXC                                         $468.49      20090101
29906       SUBTALAR ARTHRO W/DEB                                          $98.71      20090101
29906       SUBTALAR ARTHRO W/DEB                                Y        $953.22      20081209
29907       SUBTALAR ARTHRO W/FUSION                                      $121.13      20090101
29907       SUBTALAR ARTHRO W/FUSION                             Y       $1,513.86     20081209


                                          Page 157
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
30000       DRAINAGE OF NOSE LESION                                       $156.08     20090101
30020       DRAINAGE OF NOSE LESION                                       $147.18     20090101
30100       INTRANASAL BIOPSY                                              $91.54     20090101
30110       REMOVAL OF NOSE POLYP(S)                                      $149.12     20090101
30115       REMOVAL OF NOSE POLYP(S)                                      $296.85     20090101
30115       REMOVAL OF NOSE POLYP(S)                              Y       $402.81     20081209
30117       REMOVAL OF INTRANASAL LESION                          Y       $441.21     20081209
30117       REMOVAL OF INTRANASAL LESION                                  $531.94     20090101
30118       REMOVAL OF INTRANASAL LESION      80                          $108.33     20090101
30118       REMOVAL OF INTRANASAL LESION      81                          $108.33     20090101
30118       REMOVAL OF INTRANASAL LESION      82                          $108.33     20090101
30118       REMOVAL OF INTRANASAL LESION      AS                          $108.33     20090101
30118       REMOVAL OF INTRANASAL LESION                          Y       $504.53     20081209
30118       REMOVAL OF INTRANASAL LESION                                  $541.67     20090101
30124       REMOVAL OF NOSE LESION                                        $195.86     20090101
30124       REMOVAL OF NOSE LESION                                Y       $246.66     20081209
30125       REMOVAL OF NOSE LESION            80                           $87.42     20090101
30125       REMOVAL OF NOSE LESION            81                           $87.42     20090101
30125       REMOVAL OF NOSE LESION            82                           $87.42     20090101
30125       REMOVAL OF NOSE LESION            AS                           $87.42     20090101
30125       REMOVAL OF NOSE LESION                                Y       $597.79     20081209
30125       REMOVAL OF NOSE LESION                                        $437.08     20090101
30130       EXCISE INFERIOR TURBINATE                             Y       $441.21     20081209
30130       EXCISE INFERIOR TURBINATE                                     $259.85     20090101
30140       RESECT INFERIOR TURBINATE                                     $291.56     20090101
30140       RESECT INFERIOR TURBINATE                             Y       $466.13     20081209
30150       PARTIAL REMOVAL OF NOSE                                       $567.54     20090101
30150       PARTIAL REMOVAL OF NOSE                               Y       $636.19     20081209
30160       REMOVAL OF NOSE                   80                          $113.01     20090101
30160       REMOVAL OF NOSE                   81                          $113.01     20090101
30160       REMOVAL OF NOSE                   82                          $113.01     20090101
30160       REMOVAL OF NOSE                   AS                          $113.01     20090101
30160       REMOVAL OF NOSE                                       Y       $708.19     20081209
30160       REMOVAL OF NOSE                                               $565.06     20090101
30200       INJECTION TREATMENT OF NOSE                                    $74.00     20090101
30210       NASAL SINUS THERAPY                                            $97.37     20090101
30220       INSERT NASAL SEPTAL BUTTON                                    $186.67     20090101
30300       REMOVE NASAL FOREIGN BODY                                     $155.80     20090101
30310       REMOVE NASAL FOREIGN BODY                                     $143.28     20090101
30310       REMOVE NASAL FOREIGN BODY                             Y       $335.01     20081209
30320       REMOVE NASAL FOREIGN BODY                                     $324.11     20090101
30320       REMOVE NASAL FOREIGN BODY                             Y       $402.81     20081209
30400       RECONSTRUCTION OF NOSE                                Y       $708.19     20081209
30400       RECONSTRUCTION OF NOSE                                        $732.52     20090101
30410       RECONSTRUCTION OF NOSE            80                          $178.05     20090101


                                           Page 158
Proc Code   Description                 Modifier 1 Modifier 2 ASC     Price     Effective Date
30410       RECONSTRUCTION OF NOSE      81                           $178.05      20090101
30410       RECONSTRUCTION OF NOSE      82                           $178.05      20090101
30410       RECONSTRUCTION OF NOSE      AS                           $178.05      20090101
30410       RECONSTRUCTION OF NOSE                                   $890.26      20090101
30410       RECONSTRUCTION OF NOSE                          Y        $760.39      20081209
30420       RECONSTRUCTION OF NOSE                                   $972.61      20090101
30420       RECONSTRUCTION OF NOSE                          Y        $760.39      20081209
30430       REVISION OF NOSE            80                           $130.04      20090101
30430       REVISION OF NOSE            81                           $130.04      20090101
30430       REVISION OF NOSE            82                           $130.04      20090101
30430       REVISION OF NOSE            AS                           $130.04      20090101
30430       REVISION OF NOSE                                Y        $504.53      20081209
30430       REVISION OF NOSE                                         $650.19      20090101
30435       REVISION OF NOSE            80                           $172.88      20090101
30435       REVISION OF NOSE            81                           $172.88      20090101
30435       REVISION OF NOSE            82                           $172.88      20090101
30435       REVISION OF NOSE            AS                           $172.88      20090101
30435       REVISION OF NOSE                                         $864.38      20090101
30435       REVISION OF NOSE                                Y        $760.39      20081209
30450       REVISION OF NOSE            80                           $226.74      20090101
30450       REVISION OF NOSE            81                           $226.74      20090101
30450       REVISION OF NOSE            82                           $226.74      20090101
30450       REVISION OF NOSE            AS                           $226.74      20090101
30450       REVISION OF NOSE                                        $1,133.69     20090101
30450       REVISION OF NOSE                                Y        $927.19      20081209
30460       REVISION OF NOSE            80                           $111.23      20090101
30460       REVISION OF NOSE            81                           $111.23      20090101
30460       REVISION OF NOSE            82                           $111.23      20090101
30460       REVISION OF NOSE            AS                           $111.23      20090101
30460       REVISION OF NOSE                                Y        $927.19      20081209
30460       REVISION OF NOSE                                         $556.16      20090101
30462       REVISION OF NOSE            80                           $223.24      20090101
30462       REVISION OF NOSE            81                           $223.24      20090101
30462       REVISION OF NOSE            82                           $223.24      20090101
30462       REVISION OF NOSE            AS                           $223.24      20090101
30462       REVISION OF NOSE                                        $1,116.20     20090101
30462       REVISION OF NOSE                                Y       $1,133.59     20081209
30465       REPAIR NASAL STENOSIS       80                           $137.93      20090101
30465       REPAIR NASAL STENOSIS       81                           $137.93      20090101
30465       REPAIR NASAL STENOSIS       82                           $137.93      20090101
30465       REPAIR NASAL STENOSIS       AS                           $137.93      20090101
30465       REPAIR NASAL STENOSIS                                    $689.67      20090101
30465       REPAIR NASAL STENOSIS                           Y       $1,133.59     20081209
30520       REPAIR OF NASAL SEPTUM                                   $408.13      20090101
30520       REPAIR OF NASAL SEPTUM                          Y        $576.53      20081209


                                     Page 159
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
30540       REPAIR NASAL DEFECT               80                           $96.81     20090101
30540       REPAIR NASAL DEFECT               81                           $96.81     20090101
30540       REPAIR NASAL DEFECT               82                           $96.81     20090101
30540       REPAIR NASAL DEFECT               AS                           $96.81     20090101
30540       REPAIR NASAL DEFECT                                           $484.07     20090101
30540       REPAIR NASAL DEFECT                                   Y       $760.39     20081209
30545       REPAIR NASAL DEFECT               80                          $137.49     20090101
30545       REPAIR NASAL DEFECT               81                          $137.49     20090101
30545       REPAIR NASAL DEFECT               82                          $137.49     20090101
30545       REPAIR NASAL DEFECT               AS                          $137.49     20090101
30545       REPAIR NASAL DEFECT                                   Y       $760.39     20081209
30545       REPAIR NASAL DEFECT                                           $687.45     20090101
30560       RELEASE OF NASAL ADHESIONS                                    $178.33     20090101
30560       RELEASE OF NASAL ADHESIONS                            Y       $111.14     20081209
30580       REPAIR UPPER JAW FISTULA                                      $434.29     20090101
30580       REPAIR UPPER JAW FISTULA                              Y       $708.19     20081209
30600       REPAIR MOUTH/NOSE FISTULA                                     $399.79     20090101
30600       REPAIR MOUTH/NOSE FISTULA                             Y       $708.19     20081209
30620       INTRANASAL RECONSTRUCTION                                     $427.61     20090101
30620       INTRANASAL RECONSTRUCTION                             Y       $927.19     20081209
30630       REPAIR NASAL SEPTUM DEFECT                            Y       $795.53     20081209
30630       REPAIR NASAL SEPTUM DEFECT                                    $434.83     20090101
30801       ABLATE INF TURBINATE, SUPERF                                  $150.79     20090101
30801       ABLATE INF TURBINATE, SUPERF                          Y       $261.46     20081209
30802       CAUTERIZATION, INNER NOSE                                     $194.75     20090101
30802       CAUTERIZATION, INNER NOSE                             Y       $261.46     20081209
30901       CONTROL OF NOSEBLEED                                          $73.44      20090101
30903       CONTROL OF NOSEBLEED                                          $129.92     20090101
30903       CONTROL OF NOSEBLEED                                  Y        $52.81     20081209
30905       CONTROL OF NOSEBLEED                                          $163.31     20090101
30905       CONTROL OF NOSEBLEED                                  Y        $52.81     20081209
30906       REPEAT CONTROL OF NOSEBLEED                                   $187.51     20090101
30906       REPEAT CONTROL OF NOSEBLEED                           Y        $52.81     20081209
30915       LIGATION, NASAL SINUS ARTERY                          Y       $481.57     20081209
30915       LIGATION, NASAL SINUS ARTERY                                  $403.96     20090101
30920       LIGATION, UPPER JAW ARTERY                                    $578.67     20090101
30920       LIGATION, UPPER JAW ARTERY                            Y       $519.97     20081209
30930       THER FX, NASAL INF TURBINATE                                  $84.30      20090101
30930       THER FX, NASAL INF TURBINATE                          Y       $513.21     20081209
31000       IRRIGATION, MAXILLARY SINUS                                   $119.36     20090101
31002       IRRIGATION, SPHENOID SINUS                                    $140.49     20090101
31020       EXPLORATION, MAXILLARY SINUS                                  $329.68     20090101
31020       EXPLORATION, MAXILLARY SINUS                          Y       $466.13     20081209
31030       EXPLORATION, MAXILLARY SINUS                          Y       $636.19     20081209
31030       EXPLORATION, MAXILLARY SINUS                                  $487.14     20090101


                                           Page 160
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
31032       EXPLORE SINUS, REMOVE POLYPS                          Y       $708.19     20081209
31032       EXPLORE SINUS, REMOVE POLYPS                                  $398.39     20090101
31040       EXPLORATION BEHIND UPPER JAW                                  $532.21     20090101
31050       EXPLORATION, SPHENOID SINUS                           Y       $597.79     20081209
31050       EXPLORATION, SPHENOID SINUS                                   $340.25     20090101
31051       SPHENOID SINUS SURGERY                                        $447.64     20090101
31051       SPHENOID SINUS SURGERY                                Y       $708.19     20081209
31070       EXPLORATION OF FRONTAL SINUS                                  $299.35     20090101
31070       EXPLORATION OF FRONTAL SINUS                          Y       $466.13     20081209
31075       EXPLORATION OF FRONTAL SINUS      80                          $109.50     20090101
31075       EXPLORATION OF FRONTAL SINUS      81                          $109.50     20090101
31075       EXPLORATION OF FRONTAL SINUS      82                          $109.50     20090101
31075       EXPLORATION OF FRONTAL SINUS      AS                          $109.50     20090101
31075       EXPLORATION OF FRONTAL SINUS                          Y       $708.19     20081209
31075       EXPLORATION OF FRONTAL SINUS                                  $547.52     20090101
31080       REMOVAL OF FRONTAL SINUS          80                          $143.83     20090101
31080       REMOVAL OF FRONTAL SINUS          81                          $143.83     20090101
31080       REMOVAL OF FRONTAL SINUS          82                          $143.83     20090101
31080       REMOVAL OF FRONTAL SINUS          AS                          $143.83     20090101
31080       REMOVAL OF FRONTAL SINUS                              Y       $708.19     20081209
31080       REMOVAL OF FRONTAL SINUS                                      $719.17     20090101
31081       REMOVAL OF FRONTAL SINUS          80                          $173.32     20090101
31081       REMOVAL OF FRONTAL SINUS          81                          $173.32     20090101
31081       REMOVAL OF FRONTAL SINUS          82                          $173.32     20090101
31081       REMOVAL OF FRONTAL SINUS          AS                          $173.32     20090101
31081       REMOVAL OF FRONTAL SINUS                              Y       $708.19     20081209
31081       REMOVAL OF FRONTAL SINUS                                      $866.61     20090101
31084       REMOVAL OF FRONTAL SINUS          80                          $162.14     20090101
31084       REMOVAL OF FRONTAL SINUS          81                          $162.14     20090101
31084       REMOVAL OF FRONTAL SINUS          82                          $162.14     20090101
31084       REMOVAL OF FRONTAL SINUS          AS                          $162.14     20090101
31084       REMOVAL OF FRONTAL SINUS                                      $810.72     20090101
31084       REMOVAL OF FRONTAL SINUS                              Y       $708.19     20081209
31085       REMOVAL OF FRONTAL SINUS          80                          $174.55     20090101
31085       REMOVAL OF FRONTAL SINUS          81                          $174.55     20090101
31085       REMOVAL OF FRONTAL SINUS          82                          $174.55     20090101
31085       REMOVAL OF FRONTAL SINUS          AS                          $174.55     20090101
31085       REMOVAL OF FRONTAL SINUS                              Y       $708.19     20081209
31085       REMOVAL OF FRONTAL SINUS                                      $872.76     20090101
31086       REMOVAL OF FRONTAL SINUS          80                          $157.30     20090101
31086       REMOVAL OF FRONTAL SINUS          81                          $157.30     20090101
31086       REMOVAL OF FRONTAL SINUS          82                          $157.30     20090101
31086       REMOVAL OF FRONTAL SINUS          AS                          $157.30     20090101
31086       REMOVAL OF FRONTAL SINUS                                      $786.50     20090101
31086       REMOVAL OF FRONTAL SINUS                              Y       $708.19     20081209


                                           Page 161
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
31087       REMOVAL OF FRONTAL SINUS         80                           $155.41      20090101
31087       REMOVAL OF FRONTAL SINUS         81                           $155.41      20090101
31087       REMOVAL OF FRONTAL SINUS         82                           $155.41      20090101
31087       REMOVAL OF FRONTAL SINUS         AS                           $155.41      20090101
31087       REMOVAL OF FRONTAL SINUS                                      $777.03      20090101
31087       REMOVAL OF FRONTAL SINUS                             Y        $708.19      20081209
31090       EXPLORATION OF SINUSES                                        $690.23      20090101
31090       EXPLORATION OF SINUSES                               Y        $760.39      20081209
31200       REMOVAL OF ETHMOID SINUS                                      $379.75      20090101
31200       REMOVAL OF ETHMOID SINUS                             Y        $597.79      20081209
31201       REMOVAL OF ETHMOID SINUS                                      $511.90      20090101
31201       REMOVAL OF ETHMOID SINUS                             Y        $760.39      20081209
31205       REMOVAL OF ETHMOID SINUS         80                           $121.52      20090101
31205       REMOVAL OF ETHMOID SINUS         81                           $121.52      20090101
31205       REMOVAL OF ETHMOID SINUS         82                           $121.52      20090101
31205       REMOVAL OF ETHMOID SINUS         AS                           $121.52      20090101
31205       REMOVAL OF ETHMOID SINUS                             Y        $636.19      20081209
31205       REMOVAL OF ETHMOID SINUS                                      $607.60      20090101
31225       REMOVAL OF UPPER JAW             80                           $255.40      20090101
31225       REMOVAL OF UPPER JAW             81                           $255.40      20090101
31225       REMOVAL OF UPPER JAW             82                           $255.40      20090101
31225       REMOVAL OF UPPER JAW             AS                           $255.40      20090101
31225       REMOVAL OF UPPER JAW                                         $1,276.98     20090101
31230       REMOVAL OF UPPER JAW             80                           $288.11      20090101
31230       REMOVAL OF UPPER JAW             81                           $288.11      20090101
31230       REMOVAL OF UPPER JAW             82                           $288.11      20090101
31230       REMOVAL OF UPPER JAW             AS                           $288.11      20090101
31230       REMOVAL OF UPPER JAW                                         $1,440.56     20090101
31231       NASAL ENDOSCOPY, DX                                           $130.20      20090101
31233       NASAL/SINUS ENDOSCOPY, DX                                     $185.29      20090101
31233       NASAL/SINUS ENDOSCOPY, DX                            Y         $65.18      20081209
31235       NASAL/SINUS ENDOSCOPY, DX                                     $213.67      20090101
31235       NASAL/SINUS ENDOSCOPY, DX                            Y        $340.70      20081209
31237       NASAL/SINUS ENDOSCOPY, SURG                                   $231.19      20090101
31237       NASAL/SINUS ENDOSCOPY, SURG                          Y        $408.50      20081209
31238       NASAL/SINUS ENDOSCOPY, SURG                          Y        $340.70      20081209
31238       NASAL/SINUS ENDOSCOPY, SURG                                   $238.14      20090101
31239       NASAL/SINUS ENDOSCOPY, SURG                                   $474.62      20090101
31239       NASAL/SINUS ENDOSCOPY, SURG                          Y        $566.12      20081209
31240       NASAL/SINUS ENDOSCOPY, SURG                                   $121.02      20090101
31240       NASAL/SINUS ENDOSCOPY, SURG                          Y        $408.50      20081209
31254       REVISION OF ETHMOID SINUS                            Y        $494.12      20081209
31254       REVISION OF ETHMOID SINUS                                     $208.10      20090101
31255       REMOVAL OF ETHMOID SINUS                             Y        $618.32      20081209
31255       REMOVAL OF ETHMOID SINUS                                      $308.25      20090101


                                          Page 162
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
31256       EXPLORATION MAXILLARY SINUS                                   $150.79      20090101
31256       EXPLORATION MAXILLARY SINUS                          Y        $494.12      20081209
31267       ENDOSCOPY, MAXILLARY SINUS                                    $243.43      20090101
31267       ENDOSCOPY, MAXILLARY SINUS                           Y        $494.12      20081209
31276       SINUS ENDOSCOPY, SURGICAL                            Y        $494.12      20081209
31276       SINUS ENDOSCOPY, SURGICAL                                     $388.65      20090101
31287       NASAL/SINUS ENDOSCOPY, SURG                                   $177.22      20090101
31287       NASAL/SINUS ENDOSCOPY, SURG                          Y        $494.12      20081209
31288       NASAL/SINUS ENDOSCOPY, SURG                                   $205.59      20090101
31288       NASAL/SINUS ENDOSCOPY, SURG                          Y        $494.12      20081209
31290       NASAL/SINUS ENDOSCOPY, SURG                                   $847.15      20090101
31291       NASAL/SINUS ENDOSCOPY, SURG                                   $894.44      20090101
31292       NASAL/SINUS ENDOSCOPY, SURG                                   $732.80      20090101
31293       NASAL/SINUS ENDOSCOPY, SURG                                   $797.90      20090101
31294       NASAL/SINUS ENDOSCOPY, SURG                                   $918.37      20090101
31300       REMOVAL OF LARYNX LESION         80                           $176.22      20090101
31300       REMOVAL OF LARYNX LESION         81                           $176.22      20090101
31300       REMOVAL OF LARYNX LESION         82                           $176.22      20090101
31300       REMOVAL OF LARYNX LESION         AS                           $176.22      20090101
31300       REMOVAL OF LARYNX LESION                             Y        $628.73      20081209
31300       REMOVAL OF LARYNX LESION                                      $881.10      20090101
31320       DIAGNOSTIC INCISION, LARYNX                                   $453.75      20090101
31320       DIAGNOSTIC INCISION, LARYNX                          Y        $597.79      20081209
31360       REMOVAL OF LARYNX                80                           $274.65      20090101
31360       REMOVAL OF LARYNX                81                           $274.65      20090101
31360       REMOVAL OF LARYNX                82                           $274.65      20090101
31360       REMOVAL OF LARYNX                AS                           $274.65      20090101
31360       REMOVAL OF LARYNX                                            $1,373.24     20090101
31365       REMOVAL OF LARYNX                80                           $345.75      20090101
31365       REMOVAL OF LARYNX                81                           $345.75      20090101
31365       REMOVAL OF LARYNX                82                           $345.75      20090101
31365       REMOVAL OF LARYNX                AS                           $345.75      20090101
31365       REMOVAL OF LARYNX                                            $1,728.76     20090101
31367       PARTIAL REMOVAL OF LARYNX        80                           $301.74      20090101
31367       PARTIAL REMOVAL OF LARYNX        81                           $301.74      20090101
31367       PARTIAL REMOVAL OF LARYNX        82                           $301.74      20090101
31367       PARTIAL REMOVAL OF LARYNX        AS                           $301.74      20090101
31367       PARTIAL REMOVAL OF LARYNX                                    $1,508.72     20090101
31368       PARTIAL REMOVAL OF LARYNX        80                           $340.08      20090101
31368       PARTIAL REMOVAL OF LARYNX        81                           $340.08      20090101
31368       PARTIAL REMOVAL OF LARYNX        82                           $340.08      20090101
31368       PARTIAL REMOVAL OF LARYNX        AS                           $340.08      20090101
31368       PARTIAL REMOVAL OF LARYNX                                    $1,700.40     20090101
31370       PARTIAL REMOVAL OF LARYNX        80                           $284.88      20090101
31370       PARTIAL REMOVAL OF LARYNX        81                           $284.88      20090101


                                          Page 163
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
31370       PARTIAL REMOVAL OF LARYNX         82                           $284.88      20090101
31370       PARTIAL REMOVAL OF LARYNX         AS                           $284.88      20090101
31370       PARTIAL REMOVAL OF LARYNX                                     $1,424.42     20090101
31375       PARTIAL REMOVAL OF LARYNX         80                           $267.86      20090101
31375       PARTIAL REMOVAL OF LARYNX         81                           $267.86      20090101
31375       PARTIAL REMOVAL OF LARYNX         82                           $267.86      20090101
31375       PARTIAL REMOVAL OF LARYNX         AS                           $267.86      20090101
31375       PARTIAL REMOVAL OF LARYNX                                     $1,339.29     20090101
31380       PARTIAL REMOVAL OF LARYNX         80                           $265.14      20090101
31380       PARTIAL REMOVAL OF LARYNX         81                           $265.14      20090101
31380       PARTIAL REMOVAL OF LARYNX         82                           $265.14      20090101
31380       PARTIAL REMOVAL OF LARYNX         AS                           $265.14      20090101
31380       PARTIAL REMOVAL OF LARYNX                                     $1,325.68     20090101
31382       PARTIAL REMOVAL OF LARYNX         80                           $289.78      20090101
31382       PARTIAL REMOVAL OF LARYNX         81                           $289.78      20090101
31382       PARTIAL REMOVAL OF LARYNX         82                           $289.78      20090101
31382       PARTIAL REMOVAL OF LARYNX         AS                           $289.78      20090101
31382       PARTIAL REMOVAL OF LARYNX                                     $1,448.90     20090101
31390       REMOVAL OF LARYNX & PHARYNX       80                           $387.27      20090101
31390       REMOVAL OF LARYNX & PHARYNX       81                           $387.27      20090101
31390       REMOVAL OF LARYNX & PHARYNX       82                           $387.27      20090101
31390       REMOVAL OF LARYNX & PHARYNX       AS                           $387.27      20090101
31390       REMOVAL OF LARYNX & PHARYNX                                   $1,936.33     20090101
31395       RECONSTRUCT LARYNX & PHARYNX      80                           $413.80      20090101
31395       RECONSTRUCT LARYNX & PHARYNX      81                           $413.80      20090101
31395       RECONSTRUCT LARYNX & PHARYNX      82                           $413.80      20090101
31395       RECONSTRUCT LARYNX & PHARYNX      AS                           $413.80      20090101
31395       RECONSTRUCT LARYNX & PHARYNX                                  $2,069.02     20090101
31400       REVISION OF LARYNX                80                           $141.61      20090101
31400       REVISION OF LARYNX                81                           $141.61      20090101
31400       REVISION OF LARYNX                82                           $141.61      20090101
31400       REVISION OF LARYNX                AS                           $141.61      20090101
31400       REVISION OF LARYNX                                             $708.04      20090101
31400       REVISION OF LARYNX                                    Y        $597.79      20081209
31420       REMOVAL OF EPIGLOTTIS             80                           $118.07      20090101
31420       REMOVAL OF EPIGLOTTIS             81                           $118.07      20090101
31420       REMOVAL OF EPIGLOTTIS             82                           $118.07      20090101
31420       REMOVAL OF EPIGLOTTIS             AS                           $118.07      20090101
31420       REMOVAL OF EPIGLOTTIS                                 Y        $597.79      20081209
31420       REMOVAL OF EPIGLOTTIS                                          $590.36      20090101
31500       INSERT EMERGENCY AIRWAY                                        $82.90       20090101
31502       CHANGE OF WINDPIPE AIRWAY                                      $26.43       20090101
31505       DIAGNOSTIC LARYNGOSCOPY                                        $58.43       20090101
31510       LARYNGOSCOPY WITH BIOPSY                                       $148.56      20090101
31510       LARYNGOSCOPY WITH BIOPSY                              Y        $408.50      20081209


                                           Page 164
Proc Code   Description                    Modifier 1 Modifier 2 ASC    Price    Effective Date
31511       REMOVE FOREIGN BODY, LARYNX                                $149.67     20090101
31511       REMOVE FOREIGN BODY, LARYNX                        Y        $65.18     20081209
31512       REMOVAL OF LARYNX LESION                                   $148.56     20090101
31512       REMOVAL OF LARYNX LESION                           Y       $408.50     20081209
31513       INJECTION INTO VOCAL CORD                                  $98.49      20090101
31513       INJECTION INTO VOCAL CORD                          Y        $65.18     20081209
31515       LARYNGOSCOPY FOR ASPIRATION                        Y       $340.70     20081209
31515       LARYNGOSCOPY FOR ASPIRATION                                $147.73     20090101
31520       DX LARYNGOSCOPY, NEWBORN                                   $115.17     20090101
31525       DX LARYNGOSCOPY EXCL NB                                    $177.77     20090101
31525       DX LARYNGOSCOPY EXCL NB                            Y       $340.70     20081209
31526       DX LARYNGOSCOPY W/OPER SCOPE                               $118.52     20090101
31526       DX LARYNGOSCOPY W/OPER SCOPE                       Y       $455.72     20081209
31527       LARYNGOSCOPY FOR TREATMENT                                 $143.83     20090101
31527       LARYNGOSCOPY FOR TREATMENT                         Y       $387.92     20081209
31528       LARYNGOSCOPY AND DILATION                                  $106.55     20090101
31528       LARYNGOSCOPY AND DILATION                          Y       $408.50     20081209
31529       LARYNGOSCOPY AND DILATION                                  $121.85     20090101
31529       LARYNGOSCOPY AND DILATION                          Y       $408.50     20081209
31530       LARYNGOSCOPY W/FB REMOVAL                          Y       $455.72     20081209
31530       LARYNGOSCOPY W/FB REMOVAL                                  $149.40     20090101
31531       LARYNGOSCOPY W/FB & OP SCOPE                               $161.36     20090101
31531       LARYNGOSCOPY W/FB & OP SCOPE                       Y       $494.12     20081209
31535       LARYNGOSCOPY W/BIOPSY                              Y       $455.72     20081209
31535       LARYNGOSCOPY W/BIOPSY                                      $143.00     20090101
31536       LARYNGOSCOPY W/BX & OP SCOPE                       Y       $494.12     20081209
31536       LARYNGOSCOPY W/BX & OP SCOPE                               $159.97     20090101
31540       LARYNGOSCOPY W/EXC OF TUMOR                                $183.62     20090101
31540       LARYNGOSCOPY W/EXC OF TUMOR                        Y       $494.12     20081209
31541       LARYNSCOP W/TUMR EXC + SCOPE                               $201.14     20090101
31541       LARYNSCOP W/TUMR EXC + SCOPE                       Y       $566.12     20081209
31545       REMOVE VC LESION W/SCOPE                                   $268.75     20090101
31546       REMOVE VC LESION SCOPE/GRAFT                               $409.24     20090101
31560       LARYNGOSCOP W/ARYTENOIDECTOM                       Y       $618.32     20081209
31560       LARYNGOSCOP W/ARYTENOIDECTOM                               $237.32     20090101
31561       LARYNSCOP, REMVE CART + SCOP                               $259.57     20090101
31561       LARYNSCOP, REMVE CART + SCOP                       Y       $618.32     20081209
31570       LARYNGOSCOPE W/VC INJ                                      $254.28     20090101
31570       LARYNGOSCOPE W/VC INJ                              Y       $408.50     20081209
31571       LARYNGOSCOP W/VC INJ + SCOPE                               $189.74     20090101
31571       LARYNGOSCOP W/VC INJ + SCOPE                       Y       $455.72     20081209
31575       DIAGNOSTIC LARYNGOSCOPY                                    $83.18      20090101
31576       LARYNGOSCOPY WITH BIOPSY                                   $158.58     20090101
31576       LARYNGOSCOPY WITH BIOPSY                           Y       $455.72     20081209
31577       REMOVE FOREIGN BODY, LARYNX                                $173.88     20090101


                                       Page 165
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
31577       REMOVE FOREIGN BODY, LARYNX                          Y        $174.93      20081209
31578       REMOVAL OF LARYNX LESION                                      $200.58      20090101
31578       REMOVAL OF LARYNX LESION                             Y        $455.72      20081209
31579       DIAGNOSTIC LARYNGOSCOPY                                       $160.25      20090101
31580       REVISION OF LARYNX               80                           $168.82      20090101
31580       REVISION OF LARYNX               81                           $168.82      20090101
31580       REVISION OF LARYNX               82                           $168.82      20090101
31580       REVISION OF LARYNX               AS                           $168.82      20090101
31580       REVISION OF LARYNX                                            $844.09      20090101
31580       REVISION OF LARYNX                                   Y        $760.39      20081209
31582       REVISION OF LARYNX                                           $1,358.21     20090101
31582       REVISION OF LARYNX                                   Y        $760.39      20081209
31584       TREAT LARYNX FRACTURE            80                           $215.84      20090101
31584       TREAT LARYNX FRACTURE            81                           $215.84      20090101
31584       TREAT LARYNX FRACTURE            82                           $215.84      20090101
31584       TREAT LARYNX FRACTURE            AS                           $215.84      20090101
31584       TREAT LARYNX FRACTURE                                        $1,079.19     20090101
31587       REVISION OF LARYNX               80                           $139.38      20090101
31587       REVISION OF LARYNX               81                           $139.38      20090101
31587       REVISION OF LARYNX               82                           $139.38      20090101
31587       REVISION OF LARYNX               AS                           $139.38      20090101
31587       REVISION OF LARYNX                                            $696.92      20090101
31588       REVISION OF LARYNX               80                           $159.97      20090101
31588       REVISION OF LARYNX               81                           $159.97      20090101
31588       REVISION OF LARYNX               82                           $159.97      20090101
31588       REVISION OF LARYNX               AS                           $159.97      20090101
31588       REVISION OF LARYNX                                            $799.85      20090101
31588       REVISION OF LARYNX                                   Y        $760.39      20081209
31590       REINNERVATE LARYNX               80                           $125.97      20090101
31590       REINNERVATE LARYNX               81                           $125.97      20090101
31590       REINNERVATE LARYNX               82                           $125.97      20090101
31590       REINNERVATE LARYNX               AS                           $125.97      20090101
31590       REINNERVATE LARYNX                                            $629.85      20090101
31590       REINNERVATE LARYNX                                   Y        $760.39      20081209
31595       LARYNX NERVE SURGERY             80                           $108.66      20090101
31595       LARYNX NERVE SURGERY             81                           $108.66      20090101
31595       LARYNX NERVE SURGERY             82                           $108.66      20090101
31595       LARYNX NERVE SURGERY             AS                           $108.66      20090101
31595       LARYNX NERVE SURGERY                                          $543.32      20090101
31595       LARYNX NERVE SURGERY                                 Y        $597.79      20081209
31600       INCISION OF WINDPIPE                                          $297.96      20090101
31601       INCISION OF WINDPIPE             80                            $38.45      20090101
31601       INCISION OF WINDPIPE             81                            $38.45      20090101
31601       INCISION OF WINDPIPE             82                            $38.45      20090101
31601       INCISION OF WINDPIPE             AS                            $38.45      20090101


