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\"classification\": \"text_layer\", \"validation_flags\": [], \"docai_processor_id\": null}, \"akomaNtoso\": {\"act\": {\"body\": [{\"eId\": \"sec_n1\", \"num\": null, \"text\": \"Gazette No. 60 dated 15 August, 2014.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n2\", \"num\": null, \"text\": \"CAYMAN ISLANDS HEALTH SERVICES AUTHORITY\\nCHARGE MASTER\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n3\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n4\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifier\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n00100\\n00100\\nAnesthesia for procedures on salivary glands, including biopsy\\n$ 192.50\\n00102\\n00102\\nAnesthesia for procedures involving plastic repair of cleft lip\\n$ 273.00\\n00103\\n00103\\nAnesthesia for reconstructive procedures of eyelid (eg,\\nblepharoplasty, ptosis surgery)\\n$ 385.00\\n00104\\n00104\\nAnesthesia for electroconvulsive therapy\\n$ 273.00\\n00120\\n00120\\nAnesthesia for procedures on external, middle, and inner ear\\nincluding biopsy; not otherwise specified\\n$ 192.50\\n00124\\n00124\\nAnesthesia for procedures on external, middle, and inner ear\\nincluding biopsy; otoscopy\\n$ 273.00\\n00126\\n00126\\nAnesthesia for procedures on external, middle, and inner ear\\nincluding biopsy; tympanotomy\\n$ 192.50\\n00140\\n00140\\nAnesthesia for procedures on eye; not otherwise specified\\n$ 192.50\\n00142\\n00142\\nAnesthesia for procedures on eye; lens surgery\\n$ 385.00\\n00144\\n00144\\nAnesthesia for procedures on eye; corneal transplant\\n$ 385.00\\n00145\\n00145\\nAnesthesia for procedures on eye; vitreoretinal surgery\\n$ 385.00\\n00147\\n00147\\nAnesthesia for procedures on eye; iridectomy\\n$ 192.50\\n00148\\n00148\\nAnesthesia for procedures on eye; ophthalmoscopy\\n$ 273.00\\n00160\\n00160\\nAnesthesia for procedures on nose and accessory sinuses; not\\notherwise specified\\n$ 192.50\\n00162\\n00162\\nAnesthesia for procedures on nose and accessory sinuses; radical\\nsurgery\\n$ 385.00\\n00164\\n00164\\nAnesthesia for procedures on nose and accessory sinuses; biopsy,\\nsoft tissue\\n$ 273.00\\n00170\\n00170\\nAnesthesia for intraoral procedures, including biopsy; not otherwise\\nspecified\\n$ 192.50\\n00172\\n00172\\nAnesthesia for intraoral procedures, including biopsy; repair of cleft\\npalate\\n$ 273.00\\n00174\\n00174\\nAnesthesia for intraoral procedures, including biopsy; excision of\\nretropharyngeal tumor\\n$ 273.00\\n00176\\n00176\\nAnesthesia for intraoral procedures, including biopsy; radical\\nsurgery\\n$ 273.00\\n00190\\n00190\\nAnesthesia for procedures on facial bones or skull; not otherwise\\nspecified\\n$ 385.00\\n00192\\n00192\\nAnesthesia for procedures on facial bones or skull; radical surgery\\n(including prognathism)\\n$ 273.00\\n00210\\n00210\\nAnesthesia for intracranial procedures; not otherwise specified\\n$ 385.00\\n00211\\n00211\\nAnesthesia for intracranial procedures; craniotomy or craniectomy\\nfor evacuation of hematoma\\n$ 286.00\\n00214\\n00214\\nAnesthesia for intracranial procedures; burr holes, including\\nventriculography\\n$ 385.00\\n00215\\n00215\\nAnesthesia for intracranial procedures; cranioplasty or elevation of\\ndepressed skull fracture, extradural (simple or compound)\\n$ 286.00\\n00218\\n00218\\nAnesthesia for intracranial procedures; procedures in sitting\\nposition\\n$ 286.00\\n00300\\n00300\\nAnesthesia for all procedures on the integumentary system, muscles\\nand nerves of head, neck, and posterior trunk, not otherwise\\nspecified\\n$ 273.00\\n00320\\n00320\\nAnesthesia for all procedures on esophagus, thyroid, larynx, trachea\\nand lymphatic system of neck; not otherwise specified, age 1 year\\nor older\\n$ 385.00\\n00322\\n00322\\nAnesthesia for all procedures on esophagus, thyroid, larynx, trachea\\nand lymphatic system of neck; needle biopsy of thyroid\\n$ 273.00\\n00326\\n00326\\nAnesthesia for all procedures on the larynx and trachea in children\\nyounger than 1 year of age\\n$ 273.00\\n00350\\n00350\\nAnesthesia for procedures on major vessels of neck; not otherwise\\nspecified\\n$ 273.00\\n00352\\n00352\\nAnesthesia for procedures on major vessels of neck; simple ligation\\n$ 273.00\\n00400\\n00400\\nAnesthesia for procedures on the integumentary system on the\\nextremities, anterior trunk and perineum; not otherwise specified\\n$ 385.00\\n00402\\n00402\\nAnesthesia for procedures on the integumentary system on the\\nextremities, anterior trunk and perineum; reconstructive\\nprocedures on breast (eg, reduction or augmentation\\nmammoplasty, muscle flaps)\\n$ 385.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n5\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n6\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifier\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n00404\\n00404\\nAnesthesia for procedures on the integumentary system on the\\nextremities, anterior trunk and perineum; radical or modified\\nradical procedures on breast\\n$ 385.00\\n00406\\n00406\\nAnesthesia for procedures on the integumentary system on the\\nextremities, anterior trunk and perineum; radical or modified\\nradical procedures on breast with internal mammary node\\ndissection\\n$ 385.00\\n00410\\n00410\\nAnesthesia for procedures on the integumentary system on the\\nextremities, anterior trunk and perineum; electrical conversion of\\narrhythmias\\n$ 192.50\\n0042T\\n0042T\\nCerebral perfusion analysis using computed tomography with\\ncontrast administration, including post-processing of parametric\\nmaps with determination of cerebral blood flow, cerebral blood\\nvolume, and mean transit time\\n$ 1,133.10\\n00450\\n00450\\nAnesthesia for procedures on clavicle and scapula; not otherwise\\nspecified\\n$ 273.00\\n00452\\n00452\\nAnesthesia for procedures on clavicle and scapula; radical surgery\\n$ 273.00\\n00454\\n00454\\nAnesthesia for procedures on clavicle and scapula; biopsy of clavicle\\n$ 273.00\\n00500\\n00500\\nAnesthesia for all procedures on esophagus\\n$ 192.50\\n00520\\n00520\\nAnesthesia for closed chest procedures; (including bronchoscopy)\\nnot otherwise specified\\n$ 192.50\\n00524\\n00524\\nAnesthesia for closed chest procedures; pneumocentesis\\n$ 273.00\\n00530\\n00530\\nAnesthesia for permanent transvenous pacemaker insertion\\n$ 273.00\\n00532\\n00532\\nAnesthesia for access to central venous circulation\\n$ 273.00\\n00534\\n00534\\nAnesthesia for transvenous insertion or replacement of pacing\\ncardioverter-defibrillator\\n$ 273.00\\n00540\\n00540\\nAnesthesia for thoracotomy procedures involving lungs, pleura,\\ndiaphragm, and mediastinum (including surgical thoracoscopy); not\\notherwise specified\\n$ 385.00\\n00541\\n00541\\nAnesthesia for thoracotomy procedures involving lungs, pleura,\\ndiaphragm, and mediastinum (including surgical thoracoscopy);\\nutilizing 1 lung ventilation\\n$ 273.00\\n00542\\n00542\\nAnesthesia for thoracotomy procedures involving lungs, pleura,\\ndiaphragm, and mediastinum (including surgical thoracoscopy);\\ndecortication\\n$ 273.00\\n00546\\n00546\\nAnesthesia for thoracotomy procedures involving lungs, pleura,\\ndiaphragm, and mediastinum (including surgical thoracoscopy);\\npulmonary resection with thoracoplasty\\n$ 273.00\\n00548\\n00548\\nAnesthesia for thoracotomy procedures involving lungs, pleura,\\ndiaphragm, and mediastinum (including surgical thoracoscopy);\\nintrathoracic procedures on the trachea and bronchi\\n$ 273.00\\n00550\\n00550\\nAnesthesia for sternal debridement\\n$ 273.00\\n00560\\n00560\\nAnesthesia for procedures on heart, pericardial sac, and great\\nvessels of chest; without pump oxygenator\\n$ 273.00\\n00561\\n00561\\nAnesthesia for procedures on heart, pericardial sac, and great\\nvessels of chest; with pump oxygenator, younger than 1 year of age\\n$ 273.00\\n00562\\n00562\\nAnesthesia for procedures on heart, pericardial sac, and great\\nvessels of chest; with pump oxygenator, age 1 year or older, for all\\nnon-coronary bypass procedures (eg, valve procedures) or for re-\\noperation for coronary bypass more than 1 month after origi\\n$ 273.00\\n00563\\n00563\\nAnesthesia for procedures on heart, pericardial sac, and great\\nvessels of chest; with pump oxygenator with hypothermic\\ncirculatory arrest\\n$ 273.00\\n00566\\n00566\\nAnesthesia for direct coronary artery bypass grafting; without pump\\noxygenator\\n$ 273.00\\n00567\\n00567\\nAnesthesia for direct coronary artery bypass grafting; with pump\\noxygenator\\n$ 273.00\\n00580\\n00580\\nAnesthesia for heart transplant or heart\/lung transplant\\n$ 273.00\\n00600\\n00600\\nAnesthesia for procedures on cervical spine and cord; not otherwise\\nspecified\\n$ 88.00\\n00604\\n00604\\nAnesthesia for procedures on cervical spine and cord; procedures\\nwith patient in the sitting position\\n$ 273.00\\n00620\\n00620\\nAnesthesia for procedures on thoracic spine and cord; not\\notherwise specified\\n$ 273.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n7\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n8\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifier\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n00622\\n00622\\nAnesthesia for procedures on thoracic spine and cord;\\nthoracolumbar sympathectomy\\n$ 273.00\\n00625\\n00625\\nAnesthesia for procedures on the thoracic spine and cord, via an\\nanterior transthoracic approach; not utilizing 1 lung ventilation\\n$ 273.00\\n00626\\n00626\\nAnesthesia for procedures on the thoracic spine and cord, via an\\nanterior transthoracic approach; utilizing 1 lung ventilation\\n$ 273.00\\n00630\\n00630\\nAnesthesia for procedures in lumbar region; not otherwise specified $ 385.00\\n00632\\n00632\\nAnesthesia for procedures in lumbar region; lumbar\\nsympathectomy\\n$ 273.00\\n00634\\n00634\\nAnesthesia for procedures in lumbar region; chemonucleolysis\\n$ 273.00\\n00635\\n00635\\nAnesthesia for procedures in lumbar region; diagnostic or\\ntherapeutic lumbar puncture\\n$ 273.00\\n00640\\n00640\\nAnesthesia for manipulation of the spine or for closed procedures\\non the cervical, thoracic or lumbar spine\\n$ 273.00\\n00670\\n00670\\nAnesthesia for extensive spine and spinal cord procedures (eg,\\nspinal instrumentation or vascular procedures)\\n$ 273.00\\n00700\\n00700\\nAnesthesia for procedures on upper anterior abdominal wall; not\\notherwise specified\\n$ 273.00\\n00702\\n00702\\nAnesthesia for procedures on upper anterior abdominal wall;\\npercutaneous liver biopsy\\n$ 273.00\\n00730\\n00730\\nAnesthesia for procedures on upper posterior abdominal wall\\n$ 273.00\\n00740\\n00740\\nAnesthesia for upper gastrointestinal endoscopic procedures,\\nendoscope introduced proximal to duodenum\\n$ 192.50\\n00750\\n00750\\nAnesthesia for hernia repairs in upper abdomen; not otherwise\\nspecified\\n$ 273.00\\n00752\\n00752\\nAnesthesia for hernia repairs in upper abdomen; lumbar and ventral\\n(incisional) hernias and\/or wound dehiscence\\n$ 273.00\\n00754\\n00754\\nAnesthesia for hernia repairs in upper abdomen; omphalocele\\n$ 273.00\\n00756\\n00756\\nAnesthesia for hernia repairs in upper abdomen; transabdominal\\nrepair of diaphragmatic hernia\\n$ 273.00\\n00770\\n00770\\nAnesthesia for all procedures on major abdominal blood vessels\\n$ 385.00\\n00790\\n00790\\nAnesthesia for intraperitoneal procedures in upper abdomen\\nincluding laparoscopy; not otherwise specified\\n$ 385.00\\n00792\\n00792\\nAnesthesia for intraperitoneal procedures in upper abdomen\\nincluding laparoscopy; partial hepatectomy or management of liver\\nhemorrhage (excluding liver biopsy)\\n$ 385.00\\n00794\\n00794\\nAnesthesia for intraperitoneal procedures in upper abdomen\\nincluding laparoscopy; pancreatectomy, partial or total (eg, Whipple\\nprocedure)\\n$ 273.00\\n00796\\n00796\\nAnesthesia for intraperitoneal procedures in upper abdomen\\nincluding laparoscopy; liver transplant (recipient)\\n$ 273.00\\n00797\\n00797\\nAnesthesia for intraperitoneal procedures in upper abdomen\\nincluding laparoscopy; gastric restrictive procedure for morbid\\nobesity\\n$ 273.00\\n00800\\n00800\\nAnesthesia for procedures on lower anterior abdominal wall; not\\notherwise specified\\n$ 273.00\\n00802\\n00802\\nAnesthesia for procedures on lower anterior abdominal wall;\\npanniculectomy\\n$ 273.00\\n00810\\n00810\\nAnesthesia for lower intestinal endoscopic procedures, endoscope\\nintroduced distal to duodenum\\n$ 385.00\\n00820\\n00820\\nAnesthesia for procedures on lower posterior abdominal wall\\n$ 273.00\\n00830\\n00830\\nAnesthesia for hernia repairs in lower abdomen; not otherwise\\nspecified\\n$ 385.00\\n00832\\n00832\\nAnesthesia for hernia repairs in lower abdomen; ventral and\\nincisional hernias\\n$ 385.00\\n00834\\n00834\\nAnesthesia for hernia repairs in the lower abdomen not otherwise\\nspecified, younger than 1 year of age\\n$ 273.00\\n00836\\n00836\\nAnesthesia for hernia repairs in the lower abdomen not otherwise\\nspecified, infants younger than 37 weeks gestational age at birth\\nand younger than 50 weeks gestational age at time of surgery\\n$ 273.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n9\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n10\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifier\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n00840\\n00840\\nAnesthesia for intraperitoneal procedures in lower abdomen\\nincluding laparoscopy; not otherwise specified\\n$ 385.00\\n00842\\n00842\\nAnesthesia for intraperitoneal procedures in lower abdomen\\nincluding laparoscopy; amniocentesis\\n$ 273.00\\n00844\\n00844\\nAnesthesia for intraperitoneal procedures in lower abdomen\\nincluding laparoscopy; abdominoperineal resection\\n$ 385.00\\n00846\\n00846\\nAnesthesia for intraperitoneal procedures in lower abdomen\\nincluding laparoscopy; radical hysterectomy\\n$ 273.00\\n00848\\n00848\\nAnesthesia for intraperitoneal procedures in lower abdomen\\nincluding laparoscopy; pelvic exenteration\\n$ 273.00\\n00851\\n00851\\nAnesthesia for intraperitoneal procedures in lower abdomen\\nincluding laparoscopy; tubal ligation\/transection\\n$ 192.50\\n00860\\n00860\\nAnesthesia for extraperitoneal procedures in lower abdomen,\\nincluding urinary tract; not otherwise specified\\n$ 273.00\\n00862\\n00862\\nAnesthesia for extraperitoneal procedures in lower abdomen,\\nincluding urinary tract; renal procedures, including upper one-third\\nof ureter, or donor nephrectomy\\n$ 385.00\\n00864\\n00864\\nAnesthesia for extraperitoneal procedures in lower abdomen,\\nincluding urinary tract; total cystectomy\\n$ 273.00\\n00865\\n00865\\nAnesthesia for extraperitoneal procedures in lower abdomen,\\nincluding urinary tract; radical prostatectomy (suprapubic,\\nretropubic)\\n$ 385.00\\n00866\\n00866\\nAnesthesia for extraperitoneal procedures in lower abdomen,\\nincluding urinary tract; adrenalectomy\\n$ 273.00\\n00868\\n00868\\nAnesthesia for extraperitoneal procedures in lower abdomen,\\nincluding urinary tract; renal transplant (recipient)\\n$ 273.00\\n00869\\n00869\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); vasectomy, unilateral or bilateral\\n$ 385.00\\n00870\\n00870\\nAnesthesia for extraperitoneal procedures in lower abdomen,\\nincluding urinary tract; cystolithotomy\\n$ 385.00\\n00872\\n00872\\nAnesthesia for lithotripsy, extracorporeal shock wave; with water\\nbath\\n$ 273.00\\n00873\\n00873\\nAnesthesia for lithotripsy, extracorporeal shock wave; without\\nwater bath\\n$ 385.00\\n00880\\n00880\\nAnesthesia for procedures on major lower abdominal vessels; not\\notherwise specified\\n$ 273.00\\n00882\\n00882\\nAnesthesia for procedures on major lower abdominal vessels;\\ninferior vena cava ligation\\n$ 273.00\\n00902\\n00902\\nAnesthesia for; anorectal procedure\\n$ 192.50\\n00904\\n00904\\nAnesthesia for; radical perineal procedure\\n$ 273.00\\n00906\\n00906\\nAnesthesia for; vulvectomy\\n$ 273.00\\n00908\\n00908\\nAnesthesia for; perineal prostatectomy\\n$ 273.00\\n00910\\n00910\\nAnesthesia for transurethral procedures (including\\nurethrocystoscopy); not otherwise specified\\n$ 192.50\\n00912\\n00912\\nAnesthesia for transurethral procedures (including\\nurethrocystoscopy); transurethral resection of bladder tumor(s)\\n$ 192.50\\n00914\\n00914\\nAnesthesia for transurethral procedures (including\\nurethrocystoscopy); transurethral resection of prostate\\n$ 385.00\\n00916\\n00916\\nAnesthesia for transurethral procedures (including\\nurethrocystoscopy); post-transurethral resection bleeding\\n$ 273.00\\n00918\\n00918\\nAnesthesia for transurethral procedures (including\\nurethrocystoscopy); with fragmentation, manipulation and\/or\\nremoval of ureteral calculus\\n$ 192.50\\n00920\\n00920\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); not otherwise specified\\n$ 192.50\\n00921\\n00921\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); vasectomy, unilateral or bilateral\\n$ 273.00\\n00922\\n00922\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); seminal vesicles\\n$ 273.00\\n00924\\n00924\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); undescended testis, unilateral or bilateral\\n$ 192.50\\n00926\\n00926\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); radical orchiectomy, inguinal\\n$ 192.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n11\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n12\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifier\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n00928\\n00928\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); radical orchiectomy, abdominal\\n$ 273.00\\n00930\\n00930\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); orchiopexy, unilateral or bilateral\\n$ 192.50\\n00932\\n00932\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); complete amputation of penis\\n$ 273.00\\n00934\\n00934\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); radical amputation of penis with bilateral\\ninguinal lymphadenectomy\\n$ 273.00\\n00936\\n00936\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); radical amputation of penis with bilateral\\ninguinal and iliac lymphadenectomy\\n$ 273.00\\n00938\\n00938\\nAnesthesia for procedures on male genitalia (including open\\nurethral procedures); insertion of penile prosthesis (perineal\\napproach)\\n$ 273.00\\n00940\\n00940\\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\\ncervix or endometrium); not otherwise specified\\n$ 192.50\\n00942\\n00942\\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\\ncervix or endometrium); colpotomy, vaginectomy, colporrhaphy,\\nand open urethral procedures\\n$ 192.50\\n00944\\n00944\\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\\ncervix or endometrium); vaginal hysterectomy\\n$ 385.00\\n00948\\n00948\\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\\ncervix or endometrium); cervical cerclage\\n$ 192.50\\n00950\\n00950\\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\\ncervix or endometrium); culdoscopy\\n$ 273.00\\n00952\\n00952\\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\\ncervix or endometrium); hysteroscopy and\/or\\nhysterosalpingography\\n$ 192.50\\n01112\\n01112\\nAnesthesia for bone marrow aspiration and\/or biopsy, anterior or\\nposterior iliac crest\\n$ 273.00\\n01120\\n01120\\nAnesthesia for procedures on bony pelvis\\n$ 273.00\\n01130\\n01130\\nAnesthesia for body cast application or revision\\n$ 192.50\\n01140\\n01140\\nAnesthesia for interpelviabdominal (hindquarter) amputation\\n$ 273.00\\n01150\\n01150\\nAnesthesia for radical procedures for tumor of pelvis, except\\nhindquarter amputation\\n$ 273.00\\n01160\\n01160\\nAnesthesia for closed procedures involving symphysis pubis or\\nsacroiliac joint\\n$ 273.00\\n01170\\n01170\\nAnesthesia for open procedures involving symphysis pubis or\\nsacroiliac joint\\n$ 273.00\\n01173\\n01173\\nAnesthesia for open repair of fracture disruption of pelvis or column\\nfracture involving acetabulum\\n$ 273.00\\n01180\\n01180\\nAnesthesia for obturator neurectomy; extrapelvic\\n$ 273.00\\n01190\\n01190\\nAnesthesia for obturator neurectomy; intrapelvic\\n$ 273.00\\n01200\\n01200\\nAnesthesia for all closed procedures involving hip joint\\n$ 192.50\\n01202\\n01202\\nAnesthesia for arthroscopic procedures of hip joint\\n$ 273.00\\n01210\\n01210\\nAnesthesia for open procedures involving hip joint; not otherwise\\nspecified\\n$ 385.00\\n01212\\n01212\\nAnesthesia for open procedures involving hip joint; hip\\ndisarticulation\\n$ 273.00\\n01214\\n01214\\nAnesthesia for open procedures involving hip joint; total hip\\narthroplasty\\n$ 385.00\\n01215\\n01215\\nAnesthesia for open procedures involving hip joint; revision of total\\nhip arthroplasty\\n$ 385.00\\n01220\\n01220\\nAnesthesia for all closed procedures involving upper two-thirds of\\nfemur\\n$ 273.00\\n01230\\n01230\\nAnesthesia for open procedures involving upper two-thirds of\\nfemur; not otherwise specified\\n$ 385.00\\n01232\\n01232\\nAnesthesia for open procedures involving upper two-thirds of\\nfemur; amputation\\n$ 273.00\\n01234\\n01234\\nAnesthesia for open procedures involving upper two-thirds of\\nfemur; radical resection\\n$ 273.00\\n01250\\n01250\\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\\nand bursae of upper leg\\n$ 385.00\\n01260\\n01260\\nAnesthesia for all procedures involving veins of upper leg, including\\nexploration\\n$ 385.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n13\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n14\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifier\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n01270\\n01270\\nAnesthesia for procedures involving arteries of upper leg, including\\nbypass graft; not otherwise specified\\n$ 385.00\\n01272\\n01272\\nAnesthesia for procedures involving arteries of upper leg, including\\nbypass graft; femoral artery ligation\\n$ 273.00\\n01274\\n01274\\nAnesthesia for procedures involving arteries of upper leg, including\\nbypass graft; femoral artery embolectomy\\n$ 273.00\\n01320\\n01320\\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\\nand bursae of knee and\/or popliteal area\\n$ 385.00\\n01340\\n01340\\nAnesthesia for all closed procedures on lower one-third of femur\\n$ 273.00\\n01360\\n01360\\nAnesthesia for all open procedures on lower one-third of femur\\n$ 273.00\\n01380\\n01380\\nAnesthesia for all closed procedures on knee joint\\n$ 273.00\\n01382\\n01382\\nAnesthesia for diagnostic arthroscopic procedures of knee joint\\n$ 385.00\\n01390\\n01390\\nAnesthesia for all closed procedures on upper ends of tibia, fibula,\\nand\/or patella\\n$ 273.00\\n01392\\n01392\\nAnesthesia for all open procedures on upper ends of tibia, fibula,\\nand\/or patella\\n$ 385.00\\n01400\\n01400\\nAnesthesia for open or surgical arthroscopic procedures on knee\\njoint; not otherwise specified\\n$ 385.00\\n01402\\n01402\\nAnesthesia for open or surgical arthroscopic procedures on knee\\njoint; total knee arthroplasty\\n$ 385.00\\n01404\\n01404\\nAnesthesia for open or surgical arthroscopic procedures on knee\\njoint; disarticulation at knee\\n$ 273.00\\n01420\\n01420\\nAnesthesia for all cast applications, removal, or repair involving\\nknee joint\\n$ 273.00\\n01430\\n01430\\nAnesthesia for procedures on veins of knee and popliteal area; not\\notherwise specified\\n$ 273.00\\n01432\\n01432\\nAnesthesia for procedures on veins of knee and popliteal area;\\narteriovenous fistula\\n$ 273.00\\n01440\\n01440\\nAnesthesia for procedures on arteries of knee and popliteal area;\\nnot otherwise specified\\n$ 273.00\\n01442\\n01442\\nAnesthesia for procedures on arteries of knee and popliteal area;\\npopliteal thromboendarterectomy, with or without patch graft\\n$ 273.00\\n01444\\n01444\\nAnesthesia for procedures on arteries of knee and popliteal area;\\npopliteal excision and graft or repair for occlusion or aneurysm\\n$ 273.00\\n01462\\n01462\\nAnesthesia for all closed procedures on lower leg, ankle, and foot\\n$ 192.50\\n01464\\n01464\\nAnesthesia for arthroscopic procedures of ankle and\/or foot\\n$ 273.00\\n01470\\n01470\\nAnesthesia for procedures on nerves, muscles, tendons, and fascia\\nof lower leg, ankle, and foot; not otherwise specified\\n$ 385.00\\n01472\\n01472\\nAnesthesia for procedures on nerves, muscles, tendons, and fascia\\nof lower leg, ankle, and foot; repair of ruptured Achilles tendon,\\nwith or without graft\\n$ 385.00\\n01474\\n01474\\nAnesthesia for procedures on nerves, muscles, tendons, and fascia\\nof lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer\\nprocedure)\\n$ 273.00\\n01480\\n01480\\nAnesthesia for open procedures on bones of lower leg, ankle, and\\nfoot; not otherwise specified\\n$ 385.00\\n01482\\n01482\\nAnesthesia for open procedures on bones of lower leg, ankle, and\\nfoot; radical resection (including below knee amputation)\\n$ 273.00\\n01484\\n01484\\nAnesthesia for open procedures on bones of lower leg, ankle, and\\nfoot; osteotomy or osteoplasty of tibia and\/or fibula\\n$ 273.00\\n01486\\n01486\\nAnesthesia for open procedures on bones of lower leg, ankle, and\\nfoot; total ankle replacement\\n$ 273.00\\n01490\\n01490\\nAnesthesia for lower leg cast application, removal, or repair\\n$ 192.50\\n01500\\n01500\\nAnesthesia for procedures on arteries of lower leg, including bypass\\ngraft; not otherwise specified\\n$ 273.00\\n01502\\n01502\\nAnesthesia for procedures on arteries of lower leg, including bypass\\ngraft; embolectomy, direct or with catheter\\n$ 273.00\\n01520\\n01520\\nAnesthesia for procedures on veins of lower leg; not otherwise\\nspecified\\n$ 273.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n15\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n16\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n01522\\n01522\\nAnesthesia for procedures on veins of lower leg; venous\\nthrombectomy, direct or with catheter\\n$ 385.00\\n01610\\n01610\\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\\nand bursae of shoulder and axilla\\n$ 385.00\\n01620\\n01620\\nAnesthesia for all closed procedures on humeral head and neck,\\nsternoclavicular joint, acromioclavicular joint, and shoulder joint\\n$ 273.00\\n01622\\n01622\\nAnesthesia for diagnostic arthroscopic procedures of shoulder joint\\n$ 385.00\\n01630\\n01630\\nAnesthesia for open or surgical arthroscopic procedures on humeral\\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\\nshoulder joint; not otherwise specified\\n$ 385.00\\n01634\\n01634\\nAnesthesia for open or surgical arthroscopic procedures on humeral\\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\\nshoulder joint; shoulder disarticulation\\n$ 273.00\\n01636\\n01636\\nAnesthesia for open or surgical arthroscopic procedures on humeral\\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\\nshoulder joint; interthoracoscapular (forequarter) amputation\\n$ 273.00\\n01638\\n01638\\nAnesthesia for open or surgical arthroscopic procedures on humeral\\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\\nshoulder joint; total shoulder replacement\\n$ 273.00\\n01650\\n01650\\nAnesthesia for procedures on arteries of shoulder and axilla; not\\notherwise specified\\n$ 273.00\\n01652\\n01652\\nAnesthesia for procedures on arteries of shoulder and axilla; axillary-\\nbrachial aneurysm\\n$ 273.00\\n01654\\n01654\\nAnesthesia for procedures on arteries of shoulder and axilla; bypass\\ngraft\\n$ 273.00\\n01656\\n01656\\nAnesthesia for procedures on arteries of shoulder and axilla; axillary-\\nfemoral bypass graft\\n$ 273.00\\n01670\\n01670\\nAnesthesia for all procedures on veins of shoulder and axilla\\n$ 273.00\\n01680\\n01680\\nAnesthesia for shoulder cast application, removal or repair; not\\notherwise specified\\n$ 273.00\\n01682\\n01682\\nAnesthesia for shoulder cast application, removal or repair;\\nshoulder spica\\n$ 273.00\\n01710\\n01710\\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\\nbursae of upper arm and elbow; not otherwise specified\\n$ 385.00\\n01712\\n01712\\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\\nbursae of upper arm and elbow; tenotomy, elbow to shoulder, open $ 273.00\\n01714\\n01714\\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\\nbursae of upper arm and elbow; tenoplasty, elbow to shoulder\\n$ 273.00\\n01716\\n01716\\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\\nbursae of upper arm and elbow; tenodesis, rupture of long tendon\\nof biceps\\n$ 385.00\\n01730\\n01730\\nAnesthesia for all closed procedures on humerus and elbow\\n$ 192.50\\n01732\\n01732\\nAnesthesia for diagnostic arthroscopic procedures of elbow joint\\n$ 273.00\\n01740\\n01740\\nAnesthesia for open or surgical arthroscopic procedures of the\\nelbow; not otherwise specified\\n$ 385.00\\n01742\\n01742\\nAnesthesia for open or surgical arthroscopic procedures of the\\nelbow; osteotomy of humerus\\n$ 273.00\\n01744\\n01744\\nAnesthesia for open or surgical arthroscopic procedures of the\\nelbow; repair of nonunion or malunion of humerus\\n$ 273.00\\n01756\\n01756\\nAnesthesia for open or surgical arthroscopic procedures of the\\nelbow; radical procedures\\n$ 273.00\\n01758\\n01758\\nAnesthesia for open or surgical arthroscopic procedures of the\\nelbow; excision of cyst or tumor of humerus\\n$ 273.00\\n01760\\n01760\\nAnesthesia for open or surgical arthroscopic procedures of the\\nelbow; total elbow replacement\\n$ 273.00\\n01770\\n01770\\nAnesthesia for procedures on arteries of upper arm and elbow; not\\notherwise specified\\n$ 273.00\\n01772\\n01772\\nAnesthesia for procedures on arteries of upper arm and elbow;\\nembolectomy\\n$ 273.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n17\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n18\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n01780\\n01780\\nAnesthesia for procedures on veins of upper arm and elbow; not\\notherwise specified\\n$ 273.00\\n01782\\n01782\\nAnesthesia for procedures on veins of upper arm and elbow;\\nphleborrhaphy\\n$ 273.00\\n01810\\n01810\\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\\nand bursae of forearm, wrist, and hand\\n$ 385.00\\n01820\\n01820\\nAnesthesia for all closed procedures on radius, ulna, wrist, or hand\\nbones\\n$ 192.50\\n01829\\n01829\\nAnesthesia for diagnostic arthroscopic procedures on the wrist\\n$ 273.00\\n01830\\n01830\\nAnesthesia for open or surgical arthroscopic\/endoscopic procedures\\non distal radius, distal ulna, wrist, or hand joints; not otherwise\\nspecified\\n$ 385.00\\n01832\\n01832\\nAnesthesia for open or surgical arthroscopic\/endoscopic procedures\\non distal radius, distal ulna, wrist, or hand joints; total wrist\\nreplacement\\n$ 273.00\\n01840\\n01840\\nAnesthesia for procedures on arteries of forearm, wrist, and hand;\\nnot otherwise specified\\n$ 273.00\\n01842\\n01842\\nAnesthesia for procedures on arteries of forearm, wrist, and hand;\\nembolectomy\\n$ 385.00\\n01844\\n01844\\nAnesthesia for vascular shunt, or shunt revision, any type (eg,\\ndialysis)\\n$ 385.00\\n01850\\n01850\\nAnesthesia for procedures on veins of forearm, wrist, and hand; not\\notherwise specified\\n$ 273.00\\n01852\\n01852\\nAnesthesia for procedures on veins of forearm, wrist, and hand;\\nphleborrhaphy\\n$ 273.00\\n01860\\n01860\\nAnesthesia for forearm, wrist, or hand cast application, removal, or\\nrepair\\n$ 192.50\\n01916\\n01916\\nAnesthesia for diagnostic arteriography\/venography\\n$ 273.00\\n01920\\n01920\\nAnesthesia for cardiac catheterization including coronary\\nangiography and ventriculography (not to include Swan-Ganz\\ncatheter)\\n$ 273.00\\n01922\\n01922\\nAnesthesia for non-invasive imaging or radiation therapy\\n$ 192.50\\n01924\\n01924\\nAnesthesia for therapeutic interventional radiological procedures\\ninvolving the arterial system; not otherwise specified\\n$ 273.00\\n01925\\n01925\\nAnesthesia for therapeutic interventional radiological procedures\\ninvolving the arterial system; carotid or coronary\\n$ 273.00\\n01926\\n01926\\nAnesthesia for therapeutic interventional radiological procedures\\ninvolving the arterial system; intracranial, intracardiac, or aortic\\n$ 273.00\\n01930\\n01930\\nAnesthesia for therapeutic interventional radiological procedures\\ninvolving the venous\/lymphatic system (not to include access to the\\ncentral circulation); not otherwise specified\\n$ 273.00\\n01931\\n01931\\nAnesthesia for therapeutic interventional radiological procedures\\ninvolving the venous\/lymphatic system (not to include access to the\\ncentral circulation); intrahepatic or portal circulation (eg,\\ntransvenous intrahepatic portosystemic shunt[s] [TIPS])\\n$ 273.00\\n01932\\n01932\\nAnesthesia for therapeutic interventional radiological procedures\\ninvolving the venous\/lymphatic system (not to include access to the\\ncentral circulation); intrathoracic or jugular\\n$ 273.00\\n01933\\n01933\\nAnesthesia for therapeutic interventional radiological procedures\\ninvolving the venous\/lymphatic system (not to include access to the\\ncentral circulation); intracranial\\n$ 273.00\\n01935\\n01935\\nAnesthesia for percutaneous image guided procedures on the spine\\nand spinal cord; diagnostic\\n$ 273.00\\n01936\\n01936\\nAnesthesia for percutaneous image guided procedures on the spine\\nand spinal cord; therapeutic\\n$ 273.00\\n01951\\n01951\\nAnesthesia for second- and third-degree burn excision or\\ndebridement with or without skin grafting, any site, for total body\\nsurface area (TBSA) treated during anesthesia and surgery; less than\\n4% total body surface area\\n$ 273.00\\n01952\\n01952\\nAnesthesia for second- and third-degree burn excision or\\ndebridement with or without skin grafting, any site, for total body\\nsurface area (TBSA) treated during anesthesia and surgery; between\\n4% and 9% of total body surface area\\n$ 273.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n19\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n20\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n01953\\n01953\\nAnesthesia for second- and third-degree burn excision or\\ndebridement with or without skin grafting, any site, for total body\\nsurface area (TBSA) treated during anesthesia and surgery; each\\nadditional 9% total body surface area or part thereof (List separa\\n$ 273.00\\n01958\\n01958\\nAnesthesia for external cephalic version procedure\\n$ 273.00\\n01960\\n01960\\nAnesthesia for vaginal delivery only\\n$ 273.00\\n01961\\n01961\\nAnesthesia for cesarean delivery only\\n$ 214.50\\n01962\\n01962\\nAnesthesia for urgent hysterectomy following delivery\\n$ 273.00\\n01963\\n01963\\nAnesthesia for cesarean hysterectomy without any labor\\nanalgesia\/anesthesia care\\n$ 273.00\\n01965\\n01965\\nAnesthesia for incomplete or missed abortion procedures\\n$ 273.00\\n01966\\n01966\\nAnesthesia for induced abortion procedures\\n$ 273.00\\n01967\\n01967\\nNeuraxial labor analgesia\/anesthesia for planned vaginal delivery\\n(this includes any repeat subarachnoid needle placement and drug\\ninjection and\/or any necessary replacement of an epidural catheter\\nduring labor)\\n$ 273.00\\n01968\\n01968\\nAnesthesia for cesarean delivery following neuraxial labor\\nanalgesia\/anesthesia (List separately in addition to code for primary\\nprocedure performed)\\n$ 273.00\\n01969\\n01969\\nAnesthesia for cesarean hysterectomy following neuraxial labor\\nanalgesia\/anesthesia (List separately in addition to code for primary\\nprocedure performed)\\n$ 286.00\\n01990\\n01990\\nPhysiological support for harvesting of organ(s) from brain-dead\\npatient\\n$ 273.00\\n01991\\n01991\\nAnesthesia for diagnostic or therapeutic nerve blocks and injections\\n(when block or injection is performed by a different physician or\\nother qualified health care professional); other than the prone\\nposition\\n$ 286.00\\n01992\\n01992\\nAnesthesia for diagnostic or therapeutic nerve blocks and injections\\n(when block or injection is performed by a different physician or\\nother qualified health care professional); prone position\\n$ 286.00\\n01996\\n01996\\nDaily hospital management of epidural or subarachnoid continuous\\ndrug administration\\n$ 88.00\\n01999\\n01999\\nUnlisted anesthesia procedure(s)\\n$ 286.00\\n0234T\\n0234T\\nTransluminal peripheral atherectomy, open or percutaneous,\\nincluding radiological supervision and interpretation; renal artery\\n$ 8,842.66\\n0235T\\n0235T\\nTransluminal peripheral atherectomy, open or percutaneous,\\nincluding radiological supervision and interpretation; visceral artery\\n(except renal), each vessel\\n$ 2,580.30\\n0237T\\n0237T\\nTransluminal peripheral atherectomy, open or percutaneous,\\nincluding radiological supervision and interpretation;\\nbrachiocephalic trunk and branches, each vessel\\n$ 8,842.66\\n0238T\\n0238T\\nTransluminal peripheral atherectomy, open or percutaneous,\\nincluding radiological supervision and interpretation; iliac artery,\\neach vessel\\n$ 8,842.66\\n10021\\n10021\\nFine needle aspiration; without imaging guidance\\n$ 196.46\\n10022\\n10022\\nFine needle aspiration; with imaging guidance\\n$ 215.09\\n10040\\n10040\\nAcne surgery (eg, marsupialization, opening or removal of multiple\\nmilia, comedones, cysts, pustules)\\n$ 122.40\\n10060\\n10060\\nIncision and drainage of abscess (eg, carbuncle, suppurative\\nhidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or\\nparonychia); simple or single\\n$ 134.44\\n10061\\n10061\\nIncision and drainage of abscess (eg, carbuncle, suppurative\\nhidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or\\nparonychia); complicated or multiple\\n$ 358.05\\n10080\\n10080\\nIncision and drainage of pilonidal cyst; simple\\n$ 190.80\\n10081\\n10081\\nIncision and drainage of pilonidal cyst; complicated\\n$ 450.90\\n10120\\n10120\\nIncision and removal of foreign body, subcutaneous tissues; simple\\n$ 149.67\\n10121\\n10121\\nIncision and removal of foreign body, subcutaneous tissues;\\ncomplicated\\n$ 413.45\\n10140\\n10140\\nIncision and drainage of hematoma, seroma or fluid collection\\n$ 183.32\\n10160\\n10160\\nPuncture aspiration of abscess, hematoma, bulla, or cyst\\n$ 125.34\\n10180\\n10180\\nIncision and drainage, complex, postoperative wound infection\\n$ 560.32\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n21\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n22\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n11004\\n11004\\nDebridement of skin, subcutaneous tissue, muscle and fascia for\\nnecrotizing soft tissue infection; external genitalia and perineum\\n$ 756.94\\n11005\\n11005\\nDebridement of skin, subcutaneous tissue, muscle and fascia for\\nnecrotizing soft tissue infection; abdominal wall, with or without\\nfascial closure\\n$ 1,068.79\\n11006\\n11006\\nDebridement of skin, subcutaneous tissue, muscle and fascia for\\nnecrotizing soft tissue infection; external genitalia, perineum and\\nabdominal wall, with or without fascial closure\\n$ 973.26\\n11008\\n11008\\nRemoval of prosthetic material or mesh, abdominal wall for\\ninfection (eg, for chronic or recurrent mesh infection or necrotizing\\nsoft tissue infection) (List separately in addition to code for primary\\nprocedure)\\n$ 437.12\\n11044\\n11044\\nDebridement, bone (includes epidermis, dermis, subcutaneous\\ntissue, muscle and\/or fascia, if performed); first 20 sq cm or less\\n$ 846.90\\n11100\\n11100\\nBiopsy of skin, subcutaneous tissue and\/or mucous membrane\\n(including simple closure), unless otherwise listed; single lesion\\n$ 134.31\\n11101\\n11101\\nBiopsy of skin, subcutaneous tissue and\/or mucous membrane\\n(including simple closure), unless otherwise listed; each\\nseparate\/additional lesion (List separately in addition to code for\\nprimary procedure)\\n$ 77.57\\n11200\\n11200\\nRemoval of skin tags, multiple fibrocutaneous tags, any area; up to\\nand including 15 lesions\\n$ 130.55\\n11201\\n11201\\nRemoval of skin tags, multiple fibrocutaneous tags, any area; each\\nadditional 10 lesions, or part thereof (List separately in addition to\\ncode for primary procedure)\\n$ 94.70\\n11300\\n11300\\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\\nlegs; lesion diameter 0.5 cm or less\\n$ 113.80\\n11301\\n11301\\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\\nlegs; lesion diameter 0.6 to 1.0 cm\\n$ 142.45\\n11302\\n11302\\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\\nlegs; lesion diameter 1.1 to 2.0 cm\\n$ 178.74\\n11303\\n11303\\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\\nlegs; lesion diameter over 2.0 cm\\n$ 289.80\\n11305\\n11305\\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\\nhands, feet, genitalia; lesion diameter 0.5 cm or less\\n$ 125.15\\n11306\\n11306\\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\\nhands, feet, genitalia; lesion diameter 0.6 to 1.0 cm\\n$ 166.40\\n11307\\n11307\\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\\nhands, feet, genitalia; lesion diameter 1.1 to 2.0 cm\\n$ 232.20\\n11308\\n11308\\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\\nhands, feet, genitalia; lesion diameter over 2.0 cm\\n$ 261.50\\n11310\\n11310\\nShaving of epidermal or dermal lesion, single lesion, face, ears,\\neyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or\\nless\\n$ 141.10\\n11311\\n11311\\nShaving of epidermal or dermal lesion, single lesion, face, ears,\\neyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm $ 216.00\\n11312\\n11312\\nShaving of epidermal or dermal lesion, single lesion, face, ears,\\neyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm $ 252.00\\n11313\\n11313\\nShaving of epidermal or dermal lesion, single lesion, face, ears,\\neyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm\\n$ 283.29\\n11400\\n11400\\nExcision, benign lesion including margins, except skin tag (unless\\nlisted elsewhere), trunk, arms or legs; excised diameter 0.5 cm or\\nless\\n$ 151.78\\n11402\\n11402\\nExcision, benign lesion including margins, except skin tag (unless\\nlisted elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0\\ncm\\n$ 304.20\\n11403\\n11403\\nExcision, benign lesion including margins, except skin tag (unless\\nlisted elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0\\ncm\\n$ 323.56\\n11404\\n11404\\nExcision, benign lesion including margins, except skin tag (unless\\nlisted elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0\\ncm\\n$ 435.46\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n23\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n24\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n11441\\n11441\\nExcision, other benign lesion including margins, except skin tag\\n(unless listed elsewhere), face, ears, eyelids, nose, lips, mucous\\nmembrane; excised diameter 0.6 to 1.0 cm\\n$ 262.16\\n11442\\n11442\\nExcision, other benign lesion including margins, except skin tag\\n(unless listed elsewhere), face, ears, eyelids, nose, lips, mucous\\nmembrane; excised diameter 1.1 to 2.0 cm\\n$ 345.79\\n11604\\n11604\\nExcision, malignant lesion including margins, trunk, arms, or legs;\\nexcised diameter 3.1 to 4.0 cm\\n$ 582.43\\n11606\\n11606\\nExcision, malignant lesion including margins, trunk, arms, or legs;\\nexcised diameter over 4.0 cm\\n$ 780.74\\n11623\\n11623\\nExcision, malignant lesion including margins, scalp, neck, hands,\\nfeet, genitalia; excised diameter 2.1 to 3.0 cm\\n$ 568.31\\n11624\\n11624\\nExcision, malignant lesion including margins, scalp, neck, hands,\\nfeet, genitalia; excised diameter 3.1 to 4.0 cm\\n$ 820.80\\n11626\\n11626\\nExcision, malignant lesion including margins, scalp, neck, hands,\\nfeet, genitalia; excised diameter over 4.0 cm\\n$ 990.00\\n11719\\n11719\\nTrimming of nondystrophic nails, any number\\n$ 39.46\\n11720\\n11720\\nDebridement of nail(s) by any method(s); 1 to 5\\n$ 87.30\\n11721\\n11721\\nDebridement of nail(s) by any method(s); 6 or more\\n$ 122.40\\n11740\\n11740\\nEvacuation of subungual hematoma\\n$ 117.00\\n11750\\n11750\\nExcision of nail and nail matrix, partial or complete (eg, ingrown or\\ndeformed nail), for permanent removal;\\n$ 341.38\\n11765\\n11765\\nWedge excision of skin of nail fold (eg, for ingrown toenail)\\n$ 226.39\\n11900\\n11900\\nInjection, intralesional; up to and including 7 lesions\\n$ 68.38\\n11901\\n11901\\nInjection, intralesional; more than 7 lesions\\n$ 103.02\\n11950\\n11950\\nSubcutaneous injection of filling material (eg, collagen); 1 cc or less\\n$ 348.30\\n11951\\n11951\\nSubcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc $ 549.90\\n11952\\n11952\\nSubcutaneous injection of filling material (eg, collagen); 5.1 to 10.0\\ncc\\n$ 899.10\\n11954\\n11954\\nSubcutaneous injection of filling material (eg, collagen); over 10.0 cc\\n$ 1,215.90\\n11976\\n11976\\nRemoval, implantable contraceptive capsules\\n$ 318.60\\n11980\\n11980\\nSubcutaneous hormone pellet implantation (implantation of\\nestradiol and\/or testosterone pellets beneath the skin)\\n$ 430.20\\n11981\\n11981\\nInsertion, non-biodegradable drug delivery implant\\n$ 162.00\\n11982\\n11982\\nRemoval, non-biodegradable drug delivery implant\\n$ 165.40\\n11983\\n11983\\nRemoval with reinsertion, non-biodegradable drug delivery implant\\n$ 193.58\\n12001\\n12001\\nSimple repair of superficial wounds of scalp, neck, axillae, external\\ngenitalia, trunk and\/or extremities (including hands and feet); 2.5\\ncm or less\\n$ 179.15\\n12002\\n12002\\nSimple repair of superficial wounds of scalp, neck, axillae, external\\ngenitalia, trunk and\/or extremities (including hands and feet); 2.6\\ncm to 7.5 cm\\n$ 230.42\\n12004\\n12004\\nSimple repair of superficial wounds of scalp, neck, axillae, external\\ngenitalia, trunk and\/or extremities (including hands and feet); 7.6\\ncm to 12.5 cm\\n$ 327.60\\n12005\\n12005\\nSimple repair of superficial wounds of scalp, neck, axillae, external\\ngenitalia, trunk and\/or extremities (including hands and feet); 12.6\\ncm to 20.0 cm\\n$ 421.20\\n12006\\n12006\\nSimple repair of superficial wounds of scalp, neck, axillae, external\\ngenitalia, trunk and\/or extremities (including hands and feet); 20.1\\ncm to 30.0 cm\\n$ 487.80\\n12007\\n12007\\nSimple repair of superficial wounds of scalp, neck, axillae, external\\ngenitalia, trunk and\/or extremities (including hands and feet); over\\n30.0 cm\\n$ 675.90\\n12011\\n12011\\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 2.5 cm or less\\n$ 222.77\\n12013\\n12013\\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 2.6 cm to 5.0 cm\\n$ 288.43\\n12014\\n12014\\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 5.1 cm to 7.5 cm\\n$ 363.06\\n12015\\n12015\\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 7.6 cm to 12.5 cm\\n$ 477.90\\n12016\\n12016\\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 12.6 cm to 20.0 cm\\n$ 629.10\\n12017\\n12017\\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 20.1 cm to 30.0 cm\\n$ 779.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n25\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n26\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n12018\\n12018\\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; over 30.0 cm\\n$ 1,124.10\\n12020\\n12020\\nTreatment of superficial wound dehiscence; simple closure\\n$ 388.79\\n12031\\n12031\\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\\nextremities (excluding hands and feet); 2.5 cm or less\\n$ 255.60\\n12032\\n12032\\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\\nextremities (excluding hands and feet); 2.6 cm to 7.5 cm\\n$ 343.80\\n12034\\n12034\\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\\nextremities (excluding hands and feet); 7.6 cm to 12.5 cm\\n$ 423.00\\n12035\\n12035\\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\\nextremities (excluding hands and feet); 12.6 cm to 20.0 cm\\n$ 555.30\\n12036\\n12036\\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\\nextremities (excluding hands and feet); 20.1 cm to 30.0 cm\\n$ 719.10\\n12037\\n12037\\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\\nextremities (excluding hands and feet); over 30.0 cm\\n$ 922.50\\n12041\\n12041\\nRepair, intermediate, wounds of neck, hands, feet and\/or external\\ngenitalia; 2.5 cm or less\\n$ 291.60\\n12042\\n12042\\nRepair, intermediate, wounds of neck, hands, feet and\/or external\\ngenitalia; 2.6 cm to 7.5 cm\\n$ 352.09\\n12044\\n12044\\nRepair, intermediate, wounds of neck, hands, feet and\/or external\\ngenitalia; 7.6 cm to 12.5 cm\\n$ 468.90\\n12045\\n12045\\nRepair, intermediate, wounds of neck, hands, feet and\/or external\\ngenitalia; 12.6 cm to 20.0 cm\\n$ 579.60\\n12046\\n12046\\nRepair, intermediate, wounds of neck, hands, feet and\/or external\\ngenitalia; 20.1 cm to 30.0 cm\\n$ 812.70\\n12047\\n12047\\nRepair, intermediate, wounds of neck, hands, feet and\/or external\\ngenitalia; over 30.0 cm\\n$ 963.00\\n12051\\n12051\\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 2.5 cm or less\\n$ 350.10\\n12052\\n12052\\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 2.6 cm to 5.0 cm\\n$ 470.70\\n12053\\n12053\\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 5.1 cm to 7.5 cm\\n$ 549.00\\n12054\\n12054\\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 7.6 cm to 12.5 cm\\n$ 704.70\\n12055\\n12055\\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 12.6 cm to 20.0 cm\\n$ 942.30\\n12056\\n12056\\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; 20.1 cm to 30.0 cm\\n$ 1,141.20\\n12057\\n12057\\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\\nand\/or mucous membranes; over 30.0 cm\\n$ 1,338.30\\n13160\\n13160\\nSecondary closure of surgical wound or dehiscence, extensive or\\ncomplicated\\n$ 1,059.69\\n14000\\n14000\\nAdjacent tissue transfer or rearrangement, trunk; defect 10 sq cm\\nor less\\n$ 1,088.10\\n14301\\n14301\\nAdjacent tissue transfer or rearrangement, any area; defect 30.1 sq\\ncm to 60.0 sq cm\\n$ 2,113.30\\n14302\\n14302\\nAdjacent tissue transfer or rearrangement, any area; each\\nadditional 30.0 sq cm, or part thereof (list separately in addition to\\ncode for primary procedure)\\n$ 480.88\\n15005\\n15005\\nSurgical preparation or creation of recipient site by excision of open\\nwounds, burn eschar, or scar (including subcutaneous tissues), or\\nincisional release of scar contracture, face, scalp, eyelids, mouth,\\nneck, ears, orbits, genitalia, hands, feet and\/or\\n$ 265.38\\n15040\\n15040\\nHarvest of skin for tissue cultured skin autograft, 100 sq cm or less\\n$ 563.25\\n15110\\n15110\\nEpidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1%\\nof body area of infants and children\\n$ 1,887.78\\n15111\\n15111\\nEpidermal autograft, trunk, arms, legs; each additional 100 sq cm,\\nor each additional 1% of body area of infants and children, or part\\nthereof (List separately in addition to code for primary procedure)\\n$ 294.39\\n15116\\n15116\\nEpidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits,\\ngenitalia, hands, feet, and\/or multiple digits; each additional 100 sq\\ncm, or each additional 1% of body area of infants and children, or\\npart thereof (List separately in addition to co\\n$ 402.77\\n15130\\n15130\\nDermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of\\nbody area of infants and children\\n$ 1,469.33\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n27\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n28\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n15131\\n15131\\nDermal autograft, trunk, arms, legs; each additional 100 sq cm, or\\neach additional 1% of body area of infants and children, or part\\nthereof (List separately in addition to code for primary procedure)\\n$ 246.06\\n15135\\n15135\\nDermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits,\\ngenitalia, hands, feet, and\/or multiple digits; first 100 sq cm or less,\\nor 1% of body area of infants and children\\n$ 1,861.86\\n15136\\n15136\\nDermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits,\\ngenitalia, hands, feet, and\/or multiple digits; each additional 100 sq\\ncm, or each additional 1% of body area of infants and children, or\\npart thereof (List separately in addition to code\\n$ 227.31\\n15150\\n15150\\nTissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or\\nless\\n$ 1,481.15\\n15151\\n15151\\nTissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm\\nto 75 sq cm (List separately in addition to code for primary\\nprocedure)\\n$ 297.75\\n15155\\n15155\\nTissue cultured skin autograft, face, scalp, eyelids, mouth, neck,\\nears, orbits, genitalia, hands, feet, and\/or multiple digits; first 25 sq\\ncm or less\\n$ 1,472.04\\n15156\\n15156\\nTissue cultured skin autograft, face, scalp, eyelids, mouth, neck,\\nears, orbits, genitalia, hands, feet, and\/or multiple digits; additional\\n1 sq cm to 75 sq cm (List separately in addition to code for primary\\nprocedure)\\n$ 424.98\\n15157\\n15157\\nTissue cultured skin autograft, face, scalp, eyelids, mouth, neck,\\nears, orbits, genitalia, hands, feet, and\/or multiple digits; each\\nadditional 100 sq cm, or each additional 1% of body area of infants\\nand children, or part thereof (List separately in add\\n$ 481.51\\n15200\\n15200\\nFull thickness graft, free, including direct closure of donor site,\\ntrunk; 20 sq cm or less\\n$ 1,299.60\\n15738\\n15738\\nMuscle, myocutaneous, or fasciocutaneous flap; lower extremity\\n$ 5,279.40\\n15780\\n15780\\nDermabrasion; total face (eg, for acne scarring, fine wrinkling,\\nrhytids, general keratosis)\\n$ 2,763.90\\n15781\\n15781\\nDermabrasion; segmental, face\\n$ 1,148.40\\n15782\\n15782\\nDermabrasion; regional, other than face\\n$ 772.20\\n15783\\n15783\\nDermabrasion; superficial, any site (eg, tattoo removal)\\n$ 772.20\\n15786\\n15786\\nAbrasion; single lesion (eg, keratosis, scar)\\n$ 412.20\\n15787\\n15787\\nAbrasion; each additional 4 lesions or less (List separately in\\naddition to code for primary procedure)\\n$ 207.90\\n15788\\n15788\\nChemical peel, facial; epidermal\\n$ 1,545.30\\n15789\\n15789\\nChemical peel, facial; dermal\\n$ 1,901.70\\n15792\\n15792\\nChemical peel, nonfacial; epidermal\\n$ 544.50\\n15793\\n15793\\nChemical peel, nonfacial; dermal\\n$ 849.60\\n15820\\n15820\\nBlepharoplasty, lower eyelid;\\n$ 2,253.60\\n15822\\n15822\\nBlepharoplasty, upper eyelid;\\n$ 2,542.50\\n15830\\n15830\\nExcision, excessive skin and subcutaneous tissue (includes\\nlipectomy); abdomen, infraumbilical panniculectomy\\n$ 1,777.49\\n15847\\n15847\\nExcision, excessive skin and subcutaneous tissue (includes\\nlipectomy), abdomen (eg, abdominoplasty) (includes umbilical\\ntransposition and fascial plication) (List separately in addition to\\ncode for primary procedure)\\n$ 715.00\\n15851\\n15851\\nRemoval of sutures under anesthesia (other than local), other\\nsurgeon\\n$ 259.49\\n15852\\n15852\\nDressing change (for other than burns) under anesthesia (other\\nthan local)\\n$ 373.50\\n15877\\n15877\\nSuction assisted lipectomy; trunk\\n$ 2,446.20\\n15878\\n15878\\nSuction assisted lipectomy; upper extremity\\n$ 2,060.10\\n15879\\n15879\\nSuction assisted lipectomy; lower extremity\\n$ 2,292.30\\n15999\\n15999\\nUnlisted procedure, excision pressure ulcer\\nCost\\n16000\\n16000\\nInitial treatment, first degree burn, when no more than local\\ntreatment is required\\n$ 104.40\\n16020\\n16020\\nDressings and\/or debridement of partial-thickness burns, initial or\\nsubsequent; small (less than 5% total body surface area)\\n$ 115.89\\n16025\\n16025\\nDressings and\/or debridement of partial-thickness burns, initial or\\nsubsequent; medium (eg, whole face or whole extremity, or 5% to\\n10% total body surface area)\\n$ 217.86\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n29\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n30\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n16030\\n16030\\nDressings and\/or debridement of partial-thickness burns, initial or\\nsubsequent; large (eg, more than 1 extremity, or greater than 10%\\ntotal body surface area)\\n$ 363.34\\n17000\\n17000\\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\\nchemosurgery, surgical curettement), premalignant lesions (eg,\\nactinic keratoses); first lesion\\n$ 97.34\\n17003\\n17003\\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\\nchemosurgery, surgical curettement), premalignant lesions (eg,\\nactinic keratoses); second through 14 lesions, each (List separately\\nin addition to code for first lesion)\\n$ 37.26\\n17004\\n17004\\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\\nchemosurgery, surgical curettement), premalignant lesions (eg,\\nactinic keratoses), 15 or more lesions\\n$ 540.00\\n17110\\n17110\\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\\nchemosurgery, surgical curettement), of benign lesions other than\\nskin tags or cutaneous vascular proliferative lesions; up to 14 lesions $ 110.03\\n17111\\n17111\\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\\nchemosurgery, surgical curettement), of benign lesions other than\\nskin tags or cutaneous vascular proliferative lesions; 15 or more\\nlesions\\n$ 178.20\\n17250\\n17250\\nChemical cauterization of granulation tissue (proud flesh, sinus or\\nfistula)\\n$ 152.10\\n17340\\n17340\\nCryotherapy (CO2 slush, liquid N2) for acne\\n$ 74.83\\n17380\\n17380\\nElectrolysis epilation, each 30 minutes\\n$ 134.10\\n19100\\n19100\\nBiopsy of breast; percutaneous, needle core, not using imaging\\nguidance (separate procedure)\\n$ 257.40\\n19105\\n19105\\nAblation, cryosurgical, of fibroadenoma, including ultrasound\\nguidance, each fibroadenoma\\n$ 3,171.04\\n19110\\n19110\\nNipple exploration, with or without excision of a solitary lactiferous\\nduct or a papilloma lactiferous duct\\n$ 1,235.70\\n19120\\n19120\\nExcision of cyst, fibroadenoma, or other benign or malignant tumor,\\naberrant breast tissue, duct lesion, nipple or areolar lesion (except\\n19300), open, male or female, 1 or more lesions\\n$ 1,105.37\\n19125\\n19125\\nExcision of breast lesion identified by preoperative placement of\\nradiological marker, open; single lesion\\n$ 1,289.70\\n19281\\n19281\\nPlacement of breast localization device(s) (eg, clip, metallic pellet,\\nwire\/needle, radioactive seeds), percutaneous; first lesion, including\\nmammographic guidance\\n$98.25\\n19296\\n19296\\nPlacement of radiotherapy afterloading expandable catheter (single\\nor multichannel) into the breast for interstitial radioelement\\napplication following partial mastectomy, includes imaging\\nguidance; on date separate from partial mastectomy\\n$ 9,940.72\\n19297\\n19297\\nPlacement of radiotherapy afterloading expandable catheter (single\\nor multichannel) into the breast for interstitial radioelement\\napplication following partial mastectomy, includes imaging\\nguidance; concurrent with partial mastectomy (List separately in a\\n$ 218.27\\n19298\\n19298\\nPlacement of radiotherapy afterloading brachytherapy catheters\\n(multiple tube and button type) into the breast for interstitial\\nradioelement application following (at the time of or subsequent to)\\npartial mastectomy, includes imaging guidance\\n$ 3,605.44\\n19301\\n19301\\nMastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy,\\nsegmentectomy);\\n$ 933.84\\n19303\\n19303\\nMastectomy, simple, complete\\n$ 1,597.79\\n19304\\n19304\\nMastectomy, subcutaneous\\n$ 1,169.33\\n19305\\n19305\\nMastectomy, radical, including pectoral muscles, axillary lymph\\nnodes\\n$ 2,032.87\\n19306\\n19306\\nMastectomy, radical, including pectoral muscles, axillary and\\ninternal mammary lymph nodes (Urban type operation)\\n$ 2,299.98\\n19318\\n19318\\nReduction mammaplasty\\n$ 4,137.80\\n19325\\n19325\\nMammaplasty, augmentation; with prosthetic implant\\n$ 2,711.70\\n19328\\n19328\\nRemoval of intact mammary implant\\n$ 1,848.60\\n19342\\n19342\\nDelayed insertion of breast prosthesis following mastopexy,\\nmastectomy or in reconstruction\\n$ 2,786.40\\n19361\\n19361\\nBreast reconstruction with latissimus dorsi flap, without prosthetic\\nimplant\\n$ 5,408.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n31\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n32\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n19368\\n19368\\nBreast reconstruction with transverse rectus abdominis\\nmyocutaneous flap (TRAM), single pedicle, including closure of\\ndonor site; with microvascular anastomosis (supercharging)\\n$ 6,352.72\\n19369\\n19369\\nBreast reconstruction with transverse rectus abdominis\\nmyocutaneous flap (TRAM), double pedicle, including closure of\\ndonor site\\n$ 5,552.58\\n19499\\n19499\\nUnlisted procedure, breast\\nCost\\n20005\\n20005\\nIncision and drainage of soft tissue abscess, subfascial (ie, involves\\nthe soft tissue below the deep fascia)\\n$ 664.63\\n20100\\n20100\\nExploration of penetrating wound (separate procedure); neck\\n$ 1,610.10\\n20101\\n20101\\nExploration of penetrating wound (separate procedure); chest\\n$ 675.00\\n20102\\n20102\\nExploration of penetrating wound (separate procedure);\\nabdomen\/flank\/back\\n$ 798.30\\n20103\\n20103\\nExploration of penetrating wound (separate procedure); extremity\\n$ 1,134.00\\n20150\\n20150\\nExcision of epiphyseal bar, with or without autogenous soft tissue\\ngraft obtained through same fascial incision\\n$ 2,912.40\\n20200\\n20200\\nBiopsy, muscle; superficial\\n$ 412.20\\n20205\\n20205\\nBiopsy, muscle; deep\\n$ 617.40\\n20206\\n20206\\nBiopsy, muscle, percutaneous needle\\n$ 272.70\\n20220\\n20220\\nBiopsy, bone, trocar, or needle; superficial (eg, ilium, sternum,\\nspinous process, ribs)\\n$ 360.90\\n20225\\n20225\\nBiopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)\\n$ 814.50\\n20240\\n20240\\nBiopsy, bone, open; superficial (eg, ilium, sternum, spinous process,\\nribs, trochanter of femur)\\n$ 654.30\\n20245\\n20245\\nBiopsy, bone, open; deep (eg, humerus, ischium, femur)\\n$ 1,028.70\\n20250\\n20250\\nBiopsy, vertebral body, open; thoracic\\n$ 3,141.00\\n20251\\n20251\\nBiopsy, vertebral body, open; lumbar or cervical\\n$ 2,589.30\\n20500\\n20500\\nInjection of sinus tract; therapeutic (separate procedure)\\n$ 114.30\\n20501\\n20501\\nInjection of sinus tract; diagnostic (sinogram)\\n$ 147.60\\n20520\\n20520\\nRemoval of foreign body in muscle or tendon sheath; simple\\n$ 307.46\\n20525\\n20525\\nRemoval of foreign body in muscle or tendon sheath; deep or\\ncomplicated\\n$ 720.90\\n20526\\n20526\\nInjection, therapeutic (eg, local anesthetic, corticosteroid), carpal\\ntunnel\\n$ 135.84\\n20550\\n20550\\nInjection(s); single tendon sheath, or ligament, aponeurosis (eg,\\nplantar 'fascia')\\n$ 108.18\\n20551\\n20551\\nInjection(s); single tendon origin\/insertion\\n$ 104.87\\n20552\\n20552\\nInjection(s); single or multiple trigger point(s), 1 or 2 muscle(s)\\n$ 103.78\\n20553\\n20553\\nInjection(s); single or multiple trigger point(s), 3 or more muscle(s)\\n$ 121.48\\n20555\\n20555\\nPlacement of needles or catheters into muscle and\/or soft tissue for\\nsubsequent interstitial radioelement application (at the time of or\\nsubsequent to the procedure)\\n$ 582.66\\n20600\\n20600\\nArthrocentesis, aspiration and\/or injection; small joint or bursa (eg,\\nfingers, toes)\\n$ 94.96\\n20605\\n20605\\nArthrocentesis, aspiration and\/or injection; intermediate joint or\\nbursa (eg, temporomandibular, acromioclavicular, wrist, elbow or\\nankle, olecranon bursa)\\n$ 107.28\\n20610\\n20610\\nArthrocentesis, aspiration and\/or injection; major joint or bursa (eg,\\nshoulder, hip, knee joint, subacromial bursa)\\n$ 135.03\\n20612\\n20612\\nAspiration and\/or injection of ganglion cyst(s) any location\\n$ 105.01\\n20615\\n20615\\nAspiration and injection for treatment of bone cyst\\n$ 527.40\\n20650\\n20650\\nInsertion of wire or pin with application of skeletal traction,\\nincluding removal (separate procedure)\\n$ 468.90\\n20660\\n20660\\nApplication of cranial tongs, caliper, or stereotactic frame, including\\nremoval (separate procedure)\\n$ 853.20\\n20661\\n20661\\nApplication of halo, including removal; cranial\\n$ 1,326.60\\n20662\\n20662\\nApplication of halo, including removal; pelvic\\n$ 902.70\\n20663\\n20663\\nApplication of halo, including removal; femoral\\n$ 765.00\\n20664\\n20664\\nApplication of halo, including removal, cranial, 6 or more pins\\nplaced, for thin skull osteology (eg, pediatric patients,\\nhydrocephalus, osteogenesis imperfecta)\\n$ 1,032.30\\n20665\\n20665\\nRemoval of tongs or halo applied by another individual\\n$ 234.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n33\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n34\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n20670\\n20670\\nRemoval of implant; superficial (eg, buried wire, pin or rod)\\n(separate procedure)\\n$ 463.50\\n20680\\n20680\\nRemoval of implant; deep (eg, buried wire, pin, screw, metal band,\\nnail, rod or plate)\\n$ 857.90\\n20690\\n20690\\nApplication of a uniplane (pins or wires in 1 plane), unilateral,\\nexternal fixation system\\n$ 1,138.50\\n20692\\n20692\\nApplication of a multiplane (pins or wires in more than 1 plane),\\nunilateral, external fixation system (eg, Ilizarov, Monticelli type)\\n$ 1,752.30\\n20693\\n20693\\nAdjustment or revision of external fixation system requiring\\nanesthesia (eg, new pin[s] or wire[s] and\/or new ring[s] or bar[s])\\n$ 908.10\\n20694\\n20694\\nRemoval, under anesthesia, of external fixation system\\n$ 824.40\\n20696\\n20696\\nApplication of multiplane (pins or wires in more than 1 plane),\\nunilateral, external fixation with stereotactic computer-assisted\\nadjustment (eg, spatial frame), including imaging; initial and\\nsubsequent alignment(s), assessment(s), and computation(s) of\\n$ 1,752.70\\n20697\\n20697\\nApplication of multiplane (pins or wires in more than 1 plane),\\nunilateral, external fixation with stereotactic computer-assisted\\nadjustment (eg, spatial frame), including imaging; exchange (ie,\\nremoval and replacement) of strut, each\\n$ 2,193.99\\n20802\\n20802\\nReplantation, arm (includes surgical neck of humerus through elbow\\njoint), complete amputation\\n$ 9,720.90\\n20805\\n20805\\nReplantation, forearm (includes radius and ulna to radial carpal\\njoint), complete amputation\\n$ 10,085.40\\n20808\\n20808\\nReplantation, hand (includes hand through metacarpophalangeal\\njoints), complete amputation\\n$ 11,040.30\\n20816\\n20816\\nReplantation, digit, excluding thumb (includes metacarpophalangeal\\njoint to insertion of flexor sublimis tendon), complete amputation\\n$ 5,793.30\\n20822\\n20822\\nReplantation, digit, excluding thumb (includes distal tip to sublimis\\ntendon insertion), complete amputation\\n$ 5,794.20\\n20824\\n20824\\nReplantation, thumb (includes carpometacarpal joint to MP joint),\\ncomplete amputation\\n$ 6,571.80\\n20827\\n20827\\nReplantation, thumb (includes distal tip to MP joint), complete\\namputation\\n$ 5,047.20\\n20838\\n20838\\nReplantation, foot, complete amputation\\n$ 9,888.30\\n20900\\n20900\\nBone graft, any donor area; minor or small (eg, dowel or button)\\n$ 947.70\\n20902\\n20902\\nBone graft, any donor area; major or large\\n$ 1,587.60\\n20910\\n20910\\nCartilage graft; costochondral\\n$ 1,491.30\\n20912\\n20912\\nCartilage graft; nasal septum\\n$ 1,467.90\\n20920\\n20920\\nFascia lata graft; by stripper\\n$ 885.60\\n20922\\n20922\\nFascia lata graft; by incision and area exposure, complex or sheet\\n$ 1,241.10\\n20924\\n20924\\nTendon graft, from a distance (eg, palmaris, toe extensor, plantaris)\\n$ 1,360.80\\n20926\\n20926\\nTissue grafts, other (eg, paratenon, fat, dermis)\\n$ 1,014.30\\n20930\\n20930\\nAllograft, morselized, or placement of osteopromotive material, for\\nspine surgery only (List separately in addition to code for primary\\nprocedure)\\n$ 978.30\\n20931\\n20931\\nAllograft, structural, for spine surgery only (List separately in\\naddition to code for primary procedure)\\n$ 618.30\\n20936\\n20936\\nAutograft for spine surgery only (includes harvesting the graft); local\\n(eg, ribs, spinous process, or laminar fragments) obtained from\\nsame incision (List separately in addition to code for primary\\nprocedure)\\n$ 1,545.30\\n20937\\n20937\\nAutograft for spine surgery only (includes harvesting the graft);\\nmorselized (through separate skin or fascial incision) (List separately\\nin addition to code for primary procedure)\\n$ 1,235.70\\n20938\\n20938\\nAutograft for spine surgery only (includes harvesting the graft);\\nstructural, bicortical or tricortical (through separate skin or fascial\\nincision) (List separately in addition to code for primary procedure)\\n$ 1,506.60\\n20950\\n20950\\nMonitoring of interstitial fluid pressure (includes insertion of device,\\neg, wick catheter technique, needle manometer technique) in\\ndetection of muscle compartment syndrome\\n$ 293.40\\n20955\\n20955\\nBone graft with microvascular anastomosis; fibula\\n$ 10,791.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n35\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n36\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n20956\\n20956\\nBone graft with microvascular anastomosis; iliac crest\\n$ 8,655.30\\n20957\\n20957\\nBone graft with microvascular anastomosis; metatarsal\\n$ 8,967.60\\n20962\\n20962\\nBone graft with microvascular anastomosis; other than fibula, iliac\\ncrest, or metatarsal\\n$ 8,168.40\\n20969\\n20969\\nFree osteocutaneous flap with microvascular anastomosis; other\\nthan iliac crest, metatarsal, or great toe\\n$ 7,750.80\\n20970\\n20970\\nFree osteocutaneous flap with microvascular anastomosis; iliac crest $ 9,907.20\\n20972\\n20972\\nFree osteocutaneous flap with microvascular anastomosis;\\nmetatarsal\\n$ 8,745.30\\n20973\\n20973\\nFree osteocutaneous flap with microvascular anastomosis; great toe\\nwith web space\\n$ 8,745.30\\n20974\\n20974\\nElectrical stimulation to aid bone healing; noninvasive\\n(nonoperative)\\n$ 915.30\\n20975\\n20975\\nElectrical stimulation to aid bone healing; invasive (operative)\\n$ 1,344.60\\n20979\\n20979\\nLow intensity ultrasound stimulation to aid bone healing,\\nnoninvasive (nonoperative)\\n$ 124.20\\n20982\\n20982\\nAblation, bone tumor(s) (eg, osteoid osteoma, metastasis)\\nradiofrequency, percutaneous, including computed tomographic\\nguidance\\n$ 8,951.44\\n20985\\n20985\\nComputer-assisted surgical navigational procedure for\\nmusculoskeletal procedures, image-less (List separately in addition\\nto code for primary procedure)\\n$ 207.47\\n20999\\n20999\\nUnlisted procedure, musculoskeletal system, general\\nCost\\n21010\\n21010\\nArthrotomy, temporomandibular joint\\n$ 2,836.80\\n21011\\n21011\\nExcision, tumor, soft tissue of face or scalp, subcutaneous; less than\\n2 cm\\n$ 441.95\\n21012\\n21012\\nExcision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or\\ngreater\\n$ 465.84\\n21013\\n21013\\nExcision, tumor, soft tissue of face and scalp, subfascial (eg,\\nsubgaleal, intramuscular); less than 2 cm\\n$ 767.09\\n21014\\n21014\\nExcision, tumor, soft tissue of face and scalp, subfascial (eg,\\nsubgaleal, intramuscular); 2 cm or greater\\n$ 813.32\\n21015\\n21015\\nRadical resection of tumor (eg, sarcoma), soft tissue of face or scalp;\\nless than 2 cm\\n$ 1,773.90\\n21016\\n21016\\nRadical resection of tumor (eg, sarcoma), soft tissue of face or scalp;\\n2 cm or greater\\n$ 1,706.33\\n21025\\n21025\\nExcision of bone (eg, for osteomyelitis or bone abscess); mandible\\n$ 1,602.00\\n21026\\n21026\\nExcision of bone (eg, for osteomyelitis or bone abscess); facial\\nbone(s)\\n$ 1,498.50\\n21029\\n21029\\nRemoval by contouring of benign tumor of facial bone (eg, fibrous\\ndysplasia)\\n$ 1,532.70\\n21030\\n21030\\nExcision of benign tumor or cyst of maxilla or zygoma by\\nenucleation and curettage\\n$ 2,193.30\\n21031\\n21031\\nExcision of torus mandibularis\\n$ 696.60\\n21032\\n21032\\nExcision of maxillary torus palatinus\\n$ 1,056.60\\n21034\\n21034\\nExcision of malignant tumor of maxilla or zygoma\\n$ 3,169.80\\n21040\\n21040\\nExcision of benign tumor or cyst of mandible, by enucleation and\/or\\ncurettage\\n$ 1,246.50\\n21044\\n21044\\nExcision of malignant tumor of mandible;\\n$ 2,851.20\\n21045\\n21045\\nExcision of malignant tumor of mandible; radical resection\\n$ 5,918.40\\n21046\\n21046\\nExcision of benign tumor or cyst of mandible; requiring intra-oral\\nosteotomy (eg, locally aggressive or destructive lesion(s))\\n$ 1,872.04\\n21047\\n21047\\nExcision of benign tumor or cyst of mandible; requiring extra-oral\\nosteotomy and partial mandibulectomy (eg, locally aggressive or\\ndestructive lesion(s))\\n$ 2,304.17\\n21048\\n21048\\nExcision of benign tumor or cyst of maxilla; requiring intra-oral\\nosteotomy (eg, locally aggressive or destructive lesion(s))\\n$ 1,918.12\\n21049\\n21049\\nExcision of benign tumor or cyst of maxilla; requiring extra-oral\\nosteotomy and partial maxillectomy (eg, locally aggressive or\\ndestructive lesion(s))\\n$ 2,210.72\\n21050\\n21050\\nCondylectomy, temporomandibular joint (separate procedure)\\n$ 3,355.20\\n21060\\n21060\\nMeniscectomy, partial or complete, temporomandibular joint\\n(separate procedure)\\n$ 3,330.00\\n21070\\n21070\\nCoronoidectomy (separate procedure)\\n$ 2,724.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n37\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n38\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n21073\\n21073\\nManipulation of temporomandibular joint(s) (TMJ), therapeutic,\\nrequiring an anesthesia service (ie, general or monitored anesthesia\\ncare)\\n$ 524.35\\n21076\\n21076\\nImpression and custom preparation; surgical obturator prosthesis\\n$ 1,781.92\\n21077\\n21077\\nImpression and custom preparation; orbital prosthesis\\n$ 4,473.18\\n21079\\n21079\\nImpression and custom preparation; interim obturator prosthesis\\n$ 2,974.29\\n21080\\n21080\\nImpression and custom preparation; definitive obturator prosthesis\\n$ 3,342.10\\n21081\\n21081\\nImpression and custom preparation; mandibular resection\\nprosthesis\\n$ 3,048.99\\n21083\\n21083\\nImpression and custom preparation; palatal lift prosthesis\\n$ 2,579.92\\n21084\\n21084\\nImpression and custom preparation; speech aid prosthesis\\n$ 3,019.99\\n21085\\n21085\\nImpression and custom preparation; oral surgical splint\\n$ 398.70\\n21086\\n21086\\nImpression and custom preparation; auricular prosthesis\\n$ 3,303.10\\n21087\\n21087\\nImpression and custom preparation; nasal prosthesis\\n$ 3,302.27\\n21088\\n21088\\nImpression and custom preparation; facial prosthesis\\n21089\\n21089\\nUnlisted maxillofacial prosthetic procedure\\nCost\\n21100\\n21100\\nApplication of halo type appliance for maxillofacial fixation, includes\\nremoval (separate procedure)\\n$ 566.10\\n21110\\n21110\\nApplication of interdental fixation device for conditions other than\\nfracture or dislocation, includes removal\\n$ 1,364.40\\n21116\\n21116\\nInjection procedure for temporomandibular joint arthrography\\n$ 178.20\\n21120\\n21120\\nGenioplasty; augmentation (autograft, allograft, prosthetic\\nmaterial)\\n$ 2,880.90\\n21121\\n21121\\nGenioplasty; sliding osteotomy, single piece\\n$ 2,574.90\\n21122\\n21122\\nGenioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge\\nexcision or bone wedge reversal for asymmetrical chin)\\n$ 2,385.00\\n21123\\n21123\\nGenioplasty; sliding, augmentation with interpositional bone grafts\\n(includes obtaining autografts)\\n$ 2,490.30\\n21125\\n21125\\nAugmentation, mandibular body or angle; prosthetic material\\n$ 2,394.90\\n21127\\n21127\\nAugmentation, mandibular body or angle; with bone graft, onlay or\\ninterpositional (includes obtaining autograft)\\n$ 2,266.20\\n21137\\n21137\\nReduction forehead; contouring only\\n$ 2,266.20\\n21138\\n21138\\nReduction forehead; contouring and application of prosthetic\\nmaterial or bone graft (includes obtaining autograft)\\n$ 2,652.30\\n21139\\n21139\\nReduction forehead; contouring and setback of anterior frontal\\nsinus wall\\n$ 3,278.60\\n21141\\n21141\\nReconstruction midface, LeFort I; single piece, segment movement\\nin any direction (eg, for Long Face Syndrome), without bone graft\\n$ 4,120.20\\n21142\\n21142\\nReconstruction midface, LeFort I; 2 pieces, segment movement in\\nany direction, without bone graft\\n$ 4,326.30\\n21143\\n21143\\nReconstruction midface, LeFort I; 3 or more pieces, segment\\nmovement in any direction, without bone graft\\n$ 4,428.90\\n21145\\n21145\\nReconstruction midface, LeFort I; single piece, segment movement\\nin any direction, requiring bone grafts (includes obtaining\\nautografts)\\n$ 4,496.20\\n21146\\n21146\\nReconstruction midface, LeFort I; 2 pieces, segment movement in\\nany direction, requiring bone grafts (includes obtaining autografts)\\n(eg, ungrafted unilateral alveolar cleft)\\n$ 5,983.20\\n21147\\n21147\\nReconstruction midface, LeFort I; 3 or more pieces, segment\\nmovement in any direction, requiring bone grafts (includes\\nobtaining autografts) (eg, ungrafted bilateral alveolar cleft or\\nmultiple osteotomies)\\n$ 6,391.80\\n21150\\n21150\\nReconstruction midface, LeFort II; anterior intrusion (eg, Treacher-\\nCollins Syndrome)\\n$ 5,568.30\\n21151\\n21151\\nReconstruction midface, LeFort II; any direction, requiring bone\\ngrafts (includes obtaining autografts)\\n$ 6,695.10\\n21154\\n21154\\nReconstruction midface, LeFort III (extracranial), any type, requiring\\nbone grafts (includes obtaining autografts); without LeFort I\\n$ 6,677.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n39\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n40\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n21155\\n21155\\nReconstruction midface, LeFort III (extracranial), any type, requiring\\nbone grafts (includes obtaining autografts); with LeFort I\\n$ 6,431.40\\n21159\\n21159\\nReconstruction midface, LeFort III (extra and intracranial) with\\nforehead advancement (eg, mono bloc), requiring bone grafts\\n(includes obtaining autografts); without LeFort I\\n$ 9,682.20\\n21160\\n21160\\nReconstruction midface, LeFort III (extra and intracranial) with\\nforehead advancement (eg, mono bloc), requiring bone grafts\\n(includes obtaining autografts); with LeFort I\\n$ 10,815.30\\n21172\\n21172\\nReconstruction superior-lateral orbital rim and lower forehead,\\nadvancement or alteration, with or without grafts (includes\\nobtaining autografts)\\n$ 8,767.80\\n21175\\n21175\\nReconstruction, bifrontal, superior-lateral orbital rims and lower\\nforehead, advancement or alteration (eg, plagiocephaly,\\ntrigonocephaly, brachycephaly), with or without grafts (includes\\nobtaining autografts)\\n$ 9,409.50\\n21179\\n21179\\nReconstruction, entire or majority of forehead and\/or supraorbital\\nrims; with grafts (allograft or prosthetic material)\\n$ 7,056.00\\n21180\\n21180\\nReconstruction, entire or majority of forehead and\/or supraorbital\\nrims; with autograft (includes obtaining grafts)\\n$ 6,390.00\\n21181\\n21181\\nReconstruction by contouring of benign tumor of cranial bones (eg,\\nfibrous dysplasia), extracranial\\n$ 1,539.90\\n21182\\n21182\\nReconstruction of orbital walls, rims, forehead, nasoethmoid\\ncomplex following intra- and extracranial excision of benign tumor\\nof cranial bone (eg, fibrous dysplasia), with multiple autografts\\n(includes obtaining grafts); total area of bone grafting less\\n$ 6,723.90\\n21183\\n21183\\nReconstruction of orbital walls, rims, forehead, nasoethmoid\\ncomplex following intra- and extracranial excision of benign tumor\\nof cranial bone (eg, fibrous dysplasia), with multiple autografts\\n(includes obtaining grafts); total area of bone grafting grea\\n$ 7,144.20\\n21184\\n21184\\nReconstruction of orbital walls, rims, forehead, nasoethmoid\\ncomplex following intra- and extracranial excision of benign tumor\\nof cranial bone (eg, fibrous dysplasia), with multiple autografts\\n(includes obtaining grafts); total area of bone grafting grea\\n$ 7,754.40\\n21188\\n21188\\nReconstruction midface, osteotomies (other than LeFort type) and\\nbone grafts (includes obtaining autografts)\\n$ 4,563.00\\n21193\\n21193\\nReconstruction of mandibular rami, horizontal, vertical, C, or L\\nosteotomy; without bone graft\\n$ 4,586.40\\n21194\\n21194\\nReconstruction of mandibular rami, horizontal, vertical, C, or L\\nosteotomy; with bone graft (includes obtaining graft)\\n$ 5,648.40\\n21195\\n21195\\nReconstruction of mandibular rami and\/or body, sagittal split;\\nwithout internal rigid fixation\\n$ 4,891.50\\n21196\\n21196\\nReconstruction of mandibular rami and\/or body, sagittal split; with\\ninternal rigid fixation\\n$ 5,547.60\\n21198\\n21198\\nOsteotomy, mandible, segmental;\\n$ 3,804.30\\n21199\\n21199\\nOsteotomy, mandible, segmental; with genioglossus advancement\\n$ 3,879.00\\n21206\\n21206\\nOsteotomy, maxilla, segmental (eg, Wassmund or Schuchard)\\n$ 4,425.30\\n21208\\n21208\\nOsteoplasty, facial bones; augmentation (autograft, allograft, or\\nprosthetic implant)\\n$ 2,608.20\\n21209\\n21209\\nOsteoplasty, facial bones; reduction\\n$ 2,713.50\\n21210\\n21210\\nGraft, bone; nasal, maxillary or malar areas (includes obtaining\\ngraft)\\n$ 3,510.00\\n21215\\n21215\\nGraft, bone; mandible (includes obtaining graft)\\n$ 3,878.10\\n21230\\n21230\\nGraft; rib cartilage, autogenous, to face, chin, nose or ear (includes\\nobtaining graft)\\n$ 4,305.60\\n21235\\n21235\\nGraft; ear cartilage, autogenous, to nose or ear (includes obtaining\\ngraft)\\n$ 2,547.90\\n21240\\n21240\\nArthroplasty, temporomandibular joint, with or without autograft\\n(includes obtaining graft)\\n$ 4,120.20\\n21242\\n21242\\nArthroplasty, temporomandibular joint, with allograft\\n$ 3,933.00\\n21243\\n21243\\nArthroplasty, temporomandibular joint, with prosthetic joint\\nreplacement\\n$ 5,049.90\\n21244\\n21244\\nReconstruction of mandible, extraoral, with transosteal bone plate\\n(eg, mandibular staple bone plate)\\n$ 4,204.