                                          Page 166
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
31601       INCISION OF WINDPIPE                                          $192.25     20090101
31603       INCISION OF WINDPIPE                                          $167.76     20090101
31605       INCISION OF WINDPIPE                                          $138.27     20090101
31610       INCISION OF WINDPIPE                                          $503.00     20090101
31611       SURGERY/SPEECH PROSTHESIS         80                           $74.84     20090101
31611       SURGERY/SPEECH PROSTHESIS         81                           $74.84     20090101
31611       SURGERY/SPEECH PROSTHESIS         82                           $74.84     20090101
31611       SURGERY/SPEECH PROSTHESIS         AS                           $74.84     20090101
31611       SURGERY/SPEECH PROSTHESIS                                     $374.20     20090101
31611       SURGERY/SPEECH PROSTHESIS                             Y       $504.53     20081209
31612       PUNCTURE/CLEAR WINDPIPE                                       $57.87      20090101
31612       PUNCTURE/CLEAR WINDPIPE                               Y       $398.33     20081209
31613       REPAIR WINDPIPE OPENING                                       $309.37     20090101
31613       REPAIR WINDPIPE OPENING                               Y       $466.13     20081209
31614       REPAIR WINDPIPE OPENING                                       $506.34     20090101
31614       REPAIR WINDPIPE OPENING                               Y       $597.79     20081209
31615       VISUALIZATION OF WINDPIPE                                     $131.87     20090101
31615       VISUALIZATION OF WINDPIPE                             Y       $282.25     20081209
31622       DX BRONCHOSCOPE/WASH                                          $233.97     20090101
31622       DX BRONCHOSCOPE/WASH                                  Y       $282.25     20081209
31623       DX BRONCHOSCOPE/BRUSH                                 Y       $350.05     20081209
31623       DX BRONCHOSCOPE/BRUSH                                         $256.22     20090101
31624       DX BRONCHOSCOPE/LAVAGE                                Y       $350.05     20081209
31624       DX BRONCHOSCOPE/LAVAGE                                        $238.42     20090101
31625       BRONCHOSCOPY W/BIOPSY(S)                                      $255.68     20090101
31625       BRONCHOSCOPY W/BIOPSY(S)                              Y       $350.05     20081209
31628       BRONCHOSCOPY/LUNG BX, EACH                                    $305.19     20090101
31628       BRONCHOSCOPY/LUNG BX, EACH                            Y       $350.05     20081209
31629       BRONCHOSCOPY/NEEDLE BX, EACH                          Y       $350.05     20081209
31629       BRONCHOSCOPY/NEEDLE BX, EACH                                  $483.80     20090101
31630       BRONCHOSCOPY DILATE/FX REPR                                   $156.36     20090101
31630       BRONCHOSCOPY DILATE/FX REPR                           Y       $466.86     20081209
31631       BRONCHOSCOPY, DILATE W/STENT                                  $175.00     20090101
31631       BRONCHOSCOPY, DILATE W/STENT                          Y       $466.86     20081209
31632       BRONCHOSCOPY/LUNG BX, ADD?L                                   $56.76      20090101
31633       BRONCHOSCOPY/NEEDLE BX ADD?L                                  $67.61      20090101
31635       BRONCHOSCOPY W/FB REMOVAL                             Y       $350.05     20081209
31635       BRONCHOSCOPY W/FB REMOVAL                                     $266.24     20090101
31636       BRONCHOSCOPY, BRONCH STENTS                                   $171.38     20090101
31637       BRONCHOSCOPY, STENT ADD-ON                                    $60.93      20090101
31638       BRONCHOSCOPY, REVISE STENT                                    $190.85     20090101
31640       BRONCHOSCOPY W/TUMOR EXCISE                           Y       $466.86     20081209
31640       BRONCHOSCOPY W/TUMOR EXCISE                                   $200.03     20090101
31641       BRONCHOSCOPY, TREAT BLOCKAGE                          Y       $466.86     20081209
31641       BRONCHOSCOPY, TREAT BLOCKAGE                                  $196.41     20090101


                                           Page 167
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
31643       DIAG BRONCHOSCOPE/CATHETER                            Y        $350.05      20081209
31643       DIAG BRONCHOSCOPE/CATHETER                                     $134.09      20090101
31645       BRONCHOSCOPY, CLEAR AIRWAYS                                    $229.52      20090101
31645       BRONCHOSCOPY, CLEAR AIRWAYS                           Y        $282.25      20081209
31646       BRONCHOSCOPY, RECLEAR AIRWAY                                   $208.66      20090101
31646       BRONCHOSCOPY, RECLEAR AIRWAY                          Y        $282.25      20081209
31656       BRONCHOSCOPY, INJ FOR X-RAY       80                            $17.14      20090101
31656       BRONCHOSCOPY, INJ FOR X-RAY       81                            $17.14      20090101
31656       BRONCHOSCOPY, INJ FOR X-RAY       82                            $17.14      20090101
31656       BRONCHOSCOPY, INJ FOR X-RAY       AS                            $17.14      20090101
31656       BRONCHOSCOPY, INJ FOR X-RAY                                     $85.69      20090101
31656       BRONCHOSCOPY, INJ FOR X-RAY                           Y        $282.25      20081209
31715       INJECTION FOR BRONCHUS X-RAY                                    $41.17      20090101
31717       BRONCHIAL BRUSH BIOPSY                                Y        $174.93      20081209
31717       BRONCHIAL BRUSH BIOPSY                                         $259.01      20090101
31720       CLEARANCE OF AIRWAYS                                            $39.79      20090101
31720       CLEARANCE OF AIRWAYS                                  Y         $31.60      20081209
31725       CLEARANCE OF AIRWAYS                                            $72.06      20090101
31730       INTRO, WINDPIPE WIRE/TUBE                                      $473.79      20090101
31730       INTRO, WINDPIPE WIRE/TUBE                             Y        $174.93      20081209
31750       REPAIR OF WINDPIPE                80                           $187.79      20090101
31750       REPAIR OF WINDPIPE                81                           $187.79      20090101
31750       REPAIR OF WINDPIPE                82                           $187.79      20090101
31750       REPAIR OF WINDPIPE                AS                           $187.79      20090101
31750       REPAIR OF WINDPIPE                                             $938.95      20090101
31750       REPAIR OF WINDPIPE                                    Y        $760.39      20081209
31755       REPAIR OF WINDPIPE                80                           $237.86      20090101
31755       REPAIR OF WINDPIPE                81                           $237.86      20090101
31755       REPAIR OF WINDPIPE                82                           $237.86      20090101
31755       REPAIR OF WINDPIPE                AS                           $237.86      20090101
31755       REPAIR OF WINDPIPE                                    Y        $597.79      20081209
31755       REPAIR OF WINDPIPE                                            $1,189.32     20090101
31760       REPAIR OF WINDPIPE                80                           $203.43      20090101
31760       REPAIR OF WINDPIPE                81                           $203.43      20090101
31760       REPAIR OF WINDPIPE                82                           $203.43      20090101
31760       REPAIR OF WINDPIPE                AS                           $203.43      20090101
31760       REPAIR OF WINDPIPE                                            $1,017.15     20090101
31766       RECONSTRUCTION OF WINDPIPE        80                           $271.48      20090101
31766       RECONSTRUCTION OF WINDPIPE        81                           $271.48      20090101
31766       RECONSTRUCTION OF WINDPIPE        82                           $271.48      20090101
31766       RECONSTRUCTION OF WINDPIPE        AS                           $271.48      20090101
31766       RECONSTRUCTION OF WINDPIPE                                    $1,357.40     20090101
31770       REPAIR/GRAFT OF BRONCHUS          80                           $198.70      20090101
31770       REPAIR/GRAFT OF BRONCHUS          81                           $198.70      20090101
31770       REPAIR/GRAFT OF BRONCHUS          82                           $198.70      20090101


                                           Page 168
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
31770       REPAIR/GRAFT OF BRONCHUS        AS                           $198.70      20090101
31770       REPAIR/GRAFT OF BRONCHUS                                     $993.50      20090101
31775       RECONSTRUCT BRONCHUS            80                           $212.50      20090101
31775       RECONSTRUCT BRONCHUS            81                           $212.50      20090101
31775       RECONSTRUCT BRONCHUS            82                           $212.50      20090101
31775       RECONSTRUCT BRONCHUS            AS                           $212.50      20090101
31775       RECONSTRUCT BRONCHUS                                        $1,062.48     20090101
31780       RECONSTRUCT WINDPIPE            80                           $174.05      20090101
31780       RECONSTRUCT WINDPIPE            81                           $174.05      20090101
31780       RECONSTRUCT WINDPIPE            82                           $174.05      20090101
31780       RECONSTRUCT WINDPIPE            AS                           $174.05      20090101
31780       RECONSTRUCT WINDPIPE                                         $870.23      20090101
31781       RECONSTRUCT WINDPIPE            80                           $211.00      20090101
31781       RECONSTRUCT WINDPIPE            81                           $211.00      20090101
31781       RECONSTRUCT WINDPIPE            82                           $211.00      20090101
31781       RECONSTRUCT WINDPIPE            AS                           $211.00      20090101
31781       RECONSTRUCT WINDPIPE                                        $1,054.98     20090101
31785       REMOVE WINDPIPE LESION          80                           $160.30      20090101
31785       REMOVE WINDPIPE LESION          81                           $160.30      20090101
31785       REMOVE WINDPIPE LESION          82                           $160.30      20090101
31785       REMOVE WINDPIPE LESION          AS                           $160.30      20090101
31785       REMOVE WINDPIPE LESION                                       $801.50      20090101
31786       REMOVE WINDPIPE LESION          80                           $222.57      20090101
31786       REMOVE WINDPIPE LESION          81                           $222.57      20090101
31786       REMOVE WINDPIPE LESION          82                           $222.57      20090101
31786       REMOVE WINDPIPE LESION          AS                           $222.57      20090101
31786       REMOVE WINDPIPE LESION                                      $1,112.83     20090101
31800       REPAIR OF WINDPIPE INJURY                                    $496.88      20090101
31805       REPAIR OF WINDPIPE INJURY       80                           $121.80      20090101
31805       REPAIR OF WINDPIPE INJURY       81                           $121.80      20090101
31805       REPAIR OF WINDPIPE INJURY       82                           $121.80      20090101
31805       REPAIR OF WINDPIPE INJURY       AS                           $121.80      20090101
31805       REPAIR OF WINDPIPE INJURY                                    $608.99      20090101
31820       CLOSURE OF WINDPIPE LESION                          Y        $335.01      20081209
31820       CLOSURE OF WINDPIPE LESION                                   $298.24      20090101
31825       REPAIR OF WINDPIPE DEFECT                                    $419.26      20090101
31825       REPAIR OF WINDPIPE DEFECT                           Y        $466.13      20081209
31830       REVISE WINDPIPE SCAR                                         $301.30      20090101
31830       REVISE WINDPIPE SCAR                                Y        $466.13      20081209
32035       EXPLORATION OF CHEST            80                           $102.55      20090101
32035       EXPLORATION OF CHEST            81                           $102.55      20090101
32035       EXPLORATION OF CHEST            82                           $102.55      20090101
32035       EXPLORATION OF CHEST            AS                           $102.55      20090101
32035       EXPLORATION OF CHEST                                         $512.74      20090101
32036       EXPLORATION OF CHEST            80                           $111.33      20090101


                                         Page 169
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
32036       EXPLORATION OF CHEST              81                           $111.33      20090101
32036       EXPLORATION OF CHEST              82                           $111.33      20090101
32036       EXPLORATION OF CHEST              AS                           $111.33      20090101
32036       EXPLORATION OF CHEST                                           $556.67      20090101
32095       BIOPSY THROUGH CHEST WALL         80                            $91.92      20090101
32095       BIOPSY THROUGH CHEST WALL         81                            $91.92      20090101
32095       BIOPSY THROUGH CHEST WALL         82                            $91.92      20090101
32095       BIOPSY THROUGH CHEST WALL         AS                            $91.92      20090101
32095       BIOPSY THROUGH CHEST WALL                                      $459.59      20090101
32100       EXPLORATION/BIOPSY OF CHEST       80                           $143.22      20090101
32100       EXPLORATION/BIOPSY OF CHEST       81                           $143.22      20090101
32100       EXPLORATION/BIOPSY OF CHEST       82                           $143.22      20090101
32100       EXPLORATION/BIOPSY OF CHEST       AS                           $143.22      20090101
32100       EXPLORATION/BIOPSY OF CHEST                                    $716.12      20090101
32110       EXPLORE/REPAIR CHEST              80                           $215.22      20090101
32110       EXPLORE/REPAIR CHEST              81                           $215.22      20090101
32110       EXPLORE/REPAIR CHEST              82                           $215.22      20090101
32110       EXPLORE/REPAIR CHEST              AS                           $215.22      20090101
32110       EXPLORE/REPAIR CHEST                                          $1,076.09     20090101
32120       RE-EXPLORATION OF CHEST           80                           $127.03      20090101
32120       RE-EXPLORATION OF CHEST           81                           $127.03      20090101
32120       RE-EXPLORATION OF CHEST           82                           $127.03      20090101
32120       RE-EXPLORATION OF CHEST           AS                           $127.03      20090101
32120       RE-EXPLORATION OF CHEST                                        $635.13      20090101
32124       EXPLORE CHEST FREE ADHESIONS      80                           $135.32      20090101
32124       EXPLORE CHEST FREE ADHESIONS      81                           $135.32      20090101
32124       EXPLORE CHEST FREE ADHESIONS      82                           $135.32      20090101
32124       EXPLORE CHEST FREE ADHESIONS      AS                           $135.32      20090101
32124       EXPLORE CHEST FREE ADHESIONS                                   $676.58      20090101
32140       REMOVAL OF LUNG LESION(S)         80                           $144.94      20090101
32140       REMOVAL OF LUNG LESION(S)         81                           $144.94      20090101
32140       REMOVAL OF LUNG LESION(S)         82                           $144.94      20090101
32140       REMOVAL OF LUNG LESION(S)         AS                           $144.94      20090101
32140       REMOVAL OF LUNG LESION(S)                                      $724.71      20090101
32141       REMOVE/TREAT LUNG LESIONS         80                           $211.33      20090101
32141       REMOVE/TREAT LUNG LESIONS         81                           $211.33      20090101
32141       REMOVE/TREAT LUNG LESIONS         82                           $211.33      20090101
32141       REMOVE/TREAT LUNG LESIONS         AS                           $211.33      20090101
32141       REMOVE/TREAT LUNG LESIONS                                     $1,056.63     20090101
32150       REMOVAL OF LUNG LESION(S)         80                           $146.17      20090101
32150       REMOVAL OF LUNG LESION(S)         81                           $146.17      20090101
32150       REMOVAL OF LUNG LESION(S)         82                           $146.17      20090101
32150       REMOVAL OF LUNG LESION(S)         AS                           $146.17      20090101
32150       REMOVAL OF LUNG LESION(S)                                      $730.87      20090101
32151       REMOVE LUNG FOREIGN BODY          80                           $149.23      20090101


                                           Page 170
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
32151       REMOVE LUNG FOREIGN BODY        81                           $149.23      20090101
32151       REMOVE LUNG FOREIGN BODY        82                           $149.23      20090101
32151       REMOVE LUNG FOREIGN BODY        AS                           $149.23      20090101
32151       REMOVE LUNG FOREIGN BODY                                     $746.13      20090101
32160       OPEN CHEST HEART MASSAGE        80                           $110.67      20090101
32160       OPEN CHEST HEART MASSAGE        81                           $110.67      20090101
32160       OPEN CHEST HEART MASSAGE        82                           $110.67      20090101
32160       OPEN CHEST HEART MASSAGE        AS                           $110.67      20090101
32160       OPEN CHEST HEART MASSAGE                                     $553.36      20090101
32200       DRAIN, OPEN, LUNG LESION        80                           $163.08      20090101
32200       DRAIN, OPEN, LUNG LESION        81                           $163.08      20090101
32200       DRAIN, OPEN, LUNG LESION        82                           $163.08      20090101
32200       DRAIN, OPEN, LUNG LESION        AS                           $163.08      20090101
32200       DRAIN, OPEN, LUNG LESION                                     $815.42      20090101
32201       DRAIN, PERCUT, LUNG LESION      80                           $136.43      20090101
32201       DRAIN, PERCUT, LUNG LESION      81                           $136.43      20090101
32201       DRAIN, PERCUT, LUNG LESION      82                           $136.43      20090101
32201       DRAIN, PERCUT, LUNG LESION      AS                           $136.43      20090101
32201       DRAIN, PERCUT, LUNG LESION                                   $682.17      20090101
32215       TREAT CHEST LINING              80                           $117.91      20090101
32215       TREAT CHEST LINING              81                           $117.91      20090101
32215       TREAT CHEST LINING              82                           $117.91      20090101
32215       TREAT CHEST LINING              AS                           $117.91      20090101
32215       TREAT CHEST LINING                                           $589.54      20090101
32220       RELEASE OF LUNG                 80                           $236.03      20090101
32220       RELEASE OF LUNG                 81                           $236.03      20090101
32220       RELEASE OF LUNG                 82                           $236.03      20090101
32220       RELEASE OF LUNG                 AS                           $236.03      20090101
32220       RELEASE OF LUNG                                             $1,180.16     20090101
32225       PARTIAL RELEASE OF LUNG         80                           $146.11      20090101
32225       PARTIAL RELEASE OF LUNG         81                           $146.11      20090101
32225       PARTIAL RELEASE OF LUNG         82                           $146.11      20090101
32225       PARTIAL RELEASE OF LUNG         AS                           $146.11      20090101
32225       PARTIAL RELEASE OF LUNG                                      $730.55      20090101
32310       REMOVAL OF CHEST LINING         80                           $135.32      20090101
32310       REMOVAL OF CHEST LINING         81                           $135.32      20090101
32310       REMOVAL OF CHEST LINING         82                           $135.32      20090101
32310       REMOVAL OF CHEST LINING         AS                           $135.32      20090101
32310       REMOVAL OF CHEST LINING                                      $676.58      20090101
32320       FREE/REMOVE CHEST LINING        80                           $235.75      20090101
32320       FREE/REMOVE CHEST LINING        81                           $235.75      20090101
32320       FREE/REMOVE CHEST LINING        82                           $235.75      20090101
32320       FREE/REMOVE CHEST LINING        AS                           $235.75      20090101
32320       FREE/REMOVE CHEST LINING                                    $1,178.76     20090101
32400       NEEDLE BIOPSY CHEST LINING                                   $111.28      20090101


                                         Page 171
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
32400       NEEDLE BIOPSY CHEST LINING                            Y        $277.10      20081209
32402       OPEN BIOPSY CHEST LINING          80                            $82.69      20090101
32402       OPEN BIOPSY CHEST LINING          81                            $82.69      20090101
32402       OPEN BIOPSY CHEST LINING          82                            $82.69      20090101
32402       OPEN BIOPSY CHEST LINING          AS                            $82.69      20090101
32402       OPEN BIOPSY CHEST LINING                                       $413.43      20090101
32405       BIOPSY, LUNG OR MEDIASTINUM                                     $75.67      20090101
32405       BIOPSY, LUNG OR MEDIASTINUM                           Y        $277.10      20081209
32420       PUNCTURE/CLEAR LUNG                                             $83.46      20090101
32420       PUNCTURE/CLEAR LUNG                                   Y        $176.74      20081209
32421       THORACENTESIS FOR ASPIRATION                                   $121.02      20090101
32421       THORACENTESIS FOR ASPIRATION                          Y        $176.74      20081209
32440       REMOVAL OF LUNG                   80                           $237.98      20090101
32440       REMOVAL OF LUNG                   81                           $237.98      20090101
32440       REMOVAL OF LUNG                   82                           $237.98      20090101
32440       REMOVAL OF LUNG                   AS                           $237.98      20090101
32440       REMOVAL OF LUNG                                               $1,189.89     20090101
32442       SLEEVE PNEUMONECTOMY              80                           $428.27      20090101
32442       SLEEVE PNEUMONECTOMY              81                           $428.27      20090101
32442       SLEEVE PNEUMONECTOMY              82                           $428.27      20090101
32442       SLEEVE PNEUMONECTOMY              AS                           $428.27      20090101
32442       SLEEVE PNEUMONECTOMY                                          $2,141.36     20090101
32445       REMOVAL OF LUNG                   80                           $477.12      20090101
32445       REMOVAL OF LUNG                   81                           $477.12      20090101
32445       REMOVAL OF LUNG                   82                           $477.12      20090101
32445       REMOVAL OF LUNG                   AS                           $477.12      20090101
32445       REMOVAL OF LUNG                                               $2,385.62     20090101
32480       PARTIAL REMOVAL OF LUNG           80                           $224.46      20090101
32480       PARTIAL REMOVAL OF LUNG           81                           $224.46      20090101
32480       PARTIAL REMOVAL OF LUNG           82                           $224.46      20090101
32480       PARTIAL REMOVAL OF LUNG           AS                           $224.46      20090101
32480       PARTIAL REMOVAL OF LUNG                                       $1,122.30     20090101
32482       BILOBECTOMY                       80                           $239.03      20090101
32482       BILOBECTOMY                       81                           $239.03      20090101
32482       BILOBECTOMY                       82                           $239.03      20090101
32482       BILOBECTOMY                       AS                           $239.03      20090101
32482       BILOBECTOMY                                                   $1,195.17     20090101
32484       SEGMENTECTOMY                     80                           $216.00      20090101
32484       SEGMENTECTOMY                     81                           $216.00      20090101
32484       SEGMENTECTOMY                     82                           $216.00      20090101
32484       SEGMENTECTOMY                     AS                           $216.00      20090101
32484       SEGMENTECTOMY                                                 $1,080.02     20090101
32486       SLEEVE LOBECTOMY                  80                           $335.30      20090101
32486       SLEEVE LOBECTOMY                  81                           $335.30      20090101
32486       SLEEVE LOBECTOMY                  82                           $335.30      20090101


                                           Page 172
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
32486       SLEEVE LOBECTOMY                  AS                           $335.30      20090101
32486       SLEEVE LOBECTOMY                                              $1,676.49     20090101
32488       COMPLETION PNEUMONECTOMY          80                           $341.20      20090101
32488       COMPLETION PNEUMONECTOMY          81                           $341.20      20090101
32488       COMPLETION PNEUMONECTOMY          82                           $341.20      20090101
32488       COMPLETION PNEUMONECTOMY          AS                           $341.20      20090101
32488       COMPLETION PNEUMONECTOMY                                      $1,705.99     20090101
32500       PARTIAL REMOVAL OF LUNG           80                           $217.34      20090101
32500       PARTIAL REMOVAL OF LUNG           81                           $217.34      20090101
32500       PARTIAL REMOVAL OF LUNG           82                           $217.34      20090101
32500       PARTIAL REMOVAL OF LUNG           AS                           $217.34      20090101
32500       PARTIAL REMOVAL OF LUNG                                       $1,086.70     20090101
32501       REPAIR BRONCHUS ADD-ON            80                           $37.67       20090101
32501       REPAIR BRONCHUS ADD-ON            81                           $37.67       20090101
32501       REPAIR BRONCHUS ADD-ON            82                           $37.67       20090101
32501       REPAIR BRONCHUS ADD-ON            AS                            $37.67      20090101
32501       REPAIR BRONCHUS ADD-ON                                         $188.37      20090101
32503       RESECT APICAL LUNG TUMOR          80                           $275.82      20090101
32503       RESECT APICAL LUNG TUMOR          81                           $275.82      20090101
32503       RESECT APICAL LUNG TUMOR          82                           $275.82      20090101
32503       RESECT APICAL LUNG TUMOR          AS                           $275.82      20090101
32503       RESECT APICAL LUNG TUMOR                                      $1,379.08     20090101
32504       RESECT APICAL LUNG TUM/CHEST      80                           $314.82      20090101
32504       RESECT APICAL LUNG TUM/CHEST      81                           $314.82      20090101
32504       RESECT APICAL LUNG TUM/CHEST      82                           $314.82      20090101
32504       RESECT APICAL LUNG TUM/CHEST      AS                           $314.82      20090101
32504       RESECT APICAL LUNG TUM/CHEST                                  $1,574.10     20090101
32540       REMOVAL OF LUNG LESION            80                           $238.48      20090101
32540       REMOVAL OF LUNG LESION            81                           $238.48      20090101
32540       REMOVAL OF LUNG LESION            82                           $238.48      20090101
32540       REMOVAL OF LUNG LESION            AS                           $238.48      20090101
32540       REMOVAL OF LUNG LESION                                        $1,192.42     20090101
32550       INSERT PLEURAL CATH                                            $613.72      20090101
32550       INSERT PLEURAL CATH                                   Y       $1,017.13     20080101
32551       INSERTION OF CHEST TUBE                                        $135.76      20090101
32560       TREAT LUNG LINING CHEMICALLY                                   $227.58      20090101
32601       THORACOSCOPY, DIAGNOSTIC                                       $235.36      20090101
32602       THORACOSCOPY, DIAGNOSTIC                                       $255.68      20090101
32603       THORACOSCOPY, DIAGNOSTIC                                       $329.12      20090101
32604       THORACOSCOPY, DIAGNOSTIC                                       $369.18      20090101
32605       THORACOSCOPY, DIAGNOSTIC                                       $296.57      20090101
32606       THORACOSCOPY, DIAGNOSTIC                                       $354.99      20090101
32650       THORACOSCOPY, SURGICAL            80                           $102.10      20090101
32650       THORACOSCOPY, SURGICAL            81                           $102.10      20090101
32650       THORACOSCOPY, SURGICAL            82                           $102.10      20090101


                                           Page 173
Proc Code   Description                 Modifier 1 Modifier 2 ASC     Price     Effective Date
32650       THORACOSCOPY, SURGICAL      AS                           $102.10      20090101
32650       THORACOSCOPY, SURGICAL                                   $510.51      20090101
32651       THORACOSCOPY, SURGICAL      80                           $156.02      20090101
32651       THORACOSCOPY, SURGICAL      81                           $156.02      20090101
32651       THORACOSCOPY, SURGICAL      82                           $156.02      20090101
32651       THORACOSCOPY, SURGICAL      AS                           $156.02      20090101
32651       THORACOSCOPY, SURGICAL                                   $780.08      20090101
32652       THORACOSCOPY, SURGICAL      80                           $235.75      20090101
32652       THORACOSCOPY, SURGICAL      81                           $235.75      20090101
32652       THORACOSCOPY, SURGICAL      82                           $235.75      20090101
32652       THORACOSCOPY, SURGICAL      AS                           $235.75      20090101
32652       THORACOSCOPY, SURGICAL                                  $1,178.76     20090101
32653       THORACOSCOPY, SURGICAL      80                           $151.35      20090101
32653       THORACOSCOPY, SURGICAL      81                           $151.35      20090101
32653       THORACOSCOPY, SURGICAL      82                           $151.35      20090101
32653       THORACOSCOPY, SURGICAL      AS                           $151.35      20090101
32653       THORACOSCOPY, SURGICAL                                   $756.74      20090101
32654       THORACOSCOPY, SURGICAL      80                           $165.92      20090101
32654       THORACOSCOPY, SURGICAL      81                           $165.92      20090101
32654       THORACOSCOPY, SURGICAL      82                           $165.92      20090101
32654       THORACOSCOPY, SURGICAL      AS                           $165.92      20090101
32654       THORACOSCOPY, SURGICAL                                   $829.60      20090101
32655       THORACOSCOPY, SURGICAL      80                           $139.38      20090101
32655       THORACOSCOPY, SURGICAL      81                           $139.38      20090101
32655       THORACOSCOPY, SURGICAL      82                           $139.38      20090101
32655       THORACOSCOPY, SURGICAL      AS                           $139.38      20090101
32655       THORACOSCOPY, SURGICAL                                   $696.92      20090101
32656       THORACOSCOPY, SURGICAL      80                           $122.58      20090101
32656       THORACOSCOPY, SURGICAL      81                           $122.58      20090101
32656       THORACOSCOPY, SURGICAL      82                           $122.58      20090101
32656       THORACOSCOPY, SURGICAL      AS                           $122.58      20090101
32656       THORACOSCOPY, SURGICAL                                   $612.88      20090101
32657       THORACOSCOPY, SURGICAL      80                           $120.63      20090101
32657       THORACOSCOPY, SURGICAL      81                           $120.63      20090101
32657       THORACOSCOPY, SURGICAL      82                           $120.63      20090101
32657       THORACOSCOPY, SURGICAL      AS                           $120.63      20090101
32657       THORACOSCOPY, SURGICAL                                   $603.15      20090101
32658       THORACOSCOPY, SURGICAL      80                           $110.06      20090101
32658       THORACOSCOPY, SURGICAL      81                           $110.06      20090101
32658       THORACOSCOPY, SURGICAL      82                           $110.06      20090101
32658       THORACOSCOPY, SURGICAL      AS                           $110.06      20090101
32658       THORACOSCOPY, SURGICAL                                   $550.31      20090101
32659       THORACOSCOPY, SURGICAL      80                           $111.89      20090101
32659       THORACOSCOPY, SURGICAL      81                           $111.89      20090101
32659       THORACOSCOPY, SURGICAL      82                           $111.89      20090101


                                     Page 174
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
32659       THORACOSCOPY, SURGICAL          AS                           $111.89      20090101
32659       THORACOSCOPY, SURGICAL                                       $559.47      20090101
32660       THORACOSCOPY, SURGICAL          80                           $157.58      20090101
32660       THORACOSCOPY, SURGICAL          81                           $157.58      20090101
32660       THORACOSCOPY, SURGICAL          82                           $157.58      20090101
32660       THORACOSCOPY, SURGICAL          AS                           $157.58      20090101
32660       THORACOSCOPY, SURGICAL                                       $787.89      20090101
32661       THORACOSCOPY, SURGICAL          80                           $123.08      20090101
32661       THORACOSCOPY, SURGICAL          81                           $123.08      20090101
32661       THORACOSCOPY, SURGICAL          82                           $123.08      20090101
32661       THORACOSCOPY, SURGICAL          AS                           $123.08      20090101
32661       THORACOSCOPY, SURGICAL                                       $615.41      20090101
32662       THORACOSCOPY, SURGICAL          80                           $138.16      20090101
32662       THORACOSCOPY, SURGICAL          81                           $138.16      20090101
32662       THORACOSCOPY, SURGICAL          82                           $138.16      20090101
32662       THORACOSCOPY, SURGICAL          AS                           $138.16      20090101
32662       THORACOSCOPY, SURGICAL                                       $690.81      20090101
32663       THORACOSCOPY, SURGICAL          80                           $207.93      20090101
32663       THORACOSCOPY, SURGICAL          81                           $207.93      20090101
32663       THORACOSCOPY, SURGICAL          82                           $207.93      20090101
32663       THORACOSCOPY, SURGICAL          AS                           $207.93      20090101
32663       THORACOSCOPY, SURGICAL                                      $1,039.66     20090101
32664       THORACOSCOPY, SURGICAL          80                           $128.92      20090101
32664       THORACOSCOPY, SURGICAL          81                           $128.92      20090101
32664       THORACOSCOPY, SURGICAL          82                           $128.92      20090101
32664       THORACOSCOPY, SURGICAL          AS                           $128.92      20090101
32664       THORACOSCOPY, SURGICAL                                       $644.60      20090101
32665       THORACOSCOPY, SURGICAL          80                           $177.83      20090101
32665       THORACOSCOPY, SURGICAL          81                           $177.83      20090101
32665       THORACOSCOPY, SURGICAL          82                           $177.83      20090101
32665       THORACOSCOPY, SURGICAL          AS                           $177.83      20090101
32665       THORACOSCOPY, SURGICAL                                       $889.17      20090101
32800       REPAIR LUNG HERNIA              80                           $137.72      20090101
32800       REPAIR LUNG HERNIA              81                           $137.72      20090101
32800       REPAIR LUNG HERNIA              82                           $137.72      20090101
32800       REPAIR LUNG HERNIA              AS                           $137.72      20090101
32800       REPAIR LUNG HERNIA                                           $688.59      20090101
32810       CLOSE CHEST AFTER DRAINAGE      80                           $133.65      20090101
32810       CLOSE CHEST AFTER DRAINAGE      81                           $133.65      20090101
32810       CLOSE CHEST AFTER DRAINAGE      82                           $133.65      20090101
32810       CLOSE CHEST AFTER DRAINAGE      AS                           $133.65      20090101
32810       CLOSE CHEST AFTER DRAINAGE                                   $668.25      20090101
32815       CLOSE BRONCHIAL FISTULA         80                           $377.59      20090101
32815       CLOSE BRONCHIAL FISTULA         81                           $377.59      20090101
32815       CLOSE BRONCHIAL FISTULA         82                           $377.59      20090101