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n41\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n42\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n21245\\n21245\\nReconstruction of mandible or maxilla, subperiosteal implant;\\npartial\\n$ 3,759.30\\n21246\\n21246\\nReconstruction of mandible or maxilla, subperiosteal implant;\\ncomplete\\n$ 5,781.60\\n21247\\n21247\\nReconstruction of mandibular condyle with bone and cartilage\\nautografts (includes obtaining grafts) (eg, for hemifacial\\nmicrosomia)\\n$ 5,665.50\\n21248\\n21248\\nReconstruction of mandible or maxilla, endosteal implant (eg, blade,\\ncylinder); partial\\n$ 3,985.20\\n21249\\n21249\\nReconstruction of mandible or maxilla, endosteal implant (eg, blade,\\ncylinder); complete\\n$ 7,416.00\\n21255\\n21255\\nReconstruction of zygomatic arch and glenoid fossa with bone and\\ncartilage (includes obtaining autografts)\\n$ 5,665.50\\n21256\\n21256\\nReconstruction of orbit with osteotomies (extracranial) and with\\nbone grafts (includes obtaining autografts) (eg, micro-ophthalmia)\\n$ 5,800.50\\n21260\\n21260\\nPeriorbital osteotomies for orbital hypertelorism, with bone grafts;\\nextracranial approach\\n$ 6,687.00\\n21261\\n21261\\nPeriorbital osteotomies for orbital hypertelorism, with bone grafts;\\ncombined intra- and extracranial approach\\n$ 8,191.80\\n21267\\n21267\\nOrbital repositioning, periorbital osteotomies, unilateral, with bone\\ngrafts; extracranial approach\\n$ 6,246.90\\n21268\\n21268\\nOrbital repositioning, periorbital osteotomies, unilateral, with bone\\ngrafts; combined intra- and extracranial approach\\n$ 9,558.90\\n21270\\n21270\\nMalar augmentation, prosthetic material\\n$ 4,648.50\\n21275\\n21275\\nSecondary revision of orbitocraniofacial reconstruction\\n$ 6,386.40\\n21280\\n21280\\nMedial canthopexy (separate procedure)\\n$ 2,368.80\\n21282\\n21282\\nLateral canthopexy\\n$ 1,957.50\\n21295\\n21295\\nReduction of masseter muscle and bone (eg, for treatment of\\nbenign masseteric hypertrophy); extraoral approach\\n$ 2,487.73\\n21296\\n21296\\nReduction of masseter muscle and bone (eg, for treatment of\\nbenign masseteric hypertrophy); intraoral approach\\n$ 2,095.08\\n21299\\n21299\\nUnlisted craniofacial and maxillofacial procedure\\nCost\\n21310\\n21310\\nClosed treatment of nasal bone fracture without manipulation\\n$ 396.90\\n21315\\n21315\\nClosed treatment of nasal bone fracture; without stabilization\\n$ 489.60\\n21320\\n21320\\nClosed treatment of nasal bone fracture; with stabilization\\n$ 828.90\\n21325\\n21325\\nOpen treatment of nasal fracture; uncomplicated\\n$ 1,708.20\\n21330\\n21330\\nOpen treatment of nasal fracture; complicated, with internal and\/or\\nexternal skeletal fixation\\n$ 2,563.20\\n21335\\n21335\\nOpen treatment of nasal fracture; with concomitant open\\ntreatment of fractured septum\\n$ 2,959.20\\n21336\\n21336\\nOpen treatment of nasal septal fracture, with or without\\nstabilization\\n$ 1,738.80\\n21337\\n21337\\nClosed treatment of nasal septal fracture, with or without\\nstabilization\\n$ 1,325.70\\n21338\\n21338\\nOpen treatment of nasoethmoid fracture; without external fixation\\n$ 2,750.40\\n21339\\n21339\\nOpen treatment of nasoethmoid fracture; with external fixation\\n$ 3,019.50\\n21340\\n21340\\nPercutaneous treatment of nasoethmoid complex fracture, with\\nsplint, wire or headcap fixation, including repair of canthal\\nligaments and\/or the nasolacrimal apparatus\\n$ 3,490.20\\n21343\\n21343\\nOpen treatment of depressed frontal sinus fracture\\n$ 3,550.50\\n21344\\n21344\\nOpen treatment of complicated (eg, comminuted or involving\\nposterior wall) frontal sinus fracture, via coronal or multiple\\napproaches\\n$ 3,872.70\\n21345\\n21345\\nClosed treatment of nasomaxillary complex fracture (LeFort II type),\\nwith interdental wire fixation or fixation of denture or splint\\n$ 3,108.60\\n21346\\n21346\\nOpen treatment of nasomaxillary complex fracture (LeFort II type);\\nwith wiring and\/or local fixation\\n$ 3,837.60\\n21347\\n21347\\nOpen treatment of nasomaxillary complex fracture (LeFort II type);\\nrequiring multiple open approaches\\n$ 4,275.00\\n21348\\n21348\\nOpen treatment of nasomaxillary complex fracture (LeFort II type);\\nwith bone grafting (includes obtaining graft)\\n$ 3,829.50\\n21355\\n21355\\nPercutaneous treatment of fracture of malar area, including\\nzygomatic arch and malar tripod, with manipulation\\n$ 2,138.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n43\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n44\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n21356\\n21356\\nOpen treatment of depressed zygomatic arch fracture (eg, Gillies\\napproach)\\n$ 1,796.40\\n21360\\n21360\\nOpen treatment of depressed malar fracture, including zygomatic\\narch and malar tripod\\n$ 2,407.50\\n21365\\n21365\\nOpen treatment of complicated (eg, comminuted or involving\\ncranial nerve foramina) fracture(s) of malar area, including\\nzygomatic arch and malar tripod; with internal fixation and multiple\\nsurgical approaches\\n$ 3,566.70\\n21366\\n21366\\nOpen treatment of complicated (eg, comminuted or involving\\ncranial nerve foramina) fracture(s) of malar area, including\\nzygomatic arch and malar tripod; with bone grafting (includes\\nobtaining graft)\\n$ 3,804.30\\n21385\\n21385\\nOpen treatment of orbital floor blowout fracture; transantral\\napproach (Caldwell-Luc type operation)\\n$ 2,743.20\\n21386\\n21386\\nOpen treatment of orbital floor blowout fracture; periorbital\\napproach\\n$ 2,984.40\\n21387\\n21387\\nOpen treatment of orbital floor blowout fracture; combined\\napproach\\n$ 3,267.00\\n21390\\n21390\\nOpen treatment of orbital floor blowout fracture; periorbital\\napproach, with alloplastic or other implant\\n$ 3,502.80\\n21395\\n21395\\nOpen treatment of orbital floor blowout fracture; periorbital\\napproach with bone graft (includes obtaining graft)\\n$ 3,692.70\\n21400\\n21400\\nClosed treatment of fracture of orbit, except blowout; without\\nmanipulation\\n$ 879.30\\n21401\\n21401\\nClosed treatment of fracture of orbit, except blowout; with\\nmanipulation\\n$ 2,475.90\\n21406\\n21406\\nOpen treatment of fracture of orbit, except blowout; without\\nimplant\\n$ 2,877.30\\n21407\\n21407\\nOpen treatment of fracture of orbit, except blowout; with implant\\n$ 3,400.20\\n21408\\n21408\\nOpen treatment of fracture of orbit, except blowout; with bone\\ngrafting (includes obtaining graft)\\n$ 3,346.20\\n21421\\n21421\\nClosed treatment of palatal or maxillary fracture (LeFort I type),\\nwith interdental wire fixation or fixation of denture or splint\\n$ 2,632.50\\n21422\\n21422\\nOpen treatment of palatal or maxillary fracture (LeFort I type);\\n$ 3,348.90\\n21423\\n21423\\nOpen treatment of palatal or maxillary fracture (LeFort I type);\\ncomplicated (comminuted or involving cranial nerve foramina),\\nmultiple approaches\\n$ 2,865.60\\n21431\\n21431\\nClosed treatment of craniofacial separation (LeFort III type) using\\ninterdental wire fixation of denture or splint\\n$ 2,807.10\\n21432\\n21432\\nOpen treatment of craniofacial separation (LeFort III type); with\\nwiring and\/or internal fixation\\n$ 3,594.60\\n21433\\n21433\\nOpen treatment of craniofacial separation (LeFort III type);\\ncomplicated (eg, comminuted or involving cranial nerve foramina),\\nmultiple surgical approaches\\n$ 5,049.90\\n21435\\n21435\\nOpen treatment of craniofacial separation (LeFort III type);\\ncomplicated, utilizing internal and\/or external fixation techniques\\n(eg, head cap, halo device, and\/or intermaxillary fixation)\\n$ 4,278.60\\n21436\\n21436\\nOpen treatment of craniofacial separation (LeFort III type);\\ncomplicated, multiple surgical approaches, internal fixation, with\\nbone grafting (includes obtaining graft)\\n$ 5,112.00\\n21440\\n21440\\nClosed treatment of mandibular or maxillary alveolar ridge fracture\\n(separate procedure)\\n$ 1,808.10\\n21445\\n21445\\nOpen treatment of mandibular or maxillary alveolar ridge fracture\\n(separate procedure)\\n$ 2,088.00\\n21450\\n21450\\nClosed treatment of mandibular fracture; without manipulation\\n$ 812.70\\n21451\\n21451\\nClosed treatment of mandibular fracture; with manipulation\\n$ 2,193.30\\n21452\\n21452\\nPercutaneous treatment of mandibular fracture, with external\\nfixation\\n$ 1,540.80\\n21453\\n21453\\nClosed treatment of mandibular fracture with interdental fixation\\n$ 2,735.10\\n21454\\n21454\\nOpen treatment of mandibular fracture with external fixation\\n$ 2,820.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n45\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n46\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n21461\\n21461\\nOpen treatment of mandibular fracture; without interdental\\nfixation\\n$ 2,774.70\\n21462\\n21462\\nOpen treatment of mandibular fracture; with interdental fixation\\n$ 3,288.60\\n21465\\n21465\\nOpen treatment of mandibular condylar fracture\\n$ 2,871.00\\n21470\\n21470\\nOpen treatment of complicated mandibular fracture by multiple\\nsurgical approaches including internal fixation, interdental fixation,\\nand\/or wiring of dentures or splints\\n$ 4,006.80\\n21480\\n21480\\nClosed treatment of temporomandibular dislocation; initial or\\nsubsequent\\n$ 385.20\\n21485\\n21485\\nClosed treatment of temporomandibular dislocation; complicated\\n(eg, recurrent requiring intermaxillary fixation or splinting), initial or\\nsubsequent\\n$ 903.60\\n21490\\n21490\\nOpen treatment of temporomandibular dislocation\\n$ 2,578.50\\n21495\\n21495\\nOpen treatment of hyoid fracture\\n$ 2,726.10\\n21497\\n21497\\nInterdental wiring, for condition other than fracture\\n$ 2,046.60\\n21499\\n21499\\nUnlisted musculoskeletal procedure, head\\nCost\\n21501\\n21501\\nIncision and drainage, deep abscess or hematoma, soft tissues of\\nneck or thorax;\\n$ 779.40\\n21502\\n21502\\nIncision and drainage, deep abscess or hematoma, soft tissues of\\nneck or thorax; with partial rib ostectomy\\n$ 946.80\\n21510\\n21510\\nIncision, deep, with opening of bone cortex (eg, for osteomyelitis or\\nbone abscess), thorax\\n$ 1,161.90\\n21550\\n21550\\nBiopsy, soft tissue of neck or thorax\\n$ 405.00\\n21552\\n21552\\nExcision, tumor, soft tissue of neck or anterior thorax,\\nsubcutaneous; 3 cm or greater\\n$ 791.93\\n21554\\n21554\\nExcision, tumor, soft tissue of neck or anterior thorax, subfascial\\n(eg, intramuscular); 5 cm or greater\\n$ 1,366.14\\n21555\\n21555\\nExcision, tumor, soft tissue of neck or anterior thorax,\\nsubcutaneous; less than 3 cm\\n$ 632.14\\n21556\\n21556\\nExcision, tumor, soft tissue of neck or anterior thorax, subfascial\\n(eg, intramuscular); less than 5 cm\\n$ 1,127.30\\n21557\\n21557\\nRadical resection of tumor (eg, sarcoma), soft tissue of neck or\\nanterior thorax; less than 5 cm\\n$ 3,090.60\\n21558\\n21558\\nRadical resection of tumor (eg, sarcoma), soft tissue of neck or\\nanterior thorax; 5 cm or greater\\n$ 2,439.66\\n21600\\n21600\\nExcision of rib, partial\\n$ 1,256.40\\n21610\\n21610\\nCostotransversectomy (separate procedure)\\n$ 3,476.70\\n21615\\n21615\\nExcision first and\/or cervical rib;\\n$ 3,032.10\\n21616\\n21616\\nExcision first and\/or cervical rib; with sympathectomy\\n$ 2,896.20\\n21620\\n21620\\nOstectomy of sternum, partial\\n$ 3,269.70\\n21627\\n21627\\nSternal debridement\\n$ 1,960.20\\n21630\\n21630\\nRadical resection of sternum;\\n$ 3,826.80\\n21632\\n21632\\nRadical resection of sternum; with mediastinal lymphadenectomy\\n$ 4,892.40\\n21685\\n21685\\nHyoid myotomy and suspension\\n$ 2,168.29\\n21700\\n21700\\nDivision of scalenus anticus; without resection of cervical rib\\n$ 1,647.90\\n21705\\n21705\\nDivision of scalenus anticus; with resection of cervical rib\\n$ 2,286.90\\n21720\\n21720\\nDivision of sternocleidomastoid for torticollis, open operation;\\nwithout cast application\\n$ 1,333.80\\n21725\\n21725\\nDivision of sternocleidomastoid for torticollis, open operation; with\\ncast application\\n$ 1,486.80\\n21740\\n21740\\nReconstructive repair of pectus excavatum or carinatum; open\\n$ 3,577.50\\n21742\\n21742\\nReconstructive repair of pectus excavatum or carinatum; minimally\\ninvasive approach (Nuss procedure), without thoracoscopy\\n21743\\n21743\\nReconstructive repair of pectus excavatum or carinatum; minimally\\ninvasive approach (Nuss procedure), with thoracoscopy\\n21750\\n21750\\nClosure of median sternotomy separation with or without\\ndebridement (separate procedure)\\n$ 2,729.70\\n21800\\n21800\\nClosed treatment of rib fracture, uncomplicated, each\\n$ 219.60\\n21805\\n21805\\nOpen treatment of rib fracture without fixation, each\\n$ 1,426.50\\n21810\\n21810\\nTreatment of rib fracture requiring external fixation (flail chest)\\n$ 3,409.20\\n21820\\n21820\\nClosed treatment of sternum fracture\\n$ 456.30\\n21825\\n21825\\nOpen treatment of sternum fracture with or without skeletal\\nfixation\\n$ 1,791.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n47\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n48\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n21899\\n21899\\nUnlisted procedure, neck or thorax\\nCost\\n21920\\n21920\\nBiopsy, soft tissue of back or flank; superficial\\n$ 466.20\\n21925\\n21925\\nBiopsy, soft tissue of back or flank; deep\\n$ 796.50\\n21930\\n21930\\nExcision, tumor, soft tissue of back or flank, subcutaneous; less than\\n3 cm\\n$ 1,846.80\\n21931\\n21931\\nExcision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or\\ngreater\\n$ 1,124.11\\n21932\\n21932\\nExcision, tumor, soft tissue of back or flank, subfascial (eg,\\nintramuscular); less than 5 cm\\n$ 1,469.92\\n21933\\n21933\\nExcision, tumor, soft tissue of back or flank, subfascial (eg,\\nintramuscular); 5 cm or greater\\n$ 1,605.17\\n21935\\n21935\\nRadical resection of tumor (eg, sarcoma), soft tissue of back or\\nflank; less than 5 cm\\n$ 3,547.80\\n21936\\n21936\\nRadical resection of tumor (eg, sarcoma), soft tissue of back or\\nflank; 5 cm or greater\\n$ 3,109.09\\n22010\\n22010\\nIncision and drainage, open, of deep abscess (subfascial), posterior\\nspine; cervical, thoracic, or cervicothoracic\\n$ 1,829.44\\n22015\\n22015\\nIncision and drainage, open, of deep abscess (subfascial), posterior\\nspine; lumbar, sacral, or lumbosacral\\n$ 1,795.54\\n22100\\n22100\\nPartial excision of posterior vertebral component (eg, spinous\\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\\nsegment; cervical\\n$ 1,579.50\\n22101\\n22101\\nPartial excision of posterior vertebral component (eg, spinous\\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\\nsegment; thoracic\\n$ 1,560.60\\n22102\\n22102\\nPartial excision of posterior vertebral component (eg, spinous\\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\\nsegment; lumbar\\n$ 1,827.00\\n22103\\n22103\\nPartial excision of posterior vertebral component (eg, spinous\\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\\nsegment; each additional segment (List separately in addition to\\ncode for primary procedure)\\n$ 421.75\\n22110\\n22110\\nPartial excision of vertebral body, for intrinsic bony lesion, without\\ndecompression of spinal cord or nerve root(s), single vertebral\\nsegment; cervical\\n$ 2,437.20\\n22112\\n22112\\nPartial excision of vertebral body, for intrinsic bony lesion, without\\ndecompression of spinal cord or nerve root(s), single vertebral\\nsegment; thoracic\\n$ 2,290.50\\n22114\\n22114\\nPartial excision of vertebral body, for intrinsic bony lesion, without\\ndecompression of spinal cord or nerve root(s), single vertebral\\nsegment; lumbar\\n$ 1,809.90\\n22116\\n22116\\nPartial excision of vertebral body, for intrinsic bony lesion, without\\ndecompression of spinal cord or nerve root(s), single vertebral\\nsegment; each additional vertebral segment (List separately in\\naddition to code for primary procedure)\\n$ 510.03\\n22206\\n22206\\nOsteotomy of spine, posterior or posterolateral approach, 3\\ncolumns, 1 vertebral segment (eg, pedicle\/vertebral body\\nsubtraction); thoracic\\n$ 8,139.79\\n22207\\n22207\\nOsteotomy of spine, posterior or posterolateral approach, 3\\ncolumns, 1 vertebral segment (eg, pedicle\/vertebral body\\nsubtraction); lumbar\\n$ 7,918.14\\n22208\\n22208\\nOsteotomy of spine, posterior or posterolateral approach, 3\\ncolumns, 1 vertebral segment (eg, pedicle\/vertebral body\\nsubtraction); each additional vertebral segment (List separately in\\naddition to code for primary procedure)\\n$ 2,343.90\\n22210\\n22210\\nOsteotomy of spine, posterior or posterolateral approach, 1\\nvertebral segment; cervical\\n$ 5,474.70\\n22212\\n22212\\nOsteotomy of spine, posterior or posterolateral approach, 1\\nvertebral segment; thoracic\\n$ 5,826.60\\n22214\\n22214\\nOsteotomy of spine, posterior or posterolateral approach, 1\\nvertebral segment; lumbar\\n$ 5,076.00\\n22216\\n22216\\nOsteotomy of spine, posterior or posterolateral approach, 1\\nvertebral segment; each additional vertebral segment (List\\nseparately in addition to primary procedure)\\n$ 1,650.31\\n22220\\n22220\\nOsteotomy of spine, including discectomy, anterior approach, single\\nvertebral segment; cervical\\n$ 5,062.50\\n22222\\n22222\\nOsteotomy of spine, including discectomy, anterior approach, single\\nvertebral segment; thoracic\\n$ 4,892.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n49\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n50\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n22224\\n22224\\nOsteotomy of spine, including discectomy, anterior approach, single\\nvertebral segment; lumbar\\n$ 4,738.50\\n22226\\n22226\\nOsteotomy of spine, including discectomy, anterior approach, single\\nvertebral segment; each additional vertebral segment (List\\nseparately in addition to code for primary procedure)\\n$ 1,576.45\\n22305\\n22305\\nClosed treatment of vertebral process fracture(s)\\n$ 646.20\\n22310\\n22310\\nClosed treatment of vertebral body fracture(s), without\\nmanipulation, requiring and including casting or bracing\\n$ 1,089.00\\n22315\\n22315\\nClosed treatment of vertebral fracture(s) and\/or dislocation(s)\\nrequiring casting or bracing, with and including casting and\/or\\nbracing by manipulation or traction\\n$ 1,676.70\\n22318\\n22318\\nOpen treatment and\/or reduction of odontoid fracture(s) and or\\ndislocation(s) (including os odontoideum), anterior approach,\\nincluding placement of internal fixation; without grafting\\n$ 4,835.70\\n22319\\n22319\\nOpen treatment and\/or reduction of odontoid fracture(s) and or\\ndislocation(s) (including os odontoideum), anterior approach,\\nincluding placement of internal fixation; with grafting\\n$ 5,462.10\\n22325\\n22325\\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\\ndislocation(s), posterior approach, 1 fractured vertebra or\\ndislocated segment; lumbar\\n$ 3,702.60\\n22326\\n22326\\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\\ndislocation(s), posterior approach, 1 fractured vertebra or\\ndislocated segment; cervical\\n$ 4,303.80\\n22327\\n22327\\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\\ndislocation(s), posterior approach, 1 fractured vertebra or\\ndislocated segment; thoracic\\n$ 3,861.00\\n22328\\n22328\\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\\ndislocation(s), posterior approach, 1 fractured vertebra or\\ndislocated segment; each additional fractured vertebra or\\ndislocated segment (List separately in addition to code for primary\\nproce\\n$ 1,339.20\\n22505\\n22505\\nManipulation of spine requiring anesthesia, any region\\n$ 594.00\\n22520\\n22520\\nPercutaneous vertebroplasty (bone biopsy included when\\nperformed), 1 vertebral body, unilateral or bilateral injection;\\nthoracic\\n$ 10,247.30\\n22521\\n22521\\nPercutaneous vertebroplasty (bone biopsy included when\\nperformed), 1 vertebral body, unilateral or bilateral injection;\\nlumbar\\n$ 4,183.34\\n22522\\n22522\\nPercutaneous vertebroplasty (bone biopsy included when\\nperformed), 1 vertebral body, unilateral or bilateral injection; each\\nadditional thoracic or lumbar vertebral body (List separately in\\naddition to code for primary procedure)\\n$ 499.51\\n22523\\nPercutaneous vertebral augmentation, including cavity creation\\n(fracture reduction and bone biopsy included when performed)\\nusing mechanical device, 1 vertebral body, unilateral or bilateral\\ncannulation (eg, kyphoplasty); thoracic\\n$ 1,477.34\\n22524\\n22524\\nPercutaneous vertebral augmentation, including cavity creation\\n(fracture reduction and bone biopsy included when performed)\\nusing mechanical device, 1 vertebral body, unilateral or bilateral\\ncannulation (eg, kyphoplasty); lumbar\\n$ 1,382.74\\n22525\\n22525\\nPercutaneous vertebral augmentation, including cavity creation\\n(fracture reduction and bone biopsy included when performed)\\nusing mechanical device, 1 vertebral body, unilateral or bilateral\\ncannulation (eg, kyphoplasty); each additional thoracic or lumba\\n$ 716.85\\n22526\\n22526\\nPercutaneous intradiscal electrothermal annuloplasty, unilateral or\\nbilateral including fluoroscopic guidance; single level\\n$ 3,625.48\\n22527\\n22527\\nPercutaneous intradiscal electrothermal annuloplasty, unilateral or\\nbilateral including fluoroscopic guidance; 1 or more additional levels\\n(List separately in addition to code for primary procedure)\\n$ 2,933.60\\n22532\\n22532\\nArthrodesis, lateral extracavitary technique, including minimal\\ndiscectomy to prepare interspace (other than for decompression);\\nthoracic\\n$ 7,248.19\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n51\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n52\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n22533\\n22533\\nArthrodesis, lateral extracavitary technique, including minimal\\ndiscectomy to prepare interspace (other than for decompression);\\nlumbar\\n$ 6,841.56\\n22534\\n22534\\nArthrodesis, lateral extracavitary technique, including minimal\\ndiscectomy to prepare interspace (other than for decompression);\\nthoracic or lumbar, each additional vertebral segment (List\\nseparately in addition to code for primary procedure)\\n$ 1,793.42\\n22548\\n22548\\nArthrodesis, anterior transoral or extraoral technique, clivus-C1-C2\\n(atlas-axis), with or without excision of odontoid process\\n$ 4,671.90\\n22554\\n22554\\nArthrodesis, anterior interbody technique, including minimal\\ndiscectomy to prepare interspace (other than for decompression);\\ncervical below C2\\n$ 5,047.20\\n22556\\n22556\\nArthrodesis, anterior interbody technique, including minimal\\ndiscectomy to prepare interspace (other than for decompression);\\nthoracic\\n$ 5,232.60\\n22558\\n22558\\nArthrodesis, anterior interbody technique, including minimal\\ndiscectomy to prepare interspace (other than for decompression);\\nlumbar\\n$ 4,895.10\\n22585\\n22585\\nArthrodesis, anterior interbody technique, including minimal\\ndiscectomy to prepare interspace (other than for decompression);\\neach additional interspace (List separately in addition to code for\\nprimary procedure)\\n$ 2,109.60\\n22590\\n22590\\nArthrodesis, posterior technique, craniocervical (occiput-C2)\\n$ 6,695.10\\n22595\\n22595\\nArthrodesis, posterior technique, atlas-axis (C1-C2)\\n$ 5,839.20\\n22600\\n22600\\nArthrodesis, posterior or posterolateral technique, single level;\\ncervical below C2 segment\\n$ 4,428.90\\n22610\\n22610\\nArthrodesis, posterior or posterolateral technique, single level;\\nthoracic (with lateral transverse technique, when performed)\\n$ 4,143.60\\n22612\\n22612\\nArthrodesis, posterior or posterolateral technique, single level;\\nlumbar (with lateral transverse technique, when performed)\\n$ 4,961.70\\n22614\\n22614\\nArthrodesis, posterior or posterolateral technique, single level; each\\nadditional vertebral segment (List separately in addition to code for\\nprimary procedure)\\n$ 1,858.50\\n22630\\n22630\\nArthrodesis, posterior interbody technique, including laminectomy\\nand\/or discectomy to prepare interspace (other than for\\ndecompression), single interspace; lumbar\\n$ 4,412.70\\n22632\\n22632\\nArthrodesis, posterior interbody technique, including laminectomy\\nand\/or discectomy to prepare interspace (other than for\\ndecompression), single interspace; each additional interspace (List\\nseparately in addition to code for primary procedure)\\n$ 1,555.20\\n22800\\n22800\\nArthrodesis, posterior, for spinal deformity, with or without cast; up\\nto 6 vertebral segments\\n$ 4,953.60\\n22802\\n22802\\nArthrodesis, posterior, for spinal deformity, with or without cast; 7\\nto 12 vertebral segments\\n$ 6,030.00\\n22804\\n22804\\nArthrodesis, posterior, for spinal deformity, with or without cast; 13\\nor more vertebral segments\\n$ 6,646.50\\n22808\\n22808\\nArthrodesis, anterior, for spinal deformity, with or without cast; 2 to\\n3 vertebral segments\\n$ 4,555.80\\n22810\\n22810\\nArthrodesis, anterior, for spinal deformity, with or without cast; 4 to\\n7 vertebral segments\\n$ 4,892.40\\n22812\\n22812\\nArthrodesis, anterior, for spinal deformity, with or without cast; 8 or\\nmore vertebral segments\\n$ 5,985.90\\n22818\\n22818\\nKyphectomy, circumferential exposure of spine and resection of\\nvertebral segment(s) (including body and posterior elements);\\nsingle or 2 segments\\n$ 6,687.90\\n22819\\n22819\\nKyphectomy, circumferential exposure of spine and resection of\\nvertebral segment(s) (including body and posterior elements); 3 or\\nmore segments\\n$ 7,163.10\\n22830\\n22830\\nExploration of spinal fusion\\n$ 4,411.80\\n22840\\n22840\\nPosterior non-segmental instrumentation (eg, Harrington rod\\ntechnique, pedicle fixation across 1 interspace, atlantoaxial\\ntransarticular screw fixation, sublaminar wiring at C1, facet screw\\nfixation) (List separately in addition to code for primary proced\\n$ 5,926.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n53\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n54\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n22841\\n22841\\nInternal spinal fixation by wiring of spinous processes (List\\nseparately in addition to code for primary procedure)\\n$ 3,862.80\\n22842\\n22842\\nPosterior segmental instrumentation (eg, pedicle fixation, dual rods\\nwith multiple hooks and sublaminar wires); 3 to 6 vertebral\\nsegments (List separately in addition to code for primary procedure) $ 6,488.10\\n22843\\n22843\\nPosterior segmental instrumentation (eg, pedicle fixation, dual rods\\nwith multiple hooks and sublaminar wires); 7 to 12 vertebral\\nsegments (List separately in addition to code for primary procedure) $ 2,050.20\\n22844\\n22844\\nPosterior segmental instrumentation (eg, pedicle fixation, dual rods\\nwith multiple hooks and sublaminar wires); 13 or more vertebral\\nsegments (List separately in addition to code for primary procedure) $ 2,503.80\\n22845\\n22845\\nAnterior instrumentation; 2 to 3 vertebral segments (List separately\\nin addition to code for primary procedure)\\n$ 6,088.50\\n22846\\n22846\\nAnterior instrumentation; 4 to 7 vertebral segments (List separately\\nin addition to code for primary procedure)\\n$ 6,129.00\\n22847\\n22847\\nAnterior instrumentation; 8 or more vertebral segments (List\\nseparately in addition to code for primary procedure)\\n$ 4,006.54\\n22848\\n22848\\nPelvic fixation (attachment of caudal end of instrumentation to\\npelvic bony structures) other than sacrum (List separately in\\naddition to code for primary procedure)\\n$ 1,716.14\\n22849\\n22849\\nReinsertion of spinal fixation device\\n$ 3,637.80\\n22850\\n22850\\nRemoval of posterior nonsegmental instrumentation (eg,\\nHarrington rod)\\n$ 2,196.90\\n22851\\n22851\\nApplication of intervertebral biomechanical device(s) (eg, synthetic\\ncage(s), methylmethacrylate) to vertebral defect or interspace (List\\nseparately in addition to code for primary procedure)\\n$ 2,188.80\\n22852\\n22852\\nRemoval of posterior segmental instrumentation\\n$ 2,578.50\\n22855\\n22855\\nRemoval of anterior instrumentation\\n$ 3,174.30\\n22856\\n22856\\nTotal disc arthroplasty (artificial disc), anterior approach, including\\ndiscectomy with end plate preparation (includes osteophytectomy\\nfor nerve root or spinal cord decompression and microdissection),\\nsingle interspace, cervical\\n$ 7,409.11\\n22857\\n22857\\nTotal disc arthroplasty (artificial disc), anterior approach, including\\ndiscectomy to prepare interspace (other than for decompression),\\nsingle interspace, lumbar\\n$ 7,481.77\\n22861\\n22861\\nRevision including replacement of total disc arthroplasty (artificial\\ndisc), anterior approach, single interspace; cervical\\n$ 9,122.80\\n22862\\n22862\\nRevision including replacement of total disc arthroplasty (artificial\\ndisc), anterior approach, single interspace; lumbar\\n$ 8,973.95\\n22864\\n22864\\nRemoval of total disc arthroplasty (artificial disc), anterior approach,\\nsingle interspace; cervical\\n$ 8,487.18\\n22865\\n22865\\nRemoval of total disc arthroplasty (artificial disc), anterior approach,\\nsingle interspace; lumbar\\n$ 9,570.92\\n22899\\n22899\\nUnlisted procedure, spine\\n$ 1,613.81\\n22900\\n22900\\nExcision, tumor, soft tissue of abdominal wall, subfascial (eg,\\nintramuscular); less than 5 cm\\n$ 1,592.10\\n22901\\n22901\\nExcision, tumor, soft tissue of abdominal wall, subfascial (eg,\\nintramuscular); 5 cm or greater\\n$ 1,370.05\\n22902\\n22902\\nExcision, tumor, soft tissue of abdominal wall, subcutaneous; less\\nthan 3 cm\\n$ 861.30\\n22903\\n22903\\nExcision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm\\nor greater\\n$ 901.22\\n22904\\n22904\\nRadical resection of tumor (eg, sarcoma), soft tissue of abdominal\\nwall; less than 5 cm\\n$ 2,178.75\\n22905\\n22905\\nRadical resection of tumor (eg, sarcoma), soft tissue of abdominal\\nwall; 5 cm or greater\\n$ 2,821.24\\n22999\\n22999\\nUnlisted procedure, abdomen, musculoskeletal system\\nCost\\n23000\\n23000\\nRemoval of subdeltoid calcareous deposits, open\\n$ 1,048.50\\n23020\\n23020\\nCapsular contracture release (eg, Sever type procedure)\\n$ 1,676.70\\n23030\\n23030\\nIncision and drainage, shoulder area; deep abscess or hematoma\\n$ 643.50\\n23031\\n23031\\nIncision and drainage, shoulder area; infected bursa\\n$ 513.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n55\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n56\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n23035\\n23035\\nIncision, bone cortex (eg, osteomyelitis or bone abscess), shoulder\\narea\\n$ 1,620.00\\n23040\\n23040\\nArthrotomy, glenohumeral joint, including exploration, drainage, or\\nremoval of foreign body\\n$ 1,976.40\\n23044\\n23044\\nArthrotomy, acromioclavicular, sternoclavicular joint, including\\nexploration, drainage, or removal of foreign body\\n$ 1,288.80\\n23065\\n23065\\nBiopsy, soft tissue of shoulder area; superficial\\n$ 429.30\\n23066\\n23066\\nBiopsy, soft tissue of shoulder area; deep\\n$ 772.20\\n23073\\n23073\\nExcision, tumor, soft tissue of shoulder area, subfascial (eg,\\nintramuscular); 5 cm or greater\\n$ 1,601.52\\n23075\\n23075\\nExcision, tumor, soft tissue of shoulder area, subcutaneous; less\\nthan 3 cm\\n$ 690.30\\n23076\\n23076\\nExcision, tumor, soft tissue of shoulder area, subfascial (eg,\\nintramuscular); less than 5 cm\\n$ 972.00\\n23077\\n23077\\nRadical resection of tumor (eg, sarcoma), soft tissue of shoulder\\narea; less than 5 cm\\n$ 3,457.80\\n23100\\n23100\\nArthrotomy, glenohumeral joint, including biopsy\\n$ 1,900.80\\n23101\\n23101\\nArthrotomy, acromioclavicular joint or sternoclavicular joint,\\nincluding biopsy and\/or excision of torn cartilage\\n$ 1,510.20\\n23105\\n23105\\nArthrotomy; glenohumeral joint, with synovectomy, with or without\\nbiopsy\\n$ 2,547.90\\n23106\\n23106\\nArthrotomy; sternoclavicular joint, with synovectomy, with or\\nwithout biopsy\\n$ 1,841.40\\n23107\\n23107\\nArthrotomy, glenohumeral joint, with joint exploration, with or\\nwithout removal of loose or foreign body\\n$ 2,521.80\\n23120\\n23120\\nClaviculectomy; partial\\n$ 1,359.90\\n23125\\n23125\\nClaviculectomy; total\\n$ 2,212.20\\n23130\\n23130\\nAcromioplasty or acromionectomy, partial, with or without\\ncoracoacromial ligament release\\n$ 1,876.50\\n23140\\n23140\\nExcision or curettage of bone cyst or benign tumor of clavicle or\\nscapula;\\n$ 1,152.90\\n23145\\n23145\\nExcision or curettage of bone cyst or benign tumor of clavicle or\\nscapula; with autograft (includes obtaining graft)\\n$ 1,894.50\\n23146\\n23146\\nExcision or curettage of bone cyst or benign tumor of clavicle or\\nscapula; with allograft\\n$ 1,276.20\\n23150\\n23150\\nExcision or curettage of bone cyst or benign tumor of proximal\\nhumerus;\\n$ 1,902.60\\n23155\\n23155\\nExcision or curettage of bone cyst or benign tumor of proximal\\nhumerus; with autograft (includes obtaining graft)\\n$ 2,513.70\\n23156\\n23156\\nExcision or curettage of bone cyst or benign tumor of proximal\\nhumerus; with allograft\\n$ 2,136.60\\n23170\\n23170\\nSequestrectomy (eg, for osteomyelitis or bone abscess), clavicle\\n$ 1,133.10\\n23172\\n23172\\nSequestrectomy (eg, for osteomyelitis or bone abscess), scapula\\n$ 1,035.00\\n23174\\n23174\\nSequestrectomy (eg, for osteomyelitis or bone abscess), humeral\\nhead to surgical neck\\n$ 2,029.50\\n23180\\n23180\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis), clavicle\\n$ 1,142.10\\n23182\\n23182\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis), scapula\\n$ 1,146.60\\n23184\\n23184\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis), proximal humerus\\n$ 1,805.40\\n23190\\n23190\\nOstectomy of scapula, partial (eg, superior medial angle)\\n$ 1,415.70\\n23195\\n23195\\nResection, humeral head\\n$ 2,023.20\\n23200\\n23200\\nRadical resection of tumor; clavicle\\n$ 1,987.20\\n23210\\n23210\\nRadical resection of tumor; scapula\\n$ 2,709.00\\n23220\\n23220\\nRadical resection of tumor, proximal humerus\\n$ 2,718.90\\n23330\\n23330\\nRemoval of foreign body, shoulder; subcutaneous\\n$ 747.00\\n23333\\n23333\\nRemoval of foreign body, shoulder; deep (subfascial or\\nintramuscular)\\n$640.91\\n23350\\n23350\\nInjection procedure for shoulder arthrography or enhanced CT\/MRI\\nshoulder arthrography\\n$ 177.30\\n23395\\n23395\\nMuscle transfer, any type, shoulder or upper arm; single\\n$ 2,472.30\\n23397\\n23397\\nMuscle transfer, any type, shoulder or upper arm; multiple\\n$ 2,657.70\\n23400\\n23400\\nScapulopexy (eg, Sprengels deformity or for paralysis)\\n$ 2,549.70\\n23405\\n23405\\nTenotomy, shoulder area; single tendon\\n$ 1,497.60\\n23406\\n23406\\nTenotomy, shoulder area; multiple tendons through same incision\\n$ 2,154.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n57\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n58\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n23410\\n23410\\nRepair of ruptured musculotendinous cuff (eg, rotator cuff) open;\\nacute\\n$ 2,492.10\\n23412\\n23412\\nRepair of ruptured musculotendinous cuff (eg, rotator cuff) open;\\nchronic\\n$ 3,027.60\\n23415\\n23415\\nCoracoacromial ligament release, with or without acromioplasty\\n$ 1,882.80\\n23420\\n23420\\nReconstruction of complete shoulder (rotator) cuff avulsion, chronic\\n(includes acromioplasty)\\n$ 3,345.30\\n23430\\n23430\\nTenodesis of long tendon of biceps\\n$ 1,865.70\\n23440\\n23440\\nResection or transplantation of long tendon of biceps\\n$ 1,823.40\\n23450\\n23450\\nCapsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type\\noperation\\n$ 3,331.80\\n23455\\n23455\\nCapsulorrhaphy, anterior; with labral repair (eg, Bankart procedure)\\n$ 3,392.10\\n23460\\n23460\\nCapsulorrhaphy, anterior, any type; with bone block\\n$ 3,116.70\\n23462\\n23462\\nCapsulorrhaphy, anterior, any type; with coracoid process transfer\\n$ 3,337.20\\n23465\\n23465\\nCapsulorrhaphy, glenohumeral joint, posterior, with or without\\nbone block\\n$ 2,945.70\\n23466\\n23466\\nCapsulorrhaphy, glenohumeral joint, any type multi-directional\\ninstability\\n$ 3,508.20\\n23470\\n23470\\nArthroplasty, glenohumeral joint; hemiarthroplasty\\n$ 3,598.20\\n23472\\n23472\\nArthroplasty, glenohumeral joint; total shoulder (glenoid and\\nproximal humeral replacement (eg, total shoulder))\\n$ 5,374.80\\n23480\\n23480\\nOsteotomy, clavicle, with or without internal fixation;\\n$ 1,863.00\\n23485\\n23485\\nOsteotomy, clavicle, with or without internal fixation; with bone\\ngraft for nonunion or malunion (includes obtaining graft and\/or\\nnecessary fixation)\\n$ 2,413.80\\n23490\\n23490\\nProphylactic treatment (nailing, pinning, plating or wiring) with or\\nwithout methylmethacrylate; clavicle\\n$ 2,123.10\\n23491\\n23491\\nProphylactic treatment (nailing, pinning, plating or wiring) with or\\nwithout methylmethacrylate; proximal humerus\\n$ 2,097.00\\n23500\\n23500\\nClosed treatment of clavicular fracture; without manipulation\\n$ 342.90\\n23505\\n23505\\nClosed treatment of clavicular fracture; with manipulation\\n$ 586.80\\n23515\\n23515\\nOpen treatment of clavicular fracture, includes internal fixation,\\nwhen performed\\n$ 1,595.70\\n23520\\n23520\\nClosed treatment of sternoclavicular dislocation; without\\nmanipulation\\n$ 387.90\\n23525\\n23525\\nClosed treatment of sternoclavicular dislocation; with manipulation\\n$ 556.20\\n23530\\n23530\\nOpen treatment of sternoclavicular dislocation, acute or chronic;\\n$ 1,455.30\\n23532\\n23532\\nOpen treatment of sternoclavicular dislocation, acute or chronic;\\nwith fascial graft (includes obtaining graft)\\n$ 1,701.90\\n23540\\n23540\\nClosed treatment of acromioclavicular dislocation; without\\nmanipulation\\n$ 418.50\\n23545\\n23545\\nClosed treatment of acromioclavicular dislocation; with\\nmanipulation\\n$ 565.20\\n23550\\n23550\\nOpen treatment of acromioclavicular dislocation, acute or chronic;\\n$ 1,890.00\\n23552\\n23552\\nOpen treatment of acromioclavicular dislocation, acute or chronic;\\nwith fascial graft (includes obtaining graft)\\n$ 2,283.30\\n23570\\n23570\\nClosed treatment of scapular fracture; without manipulation\\n$ 372.60\\n23575\\n23575\\nClosed treatment of scapular fracture; with manipulation, with or\\nwithout skeletal traction (with or without shoulder joint\\ninvolvement)\\n$ 533.70\\n23585\\n23585\\nOpen treatment of scapular fracture (body, glenoid or acromion)\\nincludes internal fixation, when performed\\n$ 2,152.80\\n23600\\n23600\\nClosed treatment of proximal humeral (surgical or anatomical neck)\\nfracture; without manipulation\\n$ 537.30\\n23605\\n23605\\nClosed treatment of proximal humeral (surgical or anatomical neck)\\nfracture; with manipulation, with or without skeletal traction\\n$ 871.20\\n23615\\n23615\\nOpen treatment of proximal humeral (surgical or anatomical neck)\\nfracture, includes internal fixation, when performed, includes repair\\nof tuberosity(s), when performed;\\n$ 2,034.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n59\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n60\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n23616\\n23616\\nOpen treatment of proximal humeral (surgical or anatomical neck)\\nfracture, includes internal fixation, when performed, includes repair\\nof tuberosity(s), when performed; with proximal humeral prosthetic\\nreplacement\\n$ 3,965.40\\n23620\\n23620\\nClosed treatment of greater humeral tuberosity fracture; without\\nmanipulation\\n$ 471.60\\n23625\\n23625\\nClosed treatment of greater humeral tuberosity fracture; with\\nmanipulation\\n$ 744.30\\n23630\\n23630\\nOpen treatment of greater humeral tuberosity fracture, includes\\ninternal fixation, when performed\\n$ 1,616.40\\n23650\\n23650\\nClosed treatment of shoulder dislocation, with manipulation;\\nwithout anesthesia\\n$ 457.20\\n23655\\n23655\\nClosed treatment of shoulder dislocation, with manipulation;\\nrequiring anesthesia\\n$ 669.60\\n23660\\n23660\\nOpen treatment of acute shoulder dislocation\\n$ 1,996.20\\n23665\\n23665\\nClosed treatment of shoulder dislocation, with fracture of greater\\nhumeral tuberosity, with manipulation\\n$ 749.70\\n23670\\n23670\\nOpen treatment of shoulder dislocation, with fracture of greater\\nhumeral tuberosity, includes internal fixation, when performed\\n$ 1,975.50\\n23675\\n23675\\nClosed treatment of shoulder dislocation, with surgical or\\nanatomical neck fracture, with manipulation\\n$ 888.30\\n23680\\n23680\\nOpen treatment of shoulder dislocation, with surgical or anatomical\\nneck fracture, includes internal fixation, when performed\\n$ 2,415.60\\n23700\\n23700\\nManipulation under anesthesia, shoulder joint, including application\\nof fixation apparatus (dislocation excluded)\\n$ 625.50\\n23800\\n23800\\nArthrodesis, glenohumeral joint;\\n$ 3,604.50\\n23802\\n23802\\nArthrodesis, glenohumeral joint; with autogenous graft (includes\\nobtaining graft)\\n$ 3,445.20\\n23900\\n23900\\nInterthoracoscapular amputation (forequarter)\\n$ 4,063.50\\n23920\\n23920\\nDisarticulation of shoulder;\\n$ 3,162.60\\n23921\\n23921\\nDisarticulation of shoulder; secondary closure or scar revision\\n$ 909.90\\n23929\\n23929\\nUnlisted procedure, shoulder\\nCost\\n23930\\n23930\\nIncision and drainage, upper arm or elbow area; deep abscess or\\nhematoma\\n$ 819.90\\n23931\\n23931\\nIncision and drainage, upper arm or elbow area; bursa\\n$ 675.90\\n23935\\n23935\\nIncision, deep, with opening of bone cortex (eg, for osteomyelitis or\\nbone abscess), humerus or elbow\\n$ 1,374.30\\n24000\\n24000\\nArthrotomy, elbow, including exploration, drainage, or removal of\\nforeign body\\n$ 1,805.40\\n24006\\n24006\\nArthrotomy of the elbow, with capsular excision for capsular release\\n(separate procedure)\\n$ 1,784.70\\n24065\\n24065\\nBiopsy, soft tissue of upper arm or elbow area; superficial\\n$ 385.20\\n24066\\n24066\\nBiopsy, soft tissue of upper arm or elbow area; deep (subfascial or\\nintramuscular)\\n$ 707.89\\n24071\\n24071\\nExcision, tumor, soft tissue of upper arm or elbow area,\\nsubcutaneous; 3 cm or greater\\n$ 972.78\\n24073\\n24073\\nExcision, tumor, soft tissue of upper arm or elbow area, subfascial\\n(eg, intramuscular); 5 cm or greater\\n$ 1,396.93\\n24075\\n24075\\nExcision, tumor, soft tissue of upper arm or elbow area,\\nsubcutaneous; less than 3 cm\\n$ 686.70\\n24076\\n24076\\nExcision, tumor, soft tissue of upper arm or elbow area, subfascial\\n(eg, intramuscular); less than 5 cm\\n$ 1,179.00\\n24077\\n24077\\nRadical resection of tumor (eg, sarcoma), soft tissue of upper arm or\\nelbow area; less than 5 cm\\n$ 2,430.90\\n24079\\n24079\\nRadical resection of tumor (eg, sarcoma), soft tissue of upper arm or\\nelbow area; 5 cm or greater\\n$ 2,604.12\\n24100\\n24100\\nArthrotomy, elbow; with synovial biopsy only\\n$ 1,082.70\\n24101\\n24101\\nArthrotomy, elbow; with joint exploration, with or without biopsy,\\nwith or without removal of loose or foreign body\\n$ 1,861.20\\n24102\\n24102\\nArthrotomy, elbow; with synovectomy\\n$ 2,224.80\\n24105\\n24105\\nExcision, olecranon bursa\\n$ 898.20\\n24110\\n24110\\nExcision or curettage of bone cyst or benign tumor, humerus;\\n$ 1,581.30\\n24115\\n24115\\nExcision or curettage of bone cyst or benign tumor, humerus; with\\nautograft (includes obtaining graft)\\n$ 1,887.30\\n24116\\n24116\\nExcision or curettage of bone cyst or benign tumor, humerus; with\\nallograft\\n$ 1,841.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n61\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n62\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n24120\\n24120\\nExcision or curettage of bone cyst or benign tumor of head or neck\\nof radius or olecranon process;\\n$ 1,485.00\\n24125\\n24125\\nExcision or curettage of bone cyst or benign tumor of head or neck\\nof radius or olecranon process; with autograft (includes obtaining\\ngraft)\\n$ 1,740.60\\n24126\\n24126\\nExcision or curettage of bone cyst or benign tumor of head or neck\\nof radius or olecranon process; with allograft\\n$ 1,524.60\\n24130\\n24130\\nExcision, radial head\\n$ 1,459.80\\n24134\\n24134\\nSequestrectomy (eg, for osteomyelitis or bone abscess), shaft or\\ndistal humerus\\n$ 1,854.00\\n24136\\n24136\\nSequestrectomy (eg, for osteomyelitis or bone abscess), radial head\\nor neck\\n$ 1,654.20\\n24138\\n24138\\nSequestrectomy (eg, for osteomyelitis or bone abscess), olecranon\\nprocess\\n$ 1,622.70\\n24140\\n24140\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis), humerus\\n$ 2,168.10\\n24145\\n24145\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis), radial head or neck\\n$ 1,442.70\\n24147\\n24147\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis), olecranon process\\n$ 1,296.00\\n24149\\n24149\\nRadical resection of capsule, soft tissue, and heterotopic bone,\\nelbow, with contracture release (separate procedure)\\n$ 2,652.30\\n24150\\n24150\\nRadical resection of tumor, shaft or distal humerus\\n$ 2,443.50\\n24152\\n24152\\nRadical resection of tumor, radial head or neck\\n$ 2,158.20\\n24155\\n24155\\nResection of elbow joint (arthrectomy)\\n$ 2,199.60\\n24160\\n24160\\nRemoval of prosthesis, includes debridement and synovectomy\\nwhen performed; humeral and ulnar components\\n$ 1,489.50\\n24164\\n24164\\nRemoval of prosthesis, includes debridement and synovectomy\\nwhen performed; radial head\\n$ 1,359.90\\n24200\\n24200\\nRemoval of foreign body, upper arm or elbow area; subcutaneous\\n$ 368.10\\n24201\\n24201\\nRemoval of foreign body, upper arm or elbow area; deep (subfascial\\nor intramuscular)\\n$ 962.10\\n24220\\n24220\\nInjection procedure for elbow arthrography\\n$ 177.30\\n24300\\n24300\\nManipulation, elbow, under anesthesia\\n$ 777.16\\n24301\\n24301\\nMuscle or tendon transfer, any type, upper arm or elbow, single\\n(excluding 24320-24331)\\n$ 1,998.00\\n24305\\n24305\\nTendon lengthening, upper arm or elbow, each tendon\\n$ 900.90\\n24310\\n24310\\nTenotomy, open, elbow to shoulder, each tendon\\n$ 955.80\\n24320\\n24320\\nTenoplasty, with muscle transfer, with or without free graft, elbow\\nto shoulder, single (Seddon-Brookes type procedure)\\n$ 2,311.20\\n24330\\n24330\\nFlexor-plasty, elbow (eg, Steindler type advancement);\\n$ 2,269.80\\n24331\\n24331\\nFlexor-plasty, elbow (eg, Steindler type advancement); with\\nextensor advancement\\n$ 2,086.20\\n24332\\n24332\\nTenolysis, triceps\\n$ 1,181.38\\n24340\\n24340\\nTenodesis of biceps tendon at elbow (separate procedure)\\n$ 1,922.40\\n24341\\n24341\\nRepair, tendon or muscle, upper arm or elbow, each tendon or\\nmuscle, primary or secondary (excludes rotator cuff)\\n$ 1,816.20\\n24342\\n24342\\nReinsertion of ruptured biceps or triceps tendon, distal, with or\\nwithout tendon graft\\n$ 2,416.50\\n24343\\n24343\\nRepair lateral collateral ligament, elbow, with local tissue\\n$ 1,858.95\\n24344\\n24344\\nReconstruction lateral collateral ligament, elbow, with tendon graft\\n(includes harvesting of graft)\\n$ 2,485.31\\n24345\\n24345\\nRepair medial collateral ligament, elbow, with local tissue\\n$ 1,857.96\\n24357\\n24357\\nTenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow,\\ngolfer's elbow); percutaneous\\n$ 1,115.21\\n24358\\n24358\\nTenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow,\\ngolfer's elbow); debridement, soft tissue and\/or bone, open\\n$ 1,270.13\\n24359\\n24359\\nTenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow,\\ngolfer's elbow); debridement, soft tissue and\/or bone, open with\\ntendon repair or reattachment\\n$ 1,520.03\\n24360\\n24360\\nArthroplasty, elbow; with membrane (eg, fascial)\\n$ 3,267.00\\n24361\\n24361\\nArthroplasty, elbow; with distal humeral prosthetic replacement\\n$ 2,970.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n63\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n64\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifier\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n24362\\n24362\\nArthroplasty, elbow; with implant and fascia lata ligament\\nreconstruction\\n$ 3,446.10\\n24363\\n24363\\nArthroplasty, elbow; with distal humerus and proximal ulnar\\nprosthetic replacement (eg, total elbow)\\n$ 4,614.30\\n24365\\n24365\\nArthroplasty, radial head;\\n$ 1,601.10\\n24366\\n24366\\nArthroplasty, radial head; with implant\\n$ 2,054.70\\n24400\\n24400\\nOsteotomy, humerus, with or without internal fixation\\n$ 2,451.60\\n24410\\n24410\\nMultiple osteotomies with realignment on intramedullary rod,\\nhumeral shaft (Sofield type procedure)\\n$ 2,646.90\\n24420\\n24420\\nOsteoplasty, humerus (eg, shortening or lengthening) (excluding\\n64876)\\n$ 2,397.60\\n24430\\n24430\\nRepair of nonunion or malunion, humerus; without graft (eg,\\ncompression technique)\\n$ 2,629.80\\n24435\\n24435\\nRepair of nonunion or malunion, humerus; with iliac or other\\nautograft (includes obtaining graft)\\n$ 3,298.50\\n24470\\n24470\\nHemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)\\n$ 1,476.00\\n24495\\n24495\\nDecompression fasciotomy, forearm, with brachial artery\\nexploration\\n$ 2,070.00\\n24498\\n24498\\nProphylactic treatment (nailing, pinning, plating or wiring), with or\\nwithout methylmethacrylate, humeral shaft\\n$ 1,984.50\\n24500\\n24500\\nClosed treatment of humeral shaft fracture; without manipulation\\n$ 503.10\\n24505\\n24505\\nClosed treatment of humeral shaft fracture; with manipulation, with\\nor without skeletal traction\\n$ 1,046.70\\n24515\\n24515\\nOpen treatment of humeral shaft fracture with plate\/screws, with\\nor without cerclage\\n$ 2,314.80\\n24516\\n24516\\nTreatment of humeral shaft fracture, with insertion of\\nintramedullary implant, with or without cerclage and\/or locking\\nscrews\\n$ 2,646.90\\n24530\\n24530\\nClosed treatment of supracondylar or transcondylar humeral\\nfracture, with or without intercondylar extension; without\\nmanipulation\\n$ 612.20\\n24535\\n24535\\nClosed treatment of supracondylar or transcondylar humeral\\nfracture, with or without intercondylar extension; with\\nmanipulation, with or without skin or skeletal traction\\n$ 1,064.70\\n24538\\n24538\\nPercutaneous skeletal fixation of supracondylar or transcondylar\\nhumeral fracture, with or without intercondylar extension\\n$ 1,833.30\\n24545\\n24545\\nOpen treatment of humeral supracondylar or transcondylar\\nfracture, includes internal fixation, when performed; without\\nintercondylar extension\\n$ 2,343.60\\n24546\\n24546\\nOpen treatment of humeral supracondylar or transcondylar\\nfracture, includes internal fixation, when performed; with\\nintercondylar extension\\n$ 2,875.50\\n24560\\n24560\\nClosed treatment of humeral epicondylar fracture, medial or lateral;\\nwithout manipulation\\n$ 535.50\\n24565\\n24565\\nClosed treatment of humeral epicondylar fracture, medial or lateral;\\nwith manipulation\\n$ 788.40\\n24566\\n24566\\nPercutaneous skeletal fixation of humeral epicondylar fracture,\\nmedial or lateral, with manipulation\\n$ 1,277.10\\n24575\\n24575\\nOpen treatment of humeral epicondylar fracture, medial or lateral,\\nincludes internal fixation, when performed\\n$ 1,759.50\\n24576\\n24576\\nClosed treatment of humeral condylar fracture, medial or lateral;\\nwithout manipulation\\n$ 549.90\\n24577\\n24577\\nClosed treatment of humeral condylar fracture, medial or lateral;\\nwith manipulation\\n$ 991.80\\n24579\\n24579\\nOpen treatment of humeral condylar fracture, medial or lateral,\\nincludes internal fixation, when performed\\n$ 1,859.40\\n24582\\n24582\\nPercutaneous skeletal fixation of humeral condylar fracture, medial\\nor lateral, with manipulation\\n$ 1,494.00\\n24586\\n24586\\nOpen treatment of periarticular fracture and\/or dislocation of the\\nelbow (fracture distal humerus and proximal ulna and\/or proximal\\nradius);\\n$ 2,680.20\\n24587\\n24587\\nOpen treatment of periarticular fracture and\/or dislocation of the\\nelbow (fracture distal humerus and proximal ulna and\/or proximal\\nradius); with implant arthroplasty\\n$ 3,429.00\\n24600\\n24600\\nTreatment of closed elbow dislocation; without anesthesia\\n$ 462.60\\n24605\\n24605\\nTreatment of closed elbow dislocation; requiring anesthesia\\n$ 753.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n65\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n66\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n24615\\n24615\\nOpen treatment of acute or chronic elbow dislocation\\n$ 1,831.50\\n24620\\n24620\\nClosed treatment of Monteggia type of fracture dislocation at\\nelbow (fracture proximal end of ulna with dislocation of radial\\nhead), with manipulation\\n$ 952.20\\n24635\\n24635\\nOpen treatment of Monteggia type of fracture dislocation at elbow\\n(fracture proximal end of ulna with dislocation of radial head),\\nincludes internal fixation, when performed\\n$ 2,043.00\\n24640\\n24640\\nClosed treatment of radial head subluxation in child, nursemaid\\nelbow, with manipulation\\n$ 280.80\\n24650\\n24650\\nClosed treatment of radial head or neck fracture; without\\nmanipulation\\n$ 413.10\\n24655\\n24655\\nClosed treatment of radial head or neck fracture; with manipulation $ 778.50\\n24665\\n24665\\nOpen treatment of radial head or neck fracture, includes internal\\nfixation or radial head excision, when performed;\\n$ 1,544.40\\n24666\\n24666\\nOpen treatment of radial head or neck fracture, includes internal\\nfixation or radial head excision, when performed; with radial head\\nprosthetic replacement\\n$ 1,931.40\\n24670\\n24670\\nClosed treatment of ulnar fracture, proximal end (eg, olecranon or\\ncoronoid process[es]); without manipulation\\n$ 478.80\\n24675\\n24675\\nClosed treatment of ulnar fracture, proximal end (eg, olecranon or\\ncoronoid process[es]); with manipulation\\n$ 801.00\\n24685\\n24685\\nOpen treatment of ulnar fracture, proximal end (eg, olecranon or\\ncoronoid process[es]), includes internal fixation, when performed\\n$ 1,825.20\\n24800\\n24800\\nArthrodesis, elbow joint; local\\n$ 2,271.60\\n24802\\n24802\\nArthrodesis, elbow joint; with autogenous graft (includes obtaining\\ngraft)\\n$ 2,788.20\\n24900\\n24900\\nAmputation, arm through humerus; with primary closure\\n$ 1,834.20\\n24920\\n24920\\nAmputation, arm through humerus; open, circular (guillotine)\\n$ 1,599.30\\n24925\\n24925\\nAmputation, arm through humerus; secondary closure or scar\\nrevision\\n$ 774.90\\n24930\\n24930\\nAmputation, arm through humerus; re-amputation\\n$ 1,470.60\\n24931\\n24931\\nAmputation, arm through humerus; with implant\\n$ 1,900.80\\n24935\\n24935\\nStump elongation, upper extremity\\n$ 2,499.30\\n24940\\n24940\\nCineplasty, upper extremity, complete procedure\\n$ 2,632.50\\n24999\\n24999\\nUnlisted procedure, humerus or elbow\\nCost\\n25000\\n25000\\nIncision, extensor tendon sheath, wrist (eg, deQuervains disease)\\n$ 1,080.90\\n25001\\n25001\\nIncision, flexor tendon sheath, wrist (eg, flexor carpi radialis)\\n$ 963.51\\n25020\\n25020\\nDecompression fasciotomy, forearm and\/or wrist, flexor OR\\nextensor compartment; without debridement of nonviable muscle\\nand\/or nerve\\n$ 1,390.50\\n25023\\n25023\\nDecompression fasciotomy, forearm and\/or wrist, flexor OR\\nextensor compartment; with debridement of nonviable muscle\\nand\/or nerve\\n$ 1,751.40\\n25024\\n25024\\nDecompression fasciotomy, forearm and\/or wrist, flexor AND\\nextensor compartment; without debridement of nonviable muscle\\nand\/or nerve\\n$ 1,555.24\\n25025\\n25025\\nDecompression fasciotomy, forearm and\/or wrist, flexor AND\\nextensor compartment; with debridement of nonviable muscle\\nand\/or nerve\\n$ 2,070.11\\n25028\\n25028\\nIncision and drainage, forearm and\/or wrist; deep abscess or\\nhematoma\\n$ 981.00\\n25031\\n25031\\nIncision and drainage, forearm and\/or wrist; bursa\\n$ 586.80\\n25035\\n25035\\nIncision, deep, bone cortex, forearm and\/or wrist (eg, osteomyelitis\\nor bone abscess)\\n$ 1,416.60\\n25040\\n25040\\nArthrotomy, radiocarpal or midcarpal joint, with exploration,\\ndrainage, or removal of foreign body\\n$ 1,479.60\\n25065\\n25065\\nBiopsy, soft tissue of forearm and\/or wrist; superficial\\n$ 434.70\\n25066\\n25066\\nBiopsy, soft tissue of forearm and\/or wrist; deep (subfascial or\\nintramuscular)\\n$ 710.10\\n25073\\n25073\\nExcision, tumor, soft tissue of forearm and\/or wrist area, subfascial\\n(eg, intramuscular); 3 cm or greater\\n$ 1,806.54\\n25075\\n25075\\nExcision, tumor, soft tissue of forearm and\/or wrist area,\\nsubcutaneous; less than 3 cm\\n$ 650.70\\n25076\\n25076\\nExcision, tumor, soft tissue of forearm and\/or wrist area, subfascial\\n(eg, intramuscular); less than 3 cm\\n$ 1,148.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n67\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n68\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n25077\\n25077\\nRadical resection of tumor (eg, sarcoma), soft tissue of forearm\\nand\/or wrist area; less than 3 cm\\n$ 2,590.20\\n25085\\n25085\\nCapsulotomy, wrist (eg, contracture)\\n$ 1,601.10\\n25100\\n25100\\nArthrotomy, wrist joint; with biopsy\\n$ 1,330.20\\n25101\\n25101\\nArthrotomy, wrist joint; with joint exploration, with or without\\nbiopsy, with or without removal of loose or foreign body\\n$ 1,323.00\\n25105\\n25105\\nArthrotomy, wrist joint; with synovectomy\\n$ 1,722.60\\n25107\\n25107\\nArthrotomy, distal radioulnar joint including repair of triangular\\ncartilage, complex\\n$ 1,453.50\\n25109\\n25109\\nExcision of tendon, forearm and\/or wrist, flexor or extensor, each\\n$ 1,481.65\\n25110\\n25110\\nExcision, lesion of tendon sheath, forearm and\/or wrist\\n$ 801.00\\n25111\\n25111\\nExcision of ganglion, wrist (dorsal or volar); primary\\n$ 943.10\\n25112\\n25112\\nExcision of ganglion, wrist (dorsal or volar); recurrent\\n$ 1,357.20\\n25115\\n25115\\nRadical excision of bursa, synovia of wrist, or forearm tendon\\nsheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas,\\nrheumatoid arthritis); flexors\\n$ 2,098.80\\n25116\\n25116\\nRadical excision of bursa, synovia of wrist, or forearm tendon\\nsheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas,\\nrheumatoid arthritis); extensors, with or without transposition of\\ndorsal retinaculum\\n$ 2,058.30\\n25118\\n25118\\nSynovectomy, extensor tendon sheath, wrist, single compartment;\\n$ 1,926.00\\n25119\\n25119\\nSynovectomy, extensor tendon sheath, wrist, single compartment;\\nwith resection of distal ulna\\n$ 1,556.10\\n25120\\n25120\\nExcision or curettage of bone cyst or benign tumor of radius or ulna\\n(excluding head or neck of radius and olecranon process);\\n$ 1,530.90\\n25125\\n25125\\nExcision or curettage of bone cyst or benign tumor of radius or ulna\\n(excluding head or neck of radius and olecranon process); with\\nautograft (includes obtaining graft)\\n$ 1,812.60\\n25126\\n25126\\nExcision or curettage of bone cyst or benign tumor of radius or ulna\\n(excluding head or neck of radius and olecranon process); with\\nallograft\\n$ 1,601.10\\n25130\\n25130\\nExcision or curettage of bone cyst or benign tumor of carpal bones;\\n$ 1,552.50\\n25135\\n25135\\nExcision or curettage of bone cyst or benign tumor of carpal bones;\\nwith autograft (includes obtaining graft)\\n$ 1,781.10\\n25136\\n25136\\nExcision or curettage of bone cyst or benign tumor of carpal bones;\\nwith allograft\\n$ 1,669.50\\n25145\\n25145\\nSequestrectomy (eg, for osteomyelitis or bone abscess), forearm\\nand\/or wrist\\n$ 1,837.80\\n25150\\n25150\\nPartial excision (craterization, saucerization, or diaphysectomy) of\\nbone (eg, for osteomyelitis); ulna\\n$ 1,599.30\\n25151\\n25151\\nPartial excision (craterization, saucerization, or diaphysectomy) of\\nbone (eg, for osteomyelitis); radius\\n$ 1,522.80\\n25170\\n25170\\nRadical resection of tumor, radius or ulna\\n$ 2,446.20\\n25210\\n25210\\nCarpectomy; 1 bone\\n$ 1,483.20\\n25215\\n25215\\nCarpectomy; all bones of proximal row\\n$ 2,278.80\\n25230\\n25230\\nRadial styloidectomy (separate procedure)\\n$ 1,163.70\\n25240\\n25240\\nExcision distal ulna partial or complete (eg, Darrach type or\\nmatched resection)\\n$ 1,516.50\\n25246\\n25246\\nInjection procedure for wrist arthrography\\n$ 223.20\\n25248\\n25248\\nExploration with removal of deep foreign body, forearm or wrist\\n$ 1,003.50\\n25250\\n25250\\nRemoval of wrist prosthesis; (separate procedure)\\n$ 1,647.90\\n25251\\n25251\\nRemoval of wrist prosthesis; complicated, including total wrist\\n$ 2,194.20\\n25259\\n25259\\nManipulation, wrist, under anesthesia\\n$ 1,033.88\\n25260\\n25260\\nRepair, tendon or muscle, flexor, forearm and\/or wrist; primary,\\nsingle, each tendon or muscle\\n$ 1,475.10\\n25263\\n25263\\nRepair, tendon or muscle, flexor, forearm and\/or wrist; secondary,\\nsingle, each tendon or muscle\\n$ 1,476.00\\n25265\\n25265\\nRepair, tendon or muscle, flexor, forearm and\/or wrist; secondary,\\nwith free graft (includes obtaining graft), each tendon or muscle\\n$ 1,890.00\\n25270\\n25270\\nRepair, tendon or muscle, extensor, forearm and\/or wrist; primary,\\nsingle, each tendon or muscle\\n$ 1,206.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n69\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n70\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n25272\\n25272\\nRepair, tendon or muscle, extensor, forearm and\/or wrist;\\nsecondary, single, each tendon or muscle\\n$ 1,325.70\\n25274\\n25274\\nRepair, tendon or muscle, extensor, forearm and\/or wrist;\\nsecondary, with free graft (includes obtaining graft), each tendon or\\nmuscle\\n$ 2,003.40\\n25275\\n25275\\nRepair, tendon sheath, extensor, forearm and\/or wrist, with free\\ngraft (includes obtaining graft) (eg, for extensor carpi ulnaris\\nsubluxation)\\n$ 1,683.67\\n25280\\n25280\\nLengthening or shortening of flexor or extensor tendon, forearm\\nand\/or wrist, single, each tendon\\n$ 1,415.70\\n25290\\n25290\\nTenotomy, open, flexor or extensor tendon, forearm and\/or wrist,\\nsingle, each tendon\\n$ 943.20\\n25295\\n25295\\nTenolysis, flexor or extensor tendon, forearm and\/or wrist, single,\\neach tendon\\n$ 1,387.80\\n25300\\n25300\\nTenodesis at wrist; flexors of fingers\\n$ 1,893.60\\n25301\\n25301\\nTenodesis at wrist; extensors of fingers\\n$ 1,581.30\\n25310\\n25310\\nTendon transplantation or transfer, flexor or extensor, forearm\\nand\/or wrist, single; each tendon\\n$ 1,870.20\\n25312\\n25312\\nTendon transplantation or transfer, flexor or extensor, forearm\\nand\/or wrist, single; with tendon graft(s) (includes obtaining graft),\\neach tendon\\n$ 2,202.30\\n25315\\n25315\\nFlexor origin slide (eg, for cerebral palsy, Volkmann contracture),\\nforearm and\/or wrist;\\n$ 2,035.80\\n25316\\n25316\\nFlexor origin slide (eg, for cerebral palsy, Volkmann contracture),\\nforearm and\/or wrist; with tendon(s) transfer\\n$ 2,677.50\\n25320\\n25320\\nCapsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis,\\nligament repair, tendon transfer or graft) (includes synovectomy,\\ncapsulotomy and open reduction) for carpal instability\\n$ 3,002.40\\n25332\\n25332\\nArthroplasty, wrist, with or without interposition, with or without\\nexternal or internal fixation\\n$ 2,537.10\\n25335\\n25335\\nCentralization of wrist on ulna (eg, radial club hand)\\n$ 3,493.80\\n25337\\n25337\\nReconstruction for stabilization of unstable distal ulna or distal\\nradioulnar joint, secondary by soft tissue stabilization (eg, tendon\\ntransfer, tendon graft or weave, or tenodesis) with or without open\\nreduction of distal radioulnar joint\\n$ 1,961.10\\n25350\\n25350\\nOsteotomy, radius; distal third\\n$ 1,881.90\\n25355\\n25355\\nOsteotomy, radius; middle or proximal third\\n$ 1,962.90\\n25360\\n25360\\nOsteotomy; ulna\\n$ 1,773.00\\n25365\\n25365\\nOsteotomy; radius AND ulna\\n$ 2,209.50\\n25370\\n25370\\nMultiple osteotomies, with realignment on intramedullary rod\\n(Sofield type procedure); radius OR ulna\\n$ 2,259.00\\n25375\\n25375\\nMultiple osteotomies, with realignment on intramedullary rod\\n(Sofield type procedure); radius AND ulna\\n$ 3,060.90\\n25390\\n25390\\nOsteoplasty, radius OR ulna; shortening\\n$ 2,204.10\\n25391\\n25391\\nOsteoplasty, radius OR ulna; lengthening with autograft\\n$ 2,938.50\\n25392\\n25392\\nOsteoplasty, radius AND ulna; shortening (excluding 64876)\\n$ 2,710.80\\n25393\\n25393\\nOsteoplasty, radius AND ulna; lengthening with autograft\\n$ 3,029.40\\n25394\\n25394\\nOsteoplasty, carpal bone, shortening\\n$ 1,709.09\\n25400\\n25400\\nRepair of nonunion or malunion, radius OR ulna; without graft (eg,\\ncompression technique)\\n$ 1,773.90\\n25405\\n25405\\nRepair of nonunion or malunion, radius OR ulna; with autograft\\n(includes obtaining graft)\\n$ 2,500.20\\n25415\\n25415\\nRepair of nonunion or malunion, radius AND ulna; without graft (eg,\\ncompression technique)\\n$ 2,615.40\\n25420\\n25420\\nRepair of nonunion or malunion, radius AND ulna; with autograft\\n(includes obtaining graft)\\n$ 2,688.30\\n25425\\n25425\\nRepair of defect with autograft; radius OR ulna\\n$ 2,207.70\\n25426\\n25426\\nRepair of defect with autograft; radius AND ulna\\n$ 3,141.00\\n25430\\n25430\\nInsertion of vascular pedicle into carpal bone (eg, Hori procedure)\\n$ 1,713.16\\n25431\\n25431\\nRepair of nonunion of carpal bone (excluding carpal scaphoid\\n(navicular)) (includes obtaining graft and necessary fixation), each\\nbone\\n$ 2,472.29\\n25440\\n25440\\nRepair of nonunion, scaphoid carpal (navicular) bone, with or\\nwithout radial styloidectomy (includes obtaining graft and necessary\\nfixation)\\n$ 2,318.40\\n25441\\n25441\\nArthroplasty with prosthetic replacement; distal radius\\n$ 2,338.20\\n25442\\n25442\\nArthroplasty with prosthetic replacement; distal ulna\\n$ 1,840.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n71\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n72\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n25443\\n25443\\nArthroplasty with prosthetic replacement; scaphoid carpal\\n(navicular)\\n$ 2,010.60\\n25444\\n25444\\nArthroplasty with prosthetic replacement; lunate\\n$ 2,404.80\\n25445\\n25445\\nArthroplasty with prosthetic replacement; trapezium\\n$ 2,321.10\\n25446\\n25446\\nArthroplasty with prosthetic replacement; distal radius and partial\\nor entire carpus (total wrist)\\n$ 3,823.20\\n25447\\n25447\\nArthroplasty, interposition, intercarpal or carpometacarpal joints\\n$ 2,806.20\\n25449\\n25449\\nRevision of arthroplasty, including removal of implant, wrist joint\\n$ 1,763.10\\n25450\\n25450\\nEpiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna\\n$ 1,053.00\\n25455\\n25455\\nEpiphyseal arrest by epiphysiodesis or stapling; distal radius AND\\nulna\\n$ 1,548.00\\n25490\\n25490\\nProphylactic treatment (nailing, pinning, plating or wiring) with or\\nwithout methylmethacrylate; radius\\n$ 1,586.70\\n25491\\n25491\\nProphylactic treatment (nailing, pinning, plating or wiring) with or\\nwithout methylmethacrylate; ulna\\n$ 1,681.20\\n25492\\n25492\\nProphylactic treatment (nailing, pinning, plating or wiring) with or\\nwithout methylmethacrylate; radius AND ulna\\n$ 1,881.90\\n25500\\n25500\\nClosed treatment of radial shaft fracture; without manipulation\\n$ 513.00\\n25505\\n25505\\nClosed treatment of radial shaft fracture; with manipulation\\n$ 775.80\\n25515\\n25515\\nOpen treatment of radial shaft fracture, includes internal fixation,\\nwhen performed\\n$ 1,587.60\\n25520\\n25520\\nClosed treatment of radial shaft fracture and closed treatment of\\ndislocation of distal radioulnar joint (Galeazzi fracture\/dislocation)\\n$ 1,447.20\\n25525\\n25525\\nOpen treatment of radial shaft fracture, includes internal fixation,\\nwhen performed, and closed treatment of distal radioulnar joint\\ndislocation (Galeazzi fracture\/dislocation), includes percutaneous\\nskeletal fixation, when performed\\n$ 2,566.80\\n25526\\n25526\\nOpen treatment of radial shaft fracture, includes internal fixation,\\nwhen performed, and open treatment of distal radioulnar joint\\ndislocation (Galeazzi fracture\/dislocation), includes internal fixation,\\nwhen performed, includes repair of triangular fibro\\n$ 2,663.10\\n25530\\n25530\\nClosed treatment of ulnar shaft fracture; without manipulation\\n$ 475.20\\n25535\\n25535\\nClosed treatment of ulnar shaft fracture; with manipulation\\n$ 811.80\\n25545\\n25545\\nOpen treatment of ulnar shaft fracture, includes internal fixation,\\nwhen performed\\n$ 1,704.60\\n25560\\n25560\\nClosed treatment of radial and ulnar shaft fractures; without\\nmanipulation\\n$ 612.90\\n25565\\n25565\\nClosed treatment of radial and ulnar shaft fractures; with\\nmanipulation\\n$ 1,008.00\\n25574\\n25574\\nOpen treatment of radial AND ulnar shaft fractures, with internal\\nfixation, when performed; of radius OR ulna\\n$ 2,353.50\\n25575\\n25575\\nOpen treatment of radial AND ulnar shaft fractures, with internal\\nfixation, when performed; of radius AND ulna\\n$ 2,425.50\\n25600\\n25600\\nClosed treatment of distal radial fracture (eg, Colles or Smith type)\\nor epiphyseal separation, includes closed treatment of fracture of\\nulnar styloid, when performed; without manipulation\\n$ 550.80\\n25605\\n25605\\nClosed treatment of distal radial fracture (eg, Colles or Smith type)\\nor epiphyseal separation, includes closed treatment of fracture of\\nulnar styloid, when performed; with manipulation\\n$ 796.50\\n25606\\n25606\\nPercutaneous skeletal fixation of distal radial fracture or epiphyseal\\nseparation\\n$ 1,524.64\\n25607\\n25607\\nOpen treatment of distal radial extra-articular fracture or\\nepiphyseal separation, with internal fixation\\n$ 1,539.22\\n25622\\n25622\\nClosed treatment of carpal scaphoid (navicular) fracture; without\\nmanipulation\\n$ 612.90\\n25624\\n25624\\nClosed treatment of carpal scaphoid (navicular) fracture; with\\nmanipulation\\n$ 808.20\\n25628\\n25628\\nOpen treatment of carpal scaphoid (navicular) fracture, includes\\ninternal fixation, when performed\\n$ 1,751.40\\n25630\\n25630\\nClosed treatment of carpal bone fracture (excluding carpal scaphoid\\n[navicular]); without manipulation, each bone\\n$ 506.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n73\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n74\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n25635\\n25635\\nClosed treatment of carpal bone fracture (excluding carpal scaphoid\\n[navicular]); with manipulation, each bone\\n$ 699.30\\n25645\\n25645\\nOpen treatment of carpal bone fracture (other than carpal scaphoid\\n[navicular]), each bone\\n$ 1,376.10\\n25650\\n25650\\nClosed treatment of ulnar styloid fracture\\n$ 758.70\\n25651\\n25651\\nPercutaneous skeletal fixation of ulnar styloid fracture\\n$ 1,006.20\\n25652\\n25652\\nOpen treatment of ulnar styloid fracture\\n$ 1,318.22\\n25660\\n25660\\nClosed treatment of radiocarpal or intercarpal dislocation, 1 or\\nmore bones, with manipulation\\n$ 781.20\\n25670\\n25670\\nOpen treatment of radiocarpal or intercarpal dislocation, 1 or more\\nbones\\n$ 1,624.50\\n25671\\n25671\\nPercutaneous skeletal fixation of distal radioulnar dislocation\\n$ 1,128.99\\n25675\\n25675\\nClosed treatment of distal radioulnar dislocation with manipulation\\n$ 776.70\\n25676\\n25676\\nOpen treatment of distal radioulnar dislocation, acute or chronic\\n$ 1,699.20\\n25680\\n25680\\nClosed treatment of trans-scaphoperilunar type of fracture\\ndislocation, with manipulation\\n$ 1,107.90\\n25685\\n25685\\nOpen treatment of trans-scaphoperilunar type of fracture\\ndislocation\\n$ 2,005.20\\n25690\\n25690\\nClosed treatment of lunate dislocation, with manipulation\\n$ 1,141.20\\n25695\\n25695\\nOpen treatment of lunate dislocation\\n$ 1,864.80\\n25800\\n25800\\nArthrodesis, wrist; complete, without bone graft (includes\\nradiocarpal and\/or intercarpal and\/or carpometacarpal joints)\\n$ 2,785.50\\n25805\\n25805\\nArthrodesis, wrist; with sliding graft\\n$ 2,888.10\\n25810\\n25810\\nArthrodesis, wrist; with iliac or other autograft (includes obtaining\\ngraft)\\n$ 3,366.00\\n25820\\n25820\\nArthrodesis, wrist; limited, without bone graft (eg, intercarpal or\\nradiocarpal)\\n$ 2,223.00\\n25825\\n25825\\nArthrodesis, wrist; with autograft (includes obtaining graft)\\n$ 2,680.20\\n25830\\n25830\\nArthrodesis, distal radioulnar joint with segmental resection of ulna,\\nwith or without bone graft (eg, Sauve-Kapandji procedure)\\n$ 2,169.90\\n25900\\n25900\\nAmputation, forearm, through radius and ulna;\\n$ 1,926.00\\n25905\\n25905\\nAmputation, forearm, through radius and ulna; open, circular\\n(guillotine)\\n$ 1,746.00\\n25907\\n25907\\nAmputation, forearm, through radius and ulna; secondary closure\\nor scar revision\\n$ 837.00\\n25909\\n25909\\nAmputation, forearm, through radius and ulna; re-amputation\\n$ 1,625.40\\n25915\\n25915\\nKrukenberg procedure\\n$ 2,570.40\\n25920\\n25920\\nDisarticulation through wrist;\\n$ 1,611.90\\n25922\\n25922\\nDisarticulation through wrist; secondary closure or scar revision\\n$ 945.90\\n25924\\n25924\\nDisarticulation through wrist; re-amputation\\n$ 1,646.10\\n25927\\n25927\\nTransmetacarpal amputation;\\n$ 1,952.10\\n25929\\n25929\\nTransmetacarpal amputation; secondary closure or scar revision\\n$ 870.30\\n25931\\n25931\\nTransmetacarpal amputation; re-amputation\\n$ 1,794.60\\n25999\\n25999\\nUnlisted procedure, forearm or wrist\\nCost\\n26010\\n26010\\nDrainage of finger abscess; simple\\n$ 293.40\\n26011\\n26011\\nDrainage of finger abscess; complicated (eg, felon)\\n$ 568.80\\n26020\\n26020\\nDrainage of tendon sheath, digit and\/or palm, each\\n$ 1,313.10\\n26025\\n26025\\nDrainage of palmar bursa; single, bursa\\n$ 1,323.90\\n26030\\n26030\\nDrainage of palmar bursa; multiple bursa\\n$ 1,913.40\\n26034\\n26034\\nIncision, bone cortex, hand or finger (eg, osteomyelitis or bone\\nabscess)\\n$ 1,782.00\\n26035\\n26035\\nDecompression fingers and\/or hand, injection injury (eg, grease\\ngun)\\n$ 2,395.80\\n26037\\n26037\\nDecompressive fasciotomy, hand (excludes 26035)\\n$ 2,175.30\\n26040\\n26040\\nFasciotomy, palmar (eg, Dupuytren's contracture); percutaneous\\n$ 1,008.00\\n26045\\n26045\\nFasciotomy, palmar (eg, Dupuytren's contracture); open, partial\\n$ 1,457.10\\n26055\\n26055\\nTendon sheath incision (eg, for trigger finger)\\n$ 931.88\\n26060\\n26060\\nTenotomy, percutaneous, single, each digit\\n$ 499.50\\n26070\\n26070\\nArthrotomy, with exploration, drainage, or removal of loose or\\nforeign body; carpometacarpal joint\\n$ 841.