                                         Page 175
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
32815       CLOSE BRONCHIAL FISTULA          AS                           $377.59      20090101
32815       CLOSE BRONCHIAL FISTULA                                      $1,887.94     20090101
32820       RECONSTRUCT INJURED CHEST        80                           $201.59      20090101
32820       RECONSTRUCT INJURED CHEST        81                           $201.59      20090101
32820       RECONSTRUCT INJURED CHEST        82                           $201.59      20090101
32820       RECONSTRUCT INJURED CHEST        AS                           $201.59      20090101
32820       RECONSTRUCT INJURED CHEST                                    $1,007.94     20090101
32851       LUNG TRANSPLANT, SINGLE          80                           $392.05      20090101
32851       LUNG TRANSPLANT, SINGLE          81                           $392.05      20090101
32851       LUNG TRANSPLANT, SINGLE          82                           $392.05      20090101
32851       LUNG TRANSPLANT, SINGLE          AS                           $392.05      20090101
32851       LUNG TRANSPLANT, SINGLE                                      $1,960.24     20090101
32852       LUNG TRANSPLANT WITH BYPASS      80                           $437.06      20090101
32852       LUNG TRANSPLANT WITH BYPASS      81                           $437.06      20090101
32852       LUNG TRANSPLANT WITH BYPASS      82                           $437.06      20090101
32852       LUNG TRANSPLANT WITH BYPASS      AS                           $437.06      20090101
32852       LUNG TRANSPLANT WITH BYPASS                                  $2,185.30     20090101
32853       LUNG TRANSPLANT, DOUBLE          80                           $470.00      20090101
32853       LUNG TRANSPLANT, DOUBLE          81                           $470.00      20090101
32853       LUNG TRANSPLANT, DOUBLE          82                           $470.00      20090101
32853       LUNG TRANSPLANT, DOUBLE          AS                           $470.00      20090101
32853       LUNG TRANSPLANT, DOUBLE                                      $2,350.02     20090101
32854       LUNG TRANSPLANT WITH BYPASS      80                           $508.40      20090101
32854       LUNG TRANSPLANT WITH BYPASS      81                           $508.40      20090101
32854       LUNG TRANSPLANT WITH BYPASS      82                           $508.40      20090101
32854       LUNG TRANSPLANT WITH BYPASS      AS                           $508.40      20090101
32854       LUNG TRANSPLANT WITH BYPASS                                  $2,542.01     20090101
32900       REMOVAL OF RIB(S)                80                           $202.31      20090101
32900       REMOVAL OF RIB(S)                81                           $202.31      20090101
32900       REMOVAL OF RIB(S)                82                           $202.31      20090101
32900       REMOVAL OF RIB(S)                AS                           $202.31      20090101
32900       REMOVAL OF RIB(S)                                            $1,011.56     20090101
32905       REVISE & REPAIR CHEST WALL       80                           $201.26      20090101
32905       REVISE & REPAIR CHEST WALL       81                           $201.26      20090101
32905       REVISE & REPAIR CHEST WALL       82                           $201.26      20090101
32905       REVISE & REPAIR CHEST WALL       AS                           $201.26      20090101
32905       REVISE & REPAIR CHEST WALL                                   $1,006.28     20090101
32906       REVISE & REPAIR CHEST WALL       80                           $248.77      20090101
32906       REVISE & REPAIR CHEST WALL       81                           $248.77      20090101
32906       REVISE & REPAIR CHEST WALL       82                           $248.77      20090101
32906       REVISE & REPAIR CHEST WALL       AS                           $248.77      20090101
32906       REVISE & REPAIR CHEST WALL                                   $1,243.86     20090101
32940       REVISION OF LUNG                 80                           $184.18      20090101
32940       REVISION OF LUNG                 81                           $184.18      20090101
32940       REVISION OF LUNG                 82                           $184.18      20090101


                                          Page 176
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
32940       REVISION OF LUNG                  AS                           $184.18      20090101
32940       REVISION OF LUNG                                               $920.89      20090101
32960       THERAPEUTIC PNEUMOTHORAX                                       $102.38      20090101
32997       TOTAL LUNG LAVAGE                                              $270.97      20090101
33010       DRAINAGE OF HEART SAC                                 Y        $176.74      20081209
33010       DRAINAGE OF HEART SAC                                          $91.54       20090101
33011       REPEAT DRAINAGE OF HEART SAC                          Y        $176.74      20081209
33011       REPEAT DRAINAGE OF HEART SAC                                   $93.48       20090101
33015       INCISION OF HEART SAC                                          $393.38      20090101
33020       INCISION OF HEART SAC             80                           $129.36      20090101
33020       INCISION OF HEART SAC             81                           $129.36      20090101
33020       INCISION OF HEART SAC             82                           $129.36      20090101
33020       INCISION OF HEART SAC             AS                           $129.36      20090101
33020       INCISION OF HEART SAC                                          $646.82      20090101
33025       INCISION OF HEART SAC             80                           $119.97      20090101
33025       INCISION OF HEART SAC             81                           $119.97      20090101
33025       INCISION OF HEART SAC             82                           $119.97      20090101
33025       INCISION OF HEART SAC             AS                           $119.97      20090101
33025       INCISION OF HEART SAC                                          $599.83      20090101
33030       PARTIAL REMOVAL OF HEART SAC      80                           $191.63      20090101
33030       PARTIAL REMOVAL OF HEART SAC      81                           $191.63      20090101
33030       PARTIAL REMOVAL OF HEART SAC      82                           $191.63      20090101
33030       PARTIAL REMOVAL OF HEART SAC      AS                           $191.63      20090101
33030       PARTIAL REMOVAL OF HEART SAC                                   $958.15      20090101
33031       PARTIAL REMOVAL OF HEART SAC      80                           $212.83      20090101
33031       PARTIAL REMOVAL OF HEART SAC      81                           $212.83      20090101
33031       PARTIAL REMOVAL OF HEART SAC      82                           $212.83      20090101
33031       PARTIAL REMOVAL OF HEART SAC      AS                           $212.83      20090101
33031       PARTIAL REMOVAL OF HEART SAC                                  $1,064.14     20090101
33050       REMOVAL OF HEART SAC LESION       80                           $148.07      20090101
33050       REMOVAL OF HEART SAC LESION       81                           $148.07      20090101
33050       REMOVAL OF HEART SAC LESION       82                           $148.07      20090101
33050       REMOVAL OF HEART SAC LESION       AS                           $148.07      20090101
33050       REMOVAL OF HEART SAC LESION                                    $740.34      20090101
33120       REMOVAL OF HEART LESION           80                           $234.30      20090101
33120       REMOVAL OF HEART LESION           81                           $234.30      20090101
33120       REMOVAL OF HEART LESION           82                           $234.30      20090101
33120       REMOVAL OF HEART LESION           AS                           $234.30      20090101
33120       REMOVAL OF HEART LESION                                       $1,171.52     20090101
33130       REMOVAL OF HEART LESION           80                           $204.82      20090101
33130       REMOVAL OF HEART LESION           81                           $204.82      20090101
33130       REMOVAL OF HEART LESION           82                           $204.82      20090101
33130       REMOVAL OF HEART LESION           AS                           $204.82      20090101
33130       REMOVAL OF HEART LESION                                       $1,024.08     20090101
33140       HEART REVASCULARIZE (TMR)                                     $1,160.68     20090101


                                           Page 177
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
33141       HEART TMR W/OTHER PROCEDURE    80                           $24.54       20090101
33141       HEART TMR W/OTHER PROCEDURE    81                           $24.54       20090101
33141       HEART TMR W/OTHER PROCEDURE    82                           $24.54       20090101
33141       HEART TMR W/OTHER PROCEDURE    AS                            $24.54      20090101
33141       HEART TMR W/OTHER PROCEDURE                                 $122.70      20090101
33202       INSERT EPICARD ELTRD, OPEN                                  $582.57      20090101
33203       INSERT EPICARD ELTRD, ENDO                                  $596.48      20090101
33206       INSERTION OF HEART PACEMAKER                                $351.10      20090101
33207       INSERTION OF HEART PACEMAKER                                $376.42      20090101
33208       INSERTION OF HEART PACEMAKER                                $403.12      20090101
33210       INSERTION OF HEART ELECTRODE                                $137.44      20090101
33211       INSERTION OF HEART ELECTRODE                                $140.49      20090101
33212       INSERTION OF PULSE GENERATOR                                $263.46      20090101
33213       INSERTION OF PULSE GENERATOR                                $299.91      20090101
33214       UPGRADE OF PACEMAKER SYSTEM                                 $375.30      20090101
33215       REPOSITION PACING-DEFIB LEAD                                $238.98      20090101
33216       INSERT LEAD PACE-DEFIB, ONE                                 $293.24      20090101
33217       INSERT LEAD PACE-DEFIB, DUAL                                $292.12      20090101
33218       REPAIR LEAD PACE-DEFIB, ONE                                 $303.24      20090101
33220       REPAIR LEAD PACE-DEFIB, DUAL                                $304.64      20090101
33222       REVISE POCKET, PACEMAKER                           Y        $392.18      20081209
33222       REVISE POCKET, PACEMAKER                                    $270.69      20090101
33223       REVISE POCKET, PACING-DEFIB                                 $324.95      20090101
33224       INSERT PACING LEAD & CONNECT                                $390.33      20090101
33225       L VENTRIC PACING LEAD ADD-ON                                $349.99      20090101
33226       REPOSITION L VENTRIC LEAD                                   $376.97      20090101
33233       REMOVAL OF PACEMAKER SYSTEM                                 $189.74      20090101
33234       REMOVAL OF PACEMAKER SYSTEM                                 $378.64      20090101
33235       REMOVAL PACEMAKER ELECTRODE                                 $492.15      20090101
33236       REMOVE ELECTRODE/THORACOTOMY                                $590.91      20090101
33237       REMOVE ELECTRODE/THORACOTOMY                                $646.55      20090101
33238       REMOVE ELECTRODE/THORACOTOMY   80                           $141.56      20090101
33238       REMOVE ELECTRODE/THORACOTOMY   81                           $141.56      20090101
33238       REMOVE ELECTRODE/THORACOTOMY   82                           $141.56      20090101
33238       REMOVE ELECTRODE/THORACOTOMY   AS                           $141.56      20090101
33238       REMOVE ELECTRODE/THORACOTOMY                                $707.79      20090101
33240       INSERT PULSE GENERATOR                                      $360.00      20090101
33241       REMOVE PULSE GENERATOR                                      $178.61      20090101
33243       REMOVE ELTRD/THORACOTOMY       80                           $204.32      20090101
33243       REMOVE ELTRD/THORACOTOMY       81                           $204.32      20090101
33243       REMOVE ELTRD/THORACOTOMY       82                           $204.32      20090101
33243       REMOVE ELTRD/THORACOTOMY       AS                           $204.32      20090101
33243       REMOVE ELTRD/THORACOTOMY                                   $1,021.60     20090101
33244       REMOVE ELTRD, TRANSVEN                                      $667.70      20090101
33249       ELTRD/INSERT PACE-DEFIB                                     $696.91      20090101


                                       Page 178
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33250       ABLATE HEART DYSRHYTHM FOCUS      80                           $222.17      20090101
33250       ABLATE HEART DYSRHYTHM FOCUS      81                           $222.17      20090101
33250       ABLATE HEART DYSRHYTHM FOCUS      82                           $222.17      20090101
33250       ABLATE HEART DYSRHYTHM FOCUS      AS                           $222.17      20090101
33250       ABLATE HEART DYSRHYTHM FOCUS                                  $1,110.87     20090101
33251       ABLATE HEART DYSRHYTHM FOCUS      80                           $243.27      20090101
33251       ABLATE HEART DYSRHYTHM FOCUS      81                           $243.27      20090101
33251       ABLATE HEART DYSRHYTHM FOCUS      82                           $243.27      20090101
33251       ABLATE HEART DYSRHYTHM FOCUS      AS                           $243.27      20090101
33251       ABLATE HEART DYSRHYTHM FOCUS                                  $1,216.33     20090101
33254       ABLATE ATRIA, LMTD                80                           $204.21      20090101
33254       ABLATE ATRIA, LMTD                81                           $204.21      20090101
33254       ABLATE ATRIA, LMTD                82                           $204.21      20090101
33254       ABLATE ATRIA, LMTD                AS                           $204.21      20090101
33254       ABLATE ATRIA, LMTD                                            $1,021.03     20090101
33255       ABLATE ATRIA W/O BYPASS, EXT      80                           $246.05      20090101
33255       ABLATE ATRIA W/O BYPASS, EXT      81                           $246.05      20090101
33255       ABLATE ATRIA W/O BYPASS, EXT      82                           $246.05      20090101
33255       ABLATE ATRIA W/O BYPASS, EXT      AS                           $246.05      20090101
33255       ABLATE ATRIA W/O BYPASS, EXT                                  $1,230.23     20090101
33256       ABLATE ATRIA W/BYPASS, EXTEN      80                           $294.01      20090101
33256       ABLATE ATRIA W/BYPASS, EXTEN      81                           $294.01      20090101
33256       ABLATE ATRIA W/BYPASS, EXTEN      82                           $294.01      20090101
33256       ABLATE ATRIA W/BYPASS, EXTEN      AS                           $294.01      20090101
33256       ABLATE ATRIA W/BYPASS, EXTEN                                  $1,470.05     20090101
33257       ABLATE ATRIA, LMTD, ADD-ON        80                           $88.97       20090101
33257       ABLATE ATRIA, LMTD, ADD-ON                                     $444.85      20090101
33258       ABLATE ATRIA, X10SV, ADD-ON                                    $483.18      20090101
33259       ABLATE ATRIA W/BYPASS ADD-ON      80                           $131.98      20090101
33259       ABLATE ATRIA W/BYPASS ADD-ON                                   $659.89      20090101
33261       ABLATE HEART DYSRHYTHM FOCUS      80                           $244.77      20090101
33261       ABLATE HEART DYSRHYTHM FOCUS      81                           $244.77      20090101
33261       ABLATE HEART DYSRHYTHM FOCUS      82                           $244.77      20090101
33261       ABLATE HEART DYSRHYTHM FOCUS      AS                           $244.77      20090101
33261       ABLATE HEART DYSRHYTHM FOCUS                                  $1,223.84     20090101
33265       ABLATE ATRIA, LMTD, ENDO          80                           $204.21      20090101
33265       ABLATE ATRIA, LMTD, ENDO          81                           $204.21      20090101
33265       ABLATE ATRIA, LMTD, ENDO          82                           $204.21      20090101
33265       ABLATE ATRIA, LMTD, ENDO          AS                           $204.21      20090101
33265       ABLATE ATRIA, LMTD, ENDO                                      $1,021.03     20090101
33266       ABLATE ATRIA, X10SV, ENDO         80                           $279.77      20090101
33266       ABLATE ATRIA, X10SV, ENDO         81                           $279.77      20090101
33266       ABLATE ATRIA, X10SV, ENDO         82                           $279.77      20090101
33266       ABLATE ATRIA, X10SV, ENDO         AS                           $279.77      20090101
33266       ABLATE ATRIA, X10SV, ENDO                                     $1,398.83     20090101


                                           Page 179
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33282       IMPLANT PAT-ACTIVE HT RECORD                                   $252.05      20090101
33284       REMOVE PAT-ACTIVE HT RECORD                                    $184.45      20090101
33300       REPAIR OF HEART WOUND             80                           $332.18      20090101
33300       REPAIR OF HEART WOUND             81                           $332.18      20090101
33300       REPAIR OF HEART WOUND             82                           $332.18      20090101
33300       REPAIR OF HEART WOUND             AS                           $332.18      20090101
33300       REPAIR OF HEART WOUND                                         $1,660.92     20090101
33305       REPAIR OF HEART WOUND             80                           $544.51      20090101
33305       REPAIR OF HEART WOUND             81                           $544.51      20090101
33305       REPAIR OF HEART WOUND             82                           $544.51      20090101
33305       REPAIR OF HEART WOUND             AS                           $544.51      20090101
33305       REPAIR OF HEART WOUND                                         $2,722.57     20090101
33310       EXPLORATORY HEART SURGERY         80                           $176.83      20090101
33310       EXPLORATORY HEART SURGERY         81                           $176.83      20090101
33310       EXPLORATORY HEART SURGERY         82                           $176.83      20090101
33310       EXPLORATORY HEART SURGERY         AS                           $176.83      20090101
33310       EXPLORATORY HEART SURGERY                                      $884.15      20090101
33315       EXPLORATORY HEART SURGERY         80                           $222.29      20090101
33315       EXPLORATORY HEART SURGERY         81                           $222.29      20090101
33315       EXPLORATORY HEART SURGERY         82                           $222.29      20090101
33315       EXPLORATORY HEART SURGERY         AS                           $222.29      20090101
33315       EXPLORATORY HEART SURGERY                                     $1,111.43     20090101
33320       REPAIR MAJOR BLOOD VESSEL(S)      80                           $159.41      20090101
33320       REPAIR MAJOR BLOOD VESSEL(S)      81                           $159.41      20090101
33320       REPAIR MAJOR BLOOD VESSEL(S)      82                           $159.41      20090101
33320       REPAIR MAJOR BLOOD VESSEL(S)      AS                           $159.41      20090101
33320       REPAIR MAJOR BLOOD VESSEL(S)                                   $797.05      20090101
33321       REPAIR MAJOR VESSEL               80                           $181.95      20090101
33321       REPAIR MAJOR VESSEL               81                           $181.95      20090101
33321       REPAIR MAJOR VESSEL               82                           $181.95      20090101
33321       REPAIR MAJOR VESSEL               AS                           $181.95      20090101
33321       REPAIR MAJOR VESSEL                                            $909.77      20090101
33322       REPAIR MAJOR BLOOD VESSEL(S)      80                           $206.54      20090101
33322       REPAIR MAJOR BLOOD VESSEL(S)      81                           $206.54      20090101
33322       REPAIR MAJOR BLOOD VESSEL(S)      82                           $206.54      20090101
33322       REPAIR MAJOR BLOOD VESSEL(S)      AS                           $206.54      20090101
33322       REPAIR MAJOR BLOOD VESSEL(S)                                  $1,032.72     20090101
33330       INSERT MAJOR VESSEL GRAFT         80                           $210.77      20090101
33330       INSERT MAJOR VESSEL GRAFT         81                           $210.77      20090101
33330       INSERT MAJOR VESSEL GRAFT         82                           $210.77      20090101
33330       INSERT MAJOR VESSEL GRAFT         AS                           $210.77      20090101
33330       INSERT MAJOR VESSEL GRAFT                                     $1,053.84     20090101
33332       INSERT MAJOR VESSEL GRAFT         80                           $208.54      20090101
33332       INSERT MAJOR VESSEL GRAFT         81                           $208.54      20090101
33332       INSERT MAJOR VESSEL GRAFT         82                           $208.54      20090101


                                           Page 180
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
33332       INSERT MAJOR VESSEL GRAFT        AS                           $208.54      20090101
33332       INSERT MAJOR VESSEL GRAFT                                    $1,042.71     20090101
33335       INSERT MAJOR VESSEL GRAFT        80                           $283.71      20090101
33335       INSERT MAJOR VESSEL GRAFT        81                           $283.71      20090101
33335       INSERT MAJOR VESSEL GRAFT        82                           $283.71      20090101
33335       INSERT MAJOR VESSEL GRAFT        AS                           $283.71      20090101
33335       INSERT MAJOR VESSEL GRAFT                                    $1,418.57     20090101
33400       REPAIR OF AORTIC VALVE           80                           $337.24      20090101
33400       REPAIR OF AORTIC VALVE           81                           $337.24      20090101
33400       REPAIR OF AORTIC VALVE           82                           $337.24      20090101
33400       REPAIR OF AORTIC VALVE           AS                           $337.24      20090101
33400       REPAIR OF AORTIC VALVE                                       $1,686.22     20090101
33401       VALVULOPLASTY, OPEN              80                           $221.84      20090101
33401       VALVULOPLASTY, OPEN              81                           $221.84      20090101
33401       VALVULOPLASTY, OPEN              82                           $221.84      20090101
33401       VALVULOPLASTY, OPEN              AS                           $221.84      20090101
33401       VALVULOPLASTY, OPEN                                          $1,109.21     20090101
33403       VALVULOPLASTY, W/CP BYPASS       80                           $235.70      20090101
33403       VALVULOPLASTY, W/CP BYPASS       81                           $235.70      20090101
33403       VALVULOPLASTY, W/CP BYPASS       82                           $235.70      20090101
33403       VALVULOPLASTY, W/CP BYPASS       AS                           $235.70      20090101
33403       VALVULOPLASTY, W/CP BYPASS                                   $1,178.50     20090101
33404       PREPARE HEART-AORTA CONDUIT      80                           $271.86      20090101
33404       PREPARE HEART-AORTA CONDUIT      81                           $271.86      20090101
33404       PREPARE HEART-AORTA CONDUIT      82                           $271.86      20090101
33404       PREPARE HEART-AORTA CONDUIT      AS                           $271.86      20090101
33404       PREPARE HEART-AORTA CONDUIT                                  $1,359.32     20090101
33405       REPLACEMENT OF AORTIC VALVE      80                           $351.82      20090101
33405       REPLACEMENT OF AORTIC VALVE      81                           $351.82      20090101
33405       REPLACEMENT OF AORTIC VALVE      82                           $351.82      20090101
33405       REPLACEMENT OF AORTIC VALVE      AS                           $351.82      20090101
33405       REPLACEMENT OF AORTIC VALVE                                  $1,759.09     20090101
33406       REPLACEMENT OF AORTIC VALVE      80                           $427.10      20090101
33406       REPLACEMENT OF AORTIC VALVE      81                           $427.10      20090101
33406       REPLACEMENT OF AORTIC VALVE      82                           $427.10      20090101
33406       REPLACEMENT OF AORTIC VALVE      AS                           $427.10      20090101
33406       REPLACEMENT OF AORTIC VALVE                                  $2,135.52     20090101
33410       REPLACEMENT OF AORTIC VALVE      80                           $375.75      20090101
33410       REPLACEMENT OF AORTIC VALVE      81                           $375.75      20090101
33410       REPLACEMENT OF AORTIC VALVE      82                           $375.75      20090101
33410       REPLACEMENT OF AORTIC VALVE      AS                           $375.75      20090101
33410       REPLACEMENT OF AORTIC VALVE                                  $1,878.73     20090101
33411       REPLACEMENT OF AORTIC VALVE      80                           $486.03      20090101
33411       REPLACEMENT OF AORTIC VALVE      81                           $486.03      20090101
33411       REPLACEMENT OF AORTIC VALVE      82                           $486.03      20090101


                                          Page 181
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33411       REPLACEMENT OF AORTIC VALVE       AS                           $486.03      20090101
33411       REPLACEMENT OF AORTIC VALVE                                   $2,430.13     20090101
33412       REPLACEMENT OF AORTIC VALVE       80                           $381.04      20090101
33412       REPLACEMENT OF AORTIC VALVE       81                           $381.04      20090101
33412       REPLACEMENT OF AORTIC VALVE       82                           $381.04      20090101
33412       REPLACEMENT OF AORTIC VALVE       AS                           $381.04      20090101
33412       REPLACEMENT OF AORTIC VALVE                                   $1,905.18     20090101
33413       REPLACEMENT OF AORTIC VALVE       80                           $492.20      20090101
33413       REPLACEMENT OF AORTIC VALVE       81                           $492.20      20090101
33413       REPLACEMENT OF AORTIC VALVE       82                           $492.20      20090101
33413       REPLACEMENT OF AORTIC VALVE       AS                           $492.20      20090101
33413       REPLACEMENT OF AORTIC VALVE                                   $2,461.02     20090101
33414       REPAIR OF AORTIC VALVE            80                           $323.11      20090101
33414       REPAIR OF AORTIC VALVE            81                           $323.11      20090101
33414       REPAIR OF AORTIC VALVE            82                           $323.11      20090101
33414       REPAIR OF AORTIC VALVE            AS                           $323.11      20090101
33414       REPAIR OF AORTIC VALVE                                        $1,615.53     20090101
33415       REVISION, SUBVALVULAR TISSUE      80                           $300.02      20090101
33415       REVISION, SUBVALVULAR TISSUE      81                           $300.02      20090101
33415       REVISION, SUBVALVULAR TISSUE      82                           $300.02      20090101
33415       REVISION, SUBVALVULAR TISSUE      AS                           $300.02      20090101
33415       REVISION, SUBVALVULAR TISSUE                                  $1,500.08     20090101
33416       REVISE VENTRICLE MUSCLE           80                           $302.58      20090101
33416       REVISE VENTRICLE MUSCLE           81                           $302.58      20090101
33416       REVISE VENTRICLE MUSCLE           82                           $302.58      20090101
33416       REVISE VENTRICLE MUSCLE           AS                           $302.58      20090101
33416       REVISE VENTRICLE MUSCLE                                       $1,512.91     20090101
33417       REPAIR OF AORTIC VALVE            80                           $255.56      20090101
33417       REPAIR OF AORTIC VALVE            81                           $255.56      20090101
33417       REPAIR OF AORTIC VALVE            82                           $255.56      20090101
33417       REPAIR OF AORTIC VALVE            AS                           $255.56      20090101
33417       REPAIR OF AORTIC VALVE                                        $1,277.81     20090101
33420       REVISION OF MITRAL VALVE          80                           $205.99      20090101
33420       REVISION OF MITRAL VALVE          81                           $205.99      20090101
33420       REVISION OF MITRAL VALVE          82                           $205.99      20090101
33420       REVISION OF MITRAL VALVE          AS                           $205.99      20090101
33420       REVISION OF MITRAL VALVE                                      $1,029.93     20090101
33422       REVISION OF MITRAL VALVE          80                           $256.29      20090101
33422       REVISION OF MITRAL VALVE          81                           $256.29      20090101
33422       REVISION OF MITRAL VALVE          82                           $256.29      20090101
33422       REVISION OF MITRAL VALVE          AS                           $256.29      20090101
33422       REVISION OF MITRAL VALVE                                      $1,281.43     20090101
33425       REPAIR OF MITRAL VALVE            80                           $385.26      20090101
33425       REPAIR OF MITRAL VALVE            81                           $385.26      20090101
33425       REPAIR OF MITRAL VALVE            82                           $385.26      20090101


                                           Page 182
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
33425       REPAIR OF MITRAL VALVE           AS                           $385.26      20090101
33425       REPAIR OF MITRAL VALVE                                       $1,926.29     20090101
33426       REPAIR OF MITRAL VALVE           80                           $359.61      20090101
33426       REPAIR OF MITRAL VALVE           81                           $359.61      20090101
33426       REPAIR OF MITRAL VALVE           82                           $359.61      20090101
33426       REPAIR OF MITRAL VALVE           AS                           $359.61      20090101
33426       REPAIR OF MITRAL VALVE                                       $1,798.05     20090101
33427       REPAIR OF MITRAL VALVE           80                           $380.20      20090101
33427       REPAIR OF MITRAL VALVE           81                           $380.20      20090101
33427       REPAIR OF MITRAL VALVE           82                           $380.20      20090101
33427       REPAIR OF MITRAL VALVE           AS                           $380.20      20090101
33427       REPAIR OF MITRAL VALVE                                       $1,900.98     20090101
33430       REPLACEMENT OF MITRAL VALVE      80                           $410.52      20090101
33430       REPLACEMENT OF MITRAL VALVE      81                           $410.52      20090101
33430       REPLACEMENT OF MITRAL VALVE      82                           $410.52      20090101
33430       REPLACEMENT OF MITRAL VALVE      AS                           $410.52      20090101
33430       REPLACEMENT OF MITRAL VALVE                                  $2,052.61     20090101
33460       REVISION OF TRICUSPID VALVE      80                           $339.86      20090101
33460       REVISION OF TRICUSPID VALVE      81                           $339.86      20090101
33460       REVISION OF TRICUSPID VALVE      82                           $339.86      20090101
33460       REVISION OF TRICUSPID VALVE      AS                           $339.86      20090101
33460       REVISION OF TRICUSPID VALVE                                  $1,699.31     20090101
33463       VALVULOPLASTY, TRICUSPID         80                           $429.28      20090101
33463       VALVULOPLASTY, TRICUSPID         81                           $429.28      20090101
33463       VALVULOPLASTY, TRICUSPID         82                           $429.28      20090101
33463       VALVULOPLASTY, TRICUSPID         AS                           $429.28      20090101
33463       VALVULOPLASTY, TRICUSPID                                     $2,146.38     20090101
33464       VALVULOPLASTY, TRICUSPID         80                           $352.38      20090101
33464       VALVULOPLASTY, TRICUSPID         81                           $352.38      20090101
33464       VALVULOPLASTY, TRICUSPID         82                           $352.38      20090101
33464       VALVULOPLASTY, TRICUSPID         AS                           $352.38      20090101
33464       VALVULOPLASTY, TRICUSPID                                     $1,761.88     20090101
33465       REPLACE TRICUSPID VALVE          80                           $391.11      20090101
33465       REPLACE TRICUSPID VALVE          81                           $391.11      20090101
33465       REPLACE TRICUSPID VALVE          82                           $391.11      20090101
33465       REPLACE TRICUSPID VALVE          AS                           $391.11      20090101
33465       REPLACE TRICUSPID VALVE                                      $1,955.53     20090101
33468       REVISION OF TRICUSPID VALVE      80                           $285.66      20090101
33468       REVISION OF TRICUSPID VALVE      81                           $285.66      20090101
33468       REVISION OF TRICUSPID VALVE      82                           $285.66      20090101
33468       REVISION OF TRICUSPID VALVE      AS                           $285.66      20090101
33468       REVISION OF TRICUSPID VALVE                                  $1,428.30     20090101
33470       REVISION OF PULMONARY VALVE      80                           $176.16      20090101
33470       REVISION OF PULMONARY VALVE      81                           $176.16      20090101
33470       REVISION OF PULMONARY VALVE      82                           $176.16      20090101


                                          Page 183
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33470       REVISION OF PULMONARY VALVE       AS                           $176.16      20090101
33470       REVISION OF PULMONARY VALVE                                    $880.79      20090101
33471       VALVOTOMY, PULMONARY VALVE        80                           $205.31      20090101
33471       VALVOTOMY, PULMONARY VALVE        81                           $205.31      20090101
33471       VALVOTOMY, PULMONARY VALVE        82                           $205.31      20090101
33471       VALVOTOMY, PULMONARY VALVE        AS                           $205.31      20090101
33471       VALVOTOMY, PULMONARY VALVE                                    $1,026.57     20090101
33472       REVISION OF PULMONARY VALVE       80                           $204.65      20090101
33472       REVISION OF PULMONARY VALVE       81                           $204.65      20090101
33472       REVISION OF PULMONARY VALVE       82                           $204.65      20090101
33472       REVISION OF PULMONARY VALVE       AS                           $204.65      20090101
33472       REVISION OF PULMONARY VALVE                                   $1,023.25     20090101
33474       REVISION OF PULMONARY VALVE       80                           $302.75      20090101
33474       REVISION OF PULMONARY VALVE       81                           $302.75      20090101
33474       REVISION OF PULMONARY VALVE       82                           $302.75      20090101
33474       REVISION OF PULMONARY VALVE       AS                           $302.75      20090101
33474       REVISION OF PULMONARY VALVE                                   $1,513.74     20090101
33475       REPLACEMENT, PULMONARY VALVE      80                           $347.31      20090101
33475       REPLACEMENT, PULMONARY VALVE      81                           $347.31      20090101
33475       REPLACEMENT, PULMONARY VALVE      82                           $347.31      20090101
33475       REPLACEMENT, PULMONARY VALVE      AS                           $347.31      20090101
33475       REPLACEMENT, PULMONARY VALVE                                  $1,736.57     20090101
33476       REVISION OF HEART CHAMBER         80                           $222.57      20090101
33476       REVISION OF HEART CHAMBER         81                           $222.57      20090101
33476       REVISION OF HEART CHAMBER         82                           $222.57      20090101
33476       REVISION OF HEART CHAMBER         AS                           $222.57      20090101
33476       REVISION OF HEART CHAMBER                                     $1,112.83     20090101
33478       REVISION OF HEART CHAMBER         80                           $240.98      20090101
33478       REVISION OF HEART CHAMBER         81                           $240.98      20090101
33478       REVISION OF HEART CHAMBER         82                           $240.98      20090101
33478       REVISION OF HEART CHAMBER         AS                           $240.98      20090101
33478       REVISION OF HEART CHAMBER                                     $1,204.90     20090101
33496       REPAIR, PROSTH VALVE CLOT         80                           $254.67      20090101
33496       REPAIR, PROSTH VALVE CLOT         81                           $254.67      20090101
33496       REPAIR, PROSTH VALVE CLOT         82                           $254.67      20090101
33496       REPAIR, PROSTH VALVE CLOT         AS                           $254.67      20090101
33496       REPAIR, PROSTH VALVE CLOT                                     $1,273.36     20090101
33500       REPAIR HEART VESSEL FISTULA       80                           $238.93      20090101
33500       REPAIR HEART VESSEL FISTULA       81                           $238.93      20090101
33500       REPAIR HEART VESSEL FISTULA       82                           $238.93      20090101
33500       REPAIR HEART VESSEL FISTULA       AS                           $238.93      20090101
33500       REPAIR HEART VESSEL FISTULA                                   $1,194.65     20090101
33501       REPAIR HEART VESSEL FISTULA       80                           $164.03      20090101
33501       REPAIR HEART VESSEL FISTULA       81                           $164.03      20090101
33501       REPAIR HEART VESSEL FISTULA       82                           $164.03      20090101


                                           Page 184
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33501       REPAIR HEART VESSEL FISTULA       AS                           $164.03      20090101
33501       REPAIR HEART VESSEL FISTULA                                    $820.13      20090101
33502       CORONARY ARTERY CORRECTION        80                           $194.19      20090101
33502       CORONARY ARTERY CORRECTION        81                           $194.19      20090101
33502       CORONARY ARTERY CORRECTION        82                           $194.19      20090101
33502       CORONARY ARTERY CORRECTION        AS                           $194.19      20090101
33502       CORONARY ARTERY CORRECTION                                     $970.93      20090101
33503       CORONARY ARTERY GRAFT             80                           $195.30      20090101
33503       CORONARY ARTERY GRAFT             81                           $195.30      20090101
33503       CORONARY ARTERY GRAFT             82                           $195.30      20090101
33503       CORONARY ARTERY GRAFT             AS                           $195.30      20090101
33503       CORONARY ARTERY GRAFT                                          $976.52      20090101
33504       CORONARY ARTERY GRAFT             80                           $221.79      20090101
33504       CORONARY ARTERY GRAFT             81                           $221.79      20090101
33504       CORONARY ARTERY GRAFT             82                           $221.79      20090101
33504       CORONARY ARTERY GRAFT             AS                           $221.79      20090101
33504       CORONARY ARTERY GRAFT                                         $1,108.95     20090101
33505       REPAIR ARTERY W/TUNNEL            80                           $303.64      20090101
33505       REPAIR ARTERY W/TUNNEL            81                           $303.64      20090101
33505       REPAIR ARTERY W/TUNNEL            82                           $303.64      20090101
33505       REPAIR ARTERY W/TUNNEL            AS                           $303.64      20090101
33505       REPAIR ARTERY W/TUNNEL                                        $1,518.19     20090101
33506       REPAIR ARTERY, TRANSLOCATION      80                           $312.15      20090101
33506       REPAIR ARTERY, TRANSLOCATION      81                           $312.15      20090101
33506       REPAIR ARTERY, TRANSLOCATION      82                           $312.15      20090101
33506       REPAIR ARTERY, TRANSLOCATION      AS                           $312.15      20090101
33506       REPAIR ARTERY, TRANSLOCATION                                  $1,560.73     20090101
33507       REPAIR ART, INTRAMURAL            80                           $265.86      20090101
33507       REPAIR ART, INTRAMURAL            81                           $265.86      20090101
33507       REPAIR ART, INTRAMURAL            82                           $265.86      20090101
33507       REPAIR ART, INTRAMURAL            AS                           $265.86      20090101
33507       REPAIR ART, INTRAMURAL                                        $1,329.28     20090101
33508       ENDOSCOPIC VEIN HARVEST           80                            $2.50       20090101
33508       ENDOSCOPIC VEIN HARVEST           81                            $2.50       20090101
33508       ENDOSCOPIC VEIN HARVEST           82                            $2.50       20090101
33508       ENDOSCOPIC VEIN HARVEST           AS                            $2.50       20090101
33508       ENDOSCOPIC VEIN HARVEST                                        $12.52       20090101
33510       CABG, VEIN, SINGLE                80                           $299.96      20090101
33510       CABG, VEIN, SINGLE                81                           $299.96      20090101
33510       CABG, VEIN, SINGLE                82                           $299.96      20090101
33510       CABG, VEIN, SINGLE                AS                           $299.96      20090101
33510       CABG, VEIN, SINGLE                                            $1,499.82     20090101
33511       CABG, VEIN, TWO                   80                           $325.61      20090101
33511       CABG, VEIN, TWO                   81                           $325.61      20090101
33511       CABG, VEIN, TWO                   82                           $325.61      20090101


                                           Page 185
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
33511       CABG, VEIN, TWO                AS                           $325.61      20090101
33511       CABG, VEIN, TWO                                            $1,628.06     20090101
33512       CABG, VEIN, THREE              80                           $363.45      20090101
33512       CABG, VEIN, THREE              81                           $363.45      20090101
33512       CABG, VEIN, THREE              82                           $363.45      20090101
33512       CABG, VEIN, THREE              AS                           $363.45      20090101
33512       CABG, VEIN, THREE                                          $1,817.25     20090101
33513       CABG, VEIN, FOUR               80                           $374.08      20090101
33513       CABG, VEIN, FOUR               81                           $374.08      20090101
33513       CABG, VEIN, FOUR               82                           $374.08      20090101
33513       CABG, VEIN, FOUR               AS                           $374.08      20090101
33513       CABG, VEIN, FOUR                                           $1,870.40     20090101
33514       CABG, VEIN, FIVE               80                           $392.00      20090101
33514       CABG, VEIN, FIVE               81                           $392.00      20090101
33514       CABG, VEIN, FIVE               82                           $392.00      20090101
33514       CABG, VEIN, FIVE               AS                           $392.00      20090101
33514       CABG, VEIN, FIVE                                           $1,959.98     20090101
33516       CABG, VEIN, SIX OR MORE        80                           $407.13      20090101
33516       CABG, VEIN, SIX OR MORE        81                           $407.13      20090101
33516       CABG, VEIN, SIX OR MORE        82                           $407.13      20090101
33516       CABG, VEIN, SIX OR MORE        AS                           $407.13      20090101
33516       CABG, VEIN, SIX OR MORE                                    $2,035.64     20090101
33517       CABG, ARTERY-VEIN, SINGLE      80                           $27.59       20090101
33517       CABG, ARTERY-VEIN, SINGLE      81                           $27.59       20090101
33517       CABG, ARTERY-VEIN, SINGLE      82                           $27.59       20090101
33517       CABG, ARTERY-VEIN, SINGLE      AS                            $27.59      20090101
33517       CABG, ARTERY-VEIN, SINGLE                                   $137.97      20090101
33518       CABG, ARTERY-VEIN, TWO         80                           $59.15       20090101
33518       CABG, ARTERY-VEIN, TWO         81                           $59.15       20090101
33518       CABG, ARTERY-VEIN, TWO         82                           $59.15       20090101
33518       CABG, ARTERY-VEIN, TWO         AS                            $59.15      20090101
33518       CABG, ARTERY-VEIN, TWO                                      $295.75      20090101
33519       CABG, ARTERY-VEIN, THREE       80                           $79.34       20090101
33519       CABG, ARTERY-VEIN, THREE       81                           $79.34       20090101
33519       CABG, ARTERY-VEIN, THREE       82                           $79.34       20090101
33519       CABG, ARTERY-VEIN, THREE       AS                            $79.34      20090101
33519       CABG, ARTERY-VEIN, THREE                                    $396.72      20090101
33521       CABG, ARTERY-VEIN, FOUR        80                           $96.70       20090101
33521       CABG, ARTERY-VEIN, FOUR        81                           $96.70       20090101
33521       CABG, ARTERY-VEIN, FOUR        82                           $96.70       20090101
33521       CABG, ARTERY-VEIN, FOUR        AS                            $96.70      20090101
33521       CABG, ARTERY-VEIN, FOUR                                     $483.50      20090101
33522       CABG, ARTERY-VEIN, FIVE        80                           $110.95      20090101
33522       CABG, ARTERY-VEIN, FIVE        81                           $110.95      20090101
33522       CABG, ARTERY-VEIN, FIVE        82                           $110.95      20090101


                                        Page 186
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33522       CABG, ARTERY-VEIN, FIVE           AS                           $110.95      20090101
33522       CABG, ARTERY-VEIN, FIVE                                        $554.76      20090101
33523       CABG, ART-VEIN, SIX OR MORE       80                           $127.25      20090101
33523       CABG, ART-VEIN, SIX OR MORE       81                           $127.25      20090101
33523       CABG, ART-VEIN, SIX OR MORE       82                           $127.25      20090101
33523       CABG, ART-VEIN, SIX OR MORE       AS                           $127.25      20090101
33523       CABG, ART-VEIN, SIX OR MORE                                    $636.27      20090101
33530       CORONARY ARTERY, BYPASS/REOP      80                           $74.78       20090101
33530       CORONARY ARTERY, BYPASS/REOP      81                           $74.78       20090101
33530       CORONARY ARTERY, BYPASS/REOP      82                           $74.78       20090101
33530       CORONARY ARTERY, BYPASS/REOP      AS                            $74.78      20090101
33530       CORONARY ARTERY, BYPASS/REOP                                   $373.89      20090101
33533       CABG, ARTERIAL, SINGLE            80                           $293.34      20090101
33533       CABG, ARTERIAL, SINGLE            81                           $293.34      20090101
33533       CABG, ARTERIAL, SINGLE            82                           $293.34      20090101
33533       CABG, ARTERIAL, SINGLE            AS                           $293.34      20090101
33533       CABG, ARTERIAL, SINGLE                                        $1,466.70     20090101
33534       CABG, ARTERIAL, TWO               80                           $337.80      20090101
33534       CABG, ARTERIAL, TWO               81                           $337.80      20090101
33534       CABG, ARTERIAL, TWO               82                           $337.80      20090101
33534       CABG, ARTERIAL, TWO               AS                           $337.80      20090101
33534       CABG, ARTERIAL, TWO                                           $1,689.02     20090101
33535       CABG, ARTERIAL, THREE             80                           $372.19      20090101
33535       CABG, ARTERIAL, THREE             81                           $372.19      20090101
33535       CABG, ARTERIAL, THREE             82                           $372.19      20090101
33535       CABG, ARTERIAL, THREE             AS                           $372.19      20090101
33535       CABG, ARTERIAL, THREE                                         $1,860.93     20090101
33536       CABG, ARTERIAL, FOUR OR MORE      80                           $398.28      20090101
33536       CABG, ARTERIAL, FOUR OR MORE      81                           $398.28      20090101
33536       CABG, ARTERIAL, FOUR OR MORE      82                           $398.28      20090101
33536       CABG, ARTERIAL, FOUR OR MORE      AS                           $398.28      20090101
33536       CABG, ARTERIAL, FOUR OR MORE                                  $1,991.39     20090101
33542       REMOVAL OF HEART LESION           80                           $375.08      20090101
33542       REMOVAL OF HEART LESION           81                           $375.08      20090101
33542       REMOVAL OF HEART LESION           82                           $375.08      20090101
33542       REMOVAL OF HEART LESION           AS                           $375.08      20090101
33542       REMOVAL OF HEART LESION                                       $1,875.42     20090101
33545       REPAIR OF HEART DAMAGE            80                           $445.36      20090101
33545       REPAIR OF HEART DAMAGE            81                           $445.36      20090101
33545       REPAIR OF HEART DAMAGE            82                           $445.36      20090101
33545       REPAIR OF HEART DAMAGE            AS                           $445.36      20090101
33545       REPAIR OF HEART DAMAGE                                        $2,226.80     20090101
33548       RESTORE/REMODEL, VENTRICLE        80                           $438.57      20090101
33548       RESTORE/REMODEL, VENTRICLE        81                           $438.57      20090101
33548       RESTORE/REMODEL, VENTRICLE        82                           $438.57      20090101


                                           Page 187
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
33548       RESTORE/REMODEL, VENTRICLE     AS                           $438.57      20090101
33548       RESTORE/REMODEL, VENTRICLE                                 $2,192.83     20090101
33572       OPEN CORONARY ENDARTERECTOMY   80                           $36.00       20090101
33572       OPEN CORONARY ENDARTERECTOMY   81                           $36.00       20090101
33572       OPEN CORONARY ENDARTERECTOMY   82                           $36.00       20090101
33572       OPEN CORONARY ENDARTERECTOMY   AS                            $36.00      20090101
33572       OPEN CORONARY ENDARTERECTOMY                                $179.99      20090101
33600       CLOSURE OF VALVE               80                           $261.02      20090101
33600       CLOSURE OF VALVE               81                           $261.02      20090101
33600       CLOSURE OF VALVE               82                           $261.02      20090101
33600       CLOSURE OF VALVE               AS                           $261.02      20090101
33600       CLOSURE OF VALVE                                           $1,305.08     20090101
33602       CLOSURE OF VALVE               80                           $249.33      20090101
33602       CLOSURE OF VALVE               81                           $249.33      20090101
33602       CLOSURE OF VALVE               82                           $249.33      20090101
33602       CLOSURE OF VALVE               AS                           $249.33      20090101
33602       CLOSURE OF VALVE                                           $1,246.66     20090101
33606       ANASTOMOSIS/ARTERY-AORTA       80                           $270.31      20090101
33606       ANASTOMOSIS/ARTERY-AORTA       81                           $270.31      20090101
33606       ANASTOMOSIS/ARTERY-AORTA       82                           $270.31      20090101
33606       ANASTOMOSIS/ARTERY-AORTA       AS                           $270.31      20090101
33606       ANASTOMOSIS/ARTERY-AORTA                                   $1,351.55     20090101
33608       REPAIR ANOMALY W/CONDUIT       80                           $277.93      20090101
33608       REPAIR ANOMALY W/CONDUIT       81                           $277.93      20090101
33608       REPAIR ANOMALY W/CONDUIT       82                           $277.93      20090101
33608       REPAIR ANOMALY W/CONDUIT       AS                           $277.93      20090101
33608       REPAIR ANOMALY W/CONDUIT                                   $1,389.64     20090101
33610       REPAIR BY ENLARGEMENT          80                           $274.76      20090101
33610       REPAIR BY ENLARGEMENT          81                           $274.76      20090101
33610       REPAIR BY ENLARGEMENT          82                           $274.76      20090101
33610       REPAIR BY ENLARGEMENT          AS                           $274.76      20090101
33610       REPAIR BY ENLARGEMENT                                      $1,373.81     20090101
33611       REPAIR DOUBLE VENTRICLE        80                           $295.56      20090101
33611       REPAIR DOUBLE VENTRICLE        81                           $295.56      20090101
33611       REPAIR DOUBLE VENTRICLE        82                           $295.56      20090101
33611       REPAIR DOUBLE VENTRICLE        AS                           $295.56      20090101
33611       REPAIR DOUBLE VENTRICLE                                    $1,477.82     20090101
33612       REPAIR DOUBLE VENTRICLE        80                           $314.55      20090101
33612       REPAIR DOUBLE VENTRICLE        81                           $314.55      20090101
33612       REPAIR DOUBLE VENTRICLE        82                           $314.55      20090101
33612       REPAIR DOUBLE VENTRICLE        AS                           $314.55      20090101
33612       REPAIR DOUBLE VENTRICLE                                    $1,572.73     20090101
33615       REPAIR, MODIFIED FONTAN        80                           $298.02      20090101
33615       REPAIR, MODIFIED FONTAN        81                           $298.02      20090101
33615       REPAIR, MODIFIED FONTAN        82                           $298.02      20090101


                                       Page 188
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
33615       REPAIR, MODIFIED FONTAN          AS                           $298.02      20090101
33615       REPAIR, MODIFIED FONTAN                                      $1,490.09     20090101
33617       REPAIR SINGLE VENTRICLE          80                           $331.62      20090101
33617       REPAIR SINGLE VENTRICLE          81                           $331.62      20090101
33617       REPAIR SINGLE VENTRICLE          82                           $331.62      20090101
33617       REPAIR SINGLE VENTRICLE          AS                           $331.62      20090101
33617       REPAIR SINGLE VENTRICLE                                      $1,658.12     20090101
33619       REPAIR SINGLE VENTRICLE          80                           $414.31      20090101
33619       REPAIR SINGLE VENTRICLE          81                           $414.31      20090101
33619       REPAIR SINGLE VENTRICLE          82                           $414.31      20090101
33619       REPAIR SINGLE VENTRICLE          AS                           $414.31      20090101
33619       REPAIR SINGLE VENTRICLE                                      $2,071.55     20090101
33641       REPAIR HEART SEPTUM DEFECT       80                           $239.10      20090101
33641       REPAIR HEART SEPTUM DEFECT       81                           $239.10      20090101
33641       REPAIR HEART SEPTUM DEFECT       82                           $239.10      20090101
33641       REPAIR HEART SEPTUM DEFECT       AS                           $239.10      20090101
33641       REPAIR HEART SEPTUM DEFECT                                   $1,195.48     20090101
33645       REVISION OF HEART VEINS          80                           $239.26      20090101
33645       REVISION OF HEART VEINS          81                           $239.26      20090101
33645       REVISION OF HEART VEINS          82                           $239.26      20090101
33645       REVISION OF HEART VEINS          AS                           $239.26      20090101
33645       REVISION OF HEART VEINS                                      $1,196.30     20090101
33647       REPAIR HEART SEPTUM DEFECTS      80                           $255.61      20090101
33647       REPAIR HEART SEPTUM DEFECTS      81                           $255.61      20090101
33647       REPAIR HEART SEPTUM DEFECTS      82                           $255.61      20090101
33647       REPAIR HEART SEPTUM DEFECTS      AS                           $255.61      20090101
33647       REPAIR HEART SEPTUM DEFECTS                                  $1,278.07     20090101
33660       REPAIR OF HEART DEFECTS          80                           $272.09      20090101
33660       REPAIR OF HEART DEFECTS          81                           $272.09      20090101
33660       REPAIR OF HEART DEFECTS          82                           $272.09      20090101
33660       REPAIR OF HEART DEFECTS          AS                           $272.09      20090101
33660       REPAIR OF HEART DEFECTS                                      $1,360.46     20090101
33665       REPAIR OF HEART DEFECTS          80                           $288.11      20090101
33665       REPAIR OF HEART DEFECTS          81                           $288.11      20090101
33665       REPAIR OF HEART DEFECTS          82                           $288.11      20090101
33665       REPAIR OF HEART DEFECTS          AS                           $288.11      20090101
33665       REPAIR OF HEART DEFECTS                                      $1,440.56     20090101
33670       REPAIR OF HEART CHAMBERS         80                           $309.59      20090101
33670       REPAIR OF HEART CHAMBERS         81                           $309.59      20090101
33670       REPAIR OF HEART CHAMBERS         82                           $309.59      20090101
33670       REPAIR OF HEART CHAMBERS         AS                           $309.59      20090101
33670       REPAIR OF HEART CHAMBERS                                     $1,547.95     20090101
33675       CLOSE MULT VSD                   80                           $314.82      20090101
33675       CLOSE MULT VSD                   81                           $314.82      20090101
33675       CLOSE MULT VSD                   82                           $314.82      20090101


                                          Page 189
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
33675       CLOSE MULT VSD                  AS                           $314.82      20090101
33675       CLOSE MULT VSD                                              $1,574.10     20090101
33676       CLOSE MULT VSD W/RESECTION      80                           $324.78      20090101
33676       CLOSE MULT VSD W/RESECTION      81                           $324.78      20090101
33676       CLOSE MULT VSD W/RESECTION      82                           $324.78      20090101
33676       CLOSE MULT VSD W/RESECTION      AS                           $324.78      20090101
33676       CLOSE MULT VSD W/RESECTION                                  $1,623.90     20090101
33677       CL MULT VSD W/REM PUL BAND      80                           $337.63      20090101
33677       CL MULT VSD W/REM PUL BAND      81                           $337.63      20090101
33677       CL MULT VSD W/REM PUL BAND      82                           $337.63      20090101
33677       CL MULT VSD W/REM PUL BAND      AS                           $337.63      20090101
33677       CL MULT VSD W/REM PUL BAND                                  $1,688.17     20090101
33681       REPAIR HEART SEPTUM DEFECT      80                           $280.43      20090101
33681       REPAIR HEART SEPTUM DEFECT      81                           $280.43      20090101
33681       REPAIR HEART SEPTUM DEFECT      82                           $280.43      20090101
33681       REPAIR HEART SEPTUM DEFECT      AS                           $280.43      20090101
33681       REPAIR HEART SEPTUM DEFECT                                  $1,402.17     20090101
33684       REPAIR HEART SEPTUM DEFECT      80                           $284.55      20090101
33684       REPAIR HEART SEPTUM DEFECT      81                           $284.55      20090101
33684       REPAIR HEART SEPTUM DEFECT      82                           $284.55      20090101
33684       REPAIR HEART SEPTUM DEFECT      AS                           $284.55      20090101
33684       REPAIR HEART SEPTUM DEFECT                                  $1,422.76     20090101
33688       REPAIR HEART SEPTUM DEFECT      80                           $280.71      20090101
33688       REPAIR HEART SEPTUM DEFECT      81                           $280.71      20090101
33688       REPAIR HEART SEPTUM DEFECT      82                           $280.71      20090101
33688       REPAIR HEART SEPTUM DEFECT      AS                           $280.71      20090101
33688       REPAIR HEART SEPTUM DEFECT                                  $1,403.56     20090101
33690       REINFORCE PULMONARY ARTERY      80                           $175.66      20090101
33690       REINFORCE PULMONARY ARTERY      81                           $175.66      20090101
33690       REINFORCE PULMONARY ARTERY      82                           $175.66      20090101
33690       REINFORCE PULMONARY ARTERY      AS                           $175.66      20090101
33690       REINFORCE PULMONARY ARTERY                                   $878.30      20090101
33692       REPAIR OF HEART DEFECTS         80                           $293.34      20090101
33692       REPAIR OF HEART DEFECTS         81                           $293.34      20090101
33692       REPAIR OF HEART DEFECTS         82                           $293.34      20090101
33692       REPAIR OF HEART DEFECTS         AS                           $293.34      20090101
33692       REPAIR OF HEART DEFECTS                                     $1,466.70     20090101
33694       REPAIR OF HEART DEFECTS         80                           $294.40      20090101
33694       REPAIR OF HEART DEFECTS         81                           $294.40      20090101
33694       REPAIR OF HEART DEFECTS         82                           $294.40      20090101
33694       REPAIR OF HEART DEFECTS         AS                           $294.40      20090101
33694       REPAIR OF HEART DEFECTS                                     $1,471.98     20090101
33697       REPAIR OF HEART DEFECTS         80                           $319.89      20090101
33697       REPAIR OF HEART DEFECTS         81                           $319.89      20090101
33697       REPAIR OF HEART DEFECTS         82                           $319.89      20090101


                                         Page 190
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
33697       REPAIR OF HEART DEFECTS          AS                           $319.89      20090101
33697       REPAIR OF HEART DEFECTS                                      $1,599.44     20090101
33702       REPAIR OF HEART DEFECTS          80                           $235.59      20090101
33702       REPAIR OF HEART DEFECTS          81                           $235.59      20090101
33702       REPAIR OF HEART DEFECTS          82                           $235.59      20090101
33702       REPAIR OF HEART DEFECTS          AS                           $235.59      20090101
33702       REPAIR OF HEART DEFECTS                                      $1,177.93     20090101
33710       REPAIR OF HEART DEFECTS          80                           $263.36      20090101
33710       REPAIR OF HEART DEFECTS          81                           $263.36      20090101
33710       REPAIR OF HEART DEFECTS          82                           $263.36      20090101
33710       REPAIR OF HEART DEFECTS          AS                           $263.36      20090101
33710       REPAIR OF HEART DEFECTS                                      $1,316.78     20090101
33720       REPAIR OF HEART DEFECT           80                           $236.25      20090101
33720       REPAIR OF HEART DEFECT           81                           $236.25      20090101
33720       REPAIR OF HEART DEFECT           82                           $236.25      20090101
33720       REPAIR OF HEART DEFECT           AS                           $236.25      20090101
33720       REPAIR OF HEART DEFECT                                       $1,181.25     20090101
33722       REPAIR OF HEART DEFECT           80                           $236.97      20090101
33722       REPAIR OF HEART DEFECT           81                           $236.97      20090101
33722       REPAIR OF HEART DEFECT           82                           $236.97      20090101
33722       REPAIR OF HEART DEFECT           AS                           $236.97      20090101
33722       REPAIR OF HEART DEFECT                                       $1,184.87     20090101
33724       REPAIR VENOUS ANOMALY            80                           $233.31      20090101
33724       REPAIR VENOUS ANOMALY            81                           $233.31      20090101
33724       REPAIR VENOUS ANOMALY            82                           $233.31      20090101
33724       REPAIR VENOUS ANOMALY            AS                           $233.31      20090101
33724       REPAIR VENOUS ANOMALY                                        $1,166.53     20090101
33726       REPAIR PUL VENOUS STENOSIS       80                           $307.70      20090101
33726       REPAIR PUL VENOUS STENOSIS       81                           $307.70      20090101
33726       REPAIR PUL VENOUS STENOSIS       82                           $307.70      20090101
33726       REPAIR PUL VENOUS STENOSIS       AS                           $307.70      20090101
33726       REPAIR PUL VENOUS STENOSIS                                   $1,538.49     20090101
33730       REPAIR HEART-VEIN DEFECT(S)      80                           $303.47      20090101
33730       REPAIR HEART-VEIN DEFECT(S)      81                           $303.47      20090101
33730       REPAIR HEART-VEIN DEFECT(S)      82                           $303.47      20090101
33730       REPAIR HEART-VEIN DEFECT(S)      AS                           $303.47      20090101
33730       REPAIR HEART-VEIN DEFECT(S)                                  $1,517.36     20090101
33732       REPAIR HEART-VEIN DEFECT         80                           $253.22      20090101
33732       REPAIR HEART-VEIN DEFECT         81                           $253.22      20090101
33732       REPAIR HEART-VEIN DEFECT         82                           $253.22      20090101
33732       REPAIR HEART-VEIN DEFECT         AS                           $253.22      20090101
33732       REPAIR HEART-VEIN DEFECT                                     $1,266.12     20090101
33735       REVISION OF HEART CHAMBER        80                           $188.96      20090101
33735       REVISION OF HEART CHAMBER        81                           $188.96      20090101
33735       REVISION OF HEART CHAMBER        82                           $188.96      20090101


                                          Page 191
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
33735       REVISION OF HEART CHAMBER       AS                           $188.96      20090101
33735       REVISION OF HEART CHAMBER                                    $944.80      20090101
33736       REVISION OF HEART CHAMBER       80                           $218.17      20090101
33736       REVISION OF HEART CHAMBER       81                           $218.17      20090101
33736       REVISION OF HEART CHAMBER       82                           $218.17      20090101
33736       REVISION OF HEART CHAMBER       AS                           $218.17      20090101
33736       REVISION OF HEART CHAMBER                                   $1,090.84     20090101
33737       REVISION OF HEART CHAMBER       80                           $198.19      20090101
33737       REVISION OF HEART CHAMBER       81                           $198.19      20090101
33737       REVISION OF HEART CHAMBER       82                           $198.19      20090101
33737       REVISION OF HEART CHAMBER       AS                           $198.19      20090101
33737       REVISION OF HEART CHAMBER                                    $990.96      20090101
33750       MAJOR VESSEL SHUNT              80                           $183.84      20090101
33750       MAJOR VESSEL SHUNT              81                           $183.84      20090101
33750       MAJOR VESSEL SHUNT              82                           $183.84      20090101
33750       MAJOR VESSEL SHUNT              AS                           $183.84      20090101
33750       MAJOR VESSEL SHUNT                                           $919.18      20090101
33755       MAJOR VESSEL SHUNT              80                           $189.18      20090101
33755       MAJOR VESSEL SHUNT              81                           $189.18      20090101
33755       MAJOR VESSEL SHUNT              82                           $189.18      20090101
33755       MAJOR VESSEL SHUNT              AS                           $189.18      20090101
33755       MAJOR VESSEL SHUNT                                           $945.89      20090101
33762       MAJOR VESSEL SHUNT              80                           $194.80      20090101
33762       MAJOR VESSEL SHUNT              81                           $194.80      20090101
33762       MAJOR VESSEL SHUNT              82                           $194.80      20090101
33762       MAJOR VESSEL SHUNT              AS                           $194.80      20090101
33762       MAJOR VESSEL SHUNT                                           $973.99      20090101
33764       MAJOR VESSEL SHUNT & GRAFT      80                           $194.97      20090101
33764       MAJOR VESSEL SHUNT & GRAFT      81                           $194.97      20090101
33764       MAJOR VESSEL SHUNT & GRAFT      82                           $194.97      20090101
33764       MAJOR VESSEL SHUNT & GRAFT      AS                           $194.97      20090101
33764       MAJOR VESSEL SHUNT & GRAFT                                   $974.87      20090101
33766       MAJOR VESSEL SHUNT              80                           $206.93      20090101
33766       MAJOR VESSEL SHUNT              81                           $206.93      20090101
33766       MAJOR VESSEL SHUNT              82                           $206.93      20090101
33766       MAJOR VESSEL SHUNT              AS                           $206.93      20090101
33766       MAJOR VESSEL SHUNT                                          $1,034.64     20090101
33767       MAJOR VESSEL SHUNT              80                           $217.44      20090101
33767       MAJOR VESSEL SHUNT              81                           $217.44      20090101
33767       MAJOR VESSEL SHUNT              82                           $217.44      20090101
33767       MAJOR VESSEL SHUNT              AS                           $217.44      20090101
33767       MAJOR VESSEL SHUNT                                          $1,087.22     20090101
33768       CAVOPULMONARY SHUNTING          80                           $63.65       20090101
33768       CAVOPULMONARY SHUNTING          81                           $63.65       20090101
33768       CAVOPULMONARY SHUNTING          82                           $63.65       20090101


                                         Page 192
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
33768       CAVOPULMONARY SHUNTING           AS                            $63.65      20090101
33768       CAVOPULMONARY SHUNTING                                        $318.27      20090101
33770       REPAIR GREAT VESSELS DEFECT      80                           $323.05      20090101
33770       REPAIR GREAT VESSELS DEFECT      81                           $323.05      20090101
33770       REPAIR GREAT VESSELS DEFECT      82                           $323.05      20090101
33770       REPAIR GREAT VESSELS DEFECT      AS                           $323.05      20090101
33770       REPAIR GREAT VESSELS DEFECT                                  $1,615.27     20090101
33771       REPAIR GREAT VESSELS DEFECT      80                           $328.28      20090101
33771       REPAIR GREAT VESSELS DEFECT      81                           $328.28      20090101
33771       REPAIR GREAT VESSELS DEFECT      82                           $328.28      20090101
33771       REPAIR GREAT VESSELS DEFECT      AS                           $328.28      20090101
33771       REPAIR GREAT VESSELS DEFECT                                  $1,641.41     20090101
33774       REPAIR GREAT VESSELS DEFECT      80                           $277.04      20090101
33774       REPAIR GREAT VESSELS DEFECT      81                           $277.04      20090101
33774       REPAIR GREAT VESSELS DEFECT      82                           $277.04      20090101
33774       REPAIR GREAT VESSELS DEFECT      AS                           $277.04      20090101
33774       REPAIR GREAT VESSELS DEFECT                                  $1,385.19     20090101
33775       REPAIR GREAT VESSELS DEFECT      80                           $280.27      20090101
33775       REPAIR GREAT VESSELS DEFECT      81                           $280.27      20090101
33775       REPAIR GREAT VESSELS DEFECT      82                           $280.27      20090101
33775       REPAIR GREAT VESSELS DEFECT      AS                           $280.27      20090101
33775       REPAIR GREAT VESSELS DEFECT                                  $1,401.34     20090101
33776       REPAIR GREAT VESSELS DEFECT      80                           $292.96      20090101
33776       REPAIR GREAT VESSELS DEFECT      81                           $292.96      20090101
33776       REPAIR GREAT VESSELS DEFECT      82                           $292.96      20090101
33776       REPAIR GREAT VESSELS DEFECT      AS                           $292.96      20090101
33776       REPAIR GREAT VESSELS DEFECT                                  $1,464.78     20090101
33777       REPAIR GREAT VESSELS DEFECT      80                           $290.56      20090101
33777       REPAIR GREAT VESSELS DEFECT      81                           $290.56      20090101
33777       REPAIR GREAT VESSELS DEFECT      82                           $290.56      20090101
33777       REPAIR GREAT VESSELS DEFECT      AS                           $290.56      20090101
33777       REPAIR GREAT VESSELS DEFECT                                  $1,452.78     20090101
33778       REPAIR GREAT VESSELS DEFECT      80                           $360.22      20090101
33778       REPAIR GREAT VESSELS DEFECT      81                           $360.22      20090101
33778       REPAIR GREAT VESSELS DEFECT      82                           $360.22      20090101
33778       REPAIR GREAT VESSELS DEFECT      AS                           $360.22      20090101
33778       REPAIR GREAT VESSELS DEFECT                                  $1,801.11     20090101
33779       REPAIR GREAT VESSELS DEFECT      80                           $333.80      20090101
33779       REPAIR GREAT VESSELS DEFECT      81                           $333.80      20090101
33779       REPAIR GREAT VESSELS DEFECT      82                           $333.80      20090101
33779       REPAIR GREAT VESSELS DEFECT      AS                           $333.80      20090101
33779       REPAIR GREAT VESSELS DEFECT                                  $1,668.99     20090101
33780       REPAIR GREAT VESSELS DEFECT      80                           $354.16      20090101
33780       REPAIR GREAT VESSELS DEFECT      81                           $354.16      20090101
33780       REPAIR GREAT VESSELS DEFECT      82                           $354.16      20090101