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n75\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n76\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n26075\\n26075\\nArthrotomy, with exploration, drainage, or removal of loose or\\nforeign body; metacarpophalangeal joint, each\\n$ 1,145.70\\n26080\\n26080\\nArthrotomy, with exploration, drainage, or removal of loose or\\nforeign body; interphalangeal joint, each\\n$ 895.50\\n26100\\n26100\\nArthrotomy with biopsy; carpometacarpal joint, each\\n$ 920.70\\n26105\\n26105\\nArthrotomy with biopsy; metacarpophalangeal joint, each\\n$ 1,050.30\\n26110\\n26110\\nArthrotomy with biopsy; interphalangeal joint, each\\n$ 842.40\\n26111\\n26111\\nExcision, tumor or vascular malformation, soft tissue of hand or\\nfinger, subcutaneous; 1.5 cm or greater\\n$ 1,075.54\\n26113\\n26113\\nExcision, tumor, soft tissue, or vascular malformation, of hand or\\nfinger, subfascial (eg, intramuscular); 1.5 cm or greater\\n$ 1,621.65\\n26115\\n26115\\nExcision, tumor or vascular malformation, soft tissue of hand or\\nfinger, subcutaneous; less than 1.5 cm\\n$ 927.00\\n26116\\n26116\\nExcision, tumor, soft tissue, or vascular malformation, of hand or\\nfinger, subfascial (eg, intramuscular); less than 1.5 cm\\n$ 1,284.30\\n26117\\n26117\\nRadical resection of tumor (eg, sarcoma), soft tissue of hand or\\nfinger; less than 3 cm\\n$ 2,445.30\\n26118\\n26118\\nRadical resection of tumor (eg, sarcoma), soft tissue of hand or\\nfinger; 3 cm or greater\\n$ 3,201.59\\n26121\\n26121\\nFasciectomy, palm only, with or without Z-plasty, other local tissue\\nrearrangement, or skin grafting (includes obtaining graft)\\n$ 2,585.70\\n26123\\n26123\\nFasciectomy, partial palmar with release of single digit including\\nproximal interphalangeal joint, with or without Z-plasty, other local\\ntissue rearrangement, or skin grafting (includes obtaining graft);\\n$ 2,606.40\\n26125\\n26125\\nFasciectomy, partial palmar with release of single digit including\\nproximal interphalangeal joint, with or without Z-plasty, other local\\ntissue rearrangement, or skin grafting (includes obtaining graft);\\neach additional digit (List separately in addition\\n$ 2,230.20\\n26130\\n26130\\nSynovectomy, carpometacarpal joint\\n$ 1,566.00\\n26135\\n26135\\nSynovectomy, metacarpophalangeal joint including intrinsic release\\nand extensor hood reconstruction, each digit\\n$ 1,762.20\\n26140\\n26140\\nSynovectomy, proximal interphalangeal joint, including extensor\\nreconstruction, each interphalangeal joint\\n$ 1,708.20\\n26145\\n26145\\nSynovectomy, tendon sheath, radical (tenosynovectomy), flexor\\ntendon, palm and\/or finger, each tendon\\n$ 1,744.20\\n26160\\n26160\\nExcision of lesion of tendon sheath or joint capsule (eg, cyst,\\nmucous cyst, or ganglion), hand or finger\\n$ 913.50\\n26170\\n26170\\nExcision of tendon, palm, flexor or extensor, single, each tendon\\n$ 945.90\\n26180\\n26180\\nExcision of tendon, finger, flexor or extensor, each tendon\\n$ 834.30\\n26185\\n26185\\nSesamoidectomy, thumb or finger (separate procedure)\\n$ 929.70\\n26200\\n26200\\nExcision or curettage of bone cyst or benign tumor of metacarpal;\\n$ 1,137.60\\n26205\\n26205\\nExcision or curettage of bone cyst or benign tumor of metacarpal;\\nwith autograft (includes obtaining graft)\\n$ 1,695.60\\n26210\\n26210\\nExcision or curettage of bone cyst or benign tumor of proximal,\\nmiddle, or distal phalanx of finger;\\n$ 1,234.80\\n26215\\n26215\\nExcision or curettage of bone cyst or benign tumor of proximal,\\nmiddle, or distal phalanx of finger; with autograft (includes\\nobtaining graft)\\n$ 1,538.10\\n26230\\n26230\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis); metacarpal\\n$ 1,121.40\\n26235\\n26235\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis); proximal or middle phalanx of finger\\n$ 1,081.80\\n26236\\n26236\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone (eg, osteomyelitis); distal phalanx of finger\\n$ 931.50\\n26250\\n26250\\nRadical resection of tumor, metacarpal\\n$ 1,561.50\\n26260\\n26260\\nRadical resection of tumor, proximal or middle phalanx of finger\\n$ 1,692.00\\n26262\\n26262\\nRadical resection of tumor, distal phalanx of finger\\n$ 1,568.70\\n26320\\n26320\\nRemoval of implant from finger or hand\\n$ 956.70\\n26340\\n26340\\nManipulation, finger joint, under anesthesia, each joint\\n$ 841.74\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n77\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n78\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n26350\\n26350\\nRepair or advancement, flexor tendon, not in zone 2 digital flexor\\ntendon sheath (eg, no man's land); primary or secondary without\\nfree graft, each tendon\\n$ 2,094.30\\n26352\\n26352\\nRepair or advancement, flexor tendon, not in zone 2 digital flexor\\ntendon sheath (eg, no man's land); secondary with free graft\\n(includes obtaining graft), each tendon\\n$ 2,346.30\\n26356\\n26356\\nRepair or advancement, flexor tendon, in zone 2 digital flexor\\ntendon sheath (eg, no man's land); primary, without free graft, each\\ntendon\\n$ 2,266.20\\n26357\\n26357\\nRepair or advancement, flexor tendon, in zone 2 digital flexor\\ntendon sheath (eg, no man's land); secondary, without free graft,\\neach tendon\\n$ 2,317.50\\n26358\\n26358\\nRepair or advancement, flexor tendon, in zone 2 digital flexor\\ntendon sheath (eg, no man's land); secondary, with free graft\\n(includes obtaining graft), each tendon\\n$ 2,396.70\\n26370\\n26370\\nRepair or advancement of profundus tendon, with intact\\nsuperficialis tendon; primary, each tendon\\n$ 1,900.80\\n26372\\n26372\\nRepair or advancement of profundus tendon, with intact\\nsuperficialis tendon; secondary with free graft (includes obtaining\\ngraft), each tendon\\n$ 1,975.50\\n26373\\n26373\\nRepair or advancement of profundus tendon, with intact\\nsuperficialis tendon; secondary without free graft, each tendon\\n$ 1,825.20\\n26390\\n26390\\nExcision flexor tendon, with implantation of synthetic rod for\\ndelayed tendon graft, hand or finger, each rod\\n$ 1,753.20\\n26392\\n26392\\nRemoval of synthetic rod and insertion of flexor tendon graft, hand\\nor finger (includes obtaining graft), each rod\\n$ 2,260.80\\n26410\\n26410\\nRepair, extensor tendon, hand, primary or secondary; without free\\ngraft, each tendon\\n$ 1,064.70\\n26412\\n26412\\nRepair, extensor tendon, hand, primary or secondary; with free\\ngraft (includes obtaining graft), each tendon\\n$ 1,515.60\\n26415\\n26415\\nExcision of extensor tendon, with implantation of synthetic rod for\\ndelayed tendon graft, hand or finger, each rod\\n$ 1,444.50\\n26416\\n26416\\nRemoval of synthetic rod and insertion of extensor tendon graft\\n(includes obtaining graft), hand or finger, each rod\\n$ 1,515.60\\n26418\\n26418\\nRepair, extensor tendon, finger, primary or secondary; without free\\ngraft, each tendon\\n$ 1,251.90\\n26420\\n26420\\nRepair, extensor tendon, finger, primary or secondary; with free\\ngraft (includes obtaining graft) each tendon\\n$ 1,416.60\\n26426\\n26426\\nRepair of extensor tendon, central slip, secondary (eg, boutonniere\\ndeformity); using local tissue(s), including lateral band(s), each\\nfinger\\n$ 1,654.20\\n26428\\n26428\\nRepair of extensor tendon, central slip, secondary (eg, boutonniere\\ndeformity); with free graft (includes obtaining graft), each finger\\n$ 1,773.00\\n26432\\n26432\\nClosed treatment of distal extensor tendon insertion, with or\\nwithout percutaneous pinning (eg, mallet finger)\\n$ 1,139.40\\n26433\\n26433\\nRepair of extensor tendon, distal insertion, primary or secondary;\\nwithout graft (eg, mallet finger)\\n$ 1,485.00\\n26434\\n26434\\nRepair of extensor tendon, distal insertion, primary or secondary;\\nwith free graft (includes obtaining graft)\\n$ 1,368.00\\n26437\\n26437\\nRealignment of extensor tendon, hand, each tendon\\n$ 1,484.10\\n26440\\n26440\\nTenolysis, flexor tendon; palm OR finger, each tendon\\n$ 1,247.40\\n26442\\n26442\\nTenolysis, flexor tendon; palm AND finger, each tendon\\n$ 1,440.90\\n26445\\n26445\\nTenolysis, extensor tendon, hand OR finger, each tendon\\n$ 1,212.30\\n26449\\n26449\\nTenolysis, complex, extensor tendon, finger, including forearm, each\\ntendon\\n$ 1,699.20\\n26450\\n26450\\nTenotomy, flexor, palm, open, each tendon\\n$ 733.50\\n26455\\n26455\\nTenotomy, flexor, finger, open, each tendon\\n$ 847.80\\n26460\\n26460\\nTenotomy, extensor, hand or finger, open, each tendon\\n$ 849.60\\n26471\\n26471\\nTenodesis; of proximal interphalangeal joint, each joint\\n$ 1,384.20\\n26474\\n26474\\nTenodesis; of distal joint, each joint\\n$ 981.00\\n26476\\n26476\\nLengthening of tendon, extensor, hand or finger, each tendon\\n$ 1,012.50\\n26477\\n26477\\nShortening of tendon, extensor, hand or finger, each tendon\\n$ 1,078.20\\n26478\\n26478\\nLengthening of tendon, flexor, hand or finger, each tendon\\n$ 1,345.50\\n26479\\n26479\\nShortening of tendon, flexor, hand or finger, each tendon\\n$ 1,348.20\\n26480\\n26480\\nTransfer or transplant of tendon, carpometacarpal area or dorsum\\nof hand; without free graft, each tendon\\n$ 1,838.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n79\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n80\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n26483\\n26483\\nTransfer or transplant of tendon, carpometacarpal area or dorsum\\nof hand; with free tendon graft (includes obtaining graft), each\\ntendon\\n$ 2,086.20\\n26485\\n26485\\nTransfer or transplant of tendon, palmar; without free tendon graft,\\neach tendon\\n$ 1,926.90\\n26489\\n26489\\nTransfer or transplant of tendon, palmar; with free tendon graft\\n(includes obtaining graft), each tendon\\n$ 2,232.90\\n26490\\n26490\\nOpponensplasty; superficialis tendon transfer type, each tendon\\n$ 2,045.70\\n26492\\n26492\\nOpponensplasty; tendon transfer with graft (includes obtaining\\ngraft), each tendon\\n$ 2,237.40\\n26494\\n26494\\nOpponensplasty; hypothenar muscle transfer\\n$ 2,032.20\\n26496\\n26496\\nOpponensplasty; other methods\\n$ 2,317.50\\n26497\\n26497\\nTransfer of tendon to restore intrinsic function; ring and small\\nfinger\\n$ 2,201.40\\n26498\\n26498\\nTransfer of tendon to restore intrinsic function; all 4 fingers\\n$ 2,544.30\\n26499\\n26499\\nCorrection claw finger, other methods\\n$ 2,403.90\\n26500\\n26500\\nReconstruction of tendon pulley, each tendon; with local tissues\\n(separate procedure)\\n$ 1,257.30\\n26502\\n26502\\nReconstruction of tendon pulley, each tendon; with tendon or\\nfascial graft (includes obtaining graft) (separate procedure)\\n$ 1,802.70\\n26508\\n26508\\nRelease of thenar muscle(s) (eg, thumb contracture)\\n$ 1,460.70\\n26510\\n26510\\nCross intrinsic transfer, each tendon\\n$ 1,870.20\\n26516\\n26516\\nCapsulodesis, metacarpophalangeal joint; single digit\\n$ 1,593.90\\n26517\\n26517\\nCapsulodesis, metacarpophalangeal joint; 2 digits\\n$ 1,629.90\\n26518\\n26518\\nCapsulodesis, metacarpophalangeal joint; 3 or 4 digits\\n$ 2,031.30\\n26520\\n26520\\nCapsulectomy or capsulotomy; metacarpophalangeal joint, each\\njoint\\n$ 1,548.00\\n26525\\n26525\\nCapsulectomy or capsulotomy; interphalangeal joint, each joint\\n$ 1,649.70\\n26530\\n26530\\nArthroplasty, metacarpophalangeal joint; each joint\\n$ 1,611.90\\n26531\\n26531\\nArthroplasty, metacarpophalangeal joint; with prosthetic implant,\\neach joint\\n$ 1,847.70\\n26535\\n26535\\nArthroplasty, interphalangeal joint; each joint\\n$ 1,657.80\\n26536\\n26536\\nArthroplasty, interphalangeal joint; with prosthetic implant, each\\njoint\\n$ 1,911.60\\n26540\\n26540\\nRepair of collateral ligament, metacarpophalangeal or\\ninterphalangeal joint\\n$ 1,791.00\\n26541\\n26541\\nReconstruction, collateral ligament, metacarpophalangeal joint,\\nsingle; with tendon or fascial graft (includes obtaining graft)\\n$ 2,261.70\\n26542\\n26542\\nReconstruction, collateral ligament, metacarpophalangeal joint,\\nsingle; with local tissue (eg, adductor advancement)\\n$ 2,025.00\\n26545\\n26545\\nReconstruction, collateral ligament, interphalangeal joint, single,\\nincluding graft, each joint\\n$ 1,589.40\\n26546\\n26546\\nRepair non-union, metacarpal or phalanx (includes obtaining bone\\ngraft with or without external or internal fixation)\\n$ 1,758.60\\n26548\\n26548\\nRepair and reconstruction, finger, volar plate, interphalangeal joint\\n$ 1,946.70\\n26550\\n26550\\nPollicization of a digit\\n$ 3,405.60\\n26551\\n26551\\nTransfer, toe-to-hand with microvascular anastomosis; great toe\\nwrap-around with bone graft\\n$ 9,160.20\\n26553\\n26553\\nTransfer, toe-to-hand with microvascular anastomosis; other than\\ngreat toe, single\\n$ 9,096.30\\n26554\\n26554\\nTransfer, toe-to-hand with microvascular anastomosis; other than\\ngreat toe, double\\n$ 10,847.70\\n26555\\n26555\\nTransfer, finger to another position without microvascular\\nanastomosis\\n$ 2,587.50\\n26556\\n26556\\nTransfer, free toe joint, with microvascular anastomosis\\n$ 9,251.10\\n26560\\n26560\\nRepair of syndactyly (web finger) each web space; with skin flaps\\n$ 1,658.70\\n26561\\n26561\\nRepair of syndactyly (web finger) each web space; with skin flaps\\nand grafts\\n$ 2,214.90\\n26562\\n26562\\nRepair of syndactyly (web finger) each web space; complex (eg,\\ninvolving bone, nails)\\n$ 2,721.60\\n26565\\n26565\\nOsteotomy; metacarpal, each\\n$ 1,844.10\\n26567\\n26567\\nOsteotomy; phalanx of finger, each\\n$ 1,483.20\\n26568\\n26568\\nOsteoplasty, lengthening, metacarpal or phalanx\\n$ 2,240.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n81\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n82\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n26580\\n26580\\nRepair cleft hand\\n$ 3,350.70\\n26587\\n26587\\nReconstruction of polydactylous digit, soft tissue and bone\\n$ 1,975.50\\n26590\\n26590\\nRepair macrodactylia, each digit\\n$ 2,241.00\\n26591\\n26591\\nRepair, intrinsic muscles of hand, each muscle\\n$ 1,861.20\\n26593\\n26593\\nRelease, intrinsic muscles of hand, each muscle\\n$ 1,684.80\\n26596\\n26596\\nExcision of constricting ring of finger, with multiple Z-plasties\\n$ 1,884.60\\n26600\\n26600\\nClosed treatment of metacarpal fracture, single; without\\nmanipulation, each bone\\n$ 341.10\\n26605\\n26605\\nClosed treatment of metacarpal fracture, single; with manipulation,\\neach bone\\n$ 504.00\\n26607\\n26607\\nClosed treatment of metacarpal fracture, with manipulation, with\\nexternal fixation, each bone\\n$ 983.70\\n26608\\n26608\\nPercutaneous skeletal fixation of metacarpal fracture, each bone\\n$ 1,079.10\\n26615\\n26615\\nOpen treatment of metacarpal fracture, single, includes internal\\nfixation, when performed, each bone\\n$ 1,511.10\\n26641\\n26641\\nClosed treatment of carpometacarpal dislocation, thumb, with\\nmanipulation\\n$ 526.50\\n26645\\n26645\\nClosed treatment of carpometacarpal fracture dislocation, thumb\\n(Bennett fracture), with manipulation\\n$ 703.80\\n26650\\n26650\\nPercutaneous skeletal fixation of carpometacarpal fracture\\ndislocation, thumb (Bennett fracture), with manipulation\\n$ 1,207.80\\n26665\\n26665\\nOpen treatment of carpometacarpal fracture dislocation, thumb\\n(Bennett fracture), includes internal fixation, when performed\\n$ 1,818.90\\n26670\\n26670\\nClosed treatment of carpometacarpal dislocation, other than\\nthumb, with manipulation, each joint; without anesthesia\\n$ 373.50\\n26675\\n26675\\nClosed treatment of carpometacarpal dislocation, other than\\nthumb, with manipulation, each joint; requiring anesthesia\\n$ 617.66\\n26676\\n26676\\nPercutaneous skeletal fixation of carpometacarpal dislocation, other\\nthan thumb, with manipulation, each joint\\n$ 885.60\\n26685\\n26685\\nOpen treatment of carpometacarpal dislocation, other than thumb;\\nincludes internal fixation, when performed, each joint\\n$ 1,269.00\\n26686\\n26686\\nOpen treatment of carpometacarpal dislocation, other than thumb;\\ncomplex, multiple, or delayed reduction\\n$ 1,341.00\\n26700\\n26700\\nClosed treatment of metacarpophalangeal dislocation, single, with\\nmanipulation; without anesthesia\\n$ 340.20\\n26705\\n26705\\nClosed treatment of metacarpophalangeal dislocation, single, with\\nmanipulation; requiring anesthesia\\n$ 525.60\\n26706\\n26706\\nPercutaneous skeletal fixation of metacarpophalangeal dislocation,\\nsingle, with manipulation\\n$ 847.80\\n26715\\n26715\\nOpen treatment of metacarpophalangeal dislocation, single,\\nincludes internal fixation, when performed\\n$ 1,225.80\\n26720\\n26720\\nClosed treatment of phalangeal shaft fracture, proximal or middle\\nphalanx, finger or thumb; without manipulation, each\\n$ 278.10\\n26725\\n26725\\nClosed treatment of phalangeal shaft fracture, proximal or middle\\nphalanx, finger or thumb; with manipulation, with or without skin\\nor skeletal traction, each\\n$ 462.60\\n26727\\n26727\\nPercutaneous skeletal fixation of unstable phalangeal shaft fracture,\\nproximal or middle phalanx, finger or thumb, with manipulation,\\neach\\n$ 967.50\\n26735\\n26735\\nOpen treatment of phalangeal shaft fracture, proximal or middle\\nphalanx, finger or thumb, includes internal fixation, when\\nperformed, each\\n$ 1,345.50\\n26740\\n26740\\nClosed treatment of articular fracture, involving\\nmetacarpophalangeal or interphalangeal joint; without\\nmanipulation, each\\n$ 492.30\\n26742\\n26742\\nClosed treatment of articular fracture, involving\\nmetacarpophalangeal or interphalangeal joint; with manipulation,\\neach\\n$ 647.10\\n26746\\n26746\\nOpen treatment of articular fracture, involving\\nmetacarpophalangeal or interphalangeal joint, includes internal\\nfixation, when performed, each\\n$ 1,380.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n83\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n84\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n26750\\n26750\\nClosed treatment of distal phalangeal fracture, finger or thumb;\\nwithout manipulation, each\\n$ 227.70\\n26755\\n26755\\nClosed treatment of distal phalangeal fracture, finger or thumb;\\nwith manipulation, each\\n$ 368.40\\n26756\\n26756\\nPercutaneous skeletal fixation of distal phalangeal fracture, finger\\nor thumb, each\\n$ 751.50\\n26765\\n26765\\nOpen treatment of distal phalangeal fracture, finger or thumb,\\nincludes internal fixation, when performed, each\\n$ 889.20\\n26770\\n26770\\nClosed treatment of interphalangeal joint dislocation, single, with\\nmanipulation; without anesthesia\\n$ 244.56\\n26775\\n26775\\nClosed treatment of interphalangeal joint dislocation, single, with\\nmanipulation; requiring anesthesia\\n$ 448.20\\n26776\\n26776\\nPercutaneous skeletal fixation of interphalangeal joint dislocation,\\nsingle, with manipulation\\n$ 712.80\\n26785\\n26785\\nOpen treatment of interphalangeal joint dislocation, includes\\ninternal fixation, when performed, single\\n$ 990.90\\n26820\\n26820\\nFusion in opposition, thumb, with autogenous graft (includes\\nobtaining graft)\\n$ 1,808.10\\n26841\\n26841\\nArthrodesis, carpometacarpal joint, thumb, with or without internal\\nfixation;\\n$ 1,699.20\\n26842\\n26842\\nArthrodesis, carpometacarpal joint, thumb, with or without internal\\nfixation; with autograft (includes obtaining graft)\\n$ 1,946.70\\n26843\\n26843\\nArthrodesis, carpometacarpal joint, digit, other than thumb, each;\\n$ 1,415.70\\n26844\\n26844\\nArthrodesis, carpometacarpal joint, digit, other than thumb, each;\\nwith autograft (includes obtaining graft)\\n$ 1,545.30\\n26850\\n26850\\nArthrodesis, metacarpophalangeal joint, with or without internal\\nfixation;\\n$ 1,919.70\\n26852\\n26852\\nArthrodesis, metacarpophalangeal joint, with or without internal\\nfixation; with autograft (includes obtaining graft)\\n$ 1,494.00\\n26860\\n26860\\nArthrodesis, interphalangeal joint, with or without internal fixation;\\n$ 1,250.10\\n26861\\n26861\\nArthrodesis, interphalangeal joint, with or without internal fixation;\\neach additional interphalangeal joint (List separately in addition to\\ncode for primary procedure)\\n$ 540.90\\n26862\\n26862\\nArthrodesis, interphalangeal joint, with or without internal fixation;\\nwith autograft (includes obtaining graft)\\n$ 1,629.90\\n26863\\n26863\\nArthrodesis, interphalangeal joint, with or without internal fixation;\\nwith autograft (includes obtaining graft), each additional joint (List\\nseparately in addition to code for primary procedure)\\n$ 646.20\\n26910\\n26910\\nAmputation, metacarpal, with finger or thumb (ray amputation),\\nsingle, with or without interosseous transfer\\n$ 1,870.20\\n26951\\n26951\\nAmputation, finger or thumb, primary or secondary, any joint or\\nphalanx, single, including neurectomies; with direct closure\\n$ 910.80\\n26952\\n26952\\nAmputation, finger or thumb, primary or secondary, any joint or\\nphalanx, single, including neurectomies; with local advancement\\nflaps (V-Y, hood)\\n$ 1,376.10\\n26989\\n26989\\nUnlisted procedure, hands or fingers\\n$ 658.80\\n26990\\n26990\\nIncision and drainage, pelvis or hip joint area; deep abscess or\\nhematoma\\n$ 900.90\\n26991\\n26991\\nIncision and drainage, pelvis or hip joint area; infected bursa\\n$ 772.20\\n26992\\n26992\\nIncision, bone cortex, pelvis and\/or hip joint (eg, osteomyelitis or\\nbone abscess)\\n$ 1,793.70\\n27000\\n27000\\nTenotomy, adductor of hip, percutaneous (separate procedure)\\n$ 498.60\\n27001\\n27001\\nTenotomy, adductor of hip, open\\n$ 912.60\\n27003\\n27003\\nTenotomy, adductor, subcutaneous, open, with obturator\\nneurectomy\\n$ 1,064.70\\n27005\\n27005\\nTenotomy, hip flexor(s), open (separate procedure)\\n$ 1,452.60\\n27006\\n27006\\nTenotomy, abductors and\/or extensor(s) of hip, open (separate\\nprocedure)\\n$ 1,012.50\\n27025\\n27025\\nFasciotomy, hip or thigh, any type\\n$ 1,698.30\\n27027\\n27027\\nDecompression fasciotomy(ies), pelvic (buttock) compartment(s)\\n(eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and\/or\\ntensor fascia lata muscle), unilateral\\n$ 1,637.28\\n27030\\n27030\\nArthrotomy, hip, with drainage (eg, infection)\\n$ 2,173.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n85\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n86\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27033\\n27033\\nArthrotomy, hip, including exploration or removal of loose or\\nforeign body\\n$ 2,332.80\\n27035\\n27035\\nDenervation, hip joint, intrapelvic or extrapelvic intra-articular\\nbranches of sciatic, femoral, or obturator nerves\\n$ 2,578.50\\n27036\\n27036\\nCapsulectomy or capsulotomy, hip, with or without excision of\\nheterotopic bone, with release of hip flexor muscles (ie, gluteus\\nmedius, gluteus minimus, tensor fascia latae, rectus femoris,\\nsartorius, iliopsoas)\\n$ 2,480.40\\n27040\\n27040\\nBiopsy, soft tissue of pelvis and hip area; superficial\\n$ 462.60\\n27041\\n27041\\nBiopsy, soft tissue of pelvis and hip area; deep, subfascial or\\nintramuscular\\n$ 767.70\\n27043\\n27043\\nExcision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3\\ncm or greater\\n$ 877.66\\n27045\\n27045\\nExcision, tumor, soft tissue of pelvis and hip area, subfascial (eg,\\nintramuscular); 5 cm or greater\\n$ 1,380.69\\n27047\\n27047\\nExcision, tumor, soft tissue of pelvis and hip area, subcutaneous;\\nless than 3 cm\\n$ 697.50\\n27048\\n27048\\nExcision, tumor, soft tissue of pelvis and hip area, subfascial (eg,\\nintramuscular); less than 5 cm\\n$ 1,323.00\\n27049\\n27049\\nRadical resection of tumor (eg, sarcoma), soft tissue of pelvis and\\nhip area; less than 5 cm\\n$ 3,126.60\\n27050\\n27050\\nArthrotomy, with biopsy; sacroiliac joint\\n$ 1,007.10\\n27052\\n27052\\nArthrotomy, with biopsy; hip joint\\n$ 2,218.50\\n27054\\n27054\\nArthrotomy with synovectomy, hip joint\\n$ 2,638.80\\n27057\\n27057\\nDecompression fasciotomy(ies), pelvic (buttock) compartment(s)\\n(eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and\/or\\ntensor fascia lata muscle) with debridement of nonviable muscle,\\nunilateral\\n$ 1,660.89\\n27059\\n27059\\nRadical resection of tumor (eg, sarcoma), soft tissue of pelvis and\\nhip area; 5 cm or greater\\n$ 3,359.14\\n27060\\n27060\\nExcision; ischial bursa\\n$ 999.90\\n27062\\n27062\\nExcision; trochanteric bursa or calcification\\n$ 904.50\\n27065\\n27065\\nExcision of bone cyst or benign tumor, wing of ilium, symphysis\\npubis, or greater trochanter of femur; superficial, includes\\nautograft, when performed\\n$ 1,318.50\\n27066\\n27066\\nExcision of bone cyst or benign tumor, wing of ilium, symphysis\\npubis, or greater trochanter of femur; deep (subfascial), includes\\nautograft, when performed\\n$ 1,965.60\\n27067\\n27067\\nExcision of bone cyst or benign tumor, wing of ilium, symphysis\\npubis, or greater trochanter of femur; with autograft requiring\\nseparate incision\\n$ 2,286.90\\n27070\\n27070\\nPartial excision, wing of ilium, symphysis pubis, or greater\\ntrochanter of femur, (craterization, saucerization) (eg, osteomyelitis\\nor bone abscess); superficial\\n$ 1,739.70\\n27071\\n27071\\nPartial excision, wing of ilium, symphysis pubis, or greater\\ntrochanter of femur, (craterization, saucerization) (eg, osteomyelitis\\nor bone abscess); deep (subfascial or intramuscular)\\n$ 1,902.60\\n27075\\n27075\\nRadical resection of tumor; wing of ilium, 1 pubic or ischial ramus or\\nsymphysis pubis\\n$ 3,087.90\\n27076\\n27076\\nRadical resection of tumor; ilium, including acetabulum, both pubic\\nrami, or ischium and acetabulum\\n$ 4,360.50\\n27077\\n27077\\nRadical resection of tumor; innominate bone, total\\n$ 5,816.70\\n27078\\n27078\\nRadical resection of tumor; ischial tuberosity and greater trochanter\\nof femur\\n$ 1,979.10\\n27080\\n27080\\nCoccygectomy, primary\\n$ 1,275.30\\n27086\\n27086\\nRemoval of foreign body, pelvis or hip; subcutaneous tissue\\n$ 332.10\\n27087\\n27087\\nRemoval of foreign body, pelvis or hip; deep (subfascial or\\nintramuscular)\\n$ 1,123.53\\n27090\\n27090\\nRemoval of hip prosthesis; (separate procedure)\\n$ 2,482.20\\n27091\\n27091\\nRemoval of hip prosthesis; complicated, including total hip\\nprosthesis, methylmethacrylate with or without insertion of spacer\\n$ 5,319.90\\n27093\\n27093\\nInjection procedure for hip arthrography; without anesthesia\\n$ 275.40\\n27095\\n27095\\nInjection procedure for hip arthrography; with anesthesia\\n$ 504.00\\n27096\\n27096\\nInjection procedure for sacroiliac joint, anesthetic\/steroid, with\\nimage guidance (fluoroscopy or ct) including arthrography when\\nperformed\\n$ 769.50\\n27097\\n27097\\nRelease or recession, hamstring, proximal\\n$ 1,754.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n87\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n88\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27098\\n27098\\nTransfer, adductor to ischium\\n$ 2,065.50\\n27100\\n27100\\nTransfer external oblique muscle to greater trochanter including\\nfascial or tendon extension (graft)\\n$ 2,358.90\\n27105\\n27105\\nTransfer paraspinal muscle to hip (includes fascial or tendon\\nextension graft)\\n$ 2,504.70\\n27110\\n27110\\nTransfer iliopsoas; to greater trochanter of femur\\n$ 2,935.80\\n27111\\n27111\\nTransfer iliopsoas; to femoral neck\\n$ 2,898.90\\n27120\\n27120\\nAcetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type)\\n$ 3,783.60\\n27122\\n27122\\nAcetabuloplasty; resection, femoral head (eg, Girdlestone\\nprocedure)\\n$ 3,681.00\\n27125\\n27125\\nHemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar\\narthroplasty)\\n$ 4,079.70\\n27130\\n27130\\nArthroplasty, acetabular and proximal femoral prosthetic\\nreplacement (total hip arthroplasty), with or without autograft or\\nallograft\\n$ 5,616.90\\n27132\\n27132\\nConversion of previous hip surgery to total hip arthroplasty, with or\\nwithout autograft or allograft\\n$ 6,371.10\\n27134\\n27134\\nRevision of total hip arthroplasty; both components, with or\\nwithout autograft or allograft\\n$ 8,532.18\\n27137\\n27137\\nRevision of total hip arthroplasty; acetabular component only, with\\nor without autograft or allograft\\n$ 5,851.80\\n27138\\n27138\\nRevision of total hip arthroplasty; femoral component only, with or\\nwithout allograft\\n$ 5,899.50\\n27140\\n27140\\nOsteotomy and transfer of greater trochanter of femur (separate\\nprocedure)\\n$ 2,176.20\\n27146\\n27146\\nOsteotomy, iliac, acetabular or innominate bone;\\n$ 3,255.30\\n27147\\n27147\\nOsteotomy, iliac, acetabular or innominate bone; with open\\nreduction of hip\\n$ 3,914.10\\n27151\\n27151\\nOsteotomy, iliac, acetabular or innominate bone; with femoral\\nosteotomy\\n$ 3,619.80\\n27156\\n27156\\nOsteotomy, iliac, acetabular or innominate bone; with femoral\\nosteotomy and with open reduction of hip\\n$ 4,401.00\\n27158\\n27158\\nOsteotomy, pelvis, bilateral (eg, congenital malformation)\\n$ 3,836.70\\n27161\\n27161\\nOsteotomy, femoral neck (separate procedure)\\n$ 3,132.00\\n27165\\n27165\\nOsteotomy, intertrochanteric or subtrochanteric including internal\\nor external fixation and\/or cast\\n$ 3,549.60\\n27170\\n27170\\nBone graft, femoral head, neck, intertrochanteric or subtrochanteric\\narea (includes obtaining bone graft)\\n$ 3,708.00\\n27175\\n27175\\nTreatment of slipped femoral epiphysis; by traction, without\\nreduction\\n$ 1,855.80\\n27176\\n27176\\nTreatment of slipped femoral epiphysis; by single or multiple\\npinning, in situ\\n$ 2,770.20\\n27177\\n27177\\nOpen treatment of slipped femoral epiphysis; single or multiple\\npinning or bone graft (includes obtaining graft)\\n$ 3,270.60\\n27178\\n27178\\nOpen treatment of slipped femoral epiphysis; closed manipulation\\nwith single or multiple pinning\\n$ 3,458.70\\n27179\\n27179\\nOpen treatment of slipped femoral epiphysis; osteoplasty of\\nfemoral neck (Heyman type procedure)\\n$ 2,672.10\\n27181\\n27181\\nOpen treatment of slipped femoral epiphysis; osteotomy and\\ninternal fixation\\n$ 3,789.90\\n27185\\n27185\\nEpiphyseal arrest by epiphysiodesis or stapling, greater trochanter\\nof femur\\n$ 1,233.00\\n27187\\n27187\\nProphylactic treatment (nailing, pinning, plating or wiring) with or\\nwithout methylmethacrylate, femoral neck and proximal femur\\n$ 4,241.70\\n27193\\n27193\\nClosed treatment of pelvic ring fracture, dislocation, diastasis or\\nsubluxation; without manipulation\\n$ 1,030.50\\n27194\\n27194\\nClosed treatment of pelvic ring fracture, dislocation, diastasis or\\nsubluxation; with manipulation, requiring more than local\\nanesthesia\\n$ 1,568.70\\n27200\\n27200\\nClosed treatment of coccygeal fracture\\n$ 441.90\\n27202\\n27202\\nOpen treatment of coccygeal fracture\\n$ 897.30\\n27215\\n27215\\nOpen treatment of iliac spine(s), tuberosity avulsion, or iliac wing\\nfracture(s), unilateral, for pelvic bone fracture patterns that do not\\ndisrupt the pelvic ring, includes internal fixation, when performed\\n$ 2,472.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n89\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n90\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27216\\n27216\\nPercutaneous skeletal fixation of posterior pelvic bone fracture\\nand\/or dislocation, for fracture patterns that disrupt the pelvic ring,\\nunilateral (includes ipsilateral ilium, sacroiliac joint and\/or sacrum)\\n$ 2,767.50\\n27217\\n27217\\nOpen treatment of anterior pelvic bone fracture and\/or dislocation\\nfor fracture patterns that disrupt the pelvic ring, unilateral, includes\\ninternal fixation, when performed (includes pubic symphysis and\/or\\nipsilateral superior\/inferior rami)\\n$ 3,654.90\\n27218\\n27218\\nOpen treatment of posterior pelvic bone fracture and\/or\\ndislocation, for fracture patterns that disrupt the pelvic ring,\\nunilateral, includes internal fixation, when performed (includes\\nipsilateral ilium, sacroiliac joint and\/or sacrum)\\n$ 4,345.20\\n27220\\n27220\\nClosed treatment of acetabulum (hip socket) fracture(s); without\\nmanipulation\\n$ 896.40\\n27222\\n27222\\nClosed treatment of acetabulum (hip socket) fracture(s); with\\nmanipulation, with or without skeletal traction\\n$ 1,599.30\\n27226\\n27226\\nOpen treatment of posterior or anterior acetabular wall fracture,\\nwith internal fixation\\n$ 3,602.70\\n27227\\n27227\\nOpen treatment of acetabular fracture(s) involving anterior or\\nposterior (one) column, or a fracture running transversely across\\nthe acetabulum, with internal fixation\\n$ 6,057.90\\n27228\\n27228\\nOpen treatment of acetabular fracture(s) involving anterior and\\nposterior (two) columns, includes T-fracture and both column\\nfracture with complete articular detachment, or single column or\\ntransverse fracture with associated acetabular wall fracture, wit\\n$ 6,196.50\\n27230\\n27230\\nClosed treatment of femoral fracture, proximal end, neck; without\\nmanipulation\\n$ 1,077.30\\n27232\\n27232\\nClosed treatment of femoral fracture, proximal end, neck; with\\nmanipulation, with or without skeletal traction\\n$ 1,769.40\\n27235\\n27235\\nPercutaneous skeletal fixation of femoral fracture, proximal end,\\nneck\\n$ 3,135.60\\n27236\\n27236\\nOpen treatment of femoral fracture, proximal end, neck, internal\\nfixation or prosthetic replacement\\n$ 3,712.50\\n27238\\n27238\\nClosed treatment of intertrochanteric, peritrochanteric, or\\nsubtrochanteric femoral fracture; without manipulation\\n$ 1,142.10\\n27240\\n27240\\nClosed treatment of intertrochanteric, peritrochanteric, or\\nsubtrochanteric femoral fracture; with manipulation, with or\\nwithout skin or skeletal traction\\n$ 2,139.30\\n27244\\n27244\\nTreatment of intertrochanteric, peritrochanteric, or subtrochanteric\\nfemoral fracture; with plate\/screw type implant, with or without\\ncerclage\\n$ 3,339.00\\n27245\\n27245\\nTreatment of intertrochanteric, peritrochanteric, or subtrochanteric\\nfemoral fracture; with intramedullary implant, with or without\\ninterlocking screws and\/or cerclage\\n$ 3,947.40\\n27246\\n27246\\nClosed treatment of greater trochanteric fracture, without\\nmanipulation\\n$ 903.60\\n27248\\n27248\\nOpen treatment of greater trochanteric fracture, includes internal\\nfixation, when performed\\n$ 2,221.20\\n27250\\n27250\\nClosed treatment of hip dislocation, traumatic; without anesthesia\\n$ 764.10\\n27252\\n27252\\nClosed treatment of hip dislocation, traumatic; requiring anesthesia\\n$ 1,134.90\\n27253\\n27253\\nOpen treatment of hip dislocation, traumatic, without internal\\nfixation\\n$ 2,451.60\\n27254\\n27254\\nOpen treatment of hip dislocation, traumatic, with acetabular wall\\nand femoral head fracture, with or without internal or external\\nfixation\\n$ 3,348.00\\n27256\\n27256\\nTreatment of spontaneous hip dislocation (developmental,\\nincluding congenital or pathological), by abduction, splint or\\ntraction; without anesthesia, without manipulation\\n$ 1,652.40\\n27257\\n27257\\nTreatment of spontaneous hip dislocation (developmental,\\nincluding congenital or pathological), by abduction, splint or\\ntraction; with manipulation, requiring anesthesia\\n$ 1,835.10\\n27258\\n27258\\nOpen treatment of spontaneous hip dislocation (developmental,\\nincluding congenital or pathological), replacement of femoral head\\nin acetabulum (including tenotomy, etc);\\n$ 2,468.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n91\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n92\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27259\\n27259\\nOpen treatment of spontaneous hip dislocation (developmental,\\nincluding congenital or pathological), replacement of femoral head\\nin acetabulum (including tenotomy, etc); with femoral shaft\\nshortening\\n$ 2,904.30\\n27265\\n27265\\nClosed treatment of post hip arthroplasty dislocation; without\\nanesthesia\\n$ 772.20\\n27266\\n27266\\nClosed treatment of post hip arthroplasty dislocation; requiring\\nregional or general anesthesia\\n$ 1,535.40\\n27267\\n27267\\nClosed treatment of femoral fracture, proximal end, head; without\\nmanipulation\\n$ 864.17\\n27268\\n27268\\nClosed treatment of femoral fracture, proximal end, head; with\\nmanipulation\\n$ 1,109.74\\n27269\\n27269\\nOpen treatment of femoral fracture, proximal end, head, includes\\ninternal fixation, when performed\\n$ 2,878.69\\n27275\\n27275\\nManipulation, hip joint, requiring general anesthesia\\n$ 505.80\\n27280\\n27280\\nArthrodesis, sacroiliac joint (including obtaining graft)\\n$ 2,464.20\\n27282\\n27282\\nArthrodesis, symphysis pubis (including obtaining graft)\\n$ 2,461.50\\n27284\\n27284\\nArthrodesis, hip joint (including obtaining graft);\\n$ 4,975.20\\n27286\\n27286\\nArthrodesis, hip joint (including obtaining graft); with\\nsubtrochanteric osteotomy\\n$ 4,097.70\\n27290\\n27290\\nInterpelviabdominal amputation (hindquarter amputation)\\n$ 5,978.70\\n27295\\n27295\\nDisarticulation of hip\\n$ 4,355.10\\n27299\\n27299\\nUnlisted procedure, pelvis or hip joint\\nCost\\n27301\\n27301\\nIncision and drainage, deep abscess, bursa, or hematoma, thigh or\\nknee region\\n$ 832.94\\n27303\\n27303\\nIncision, deep, with opening of bone cortex, femur or knee (eg,\\nosteomyelitis or bone abscess)\\n$ 1,818.00\\n27305\\n27305\\nFasciotomy, iliotibial (tenotomy), open\\n$ 1,055.70\\n27306\\n27306\\nTenotomy, percutaneous, adductor or hamstring; single tendon\\n(separate procedure)\\n$ 681.30\\n27307\\n27307\\nTenotomy, percutaneous, adductor or hamstring; multiple tendons\\n$ 1,024.20\\n27310\\n27310\\nArthrotomy, knee, with exploration, drainage, or removal of foreign\\nbody (eg, infection)\\n$ 1,787.40\\n27323\\n27323\\nBiopsy, soft tissue of thigh or knee area; superficial\\n$ 360.90\\n27324\\n27324\\nBiopsy, soft tissue of thigh or knee area; deep (subfascial or\\nintramuscular)\\n$ 807.30\\n27325\\n27325\\nNeurectomy, hamstring muscle\\n$ 1,757.66\\n27326\\n27326\\nNeurectomy, popliteal (gastrocnemius)\\n$ 1,605.75\\n27327\\n27327\\nExcision, tumor, soft tissue of thigh or knee area, subcutaneous; less\\nthan 3 cm\\n$ 720.00\\n27328\\n27328\\nExcision, tumor, soft tissue of thigh or knee area, subfascial (eg,\\nintramuscular); less than 5 cm\\n$ 1,256.40\\n27329\\n27329\\nRadical resection of tumor (eg, sarcoma), soft tissue of thigh or\\nknee area; less than 5 cm\\n$ 2,625.30\\n27330\\n27330\\nArthrotomy, knee; with synovial biopsy only\\n$ 2,022.30\\n27331\\n27331\\nArthrotomy, knee; including joint exploration, biopsy, or removal of\\nloose or foreign bodies\\n$ 1,806.30\\n27332\\n27332\\nArthrotomy, with excision of semilunar cartilage (meniscectomy)\\nknee; medial OR lateral\\n$ 2,399.40\\n27333\\n27333\\nArthrotomy, with excision of semilunar cartilage (meniscectomy)\\nknee; medial AND lateral\\n$ 3,174.14\\n27334\\n27334\\nArthrotomy, with synovectomy, knee; anterior OR posterior\\n$ 2,421.00\\n27335\\n27335\\nArthrotomy, with synovectomy, knee; anterior AND posterior\\nincluding popliteal area\\n$ 2,895.30\\n27337\\n27337\\nExcision, tumor, soft tissue of thigh or knee area, subcutaneous; 3\\ncm or greater\\n$ 1,376.91\\n27339\\n27339\\nExcision, tumor, soft tissue of thigh or knee area, subfascial (eg,\\nintramuscular); 5 cm or greater\\n$ 2,414.25\\n27340\\n27340\\nExcision, prepatellar bursa\\n$ 1,103.40\\n27345\\n27345\\nExcision of synovial cyst of popliteal space (eg, Baker's cyst)\\n$ 1,524.60\\n27347\\n27347\\nExcision of lesion of meniscus or capsule (eg, cyst, ganglion), knee\\n$ 784.80\\n27350\\n27350\\nPatellectomy or hemipatellectomy\\n$ 2,124.00\\n27355\\n27355\\nExcision or curettage of bone cyst or benign tumor of femur;\\n$ 1,802.70\\n27356\\n27356\\nExcision or curettage of bone cyst or benign tumor of femur; with\\nallograft\\n$ 2,199.60\\n27357\\n27357\\nExcision or curettage of bone cyst or benign tumor of femur; with\\nautograft (includes obtaining graft)\\n$ 2,436.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n93\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n94\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27358\\n27358\\nExcision or curettage of bone cyst or benign tumor of femur; with\\ninternal fixation (List in addition to code for primary procedure)\\n$ 2,508.30\\n27360\\n27360\\nPartial excision (craterization, saucerization, or diaphysectomy)\\nbone, femur, proximal tibia and\/or fibula (eg, osteomyelitis or bone\\nabscess)\\n$ 1,926.90\\n27364\\n27364\\nRadical resection of tumor (eg, sarcoma), soft tissue of thigh or\\nknee area; 5 cm or greater\\n$ 4,912.84\\n27365\\n27365\\nRadical resection of tumor, femur or knee\\n$ 3,127.50\\n27370\\n27370\\nInjection procedure for knee arthrography\\n$ 197.10\\n27372\\n27372\\nRemoval of foreign body, deep, thigh region or knee area\\n$ 955.80\\n27380\\n27380\\nSuture of infrapatellar tendon; primary\\n$ 1,602.00\\n27381\\n27381\\nSuture of infrapatellar tendon; secondary reconstruction, including\\nfascial or tendon graft\\n$ 2,480.40\\n27385\\n27385\\nSuture of quadriceps or hamstring muscle rupture; primary\\n$ 1,827.90\\n27386\\n27386\\nSuture of quadriceps or hamstring muscle rupture; secondary\\nreconstruction, including fascial or tendon graft\\n$ 2,734.20\\n27390\\n27390\\nTenotomy, open, hamstring, knee to hip; single tendon\\n$ 1,061.10\\n27391\\n27391\\nTenotomy, open, hamstring, knee to hip; multiple tendons, 1 leg\\n$ 1,390.50\\n27392\\n27392\\nTenotomy, open, hamstring, knee to hip; multiple tendons, bilateral\\n$ 2,008.80\\n27393\\n27393\\nLengthening of hamstring tendon; single tendon\\n$ 1,071.00\\n27394\\n27394\\nLengthening of hamstring tendon; multiple tendons, 1 leg\\n$ 1,632.60\\n27395\\n27395\\nLengthening of hamstring tendon; multiple tendons, bilateral\\n$ 2,038.50\\n27396\\n27396\\nTransplant or transfer (with muscle redirection or rerouting), thigh\\n(eg, extensor to flexor); single tendon\\n$ 2,131.20\\n27397\\n27397\\nTransplant or transfer (with muscle redirection or rerouting), thigh\\n(eg, extensor to flexor); multiple tendons\\n$ 2,707.20\\n27400\\n27400\\nTransfer, tendon or muscle, hamstrings to femur (eg, Egger's type\\nprocedure)\\n$ 1,980.00\\n27403\\n27403\\nArthrotomy with meniscus repair, knee\\n$ 2,745.00\\n27405\\n27405\\nRepair, primary, torn ligament and\/or capsule, knee; collateral\\n$ 2,272.50\\n27407\\n27407\\nRepair, primary, torn ligament and\/or capsule, knee; cruciate\\n$ 3,190.50\\n27409\\n27409\\nRepair, primary, torn ligament and\/or capsule, knee; collateral and\\ncruciate ligaments\\n$ 3,634.20\\n27412\\n27412\\nAutologous chondrocyte implantation, knee\\n$ 5,606.85\\n27415\\n27415\\nOsteochondral allograft, knee, open\\n$ 4,366.31\\n27416\\n27416\\nOsteochondral autograft(s), knee, open (eg, mosaicplasty) (includes\\nharvesting of autograft[s])\\n$ 2,968.11\\n27418\\n27418\\nAnterior tibial tubercleplasty (eg, Maquet type procedure)\\n$ 3,002.40\\n27420\\n27420\\nReconstruction of dislocating patella; (eg, Hauser type procedure)\\n$ 2,293.20\\n27422\\n27422\\nReconstruction of dislocating patella; with extensor realignment\\nand\/or muscle advancement or release (eg, Campbell, Goldwaite\\ntype procedure)\\n$ 2,475.00\\n27424\\n27424\\nReconstruction of dislocating patella; with patellectomy\\n$ 2,765.70\\n27425\\n27425\\nLateral retinacular release, open\\n$ 2,367.00\\n27427\\n27427\\nLigamentous reconstruction (augmentation), knee; extra-articular\\n$ 3,698.10\\n27428\\n27428\\nLigamentous reconstruction (augmentation), knee; intra-articular\\n(open)\\n$ 3,715.20\\n27429\\n27429\\nLigamentous reconstruction (augmentation), knee; intra-articular\\n(open) and extra-articular\\n$ 4,960.80\\n27430\\n27430\\nQuadricepsplasty (eg, Bennett or Thompson type)\\n$ 2,210.40\\n27435\\n27435\\nCapsulotomy, posterior capsular release, knee\\n$ 2,236.50\\n27437\\n27437\\nArthroplasty, patella; without prosthesis\\n$ 2,274.30\\n27438\\n27438\\nArthroplasty, patella; with prosthesis\\n$ 2,720.70\\n27440\\n27440\\nArthroplasty, knee, tibial plateau;\\n$ 3,292.20\\n27441\\n27441\\nArthroplasty, knee, tibial plateau; with debridement and partial\\nsynovectomy\\n$ 3,002.40\\n27442\\n27442\\nArthroplasty, femoral condyles or tibial plateau(s), knee;\\n$ 3,510.00\\n27443\\n27443\\nArthroplasty, femoral condyles or tibial plateau(s), knee; with\\ndebridement and partial synovectomy\\n$ 3,554.10\\n27445\\n27445\\nArthroplasty, knee, hinge prosthesis (eg, Walldius type)\\n$ 4,499.10\\n27446\\n27446\\nArthroplasty, knee, condyle and plateau; medial OR lateral\\ncompartment\\n$ 4,126.63\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n95\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n96\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27447\\n27447\\nArthroplasty, knee, condyle and plateau; medial AND lateral\\ncompartments with or without patella resurfacing (total knee\\narthroplasty)\\n$ 5,226.12\\n27448\\n27448\\nOsteotomy, femur, shaft or supracondylar; without fixation\\n$ 2,877.30\\n27450\\n27450\\nOsteotomy, femur, shaft or supracondylar; with fixation\\n$ 2,826.90\\n27454\\n27454\\nOsteotomy, multiple, with realignment on intramedullary rod,\\nfemoral shaft (eg, Sofield type procedure)\\n$ 3,295.80\\n27455\\n27455\\nOsteotomy, proximal tibia, including fibular excision or osteotomy\\n(includes correction of genu varus [bowleg] or genu valgus [knock-\\nknee]); before epiphyseal closure\\n$ 2,394.90\\n27457\\n27457\\nOsteotomy, proximal tibia, including fibular excision or osteotomy\\n(includes correction of genu varus [bowleg] or genu valgus [knock-\\nknee]); after epiphyseal closure\\n$ 2,886.30\\n27465\\n27465\\nOsteoplasty, femur; shortening (excluding 64876)\\n$ 3,267.90\\n27466\\n27466\\nOsteoplasty, femur; lengthening\\n$ 3,707.10\\n27468\\n27468\\nOsteoplasty, femur; combined, lengthening and shortening with\\nfemoral segment transfer\\n$ 4,853.70\\n27470\\n27470\\nRepair, nonunion or malunion, femur, distal to head and neck;\\nwithout graft (eg, compression technique)\\n$ 3,579.30\\n27472\\n27472\\nRepair, nonunion or malunion, femur, distal to head and neck; with\\niliac or other autogenous bone graft (includes obtaining graft)\\n$ 4,050.00\\n27475\\n27475\\nArrest, epiphyseal, any method (eg, epiphysiodesis); distal femur\\n$ 2,453.40\\n27477\\n27477\\nArrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula,\\nproximal\\n$ 2,636.10\\n27479\\n27479\\nArrest, epiphyseal, any method (eg, epiphysiodesis); combined\\ndistal femur, proximal tibia and fibula\\n$ 3,160.80\\n27485\\n27485\\nArrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg,\\ngenu varus or valgus)\\n$ 1,805.40\\n27486\\n27486\\nRevision of total knee arthroplasty, with or without allograft; 1\\ncomponent\\n$ 5,175.90\\n27487\\n27487\\nRevision of total knee arthroplasty, with or without allograft;\\nfemoral and entire tibial component\\n$ 6,452.10\\n27488\\n27488\\nRemoval of prosthesis, including total knee prosthesis,\\nmethylmethacrylate with or without insertion of spacer, knee\\n$ 3,144.60\\n27495\\n27495\\nProphylactic treatment (nailing, pinning, plating, or wiring) with or\\nwithout methylmethacrylate, femur\\n$ 3,450.60\\n27496\\n27496\\nDecompression fasciotomy, thigh and\/or knee, 1 compartment\\n(flexor or extensor or adductor);\\n$ 1,184.40\\n27497\\n27497\\nDecompression fasciotomy, thigh and\/or knee, 1 compartment\\n(flexor or extensor or adductor); with debridement of nonviable\\nmuscle and\/or nerve\\n$ 1,555.20\\n27498\\n27498\\nDecompression fasciotomy, thigh and\/or knee, multiple\\ncompartments;\\n$ 2,394.90\\n27499\\n27499\\nDecompression fasciotomy, thigh and\/or knee, multiple\\ncompartments; with debridement of nonviable muscle and\/or nerve $ 2,421.00\\n27500\\n27500\\nClosed treatment of femoral shaft fracture, without manipulation\\n$ 1,207.80\\n27501\\n27501\\nClosed treatment of supracondylar or transcondylar femoral\\nfracture with or without intercondylar extension, without\\nmanipulation\\n$ 1,495.80\\n27502\\n27502\\nClosed treatment of femoral shaft fracture, with manipulation, with\\nor without skin or skeletal traction\\n$ 1,648.80\\n27503\\n27503\\nClosed treatment of supracondylar or transcondylar femoral\\nfracture with or without intercondylar extension, with\\nmanipulation, with or without skin or skeletal traction\\n$ 2,035.80\\n27506\\n27506\\nOpen treatment of femoral shaft fracture, with or without external\\nfixation, with insertion of intramedullary implant, with or without\\ncerclage and\/or locking screws\\n$ 3,828.60\\n27507\\n27507\\nOpen treatment of femoral shaft fracture with plate\/screws, with or\\nwithout cerclage\\n$ 3,386.70\\n27508\\n27508\\nClosed treatment of femoral fracture, distal end, medial or lateral\\ncondyle, without manipulation\\n$ 1,017.00\\n27509\\n27509\\nPercutaneous skeletal fixation of femoral fracture, distal end,\\nmedial or lateral condyle, or supracondylar or transcondylar, with or\\nwithout intercondylar extension, or distal femoral epiphyseal\\nseparation\\n$ 1,913.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n97\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n98\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27510\\n27510\\nClosed treatment of femoral fracture, distal end, medial or lateral\\ncondyle, with manipulation\\n$ 1,447.20\\n27511\\n27511\\nOpen treatment of femoral supracondylar or transcondylar fracture\\nwithout intercondylar extension, includes internal fixation, when\\nperformed\\n$ 3,213.90\\n27513\\n27513\\nOpen treatment of femoral supracondylar or transcondylar fracture\\nwith intercondylar extension, includes internal fixation, when\\nperformed\\n$ 3,411.90\\n27514\\n27514\\nOpen treatment of femoral fracture, distal end, medial or lateral\\ncondyle, includes internal fixation, when performed\\n$ 3,283.20\\n27516\\n27516\\nClosed treatment of distal femoral epiphyseal separation; without\\nmanipulation\\n$ 1,274.40\\n27517\\n27517\\nClosed treatment of distal femoral epiphyseal separation; with\\nmanipulation, with or without skin or skeletal traction\\n$ 1,467.90\\n27519\\n27519\\nOpen treatment of distal femoral epiphyseal separation, includes\\ninternal fixation, when performed\\n$ 3,119.40\\n27520\\n27520\\nClosed treatment of patellar fracture, without manipulation\\n$ 578.70\\n27524\\n27524\\nOpen treatment of patellar fracture, with internal fixation and\/or\\npartial or complete patellectomy and soft tissue repair\\n$ 2,121.30\\n27530\\n27530\\nClosed treatment of tibial fracture, proximal (plateau); without\\nmanipulation\\n$ 852.30\\n27532\\n27532\\nClosed treatment of tibial fracture, proximal (plateau); with or\\nwithout manipulation, with skeletal traction\\n$ 1,169.10\\n27535\\n27535\\nOpen treatment of tibial fracture, proximal (plateau); unicondylar,\\nincludes internal fixation, when performed\\n$ 2,665.80\\n27536\\n27536\\nOpen treatment of tibial fracture, proximal (plateau); bicondylar,\\nwith or without internal fixation\\n$ 2,615.40\\n27538\\n27538\\nClosed treatment of intercondylar spine(s) and\/or tuberosity\\nfracture(s) of knee, with or without manipulation\\n$ 950.40\\n27540\\n27540\\nOpen treatment of intercondylar spine(s) and\/or tuberosity\\nfracture(s) of the knee, includes internal fixation, when performed\\n$ 2,468.70\\n27550\\n27550\\nClosed treatment of knee dislocation; without anesthesia\\n$ 669.60\\n27552\\n27552\\nClosed treatment of knee dislocation; requiring anesthesia\\n$ 1,050.30\\n27556\\n27556\\nOpen treatment of knee dislocation, includes internal fixation, when\\nperformed; without primary ligamentous repair or\\naugmentation\/reconstruction\\n$ 2,856.60\\n27557\\n27557\\nOpen treatment of knee dislocation, includes internal fixation, when\\nperformed; with primary ligamentous repair\\n$ 3,537.90\\n27558\\n27558\\nOpen treatment of knee dislocation, includes internal fixation, when\\nperformed; with primary ligamentous repair, with\\naugmentation\/reconstruction\\n$ 3,331.80\\n27560\\n27560\\nClosed treatment of patellar dislocation; without anesthesia\\n$ 461.70\\n27562\\n27562\\nClosed treatment of patellar dislocation; requiring anesthesia\\n$ 789.30\\n27566\\n27566\\nOpen treatment of patellar dislocation, with or without partial or\\ntotal patellectomy\\n$ 2,060.10\\n27570\\n27570\\nManipulation of knee joint under general anesthesia (includes\\napplication of traction or other fixation devices)\\n$ 529.96\\n27580\\n27580\\nArthrodesis, knee, any technique\\n$ 3,822.30\\n27590\\n27590\\nAmputation, thigh, through femur, any level;\\n$ 2,446.20\\n27591\\n27591\\nAmputation, thigh, through femur, any level; immediate fitting\\ntechnique including first cast\\n$ 2,583.00\\n27592\\n27592\\nAmputation, thigh, through femur, any level; open, circular\\n(guillotine)\\n$ 2,543.40\\n27594\\n27594\\nAmputation, thigh, through femur, any level; secondary closure or\\nscar revision\\n$ 1,235.70\\n27596\\n27596\\nAmputation, thigh, through femur, any level; re-amputation\\n$ 2,379.60\\n27598\\n27598\\nDisarticulation at knee\\n$ 2,443.50\\n27599\\n27599\\nUnlisted procedure, femur or knee\\nCost\\n27600\\n27600\\nDecompression fasciotomy, leg; anterior and\/or lateral\\ncompartments only\\n$ 991.80\\n27601\\n27601\\nDecompression fasciotomy, leg; posterior compartment(s) only\\n$ 1,097.10\\n27602\\n27602\\nDecompression fasciotomy, leg; anterior and\/or lateral, and\\nposterior compartment(s)\\n$ 1,403.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n99\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n100\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27603\\n27603\\nIncision and drainage, leg or ankle; deep abscess or hematoma\\n$ 799.29\\n27604\\n27604\\nIncision and drainage, leg or ankle; infected bursa\\n$ 529.20\\n27605\\n27605\\nTenotomy, percutaneous, Achilles tendon (separate procedure);\\nlocal anesthesia\\n$ 489.60\\n27606\\n27606\\nTenotomy, percutaneous, Achilles tendon (separate procedure);\\ngeneral anesthesia\\n$ 918.90\\n27607\\n27607\\nIncision (eg, osteomyelitis or bone abscess), leg or ankle\\n$ 1,390.50\\n27610\\n27610\\nArthrotomy, ankle, including exploration, drainage, or removal of\\nforeign body\\n$ 1,504.80\\n27612\\n27612\\nArthrotomy, posterior capsular release, ankle, with or without\\nAchilles tendon lengthening\\n$ 1,591.20\\n27613\\n27613\\nBiopsy, soft tissue of leg or ankle area; superficial\\n$ 421.20\\n27614\\n27614\\nBiopsy, soft tissue of leg or ankle area; deep (subfascial or\\nintramuscular)\\n$ 842.40\\n27615\\n27615\\nRadical resection of tumor (eg, sarcoma), soft tissue of leg or ankle\\narea; less than 5 cm\\n$ 2,870.10\\n27616\\n27616\\nRadical resection of tumor (eg, sarcoma), soft tissue of leg or ankle\\narea; 5 cm or greater\\n$ 3,296.27\\n27618\\n27618\\nExcision, tumor, soft tissue of leg or ankle area, subcutaneous; less\\nthan 3 cm\\n$ 846.00\\n27619\\n27619\\nExcision, tumor, soft tissue of leg or ankle area, subfascial (eg,\\nintramuscular); less than 5 cm\\n$ 1,333.80\\n27620\\n27620\\nArthrotomy, ankle, with joint exploration, with or without biopsy,\\nwith or without removal of loose or foreign body\\n$ 1,577.70\\n27625\\n27625\\nArthrotomy, with synovectomy, ankle;\\n$ 2,103.30\\n27626\\n27626\\nArthrotomy, with synovectomy, ankle; including tenosynovectomy\\n$ 2,202.30\\n27630\\n27630\\nExcision of lesion of tendon sheath or capsule (eg, cyst or ganglion),\\nleg and\/or ankle\\n$ 867.60\\n27632\\n27632\\nExcision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm\\nor greater\\n$ 802.95\\n27634\\n27634\\nExcision, tumor, soft tissue of leg or ankle area, subfascial (eg,\\nintramuscular); 5 cm or greater\\n$ 1,801.95\\n27635\\n27635\\nExcision or curettage of bone cyst or benign tumor, tibia or fibula;\\n$ 1,979.10\\n27637\\n27637\\nExcision or curettage of bone cyst or benign tumor, tibia or fibula;\\nwith autograft (includes obtaining graft)\\n$ 2,095.20\\n27638\\n27638\\nExcision or curettage of bone cyst or benign tumor, tibia or fibula;\\nwith allograft\\n$ 2,301.30\\n27640\\n27640\\nPartial excision (craterization, saucerization, or diaphysectomy),\\nbone (eg, osteomyelitis); tibia\\n$ 2,338.20\\n27641\\n27641\\nPartial excision (craterization, saucerization, or diaphysectomy),\\nbone (eg, osteomyelitis); fibula\\n$ 1,883.70\\n27645\\n27645\\nRadical resection of tumor; tibia\\n$ 2,884.50\\n27646\\n27646\\nRadical resection of tumor; fibula\\n$ 2,287.80\\n27647\\n27647\\nRadical resection of tumor; talus or calcaneus\\n$ 2,766.60\\n27648\\n27648\\nInjection procedure for ankle arthrography\\n$ 187.20\\n27650\\n27650\\nRepair, primary, open or percutaneous, ruptured Achilles tendon;\\n$ 1,908.66\\n27652\\n27652\\nRepair, primary, open or percutaneous, ruptured Achilles tendon;\\nwith graft (includes obtaining graft)\\n$ 2,335.50\\n27654\\n27654\\nRepair, secondary, Achilles tendon, with or without graft\\n$ 2,672.10\\n27656\\n27656\\nRepair, fascial defect of leg\\n$ 1,035.90\\n27658\\n27658\\nRepair, flexor tendon, leg; primary, without graft, each tendon\\n$ 1,115.10\\n27659\\n27659\\nRepair, flexor tendon, leg; secondary, with or without graft, each\\ntendon\\n$ 1,606.50\\n27664\\n27664\\nRepair, extensor tendon, leg; primary, without graft, each tendon\\n$ 1,085.40\\n27665\\n27665\\nRepair, extensor tendon, leg; secondary, with or without graft, each\\ntendon\\n$ 1,157.40\\n27675\\n27675\\nRepair, dislocating peroneal tendons; without fibular osteotomy\\n$ 1,295.10\\n27676\\n27676\\nRepair, dislocating peroneal tendons; with fibular osteotomy\\n$ 1,339.20\\n27680\\n27680\\nTenolysis, flexor or extensor tendon, leg and\/or ankle; single, each\\ntendon\\n$ 1,331.10\\n27681\\n27681\\nTenolysis, flexor or extensor tendon, leg and\/or ankle; multiple\\ntendons (through separate incision(s))\\n$ 1,042.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n101\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n102\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27685\\n27685\\nLengthening or shortening of tendon, leg or ankle; single tendon\\n(separate procedure)\\n$ 1,200.60\\n27686\\n27686\\nLengthening or shortening of tendon, leg or ankle; multiple tendons\\n(through same incision), each\\n$ 1,363.50\\n27687\\n27687\\nGastrocnemius recession (eg, Strayer procedure)\\n$ 1,171.80\\n27690\\n27690\\nTransfer or transplant of single tendon (with muscle redirection or\\nrerouting); superficial (eg, anterior tibial extensors into midfoot)\\n$ 1,647.90\\n27691\\n27691\\nTransfer or transplant of single tendon (with muscle redirection or\\nrerouting); deep (eg, anterior tibial or posterior tibial through\\ninterosseous space, flexor digitorum longus, flexor hallucis longus,\\nor peroneal tendon to midfoot or hindfoot)\\n$ 1,859.40\\n27692\\n27692\\nTransfer or transplant of single tendon (with muscle redirection or\\nrerouting); each additional tendon (List separately in addition to\\ncode for primary procedure)\\n$ 544.50\\n27695\\n27695\\nRepair, primary, disrupted ligament, ankle; collateral\\n$ 1,703.70\\n27696\\n27696\\nRepair, primary, disrupted ligament, ankle; both collateral ligaments $ 2,338.20\\n27698\\n27698\\nRepair, secondary, disrupted ligament, ankle, collateral (eg, Watson-\\nJones procedure)\\n$ 2,367.00\\n27700\\n27700\\nArthroplasty, ankle;\\n$ 2,807.10\\n27702\\n27702\\nArthroplasty, ankle; with implant (total ankle)\\n$ 4,042.80\\n27703\\n27703\\nArthroplasty, ankle; revision, total ankle\\n$ 3,919.50\\n27704\\n27704\\nRemoval of ankle implant\\n$ 2,137.50\\n27705\\n27705\\nOsteotomy; tibia\\n$ 2,241.00\\n27707\\n27707\\nOsteotomy; fibula\\n$ 1,283.40\\n27709\\n27709\\nOsteotomy; tibia and fibula\\n$ 2,755.80\\n27712\\n27712\\nOsteotomy; multiple, with realignment on intramedullary rod (eg,\\nSofield type procedure)\\n$ 2,601.00\\n27715\\n27715\\nOsteoplasty, tibia and fibula, lengthening or shortening\\n$ 3,445.20\\n27720\\n27720\\nRepair of nonunion or malunion, tibia; without graft, (eg,\\ncompression technique)\\n$ 2,987.10\\n27722\\n27722\\nRepair of nonunion or malunion, tibia; with sliding graft\\n$ 3,027.60\\n27724\\n27724\\nRepair of nonunion or malunion, tibia; with iliac or other autograft\\n(includes obtaining graft)\\n$ 3,375.90\\n27725\\n27725\\nRepair of nonunion or malunion, tibia; by synostosis, with fibula,\\nany method\\n$ 3,711.60\\n27726\\n27726\\nRepair of fibula nonunion and\/or malunion with internal fixation\\n$ 2,950.61\\n27727\\n27727\\nRepair of congenital pseudarthrosis, tibia\\n$ 2,699.10\\n27730\\n27730\\nArrest, epiphyseal (epiphysiodesis), open; distal tibia\\n$ 1,624.50\\n27732\\n27732\\nArrest, epiphyseal (epiphysiodesis), open; distal fibula\\n$ 1,235.70\\n27734\\n27734\\nArrest, epiphyseal (epiphysiodesis), open; distal tibia and fibula\\n$ 1,830.60\\n27740\\n27740\\nArrest, epiphyseal (epiphysiodesis), any method, combined,\\nproximal and distal tibia and fibula;\\n$ 2,415.60\\n27742\\n27742\\nArrest, epiphyseal (epiphysiodesis), any method, combined,\\nproximal and distal tibia and fibula; and distal femur\\n$ 3,129.30\\n27745\\n27745\\nProphylactic treatment (nailing, pinning, plating or wiring) with or\\nwithout methylmethacrylate, tibia\\n$ 2,493.00\\n27750\\n27750\\nClosed treatment of tibial shaft fracture (with or without fibular\\nfracture); without manipulation\\n$ 702.97\\n27752\\n27752\\nClosed treatment of tibial shaft fracture (with or without fibular\\nfracture); with manipulation, with or without skeletal traction\\n$ 1,081.80\\n27756\\n27756\\nPercutaneous skeletal fixation of tibial shaft fracture (with or\\nwithout fibular fracture) (eg, pins or screws)\\n$ 2,086.20\\n27758\\n27758\\nOpen treatment of tibial shaft fracture (with or without fibular\\nfracture), with plate\/screws, with or without cerclage\\n$ 2,968.20\\n27759\\n27759\\nTreatment of tibial shaft fracture (with or without fibular fracture)\\nby intramedullary implant, with or without interlocking screws\\nand\/or cerclage\\n$ 3,328.20\\n27760\\n27760\\nClosed treatment of medial malleolus fracture; without\\nmanipulation\\n$ 503.10\\n27762\\n27762\\nClosed treatment of medial malleolus fracture; with manipulation,\\nwith or without skin or skeletal traction\\n$ 824.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n103\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n104\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27766\\n27766\\nOpen treatment of medial malleolus fracture, includes internal\\nfixation, when performed\\n$ 1,553.40\\n27767\\n27767\\nClosed treatment of posterior malleolus fracture; without\\nmanipulation\\n$ 548.09\\n27768\\n27768\\nClosed treatment of posterior malleolus fracture; with manipulation $ 868.53\\n27769\\n27769\\nOpen treatment of posterior malleolus fracture, includes internal\\nfixation, when performed\\n$ 1,707.43\\n27780\\n27780\\nClosed treatment of proximal fibula or shaft fracture; without\\nmanipulation\\n$ 562.50\\n27781\\n27781\\nClosed treatment of proximal fibula or shaft fracture; with\\nmanipulation\\n$ 893.70\\n27784\\n27784\\nOpen treatment of proximal fibula or shaft fracture, includes\\ninternal fixation, when performed\\n$ 1,605.60\\n27786\\n27786\\nClosed treatment of distal fibular fracture (lateral malleolus);\\nwithout manipulation\\n$ 463.50\\n27788\\n27788\\nClosed treatment of distal fibular fracture (lateral malleolus); with\\nmanipulation\\n$ 818.10\\n27792\\n27792\\nOpen treatment of distal fibular fracture (lateral malleolus),\\nincludes internal fixation, when performed\\n$ 1,539.90\\n27808\\n27808\\nClosed treatment of bimalleolar ankle fracture (eg, lateral and\\nmedial malleoli, or lateral and posterior malleoli, or medial and\\nposterior malleoli); without manipulation\\n$ 643.50\\n27810\\n27810\\nClosed treatment of bimalleolar ankle fracture (eg, lateral and\\nmedial malleoli, or lateral and posterior malleoli, or medial and\\nposterior malleoli); with manipulation\\n$ 1,189.80\\n27814\\n27814\\nOpen treatment of bimalleolar ankle fracture (eg, lateral and medial\\nmalleoli, or lateral and posterior malleoli, or medial and posterior\\nmalleoli), includes internal fixation, when performed\\n$ 2,196.90\\n27816\\n27816\\nClosed treatment of trimalleolar ankle fracture; without\\nmanipulation\\n$ 842.40\\n27818\\n27818\\nClosed treatment of trimalleolar ankle fracture; with manipulation\\n$ 1,312.20\\n27822\\n27822\\nOpen treatment of trimalleolar ankle fracture, includes internal\\nfixation, when performed, medial and\/or lateral malleolus; without\\nfixation of posterior lip\\n$ 2,358.90\\n27823\\n27823\\nOpen treatment of trimalleolar ankle fracture, includes internal\\nfixation, when performed, medial and\/or lateral malleolus; with\\nfixation of posterior lip\\n$ 2,880.90\\n27824\\n27824\\nClosed treatment of fracture of weight bearing articular portion of\\ndistal tibia (eg, pilon or tibial plafond), with or without anesthesia;\\nwithout manipulation\\n$ 813.60\\n27825\\n27825\\nClosed treatment of fracture of weight bearing articular portion of\\ndistal tibia (eg, pilon or tibial plafond), with or without anesthesia;\\nwith skeletal traction and\/or requiring manipulation\\n$ 1,673.10\\n27826\\n27826\\nOpen treatment of fracture of weight bearing articular\\nsurface\/portion of distal tibia (eg, pilon or tibial plafond), with\\ninternal fixation, when performed; of fibula only\\n$ 2,421.00\\n27827\\n27827\\nOpen treatment of fracture of weight bearing articular\\nsurface\/portion of distal tibia (eg, pilon or tibial plafond), with\\ninternal fixation, when performed; of tibia only\\n$ 2,786.40\\n27828\\n27828\\nOpen treatment of fracture of weight bearing articular\\nsurface\/portion of distal tibia (eg, pilon or tibial plafond), with\\ninternal fixation, when performed; of both tibia and fibula\\n$ 3,352.50\\n27829\\n27829\\nOpen treatment of distal tibiofibular joint (syndesmosis) disruption,\\nincludes internal fixation, when performed\\n$ 1,629.90\\n27830\\n27830\\nClosed treatment of proximal tibiofibular joint dislocation; without\\nanesthesia\\n$ 607.50\\n27831\\n27831\\nClosed treatment of proximal tibiofibular joint dislocation; requiring\\nanesthesia\\n$ 695.70\\n27832\\n27832\\nOpen treatment of proximal tibiofibular joint dislocation, includes\\ninternal fixation, when performed, or with excision of proximal\\nfibula\\n$ 1,254.60\\n27840\\n27840\\nClosed treatment of ankle dislocation; without anesthesia\\n$ 537.30\\n27842\\n27842\\nClosed treatment of ankle dislocation; requiring anesthesia, with or\\nwithout percutaneous skeletal fixation\\n$ 761.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n105\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n106\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n27846\\n27846\\nOpen treatment of ankle dislocation, with or without percutaneous\\nskeletal fixation; without repair or internal fixation\\n$ 1,946.70\\n27848\\n27848\\nOpen treatment of ankle dislocation, with or without percutaneous\\nskeletal fixation; with repair or internal or external fixation\\n$ 2,139.30\\n27860\\n27860\\nManipulation of ankle under general anesthesia (includes\\napplication of traction or other fixation apparatus)\\n$ 425.70\\n27870\\n27870\\nArthrodesis, ankle, open\\n$ 2,708.10\\n27871\\n27871\\nArthrodesis, tibiofibular joint, proximal or distal\\n$ 2,174.40\\n27880\\n27880\\nAmputation, leg, through tibia and fibula;\\n$ 2,462.40\\n27881\\n27881\\nAmputation, leg, through tibia and fibula; with immediate fitting\\ntechnique including application of first cast\\n$ 2,837.70\\n27882\\n27882\\nAmputation, leg, through tibia and fibula; open, circular (guillotine)\\n$ 2,366.10\\n27884\\n27884\\nAmputation, leg, through tibia and fibula; secondary closure or scar\\nrevision\\n$ 1,488.60\\n27886\\n27886\\nAmputation, leg, through tibia and fibula; re-amputation\\n$ 2,375.10\\n27888\\n27888\\nAmputation, ankle, through malleoli of tibia and fibula (eg, Syme,\\nPirogoff type procedures), with plastic closure and resection of\\nnerves\\n$ 2,007.90\\n27889\\n27889\\nAnkle disarticulation\\n$ 1,886.40\\n27892\\n27892\\nDecompression fasciotomy, leg; anterior and\/or lateral\\ncompartments only, with debridement of nonviable muscle and\/or\\nnerve\\n$ 1,674.00\\n27893\\n27893\\nDecompression fasciotomy, leg; posterior compartment(s) only,\\nwith debridement of nonviable muscle and\/or nerve\\n$ 1,622.70\\n27894\\n27894\\nDecompression fasciotomy, leg; anterior and\/or lateral, and\\nposterior compartment(s), with debridement of nonviable muscle\\nand\/or nerve\\n$ 1,946.70\\n27899\\n27899\\nUnlisted procedure, leg or ankle\\nCost\\n28001\\n28001\\nIncision and drainage, bursa, foot\\n$ 412.20\\n28002\\n28002\\nIncision and drainage below fascia, with or without tendon sheath\\ninvolvement, foot; single bursal space\\n$ 779.40\\n28003\\n28003\\nIncision and drainage below fascia, with or without tendon sheath\\ninvolvement, foot; multiple areas\\n$ 973.80\\n28005\\n28005\\nIncision, bone cortex (eg, osteomyelitis or bone abscess), foot\\n$ 991.80\\n28008\\n28008\\nFasciotomy, foot and\/or toe\\n$ 700.20\\n28010\\n28010\\nTenotomy, percutaneous, toe; single tendon\\n$ 425.70\\n28011\\n28011\\nTenotomy, percutaneous, toe; multiple tendons\\n$ 526.50\\n28020\\n28020\\nArthrotomy, including exploration, drainage, or removal of loose or\\nforeign body; intertarsal or tarsometatarsal joint\\n$ 1,106.10\\n28022\\n28022\\nArthrotomy, including exploration, drainage, or removal of loose or\\nforeign body; metatarsophalangeal joint\\n$ 725.40\\n28024\\n28024\\nArthrotomy, including exploration, drainage, or removal of loose or\\nforeign body; interphalangeal joint\\n$ 669.60\\n28035\\n28035\\nRelease, tarsal tunnel (posterior tibial nerve decompression)\\n$ 1,653.30\\n28039\\n28039\\nExcision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or\\ngreater\\n$ 805.26\\n28041\\n28041\\nExcision, tumor, soft tissue of foot or toe, subfascial (eg,\\nintramuscular); 1.5 cm or greater\\n$ 941.09\\n28043\\n28043\\nExcision, tumor, soft tissue of foot or toe, subcutaneous; less than\\n1.5 cm\\n$ 525.60\\n28045\\n28045\\nExcision, tumor, soft tissue of foot or toe, subfascial (eg,\\nintramuscular); less than 1.5 cm\\n$ 1,077.30\\n28046\\n28046\\nRadical resection of tumor (eg, sarcoma), soft tissue of foot or toe;\\nless than 3 cm\\n$ 1,923.30\\n28047\\n28047\\nRadical resection of tumor (eg, sarcoma), soft tissue of foot or toe; 3\\ncm or greater\\n$ 1,845.03\\n28050\\n28050\\nArthrotomy with biopsy; intertarsal or tarsometatarsal joint\\n$ 1,000.80\\n28052\\n28052\\nArthrotomy with biopsy; metatarsophalangeal joint\\n$ 690.30\\n28054\\n28054\\nArthrotomy with biopsy; interphalangeal joint\\n$ 588.60\\n28055\\n28055\\nNeurectomy, intrinsic musculature of foot\\n$ 757.64\\n28060\\n28060\\nFasciectomy, plantar fascia; partial (separate procedure)\\n$ 1,038.60\\n28062\\n28062\\nFasciectomy, plantar fascia; radical (separate procedure)\\n$ 1,872.90\\n28070\\n28070\\nSynovectomy; intertarsal or tarsometatarsal joint, each\\n$ 1,097.10\\n28072\\n28072\\nSynovectomy; metatarsophalangeal joint, each\\n$ 727.20\\n28080\\n28080\\nExcision, interdigital (Morton) neuroma, single, each\\n$ 817.76\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n107\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n108\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n28086\\n28086\\nSynovectomy, tendon sheath, foot; flexor\\n$ 1,244.70\\n28088\\n28088\\nSynovectomy, tendon sheath, foot; extensor\\n$ 873.90\\n28090\\n28090\\nExcision of lesion, tendon, tendon sheath, or capsule (including\\nsynovectomy) (eg, cyst or ganglion); foot\\n$ 762.08\\n28092\\n28092\\nExcision of lesion, tendon, tendon sheath, or capsule (including\\nsynovectomy) (eg, cyst or ganglion); toe(s), each\\n$ 675.00\\n28100\\n28100\\nExcision or curettage of bone cyst or benign tumor, talus or\\ncalcaneus;\\n$ 1,274.40\\n28102\\n28102\\nExcision or curettage of bone cyst or benign tumor, talus or\\ncalcaneus; with iliac or other autograft (includes obtaining graft)\\n$ 1,674.00\\n28103\\n28103\\nExcision or curettage of bone cyst or benign tumor, talus or\\ncalcaneus; with allograft\\n$ 1,577.70\\n28104\\n28104\\nExcision or curettage of bone cyst or benign tumor, tarsal or\\nmetatarsal, except talus or calcaneus;\\n$ 1,057.50\\n28106\\n28106\\nExcision or curettage of bone cyst or benign tumor, tarsal or\\nmetatarsal, except talus or calcaneus; with iliac or other autograft\\n(includes obtaining graft)\\n$ 1,435.50\\n28107\\n28107\\nExcision or curettage of bone cyst or benign tumor, tarsal or\\nmetatarsal, except talus or calcaneus; with allograft\\n$ 1,215.90\\n28108\\n28108\\nExcision or curettage of bone cyst or benign tumor, phalanges of\\nfoot\\n$ 862.20\\n28110\\n28110\\nOstectomy, partial excision, fifth metatarsal head (bunionette)\\n(separate procedure)\\n$ 828.90\\n28111\\n28111\\nOstectomy, complete excision; first metatarsal head\\n$ 1,013.40\\n28112\\n28112\\nOstectomy, complete excision; other metatarsal head (second, third\\nor fourth)\\n$ 956.70\\n28113\\n28113\\nOstectomy, complete excision; fifth metatarsal head\\n$ 973.80\\n28114\\n28114\\nOstectomy, complete excision; all metatarsal heads, with partial\\nproximal phalangectomy, excluding first metatarsal (eg, Clayton\\ntype procedure)\\n$ 2,032.20\\n28116\\n28116\\nOstectomy, excision of tarsal coalition\\n$ 1,553.40\\n28118\\n28118\\nOstectomy, calcaneus;\\n$ 1,267.20\\n28119\\n28119\\nOstectomy, calcaneus; for spur, with or without plantar fascial\\nrelease\\n$ 1,184.40\\n28120\\n28120\\nPartial excision (craterization, saucerization, sequestrectomy, or\\ndiaphysectomy) bone (eg, osteomyelitis or bossing); talus or\\ncalcaneus\\n$ 1,287.90\\n28122\\n28122\\nPartial excision (craterization, saucerization, sequestrectomy, or\\ndiaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or\\nmetatarsal bone, except talus or calcaneus\\n$ 1,105.20\\n28124\\n28124\\nPartial excision (craterization, saucerization, sequestrectomy, or\\ndiaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe\\n$ 754.20\\n28126\\n28126\\nResection, partial or complete, phalangeal base, each toe\\n$ 708.30\\n28130\\n28130\\nTalectomy (astragalectomy)\\n$ 1,640.70\\n28140\\n28140\\nMetatarsectomy\\n$ 1,133.10\\n28150\\n28150\\nPhalangectomy, toe, each toe\\n$ 699.30\\n28153\\n28153\\nResection, condyle(s), distal end of phalanx, each toe\\n$ 751.50\\n28160\\n28160\\nHemiphalangectomy or interphalangeal joint excision, toe, proximal\\nend of phalanx, each\\n$ 651.60\\n28171\\n28171\\nRadical resection of tumor; tarsal (except talus or calcaneus)\\n$ 1,622.70\\n28173\\n28173\\nRadical resection of tumor; metatarsal\\n$ 1,408.50\\n28175\\n28175\\nRadical resection of tumor; phalanx of toe\\n$ 999.00\\n28190\\n28190\\nRemoval of foreign body, foot; subcutaneous\\n$ 346.50\\n28192\\n28192\\nRemoval of foreign body, foot; deep\\n$ 671.40\\n28193\\n28193\\nRemoval of foreign body, foot; complicated\\n$ 1,028.70\\n28200\\n28200\\nRepair, tendon, flexor, foot; primary or secondary, without free\\ngraft, each tendon\\n$ 1,134.00\\n28202\\n28202\\nRepair, tendon, flexor, foot; secondary with free graft, each tendon\\n(includes obtaining graft)\\n$ 1,766.70\\n28208\\n28208\\nRepair, tendon, extensor, foot; primary or secondary, each tendon\\n$ 967.50\\n28210\\n28210\\nRepair, tendon, extensor, foot; secondary with free graft, each\\ntendon (includes obtaining graft)\\n$ 1,038.60\\n28222\\n28222\\nTenolysis, flexor, foot; multiple tendons\\n$ 1,048.50\\n28225\\n28225\\nTenolysis, extensor, foot; single tendon\\n$ 580.50\\n28226\\n28226\\nTenolysis, extensor, foot; multiple tendons\\n$ 747.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n109\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n110\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n28230\\n28230\\nTenotomy, open, tendon flexor; foot, single or multiple tendon(s)\\n(separate procedure)\\n$ 724.50\\n28232\\n28232\\nTenotomy, open, tendon flexor; toe, single tendon (separate\\nprocedure)\\n$ 399.60\\n28234\\n28234\\nTenotomy, open, extensor, foot or toe, each tendon\\n$ 517.50\\n28238\\n28238\\nReconstruction (advancement), posterior tibial tendon with excision\\nof accessory tarsal navicular bone (eg, Kidner type procedure)\\n$ 1,545.30\\n28240\\n28240\\nTenotomy, lengthening, or release, abductor hallucis muscle\\n$ 711.90\\n28250\\n28250\\nDivision of plantar fascia and muscle (eg, Steindler stripping)\\n(separate procedure)\\n$ 1,148.40\\n28260\\n28260\\nCapsulotomy, midfoot; medial release only (separate procedure)\\n$ 1,608.30\\n28261\\n28261\\nCapsulotomy, midfoot; with tendon lengthening\\n$ 1,545.30\\n28262\\n28262\\nCapsulotomy, midfoot; extensive, including posterior talotibial\\ncapsulotomy and tendon(s) lengthening (eg, resistant clubfoot\\ndeformity)\\n$ 2,923.20\\n28264\\n28264\\nCapsulotomy, midtarsal (eg, Heyman type procedure)\\n$ 2,145.60\\n28270\\n28270\\nCapsulotomy; metatarsophalangeal joint, with or without\\ntenorrhaphy, each joint (separate procedure)\\n$ 712.80\\n28272\\n28272\\nCapsulotomy; interphalangeal joint, each joint (separate procedure) $ 654.30\\n28280\\n28280\\nSyndactylization, toes (eg, webbing or Kelikian type procedure)\\n$ 747.00\\n28285\\n28285\\nCorrection, hammertoe (eg, interphalangeal fusion, partial or total\\nphalangectomy)\\n$ 813.60\\n28286\\n28286\\nCorrection, cock-up fifth toe, with plastic skin closure (eg, Ruiz-\\nMora type procedure)\\n$ 875.70\\n28288\\n28288\\nOstectomy, partial, exostectomy or condylectomy, metatarsal head,\\neach metatarsal head\\n$ 1,009.80\\n28289\\n28289\\nHallux rigidus correction with cheilectomy, debridement and\\ncapsular release of the first metatarsophalangeal joint\\n$ 896.40\\n28290\\n28290\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; simple exostectomy (eg, Silver type procedure)\\n$ 1,244.70\\n28292\\n28292\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; Keller, McBride, or Mayo type procedure\\n$ 1,545.30\\n28293\\n28293\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; resection of joint with implant\\n$ 1,776.60\\n28294\\n28294\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; with tendon transplants (eg, Joplin type\\nprocedure)\\n$ 1,939.50\\n28296\\n28296\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; with metatarsal osteotomy (eg, Mitchell,\\nChevron, or concentric type procedures)\\n$ 1,827.42\\n28297\\n28297\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; Lapidus-type procedure\\n$ 1,831.50\\n28298\\n28298\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; by phalanx osteotomy\\n$ 1,392.30\\n28299\\n28299\\nCorrection, hallux valgus (bunion), with or without\\nsesamoidectomy; by double osteotomy\\n$ 1,931.40\\n28300\\n28300\\nOsteotomy; calcaneus (eg, Dwyer or Chambers type procedure),\\nwith or without internal fixation\\n$ 1,506.60\\n28302\\n28302\\nOsteotomy; talus\\n$ 1,606.50\\n28304\\n28304\\nOsteotomy, tarsal bones, other than calcaneus or talus;\\n$ 1,385.10\\n28305\\n28305\\nOsteotomy, tarsal bones, other than calcaneus or talus; with\\nautograft (includes obtaining graft) (eg, Fowler type)\\n$ 1,545.30\\n28306\\n28306\\nOsteotomy, with or without lengthening, shortening or angular\\ncorrection, metatarsal; first metatarsal\\n$ 1,287.90\\n28307\\n28307\\nOsteotomy, with or without lengthening, shortening or angular\\ncorrection, metatarsal; first metatarsal with autograft (other than\\nfirst toe)\\n$ 1,416.60\\n28308\\n28308\\nOsteotomy, with or without lengthening, shortening or angular\\ncorrection, metatarsal; other than first metatarsal, each\\n$ 1,104.30\\n28309\\n28309\\nOsteotomy, with or without lengthening, shortening or angular\\ncorrection, metatarsal; multiple (eg, Swanson type cavus foot\\nprocedure)\\n$ 1,880.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n111\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n112\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n28310\\n28310\\nOsteotomy, shortening, angular or rotational correction; proximal\\nphalanx, first toe (separate procedure)\\n$ 986.40\\n28312\\n28312\\nOsteotomy, shortening, angular or rotational correction; other\\nphalanges, any toe\\n$ 724.50\\n28313\\n28313\\nReconstruction, angular deformity of toe, soft tissue procedures\\nonly (eg, overlapping second toe, fifth toe, curly toes)\\n$ 919.80\\n28315\\n28315\\nSesamoidectomy, first toe (separate procedure)\\n$ 1,097.10\\n28320\\n28320\\nRepair, nonunion or malunion; tarsal bones\\n$ 1,640.70\\n28322\\n28322\\nRepair, nonunion or malunion; metatarsal, with or without bone\\ngraft (includes obtaining graft)\\n$ 1,387.80\\n28340\\n28340\\nReconstruction, toe, macrodactyly; soft tissue resection\\n$ 1,427.40\\n28341\\n28341\\nReconstruction, toe, macrodactyly; requiring bone resection\\n$ 1,542.60\\n28344\\n28344\\nReconstruction, toe(s); polydactyly\\n$ 1,073.70\\n28345\\n28345\\nReconstruction, toe(s); syndactyly, with or without skin graft(s),\\neach web\\n$ 1,471.50\\n28360\\n28360\\nReconstruction, cleft foot\\n$ 2,493.00\\n28400\\n28400\\nClosed treatment of calcaneal fracture; without manipulation\\n$ 621.90\\n28405\\n28405\\nClosed treatment of calcaneal fracture; with manipulation\\n$ 1,003.50\\n28406\\n28406\\nPercutaneous skeletal fixation of calcaneal fracture, with\\nmanipulation\\n$ 1,278.00\\n28415\\n28415\\nOpen treatment of calcaneal fracture, includes internal fixation,\\nwhen performed;\\n$ 2,162.70\\n28420\\n28420\\nOpen treatment of calcaneal fracture, includes internal fixation,\\nwhen performed; with primary iliac or other autogenous bone graft\\n(includes obtaining graft)\\n$ 2,753.10\\n28430\\n28430\\nClosed treatment of talus fracture; without manipulation\\n$ 514.80\\n28435\\n28435\\nClosed treatment of talus fracture; with manipulation\\n$ 768.60\\n28436\\n28436\\nPercutaneous skeletal fixation of talus fracture, with manipulation\\n$ 918.00\\n28445\\n28445\\nOpen treatment of talus fracture, includes internal fixation, when\\nperformed\\n$ 1,998.00\\n28446\\n28446\\nOpen osteochondral autograft, talus (includes obtaining graft[s])\\n$ 2,581.39\\n28450\\n28450\\nTreatment of tarsal bone fracture (except talus and calcaneus);\\nwithout manipulation, each\\n$ 496.80\\n28455\\n28455\\nTreatment of tarsal bone fracture (except talus and calcaneus); with\\nmanipulation, each\\n$ 643.50\\n28456\\n28456\\nPercutaneous skeletal fixation of tarsal bone fracture (except talus\\nand calcaneus), with manipulation, each\\n$ 710.10\\n28465\\n28465\\nOpen treatment of tarsal bone fracture (except talus and\\ncalcaneus), includes internal fixation, when performed, each\\n$ 1,416.60\\n28470\\n28470\\nClosed treatment of metatarsal fracture; without manipulation,\\neach\\n$ 459.00\\n28475\\n28475\\nClosed treatment of metatarsal fracture; with manipulation, each\\n$ 514.80\\n28476\\n28476\\nPercutaneous skeletal fixation of metatarsal fracture, with\\nmanipulation, each\\n$ 925.20\\n28485\\n28485\\nOpen treatment of metatarsal fracture, includes internal fixation,\\nwhen performed, each\\n$ 1,177.20\\n28490\\n28490\\nClosed treatment of fracture great toe, phalanx or phalanges;\\nwithout manipulation\\n$ 266.40\\n28495\\n28495\\nClosed treatment of fracture great toe, phalanx or phalanges; with\\nmanipulation\\n$ 378.90\\n28496\\n28496\\nPercutaneous skeletal fixation of fracture great toe, phalanx or\\nphalanges, with manipulation\\n$ 576.90\\n28505\\n28505\\nOpen treatment of fracture, great toe, phalanx or phalanges,\\nincludes internal fixation, when performed\\n$ 783.90\\n28510\\n28510\\nClosed treatment of fracture, phalanx or phalanges, other than\\ngreat toe; without manipulation, each\\n$ 208.80\\n28515\\n28515\\nClosed treatment of fracture, phalanx or phalanges, other than\\ngreat toe; with manipulation, each\\n$ 297.00\\n28525\\n28525\\nOpen treatment of fracture, phalanx or phalanges, other than great\\ntoe, includes internal fixation, when performed, each\\n$ 744.30\\n28530\\n28530\\nClosed treatment of sesamoid fracture\\n$ 348.