                                          Page 193
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33780       REPAIR GREAT VESSELS DEFECT       AS                           $354.16      20090101
33780       REPAIR GREAT VESSELS DEFECT                                   $1,770.78     20090101
33781       REPAIR GREAT VESSELS DEFECT       80                           $341.42      20090101
33781       REPAIR GREAT VESSELS DEFECT       81                           $341.42      20090101
33781       REPAIR GREAT VESSELS DEFECT       82                           $341.42      20090101
33781       REPAIR GREAT VESSELS DEFECT       AS                           $341.42      20090101
33781       REPAIR GREAT VESSELS DEFECT                                   $1,707.08     20090101
33786       REPAIR ARTERIAL TRUNK             80                           $349.77      20090101
33786       REPAIR ARTERIAL TRUNK             81                           $349.77      20090101
33786       REPAIR ARTERIAL TRUNK             82                           $349.77      20090101
33786       REPAIR ARTERIAL TRUNK             AS                           $349.77      20090101
33786       REPAIR ARTERIAL TRUNK                                         $1,748.84     20090101
33788       REVISION OF PULMONARY ARTERY      80                           $230.30      20090101
33788       REVISION OF PULMONARY ARTERY      81                           $230.30      20090101
33788       REVISION OF PULMONARY ARTERY      82                           $230.30      20090101
33788       REVISION OF PULMONARY ARTERY      AS                           $230.30      20090101
33788       REVISION OF PULMONARY ARTERY                                  $1,151.49     20090101
33800       AORTIC SUSPENSION                 80                           $151.12      20090101
33800       AORTIC SUSPENSION                 81                           $151.12      20090101
33800       AORTIC SUSPENSION                 82                           $151.12      20090101
33800       AORTIC SUSPENSION                 AS                           $151.12      20090101
33800       AORTIC SUSPENSION                                              $755.60      20090101
33802       REPAIR VESSEL DEFECT              80                           $161.92      20090101
33802       REPAIR VESSEL DEFECT              81                           $161.92      20090101
33802       REPAIR VESSEL DEFECT              82                           $161.92      20090101
33802       REPAIR VESSEL DEFECT              AS                           $161.92      20090101
33802       REPAIR VESSEL DEFECT                                           $809.58      20090101
33803       REPAIR VESSEL DEFECT              80                           $175.05      20090101
33803       REPAIR VESSEL DEFECT              81                           $175.05      20090101
33803       REPAIR VESSEL DEFECT              82                           $175.05      20090101
33803       REPAIR VESSEL DEFECT              AS                           $175.05      20090101
33803       REPAIR VESSEL DEFECT                                           $875.25      20090101
33813       REPAIR SEPTAL DEFECT              80                           $190.46      20090101
33813       REPAIR SEPTAL DEFECT              81                           $190.46      20090101
33813       REPAIR SEPTAL DEFECT              82                           $190.46      20090101
33813       REPAIR SEPTAL DEFECT              AS                           $190.46      20090101
33813       REPAIR SEPTAL DEFECT                                           $952.30      20090101
33814       REPAIR SEPTAL DEFECT              80                           $232.52      20090101
33814       REPAIR SEPTAL DEFECT              81                           $232.52      20090101
33814       REPAIR SEPTAL DEFECT              82                           $232.52      20090101
33814       REPAIR SEPTAL DEFECT              AS                           $232.52      20090101
33814       REPAIR SEPTAL DEFECT                                          $1,162.62     20090101
33820       REVISE MAJOR VESSEL               80                           $148.12      20090101
33820       REVISE MAJOR VESSEL               81                           $148.12      20090101
33820       REVISE MAJOR VESSEL               82                           $148.12      20090101


                                           Page 194
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
33820       REVISE MAJOR VESSEL            AS                           $148.12      20090101
33820       REVISE MAJOR VESSEL                                         $740.59      20090101
33822       REVISE MAJOR VESSEL            80                           $154.46      20090101
33822       REVISE MAJOR VESSEL            81                           $154.46      20090101
33822       REVISE MAJOR VESSEL            82                           $154.46      20090101
33822       REVISE MAJOR VESSEL            AS                           $154.46      20090101
33822       REVISE MAJOR VESSEL                                         $772.32      20090101
33824       REVISE MAJOR VESSEL            80                           $179.22      20090101
33824       REVISE MAJOR VESSEL            81                           $179.22      20090101
33824       REVISE MAJOR VESSEL            82                           $179.22      20090101
33824       REVISE MAJOR VESSEL            AS                           $179.22      20090101
33824       REVISE MAJOR VESSEL                                         $896.10      20090101
33840       REMOVE AORTA CONSTRICTION      80                           $184.68      20090101
33840       REMOVE AORTA CONSTRICTION      81                           $184.68      20090101
33840       REMOVE AORTA CONSTRICTION      82                           $184.68      20090101
33840       REMOVE AORTA CONSTRICTION      AS                           $184.68      20090101
33840       REMOVE AORTA CONSTRICTION                                   $923.38      20090101
33845       REMOVE AORTA CONSTRICTION      80                           $202.31      20090101
33845       REMOVE AORTA CONSTRICTION      81                           $202.31      20090101
33845       REMOVE AORTA CONSTRICTION      82                           $202.31      20090101
33845       REMOVE AORTA CONSTRICTION      AS                           $202.31      20090101
33845       REMOVE AORTA CONSTRICTION                                  $1,011.56     20090101
33851       REMOVE AORTA CONSTRICTION      80                           $193.69      20090101
33851       REMOVE AORTA CONSTRICTION      81                           $193.69      20090101
33851       REMOVE AORTA CONSTRICTION      82                           $193.69      20090101
33851       REMOVE AORTA CONSTRICTION      AS                           $193.69      20090101
33851       REMOVE AORTA CONSTRICTION                                   $968.45      20090101
33852       REPAIR SEPTAL DEFECT           80                           $219.84      20090101
33852       REPAIR SEPTAL DEFECT           81                           $219.84      20090101
33852       REPAIR SEPTAL DEFECT           82                           $219.84      20090101
33852       REPAIR SEPTAL DEFECT           AS                           $219.84      20090101
33852       REPAIR SEPTAL DEFECT                                       $1,099.22     20090101
33853       REPAIR SEPTAL DEFECT           80                           $280.27      20090101
33853       REPAIR SEPTAL DEFECT           81                           $280.27      20090101
33853       REPAIR SEPTAL DEFECT           82                           $280.27      20090101
33853       REPAIR SEPTAL DEFECT           AS                           $280.27      20090101
33853       REPAIR SEPTAL DEFECT                                       $1,401.34     20090101
33860       ASCENDING AORTIC GRAFT         80                           $464.22      20090101
33860       ASCENDING AORTIC GRAFT         81                           $464.22      20090101
33860       ASCENDING AORTIC GRAFT         82                           $464.22      20090101
33860       ASCENDING AORTIC GRAFT         AS                           $464.22      20090101
33860       ASCENDING AORTIC GRAFT                                     $2,321.09     20090101
33861       ASCENDING AORTIC GRAFT         80                           $372.91      20090101
33861       ASCENDING AORTIC GRAFT         81                           $372.91      20090101
33861       ASCENDING AORTIC GRAFT         82                           $372.91      20090101


                                        Page 195
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33861       ASCENDING AORTIC GRAFT            AS                           $372.91      20090101
33861       ASCENDING AORTIC GRAFT                                        $1,864.55     20090101
33863       ASCENDING AORTIC GRAFT            80                           $469.89      20090101
33863       ASCENDING AORTIC GRAFT            81                           $469.89      20090101
33863       ASCENDING AORTIC GRAFT            82                           $469.89      20090101
33863       ASCENDING AORTIC GRAFT            AS                           $469.89      20090101
33863       ASCENDING AORTIC GRAFT                                        $2,349.45     20090101
33864       ASCENDING AORTIC GRAFT            80                           $483.18      20090101
33864       ASCENDING AORTIC GRAFT                                        $2,415.89     20090101
33870       TRANSVERSE AORTIC ARCH GRAFT      80                           $388.88      20090101
33870       TRANSVERSE AORTIC ARCH GRAFT      81                           $388.88      20090101
33870       TRANSVERSE AORTIC ARCH GRAFT      82                           $388.88      20090101
33870       TRANSVERSE AORTIC ARCH GRAFT      AS                           $388.88      20090101
33870       TRANSVERSE AORTIC ARCH GRAFT                                  $1,944.40     20090101
33875       THORACIC AORTIC GRAFT             80                           $300.91      20090101
33875       THORACIC AORTIC GRAFT             81                           $300.91      20090101
33875       THORACIC AORTIC GRAFT             82                           $300.91      20090101
33875       THORACIC AORTIC GRAFT             AS                           $300.91      20090101
33875       THORACIC AORTIC GRAFT                                         $1,504.53     20090101
33877       THORACOABDOMINAL GRAFT            80                           $520.08      20090101
33877       THORACOABDOMINAL GRAFT            81                           $520.08      20090101
33877       THORACOABDOMINAL GRAFT            82                           $520.08      20090101
33877       THORACOABDOMINAL GRAFT            AS                           $520.08      20090101
33877       THORACOABDOMINAL GRAFT                                        $2,600.39     20090101
33880       ENDOVASC TAA REPR INCL SUBCL      80                           $275.04      20090101
33880       ENDOVASC TAA REPR INCL SUBCL      81                           $275.04      20090101
33880       ENDOVASC TAA REPR INCL SUBCL      82                           $275.04      20090101
33880       ENDOVASC TAA REPR INCL SUBCL      AS                           $275.04      20090101
33880       ENDOVASC TAA REPR INCL SUBCL                                  $1,375.18     20090101
33881       ENDOVASC TAA REPR W/O SUBCL       80                           $237.20      20090101
33881       ENDOVASC TAA REPR W/O SUBCL       81                           $237.20      20090101
33881       ENDOVASC TAA REPR W/O SUBCL       82                           $237.20      20090101
33881       ENDOVASC TAA REPR W/O SUBCL       AS                           $237.20      20090101
33881       ENDOVASC TAA REPR W/O SUBCL                                   $1,186.00     20090101
33883       INSERT ENDOVASC PROSTH, TAA       80                           $174.21      20090101
33883       INSERT ENDOVASC PROSTH, TAA       81                           $174.21      20090101
33883       INSERT ENDOVASC PROSTH, TAA       82                           $174.21      20090101
33883       INSERT ENDOVASC PROSTH, TAA       AS                           $174.21      20090101
33883       INSERT ENDOVASC PROSTH, TAA                                    $871.07      20090101
33884       ENDOVASC PROSTH, TAA, ADD-ON      80                           $63.38       20090101
33884       ENDOVASC PROSTH, TAA, ADD-ON      81                           $63.38       20090101
33884       ENDOVASC PROSTH, TAA, ADD-ON      82                           $63.38       20090101
33884       ENDOVASC PROSTH, TAA, ADD-ON      AS                            $63.38      20090101
33884       ENDOVASC PROSTH, TAA, ADD-ON                                   $316.88      20090101
33886       ENDOVASC PROSTH, DELAYED          80                           $150.68      20090101


                                           Page 196
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33886       ENDOVASC PROSTH, DELAYED          81                           $150.68      20090101
33886       ENDOVASC PROSTH, DELAYED          82                           $150.68      20090101
33886       ENDOVASC PROSTH, DELAYED          AS                           $150.68      20090101
33886       ENDOVASC PROSTH, DELAYED                                       $753.39      20090101
33889       ARTERY TRANSPOSE/ENDOVAS TAA      80                           $126.20      20090101
33889       ARTERY TRANSPOSE/ENDOVAS TAA      81                           $126.20      20090101
33889       ARTERY TRANSPOSE/ENDOVAS TAA      82                           $126.20      20090101
33889       ARTERY TRANSPOSE/ENDOVAS TAA      AS                           $126.20      20090101
33889       ARTERY TRANSPOSE/ENDOVAS TAA                                   $630.98      20090101
33891       CAR-CAR BP GRFT/ENDOVAS TAA       80                           $162.03      20090101
33891       CAR-CAR BP GRFT/ENDOVAS TAA       81                           $162.03      20090101
33891       CAR-CAR BP GRFT/ENDOVAS TAA       82                           $162.03      20090101
33891       CAR-CAR BP GRFT/ENDOVAS TAA       AS                           $162.03      20090101
33891       CAR-CAR BP GRFT/ENDOVAS TAA                                    $810.15      20090101
33910       REMOVE LUNG ARTERY EMBOLI         80                           $248.61      20090101
33910       REMOVE LUNG ARTERY EMBOLI         81                           $248.61      20090101
33910       REMOVE LUNG ARTERY EMBOLI         82                           $248.61      20090101
33910       REMOVE LUNG ARTERY EMBOLI         AS                           $248.61      20090101
33910       REMOVE LUNG ARTERY EMBOLI                                     $1,243.04     20090101
33915       REMOVE LUNG ARTERY EMBOLI         80                           $198.36      20090101
33915       REMOVE LUNG ARTERY EMBOLI         81                           $198.36      20090101
33915       REMOVE LUNG ARTERY EMBOLI         82                           $198.36      20090101
33915       REMOVE LUNG ARTERY EMBOLI         AS                           $198.36      20090101
33915       REMOVE LUNG ARTERY EMBOLI                                      $991.79      20090101
33916       SURGERY OF GREAT VESSEL           80                           $239.59      20090101
33916       SURGERY OF GREAT VESSEL           81                           $239.59      20090101
33916       SURGERY OF GREAT VESSEL           82                           $239.59      20090101
33916       SURGERY OF GREAT VESSEL           AS                           $239.59      20090101
33916       SURGERY OF GREAT VESSEL                                       $1,197.96     20090101
33917       REPAIR PULMONARY ARTERY           80                           $222.34      20090101
33917       REPAIR PULMONARY ARTERY           81                           $222.34      20090101
33917       REPAIR PULMONARY ARTERY           82                           $222.34      20090101
33917       REPAIR PULMONARY ARTERY           AS                           $222.34      20090101
33917       REPAIR PULMONARY ARTERY                                       $1,111.69     20090101
33920       REPAIR PULMONARY ATRESIA          80                           $270.48      20090101
33920       REPAIR PULMONARY ATRESIA          81                           $270.48      20090101
33920       REPAIR PULMONARY ATRESIA          82                           $270.48      20090101
33920       REPAIR PULMONARY ATRESIA          AS                           $270.48      20090101
33920       REPAIR PULMONARY ATRESIA                                      $1,352.38     20090101
33922       TRANSECT PULMONARY ARTERY         80                           $210.16      20090101
33922       TRANSECT PULMONARY ARTERY         81                           $210.16      20090101
33922       TRANSECT PULMONARY ARTERY         82                           $210.16      20090101
33922       TRANSECT PULMONARY ARTERY         AS                           $210.16      20090101
33922       TRANSECT PULMONARY ARTERY                                     $1,050.78     20090101
33924       REMOVE PULMONARY SHUNT            80                           $44.68       20090101


                                           Page 197
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33924       REMOVE PULMONARY SHUNT            81                           $44.68       20090101
33924       REMOVE PULMONARY SHUNT            82                           $44.68       20090101
33924       REMOVE PULMONARY SHUNT            AS                            $44.68      20090101
33924       REMOVE PULMONARY SHUNT                                         $223.40      20090101
33925       RPR PUL ART UNIFOCAL W/O CPB      80                           $286.11      20090101
33925       RPR PUL ART UNIFOCAL W/O CPB      81                           $286.11      20090101
33925       RPR PUL ART UNIFOCAL W/O CPB      82                           $286.11      20090101
33925       RPR PUL ART UNIFOCAL W/O CPB      AS                           $286.11      20090101
33925       RPR PUL ART UNIFOCAL W/O CPB                                  $1,430.55     20090101
33926       REPR PUL ART, UNIFOCAL W/CPB      80                           $373.63      20090101
33926       REPR PUL ART, UNIFOCAL W/CPB      81                           $373.63      20090101
33926       REPR PUL ART, UNIFOCAL W/CPB      82                           $373.63      20090101
33926       REPR PUL ART, UNIFOCAL W/CPB      AS                           $373.63      20090101
33926       REPR PUL ART, UNIFOCAL W/CPB                                  $1,868.16     20090101
33935       TRANSPLANTATION, HEART/LUNG       80                           $537.56      20090101
33935       TRANSPLANTATION, HEART/LUNG       81                           $537.56      20090101
33935       TRANSPLANTATION, HEART/LUNG       82                           $537.56      20090101
33935       TRANSPLANTATION, HEART/LUNG       AS                           $537.56      20090101
33935       TRANSPLANTATION, HEART/LUNG                                   $2,687.79     20090101
33944       PREPARE DONOR HEART               80                           $120.36      20090101
33944       PREPARE DONOR HEART               81                           $120.36      20090101
33944       PREPARE DONOR HEART               82                           $120.36      20090101
33944       PREPARE DONOR HEART               AS                           $120.36      20090101
33944       PREPARE DONOR HEART                                            $601.80      20090101
33945       TRANSPLANTATION OF HEART          80                           $674.60      20090101
33945       TRANSPLANTATION OF HEART          81                           $674.60      20090101
33945       TRANSPLANTATION OF HEART          82                           $674.60      20090101
33945       TRANSPLANTATION OF HEART          AS                           $674.60      20090101
33945       TRANSPLANTATION OF HEART                                      $3,373.01     20090101
33960       EXTERNAL CIRCULATION ASSIST                                    $753.39      20090101
33961       EXTERNAL CIRCULATION ASSIST                                    $419.82      20090101
33967       INSERT IA PERCUT DEVICE                                        $203.65      20090101
33968       REMOVE AORTIC ASSIST DEVICE       80                             $5.29      20090101
33968       REMOVE AORTIC ASSIST DEVICE       81                             $5.29      20090101
33968       REMOVE AORTIC ASSIST DEVICE       82                             $5.29      20090101
33968       REMOVE AORTIC ASSIST DEVICE       AS                            $5.29       20090101
33968       REMOVE AORTIC ASSIST DEVICE                                    $26.44       20090101
33970       AORTIC CIRCULATION ASSIST         80                           $55.48       20090101
33970       AORTIC CIRCULATION ASSIST         81                           $55.48       20090101
33970       AORTIC CIRCULATION ASSIST         82                           $55.48       20090101
33970       AORTIC CIRCULATION ASSIST         AS                            $55.48      20090101
33970       AORTIC CIRCULATION ASSIST                                      $277.38      20090101
33971       AORTIC CIRCULATION ASSIST                                      $533.33      20090101
33973       INSERT BALLOON DEVICE             80                           $81.45       20090101
33973       INSERT BALLOON DEVICE             81                           $81.45       20090101


                                           Page 198
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
33973       INSERT BALLOON DEVICE             82                           $81.45       20090101
33973       INSERT BALLOON DEVICE             AS                            $81.45      20090101
33973       INSERT BALLOON DEVICE                                          $407.27      20090101
33974       REMOVE INTRA-AORTIC BALLOON                                    $681.05      20090101
33975       IMPLANT VENTRICULAR DEVICE        80                           $168.76      20090101
33975       IMPLANT VENTRICULAR DEVICE        81                           $168.76      20090101
33975       IMPLANT VENTRICULAR DEVICE        82                           $168.76      20090101
33975       IMPLANT VENTRICULAR DEVICE        AS                           $168.76      20090101
33975       IMPLANT VENTRICULAR DEVICE                                     $843.78      20090101
33976       IMPLANT VENTRICULAR DEVICE        80                           $188.29      20090101
33976       IMPLANT VENTRICULAR DEVICE        81                           $188.29      20090101
33976       IMPLANT VENTRICULAR DEVICE        82                           $188.29      20090101
33976       IMPLANT VENTRICULAR DEVICE        AS                           $188.29      20090101
33976       IMPLANT VENTRICULAR DEVICE                                     $941.44      20090101
33977       REMOVE VENTRICULAR DEVICE         80                           $184.34      20090101
33977       REMOVE VENTRICULAR DEVICE         81                           $184.34      20090101
33977       REMOVE VENTRICULAR DEVICE         82                           $184.34      20090101
33977       REMOVE VENTRICULAR DEVICE         AS                           $184.34      20090101
33977       REMOVE VENTRICULAR DEVICE                                      $921.72      20090101
33978       REMOVE VENTRICULAR DEVICE         80                           $205.38      20090101
33978       REMOVE VENTRICULAR DEVICE         81                           $205.38      20090101
33978       REMOVE VENTRICULAR DEVICE         82                           $205.38      20090101
33978       REMOVE VENTRICULAR DEVICE         AS                           $205.38      20090101
33978       REMOVE VENTRICULAR DEVICE                                     $1,026.88     20090101
33979       INSERT INTRACORPOREAL DEVICE                                  $1,864.27     20090101
33980       REMOVE INTRACORPOREAL DEVICE                                  $2,715.87     20090101
34001       REMOVAL OF ARTERY CLOT            80                           $145.61      20090101
34001       REMOVAL OF ARTERY CLOT            81                           $145.61      20090101
34001       REMOVAL OF ARTERY CLOT            82                           $145.61      20090101
34001       REMOVAL OF ARTERY CLOT            AS                           $145.61      20090101
34001       REMOVAL OF ARTERY CLOT                                         $728.07      20090101
34051       REMOVAL OF ARTERY CLOT            80                           $148.73      20090101
34051       REMOVAL OF ARTERY CLOT            81                           $148.73      20090101
34051       REMOVAL OF ARTERY CLOT            82                           $148.73      20090101
34051       REMOVAL OF ARTERY CLOT            AS                           $148.73      20090101
34051       REMOVAL OF ARTERY CLOT                                         $743.65      20090101
34101       REMOVAL OF ARTERY CLOT            80                           $95.10       20090101
34101       REMOVAL OF ARTERY CLOT            81                           $95.10       20090101
34101       REMOVAL OF ARTERY CLOT            82                           $95.10       20090101
34101       REMOVAL OF ARTERY CLOT            AS                            $95.10      20090101
34101       REMOVAL OF ARTERY CLOT                                         $475.48      20090101
34111       REMOVAL OF ARM ARTERY CLOT        80                            $94.98      20090101
34111       REMOVAL OF ARM ARTERY CLOT        81                            $94.98      20090101
34111       REMOVAL OF ARM ARTERY CLOT        82                            $94.98      20090101
34111       REMOVAL OF ARM ARTERY CLOT        AS                            $94.98      20090101


                                           Page 199
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
34111       REMOVAL OF ARM ARTERY CLOT                                   $474.91      20090101
34151       REMOVAL OF ARTERY CLOT          80                           $219.78      20090101
34151       REMOVAL OF ARTERY CLOT          81                           $219.78      20090101
34151       REMOVAL OF ARTERY CLOT          82                           $219.78      20090101
34151       REMOVAL OF ARTERY CLOT          AS                           $219.78      20090101
34151       REMOVAL OF ARTERY CLOT                                      $1,098.91     20090101
34201       REMOVAL OF ARTERY CLOT          80                           $149.17      20090101
34201       REMOVAL OF ARTERY CLOT          81                           $149.17      20090101
34201       REMOVAL OF ARTERY CLOT          82                           $149.17      20090101
34201       REMOVAL OF ARTERY CLOT          AS                           $149.17      20090101
34201       REMOVAL OF ARTERY CLOT                                       $745.87      20090101
34203       REMOVAL OF LEG ARTERY CLOT      80                           $151.96      20090101
34203       REMOVAL OF LEG ARTERY CLOT      81                           $151.96      20090101
34203       REMOVAL OF LEG ARTERY CLOT      82                           $151.96      20090101
34203       REMOVAL OF LEG ARTERY CLOT      AS                           $151.96      20090101
34203       REMOVAL OF LEG ARTERY CLOT                                   $759.79      20090101
34401       REMOVAL OF VEIN CLOT            80                           $219.67      20090101
34401       REMOVAL OF VEIN CLOT            81                           $219.67      20090101
34401       REMOVAL OF VEIN CLOT            82                           $219.67      20090101
34401       REMOVAL OF VEIN CLOT            AS                           $219.67      20090101
34401       REMOVAL OF VEIN CLOT                                        $1,098.34     20090101
34421       REMOVAL OF VEIN CLOT            80                           $114.56      20090101
34421       REMOVAL OF VEIN CLOT            81                           $114.56      20090101
34421       REMOVAL OF VEIN CLOT            82                           $114.56      20090101
34421       REMOVAL OF VEIN CLOT            AS                           $114.56      20090101
34421       REMOVAL OF VEIN CLOT                                         $572.82      20090101
34451       REMOVAL OF VEIN CLOT            80                           $237.42      20090101
34451       REMOVAL OF VEIN CLOT            81                           $237.42      20090101
34451       REMOVAL OF VEIN CLOT            82                           $237.42      20090101
34451       REMOVAL OF VEIN CLOT            AS                           $237.42      20090101
34451       REMOVAL OF VEIN CLOT                                        $1,187.09     20090101
34471       REMOVAL OF VEIN CLOT            80                           $160.08      20090101
34471       REMOVAL OF VEIN CLOT            81                           $160.08      20090101
34471       REMOVAL OF VEIN CLOT            82                           $160.08      20090101
34471       REMOVAL OF VEIN CLOT            AS                           $160.08      20090101
34471       REMOVAL OF VEIN CLOT                                         $800.42      20090101
34490       REMOVAL OF VEIN CLOT            80                            $95.31      20090101
34490       REMOVAL OF VEIN CLOT            81                            $95.31      20090101
34490       REMOVAL OF VEIN CLOT            82                            $95.31      20090101
34490       REMOVAL OF VEIN CLOT            AS                            $95.31      20090101
34490       REMOVAL OF VEIN CLOT                                         $476.57      20090101
34501       REPAIR VALVE, FEMORAL VEIN      80                           $147.73      20090101
34501       REPAIR VALVE, FEMORAL VEIN      81                           $147.73      20090101
34501       REPAIR VALVE, FEMORAL VEIN      82                           $147.73      20090101
34501       REPAIR VALVE, FEMORAL VEIN      AS                           $147.73      20090101


                                         Page 200
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
34501       REPAIR VALVE, FEMORAL VEIN                                     $738.63      20090101
34502       RECONSTRUCT VENA CAVA             80                           $238.59      20090101
34502       RECONSTRUCT VENA CAVA             81                           $238.59      20090101
34502       RECONSTRUCT VENA CAVA             82                           $238.59      20090101
34502       RECONSTRUCT VENA CAVA             AS                           $238.59      20090101
34502       RECONSTRUCT VENA CAVA                                         $1,192.94     20090101
34510       TRANSPOSITION OF VEIN VALVE       80                           $170.27      20090101
34510       TRANSPOSITION OF VEIN VALVE       81                           $170.27      20090101
34510       TRANSPOSITION OF VEIN VALVE       82                           $170.27      20090101
34510       TRANSPOSITION OF VEIN VALVE       AS                           $170.27      20090101
34510       TRANSPOSITION OF VEIN VALVE                                    $851.34      20090101
34520       CROSS-OVER VEIN GRAFT             80                           $161.80      20090101
34520       CROSS-OVER VEIN GRAFT             81                           $161.80      20090101
34520       CROSS-OVER VEIN GRAFT             82                           $161.80      20090101
34520       CROSS-OVER VEIN GRAFT             AS                           $161.80      20090101
34520       CROSS-OVER VEIN GRAFT                                          $809.01      20090101
34530       LEG VEIN FUSION                   80                           $151.35      20090101
34530       LEG VEIN FUSION                   81                           $151.35      20090101
34530       LEG VEIN FUSION                   82                           $151.35      20090101
34530       LEG VEIN FUSION                   AS                           $151.35      20090101
34530       LEG VEIN FUSION                                                $756.74      20090101
34800       ENDOVAS AAA REPR W/SM TUBE        80                           $178.78      20090101
34800       ENDOVAS AAA REPR W/SM TUBE        81                           $178.78      20090101
34800       ENDOVAS AAA REPR W/SM TUBE        82                           $178.78      20090101
34800       ENDOVAS AAA REPR W/SM TUBE        AS                           $178.78      20090101
34800       ENDOVAS AAA REPR W/SM TUBE                                     $893.88      20090101
34802       ENDOVAS AAA REPR W/2-P PART       80                           $194.91      20090101
34802       ENDOVAS AAA REPR W/2-P PART       81                           $194.91      20090101
34802       ENDOVAS AAA REPR W/2-P PART       82                           $194.91      20090101
34802       ENDOVAS AAA REPR W/2-P PART       AS                           $194.91      20090101
34802       ENDOVAS AAA REPR W/2-P PART                                    $974.56      20090101
34803       ENDOVAS AAA REPR W/3-P PART       80                           $199.59      20090101
34803       ENDOVAS AAA REPR W/3-P PART       81                           $199.59      20090101
34803       ENDOVAS AAA REPR W/3-P PART       82                           $199.59      20090101
34803       ENDOVAS AAA REPR W/3-P PART       AS                           $199.59      20090101
34803       ENDOVAS AAA REPR W/3-P PART                                    $997.95      20090101
34804       ENDOVAS AAA REPR W/1-P PART       80                           $194.47      20090101
34804       ENDOVAS AAA REPR W/1-P PART       81                           $194.47      20090101
34804       ENDOVAS AAA REPR W/1-P PART       82                           $194.47      20090101
34804       ENDOVAS AAA REPR W/1-P PART       AS                           $194.47      20090101
34804       ENDOVAS AAA REPR W/1-P PART                                    $972.33      20090101
34805       ENDOVAS AAA REPR W/LONG TUBE      80                           $183.95      20090101
34805       ENDOVAS AAA REPR W/LONG TUBE      81                           $183.95      20090101
34805       ENDOVAS AAA REPR W/LONG TUBE      82                           $183.95      20090101
34805       ENDOVAS AAA REPR W/LONG TUBE      AS                           $183.95      20090101


                                           Page 201
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
34805       ENDOVAS AAA REPR W/LONG TUBE                                   $919.75      20090101
34806       ANEURYSM PRESS SENSOR ADD-ON                                   $79.85       20090101
34808       ENDOVAS ILIAC A DEVICE ADDON      80                           $32.94       20090101
34808       ENDOVAS ILIAC A DEVICE ADDON      81                           $32.94       20090101
34808       ENDOVAS ILIAC A DEVICE ADDON      82                           $32.94       20090101
34808       ENDOVAS ILIAC A DEVICE ADDON      AS                            $32.94      20090101
34808       ENDOVAS ILIAC A DEVICE ADDON                                   $164.72      20090101
34812       XPOSE FOR ENDOPROSTH, FEMORL      80                            $54.92      20090101
34812       XPOSE FOR ENDOPROSTH, FEMORL      81                            $54.92      20090101
34812       XPOSE FOR ENDOPROSTH, FEMORL      82                            $54.92      20090101
34812       XPOSE FOR ENDOPROSTH, FEMORL      AS                            $54.92      20090101
34812       XPOSE FOR ENDOPROSTH, FEMORL                                   $274.59      20090101
34813       FEMORAL ENDOVAS GRAFT ADD-ON      80                           $37.94       20090101
34813       FEMORAL ENDOVAS GRAFT ADD-ON      81                           $37.94       20090101
34813       FEMORAL ENDOVAS GRAFT ADD-ON      82                           $37.94       20090101
34813       FEMORAL ENDOVAS GRAFT ADD-ON      AS                            $37.94      20090101
34813       FEMORAL ENDOVAS GRAFT ADD-ON                                   $189.72      20090101
34820       XPOSE FOR ENDOPROSTH, ILIAC       80                            $78.34      20090101
34820       XPOSE FOR ENDOPROSTH, ILIAC       81                            $78.34      20090101
34820       XPOSE FOR ENDOPROSTH, ILIAC       82                            $78.34      20090101
34820       XPOSE FOR ENDOPROSTH, ILIAC       AS                            $78.34      20090101
34820       XPOSE FOR ENDOPROSTH, ILIAC                                    $391.70      20090101
34825       ENDOVASC EXTEND PROSTH, INIT      80                           $109.34      20090101
34825       ENDOVASC EXTEND PROSTH, INIT      81                           $109.34      20090101
34825       ENDOVASC EXTEND PROSTH, INIT      82                           $109.34      20090101
34825       ENDOVASC EXTEND PROSTH, INIT      AS                           $109.34      20090101
34825       ENDOVASC EXTEND PROSTH, INIT                                   $546.69      20090101
34826       ENDOVASC EXTEN PROSTH, ADD?L      80                           $32.32       20090101
34826       ENDOVASC EXTEN PROSTH, ADD?L      81                           $32.32       20090101
34826       ENDOVASC EXTEN PROSTH, ADD?L      82                           $32.32       20090101
34826       ENDOVASC EXTEN PROSTH, ADD?L      AS                            $32.32      20090101
34826       ENDOVASC EXTEN PROSTH, ADD?L                                   $161.62      20090101
34830       OPEN AORTIC TUBE PROSTH REPR      80                           $287.50      20090101
34830       OPEN AORTIC TUBE PROSTH REPR      81                           $287.50      20090101
34830       OPEN AORTIC TUBE PROSTH REPR      82                           $287.50      20090101
34830       OPEN AORTIC TUBE PROSTH REPR      AS                           $287.50      20090101
34830       OPEN AORTIC TUBE PROSTH REPR                                  $1,437.51     20090101
34831       OPEN AORTOILIAC PROSTH REPR       80                           $301.86      20090101
34831       OPEN AORTOILIAC PROSTH REPR       81                           $301.86      20090101
34831       OPEN AORTOILIAC PROSTH REPR       82                           $301.86      20090101
34831       OPEN AORTOILIAC PROSTH REPR       AS                           $301.86      20090101
34831       OPEN AORTOILIAC PROSTH REPR                                   $1,509.29     20090101
34832       OPEN AORTOFEMOR PROSTH REPR       80                           $311.15      20090101
34832       OPEN AORTOFEMOR PROSTH REPR       81                           $311.15      20090101
34832       OPEN AORTOFEMOR PROSTH REPR       82                           $311.15      20090101


                                           Page 202
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
34832       OPEN AORTOFEMOR PROSTH REPR      AS                           $311.15      20090101
34832       OPEN AORTOFEMOR PROSTH REPR                                  $1,555.76     20090101
34833       XPOSE FOR ENDOPROSTH, ILIAC      80                            $97.60      20090101
34833       XPOSE FOR ENDOPROSTH, ILIAC      81                            $97.60      20090101
34833       XPOSE FOR ENDOPROSTH, ILIAC      82                            $97.60      20090101
34833       XPOSE FOR ENDOPROSTH, ILIAC      AS                            $97.60      20090101
34833       XPOSE FOR ENDOPROSTH, ILIAC                                   $488.00      20090101
34834       XPOSE, ENDOPROSTH, BRACHIAL      80                            $44.40      20090101
34834       XPOSE, ENDOPROSTH, BRACHIAL      81                            $44.40      20090101
34834       XPOSE, ENDOPROSTH, BRACHIAL      82                            $44.40      20090101
34834       XPOSE, ENDOPROSTH, BRACHIAL      AS                            $44.40      20090101
34834       XPOSE, ENDOPROSTH, BRACHIAL                                   $222.01      20090101
34900       ENDOVASC ILIAC REPR W/GRAFT      80                           $142.38      20090101
34900       ENDOVASC ILIAC REPR W/GRAFT      81                           $142.38      20090101
34900       ENDOVASC ILIAC REPR W/GRAFT      82                           $142.38      20090101
34900       ENDOVASC ILIAC REPR W/GRAFT      AS                           $142.38      20090101
34900       ENDOVASC ILIAC REPR W/GRAFT                                   $711.92      20090101
35001       REPAIR DEFECT OF ARTERY          80                           $178.83      20090101
35001       REPAIR DEFECT OF ARTERY          81                           $178.83      20090101
35001       REPAIR DEFECT OF ARTERY          82                           $178.83      20090101
35001       REPAIR DEFECT OF ARTERY          AS                           $178.83      20090101
35001       REPAIR DEFECT OF ARTERY                                       $894.14      20090101
35002       REPAIR ARTERY RUPTURE, NECK      80                           $187.68      20090101
35002       REPAIR ARTERY RUPTURE, NECK      81                           $187.68      20090101
35002       REPAIR ARTERY RUPTURE, NECK      82                           $187.68      20090101
35002       REPAIR ARTERY RUPTURE, NECK      AS                           $187.68      20090101
35002       REPAIR ARTERY RUPTURE, NECK                                   $938.38      20090101
35005       REPAIR DEFECT OF ARTERY          80                           $164.92      20090101
35005       REPAIR DEFECT OF ARTERY          81                           $164.92      20090101
35005       REPAIR DEFECT OF ARTERY          82                           $164.92      20090101
35005       REPAIR DEFECT OF ARTERY          AS                           $164.92      20090101
35005       REPAIR DEFECT OF ARTERY                                       $824.58      20090101
35011       REPAIR DEFECT OF ARTERY          80                           $156.85      20090101
35011       REPAIR DEFECT OF ARTERY          81                           $156.85      20090101
35011       REPAIR DEFECT OF ARTERY          82                           $156.85      20090101
35011       REPAIR DEFECT OF ARTERY          AS                           $156.85      20090101
35011       REPAIR DEFECT OF ARTERY                                       $784.27      20090101
35013       REPAIR ARTERY RUPTURE, ARM       80                           $194.30      20090101
35013       REPAIR ARTERY RUPTURE, ARM       81                           $194.30      20090101
35013       REPAIR ARTERY RUPTURE, ARM       82                           $194.30      20090101
35013       REPAIR ARTERY RUPTURE, ARM       AS                           $194.30      20090101
35013       REPAIR ARTERY RUPTURE, ARM                                    $971.50      20090101
35021       REPAIR DEFECT OF ARTERY          80                           $188.63      20090101
35021       REPAIR DEFECT OF ARTERY          81                           $188.63      20090101
35021       REPAIR DEFECT OF ARTERY          82                           $188.63      20090101


                                          Page 203
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
35021       REPAIR DEFECT OF ARTERY           AS                           $188.63      20090101
35021       REPAIR DEFECT OF ARTERY                                        $943.14      20090101
35022       REPAIR ARTERY RUPTURE, CHEST      80                           $217.06      20090101
35022       REPAIR ARTERY RUPTURE, CHEST      81                           $217.06      20090101
35022       REPAIR ARTERY RUPTURE, CHEST      82                           $217.06      20090101
35022       REPAIR ARTERY RUPTURE, CHEST      AS                           $217.06      20090101
35022       REPAIR ARTERY RUPTURE, CHEST                                  $1,085.30     20090101
35045       REPAIR DEFECT OF ARM ARTERY       80                           $151.79      20090101
35045       REPAIR DEFECT OF ARM ARTERY       81                           $151.79      20090101
35045       REPAIR DEFECT OF ARM ARTERY       82                           $151.79      20090101
35045       REPAIR DEFECT OF ARM ARTERY       AS                           $151.79      20090101
35045       REPAIR DEFECT OF ARM ARTERY                                    $758.97      20090101
35081       REPAIR DEFECT OF ARTERY           80                           $269.69      20090101
35081       REPAIR DEFECT OF ARTERY           81                           $269.69      20090101
35081       REPAIR DEFECT OF ARTERY           82                           $269.69      20090101
35081       REPAIR DEFECT OF ARTERY           AS                           $269.69      20090101
35081       REPAIR DEFECT OF ARTERY                                       $1,348.45     20090101
35082       REPAIR ARTERY RUPTURE, AORTA      80                           $341.69      20090101
35082       REPAIR ARTERY RUPTURE, AORTA      81                           $341.69      20090101
35082       REPAIR ARTERY RUPTURE, AORTA      82                           $341.69      20090101
35082       REPAIR ARTERY RUPTURE, AORTA      AS                           $341.69      20090101
35082       REPAIR ARTERY RUPTURE, AORTA                                  $1,708.47     20090101
35091       REPAIR DEFECT OF ARTERY           80                           $290.90      20090101
35091       REPAIR DEFECT OF ARTERY           81                           $290.90      20090101
35091       REPAIR DEFECT OF ARTERY           82                           $290.90      20090101
35091       REPAIR DEFECT OF ARTERY           AS                           $290.90      20090101
35091       REPAIR DEFECT OF ARTERY                                       $1,454.49     20090101
35092       REPAIR ARTERY RUPTURE, AORTA      80                           $407.80      20090101
35092       REPAIR ARTERY RUPTURE, AORTA      81                           $407.80      20090101
35092       REPAIR ARTERY RUPTURE, AORTA      82                           $407.80      20090101
35092       REPAIR ARTERY RUPTURE, AORTA      AS                           $407.80      20090101
35092       REPAIR ARTERY RUPTURE, AORTA                                  $2,039.00     20090101
35102       REPAIR DEFECT OF ARTERY           80                           $293.12      20090101
35102       REPAIR DEFECT OF ARTERY           81                           $293.12      20090101
35102       REPAIR DEFECT OF ARTERY           82                           $293.12      20090101
35102       REPAIR DEFECT OF ARTERY           AS                           $293.12      20090101
35102       REPAIR DEFECT OF ARTERY                                       $1,465.61     20090101
35103       REPAIR ARTERY RUPTURE, GROIN      80                           $353.33      20090101
35103       REPAIR ARTERY RUPTURE, GROIN      81                           $353.33      20090101
35103       REPAIR ARTERY RUPTURE, GROIN      82                           $353.33      20090101
35103       REPAIR ARTERY RUPTURE, GROIN      AS                           $353.33      20090101
35103       REPAIR ARTERY RUPTURE, GROIN                                  $1,766.64     20090101
35111       REPAIR DEFECT OF ARTERY           80                           $217.72      20090101
35111       REPAIR DEFECT OF ARTERY           81                           $217.72      20090101
35111       REPAIR DEFECT OF ARTERY           82                           $217.72      20090101


                                           Page 204
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
35111       REPAIR DEFECT OF ARTERY           AS                           $217.72      20090101
35111       REPAIR DEFECT OF ARTERY                                       $1,088.61     20090101
35112       REPAIR ARTERY RUPTURE,SPLEEN      80                           $264.53      20090101
35112       REPAIR ARTERY RUPTURE,SPLEEN      81                           $264.53      20090101
35112       REPAIR ARTERY RUPTURE,SPLEEN      82                           $264.53      20090101
35112       REPAIR ARTERY RUPTURE,SPLEEN      AS                           $264.53      20090101
35112       REPAIR ARTERY RUPTURE,SPLEEN                                  $1,322.63     20090101
35121       REPAIR DEFECT OF ARTERY           80                           $260.85      20090101
35121       REPAIR DEFECT OF ARTERY           81                           $260.85      20090101
35121       REPAIR DEFECT OF ARTERY           82                           $260.85      20090101
35121       REPAIR DEFECT OF ARTERY           AS                           $260.85      20090101
35121       REPAIR DEFECT OF ARTERY                                       $1,304.26     20090101
35122       REPAIR ARTERY RUPTURE, BELLY      80                           $306.97      20090101
35122       REPAIR ARTERY RUPTURE, BELLY      81                           $306.97      20090101
35122       REPAIR ARTERY RUPTURE, BELLY      82                           $306.97      20090101
35122       REPAIR ARTERY RUPTURE, BELLY      AS                           $306.97      20090101
35122       REPAIR ARTERY RUPTURE, BELLY                                  $1,534.85     20090101
35131       REPAIR DEFECT OF ARTERY           80                           $221.35      20090101
35131       REPAIR DEFECT OF ARTERY           81                           $221.35      20090101
35131       REPAIR DEFECT OF ARTERY           82                           $221.35      20090101
35131       REPAIR DEFECT OF ARTERY           AS                           $221.35      20090101
35131       REPAIR DEFECT OF ARTERY                                       $1,106.73     20090101
35132       REPAIR ARTERY RUPTURE, GROIN      80                           $267.53      20090101
35132       REPAIR ARTERY RUPTURE, GROIN      81                           $267.53      20090101
35132       REPAIR ARTERY RUPTURE, GROIN      82                           $267.53      20090101
35132       REPAIR ARTERY RUPTURE, GROIN      AS                           $267.53      20090101
35132       REPAIR ARTERY RUPTURE, GROIN                                  $1,337.63     20090101
35141       REPAIR DEFECT OF ARTERY           80                           $176.16      20090101
35141       REPAIR DEFECT OF ARTERY           81                           $176.16      20090101
35141       REPAIR DEFECT OF ARTERY           82                           $176.16      20090101
35141       REPAIR DEFECT OF ARTERY           AS                           $176.16      20090101
35141       REPAIR DEFECT OF ARTERY                                        $880.79      20090101
35142       REPAIR ARTERY RUPTURE, THIGH      80                           $209.77      20090101
35142       REPAIR ARTERY RUPTURE, THIGH      81                           $209.77      20090101
35142       REPAIR ARTERY RUPTURE, THIGH      82                           $209.77      20090101
35142       REPAIR ARTERY RUPTURE, THIGH      AS                           $209.77      20090101
35142       REPAIR ARTERY RUPTURE, THIGH                                  $1,048.87     20090101
35151       REPAIR DEFECT OF ARTERY           80                           $198.47      20090101
35151       REPAIR DEFECT OF ARTERY           81                           $198.47      20090101
35151       REPAIR DEFECT OF ARTERY           82                           $198.47      20090101
35151       REPAIR DEFECT OF ARTERY           AS                           $198.47      20090101
35151       REPAIR DEFECT OF ARTERY                                        $992.36      20090101
35152       REPAIR ARTERY RUPTURE, KNEE       80                           $230.30      20090101
35152       REPAIR ARTERY RUPTURE, KNEE       81                           $230.30      20090101
35152       REPAIR ARTERY RUPTURE, KNEE       82                           $230.30      20090101


                                           Page 205
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
35152       REPAIR ARTERY RUPTURE, KNEE      AS                           $230.30      20090101
35152       REPAIR ARTERY RUPTURE, KNEE                                  $1,151.49     20090101
35180       REPAIR BLOOD VESSEL LESION       80                           $125.80      20090101
35180       REPAIR BLOOD VESSEL LESION       81                           $125.80      20090101
35180       REPAIR BLOOD VESSEL LESION       82                           $125.80      20090101
35180       REPAIR BLOOD VESSEL LESION       AS                           $125.80      20090101
35180       REPAIR BLOOD VESSEL LESION                                    $629.02      20090101
35182       REPAIR BLOOD VESSEL LESION       80                           $265.75      20090101
35182       REPAIR BLOOD VESSEL LESION       81                           $265.75      20090101
35182       REPAIR BLOOD VESSEL LESION       82                           $265.75      20090101
35182       REPAIR BLOOD VESSEL LESION       AS                           $265.75      20090101
35182       REPAIR BLOOD VESSEL LESION                                   $1,328.73     20090101
35184       REPAIR BLOOD VESSEL LESION       80                           $159.41      20090101
35184       REPAIR BLOOD VESSEL LESION       81                           $159.41      20090101
35184       REPAIR BLOOD VESSEL LESION       82                           $159.41      20090101
35184       REPAIR BLOOD VESSEL LESION       AS                           $159.41      20090101
35184       REPAIR BLOOD VESSEL LESION                                    $797.05      20090101
35188       REPAIR BLOOD VESSEL LESION       80                           $134.49      20090101
35188       REPAIR BLOOD VESSEL LESION       81                           $134.49      20090101
35188       REPAIR BLOOD VESSEL LESION       82                           $134.49      20090101
35188       REPAIR BLOOD VESSEL LESION       AS                           $134.49      20090101
35188       REPAIR BLOOD VESSEL LESION                           Y        $699.00      20081209
35188       REPAIR BLOOD VESSEL LESION                                    $672.44      20090101
35189       REPAIR BLOOD VESSEL LESION       80                           $251.39      20090101
35189       REPAIR BLOOD VESSEL LESION       81                           $251.39      20090101
35189       REPAIR BLOOD VESSEL LESION       82                           $251.39      20090101
35189       REPAIR BLOOD VESSEL LESION       AS                           $251.39      20090101
35189       REPAIR BLOOD VESSEL LESION                                   $1,256.96     20090101
35190       REPAIR BLOOD VESSEL LESION       80                           $116.79      20090101
35190       REPAIR BLOOD VESSEL LESION       81                           $116.79      20090101
35190       REPAIR BLOOD VESSEL LESION       82                           $116.79      20090101
35190       REPAIR BLOOD VESSEL LESION       AS                           $116.79      20090101
35190       REPAIR BLOOD VESSEL LESION                                    $583.95      20090101
35201       REPAIR BLOOD VESSEL LESION       80                           $146.56      20090101
35201       REPAIR BLOOD VESSEL LESION       81                           $146.56      20090101
35201       REPAIR BLOOD VESSEL LESION       82                           $146.56      20090101
35201       REPAIR BLOOD VESSEL LESION       AS                           $146.56      20090101
35201       REPAIR BLOOD VESSEL LESION                                    $732.78      20090101
35206       REPAIR BLOOD VESSEL LESION       80                           $119.97      20090101
35206       REPAIR BLOOD VESSEL LESION       81                           $119.97      20090101
35206       REPAIR BLOOD VESSEL LESION       82                           $119.97      20090101
35206       REPAIR BLOOD VESSEL LESION       AS                           $119.97      20090101
35206       REPAIR BLOOD VESSEL LESION                                    $599.83      20090101
35207       REPAIR BLOOD VESSEL LESION       80                           $107.56      20090101
35207       REPAIR BLOOD VESSEL LESION       81                           $107.56      20090101


                                          Page 206
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
35207       REPAIR BLOOD VESSEL LESION      82                           $107.56      20090101
35207       REPAIR BLOOD VESSEL LESION      AS                           $107.56      20090101
35207       REPAIR BLOOD VESSEL LESION                                   $537.79      20090101
35207       REPAIR BLOOD VESSEL LESION                          Y        $699.00      20081209
35211       REPAIR BLOOD VESSEL LESION      80                           $210.72      20090101
35211       REPAIR BLOOD VESSEL LESION      81                           $210.72      20090101
35211       REPAIR BLOOD VESSEL LESION      82                           $210.72      20090101
35211       REPAIR BLOOD VESSEL LESION      AS                           $210.72      20090101
35211       REPAIR BLOOD VESSEL LESION                                  $1,053.58     20090101
35216       REPAIR BLOOD VESSEL LESION      80                           $280.43      20090101
35216       REPAIR BLOOD VESSEL LESION      81                           $280.43      20090101
35216       REPAIR BLOOD VESSEL LESION      82                           $280.43      20090101
35216       REPAIR BLOOD VESSEL LESION      AS                           $280.43      20090101
35216       REPAIR BLOOD VESSEL LESION                                  $1,402.17     20090101
35221       REPAIR BLOOD VESSEL LESION      80                           $217.28      20090101
35221       REPAIR BLOOD VESSEL LESION      81                           $217.28      20090101
35221       REPAIR BLOOD VESSEL LESION      82                           $217.28      20090101
35221       REPAIR BLOOD VESSEL LESION      AS                           $217.28      20090101
35221       REPAIR BLOOD VESSEL LESION                                  $1,086.39     20090101
35226       REPAIR BLOOD VESSEL LESION      80                           $132.76      20090101
35226       REPAIR BLOOD VESSEL LESION      81                           $132.76      20090101
35226       REPAIR BLOOD VESSEL LESION      82                           $132.76      20090101
35226       REPAIR BLOOD VESSEL LESION      AS                           $132.76      20090101
35226       REPAIR BLOOD VESSEL LESION                                   $663.80      20090101
35231       REPAIR BLOOD VESSEL LESION      80                           $182.06      20090101
35231       REPAIR BLOOD VESSEL LESION      81                           $182.06      20090101
35231       REPAIR BLOOD VESSEL LESION      82                           $182.06      20090101
35231       REPAIR BLOOD VESSEL LESION      AS                           $182.06      20090101
35231       REPAIR BLOOD VESSEL LESION                                   $910.28      20090101
35236       REPAIR BLOOD VESSEL LESION      80                           $152.79      20090101
35236       REPAIR BLOOD VESSEL LESION      81                           $152.79      20090101
35236       REPAIR BLOOD VESSEL LESION      82                           $152.79      20090101
35236       REPAIR BLOOD VESSEL LESION      AS                           $152.79      20090101
35236       REPAIR BLOOD VESSEL LESION                                   $763.93      20090101
35241       REPAIR BLOOD VESSEL LESION      80                           $220.39      20090101
35241       REPAIR BLOOD VESSEL LESION      81                           $220.39      20090101
35241       REPAIR BLOOD VESSEL LESION      82                           $220.39      20090101
35241       REPAIR BLOOD VESSEL LESION      AS                           $220.39      20090101
35241       REPAIR BLOOD VESSEL LESION                                  $1,101.96     20090101
35246       REPAIR BLOOD VESSEL LESION      80                           $238.04      20090101
35246       REPAIR BLOOD VESSEL LESION      81                           $238.04      20090101
35246       REPAIR BLOOD VESSEL LESION      82                           $238.04      20090101
35246       REPAIR BLOOD VESSEL LESION      AS                           $238.04      20090101
35246       REPAIR BLOOD VESSEL LESION                                  $1,190.20     20090101
35251       REPAIR BLOOD VESSEL LESION      80                           $259.24      20090101


                                         Page 207
Proc Code   Description                     Modifier 1 Modifier 2 ASC     Price     Effective Date
35251       REPAIR BLOOD VESSEL LESION      81                           $259.24      20090101
35251       REPAIR BLOOD VESSEL LESION      82                           $259.24      20090101
35251       REPAIR BLOOD VESSEL LESION      AS                           $259.24      20090101
35251       REPAIR BLOOD VESSEL LESION                                  $1,296.18     20090101
35256       REPAIR BLOOD VESSEL LESION      80                           $161.19      20090101
35256       REPAIR BLOOD VESSEL LESION      81                           $161.19      20090101
35256       REPAIR BLOOD VESSEL LESION      82                           $161.19      20090101
35256       REPAIR BLOOD VESSEL LESION      AS                           $161.19      20090101
35256       REPAIR BLOOD VESSEL LESION                                   $805.95      20090101
35261       REPAIR BLOOD VESSEL LESION      80                           $161.30      20090101
35261       REPAIR BLOOD VESSEL LESION      81                           $161.30      20090101
35261       REPAIR BLOOD VESSEL LESION      82                           $161.30      20090101
35261       REPAIR BLOOD VESSEL LESION      AS                           $161.30      20090101
35261       REPAIR BLOOD VESSEL LESION                                   $806.52      20090101
35266       REPAIR BLOOD VESSEL LESION      80                           $134.04      20090101
35266       REPAIR BLOOD VESSEL LESION      81                           $134.04      20090101
35266       REPAIR BLOOD VESSEL LESION      82                           $134.04      20090101
35266       REPAIR BLOOD VESSEL LESION      AS                           $134.04      20090101
35266       REPAIR BLOOD VESSEL LESION                                   $670.21      20090101
35271       REPAIR BLOOD VESSEL LESION      80                           $210.11      20090101
35271       REPAIR BLOOD VESSEL LESION      81                           $210.11      20090101
35271       REPAIR BLOOD VESSEL LESION      82                           $210.11      20090101
35271       REPAIR BLOOD VESSEL LESION      AS                           $210.11      20090101
35271       REPAIR BLOOD VESSEL LESION                                  $1,050.53     20090101
35276       REPAIR BLOOD VESSEL LESION      80                           $220.95      20090101
35276       REPAIR BLOOD VESSEL LESION      81                           $220.95      20090101
35276       REPAIR BLOOD VESSEL LESION      82                           $220.95      20090101
35276       REPAIR BLOOD VESSEL LESION      AS                           $220.95      20090101
35276       REPAIR BLOOD VESSEL LESION                                  $1,104.76     20090101
35281       REPAIR BLOOD VESSEL LESION      80                           $247.04      20090101
35281       REPAIR BLOOD VESSEL LESION      81                           $247.04      20090101
35281       REPAIR BLOOD VESSEL LESION      82                           $247.04      20090101
35281       REPAIR BLOOD VESSEL LESION      AS                           $247.04      20090101
35281       REPAIR BLOOD VESSEL LESION                                  $1,235.22     20090101
35286       REPAIR BLOOD VESSEL LESION      80                           $147.95      20090101
35286       REPAIR BLOOD VESSEL LESION      81                           $147.95      20090101
35286       REPAIR BLOOD VESSEL LESION      82                           $147.95      20090101
35286       REPAIR BLOOD VESSEL LESION      AS                           $147.95      20090101
35286       REPAIR BLOOD VESSEL LESION                                   $739.77      20090101
35301       RECHANNELING OF ARTERY          80                           $165.64      20090101
35301       RECHANNELING OF ARTERY          81                           $165.64      20090101
35301       RECHANNELING OF ARTERY          82                           $165.64      20090101
35301       RECHANNELING OF ARTERY          AS                           $165.64      20090101
35301       RECHANNELING OF ARTERY                                       $828.21      20090101
35302       RECHANNELING OF ARTERY          80                           $173.38      20090101


                                         Page 208
Proc Code   Description                 Modifier 1 Modifier 2 ASC     Price     Effective Date
35302       RECHANNELING OF ARTERY      81                           $173.38      20090101
35302       RECHANNELING OF ARTERY      82                           $173.38      20090101
35302       RECHANNELING OF ARTERY      AS                           $173.38      20090101
35302       RECHANNELING OF ARTERY                                   $866.90      20090101
35303       RECHANNELING OF ARTERY      80                           $190.52      20090101
35303       RECHANNELING OF ARTERY      81                           $190.52      20090101
35303       RECHANNELING OF ARTERY      82                           $190.52      20090101
35303       RECHANNELING OF ARTERY      AS                           $190.52      20090101
35303       RECHANNELING OF ARTERY                                   $952.58      20090101
35304       RECHANNELING OF ARTERY      80                           $198.31      20090101
35304       RECHANNELING OF ARTERY      81                           $198.31      20090101
35304       RECHANNELING OF ARTERY      82                           $198.31      20090101
35304       RECHANNELING OF ARTERY      AS                           $198.31      20090101
35304       RECHANNELING OF ARTERY                                   $991.53      20090101
35305       RECHANNELING OF ARTERY      80                           $190.52      20090101
35305       RECHANNELING OF ARTERY      81                           $190.52      20090101
35305       RECHANNELING OF ARTERY      82                           $190.52      20090101
35305       RECHANNELING OF ARTERY      AS                           $190.52      20090101
35305       RECHANNELING OF ARTERY                                   $952.58      20090101
35306       RECHANNELING OF ARTERY      80                            $71.61      20090101
35306       RECHANNELING OF ARTERY      81                            $71.61      20090101
35306       RECHANNELING OF ARTERY      82                            $71.61      20090101
35306       RECHANNELING OF ARTERY      AS                            $71.61      20090101
35306       RECHANNELING OF ARTERY                                   $358.06      20090101
35311       RECHANNELING OF ARTERY      80                           $237.20      20090101
35311       RECHANNELING OF ARTERY      81                           $237.20      20090101
35311       RECHANNELING OF ARTERY      82                           $237.20      20090101
35311       RECHANNELING OF ARTERY      AS                           $237.20      20090101
35311       RECHANNELING OF ARTERY                                  $1,186.01     20090101
35321       RECHANNELING OF ARTERY      80                           $141.00      20090101
35321       RECHANNELING OF ARTERY      81                           $141.00      20090101
35321       RECHANNELING OF ARTERY      82                           $141.00      20090101
35321       RECHANNELING OF ARTERY      AS                           $141.00      20090101
35321       RECHANNELING OF ARTERY                                   $704.99      20090101
35331       RECHANNELING OF ARTERY      80                           $230.74      20090101
35331       RECHANNELING OF ARTERY      81                           $230.74      20090101
35331       RECHANNELING OF ARTERY      82                           $230.74      20090101
35331       RECHANNELING OF ARTERY      AS                           $230.74      20090101
35331       RECHANNELING OF ARTERY                                  $1,153.71     20090101
35341       RECHANNELING OF ARTERY      80                           $219.45      20090101
35341       RECHANNELING OF ARTERY      81                           $219.45      20090101
35341       RECHANNELING OF ARTERY      82                           $219.45      20090101
35341       RECHANNELING OF ARTERY      AS                           $219.45      20090101
35341       RECHANNELING OF ARTERY                                  $1,097.26     20090101
35351       RECHANNELING OF ARTERY      80                           $203.09      20090101


                                     Page 209
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
35351       RECHANNELING OF ARTERY           81                           $203.09      20090101
35351       RECHANNELING OF ARTERY           82                           $203.09      20090101
35351       RECHANNELING OF ARTERY           AS                           $203.09      20090101
35351       RECHANNELING OF ARTERY                                       $1,015.44     20090101
35355       RECHANNELING OF ARTERY           80                           $165.09      20090101
35355       RECHANNELING OF ARTERY           81                           $165.09      20090101
35355       RECHANNELING OF ARTERY           82                           $165.09      20090101
35355       RECHANNELING OF ARTERY           AS                           $165.09      20090101
35355       RECHANNELING OF ARTERY                                        $825.46      20090101
35361       RECHANNELING OF ARTERY           80                           $249.89      20090101
35361       RECHANNELING OF ARTERY           81                           $249.89      20090101
35361       RECHANNELING OF ARTERY           82                           $249.89      20090101
35361       RECHANNELING OF ARTERY           AS                           $249.89      20090101
35361       RECHANNELING OF ARTERY                                       $1,249.45     20090101
35363       RECHANNELING OF ARTERY           80                           $267.46      20090101
35363       RECHANNELING OF ARTERY           81                           $267.46      20090101
35363       RECHANNELING OF ARTERY           82                           $267.46      20090101
35363       RECHANNELING OF ARTERY           AS                           $267.46      20090101
35363       RECHANNELING OF ARTERY                                       $1,337.32     20090101
35371       RECHANNELING OF ARTERY           80                           $130.81      20090101
35371       RECHANNELING OF ARTERY           81                           $130.81      20090101
35371       RECHANNELING OF ARTERY           82                           $130.81      20090101
35371       RECHANNELING OF ARTERY           AS                           $130.81      20090101
35371       RECHANNELING OF ARTERY                                        $654.07      20090101
35372       RECHANNELING OF ARTERY           80                           $157.02      20090101
35372       RECHANNELING OF ARTERY           81                           $157.02      20090101
35372       RECHANNELING OF ARTERY           82                           $157.02      20090101
35372       RECHANNELING OF ARTERY           AS                           $157.02      20090101
35372       RECHANNELING OF ARTERY                                        $785.10      20090101
35390       REOPERATION, CAROTID ADD-ON      80                           $25.54       20090101
35390       REOPERATION, CAROTID ADD-ON      81                           $25.54       20090101
35390       REOPERATION, CAROTID ADD-ON      82                           $25.54       20090101
35390       REOPERATION, CAROTID ADD-ON      AS                            $25.54      20090101
35390       REOPERATION, CAROTID ADD-ON                                   $127.72      20090101
35400       ANGIOSCOPY                                                    $120.74      20090101
35450       REPAIR ARTERIAL BLOCKAGE         80                           $81.07       20090101
35450       REPAIR ARTERIAL BLOCKAGE         81                           $81.07       20090101
35450       REPAIR ARTERIAL BLOCKAGE         82                           $81.07       20090101
35450       REPAIR ARTERIAL BLOCKAGE         AS                            $81.07      20090101
35450       REPAIR ARTERIAL BLOCKAGE                                      $405.36      20090101
35452       REPAIR ARTERIAL BLOCKAGE         80                           $56.58       20090101
35452       REPAIR ARTERIAL BLOCKAGE         81                           $56.58       20090101
35452       REPAIR ARTERIAL BLOCKAGE         82                           $56.58       20090101
35452       REPAIR ARTERIAL BLOCKAGE         AS                            $56.58      20090101
35452       REPAIR ARTERIAL BLOCKAGE                                      $282.92      20090101