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n113\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n114\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n28531\\n28531\\nOpen treatment of sesamoid fracture, with or without internal\\nfixation\\n$ 880.47\\n28540\\n28540\\nClosed treatment of tarsal bone dislocation, other than talotarsal;\\nwithout anesthesia\\n$ 410.40\\n28545\\n28545\\nClosed treatment of tarsal bone dislocation, other than talotarsal;\\nrequiring anesthesia\\n$ 564.30\\n28546\\n28546\\nPercutaneous skeletal fixation of tarsal bone dislocation, other than\\ntalotarsal, with manipulation\\n$ 690.30\\n28555\\n28555\\nOpen treatment of tarsal bone dislocation, includes internal\\nfixation, when performed\\n$ 1,030.50\\n28570\\n28570\\nClosed treatment of talotarsal joint dislocation; without anesthesia\\n$ 425.70\\n28575\\n28575\\nClosed treatment of talotarsal joint dislocation; requiring anesthesia $ 577.80\\n28576\\n28576\\nPercutaneous skeletal fixation of talotarsal joint dislocation, with\\nmanipulation\\n$ 801.00\\n28585\\n28585\\nOpen treatment of talotarsal joint dislocation, includes internal\\nfixation, when performed\\n$ 1,476.00\\n28600\\n28600\\nClosed treatment of tarsometatarsal joint dislocation; without\\nanesthesia\\n$ 530.10\\n28605\\n28605\\nClosed treatment of tarsometatarsal joint dislocation; requiring\\nanesthesia\\n$ 592.20\\n28606\\n28606\\nPercutaneous skeletal fixation of tarsometatarsal joint dislocation,\\nwith manipulation\\n$ 1,009.80\\n28615\\n28615\\nOpen treatment of tarsometatarsal joint dislocation, includes\\ninternal fixation, when performed\\n$ 1,235.70\\n28630\\n28630\\nClosed treatment of metatarsophalangeal joint dislocation; without\\nanesthesia\\n$ 335.70\\n28635\\n28635\\nClosed treatment of metatarsophalangeal joint dislocation;\\nrequiring anesthesia\\n$ 369.90\\n28636\\n28636\\nPercutaneous skeletal fixation of metatarsophalangeal joint\\ndislocation, with manipulation\\n$ 566.10\\n28645\\n28645\\nOpen treatment of metatarsophalangeal joint dislocation, includes\\ninternal fixation, when performed\\n$ 782.10\\n28660\\n28660\\nClosed treatment of interphalangeal joint dislocation; without\\nanesthesia\\n$ 239.40\\n28665\\n28665\\nClosed treatment of interphalangeal joint dislocation; requiring\\nanesthesia\\n$ 320.40\\n28666\\n28666\\nPercutaneous skeletal fixation of interphalangeal joint dislocation,\\nwith manipulation\\n$ 564.30\\n28675\\n28675\\nOpen treatment of interphalangeal joint dislocation, includes\\ninternal fixation, when performed\\n$ 684.90\\n28705\\n28705\\nArthrodesis; pantalar\\n$ 2,897.10\\n28715\\n28715\\nArthrodesis; triple\\n$ 3,185.10\\n28725\\n28725\\nArthrodesis; subtalar\\n$ 2,137.50\\n28730\\n28730\\nArthrodesis, midtarsal or tarsometatarsal, multiple or transverse;\\n$ 2,230.20\\n28735\\n28735\\nArthrodesis, midtarsal or tarsometatarsal, multiple or transverse;\\nwith osteotomy (eg, flatfoot correction)\\n$ 2,173.50\\n28737\\n28737\\nArthrodesis, with tendon lengthening and advancement, midtarsal,\\ntarsal navicular-cuneiform (eg, Miller type procedure)\\n$ 1,982.70\\n28740\\n28740\\nArthrodesis, midtarsal or tarsometatarsal, single joint\\n$ 1,674.00\\n28750\\n28750\\nArthrodesis, great toe; metatarsophalangeal joint\\n$ 1,392.70\\n28755\\n28755\\nArthrodesis, great toe; interphalangeal joint\\n$ 1,186.20\\n28760\\n28760\\nArthrodesis, with extensor hallucis longus transfer to first\\nmetatarsal neck, great toe, interphalangeal joint (eg, Jones type\\nprocedure)\\n$ 1,071.90\\n28800\\n28800\\nAmputation, foot; midtarsal (eg, Chopart type procedure)\\n$ 1,847.70\\n28805\\n28805\\nAmputation, foot; transmetatarsal\\n$ 2,238.30\\n28810\\n28810\\nAmputation, metatarsal, with toe, single\\n$ 1,152.90\\n28820\\n28820\\nAmputation, toe; metatarsophalangeal joint\\n$ 875.70\\n28825\\n28825\\nAmputation, toe; interphalangeal joint\\n$ 782.10\\n28890\\n28890\\nExtracorporeal shock wave, high energy, performed by a physician\\nor other qualified health care professional, requiring anesthesia\\nother than local, including ultrasound guidance, involving the\\nplantar fascia\\n$ 905.09\\n28899\\n28899\\nUnlisted procedure, foot or toes\\nCost\\n29000\\n29000\\nApplication of halo type body cast (see 20661-20663 for insertion)\\n$ 608.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n115\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n116\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n29010\\n29010\\nApplication of Risser jacket, localizer, body; only\\n$ 492.30\\n29015\\n29015\\nApplication of Risser jacket, localizer, body; including head\\n$ 670.50\\n29020\\n29020\\nApplication of turnbuckle jacket, body; only\\n$ 534.60\\n29025\\n29025\\nApplication of turnbuckle jacket, body; including head\\n$ 578.70\\n29035\\n29035\\nApplication of body cast, shoulder to hips;\\n$ 475.20\\n29040\\n29040\\nApplication of body cast, shoulder to hips; including head, Minerva\\ntype\\n$ 495.90\\n29044\\n29044\\nApplication of body cast, shoulder to hips; including 1 thigh\\n$ 380.70\\n29046\\n29046\\nApplication of body cast, shoulder to hips; including both thighs\\n$ 469.80\\n29049\\n29049\\nApplication, cast; figure-of-eight\\n$ 194.40\\n29055\\n29055\\nApplication, cast; shoulder spica\\n$ 389.70\\n29058\\n29058\\nApplication, cast; plaster Velpeau\\n$ 198.90\\n29065\\n29065\\nApplication, cast; shoulder to hand (long arm)\\n$ 206.10\\n29075\\n29075\\nApplication, cast; elbow to finger (short arm)\\n$ 157.50\\n29085\\n29085\\nApplication, cast; hand and lower forearm (gauntlet)\\n$ 156.05\\n29086\\n29086\\nApplication, cast; finger (eg, contracture)\\n$ 110.50\\n29105\\n29105\\nApplication of long arm splint (shoulder to hand)\\n$ 128.70\\n29125\\n29125\\nApplication of short arm splint (forearm to hand); static\\n$ 99.00\\n29126\\n29126\\nApplication of short arm splint (forearm to hand); dynamic\\n$ 134.10\\n29130\\n29130\\nApplication of finger splint; static\\n$ 82.80\\n29131\\n29131\\nApplication of finger splint; dynamic\\n$ 134.10\\n29200\\n29200\\nStrapping; thorax\\n$ 81.00\\n29240\\n29240\\nStrapping; shoulder (eg, Velpeau)\\n$ 90.00\\n29260\\n29260\\nStrapping; elbow or wrist\\n$ 65.68\\n29280\\n29280\\nStrapping; hand or finger\\n$ 86.40\\n29305\\n29305\\nApplication of hip spica cast; 1 leg\\n$ 540.90\\n29325\\n29325\\nApplication of hip spica cast; 1 and one-half spica or both legs\\n$ 494.10\\n29345\\n29345\\nApplication of long leg cast (thigh to toes);\\n$ 297.00\\n29355\\n29355\\nApplication of long leg cast (thigh to toes); walker or ambulatory\\ntype\\n$ 270.90\\n29358\\n29358\\nApplication of long leg cast brace\\n$ 451.80\\n29365\\n29365\\nApplication of cylinder cast (thigh to ankle)\\n$ 236.70\\n29405\\n29405\\nApplication of short leg cast (below knee to toes);\\n$ 215.17\\n29425\\n29425\\nApplication of short leg cast (below knee to toes); walking or\\nambulatory type\\n$ 237.60\\n29435\\n29435\\nApplication of patellar tendon bearing (PTB) cast\\n$ 282.60\\n29440\\n29440\\nAdding walker to previously applied cast\\n$ 83.70\\n29445\\n29445\\nApplication of rigid total contact leg cast\\n$ 339.30\\n29450\\n29450\\nApplication of clubfoot cast with molding or manipulation, long or\\nshort leg\\n$ 173.70\\n29505\\n29505\\nApplication of long leg splint (thigh to ankle or toes)\\n$ 153.90\\n29515\\n29515\\nApplication of short leg splint (calf to foot)\\n$ 120.60\\n29520\\n29520\\nStrapping; hip\\n$ 98.10\\n29530\\n29530\\nStrapping; knee\\n$ 95.40\\n29540\\n29540\\nStrapping; ankle and\/or foot\\n$ 73.52\\n29550\\n29550\\nStrapping; toes\\n$ 66.60\\n29580\\n29580\\nStrapping; Unna boot\\n$ 96.09\\n29581\\n29581\\nApplication of multi-layer compression system; leg (below knee),\\nincluding ankle and foot\\n$ 132.61\\n29700\\n29700\\nRemoval or bivalving; gauntlet, boot or body cast\\n$ 92.42\\n29705\\n29705\\nRemoval or bivalving; full arm or full leg cast\\n$ 90.31\\n29710\\n29710\\nRemoval or bivalving; shoulder or hip spica, Minerva, or Risser\\njacket, etc.\\n$ 186.30\\n29715\\n29715\\nRemoval or bivalving; turnbuckle jacket\\n$ 124.20\\n29720\\n29720\\nRepair of spica, body cast or jacket\\n$ 87.30\\n29730\\n29730\\nWindowing of cast\\n$ 85.50\\n29740\\n29740\\nWedging of cast (except clubfoot casts)\\n$ 136.80\\n29750\\n29750\\nWedging of clubfoot cast\\n$ 97.20\\n29799\\n29799\\nUnlisted procedure, casting or strapping\\n$ 100.21\\n29800\\n29800\\nArthroscopy, temporomandibular joint, diagnostic, with or without\\nsynovial biopsy (separate procedure)\\n$ 1,545.30\\n29804\\n29804\\nArthroscopy, temporomandibular joint, surgical\\n$ 2,266.20\\n29805\\n29805\\nArthroscopy, shoulder, diagnostic, with or without synovial biopsy\\n(separate procedure)\\n$ 1,129.02\\n29806\\n29806\\nArthroscopy, shoulder, surgical; capsulorrhaphy\\n$ 2,796.86\\n29807\\n29807\\nArthroscopy, shoulder, surgical; repair of SLAP lesion\\n$ 2,663.48\\n29819\\n29819\\nArthroscopy, shoulder, surgical; with removal of loose body or\\nforeign body\\n$ 2,304.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n117\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n118\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n29820\\n29820\\nArthroscopy, shoulder, surgical; synovectomy, partial\\n$ 2,215.80\\n29821\\n29821\\nArthroscopy, shoulder, surgical; synovectomy, complete\\n$ 2,396.70\\n29822\\n29822\\nArthroscopy, shoulder, surgical; debridement, limited\\n$ 2,419.20\\n29823\\n29823\\nArthroscopy, shoulder, surgical; debridement, extensive\\n$ 2,801.70\\n29824\\n29824\\nArthroscopy, shoulder, surgical; distal claviculectomy including\\ndistal articular surface (Mumford procedure)\\n$ 1,813.74\\n29825\\n29825\\nArthroscopy, shoulder, surgical; with lysis and resection of\\nadhesions, with or without manipulation\\n$ 2,412.00\\n29826\\n29826\\nArthroscopy, shoulder, surgical; decompression of subacromial\\nspace with partial acromioplasty, with coracoacromial ligament (ie,\\narch)release, when performed (List separately in addition to code\\nfor primary procedure)\\n$ 2,722.75\\n29827\\n29827\\nArthroscopy, shoulder, surgical; with rotator cuff repair\\n$ 2,928.75\\n29828\\n29828\\nArthroscopy, shoulder, surgical; biceps tenodesis\\n$ 2,558.94\\n29830\\n29830\\nArthroscopy, elbow, diagnostic, with or without synovial biopsy\\n(separate procedure)\\n$ 1,206.00\\n29834\\n29834\\nArthroscopy, elbow, surgical; with removal of loose body or foreign\\nbody\\n$ 2,052.00\\n29835\\n29835\\nArthroscopy, elbow, surgical; synovectomy, partial\\n$ 2,308.50\\n29836\\n29836\\nArthroscopy, elbow, surgical; synovectomy, complete\\n$ 2,322.90\\n29837\\n29837\\nArthroscopy, elbow, surgical; debridement, limited\\n$ 1,981.80\\n29838\\n29838\\nArthroscopy, elbow, surgical; debridement, extensive\\n$ 2,250.90\\n29840\\n29840\\nArthroscopy, wrist, diagnostic, with or without synovial biopsy\\n(separate procedure)\\n$ 1,214.10\\n29843\\n29843\\nArthroscopy, wrist, surgical; for infection, lavage and drainage\\n$ 1,751.40\\n29844\\n29844\\nArthroscopy, wrist, surgical; synovectomy, partial\\n$ 1,881.00\\n29845\\n29845\\nArthroscopy, wrist, surgical; synovectomy, complete\\n$ 1,916.10\\n29846\\n29846\\nArthroscopy, wrist, surgical; excision and\/or repair of triangular\\nfibrocartilage and\/or joint debridement\\n$ 2,266.20\\n29847\\n29847\\nArthroscopy, wrist, surgical; internal fixation for fracture or\\ninstability\\n$ 2,093.40\\n29848\\n29848\\nEndoscopy, wrist, surgical, with release of transverse carpal\\nligament\\n$ 1,758.60\\n29850\\n29850\\nArthroscopically aided treatment of intercondylar spine(s) and\/or\\ntuberosity fracture(s) of the knee, with or without manipulation;\\nwithout internal or external fixation (includes arthroscopy)\\n$ 2,285.10\\n29851\\n29851\\nArthroscopically aided treatment of intercondylar spine(s) and\/or\\ntuberosity fracture(s) of the knee, with or without manipulation;\\nwith internal or external fixation (includes arthroscopy)\\n$ 2,887.20\\n29855\\n29855\\nArthroscopically aided treatment of tibial fracture, proximal\\n(plateau); unicondylar, includes internal fixation, when performed\\n(includes arthroscopy)\\n$ 2,574.90\\n29856\\n29856\\nArthroscopically aided treatment of tibial fracture, proximal\\n(plateau); bicondylar, includes internal fixation, when performed\\n(includes arthroscopy)\\n$ 2,907.90\\n29860\\n29860\\nArthroscopy, hip, diagnostic with or without synovial biopsy\\n(separate procedure)\\n$ 1,547.10\\n29861\\n29861\\nArthroscopy, hip, surgical; with removal of loose body or foreign\\nbody\\n$ 2,295.90\\n29862\\n29862\\nArthroscopy, hip, surgical; with debridement\/shaving of articular\\ncartilage (chondroplasty), abrasion arthroplasty, and\/or resection of\\nlabrum\\n$ 2,525.40\\n29863\\n29863\\nArthroscopy, hip, surgical; with synovectomy\\n$ 2,306.70\\n29866\\n29866\\nArthroscopy, knee, surgical; osteochondral autograft(s) (eg,\\nmosaicplasty) (includes harvesting of the autograft[s])\\n$ 2,666.26\\n29867\\n29867\\nArthroscopy, knee, surgical; osteochondral allograft (eg,\\nmosaicplasty)\\n$ 4,120.16\\n29868\\n29868\\nArthroscopy, knee, surgical; meniscal transplantation (includes\\narthrotomy for meniscal insertion), medial or lateral\\n$ 5,488.61\\n29870\\n29870\\nArthroscopy, knee, diagnostic, with or without synovial biopsy\\n(separate procedure)\\n$ 1,352.70\\n29871\\n29871\\nArthroscopy, knee, surgical; for infection, lavage and drainage\\n$ 1,984.50\\n29873\\n29873\\nArthroscopy, knee, surgical; with lateral release\\n$ 1,675.37\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n119\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n120\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n29874\\n29874\\nArthroscopy, knee, surgical; for removal of loose body or foreign\\nbody (eg, osteochondritis dissecans fragmentation, chondral\\nfragmentation)\\n$ 2,348.10\\n29875\\n29875\\nArthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf\\nresection) (separate procedure)\\n$ 2,459.70\\n29876\\n29876\\nArthroscopy, knee, surgical; synovectomy, major, 2 or more\\ncompartments (eg, medial or lateral)\\n$ 2,733.79\\n29877\\n29877\\nArthroscopy, knee, surgical; debridement\/shaving of articular\\ncartilage (chondroplasty)\\n$ 2,552.87\\n29879\\n29879\\nArthroscopy, knee, surgical; abrasion arthroplasty (includes\\nchondroplasty where necessary) or multiple drilling or\\nmicrofracture\\n$ 2,652.30\\n29880\\n29880\\nArthroscopy, knee, surgical; with meniscectomy (medial AND\\nlateral, including any meniscal shaving) including\\ndebridement\/shaving of articular cartilage (chondroplasty), same or\\nseparate compartment(s), when performed\\n$ 3,254.71\\n29882\\n29882\\nArthroscopy, knee, surgical; with meniscus repair (medial OR\\nlateral)\\n$ 2,919.72\\n29883\\n29883\\nArthroscopy, knee, surgical; with meniscus repair (medial AND\\nlateral)\\n$ 3,747.60\\n29884\\n29884\\nArthroscopy, knee, surgical; with lysis of adhesions, with or without\\nmanipulation (separate procedure)\\n$ 2,337.30\\n29885\\n29885\\nArthroscopy, knee, surgical; drilling for osteochondritis dissecans\\nwith bone grafting, with or without internal fixation (including\\ndebridement of base of lesion)\\n$ 2,697.30\\n29886\\n29886\\nArthroscopy, knee, surgical; drilling for intact osteochondritis\\ndissecans lesion\\n$ 2,547.90\\n29887\\n29887\\nArthroscopy, knee, surgical; drilling for intact osteochondritis\\ndissecans lesion with internal fixation\\n$ 3,380.40\\n29888\\n29888\\nArthroscopically aided anterior cruciate ligament\\nrepair\/augmentation or reconstruction\\n$ 4,793.75\\n29889\\n29889\\nArthroscopically aided posterior cruciate ligament\\nrepair\/augmentation or reconstruction\\n$ 4,867.20\\n29891\\n29891\\nArthroscopy, ankle, surgical, excision of osteochondral defect of\\ntalus and\/or tibia, including drilling of the defect\\n$ 2,214.90\\n29892\\n29892\\nArthroscopically aided repair of large osteochondritis dissecans\\nlesion, talar dome fracture, or tibial plafond fracture, with or\\nwithout internal fixation (includes arthroscopy)\\n$ 2,223.90\\n29893\\n29893\\nEndoscopic plantar fasciotomy\\n$ 1,233.00\\n29894\\n29894\\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with\\nremoval of loose body or foreign body\\n$ 2,206.80\\n29895\\n29895\\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical;\\nsynovectomy, partial\\n$ 2,299.50\\n29897\\n29897\\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical;\\ndebridement, limited\\n$ 2,115.00\\n29898\\n29898\\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical;\\ndebridement, extensive\\n$ 2,721.60\\n29899\\n29899\\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with\\nankle arthrodesis\\n$ 2,665.75\\n29900\\n29900\\nArthroscopy, metacarpophalangeal joint, diagnostic, includes\\nsynovial biopsy\\n$ 1,121.89\\n29901\\n29901\\nArthroscopy, metacarpophalangeal joint, surgical; with\\ndebridement\\n$ 1,598.44\\n29902\\n29902\\nArthroscopy, metacarpophalangeal joint, surgical; with reduction of\\ndisplaced ulnar collateral ligament (eg, Stenar lesion)\\n$ 1,839.03\\n29904\\n29904\\nArthroscopy, subtalar joint, surgical; with removal of loose body or\\nforeign body\\n$ 2,032.59\\n29905\\n29905\\nArthroscopy, subtalar joint, surgical; with synovectomy\\n$ 2,146.58\\n29906\\n29906\\nArthroscopy, subtalar joint, surgical; with debridement\\n$ 2,078.55\\n29907\\n29907\\nArthroscopy, subtalar joint, surgical; with subtalar arthrodesis\\n$ 2,547.20\\n29999\\n29999\\nUnlisted procedure, arthroscopy\\nCost\\n30000\\n30000\\nDrainage abscess or hematoma, nasal, internal approach\\n$ 329.40\\n30020\\n30020\\nDrainage abscess or hematoma, nasal septum\\n$ 311.40\\n30100\\n30100\\nBiopsy, intranasal\\n$ 187.20\\n30110\\n30110\\nExcision, nasal polyp(s), simple\\n$ 385.20\\n30115\\n30115\\nExcision, nasal polyp(s), extensive\\n$ 992.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n121\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n122\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n30117\\n30117\\nExcision or destruction (eg, laser), intranasal lesion; internal\\napproach\\n$ 871.20\\n30118\\n30118\\nExcision or destruction (eg, laser), intranasal lesion; external\\napproach (lateral rhinotomy)\\n$ 2,187.00\\n30120\\n30120\\nExcision or surgical planing of skin of nose for rhinophyma\\n$ 2,003.40\\n30124\\n30124\\nExcision dermoid cyst, nose; simple, skin, subcutaneous\\n$ 774.00\\n30125\\n30125\\nExcision dermoid cyst, nose; complex, under bone or cartilage\\n$ 1,936.80\\n30130\\n30130\\nExcision inferior turbinate, partial or complete, any method\\n$ 785.70\\n30140\\n30140\\nSubmucous resection inferior turbinate, partial or complete, any\\nmethod\\n$ 1,149.30\\n30150\\n30150\\nRhinectomy; partial\\n$ 2,242.80\\n30160\\n30160\\nRhinectomy; total\\n$ 2,889.00\\n30200\\n30200\\nInjection into turbinate(s), therapeutic\\n$ 129.60\\n30210\\n30210\\nDisplacement therapy (Proetz type)\\n$ 211.50\\n30220\\n30220\\nInsertion, nasal septal prosthesis (button)\\n$ 401.40\\n30300\\n30300\\nRemoval foreign body, intranasal; office type procedure\\n$ 134.21\\n30310\\n30310\\nRemoval foreign body, intranasal; requiring general anesthesia\\n$ 567.90\\n30320\\n30320\\nRemoval foreign body, intranasal; by lateral rhinotomy\\n$ 1,482.30\\n30400\\n30400\\nRhinoplasty, primary; lateral and alar cartilages and\/or elevation of\\nnasal tip\\n$ 3,656.70\\n30410\\n30410\\nRhinoplasty, primary; complete, external parts including bony\\npyramid, lateral and alar cartilages, and\/or elevation of nasal tip\\n$ 3,969.90\\n30420\\n30420\\nRhinoplasty, primary; including major septal repair\\n$ 4,673.70\\n30430\\n30430\\nRhinoplasty, secondary; minor revision (small amount of nasal tip\\nwork)\\n$ 1,877.40\\n30435\\n30435\\nRhinoplasty, secondary; intermediate revision (bony work with\\nosteotomies)\\n$ 2,531.70\\n30450\\n30450\\nRhinoplasty, secondary; major revision (nasal tip work and\\nosteotomies)\\n$ 4,104.90\\n30460\\n30460\\nRhinoplasty for nasal deformity secondary to congenital cleft lip\\nand\/or palate, including columellar lengthening; tip only\\n$ 2,551.50\\n30462\\n30462\\nRhinoplasty for nasal deformity secondary to congenital cleft lip\\nand\/or palate, including columellar lengthening; tip, septum,\\nosteotomies\\n$ 4,778.10\\n30465\\n30465\\nRepair of nasal vestibular stenosis (eg, spreader grafting, lateral\\nnasal wall reconstruction)\\n$ 2,367.57\\n30520\\n30520\\nSeptoplasty or submucous resection, with or without cartilage\\nscoring, contouring or replacement with graft\\n$ 2,891.27\\n30540\\n30540\\nRepair choanal atresia; intranasal\\n$ 2,054.70\\n30545\\n30545\\nRepair choanal atresia; transpalatine\\n$ 3,063.60\\n30560\\n30560\\nLysis intranasal synechia\\n$ 240.30\\n30580\\n30580\\nRepair fistula; oromaxillary (combine with 31030 if antrotomy is\\nincluded)\\n$ 1,683.00\\n30600\\n30600\\nRepair fistula; oronasal\\n$ 1,819.80\\n30620\\n30620\\nSeptal or other intranasal dermatoplasty (does not include\\nobtaining graft)\\n$ 2,832.30\\n30630\\n30630\\nRepair nasal septal perforations\\n$ 2,162.70\\n30801\\n30801\\nAblation, soft tissue of inferior turbinates, unilateral or bilateral,\\nany method (eg, electrocautery, radiofrequency ablation, or tissue\\nvolume reduction); superficial\\n$ 264.60\\n30802\\n30802\\nAblation, soft tissue of inferior turbinates, unilateral or bilateral,\\nany method (eg, electrocautery, radiofrequency ablation, or tissue\\nvolume reduction); intramural (ie, submucosal)\\n$ 407.70\\n30901\\n30901\\nControl nasal hemorrhage, anterior, simple (limited cautery and\/or\\npacking) any method\\n$ 189.81\\n30903\\n30903\\nControl nasal hemorrhage, anterior, complex (extensive cautery\\nand\/or packing) any method\\n$ 280.57\\n30905\\n30905\\nControl nasal hemorrhage, posterior, with posterior nasal packs\\nand\/or cautery, any method; initial\\n$ 495.90\\n30906\\n30906\\nControl nasal hemorrhage, posterior, with posterior nasal packs\\nand\/or cautery, any method; subsequent\\n$ 449.10\\n30915\\n30915\\nLigation arteries; ethmoidal\\n$ 1,781.10\\n30920\\n30920\\nLigation arteries; internal maxillary artery, transantral\\n$ 2,600.10\\n30930\\n30930\\nFracture nasal inferior turbinate(s), therapeutic\\n$ 437.40\\n30999\\n30999\\nUnlisted procedure, nose\\nCost\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n123\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n124\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n31000\\n31000\\nLavage by cannulation; maxillary sinus (antrum puncture or natural\\nostium)\\n$ 134.23\\n31002\\n31002\\nLavage by cannulation; sphenoid sinus\\n$ 291.60\\n31020\\n31020\\nSinusotomy, maxillary (antrotomy); intranasal\\n$ 822.60\\n31030\\n31030\\nSinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without\\nremoval of antrochoanal polyps\\n$ 1,966.50\\n31032\\n31032\\nSinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with\\nremoval of antrochoanal polyps\\n$ 2,162.70\\n31040\\n31040\\nPterygomaxillary fossa surgery, any approach\\n$ 3,172.50\\n31050\\n31050\\nSinusotomy, sphenoid, with or without biopsy;\\n$ 1,484.10\\n31051\\n31051\\nSinusotomy, sphenoid, with or without biopsy; with mucosal\\nstripping or removal of polyp(s)\\n$ 2,057.40\\n31070\\n31070\\nSinusotomy frontal; external, simple (trephine operation)\\n$ 1,499.40\\n31075\\n31075\\nSinusotomy frontal; transorbital, unilateral (for mucocele or\\nosteoma, Lynch type)\\n$ 2,574.00\\n31080\\n31080\\nSinusotomy frontal; obliterative without osteoplastic flap, brow\\nincision (includes ablation)\\n$ 3,005.10\\n31081\\n31081\\nSinusotomy frontal; obliterative, without osteoplastic flap, coronal\\nincision (includes ablation)\\n$ 2,971.80\\n31084\\n31084\\nSinusotomy frontal; obliterative, with osteoplastic flap, brow\\nincision\\n$ 3,605.40\\n31085\\n31085\\nSinusotomy frontal; obliterative, with osteoplastic flap, coronal\\nincision\\n$ 3,885.30\\n31086\\n31086\\nSinusotomy frontal; nonobliterative, with osteoplastic flap, brow\\nincision\\n$ 3,278.70\\n31087\\n31087\\nSinusotomy frontal; nonobliterative, with osteoplastic flap, coronal\\nincision\\n$ 3,210.30\\n31090\\n31090\\nSinusotomy, unilateral, 3 or more paranasal sinuses (frontal,\\nmaxillary, ethmoid, sphenoid)\\n$ 4,236.30\\n31200\\n31200\\nEthmoidectomy; intranasal, anterior\\n$ 1,301.40\\n31201\\n31201\\nEthmoidectomy; intranasal, total\\n$ 2,008.80\\n31205\\n31205\\nEthmoidectomy; extranasal, total\\n$ 2,160.00\\n31225\\n31225\\nMaxillectomy; without orbital exenteration\\n$ 4,426.20\\n31230\\n31230\\nMaxillectomy; with orbital exenteration (en bloc)\\n$ 5,388.30\\n31231\\n31231\\nNasal endoscopy, diagnostic, unilateral or bilateral (separate\\nprocedure)\\n$ 244.28\\n31233\\n31233\\nNasal\/sinus endoscopy, diagnostic with maxillary sinusoscopy (via\\ninferior meatus or canine fossa puncture)\\n$ 683.10\\n31235\\n31235\\nNasal\/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via\\npuncture of sphenoidal face or cannulation of ostium)\\n$ 760.50\\n31237\\n31237\\nNasal\/sinus endoscopy, surgical; with biopsy, polypectomy or\\ndebridement (separate procedure)\\n$ 871.20\\n31238\\n31238\\nNasal\/sinus endoscopy, surgical; with control of nasal hemorrhage\\n$ 909.90\\n31239\\n31239\\nNasal\/sinus endoscopy, surgical; with dacryocystorhinostomy\\n$ 2,768.40\\n31240\\n31240\\nNasal\/sinus endoscopy, surgical; with concha bullosa resection\\n$ 842.40\\n31254\\n31254\\nNasal\/sinus endoscopy, surgical; with ethmoidectomy, partial\\n(anterior)\\n$ 1,690.20\\n31255\\n31255\\nNasal\/sinus endoscopy, surgical; with ethmoidectomy, total\\n(anterior and posterior)\\n$ 1,789.35\\n31256\\n31256\\nNasal\/sinus endoscopy, surgical, with maxillary antrostomy;\\n$ 1,530.00\\n31267\\n31267\\nNasal\/sinus endoscopy, surgical, with maxillary antrostomy; with\\nremoval of tissue from maxillary sinus\\n$ 1,867.50\\n31276\\n31276\\nNasal\/sinus endoscopy, surgical with frontal sinus exploration, with\\nor without removal of tissue from frontal sinus\\n$ 1,931.40\\n31287\\n31287\\nNasal\/sinus endoscopy, surgical, with sphenoidotomy;\\n$ 1,337.40\\n31288\\n31288\\nNasal\/sinus endoscopy, surgical, with sphenoidotomy; with removal\\nof tissue from the sphenoid sinus\\n$ 1,647.90\\n31290\\n31290\\nNasal\/sinus endoscopy, surgical, with repair of cerebrospinal fluid\\nleak; ethmoid region\\n$ 3,514.50\\n31291\\n31291\\nNasal\/sinus endoscopy, surgical, with repair of cerebrospinal fluid\\nleak; sphenoid region\\n$ 3,903.30\\n31292\\n31292\\nNasal\/sinus endoscopy, surgical; with medial or inferior orbital wall\\ndecompression\\n$ 3,122.10\\n31293\\n31293\\nNasal\/sinus endoscopy, surgical; with medial orbital wall and\\ninferior orbital wall decompression\\n$ 3,414.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n125\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n126\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n31294\\n31294\\nNasal\/sinus endoscopy, surgical; with optic nerve decompression\\n$ 3,854.70\\n31299\\n31299\\nUnlisted procedure, accessory sinuses\\nCost\\n31300\\n31300\\nLaryngotomy (thyrotomy, laryngofissure); with removal of tumor or\\nlaryngocele, cordectomy\\n$ 2,842.20\\n31320\\n31320\\nLaryngotomy (thyrotomy, laryngofissure); diagnostic\\n$ 1,349.10\\n31360\\n31360\\nLaryngectomy; total, without radical neck dissection\\n$ 3,825.90\\n31365\\n31365\\nLaryngectomy; total, with radical neck dissection\\n$ 5,740.20\\n31367\\n31367\\nLaryngectomy; subtotal supraglottic, without radical neck dissection\\n$ 4,111.20\\n31368\\n31368\\nLaryngectomy; subtotal supraglottic, with radical neck dissection\\n$ 6,336.00\\n31370\\n31370\\nPartial laryngectomy (hemilaryngectomy); horizontal\\n$ 4,670.10\\n31375\\n31375\\nPartial laryngectomy (hemilaryngectomy); laterovertical\\n$ 3,898.80\\n31380\\n31380\\nPartial laryngectomy (hemilaryngectomy); anterovertical\\n$ 3,970.80\\n31382\\n31382\\nPartial laryngectomy (hemilaryngectomy); antero-latero-vertical\\n$ 4,020.30\\n31390\\n31390\\nPharyngolaryngectomy, with radical neck dissection; without\\nreconstruction\\n$ 5,854.50\\n31395\\n31395\\nPharyngolaryngectomy, with radical neck dissection; with\\nreconstruction\\n$ 6,849.90\\n31400\\n31400\\nArytenoidectomy or arytenoidopexy, external approach\\n$ 2,953.80\\n31420\\n31420\\nEpiglottidectomy\\n$ 2,694.60\\n31500\\n31500\\nIntubation, endotracheal, emergency procedure\\n$ 307.80\\n31502\\n31502\\nTracheotomy tube change prior to establishment of fistula tract\\n$ 195.30\\n31505\\n31505\\nLaryngoscopy, indirect; diagnostic (separate procedure)\\n$ 217.68\\n31510\\n31510\\nLaryngoscopy, indirect; with biopsy\\n$ 306.90\\n31511\\n31511\\nLaryngoscopy, indirect; with removal of foreign body\\n$ 391.50\\n31512\\n31512\\nLaryngoscopy, indirect; with removal of lesion\\n$ 429.30\\n31513\\n31513\\nLaryngoscopy, indirect; with vocal cord injection\\n$ 585.90\\n31515\\n31515\\nLaryngoscopy direct, with or without tracheoscopy; for aspiration\\n$ 377.10\\n31520\\n31520\\nLaryngoscopy direct, with or without tracheoscopy; diagnostic,\\nnewborn\\n$ 460.04\\n31525\\n31525\\nLaryngoscopy direct, with or without tracheoscopy; diagnostic,\\nexcept newborn\\n$ 647.10\\n31526\\n31526\\nLaryngoscopy direct, with or without tracheoscopy; diagnostic, with\\noperating microscope or telescope\\n$ 978.30\\n31527\\n31527\\nLaryngoscopy direct, with or without tracheoscopy; with insertion of\\nobturator\\n$ 1,164.60\\n31528\\n31528\\nLaryngoscopy direct, with or without tracheoscopy; with dilation,\\ninitial\\n$ 824.40\\n31529\\n31529\\nLaryngoscopy direct, with or without tracheoscopy; with dilation,\\nsubsequent\\n$ 772.20\\n31530\\n31530\\nLaryngoscopy, direct, operative, with foreign body removal;\\n$ 896.40\\n31531\\n31531\\nLaryngoscopy, direct, operative, with foreign body removal; with\\noperating microscope or telescope\\n$ 1,302.30\\n31535\\n31535\\nLaryngoscopy, direct, operative, with biopsy;\\n$ 903.60\\n31536\\n31536\\nLaryngoscopy, direct, operative, with biopsy; with operating\\nmicroscope or telescope\\n$ 1,141.20\\n31540\\n31540\\nLaryngoscopy, direct, operative, with excision of tumor and\/or\\nstripping of vocal cords or epiglottis;\\n$ 1,155.60\\n31541\\n31541\\nLaryngoscopy, direct, operative, with excision of tumor and\/or\\nstripping of vocal cords or epiglottis; with operating microscope or\\ntelescope\\n$ 1,328.82\\n31545\\n31545\\nLaryngoscopy, direct, operative, with operating microscope or\\ntelescope, with submucosal removal of non-neoplastic lesion(s) of\\nvocal cord; reconstruction with local tissue flap(s)\\n$ 1,137.51\\n31546\\n31546\\nLaryngoscopy, direct, operative, with operating microscope or\\ntelescope, with submucosal removal of non-neoplastic lesion(s) of\\nvocal cord; reconstruction with graft(s) (includes obtaining\\nautograft)\\n$ 1,746.43\\n31560\\n31560\\nLaryngoscopy, direct, operative, with arytenoidectomy;\\n$ 2,224.80\\n31561\\n31561\\nLaryngoscopy, direct, operative, with arytenoidectomy; with\\noperating microscope or telescope\\n$ 2,378.70\\n31570\\n31570\\nLaryngoscopy, direct, with injection into vocal cord(s), therapeutic;\\n$ 1,323.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n127\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n128\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n31571\\n31571\\nLaryngoscopy, direct, with injection into vocal cord(s), therapeutic;\\nwith operating microscope or telescope\\n$ 1,458.90\\n31575\\n31575\\nLaryngoscopy, flexible fiberoptic; diagnostic\\n$ 323.11\\n31576\\n31576\\nLaryngoscopy, flexible fiberoptic; with biopsy\\n$ 568.80\\n31577\\n31577\\nLaryngoscopy, flexible fiberoptic; with removal of foreign body\\n$ 982.80\\n31578\\n31578\\nLaryngoscopy, flexible fiberoptic; with removal of lesion\\n$ 1,133.10\\n31579\\n31579\\nLaryngoscopy, flexible or rigid fiberoptic, with stroboscopy\\n$ 626.40\\n31580\\n31580\\nLaryngoplasty; for laryngeal web, 2- stage, with keel insertion and\\nremoval\\n$ 3,399.30\\n31582\\n31582\\nLaryngoplasty; for laryngeal stenosis, with graft or core mold,\\nincluding tracheotomy\\n$ 4,155.30\\n31584\\n31584\\nLaryngoplasty; with open reduction of fracture\\n$ 3,971.70\\n31587\\n31587\\nLaryngoplasty, cricoid split\\n$ 2,544.30\\n31588\\n31588\\nLaryngoplasty, not otherwise specified (eg, for burns, reconstruction\\nafter partial laryngectomy)\\n$ 3,209.40\\n31590\\n31590\\nLaryngeal reinnervation by neuromuscular pedicle\\n$ 2,811.60\\n31595\\n31595\\nSection recurrent laryngeal nerve, therapeutic (separate\\nprocedure), unilateral\\n$ 2,338.20\\n31599\\n31599\\nUnlisted procedure, larynx\\nCost\\n31600\\n31600\\nTracheostomy, planned (separate procedure);\\n$ 1,148.40\\n31601\\n31601\\nTracheostomy, planned (separate procedure); younger than 2 years\\n$ 1,423.80\\n31605\\n31605\\nTracheostomy, emergency procedure; cricothyroid membrane\\n$ 957.60\\n31610\\n31610\\nTracheostomy, fenestration procedure with skin flaps\\n$ 1,731.60\\n31611\\n31611\\nConstruction of tracheoesophageal fistula and subsequent insertion\\nof an alaryngeal speech prosthesis (eg, voice button, Blom-Singer\\nprosthesis)\\n$ 1,748.70\\n31612\\n31612\\nTracheal puncture, percutaneous with transtracheal aspiration\\nand\/or injection\\n$ 232.20\\n31613\\n31613\\nTracheostoma revision; simple, without flap rotation\\n$ 767.70\\n31614\\n31614\\nTracheostoma revision; complex, with flap rotation\\n$ 1,881.90\\n31615\\n31615\\nTracheobronchoscopy through established tracheostomy incision\\n$ 555.30\\n31620\\n31620\\nEndobronchial ultrasound (EBUS) during bronchoscopic diagnostic\\nor therapeutic intervention(s) (List separately in addition to code for\\nprimary procedure[s])\\n$ 798.23\\n31622\\n31622\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; diagnostic, with cell washing, when performed\\n(separate procedure)\\n$ 715.50\\n31623\\n31623\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with brushing or protected brushings\\n$ 686.70\\n31624\\n31624\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with bronchial alveolar lavage\\n$ 693.00\\n31625\\n31625\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with bronchial or endobronchial biopsy(s), single\\nor multiple sites\\n$ 822.60\\n31626\\n31626\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with placement of fiducial markers, single or\\nmultiple\\n$ 823.11\\n31627\\n31627\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with computer-assisted, image-guided navigation\\n(List separately in addition to code for primary procedure[s])\\n$ 948.86\\n31628\\n31628\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with transbronchial lung biopsy(s), single lobe\\n$ 915.30\\n31629\\n31629\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with transbronchial needle aspiration biopsy(s),\\ntrachea, main stem and\/or lobar bronchus(i)\\n$ 922.50\\n31630\\n31630\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with tracheal\/bronchial dilation or closed\\nreduction of fracture\\n$ 874.80\\n31632\\n31632\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with transbronchial lung biopsy(s), each\\nadditional lobe (List separately in addition to code for primary\\nprocedure)\\n$ 221.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n129\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n130\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n31633\\n31633\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with transbronchial needle aspiration biopsy(s),\\neach additional lobe (List separately in addition to code for primary\\nprocedure)\\n$ 302.61\\n31635\\n31635\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with removal of foreign body\\n$ 992.70\\n31636\\n31636\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with placement of bronchial stent(s) (includes\\ntracheal\/bronchial dilation as required), initial bronchus\\n$ 822.83\\n31637\\n31637\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; each additional major bronchus stented (List\\nseparately in addition to code for primary procedure)\\n$ 274.30\\n31638\\n31638\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with revision of tracheal or bronchial stent\\ninserted at previous session (includes tracheal\/bronchial dilation as\\nrequired)\\n$ 907.48\\n31640\\n31640\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with excision of tumor\\n$ 1,161.00\\n31641\\n31641\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with destruction of tumor or relief of stenosis by\\nany method other than excision (eg, laser therapy, cryotherapy)\\n$ 1,545.30\\n31643\\n31643\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with placement of catheter(s) for intracavitary\\nradioelement application\\n$ 606.60\\n31645\\n31645\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with therapeutic aspiration of tracheobronchial\\ntree, initial (eg, drainage of lung abscess)\\n$ 801.00\\n31646\\n31646\\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\\nwhen performed; with therapeutic aspiration of tracheobronchial\\ntree, subsequent\\n$ 706.50\\n31717\\n31717\\nCatheterization with bronchial brush biopsy\\n$ 230.40\\n31720\\n31720\\nCatheter aspiration (separate procedure); nasotracheal\\n$ 169.20\\n31725\\n31725\\nCatheter aspiration (separate procedure); tracheobronchial with\\nfiberscope, bedside\\n$ 406.80\\n31730\\n31730\\nTranstracheal (percutaneous) introduction of needle wire\\ndilator\/stent or indwelling tube for oxygen therapy\\n$ 668.70\\n31750\\n31750\\nTracheoplasty; cervical\\n$ 3,236.40\\n31755\\n31755\\nTracheoplasty; tracheopharyngeal fistulization, each stage\\n$ 3,572.10\\n31760\\n31760\\nTracheoplasty; intrathoracic\\n$ 3,681.00\\n31766\\n31766\\nCarinal reconstruction\\n$ 4,428.90\\n31770\\n31770\\nBronchoplasty; graft repair\\n$ 3,687.30\\n31775\\n31775\\nBronchoplasty; excision stenosis and anastomosis\\n$ 4,083.30\\n31780\\n31780\\nExcision tracheal stenosis and anastomosis; cervical\\n$ 3,804.30\\n31781\\n31781\\nExcision tracheal stenosis and anastomosis; cervicothoracic\\n$ 4,003.20\\n31785\\n31785\\nExcision of tracheal tumor or carcinoma; cervical\\n$ 3,078.00\\n31786\\n31786\\nExcision of tracheal tumor or carcinoma; thoracic\\n$ 4,113.90\\n31800\\n31800\\nSuture of tracheal wound or injury; cervical\\n$ 2,929.50\\n31805\\n31805\\nSuture of tracheal wound or injury; intrathoracic\\n$ 2,932.20\\n31820\\n31820\\nSurgical closure tracheostomy or fistula; without plastic repair\\n$ 899.10\\n31825\\n31825\\nSurgical closure tracheostomy or fistula; with plastic repair\\n$ 1,259.10\\n31830\\n31830\\nRevision of tracheostomy scar\\n$ 927.00\\n31899\\n31899\\nUnlisted procedure, trachea, bronchi\\n$ 951.62\\n32035\\n32035\\nThoracostomy; with rib resection for empyema\\n$ 1,596.60\\n32036\\n32036\\nThoracostomy; with open flap drainage for empyema\\n$ 1,944.00\\n32096\\n32096\\nThoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg,\\nwedge, incisional), unilateral\\n$ 2,016.26\\n32097\\n32097\\nThoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or\\nmass(es) (eg, wedge, incisional), unilateral\\n$ 2,016.26\\n32098\\n32098\\nThoracotomy, with biopsy(ies) of pleura\\n$ 1,955.37\\n32100\\n32100\\nThoracotomy; with exploration\\n$ 2,701.80\\n32110\\n32110\\nThoracotomy; with control of traumatic hemorrhage and\/or repair\\nof lung tear\\n$ 3,024.90\\n32120\\n32120\\nThoracotomy; for postoperative complications\\n$ 2,522.70\\n32124\\n32124\\nThoracotomy; with open intrapleural pneumonolysis\\n$ 2,365.20\\n32140\\n32140\\nThoracotomy; with cyst(s) removal, includes pleural procedure\\nwhen performed\\n$ 2,574.