                                          Page 210
Proc Code   Description                   Modifier 1 Modifier 2 ASC    Price    Effective Date
35454       REPAIR ARTERIAL BLOCKAGE      80                          $49.74      20090101
35454       REPAIR ARTERIAL BLOCKAGE      81                          $49.74      20090101
35454       REPAIR ARTERIAL BLOCKAGE      82                          $49.74      20090101
35454       REPAIR ARTERIAL BLOCKAGE      AS                           $49.74     20090101
35454       REPAIR ARTERIAL BLOCKAGE                                  $248.71     20090101
35456       REPAIR ARTERIAL BLOCKAGE      80                          $60.21      20090101
35456       REPAIR ARTERIAL BLOCKAGE      81                          $60.21      20090101
35456       REPAIR ARTERIAL BLOCKAGE      82                          $60.21      20090101
35456       REPAIR ARTERIAL BLOCKAGE      AS                           $60.21     20090101
35456       REPAIR ARTERIAL BLOCKAGE                                  $301.03     20090101
35458       REPAIR ARTERIAL BLOCKAGE      80                          $77.23      20090101
35458       REPAIR ARTERIAL BLOCKAGE      81                          $77.23      20090101
35458       REPAIR ARTERIAL BLOCKAGE      82                          $77.23      20090101
35458       REPAIR ARTERIAL BLOCKAGE      AS                           $77.23     20090101
35458       REPAIR ARTERIAL BLOCKAGE                                  $386.16     20090101
35459       REPAIR ARTERIAL BLOCKAGE      80                          $70.89      20090101
35459       REPAIR ARTERIAL BLOCKAGE      81                          $70.89      20090101
35459       REPAIR ARTERIAL BLOCKAGE      82                          $70.89      20090101
35459       REPAIR ARTERIAL BLOCKAGE      AS                           $70.89     20090101
35459       REPAIR ARTERIAL BLOCKAGE                                  $354.44     20090101
35460       REPAIR VENOUS BLOCKAGE        80                          $49.36      20090101
35460       REPAIR VENOUS BLOCKAGE        81                          $49.36      20090101
35460       REPAIR VENOUS BLOCKAGE        82                          $49.36      20090101
35460       REPAIR VENOUS BLOCKAGE        AS                           $49.36     20090101
35460       REPAIR VENOUS BLOCKAGE                                    $246.80     20090101
35470       REPAIR ARTERIAL BLOCKAGE      80                          $469.44     20090101
35470       REPAIR ARTERIAL BLOCKAGE      81                          $469.44     20090101
35470       REPAIR ARTERIAL BLOCKAGE      82                          $469.44     20090101
35470       REPAIR ARTERIAL BLOCKAGE      AS                          $469.44     20090101
35470       REPAIR ARTERIAL BLOCKAGE                                  $353.59     20090101
35471       REPAIR ARTERIAL BLOCKAGE      80                          $522.53     20090101
35471       REPAIR ARTERIAL BLOCKAGE      81                          $522.53     20090101
35471       REPAIR ARTERIAL BLOCKAGE      82                          $522.53     20090101
35471       REPAIR ARTERIAL BLOCKAGE      AS                          $522.53     20090101
35471       REPAIR ARTERIAL BLOCKAGE                                  $418.41     20090101
35472       REPAIR ARTERIAL BLOCKAGE      80                          $353.05     20090101
35472       REPAIR ARTERIAL BLOCKAGE      81                          $353.05     20090101
35472       REPAIR ARTERIAL BLOCKAGE      82                          $353.05     20090101
35472       REPAIR ARTERIAL BLOCKAGE      AS                          $353.05     20090101
35472       REPAIR ARTERIAL BLOCKAGE                                  $285.43     20090101
35473       REPAIR ARTERIAL BLOCKAGE      80                          $332.51     20090101
35473       REPAIR ARTERIAL BLOCKAGE      81                          $332.51     20090101
35473       REPAIR ARTERIAL BLOCKAGE      82                          $332.51     20090101
35473       REPAIR ARTERIAL BLOCKAGE      AS                          $332.51     20090101
35473       REPAIR ARTERIAL BLOCKAGE                                  $250.38     20090101


                                       Page 211
Proc Code   Description                   Modifier 1 Modifier 2 ASC    Price    Effective Date
35474       REPAIR ARTERIAL BLOCKAGE      80                          $456.42     20090101
35474       REPAIR ARTERIAL BLOCKAGE      81                          $456.42     20090101
35474       REPAIR ARTERIAL BLOCKAGE      82                          $456.42     20090101
35474       REPAIR ARTERIAL BLOCKAGE      AS                          $456.42     20090101
35474       REPAIR ARTERIAL BLOCKAGE                                  $302.13     20090101
35475       REPAIR ARTERIAL BLOCKAGE      80                          $347.81     20090101
35475       REPAIR ARTERIAL BLOCKAGE      81                          $347.81     20090101
35475       REPAIR ARTERIAL BLOCKAGE      82                          $347.81     20090101
35475       REPAIR ARTERIAL BLOCKAGE      AS                          $347.81     20090101
35475       REPAIR ARTERIAL BLOCKAGE                                  $377.52     20090101
35476       REPAIR VENOUS BLOCKAGE        80                          $263.36     20090101
35476       REPAIR VENOUS BLOCKAGE        81                          $263.36     20090101
35476       REPAIR VENOUS BLOCKAGE        82                          $263.36     20090101
35476       REPAIR VENOUS BLOCKAGE        AS                          $263.36     20090101
35476       REPAIR VENOUS BLOCKAGE                                    $240.92     20090101
35480       ATHERECTOMY, OPEN             80                          $91.14      20090101
35480       ATHERECTOMY, OPEN             81                          $91.14      20090101
35480       ATHERECTOMY, OPEN             82                          $91.14      20090101
35480       ATHERECTOMY, OPEN             AS                           $91.14     20090101
35480       ATHERECTOMY, OPEN                                         $455.71     20090101
35481       ATHERECTOMY, OPEN             80                          $63.71      20090101
35481       ATHERECTOMY, OPEN             81                          $63.71      20090101
35481       ATHERECTOMY, OPEN             82                          $63.71      20090101
35481       ATHERECTOMY, OPEN             AS                           $63.71     20090101
35481       ATHERECTOMY, OPEN                                         $318.57     20090101
35482       ATHERECTOMY, OPEN             80                          $54.64      20090101
35482       ATHERECTOMY, OPEN             81                          $54.64      20090101
35482       ATHERECTOMY, OPEN             82                          $54.64      20090101
35482       ATHERECTOMY, OPEN             AS                           $54.64     20090101
35482       ATHERECTOMY, OPEN                                         $273.19     20090101
35483       ATHERECTOMY, OPEN             80                          $66.93      20090101
35483       ATHERECTOMY, OPEN             81                          $66.93      20090101
35483       ATHERECTOMY, OPEN             82                          $66.93      20090101
35483       ATHERECTOMY, OPEN             AS                           $66.93     20090101
35483       ATHERECTOMY, OPEN                                         $334.67     20090101
35484       ATHERECTOMY, OPEN             80                          $83.63      20090101
35484       ATHERECTOMY, OPEN             81                          $83.63      20090101
35484       ATHERECTOMY, OPEN             82                          $83.63      20090101
35484       ATHERECTOMY, OPEN             AS                           $83.63     20090101
35484       ATHERECTOMY, OPEN                                         $418.14     20090101
35485       ATHERECTOMY, OPEN             80                          $78.07      20090101
35485       ATHERECTOMY, OPEN             81                          $78.07      20090101
35485       ATHERECTOMY, OPEN             82                          $78.07      20090101
35485       ATHERECTOMY, OPEN             AS                           $78.07     20090101
35485       ATHERECTOMY, OPEN                                         $390.35     20090101


                                       Page 212
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
35490       ATHERECTOMY, PERCUTANEOUS                                   $464.88      20090101
35491       ATHERECTOMY, PERCUTANEOUS                                   $331.34      20090101
35492       ATHERECTOMY, PERCUTANEOUS                                   $289.61      20090101
35493       ATHERECTOMY, PERCUTANEOUS                                   $348.60      20090101
35494       ATHERECTOMY, PERCUTANEOUS                                   $440.12      20090101
35495       ATHERECTOMY, PERCUTANEOUS                                   $405.91      20090101
35500       HARVEST VEIN FOR BYPASS        80                           $51.08       20090101
35500       HARVEST VEIN FOR BYPASS        81                           $51.08       20090101
35500       HARVEST VEIN FOR BYPASS        82                           $51.08       20090101
35500       HARVEST VEIN FOR BYPASS        AS                            $51.08      20090101
35500       HARVEST VEIN FOR BYPASS                                     $255.39      20090101
35501       ARTERY BYPASS GRAFT            80                           $238.48      20090101
35501       ARTERY BYPASS GRAFT            81                           $238.48      20090101
35501       ARTERY BYPASS GRAFT            82                           $238.48      20090101
35501       ARTERY BYPASS GRAFT            AS                           $238.48      20090101
35501       ARTERY BYPASS GRAFT                                        $1,192.42     20090101
35506       ARTERY BYPASS GRAFT            80                           $205.82      20090101
35506       ARTERY BYPASS GRAFT            81                           $205.82      20090101
35506       ARTERY BYPASS GRAFT            82                           $205.82      20090101
35506       ARTERY BYPASS GRAFT            AS                           $205.82      20090101
35506       ARTERY BYPASS GRAFT                                        $1,029.10     20090101
35508       ARTERY BYPASS GRAFT            80                           $210.77      20090101
35508       ARTERY BYPASS GRAFT            81                           $210.77      20090101
35508       ARTERY BYPASS GRAFT            82                           $210.77      20090101
35508       ARTERY BYPASS GRAFT            AS                           $210.77      20090101
35508       ARTERY BYPASS GRAFT                                        $1,053.84     20090101
35509       ARTERY BYPASS GRAFT            80                           $231.97      20090101
35509       ARTERY BYPASS GRAFT            81                           $231.97      20090101
35509       ARTERY BYPASS GRAFT            82                           $231.97      20090101
35509       ARTERY BYPASS GRAFT            AS                           $231.97      20090101
35509       ARTERY BYPASS GRAFT                                        $1,159.87     20090101
35510       ARTERY BYPASS GRAFT            80                           $196.69      20090101
35510       ARTERY BYPASS GRAFT            81                           $196.69      20090101
35510       ARTERY BYPASS GRAFT            82                           $196.69      20090101
35510       ARTERY BYPASS GRAFT            AS                           $196.69      20090101
35510       ARTERY BYPASS GRAFT                                         $983.46      20090101
35511       ARTERY BYPASS GRAFT            80                           $186.62      20090101
35511       ARTERY BYPASS GRAFT            81                           $186.62      20090101
35511       ARTERY BYPASS GRAFT            82                           $186.62      20090101
35511       ARTERY BYPASS GRAFT            AS                           $186.62      20090101
35511       ARTERY BYPASS GRAFT                                         $933.10      20090101
35512       ARTERY BYPASS GRAFT            80                           $192.80      20090101
35512       ARTERY BYPASS GRAFT            81                           $192.80      20090101
35512       ARTERY BYPASS GRAFT            82                           $192.80      20090101
35512       ARTERY BYPASS GRAFT            AS                           $192.80      20090101


                                        Page 213
Proc Code   Description              Modifier 1 Modifier 2 ASC     Price     Effective Date
35512       ARTERY BYPASS GRAFT                                   $964.00      20090101
35515       ARTERY BYPASS GRAFT      80                           $211.21      20090101
35515       ARTERY BYPASS GRAFT      81                           $211.21      20090101
35515       ARTERY BYPASS GRAFT      82                           $211.21      20090101
35515       ARTERY BYPASS GRAFT      AS                           $211.21      20090101
35515       ARTERY BYPASS GRAFT                                  $1,056.06     20090101
35516       ARTERY BYPASS GRAFT      80                           $186.85      20090101
35516       ARTERY BYPASS GRAFT      81                           $186.85      20090101
35516       ARTERY BYPASS GRAFT      82                           $186.85      20090101
35516       ARTERY BYPASS GRAFT      AS                           $186.85      20090101
35516       ARTERY BYPASS GRAFT                                   $934.24      20090101
35518       ARTERY BYPASS GRAFT      80                           $187.79      20090101
35518       ARTERY BYPASS GRAFT      81                           $187.79      20090101
35518       ARTERY BYPASS GRAFT      82                           $187.79      20090101
35518       ARTERY BYPASS GRAFT      AS                           $187.79      20090101
35518       ARTERY BYPASS GRAFT                                   $938.95      20090101
35521       ARTERY BYPASS GRAFT      80                           $200.42      20090101
35521       ARTERY BYPASS GRAFT      81                           $200.42      20090101
35521       ARTERY BYPASS GRAFT      82                           $200.42      20090101
35521       ARTERY BYPASS GRAFT      AS                           $200.42      20090101
35521       ARTERY BYPASS GRAFT                                  $1,002.09     20090101
35522       ARTERY BYPASS GRAFT      80                           $187.79      20090101
35522       ARTERY BYPASS GRAFT      81                           $187.79      20090101
35522       ARTERY BYPASS GRAFT      82                           $187.79      20090101
35522       ARTERY BYPASS GRAFT      AS                           $187.79      20090101
35522       ARTERY BYPASS GRAFT                                   $938.95      20090101
35523       ARTERY BYPASS GRAFT      80                           $196.74      20090101
35523       ARTERY BYPASS GRAFT                                   $983.75      20090101
35525       ARTERY BYPASS GRAFT      80                           $177.61      20090101
35525       ARTERY BYPASS GRAFT      81                           $177.61      20090101
35525       ARTERY BYPASS GRAFT      82                           $177.61      20090101
35525       ARTERY BYPASS GRAFT      AS                           $177.61      20090101
35525       ARTERY BYPASS GRAFT                                   $888.03      20090101
35526       ARTERY BYPASS GRAFT      80                           $269.19      20090101
35526       ARTERY BYPASS GRAFT      81                           $269.19      20090101
35526       ARTERY BYPASS GRAFT      82                           $269.19      20090101
35526       ARTERY BYPASS GRAFT      AS                           $269.19      20090101
35526       ARTERY BYPASS GRAFT                                  $1,345.97     20090101
35531       ARTERY BYPASS GRAFT      80                           $317.93      20090101
35531       ARTERY BYPASS GRAFT      81                           $317.93      20090101
35531       ARTERY BYPASS GRAFT      82                           $317.93      20090101
35531       ARTERY BYPASS GRAFT      AS                           $317.93      20090101
35531       ARTERY BYPASS GRAFT                                  $1,589.66     20090101
35533       ARTERY BYPASS GRAFT      80                           $246.22      20090101
35533       ARTERY BYPASS GRAFT      81                           $246.22      20090101


                                  Page 214
Proc Code   Description              Modifier 1 Modifier 2 ASC     Price     Effective Date
35533       ARTERY BYPASS GRAFT      82                           $246.22      20090101
35533       ARTERY BYPASS GRAFT      AS                           $246.22      20090101
35533       ARTERY BYPASS GRAFT                                  $1,231.08     20090101
35536       ARTERY BYPASS GRAFT      80                           $275.14      20090101
35536       ARTERY BYPASS GRAFT      81                           $275.14      20090101
35536       ARTERY BYPASS GRAFT      82                           $275.14      20090101
35536       ARTERY BYPASS GRAFT      AS                           $275.14      20090101
35536       ARTERY BYPASS GRAFT                                  $1,375.72     20090101
35537       ARTERY BYPASS GRAFT      80                           $337.02      20090101
35537       ARTERY BYPASS GRAFT      81                           $337.02      20090101
35537       ARTERY BYPASS GRAFT      82                           $337.02      20090101
35537       ARTERY BYPASS GRAFT      AS                           $337.02      20090101
35537       ARTERY BYPASS GRAFT                                  $1,685.08     20090101
35538       ARTERY BYPASS GRAFT      80                           $376.47      20090101
35538       ARTERY BYPASS GRAFT      81                           $376.47      20090101
35538       ARTERY BYPASS GRAFT      82                           $376.47      20090101
35538       ARTERY BYPASS GRAFT      AS                           $376.47      20090101
35538       ARTERY BYPASS GRAFT                                  $1,882.35     20090101
35539       ARTERY BYPASS GRAFT      80                           $353.15      20090101
35539       ARTERY BYPASS GRAFT      81                           $353.15      20090101
35539       ARTERY BYPASS GRAFT      82                           $353.15      20090101
35539       ARTERY BYPASS GRAFT      AS                           $353.15      20090101
35539       ARTERY BYPASS GRAFT                                  $1,765.76     20090101
35540       ARTERY BYPASS GRAFT                                  $1,969.16     20090101
35548       ARTERY BYPASS GRAFT      80                           $189.90      20090101
35548       ARTERY BYPASS GRAFT      81                           $189.90      20090101
35548       ARTERY BYPASS GRAFT      82                           $189.90      20090101
35548       ARTERY BYPASS GRAFT      AS                           $189.90      20090101
35548       ARTERY BYPASS GRAFT                                   $949.51      20090101
35549       ARTERY BYPASS GRAFT      80                           $206.99      20090101
35549       ARTERY BYPASS GRAFT      81                           $206.99      20090101
35549       ARTERY BYPASS GRAFT      82                           $206.99      20090101
35549       ARTERY BYPASS GRAFT      AS                           $206.99      20090101
35549       ARTERY BYPASS GRAFT                                  $1,034.95     20090101
35551       ARTERY BYPASS GRAFT      80                           $233.20      20090101
35551       ARTERY BYPASS GRAFT      81                           $233.20      20090101
35551       ARTERY BYPASS GRAFT      82                           $233.20      20090101
35551       ARTERY BYPASS GRAFT      AS                           $233.20      20090101
35551       ARTERY BYPASS GRAFT                                  $1,165.98     20090101
35556       ARTERY BYPASS GRAFT      80                           $216.45      20090101
35556       ARTERY BYPASS GRAFT      81                           $216.45      20090101
35556       ARTERY BYPASS GRAFT      82                           $216.45      20090101
35556       ARTERY BYPASS GRAFT      AS                           $216.45      20090101
35556       ARTERY BYPASS GRAFT                                  $1,082.25     20090101
35558       ARTERY BYPASS GRAFT      80                           $193.13      20090101


                                  Page 215
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
35558       ARTERY BYPASS GRAFT               81                           $193.13      20090101
35558       ARTERY BYPASS GRAFT               82                           $193.13      20090101
35558       ARTERY BYPASS GRAFT               AS                           $193.13      20090101
35558       ARTERY BYPASS GRAFT                                            $965.66      20090101
35560       ARTERY BYPASS GRAFT               80                           $281.65      20090101
35560       ARTERY BYPASS GRAFT               81                           $281.65      20090101
35560       ARTERY BYPASS GRAFT               82                           $281.65      20090101
35560       ARTERY BYPASS GRAFT               AS                           $281.65      20090101
35560       ARTERY BYPASS GRAFT                                           $1,408.27     20090101
35563       ARTERY BYPASS GRAFT               80                           $218.17      20090101
35563       ARTERY BYPASS GRAFT               81                           $218.17      20090101
35563       ARTERY BYPASS GRAFT               82                           $218.17      20090101
35563       ARTERY BYPASS GRAFT               AS                           $218.17      20090101
35563       ARTERY BYPASS GRAFT                                           $1,090.84     20090101
35565       ARTERY BYPASS GRAFT               80                           $208.38      20090101
35565       ARTERY BYPASS GRAFT               81                           $208.38      20090101
35565       ARTERY BYPASS GRAFT               82                           $208.38      20090101
35565       ARTERY BYPASS GRAFT               AS                           $208.38      20090101
35565       ARTERY BYPASS GRAFT                                           $1,041.88     20090101
35566       ARTERY BYPASS GRAFT               80                           $259.68      20090101
35566       ARTERY BYPASS GRAFT               81                           $259.68      20090101
35566       ARTERY BYPASS GRAFT               82                           $259.68      20090101
35566       ARTERY BYPASS GRAFT               AS                           $259.68      20090101
35566       ARTERY BYPASS GRAFT                                           $1,298.41     20090101
35571       ARTERY BYPASS GRAFT               80                           $213.05      20090101
35571       ARTERY BYPASS GRAFT               81                           $213.05      20090101
35571       ARTERY BYPASS GRAFT               82                           $213.05      20090101
35571       ARTERY BYPASS GRAFT               AS                           $213.05      20090101
35571       ARTERY BYPASS GRAFT                                           $1,065.27     20090101
35572       HARVEST FEMOROPOPLITEAL VEIN      80                            $54.97      20090101
35572       HARVEST FEMOROPOPLITEAL VEIN      81                            $54.97      20090101
35572       HARVEST FEMOROPOPLITEAL VEIN      82                            $54.97      20090101
35572       HARVEST FEMOROPOPLITEAL VEIN      AS                            $54.97      20090101
35572       HARVEST FEMOROPOPLITEAL VEIN                                   $274.84      20090101
35583       VEIN BYPASS GRAFT                 80                           $223.62      20090101
35583       VEIN BYPASS GRAFT                 81                           $223.62      20090101
35583       VEIN BYPASS GRAFT                 82                           $223.62      20090101
35583       VEIN BYPASS GRAFT                 AS                           $223.62      20090101
35583       VEIN BYPASS GRAFT                                             $1,118.11     20090101
35585       VEIN BYPASS GRAFT                 80                           $263.80      20090101
35585       VEIN BYPASS GRAFT                 81                           $263.80      20090101
35585       VEIN BYPASS GRAFT                 82                           $263.80      20090101
35585       VEIN BYPASS GRAFT                 AS                           $263.80      20090101
35585       VEIN BYPASS GRAFT                                             $1,319.00     20090101
35587       VEIN BYPASS GRAFT                 80                           $220.23      20090101


                                           Page 216
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
35587       VEIN BYPASS GRAFT                81                           $220.23      20090101
35587       VEIN BYPASS GRAFT                82                           $220.23      20090101
35587       VEIN BYPASS GRAFT                AS                           $220.23      20090101
35587       VEIN BYPASS GRAFT                                            $1,101.14     20090101
35600       HARVEST ART FOR CABG ADD-ON      80                           $40.28       20090101
35600       HARVEST ART FOR CABG ADD-ON      81                           $40.28       20090101
35600       HARVEST ART FOR CABG ADD-ON      82                           $40.28       20090101
35600       HARVEST ART FOR CABG ADD-ON      AS                            $40.28      20090101
35600       HARVEST ART FOR CABG ADD-ON                                   $201.41      20090101
35601       ARTERY BYPASS GRAFT              80                           $223.90      20090101
35601       ARTERY BYPASS GRAFT              81                           $223.90      20090101
35601       ARTERY BYPASS GRAFT              82                           $223.90      20090101
35601       ARTERY BYPASS GRAFT              AS                           $223.90      20090101
35601       ARTERY BYPASS GRAFT                                          $1,119.51     20090101
35606       ARTERY BYPASS GRAFT              80                           $184.84      20090101
35606       ARTERY BYPASS GRAFT              81                           $184.84      20090101
35606       ARTERY BYPASS GRAFT              82                           $184.84      20090101
35606       ARTERY BYPASS GRAFT              AS                           $184.84      20090101
35606       ARTERY BYPASS GRAFT                                           $924.20      20090101
35612       ARTERY BYPASS GRAFT              80                           $144.11      20090101
35612       ARTERY BYPASS GRAFT              81                           $144.11      20090101
35612       ARTERY BYPASS GRAFT              82                           $144.11      20090101
35612       ARTERY BYPASS GRAFT              AS                           $144.11      20090101
35612       ARTERY BYPASS GRAFT                                           $720.57      20090101
35616       ARTERY BYPASS GRAFT              80                           $175.61      20090101
35616       ARTERY BYPASS GRAFT              81                           $175.61      20090101
35616       ARTERY BYPASS GRAFT              82                           $175.61      20090101
35616       ARTERY BYPASS GRAFT              AS                           $175.61      20090101
35616       ARTERY BYPASS GRAFT                                           $878.04      20090101
35621       ARTERY BYPASS GRAFT              80                           $175.83      20090101
35621       ARTERY BYPASS GRAFT              81                           $175.83      20090101
35621       ARTERY BYPASS GRAFT              82                           $175.83      20090101
35621       ARTERY BYPASS GRAFT              AS                           $175.83      20090101
35621       ARTERY BYPASS GRAFT                                           $879.13      20090101
35623       BYPASS GRAFT, NOT VEIN           80                           $215.45      20090101
35623       BYPASS GRAFT, NOT VEIN           81                           $215.45      20090101
35623       BYPASS GRAFT, NOT VEIN           82                           $215.45      20090101
35623       BYPASS GRAFT, NOT VEIN           AS                           $215.45      20090101
35623       BYPASS GRAFT, NOT VEIN                                       $1,077.23     20090101
35626       ARTERY BYPASS GRAFT              80                           $246.33      20090101
35626       ARTERY BYPASS GRAFT              81                           $246.33      20090101
35626       ARTERY BYPASS GRAFT              82                           $246.33      20090101
35626       ARTERY BYPASS GRAFT              AS                           $246.33      20090101
35626       ARTERY BYPASS GRAFT                                          $1,231.65     20090101
35631       ARTERY BYPASS GRAFT              80                           $295.23      20090101


                                          Page 217
Proc Code   Description              Modifier 1 Modifier 2 ASC     Price     Effective Date
35631       ARTERY BYPASS GRAFT      81                           $295.23      20090101
35631       ARTERY BYPASS GRAFT      82                           $295.23      20090101
35631       ARTERY BYPASS GRAFT      AS                           $295.23      20090101
35631       ARTERY BYPASS GRAFT                                  $1,476.17     20090101
35636       ARTERY BYPASS GRAFT      80                           $260.01      20090101
35636       ARTERY BYPASS GRAFT      81                           $260.01      20090101
35636       ARTERY BYPASS GRAFT      82                           $260.01      20090101
35636       ARTERY BYPASS GRAFT      AS                           $260.01      20090101
35636       ARTERY BYPASS GRAFT                                  $1,300.06     20090101
35637       ARTERY BYPASS GRAFT      80                           $267.14      20090101
35637       ARTERY BYPASS GRAFT      81                           $267.14      20090101
35637       ARTERY BYPASS GRAFT      82                           $267.14      20090101
35637       ARTERY BYPASS GRAFT      AS                           $267.14      20090101
35637       ARTERY BYPASS GRAFT                                  $1,335.68     20090101
35638       ARTERY BYPASS GRAFT      80                           $271.42      20090101
35638       ARTERY BYPASS GRAFT      81                           $271.42      20090101
35638       ARTERY BYPASS GRAFT      82                           $271.42      20090101
35638       ARTERY BYPASS GRAFT      AS                           $271.42      20090101
35638       ARTERY BYPASS GRAFT                                  $1,357.10     20090101
35642       ARTERY BYPASS GRAFT      80                           $159.03      20090101
35642       ARTERY BYPASS GRAFT      81                           $159.03      20090101
35642       ARTERY BYPASS GRAFT      82                           $159.03      20090101
35642       ARTERY BYPASS GRAFT      AS                           $159.03      20090101
35642       ARTERY BYPASS GRAFT                                   $795.14      20090101
35645       ARTERY BYPASS GRAFT      80                           $161.19      20090101
35645       ARTERY BYPASS GRAFT      81                           $161.19      20090101
35645       ARTERY BYPASS GRAFT      82                           $161.19      20090101
35645       ARTERY BYPASS GRAFT      AS                           $161.19      20090101
35645       ARTERY BYPASS GRAFT                                   $805.95      20090101
35646       ARTERY BYPASS GRAFT      80                           $272.98      20090101
35646       ARTERY BYPASS GRAFT      81                           $272.98      20090101
35646       ARTERY BYPASS GRAFT      82                           $272.98      20090101
35646       ARTERY BYPASS GRAFT      AS                           $272.98      20090101
35646       ARTERY BYPASS GRAFT                                  $1,364.91     20090101
35647       ARTERY BYPASS GRAFT      80                           $246.66      20090101
35647       ARTERY BYPASS GRAFT      81                           $246.66      20090101
35647       ARTERY BYPASS GRAFT      82                           $246.66      20090101
35647       ARTERY BYPASS GRAFT      AS                           $246.66      20090101
35647       ARTERY BYPASS GRAFT                                  $1,233.31     20090101
35650       ARTERY BYPASS GRAFT      80                           $169.43      20090101
35650       ARTERY BYPASS GRAFT      81                           $169.43      20090101
35650       ARTERY BYPASS GRAFT      82                           $169.43      20090101
35650       ARTERY BYPASS GRAFT      AS                           $169.43      20090101
35650       ARTERY BYPASS GRAFT                                   $847.15      20090101
35651       ARTERY BYPASS GRAFT      80                           $217.28      20090101


                                  Page 218
Proc Code   Description                 Modifier 1 Modifier 2 ASC     Price     Effective Date
35651       ARTERY BYPASS GRAFT         81                           $217.28      20090101
35651       ARTERY BYPASS GRAFT         82                           $217.28      20090101
35651       ARTERY BYPASS GRAFT         AS                           $217.28      20090101
35651       ARTERY BYPASS GRAFT                                     $1,086.39     20090101
35654       ARTERY BYPASS GRAFT         80                           $218.17      20090101
35654       ARTERY BYPASS GRAFT         81                           $218.17      20090101
35654       ARTERY BYPASS GRAFT         82                           $218.17      20090101
35654       ARTERY BYPASS GRAFT         AS                           $218.17      20090101
35654       ARTERY BYPASS GRAFT                                     $1,090.84     20090101
35656       ARTERY BYPASS GRAFT         80                           $171.99      20090101
35656       ARTERY BYPASS GRAFT         81                           $171.99      20090101
35656       ARTERY BYPASS GRAFT         82                           $171.99      20090101
35656       ARTERY BYPASS GRAFT         AS                           $171.99      20090101
35656       ARTERY BYPASS GRAFT                                      $859.93      20090101
35661       ARTERY BYPASS GRAFT         80                           $172.10      20090101
35661       ARTERY BYPASS GRAFT         81                           $172.10      20090101
35661       ARTERY BYPASS GRAFT         82                           $172.10      20090101
35661       ARTERY BYPASS GRAFT         AS                           $172.10      20090101
35661       ARTERY BYPASS GRAFT                                      $860.50      20090101
35663       ARTERY BYPASS GRAFT         80                           $199.48      20090101
35663       ARTERY BYPASS GRAFT         81                           $199.48      20090101
35663       ARTERY BYPASS GRAFT         82                           $199.48      20090101
35663       ARTERY BYPASS GRAFT         AS                           $199.48      20090101
35663       ARTERY BYPASS GRAFT                                      $997.38      20090101
35665       ARTERY BYPASS GRAFT         80                           $187.18      20090101
35665       ARTERY BYPASS GRAFT         81                           $187.18      20090101
35665       ARTERY BYPASS GRAFT         82                           $187.18      20090101
35665       ARTERY BYPASS GRAFT         AS                           $187.18      20090101
35665       ARTERY BYPASS GRAFT                                      $935.90      20090101
35666       ARTERY BYPASS GRAFT         80                           $201.81      20090101
35666       ARTERY BYPASS GRAFT         81                           $201.81      20090101
35666       ARTERY BYPASS GRAFT         82                           $201.81      20090101
35666       ARTERY BYPASS GRAFT         AS                           $201.81      20090101
35666       ARTERY BYPASS GRAFT                                     $1,009.07     20090101
35671       ARTERY BYPASS GRAFT         80                           $177.61      20090101
35671       ARTERY BYPASS GRAFT         81                           $177.61      20090101
35671       ARTERY BYPASS GRAFT         82                           $177.61      20090101
35671       ARTERY BYPASS GRAFT         AS                           $177.61      20090101
35671       ARTERY BYPASS GRAFT                                      $888.03      20090101
35681       COMPOSITE BYPASS GRAFT      80                           $12.79       20090101
35681       COMPOSITE BYPASS GRAFT      81                           $12.79       20090101
35681       COMPOSITE BYPASS GRAFT      82                           $12.79       20090101
35681       COMPOSITE BYPASS GRAFT      AS                            $12.79      20090101
35681       COMPOSITE BYPASS GRAFT                                   $63.96       20090101
35682       COMPOSITE BYPASS GRAFT      80                           $57.09       20090101


                                     Page 219
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
35682       COMPOSITE BYPASS GRAFT            81                          $57.09      20090101
35682       COMPOSITE BYPASS GRAFT            82                          $57.09      20090101
35682       COMPOSITE BYPASS GRAFT            AS                           $57.09     20090101
35682       COMPOSITE BYPASS GRAFT                                        $285.45     20090101
35683       COMPOSITE BYPASS GRAFT            80                          $67.21      20090101
35683       COMPOSITE BYPASS GRAFT            81                          $67.21      20090101
35683       COMPOSITE BYPASS GRAFT            82                          $67.21      20090101
35683       COMPOSITE BYPASS GRAFT            AS                           $67.21     20090101
35683       COMPOSITE BYPASS GRAFT                                        $336.06     20090101
35685       BYPASS GRAFT PATENCY/PATCH                                    $160.53     20090101
35686       BYPASS GRAFT/AV FIST PATENCY                                  $133.54     20090101
35691       ARTERIAL TRANSPOSITION            80                          $156.30     20090101
35691       ARTERIAL TRANSPOSITION            81                          $156.30     20090101
35691       ARTERIAL TRANSPOSITION            82                          $156.30     20090101
35691       ARTERIAL TRANSPOSITION            AS                          $156.30     20090101
35691       ARTERIAL TRANSPOSITION                                        $781.48     20090101
35693       ARTERIAL TRANSPOSITION            80                          $137.88     20090101
35693       ARTERIAL TRANSPOSITION            81                          $137.88     20090101
35693       ARTERIAL TRANSPOSITION            82                          $137.88     20090101
35693       ARTERIAL TRANSPOSITION            AS                          $137.88     20090101
35693       ARTERIAL TRANSPOSITION                                        $689.41     20090101
35694       ARTERIAL TRANSPOSITION            80                          $163.31     20090101
35694       ARTERIAL TRANSPOSITION            81                          $163.31     20090101
35694       ARTERIAL TRANSPOSITION            82                          $163.31     20090101
35694       ARTERIAL TRANSPOSITION            AS                          $163.31     20090101
35694       ARTERIAL TRANSPOSITION                                        $816.56     20090101
35695       ARTERIAL TRANSPOSITION            80                          $168.82     20090101
35695       ARTERIAL TRANSPOSITION            81                          $168.82     20090101
35695       ARTERIAL TRANSPOSITION            82                          $168.82     20090101
35695       ARTERIAL TRANSPOSITION            AS                          $168.82     20090101
35695       ARTERIAL TRANSPOSITION                                        $844.09     20090101
35697       REIMPLANT ARTERY EACH                                         $119.36     20090101
35700       REOPERATION, BYPASS GRAFT         80                          $24.54      20090101
35700       REOPERATION, BYPASS GRAFT         81                          $24.54      20090101
35700       REOPERATION, BYPASS GRAFT         82                          $24.54      20090101
35700       REOPERATION, BYPASS GRAFT         AS                           $24.54     20090101
35700       REOPERATION, BYPASS GRAFT                                     $122.70     20090101
35701       EXPLORATION, CAROTID ARTERY       80                           $83.23     20090101
35701       EXPLORATION, CAROTID ARTERY       81                           $83.23     20090101
35701       EXPLORATION, CAROTID ARTERY       82                           $83.23     20090101
35701       EXPLORATION, CAROTID ARTERY       AS                           $83.23     20090101
35701       EXPLORATION, CAROTID ARTERY                                   $416.17     20090101
35721       EXPLORATION, FEMORAL ARTERY       80                          $71.33      20090101
35721       EXPLORATION, FEMORAL ARTERY       81                          $71.33      20090101
35721       EXPLORATION, FEMORAL ARTERY       82                          $71.33      20090101


                                           Page 220
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
35721       EXPLORATION, FEMORAL ARTERY       AS                            $71.33      20090101
35721       EXPLORATION, FEMORAL ARTERY                                    $356.66      20090101
35741       EXPLORATION POPLITEAL ARTERY      80                           $77.84       20090101
35741       EXPLORATION POPLITEAL ARTERY      81                           $77.84       20090101
35741       EXPLORATION POPLITEAL ARTERY      82                           $77.84       20090101
35741       EXPLORATION POPLITEAL ARTERY      AS                            $77.84      20090101
35741       EXPLORATION POPLITEAL ARTERY                                   $389.21      20090101
35761       EXPLORATION OF ARTERY/VEIN        80                            $57.37      20090101
35761       EXPLORATION OF ARTERY/VEIN        81                            $57.37      20090101
35761       EXPLORATION OF ARTERY/VEIN        82                            $57.37      20090101
35761       EXPLORATION OF ARTERY/VEIN        AS                            $57.37      20090101
35761       EXPLORATION OF ARTERY/VEIN                                     $286.85      20090101
35800       EXPLORE NECK VESSELS              80                           $73.67       20090101
35800       EXPLORE NECK VESSELS              81                           $73.67       20090101
35800       EXPLORE NECK VESSELS              82                           $73.67       20090101
35800       EXPLORE NECK VESSELS              AS                            $73.67      20090101
35800       EXPLORE NECK VESSELS                                           $368.36      20090101
35820       EXPLORE CHEST VESSELS             80                           $271.65      20090101
35820       EXPLORE CHEST VESSELS             81                           $271.65      20090101
35820       EXPLORE CHEST VESSELS             82                           $271.65      20090101
35820       EXPLORE CHEST VESSELS             AS                           $271.65      20090101
35820       EXPLORE CHEST VESSELS                                         $1,358.23     20090101
35840       EXPLORE ABDOMINAL VESSELS         80                           $96.04       20090101
35840       EXPLORE ABDOMINAL VESSELS         81                           $96.04       20090101
35840       EXPLORE ABDOMINAL VESSELS         82                           $96.04       20090101
35840       EXPLORE ABDOMINAL VESSELS         AS                            $96.04      20090101
35840       EXPLORE ABDOMINAL VESSELS                                      $480.19      20090101
35860       EXPLORE LIMB VESSELS              80                           $62.37       20090101
35860       EXPLORE LIMB VESSELS              81                           $62.37       20090101
35860       EXPLORE LIMB VESSELS              82                           $62.37       20090101
35860       EXPLORE LIMB VESSELS              AS                            $62.37      20090101
35860       EXPLORE LIMB VESSELS                                           $311.85      20090101
35870       REPAIR VESSEL GRAFT DEFECT        80                           $201.70      20090101
35870       REPAIR VESSEL GRAFT DEFECT        81                           $201.70      20090101
35870       REPAIR VESSEL GRAFT DEFECT        82                           $201.70      20090101
35870       REPAIR VESSEL GRAFT DEFECT        AS                           $201.70      20090101
35870       REPAIR VESSEL GRAFT DEFECT                                    $1,008.50     20090101
35875       REMOVAL OF CLOT IN GRAFT          80                            $93.42      20090101
35875       REMOVAL OF CLOT IN GRAFT          81                            $93.42      20090101
35875       REMOVAL OF CLOT IN GRAFT          82                            $93.42      20090101
35875       REMOVAL OF CLOT IN GRAFT          AS                            $93.42      20090101
35875       REMOVAL OF CLOT IN GRAFT                                       $467.10      20090101
35875       REMOVAL OF CLOT IN GRAFT                              Y       $1,124.40     20081209
35876       REMOVAL OF CLOT IN GRAFT          80                           $149.51      20090101
35876       REMOVAL OF CLOT IN GRAFT          81                           $149.51      20090101


                                           Page 221
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
35876       REMOVAL OF CLOT IN GRAFT          82                           $149.51      20090101
35876       REMOVAL OF CLOT IN GRAFT          AS                           $149.51      20090101
35876       REMOVAL OF CLOT IN GRAFT                              Y       $1,124.40     20081209
35876       REMOVAL OF CLOT IN GRAFT                                       $747.53      20090101
35879       REVISE GRAFT W/VEIN               80                           $146.84      20090101
35879       REVISE GRAFT W/VEIN               81                           $146.84      20090101
35879       REVISE GRAFT W/VEIN               82                           $146.84      20090101
35879       REVISE GRAFT W/VEIN               AS                           $146.84      20090101
35879       REVISE GRAFT W/VEIN                                            $734.18      20090101
35881       REVISE GRAFT W/VEIN               80                           $163.31      20090101
35881       REVISE GRAFT W/VEIN               81                           $163.31      20090101
35881       REVISE GRAFT W/VEIN               82                           $163.31      20090101
35881       REVISE GRAFT W/VEIN               AS                           $163.31      20090101
35881       REVISE GRAFT W/VEIN                                            $816.56      20090101
35883       REVISE GRAFT W/NONAUTO GRAFT      80                           $193.41      20090101
35883       REVISE GRAFT W/NONAUTO GRAFT      81                           $193.41      20090101
35883       REVISE GRAFT W/NONAUTO GRAFT      82                           $193.41      20090101
35883       REVISE GRAFT W/NONAUTO GRAFT      AS                           $193.41      20090101
35883       REVISE GRAFT W/NONAUTO GRAFT                                   $967.05      20090101
35884       REVISE GRAFT W/VEIN               80                           $205.43      20090101
35884       REVISE GRAFT W/VEIN               81                           $205.43      20090101
35884       REVISE GRAFT W/VEIN               82                           $205.43      20090101
35884       REVISE GRAFT W/VEIN               AS                           $205.43      20090101
35884       REVISE GRAFT W/VEIN                                           $1,027.14     20090101
35901       EXCISION, GRAFT, NECK             80                            $78.90      20090101
35901       EXCISION, GRAFT, NECK             81                            $78.90      20090101
35901       EXCISION, GRAFT, NECK             82                            $78.90      20090101
35901       EXCISION, GRAFT, NECK             AS                            $78.90      20090101
35901       EXCISION, GRAFT, NECK                                          $394.49      20090101
35903       EXCISION, GRAFT, EXTREMITY        80                           $89.69       20090101
35903       EXCISION, GRAFT, EXTREMITY        81                           $89.69       20090101
35903       EXCISION, GRAFT, EXTREMITY        82                           $89.69       20090101
35903       EXCISION, GRAFT, EXTREMITY        AS                            $89.69      20090101
35903       EXCISION, GRAFT, EXTREMITY                                     $448.47      20090101
35905       EXCISION, GRAFT, THORAX           80                           $276.82      20090101
35905       EXCISION, GRAFT, THORAX           81                           $276.82      20090101
35905       EXCISION, GRAFT, THORAX           82                           $276.82      20090101
35905       EXCISION, GRAFT, THORAX           AS                           $276.82      20090101
35905       EXCISION, GRAFT, THORAX                                       $1,384.11     20090101
35907       EXCISION, GRAFT, ABDOMEN          80                           $303.75      20090101
35907       EXCISION, GRAFT, ABDOMEN          81                           $303.75      20090101
35907       EXCISION, GRAFT, ABDOMEN          82                           $303.75      20090101
35907       EXCISION, GRAFT, ABDOMEN          AS                           $303.75      20090101
35907       EXCISION, GRAFT, ABDOMEN                                      $1,518.76     20090101
36000       PLACE NEEDLE IN VEIN                                           $19.48       20090101


                                           Page 222
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price    Effective Date
36002       PSEUDOANEURYSM INJECTION TRT                                  $130.20     20090101
36005       INJECTION EXT VENOGRAPHY                                      $252.05     20090101
36010       PLACE CATHETER IN VEIN                                        $95.14      20090101
36011       PLACE CATHETER IN VEIN                                        $123.52     20090101
36012       PLACE CATHETER IN VEIN                                        $138.27     20090101
36013       PLACE CATHETER IN ARTERY                                      $99.60      20090101
36014       PLACE CATHETER IN ARTERY                                      $119.07     20090101
36015       PLACE CATHETER IN ARTERY                                      $134.65     20090101
36100       ESTABLISH ACCESS TO ARTERY                                    $123.52     20090101
36120       ESTABLISH ACCESS TO ARTERY                                    $77.06      20090101
36140       ESTABLISH ACCESS TO ARTERY                                    $79.01      20090101
36145       ARTERY TO VEIN SHUNT                                          $77.34      20090101
36160       ESTABLISH ACCESS TO AORTA                                     $103.77     20090101
36200       PLACE CATHETER IN AORTA                                       $118.79     20090101
36215       PLACE CATHETER IN ARTERY                                      $186.12     20090101
36216       PLACE CATHETER IN ARTERY                                      $209.21     20090101
36217       PLACE CATHETER IN ARTERY                                      $251.21     20090101
36218       PLACE CATHETER IN ARTERY                                      $40.06      20090101
36245       PLACE CATHETER IN ARTERY                                      $191.45     20090101
36246       PLACE CATHETER IN ARTERY                                      $210.32     20090101
36247       PLACE CATHETER IN ARTERY                                      $250.66     20090101
36248       PLACE CATHETER IN ARTERY                                      $40.06      20090101
36260       INSERTION OF INFUSION PUMP                                    $441.52     20090101
36260       INSERTION OF INFUSION PUMP                            Y       $545.09     20081209
36261       REVISION OF INFUSION PUMP         80                           $53.47     20090101
36261       REVISION OF INFUSION PUMP         81                           $53.47     20090101
36261       REVISION OF INFUSION PUMP         82                           $53.47     20090101
36261       REVISION OF INFUSION PUMP         AS                           $53.47     20090101
36261       REVISION OF INFUSION PUMP                                     $267.34     20090101
36261       REVISION OF INFUSION PUMP                             Y       $466.16     20081209
36262       REMOVAL OF INFUSION PUMP                                      $203.65     20090101
36262       REMOVAL OF INFUSION PUMP                              Y       $398.36     20081209
36400       BL DRAW < 3 YRS FEM/JUGULAR                                   $19.20      20090101
36405       BL DRAW < 3 YRS SCALP VEIN                                    $16.97      20090101
36406       BL DRAW < 3 YRS OTHER VEIN                                    $12.52      20090101
36410       NON-ROUTINE BL DRAW > 3 YRS                                   $13.63      20090101
36415       ROUTINE VENIPUNCTURE              TC                            $2.22     20080701
36415       ROUTINE VENIPUNCTURE                                            $3.11     20080101
36416       CAPILLARY BLOOD DRAW                                            $3.11     20080101
36420       VEIN ACCESS CUTDOWN < 1 YR                                    $36.72      20090101
36425       VEIN ACCESS CUTDOWN > 1 YR                                    $28.66      20090101
36430       BLOOD TRANSFUSION SERVICE                                     $28.66      20090101
36440       BL PUSH TRANSFUSE, 2 YR OR <                                  $38.95      20090101
36450       BL EXCHANGE/TRANSFUSE, NB                                     $88.47      20090101
36455       BL EXCHANGE/TRANSFUSE NON-NB      80                           $19.03     20090101


                                           Page 223
Proc Code   Description                       Modifier 1 Modifier 2 ASC     Price     Effective Date
36455       BL EXCHANGE/TRANSFUSE NON-NB      81                            $19.03      20090101
36455       BL EXCHANGE/TRANSFUSE NON-NB      82                            $19.03      20090101
36455       BL EXCHANGE/TRANSFUSE NON-NB      AS                            $19.03      20090101
36455       BL EXCHANGE/TRANSFUSE NON-NB                                   $95.17       20090101
36460       TRANSFUSION SERVICE, FETAL        80                            $52.30      20090101
36460       TRANSFUSION SERVICE, FETAL        81                            $52.30      20090101
36460       TRANSFUSION SERVICE, FETAL        82                            $52.30      20090101
36460       TRANSFUSION SERVICE, FETAL        AS                            $52.30      20090101
36460       TRANSFUSION SERVICE, FETAL                                     $261.49      20090101
36475       ENDOVENOUS RF, 1ST VEIN                                       $1,410.24     20090101
36476       ENDOVENOUS RF, VEIN ADD-ON                                     $294.06      20090101
36478       ENDOVENOUS LASER, 1ST VEIN                                    $1,223.84     20090101
36479       ENDOVENOUS LASER VEIN ADDON                                    $298.79      20090101
36481       INSERTION OF CATHETER, VEIN                                    $278.49      20090101
36500       INSERTION OF CATHETER, VEIN                                    $139.66      20090101
36510       INSERTION OF CATHETER, VEIN                                    $102.10      20090101
36522       PHOTOPHERESIS                                                 $1,021.58     20090101
36555       INSERT NON-TUNNEL CV CATH                             Y        $290.13      20081209
36555       INSERT NON-TUNNEL CV CATH                                      $210.60      20090101
36556       INSERT NON-TUNNEL CV CATH                                      $192.80      20090101
36556       INSERT NON-TUNNEL CV CATH                             Y        $290.13      20081209
36557       INSERT TUNNELED CV CATH                                        $662.41      20090101
36557       INSERT TUNNELED CV CATH                               Y        $467.21      20081209
36558       INSERT TUNNELED CV CATH                                        $649.06      20090101
36558       INSERT TUNNELED CV CATH                               Y        $467.21      20081209
36560       INSERT TUNNELED CV CATH                                        $899.73      20090101
36560       INSERT TUNNELED CV CATH                               Y        $545.09      20081209
36561       INSERT TUNNELED CV CATH                                        $904.73      20090101
36561       INSERT TUNNELED CV CATH                               Y        $545.09      20081209
36563       INSERT TUNNELED CV CATH                               Y        $545.09      20081209
36563       INSERT TUNNELED CV CATH                                        $889.99      20090101
36565       INSERT TUNNELED CV CATH                               Y        $545.09      20081209
36565       INSERT TUNNELED CV CATH                                        $770.64      20090101
36566       INSERT TUNNELED CV CATH                                       $2,109.09     20090101
36566       INSERT TUNNELED CV CATH                               Y       $3,036.98     20081209
36568       INSERT PICC CATH                                               $242.87      20090101
36568       INSERT PICC CATH                                      Y        $290.13      20081209
36569       INSERT PICC CATH                                      Y        $290.13      20081209
36569       INSERT PICC CATH                                               $220.34      20090101
36570       INSERT PICVAD CATH                                             $921.43      20090101
36570       INSERT PICVAD CATH                                    Y        $505.61      20081209
36571       INSERT PICVAD CATH                                             $967.61      20090101
36571       INSERT PICVAD CATH                                    Y        $505.61      20081209
36575       REPAIR TUNNELED CV CATH                                        $126.58      20090101
36575       REPAIR TUNNELED CV CATH                               Y        $314.48      20081209


                                           Page 224
Proc Code   Description                     Modifier 1 Modifier 2 ASC    Price    Effective Date
36576       REPAIR TUNNELED CV CATH                                     $273.48     20090101
36576       REPAIR TUNNELED CV CATH                             Y       $357.93     20081209
36578       REPLACE TUNNELED CV CATH                            Y       $467.21     20081209
36578       REPLACE TUNNELED CV CATH                                    $385.60     20090101
36580       REPLACE CVAD CATH                                   Y       $290.13     20081209
36580       REPLACE CVAD CATH                                           $193.36     20090101
36581       REPLACE TUNNELED CV CATH                            Y       $467.21     20081209
36581       REPLACE TUNNELED CV CATH                                    $588.41     20090101
36582       REPLACE TUNNELED CV CATH                                    $812.09     20090101
36582       REPLACE TUNNELED CV CATH                            Y       $545.09     20081209
36583       REPLACE TUNNELED CV CATH                                    $814.32     20090101
36583       REPLACE TUNNELED CV CATH                            Y       $545.09     20081209
36584       REPLACE PICC CATH                                           $190.85     20090101
36584       REPLACE PICC CATH                                   Y       $290.13     20081209
36585       REPLACE PICVAD CATH                                 Y       $505.61     20081209
36585       REPLACE PICVAD CATH                                         $840.19     20090101
36589       REMOVAL TUNNELED CV CATH                            Y       $246.68     20081209
36589       REMOVAL TUNNELED CV CATH                                    $126.86     20090101
36590       REMOVAL TUNNELED CV CATH                            Y       $290.13     20081209
36590       REMOVAL TUNNELED CV CATH                                    $201.98     20090101
36591       DRAW BLOOD OFF VENOUS DEVICE                                $15.30      20090101
36592       COLLECT BLOOD FROM PICC                                     $18.92      20090101
36593       DECLOT VASCULAR DEVICE                              Y        $18.28     20080101
36593       DECLOT VASCULAR DEVICE                                      $26.98      20090101
36595       MECH REMOV TUNNELED CV CATH                                 $496.60     20090101
36596       MECH REMOV TUNNELED CV CATH                                 $109.34     20090101
36597       REPOSITION VENOUS CATHETER                                  $97.37      20090101
36598       INJ W/FLUOR, EVAL CV DEVICE                                 $89.58      20090101
36600       ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD F                     $23.09     20090101
36620       INSERTION CATHETER, ARTERY                                  $39.23      20090101
36625       INSERTION CATHETER, ARTERY                                  $80.40      20090101
36640       INSERTION CATHETER, ARTERY                                  $91.26      20090101
36640       INSERTION CATHETER, ARTERY                          Y       $438.89     20081209
36660       INSERTION CATHETER, ARTERY                                  $54.52      20090101
36680       INSERT NEEDLE, BONE CAVITY                                  $47.30      20090101
36800       INSERTION OF CANNULA                                        $121.02     20090101
36800       INSERTION OF CANNULA                                Y       $551.90     20081209
36810       INSERTION OF CANNULA                                        $164.42     20090101
36810       INSERTION OF CANNULA                                Y       $551.90     20081209
36815       INSERTION OF CANNULA                                        $113.23     20090101
36815       INSERTION OF CANNULA                                Y       $551.90     20081209
36818       AV FUSE, UPPR ARM, CEPHALIC     80                          $105.55     20090101
36818       AV FUSE, UPPR ARM, CEPHALIC     81                          $105.55     20090101
36818       AV FUSE, UPPR ARM, CEPHALIC     82                          $105.55     20090101
36818       AV FUSE, UPPR ARM, CEPHALIC     AS                          $105.55     20090101


                                         Page 225
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
36818       AV FUSE, UPPR ARM, CEPHALIC                                   $527.75      20090101
36819       AV FUSE, UPPR ARM, BASILIC       80                           $122.97      20090101
36819       AV FUSE, UPPR ARM, BASILIC       81                           $122.97      20090101
36819       AV FUSE, UPPR ARM, BASILIC       82                           $122.97      20090101
36819       AV FUSE, UPPR ARM, BASILIC       AS                           $122.97      20090101
36819       AV FUSE, UPPR ARM, BASILIC                           Y        $627.00      20081209
36819       AV FUSE, UPPR ARM, BASILIC                                    $614.84      20090101
36820       AV FUSION/FOREARM VEIN                                        $616.51      20090101
36820       AV FUSION/FOREARM VEIN                               Y        $627.00      20081209
36821       AV FUSION DIRECT ANY SITE        80                           $81.68       20090101
36821       AV FUSION DIRECT ANY SITE        81                           $81.68       20090101
36821       AV FUSION DIRECT ANY SITE        82                           $81.68       20090101
36821       AV FUSION DIRECT ANY SITE        AS                            $81.68      20090101
36821       AV FUSION DIRECT ANY SITE                                     $408.41      20090101
36821       AV FUSION DIRECT ANY SITE                            Y        $627.00      20081209
36822       INSERTION OF CANNULA(S)                                       $288.23      20090101
36823       INSERTION OF CANNULA(S)                                       $965.93      20090101
36825       ARTERY-VEIN AUTOGRAFT            80                           $88.97       20090101
36825       ARTERY-VEIN AUTOGRAFT            81                           $88.97       20090101
36825       ARTERY-VEIN AUTOGRAFT            82                           $88.97       20090101
36825       ARTERY-VEIN AUTOGRAFT            AS                            $88.97      20090101
36825       ARTERY-VEIN AUTOGRAFT                                         $444.84      20090101
36825       ARTERY-VEIN AUTOGRAFT                                Y        $699.00      20081209
36830       ARTERY-VEIN NONAUTOGRAFT         80                           $102.05      20090101
36830       ARTERY-VEIN NONAUTOGRAFT         81                           $102.05      20090101
36830       ARTERY-VEIN NONAUTOGRAFT         82                           $102.05      20090101
36830       ARTERY-VEIN NONAUTOGRAFT         AS                           $102.05      20090101
36830       ARTERY-VEIN NONAUTOGRAFT                                      $510.26      20090101
36830       ARTERY-VEIN NONAUTOGRAFT                             Y        $699.00      20081209
36831       OPEN THROMBECT AV FISTULA        80                           $70.49       20090101
36831       OPEN THROMBECT AV FISTULA        81                           $70.49       20090101
36831       OPEN THROMBECT AV FISTULA        82                           $70.49       20090101
36831       OPEN THROMBECT AV FISTULA        AS                            $70.49      20090101
36831       OPEN THROMBECT AV FISTULA                            Y       $1,124.40     20081209
36831       OPEN THROMBECT AV FISTULA                                     $352.47      20090101
36832       AV FISTULA REVISION, OPEN        80                           $89.97       20090101
36832       AV FISTULA REVISION, OPEN        81                           $89.97       20090101
36832       AV FISTULA REVISION, OPEN        82                           $89.97       20090101
36832       AV FISTULA REVISION, OPEN        AS                            $89.97      20090101
36832       AV FISTULA REVISION, OPEN                            Y        $699.00      20081209
36832       AV FISTULA REVISION, OPEN                                     $449.86      20090101
36833       AV FISTULA REVISION              80                           $101.61      20090101
36833       AV FISTULA REVISION              81                           $101.61      20090101
36833       AV FISTULA REVISION              82                           $101.61      20090101
36833       AV FISTULA REVISION              AS                           $101.61      20090101


                                          Page 226
Proc Code   Description                      Modifier 1 Modifier 2 ASC     Price     Effective Date
36833       AV FISTULA REVISION                                           $508.03      20090101
36834       REPAIR A-V ANEURYSM              80                           $94.47       20090101
36834       REPAIR A-V ANEURYSM              81                           $94.47       20090101
36834       REPAIR A-V ANEURYSM              82                           $94.47       20090101
36834       REPAIR A-V ANEURYSM              AS                            $94.47      20090101
36834       REPAIR A-V ANEURYSM                                           $472.37      20090101
36835       ARTERY TO VEIN SHUNT                                          $346.09      20090101
36835       ARTERY TO VEIN SHUNT                                 Y        $623.90      20081209
36838       DIST REVAS LIGATION, HEMO        80                           $182.67      20090101
36838       DIST REVAS LIGATION, HEMO        81                           $182.67      20090101
36838       DIST REVAS LIGATION, HEMO        82                           $182.67      20090101
36838       DIST REVAS LIGATION, HEMO        AS                           $182.67      20090101
36838       DIST REVAS LIGATION, HEMO                                     $913.34      20090101
36860       EXTERNAL CANNULA DECLOTTING                                   $130.48      20090101
36860       EXTERNAL CANNULA DECLOTTING                          Y        $96.99       20081209
36861       CANNULA DECLOTTING                                   Y        $551.90      20081209
36861       CANNULA DECLOTTING                                            $115.17      20090101
36870       PERCUT THROMBECT AV FISTULA                          Y       $1,138.47     20081209
36870       PERCUT THROMBECT AV FISTULA                                  $1,457.81     20090101
37140       REVISION OF CIRCULATION                                      $1,025.20     20090101
37145       REVISION OF CIRCULATION          80                           $222.85      20090101
37145       REVISION OF CIRCULATION          81                           $222.85      20090101
37145       REVISION OF CIRCULATION          82                           $222.85      20090101
37145       REVISION OF CIRCULATION          AS                           $222.85      20090101
37145       REVISION OF CIRCULATION                                      $1,114.23     20090101
37160       REVISION OF CIRCULATION          80                           $192.24      20090101
37160       REVISION OF CIRCULATION          81                           $192.24      20090101
37160       REVISION OF CIRCULATION          82                           $192.24      20090101
37160       REVISION OF CIRCULATION          AS                           $192.24      20090101
37160       REVISION OF CIRCULATION                                       $961.20      20090101
37180       REVISION OF CIRCULATION          80                           $218.51      20090101
37180       REVISION OF CIRCULATION          81                           $218.51      20090101
37180       REVISION OF CIRCULATION          82                           $218.51      20090101
37180       REVISION OF CIRCULATION          AS                           $218.51      20090101
37180       REVISION OF CIRCULATION                                      $1,092.55     20090101
37181       SPLICE SPLEEN/KIDNEY VEINS       80                           $231.42      20090101
37181       SPLICE SPLEEN/KIDNEY VEINS       81                           $231.42      20090101
37181       SPLICE SPLEEN/KIDNEY VEINS       82                           $231.42      20090101
37181       SPLICE SPLEEN/KIDNEY VEINS       AS                           $231.42      20090101
37181       SPLICE SPLEEN/KIDNEY VEINS                                   $1,157.08     20090101
37182       INSERT HEPATIC SHUNT (TIPS)      80                           $134.49      20090101
37182       INSERT HEPATIC SHUNT (TIPS)      81                           $134.49      20090101
37182       INSERT HEPATIC SHUNT (TIPS)      82                           $134.49      20090101
37182       INSERT HEPATIC SHUNT (TIPS)      AS                           $134.49      20090101
37182       INSERT HEPATIC SHUNT (TIPS)                                   $672.44      20090101


                                          Page 227
Proc Code   Description                    Modifier 1 Modifier 2 ASC     Price     Effective Date
37183       REMOVE HEPATIC SHUNT (TIPS)    80                           $64.05       20090101
37183       REMOVE HEPATIC SHUNT (TIPS)    81                           $64.05       20090101
37183       REMOVE HEPATIC SHUNT (TIPS)    82                           $64.05       20090101
37183       REMOVE HEPATIC SHUNT (TIPS)    AS                            $64.05      20090101
37183       REMOVE HEPATIC SHUNT (TIPS)                                 $320.23      20090101
37184       PRIM ART MECH THROMBECTOMY                                 $1,949.40     20090101
37185       PRIM ART M-THROMBECT ADD-ON                                 $643.77      20090101
37186       SEC ART M-THROMBECT ADD-ON                                 $1,319.26     20090101
37187       VENOUS MECH THROMBECTOMY                                   $1,885.98     20090101
37188       VENOUS M-THROMBECTOMY ADD-ON                               $1,619.72     20090101
37195       THROMBOLYTIC THERAPY, STROKE                                $229.59      20080101
37200       TRANSCATHETER BIOPSY                                        $178.05      20090101
37201       TRANSCATHETER THERAPY INFUSE                                $215.89      20090101
37202       TRANSCATHETER THERAPY INFUSE                                $258.46      20090101
37203       TRANSCATHETER RETRIEVAL                                    $1,024.64     20090101
37204       TRANSCATHETER OCCLUSION                                     $713.88      20090101
37205       TRANSCATH IV STENT, PERCUT                                 $1,811.96     20090101
37206       TRANSCATH IV STENT/PERC ADDL                               $1,068.60     20090101
37207       TRANSCATH IV STENT, OPEN       80                           $67.94       20090101
37207       TRANSCATH IV STENT, OPEN       81                           $67.94       20090101
37207       TRANSCATH IV STENT, OPEN       82                           $67.94       20090101
37207       TRANSCATH IV STENT, OPEN       AS                            $67.94      20090101
37207       TRANSCATH IV STENT, OPEN                                    $339.69      20090101
37208       TRANSCATH IV STENT/OPEN ADDL   80                            $32.83      20090101
37208       TRANSCATH IV STENT/OPEN ADDL   81                            $32.83      20090101
37208       TRANSCATH IV STENT/OPEN ADDL   82                            $32.83      20090101
37208       TRANSCATH IV STENT/OPEN ADDL   AS                            $32.83      20090101
37208       TRANSCATH IV STENT/OPEN ADDL                                $164.14      20090101
37209       CHANGE IV CATH AT THROMB TX                                 $88.19       20090101
37215       TRANSCATH STENT, CCA W/EPS     80                           $167.98      20090101
37215       TRANSCATH STENT, CCA W/EPS     81                           $167.98      20090101
37215       TRANSCATH STENT, CCA W/EPS     82                           $167.98      20090101
37215       TRANSCATH STENT, CCA W/EPS     AS                           $167.98      20090101
37215       TRANSCATH STENT, CCA W/EPS                                  $839.90      20090101
37216       TRANSCATH STENT, CCA W/O EPS   80                           $151.23      20090101
37216       TRANSCATH STENT, CCA W/O EPS   81                           $151.23      20090101
37216       TRANSCATH STENT, CCA W/O EPS   82                           $151.23      20090101
37216       TRANSCATH STENT, CCA W/O EPS   AS                           $151.23      20090101
37216       TRANSCATH STENT, CCA W/O EPS                                $756.17      20090101
37250       IV US FIRST VESSEL ADD-ON                                   $85.41       20090101
37251       IV US EACH ADD VESSEL ADD-ON                                $64.26       20090101
37500       ENDOSCOPY LIGATE PERF VEINS                                 $533.60      20090101
37565       LIGATION OF NECK VEIN                                       $519.69      20090101
37600       LIGATION OF NECK ARTERY        80                           $108.66      20090101
37600       LIGATION OF NECK ARTERY        81                           $108.66      20090101


                                       Page 228
Proc Code   Description                       Modifier 1 Modifier 2 ASC    Price