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n131\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n132\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n32141\\n32141\\nThoracotomy; with resection-plication of bullae, includes any\\npleural procedure when performed\\n$ 2,962.80\\n32150\\n32150\\nThoracotomy; with removal of intrapleural foreign body or fibrin\\ndeposit\\n$ 2,801.70\\n32151\\n32151\\nThoracotomy; with removal of intrapulmonary foreign body\\n$ 2,255.40\\n32160\\n32160\\nThoracotomy; with cardiac massage\\n$ 2,646.00\\n32200\\n32200\\nPneumonostomy, with open drainage of abscess or cyst\\n$ 2,478.60\\n32215\\n32215\\nPleural scarification for repeat pneumothorax\\n$ 2,565.90\\n32220\\n32220\\nDecortication, pulmonary (separate procedure); total\\n$ 3,480.30\\n32225\\n32225\\nDecortication, pulmonary (separate procedure); partial\\n$ 2,477.70\\n32310\\n32310\\nPleurectomy, parietal (separate procedure)\\n$ 3,073.50\\n32320\\n32320\\nDecortication and parietal pleurectomy\\n$ 4,303.80\\n32400\\n32400\\nBiopsy, pleura; percutaneous needle\\n$ 387.90\\n32405\\n32405\\nBiopsy, lung or mediastinum, percutaneous needle;\\n$ 518.40\\n32440\\n32440\\nRemoval of lung, pneumonectomy;\\n$ 4,605.30\\n32442\\n32442\\nRemoval of lung, pneumonectomy; with resection of segment of\\ntrachea followed by broncho-tracheal anastomosis (sleeve\\npneumonectomy)\\n$ 4,649.40\\n32445\\n32445\\nRemoval of lung, pneumonectomy; extrapleural\\n$ 4,839.30\\n32480\\n32480\\nRemoval of lung, other than pneumonectomy; single lobe\\n(lobectomy)\\n$ 4,327.20\\n32482\\n32482\\nRemoval of lung, other than pneumonectomy; 2 lobes\\n(bilobectomy)\\n$ 4,661.10\\n32484\\n32484\\nRemoval of lung, other than pneumonectomy; single segment\\n(segmentectomy)\\n$ 4,255.20\\n32486\\n32486\\nRemoval of lung, other than pneumonectomy; with circumferential\\nresection of segment of bronchus followed by broncho-bronchial\\nanastomosis (sleeve lobectomy)\\n$ 4,365.00\\n32488\\n32488\\nRemoval of lung, other than pneumonectomy; with all remaining\\nlung following previous removal of a portion of lung (completion\\npneumonectomy)\\n$ 5,346.00\\n32491\\n32491\\nRemoval of lung, other than pneumonectomy; with resection-\\nplication of emphysematous lung(s) (bullous or non-bullous) for\\nlung volume reduction, sternal split or transthoracic approach,\\nincludes any pleural procedure, when performed\\n$ 3,131.92\\n32501\\n32501\\nResection and repair of portion of bronchus (bronchoplasty) when\\nperformed at time of lobectomy or segmentectomy (List separately\\nin addition to code for primary procedure)\\n$ 529.40\\n32503\\n32503\\nResection of apical lung tumor (eg, Pancoast tumor), including chest\\nwall resection, rib(s) resection(s), neurovascular dissection, when\\nperformed; without chest wall reconstruction(s)\\n$ 4,016.73\\n32504\\n32504\\nResection of apical lung tumor (eg, Pancoast tumor), including chest\\nwall resection, rib(s) resection(s), neurovascular dissection, when\\nperformed; with chest wall reconstruction\\n$ 4,300.61\\n32505\\n32505\\nThoracotomy; with therapeutic wedge resection (eg, mass, nodule),\\ninitial\\n$ 2,383.63\\n32506\\n32506\\nThoracotomy; with therapeutic wedge resection (eg, mass or\\nnodule), each additional resection, ipsilateral (List separately in\\naddition to code for primary procedure)\\n$ 409.31\\n32507\\n32507\\nThoracotomy; with diagnostic wedge resection followed by\\nanatomic lung resection (List separately in addition to code for\\nprimary procedure)\\n$ 409.31\\n32540\\n32540\\nExtrapleural enucleation of empyema (empyemectomy)\\n$ 3,656.70\\n32550\\n32550\\nInsertion of indwelling tunneled pleural catheter with cuff\\n$ 739.02\\n32551\\n32551\\nTube thoracostomy, includes connection to drainage system (eg,\\nwater seal), when performed, open (separate procedure)\\n$ 397.73\\n32552\\n32552\\nRemoval of indwelling tunneled pleural catheter with cuff\\n$ 393.46\\n32553\\n32553\\nPlacement of interstitial device(s) for radiation therapy guidance\\n(eg, fiducial markers, dosimeter), percutaneous, intra-thoracic,\\nsingle or multiple\\n$ 603.94\\n32554\\n32554\\nThoracentesis, needle or catheter, aspiration of the pleural space;\\nwithout imaging guidance\\n$ 1,393.37\\n32555\\n32555\\nThoracentesis, needle or catheter, aspiration of the pleural space;\\nwith imaging guidance\\n$ 1,606.11\\n32560\\n32560\\nInstillation, via chest tube\/catheter, agent for pleurodesis (eg, talc\\nfor recurrent or persistent pneumothorax)\\n$ 300.45\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n133\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n134\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n32561\\n32561\\nInstillation(s), via chest tube\/catheter, agent for fibrinolysis (eg,\\nfibrinolytic agent for break up of multiloculated effusion); initial day $ 184.63\\n32562\\n32562\\nInstillation(s), via chest tube\/catheter, agent for fibrinolysis (eg,\\nfibrinolytic agent for break up of multiloculated effusion);\\nsubsequent day\\n$ 170.85\\n32601\\n32601\\nThoracoscopy, diagnostic (separate procedure); lungs, pericardial\\nsac, mediastinal or pleural space, without biopsy\\n$ 1,074.60\\n32604\\n32604\\nThoracoscopy, diagnostic (separate procedure); pericardial sac, with\\nbiopsy\\n$ 1,803.60\\n32606\\n32606\\nThoracoscopy, diagnostic (separate procedure); mediastinal space,\\nwith biopsy\\n$ 1,832.40\\n32607\\n32607\\nThoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg,\\nwedge, incisional), unilateral\\n$ 795.40\\n32608\\n32608\\nThoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or\\nmass(es) (eg, wedge, incisional), unilateral\\n$ 979.00\\n32609\\n32609\\nThoracoscopy; with biopsy(ies) of pleura\\n$ 675.96\\n32650\\n32650\\nThoracoscopy, surgical; with pleurodesis (eg, mechanical or\\nchemical)\\n$ 2,230.20\\n32651\\n32651\\nThoracoscopy, surgical; with partial pulmonary decortication\\n$ 2,722.50\\n32652\\n32652\\nThoracoscopy, surgical; with total pulmonary decortication,\\nincluding intrapleural pneumonolysis\\n$ 3,548.70\\n32653\\n32653\\nThoracoscopy, surgical; with removal of intrapleural foreign body or\\nfibrin deposit\\n$ 2,567.70\\n32654\\n32654\\nThoracoscopy, surgical; with control of traumatic hemorrhage\\n$ 2,729.70\\n32655\\n32655\\nThoracoscopy, surgical; with resection-plication of bullae, includes\\nany pleural procedure when performed\\n$ 2,972.70\\n32656\\n32656\\nThoracoscopy, surgical; with parietal pleurectomy\\n$ 2,995.20\\n32658\\n32658\\nThoracoscopy, surgical; with removal of clot or foreign body from\\npericardial sac\\n$ 2,766.60\\n32659\\n32659\\nThoracoscopy, surgical; with creation of pericardial window or\\npartial resection of pericardial sac for drainage\\n$ 2,986.20\\n32661\\n32661\\nThoracoscopy, surgical; with excision of pericardial cyst, tumor, or\\nmass\\n$ 3,141.90\\n32662\\n32662\\nThoracoscopy, surgical; with excision of mediastinal cyst, tumor, or\\nmass\\n$ 3,102.30\\n32663\\n32663\\nThoracoscopy, surgical; with lobectomy (single lobe)\\n$ 3,747.60\\n32664\\n32664\\nThoracoscopy, surgical; with thoracic sympathectomy\\n$ 2,699.10\\n32665\\n32665\\nThoracoscopy, surgical; with esophagomyotomy (Heller type)\\n$ 3,350.70\\n32666\\n32666\\nThoracoscopy, surgical; with therapeutic wedge resection (eg, mass,\\nnodule), initial unilateral\\n$ 2,222.05\\n32667\\n32667\\nThoracoscopy, surgical; with therapeutic wedge resection (eg, mass\\nor nodule), each additional resection, ipsilateral (List separately in\\naddition to code for primary procedure)\\n$ 409.31\\n32668\\n32668\\nThoracoscopy, surgical; with diagnostic wedge resection followed by\\nanatomic lung resection (List separately in addition to code for\\nprimary procedure)\\n$ 411.71\\n32669\\n32669\\nThoracoscopy, surgical; with removal of a single lung segment\\n(segmentectomy)\\n$ 3,335.83\\n32670\\n32670\\nThoracoscopy, surgical; with removal of two lobes (bilobectomy)\\n$ 3,974.02\\n32671\\n32671\\nThoracoscopy, surgical; with removal of lung (pneumonectomy)\\n$ 4,409.85\\n32672\\n32672\\nThoracoscopy, surgical; with resection-plication for emphysematous\\nlung (bullous or non-bullous) for lung volume reduction (LVRS),\\nunilateral includes any pleural procedure, when performed\\n$ 3,774.81\\n32673\\n32673\\nThoracoscopy, surgical; with resection of thymus, unilateral or\\nbilateral\\n$ 2,957.25\\n32674\\n32674\\nThoracoscopy, surgical; with mediastinal and regional\\nlymphadenectomy (List separately in addition to code for primary\\nprocedure)\\n$ 531.96\\n32800\\n32800\\nRepair lung hernia through chest wall\\n$ 2,565.00\\n32810\\n32810\\nClosure of chest wall following open flap drainage for empyema\\n(Clagett type procedure)\\n$ 2,710.80\\n32815\\n32815\\nOpen closure of major bronchial fistula\\n$ 4,140.90\\n32820\\n32820\\nMajor reconstruction, chest wall (posttraumatic)\\n$ 3,856.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n135\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n136\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n32850\\n32850\\nDonor pneumonectomy(s) (including cold preservation), from\\ncadaver donor\\n$ -\\n32851\\n32851\\nLung transplant, single; without cardiopulmonary bypass\\n$ 8,134.00\\n32852\\n32852\\nLung transplant, single; with cardiopulmonary bypass\\n$ 8,881.42\\n32853\\n32853\\nLung transplant, double (bilateral sequential or en bloc); without\\ncardiopulmonary bypass\\n$ 11,365.84\\n32854\\n32854\\nLung transplant, double (bilateral sequential or en bloc); with\\ncardiopulmonary bypass\\n$ 12,075.71\\n32855\\n32855\\nBackbench standard preparation of cadaver donor lung allograft\\nprior to transplantation, including dissection of allograft from\\nsurrounding soft tissues to prepare pulmonary venous\/atrial cuff,\\npulmonary artery, and bronchus; unilateral\\n$ -\\n32856\\n32856\\nBackbench standard preparation of cadaver donor lung allograft\\nprior to transplantation, including dissection of allograft from\\nsurrounding soft tissues to prepare pulmonary venous\/atrial cuff,\\npulmonary artery, and bronchus; bilateral\\n$ -\\n32900\\n32900\\nResection of ribs, extrapleural, all stages\\n$ 2,188.80\\n32905\\n32905\\nThoracoplasty, Schede type or extrapleural (all stages);\\n$ 2,652.30\\n32906\\n32906\\nThoracoplasty, Schede type or extrapleural (all stages); with closure\\nof bronchopleural fistula\\n$ 3,554.10\\n32940\\n32940\\nPneumonolysis, extraperiosteal, including filling or packing\\nprocedures\\n$ 2,266.20\\n32960\\n32960\\nPneumothorax, therapeutic, intrapleural injection of air\\n$ 261.00\\n32997\\n32997\\nTotal lung lavage (unilateral)\\n$ 993.60\\n32998\\n32998\\nAblation therapy for reduction or eradication of 1 or more\\npulmonary tumor(s) including pleura or chest wall when involved by\\ntumor extension, percutaneous, radiofrequency, unilateral\\n$ 2,369.98\\n32999\\n32999\\nUnlisted procedure, lungs and pleura\\nCost\\n33010\\n33010\\nPericardiocentesis; initial\\n$ 483.30\\n33011\\n33011\\nPericardiocentesis; subsequent\\n$ 407.70\\n33015\\n33015\\nTube pericardiostomy\\n$ 1,074.60\\n33020\\n33020\\nPericardiotomy for removal of clot or foreign body (primary\\nprocedure)\\n$ 2,667.60\\n33025\\n33025\\nCreation of pericardial window or partial resection for drainage\\n$ 3,193.20\\n33030\\n33030\\nPericardiectomy, subtotal or complete; without cardiopulmonary\\nbypass\\n$ 4,041.00\\n33031\\n33031\\nPericardiectomy, subtotal or complete; with cardiopulmonary\\nbypass\\n$ 5,037.30\\n33050\\n33050\\nResection of pericardial cyst or tumor\\n$ 3,219.30\\n33120\\n33120\\nExcision of intracardiac tumor, resection with cardiopulmonary\\nbypass\\n$ 6,552.90\\n33130\\n33130\\nResection of external cardiac tumor\\n$ 4,139.10\\n33140\\n33140\\nTransmyocardial laser revascularization, by thoracotomy; (separate\\nprocedure)\\n$ 3,384.56\\n33141\\n33141\\nTransmyocardial laser revascularization, by thoracotomy;\\nperformed at the time of other open cardiac procedure(s) (List\\nseparately in addition to code for primary procedure)\\n$ 1,649.90\\n33202\\n33202\\nInsertion of epicardial electrode(s); open incision (eg, thoracotomy,\\nmedian sternotomy, subxiphoid approach)\\n$ 2,051.82\\n33203\\n33203\\nInsertion of epicardial electrode(s); endoscopic approach (eg,\\nthoracoscopy, pericardioscopy)\\n$ 2,105.33\\n33206\\n33206\\nInsertion of new or replacement of permanent pacemaker with\\ntransvenous electrode(s); atrial\\n$ 2,232.90\\n33207\\n33207\\nInsertion of new or replacement of permanent pacemaker with\\ntransvenous electrode(s); ventricular\\n$ 2,424.60\\n33208\\n33208\\nInsertion of new or replacement of permanent pacemaker with\\ntransvenous electrode(s); atrial and ventricular\\n$ 3,028.50\\n33210\\n33210\\nInsertion or replacement of temporary transvenous single chamber\\ncardiac electrode or pacemaker catheter (separate procedure)\\n$ 874.80\\n33211\\n33211\\nInsertion or replacement of temporary transvenous dual chamber\\npacing electrodes (separate procedure)\\n$ 1,017.90\\n33212\\n33212\\nInsertion of pacemaker pulse generator only; with existing single\\nlead\\n$ 1,445.40\\n33213\\n33213\\nInsertion of pacemaker pulse generator only; with existing dual\\nleads\\n$ 1,467.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n137\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n138\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33214\\n33214\\nUpgrade of implanted pacemaker system, conversion of single\\nchamber system to dual chamber system (includes removal of\\npreviously placed pulse generator, testing of existing lead, insertion\\nof new lead, insertion of new pulse generator)\\n$ 1,986.30\\n33215\\n33215\\nRepositioning of previously implanted transvenous pacemaker or\\npacing cardioverter-defibrillator (right atrial or right ventricular)\\nelectrode\\n$ 829.37\\n33216\\n33216\\nInsertion of a single transvenous electrode, permanent pacemaker\\nor cardioverter-defibrillator\\n$ 1,427.40\\n33217\\n33217\\nInsertion of 2 transvenous electrodes, permanent pacemaker or\\ncardioverter-defibrillator\\n$ 1,512.90\\n33218\\n33218\\nRepair of single transvenous electrode, permanent pacemaker or\\npacing cardioverter-defibrillator\\n$ 1,392.30\\n33220\\n33220\\nRepair of 2 transvenous electrodes for permanent pacemaker or\\npacing cardioverter-defibrillator\\n$ 1,192.50\\n33222\\n33222\\nRelocation of skin pocket for pacemaker\\n$ 1,442.70\\n33223\\n33223\\nRelocation of skin pocket for cardioverter-defibrillator\\n$ 1,238.40\\n33224\\n33224\\nInsertion of pacing electrode, cardiac venous system, for left\\nventricular pacing, with attachment to previously placed pacemaker\\nor pacing cardioverter-defibrillator pulse generator (including\\nrevision of pocket, removal, insertion, and\/or replacement of\\n$ 1,345.09\\n33225\\n33225\\nInsertion of pacing electrode, cardiac venous system, for left\\nventricular pacing, at time of insertion of pacing cardioverter-\\ndefibrillator or pacemaker pulse generator (eg, for upgrade to dual\\nchamber system) (List separately in addition to code for pri\\n$ 1,199.61\\n33226\\n33226\\nRepositioning of previously implanted cardiac venous system (left\\nventricular) electrode (including removal, insertion and\/or\\nreplacement of existing generator)\\n$ 1,296.07\\n33233\\n33233\\nRemoval of permanent pacemaker pulse generator only\\n$ 995.40\\n33234\\n33234\\nRemoval of transvenous pacemaker electrode(s); single lead system,\\natrial or ventricular\\n$ 1,511.10\\n33235\\n33235\\nRemoval of transvenous pacemaker electrode(s); dual lead system\\n$ 1,649.70\\n33236\\n33236\\nRemoval of permanent epicardial pacemaker and electrodes by\\nthoracotomy; single lead system, atrial or ventricular\\n$ 1,722.60\\n33237\\n33237\\nRemoval of permanent epicardial pacemaker and electrodes by\\nthoracotomy; dual lead system\\n$ 2,735.10\\n33238\\n33238\\nRemoval of permanent transvenous electrode(s) by thoracotomy\\n$ 2,816.10\\n33240\\n33240\\nInsertion of pacing cardioverter-defibrillator pulse generator only;\\nwith existing single lead\\n$ 1,513.80\\n33241\\n33241\\nRemoval of pacing cardioverter-defibrillator pulse generator only\\n$ 1,061.10\\n33243\\n33243\\nRemoval of single or dual chamber pacing cardioverter-defibrillator\\nelectrode(s); by thoracotomy\\n$ 3,192.30\\n33244\\n33244\\nRemoval of single or dual chamber pacing cardioverter-defibrillator\\nelectrode(s); by transvenous extraction\\n$ 2,707.20\\n33249\\n33249\\nInsertion or replacement of permanent pacing cardioverter-\\ndefibrillator system with transvenous lead(s), single or dual\\nchamber\\n$ 3,577.50\\n33250\\n33250\\nOperative ablation of supraventricular arrhythmogenic focus or\\npathway (eg, Wolff-Parkinson-White, atrioventricular node re-\\nentry), tract(s) and\/or focus (foci); without cardiopulmonary bypass\\n$ 3,759.30\\n33251\\n33251\\nOperative ablation of supraventricular arrhythmogenic focus or\\npathway (eg, Wolff-Parkinson-White, atrioventricular node re-\\nentry), tract(s) and\/or focus (foci); with cardiopulmonary bypass\\n$ 5,150.70\\n33254\\n33254\\nOperative tissue ablation and reconstruction of atria, limited (eg,\\nmodified maze procedure)\\n$ 2,975.87\\n33255\\n33255\\nOperative tissue ablation and reconstruction of atria, extensive (eg,\\nmaze procedure); without cardiopulmonary bypass\\n$ 3,580.01\\n33256\\n33256\\nOperative tissue ablation and reconstruction of atria, extensive (eg,\\nmaze procedure); with cardiopulmonary bypass\\n$ 4,278.05\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n139\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n140\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33257\\n33257\\nOperative tissue ablation and reconstruction of atria, performed at\\nthe time of other cardiac procedure(s), limited (eg, modified maze\\nprocedure) (List separately in addition to code for primary\\nprocedure)\\n$ 1,362.89\\n33258\\n33258\\nOperative tissue ablation and reconstruction of atria, performed at\\nthe time of other cardiac procedure(s), extensive (eg, maze\\nprocedure), without cardiopulmonary bypass (List separately in\\naddition to code for primary procedure)\\n$ 1,535.93\\n33259\\n33259\\nOperative tissue ablation and reconstruction of atria, performed at\\nthe time of other cardiac procedure(s), extensive (eg, maze\\nprocedure), with cardiopulmonary bypass (List separately in\\naddition to code for primary procedure)\\n$ 2,004.34\\n33261\\n33261\\nOperative ablation of ventricular arrhythmogenic focus with\\ncardiopulmonary bypass\\n$ 5,135.40\\n33265\\n33265\\nEndoscopy, surgical; operative tissue ablation and reconstruction of\\natria, limited (eg, modified maze procedure), without\\ncardiopulmonary bypass\\n$ 2,970.81\\n33266\\n33266\\nEndoscopy, surgical; operative tissue ablation and reconstruction of\\natria, extensive (eg, maze procedure), without cardiopulmonary\\nbypass\\n$ 4,068.64\\n33282\\n33282\\nImplantation of patient-activated cardiac event recorder\\n$ 786.37\\n33284\\n33284\\nRemoval of an implantable, patient-activated cardiac event recorder $ 567.29\\n33300\\n33300\\nRepair of cardiac wound; without bypass\\n$ 3,836.70\\n33305\\n33305\\nRepair of cardiac wound; with cardiopulmonary bypass\\n$ 5,122.80\\n33310\\n33310\\nCardiotomy, exploratory (includes removal of foreign body, atrial or\\nventricular thrombus); without bypass\\n$ 3,654.90\\n33315\\n33315\\nCardiotomy, exploratory (includes removal of foreign body, atrial or\\nventricular thrombus); with cardiopulmonary bypass\\n$ 5,318.10\\n33320\\n33320\\nSuture repair of aorta or great vessels; without shunt or\\ncardiopulmonary bypass\\n$ 4,713.30\\n33321\\n33321\\nSuture repair of aorta or great vessels; with shunt bypass\\n$ 3,833.13\\n33322\\n33322\\nSuture repair of aorta or great vessels; with cardiopulmonary\\nbypass\\n$ 5,744.70\\n33330\\n33330\\nInsertion of graft, aorta or great vessels; without shunt, or\\ncardiopulmonary bypass\\n$ 6,261.30\\n33332\\n33332\\nInsertion of graft, aorta or great vessels; with shunt bypass\\n$ 5,066.72\\n33335\\n33335\\nInsertion of graft, aorta or great vessels; with cardiopulmonary\\nbypass\\n$ 6,984.00\\n33400\\n33400\\nValvuloplasty, aortic valve; open, with cardiopulmonary bypass\\n$ 5,665.50\\n33401\\n33401\\nValvuloplasty, aortic valve; open, with inflow occlusion\\n$ 5,706.90\\n33403\\n33403\\nValvuloplasty, aortic valve; using transventricular dilation, with\\ncardiopulmonary bypass\\n$ 6,159.60\\n33404\\n33404\\nConstruction of apical-aortic conduit\\n$ 6,695.10\\n33405\\n33405\\nReplacement, aortic valve, with cardiopulmonary bypass; with\\nprosthetic valve other than homograft or stentless valve\\n$ 7,717.50\\n33406\\n33406\\nReplacement, aortic valve, with cardiopulmonary bypass; with\\nallograft valve (freehand)\\n$ 7,029.90\\n33410\\n33410\\nReplacement, aortic valve, with cardiopulmonary bypass; with\\nstentless tissue valve\\n$ 6,661.86\\n33411\\n33411\\nReplacement, aortic valve; with aortic annulus enlargement,\\nnoncoronary sinus\\n$ 7,921.80\\n33412\\n33412\\nReplacement, aortic valve; with transventricular aortic annulus\\nenlargement (Konno procedure)\\n$ 8,019.00\\n33413\\n33413\\nReplacement, aortic valve; by translocation of autologous\\npulmonary valve with allograft replacement of pulmonary valve\\n(Ross procedure)\\n$ 7,622.10\\n33414\\n33414\\nRepair of left ventricular outflow tract obstruction by patch\\nenlargement of the outflow tract\\n$ 6,825.57\\n33415\\n33415\\nResection or incision of subvalvular tissue for discrete subvalvular\\naortic stenosis\\n$ 6,087.60\\n33416\\n33416\\nVentriculomyotomy (-myectomy) for idiopathic hypertrophic\\nsubaortic stenosis (eg, asymmetric septal hypertrophy)\\n$ 6,592.50\\n33417\\n33417\\nAortoplasty (gusset) for supravalvular stenosis\\n$ 6,952.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n141\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n142\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33420\\n33420\\nValvotomy, mitral valve; closed heart\\n$ 5,495.40\\n33422\\n33422\\nValvotomy, mitral valve; open heart, with cardiopulmonary bypass\\n$ 6,451.20\\n33425\\n33425\\nValvuloplasty, mitral valve, with cardiopulmonary bypass;\\n$ 6,628.50\\n33426\\n33426\\nValvuloplasty, mitral valve, with cardiopulmonary bypass; with\\nprosthetic ring\\n$ 7,905.60\\n33427\\n33427\\nValvuloplasty, mitral valve, with cardiopulmonary bypass; radical\\nreconstruction, with or without ring\\n$ 6,978.60\\n33430\\n33430\\nReplacement, mitral valve, with cardiopulmonary bypass\\n$ 7,627.50\\n33460\\n33460\\nValvectomy, tricuspid valve, with cardiopulmonary bypass\\n$ 6,223.50\\n33463\\n33463\\nValvuloplasty, tricuspid valve; without ring insertion\\n$ 7,105.50\\n33464\\n33464\\nValvuloplasty, tricuspid valve; with ring insertion\\n$ 6,801.30\\n33465\\n33465\\nReplacement, tricuspid valve, with cardiopulmonary bypass\\n$ 6,721.20\\n33468\\n33468\\nTricuspid valve repositioning and plication for Ebstein anomaly\\n$ 6,988.50\\n33470\\n33470\\nValvotomy, pulmonary valve, closed heart; transventricular\\n$ 5,030.10\\n33471\\n33471\\nValvotomy, pulmonary valve, closed heart; via pulmonary artery\\n$ 4,708.80\\n33472\\n33472\\nValvotomy, pulmonary valve, open heart; with inflow occlusion\\n$ 4,979.70\\n33474\\n33474\\nValvotomy, pulmonary valve, open heart; with cardiopulmonary\\nbypass\\n$ 5,535.90\\n33475\\n33475\\nReplacement, pulmonary valve\\n$ 7,105.50\\n33476\\n33476\\nRight ventricular resection for infundibular stenosis, with or without\\ncommissurotomy\\n$ 5,840.10\\n33478\\n33478\\nOutflow tract augmentation (gusset), with or without\\ncommissurotomy or infundibular resection\\n$ 5,840.10\\n33496\\n33496\\nRepair of non-structural prosthetic valve dysfunction with\\ncardiopulmonary bypass (separate procedure)\\n$ 5,799.60\\n33500\\n33500\\nRepair of coronary arteriovenous or arteriocardiac chamber fistula;\\nwith cardiopulmonary bypass\\n$ 5,355.90\\n33501\\n33501\\nRepair of coronary arteriovenous or arteriocardiac chamber fistula;\\nwithout cardiopulmonary bypass\\n$ 4,027.50\\n33502\\n33502\\nRepair of anomalous coronary artery from pulmonary artery origin;\\nby ligation\\n$ 3,878.10\\n33503\\n33503\\nRepair of anomalous coronary artery from pulmonary artery origin;\\nby graft, without cardiopulmonary bypass\\n$ 4,377.60\\n33504\\n33504\\nRepair of anomalous coronary artery from pulmonary artery origin;\\nby graft, with cardiopulmonary bypass\\n$ 6,170.40\\n33505\\n33505\\nRepair of anomalous coronary artery from pulmonary artery origin;\\nwith construction of intrapulmonary artery tunnel (Takeuchi\\nprocedure)\\n$ 5,183.04\\n33506\\n33506\\nRepair of anomalous coronary artery from pulmonary artery origin;\\nby translocation from pulmonary artery to aorta\\n$ 5,719.19\\n33507\\n33507\\nRepair of anomalous (eg, intramural) aortic origin of coronary artery\\nby unroofing or translocation\\n$ 5,300.00\\n33508\\n33508\\nEndoscopy, surgical, including video-assisted harvest of vein(s) for\\ncoronary artery bypass procedure (List separately in addition to\\ncode for primary procedure)\\n$ 260.39\\n33510\\n33510\\nCoronary artery bypass, vein only; single coronary venous graft\\n$ 7,254.00\\n33511\\n33511\\nCoronary artery bypass, vein only; 2 coronary venous grafts\\n$ 7,448.40\\n33512\\n33512\\nCoronary artery bypass, vein only; 3 coronary venous grafts\\n$ 8,284.50\\n33513\\n33513\\nCoronary artery bypass, vein only; 4 coronary venous grafts\\n$ 9,268.20\\n33514\\n33514\\nCoronary artery bypass, vein only; 5 coronary venous grafts\\n$ 10,083.60\\n33516\\n33516\\nCoronary artery bypass, vein only; 6 or more coronary venous grafts\\n$ 10,809.00\\n33517\\n33517\\nCoronary artery bypass, using venous graft(s) and arterial graft(s);\\nsingle vein graft (List separately in addition to code for primary\\nprocedure)\\n$ 1,161.90\\n33518\\n33518\\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 2\\nvenous grafts (List separately in addition to code for primary\\nprocedure)\\n$ 1,747.80\\n33519\\n33519\\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 3\\nvenous grafts (List separately in addition to code for primary\\nprocedure)\\n$ 2,054.70\\n33521\\n33521\\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 4\\nvenous grafts (List separately in addition to code for primary\\nprocedure)\\n$ 2,816.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n143\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n144\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33522\\n33522\\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 5\\nvenous grafts (List separately in addition to code for primary\\nprocedure)\\n$ 3,634.20\\n33523\\n33523\\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 6\\nor more venous grafts (List separately in addition to code for\\nprimary procedure)\\n$ 4,606.20\\n33530\\n33530\\nReoperation, coronary artery bypass procedure or valve procedure,\\nmore than 1 month after original operation (List separately in\\naddition to code for primary procedure)\\n$ 2,003.40\\n33533\\n33533\\nCoronary artery bypass, using arterial graft(s); single arterial graft\\n$ 6,878.70\\n33534\\n33534\\nCoronary artery bypass, using arterial graft(s); 2 coronary arterial\\ngrafts\\n$ 7,822.80\\n33535\\n33535\\nCoronary artery bypass, using arterial graft(s); 3 coronary arterial\\ngrafts\\n$ 8,479.80\\n33536\\n33536\\nCoronary artery bypass, using arterial graft(s); 4 or more coronary\\narterial grafts\\n$ 8,454.60\\n33542\\n33542\\nMyocardial resection (eg, ventricular aneurysmectomy)\\n$ 6,769.80\\n33545\\n33545\\nRepair of postinfarction ventricular septal defect, with or without\\nmyocardial resection\\n$ 7,679.70\\n33548\\n33548\\nSurgical ventricular restoration procedure, includes prosthetic\\npatch, when performed (eg, ventricular remodeling, SVR, SAVER,\\nDor procedures)\\n$ 7,924.63\\n33572\\n33572\\nCoronary endarterectomy, open, any method, of left anterior\\ndescending, circumflex, or right coronary artery performed in\\nconjunction with coronary artery bypass graft procedure, each\\nvessel (List separately in addition to primary procedure)\\n$ 1,008.00\\n33600\\n33600\\nClosure of atrioventricular valve (mitral or tricuspid) by suture or\\npatch\\n$ 6,489.00\\n33602\\n33602\\nClosure of semilunar valve (aortic or pulmonary) by suture or patch\\n$ 6,479.10\\n33606\\n33606\\nAnastomosis of pulmonary artery to aorta (Damus-Kaye-Stansel\\nprocedure)\\n$ 6,581.70\\n33608\\n33608\\nRepair of complex cardiac anomaly other than pulmonary atresia\\nwith ventricular septal defect by construction or replacement of\\nconduit from right or left ventricle to pulmonary artery\\n$ 6,643.80\\n33610\\n33610\\nRepair of complex cardiac anomalies (eg, single ventricle with\\nsubaortic obstruction) by surgical enlargement of ventricular septal\\ndefect\\n$ 6,591.66\\n33611\\n33611\\nRepair of double outlet right ventricle with intraventricular tunnel\\nrepair;\\n$ 6,644.56\\n33612\\n33612\\nRepair of double outlet right ventricle with intraventricular tunnel\\nrepair; with repair of right ventricular outflow tract obstruction\\n$ 7,416.00\\n33615\\n33615\\nRepair of complex cardiac anomalies (eg, tricuspid atresia) by\\nclosure of atrial septal defect and anastomosis of atria or vena cava\\nto pulmonary artery (simple Fontan procedure)\\n$ 7,004.70\\n33617\\n33617\\nRepair of complex cardiac anomalies (eg, single ventricle) by\\nmodified Fontan procedure\\n$ 7,584.08\\n33619\\n33619\\nRepair of single ventricle with aortic outflow obstruction and aortic\\narch hypoplasia (hypoplastic left heart syndrome) (eg, Norwood\\nprocedure)\\n$ 8,214.30\\n33641\\n33641\\nRepair atrial septal defect, secundum, with cardiopulmonary\\nbypass, with or without patch\\n$ 5,459.40\\n33645\\n33645\\nDirect or patch closure, sinus venosus, with or without anomalous\\npulmonary venous drainage\\n$ 6,368.40\\n33647\\n33647\\nRepair of atrial septal defect and ventricular septal defect, with\\ndirect or patch closure\\n$ 7,210.80\\n33660\\n33660\\nRepair of incomplete or partial atrioventricular canal (ostium\\nprimum atrial septal defect), with or without atrioventricular valve\\nrepair\\n$ 6,916.50\\n33665\\n33665\\nRepair of intermediate or transitional atrioventricular canal, with or\\nwithout atrioventricular valve repair\\n$ 7,938.00\\n33670\\n33670\\nRepair of complete atrioventricular canal, with or without\\nprosthetic valve\\n$ 7,625.70\\n33675\\n33675\\nClosure of multiple ventricular septal defects;\\n$ 6,647.90\\n33676\\n33676\\nClosure of multiple ventricular septal defects; with pulmonary\\nvalvotomy or infundibular resection (acyanotic)\\n$ 6,341.84\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n145\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n146\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33677\\n33677\\nClosure of multiple ventricular septal defects; with removal of\\npulmonary artery band, with or without gusset\\n$ 6,334.62\\n33681\\n33681\\nClosure of single ventricular septal defect, with or without patch;\\n$ 6,144.30\\n33684\\n33684\\nClosure of single ventricular septal defect, with or without patch;\\nwith pulmonary valvotomy or infundibular resection (acyanotic)\\n$ 6,494.40\\n33688\\n33688\\nClosure of single ventricular septal defect, with or without patch;\\nwith removal of pulmonary artery band, with or without gusset\\n$ 6,613.20\\n33690\\n33690\\nBanding of pulmonary artery\\n$ 3,090.60\\n33692\\n33692\\nComplete repair tetralogy of Fallot without pulmonary atresia;\\n$ 6,437.70\\n33694\\n33694\\nComplete repair tetralogy of Fallot without pulmonary atresia; with\\ntransannular patch\\n$ 7,090.20\\n33697\\n33697\\nComplete repair tetralogy of Fallot with pulmonary atresia including\\nconstruction of conduit from right ventricle to pulmonary artery\\nand closure of ventricular septal defect\\n$ 7,173.90\\n33702\\n33702\\nRepair sinus of Valsalva fistula, with cardiopulmonary bypass;\\n$ 5,951.70\\n33710\\n33710\\nRepair sinus of Valsalva fistula, with cardiopulmonary bypass; with\\nrepair of ventricular septal defect\\n$ 7,786.80\\n33720\\n33720\\nRepair sinus of Valsalva aneurysm, with cardiopulmonary bypass\\n$ 6,746.40\\n33722\\n33722\\nClosure of aortico-left ventricular tunnel\\n$ 6,437.70\\n33724\\n33724\\nRepair of isolated partial anomalous pulmonary venous return (eg,\\nScimitar Syndrome)\\n$ 5,384.20\\n33726\\n33726\\nRepair of pulmonary venous stenosis\\n$ 6,373.14\\n33730\\n33730\\nComplete repair of anomalous pulmonary venous return\\n(supracardiac, intracardiac, or infracardiac types)\\n$ 6,602.40\\n33732\\n33732\\nRepair of cor triatriatum or supravalvular mitral ring by resection of\\nleft atrial membrane\\n$ 5,942.70\\n33735\\n33735\\nAtrial septectomy or septostomy; closed heart (Blalock-Hanlon type\\noperation)\\n$ 4,538.70\\n33736\\n33736\\nAtrial septectomy or septostomy; open heart with cardiopulmonary\\nbypass\\n$ 5,480.10\\n33737\\n33737\\nAtrial septectomy or septostomy; open heart, with inflow occlusion\\n$ 4,892.40\\n33750\\n33750\\nShunt; subclavian to pulmonary artery (Blalock-Taussig type\\noperation)\\n$ 4,233.60\\n33755\\n33755\\nShunt; ascending aorta to pulmonary artery (Waterston type\\noperation)\\n$ 4,748.40\\n33762\\n33762\\nShunt; descending aorta to pulmonary artery (Potts-Smith type\\noperation)\\n$ 4,645.80\\n33764\\n33764\\nShunt; central, with prosthetic graft\\n$ 4,686.30\\n33766\\n33766\\nShunt; superior vena cava to pulmonary artery for flow to 1 lung\\n(classical Glenn procedure)\\n$ 4,068.90\\n33767\\n33767\\nShunt; superior vena cava to pulmonary artery for flow to both\\nlungs (bidirectional Glenn procedure)\\n$ 4,686.30\\n33768\\n33768\\nAnastomosis, cavopulmonary, second superior vena cava (List\\nseparately in addition to primary procedure)\\n$ 1,373.84\\n33770\\n33770\\nRepair of transposition of the great arteries with ventricular septal\\ndefect and subpulmonary stenosis; without surgical enlargement of\\nventricular septal defect\\n$ 7,014.60\\n33771\\n33771\\nRepair of transposition of the great arteries with ventricular septal\\ndefect and subpulmonary stenosis; with surgical enlargement of\\nventricular septal defect\\n$ 7,655.60\\n33774\\n33774\\nRepair of transposition of the great arteries, atrial baffle procedure\\n(eg, Mustard or Senning type) with cardiopulmonary bypass;\\n$ 6,746.40\\n33775\\n33775\\nRepair of transposition of the great arteries, atrial baffle procedure\\n(eg, Mustard or Senning type) with cardiopulmonary bypass; with\\nremoval of pulmonary band\\n$ 6,685.20\\n33776\\n33776\\nRepair of transposition of the great arteries, atrial baffle procedure\\n(eg, Mustard or Senning type) with cardiopulmonary bypass; with\\nclosure of ventricular septal defect\\n$ 8,601.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n147\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n148\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33777\\n33777\\nRepair of transposition of the great arteries, atrial baffle procedure\\n(eg, Mustard or Senning type) with cardiopulmonary bypass; with\\nrepair of subpulmonic obstruction\\n$ 8,343.00\\n33778\\n33778\\nRepair of transposition of the great arteries, aortic pulmonary\\nartery reconstruction (eg, Jatene type);\\n$ 9,038.70\\n33779\\n33779\\nRepair of transposition of the great arteries, aortic pulmonary\\nartery reconstruction (eg, Jatene type); with removal of pulmonary\\nband\\n$ 8,766.00\\n33780\\n33780\\nRepair of transposition of the great arteries, aortic pulmonary\\nartery reconstruction (eg, Jatene type); with closure of ventricular\\nseptal defect\\n$ 8,766.00\\n33781\\n33781\\nRepair of transposition of the great arteries, aortic pulmonary\\nartery reconstruction (eg, Jatene type); with repair of subpulmonic\\nobstruction\\n$ 8,766.00\\n33782\\n33782\\nAortic root translocation with ventricular septal defect and\\npulmonary stenosis repair (ie, Nikaidoh procedure); without\\ncoronary ostium reimplantation\\n$ 12,843.24\\n33783\\n33783\\nAortic root translocation with ventricular septal defect and\\npulmonary stenosis repair (ie, Nikaidoh procedure); with\\nreimplantation of 1 or both coronary ostia\\n$ 13,932.80\\n33786\\n33786\\nTotal repair, truncus arteriosus (Rastelli type operation)\\n$ 7,416.00\\n33788\\n33788\\nReimplantation of an anomalous pulmonary artery\\n$ 5,548.50\\n33800\\n33800\\nAortic suspension (aortopexy) for tracheal decompression (eg, for\\ntracheomalacia) (separate procedure)\\n$ 2,654.10\\n33802\\n33802\\nDivision of aberrant vessel (vascular ring);\\n$ 3,554.10\\n33803\\n33803\\nDivision of aberrant vessel (vascular ring); with reanastomosis\\n$ 3,893.40\\n33813\\n33813\\nObliteration of aortopulmonary septal defect; without\\ncardiopulmonary bypass\\n$ 4,243.50\\n33814\\n33814\\nObliteration of aortopulmonary septal defect; with\\ncardiopulmonary bypass\\n$ 5,994.90\\n33820\\n33820\\nRepair of patent ductus arteriosus; by ligation\\n$ 3,869.10\\n33822\\n33822\\nRepair of patent ductus arteriosus; by division, younger than 18\\nyears\\n$ 3,641.40\\n33824\\n33824\\nRepair of patent ductus arteriosus; by division, 18 years and older\\n$ 4,058.10\\n33840\\n33840\\nExcision of coarctation of aorta, with or without associated patent\\nductus arteriosus; with direct anastomosis\\n$ 4,342.50\\n33845\\n33845\\nExcision of coarctation of aorta, with or without associated patent\\nductus arteriosus; with graft\\n$ 6,087.60\\n33851\\n33851\\nExcision of coarctation of aorta, with or without associated patent\\nductus arteriosus; repair using either left subclavian artery or\\nprosthetic material as gusset for enlargement\\n$ 5,986.48\\n33852\\n33852\\nRepair of hypoplastic or interrupted aortic arch using autogenous or\\nprosthetic material; without cardiopulmonary bypass\\n$ 5,514.30\\n33853\\n33853\\nRepair of hypoplastic or interrupted aortic arch using autogenous or\\nprosthetic material; with cardiopulmonary bypass\\n$ 6,901.20\\n33860\\n33860\\nAscending aorta graft, with cardiopulmonary bypass, includes valve\\nsuspension, when performed\\n$ 7,323.30\\n33863\\n33863\\nAscending aorta graft, with cardiopulmonary bypass, with aortic\\nroot replacement using valved conduit and coronary reconstruction\\n(eg, Bentall)\\n$ 7,577.10\\n33864\\n33864\\nAscending aorta graft, with cardiopulmonary bypass with valve\\nsuspension, with coronary reconstruction and valve-sparing aortic\\nroot remodeling (eg, David Procedure, Yacoub Procedure)\\n$ 7,601.41\\n33870\\n33870\\nTransverse arch graft, with cardiopulmonary bypass\\n$ 9,652.50\\n33875\\n33875\\nDescending thoracic aorta graft, with or without bypass\\n$ 7,810.20\\n33877\\n33877\\nRepair of thoracoabdominal aortic aneurysm with graft, with or\\nwithout cardiopulmonary bypass\\n$ 9,241.20\\n33880\\n33880\\nEndovascular repair of descending thoracic aorta (eg, aneurysm,\\npseudoaneurysm, dissection, penetrating ulcer, intramural\\nhematoma, or traumatic disruption); involving coverage of left\\nsubclavian artery origin, initial endoprosthesis plus descending\\nthora\\n$ 5,712.22\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n149\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n150\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33881\\n33881\\nEndovascular repair of descending thoracic aorta (eg, aneurysm,\\npseudoaneurysm, dissection, penetrating ulcer, intramural\\nhematoma, or traumatic disruption); not involving coverage of left\\nsubclavian artery origin, initial endoprosthesis plus descending t\\n$ 4,930.62\\n33883\\n33883\\nPlacement of proximal extension prosthesis for endovascular repair\\nof descending thoracic aorta (eg, aneurysm, pseudoaneurysm,\\ndissection, penetrating ulcer, intramural hematoma, or traumatic\\ndisruption); initial extension\\n$ 3,643.31\\n33884\\n33884\\nPlacement of proximal extension prosthesis for endovascular repair\\nof descending thoracic aorta (eg, aneurysm, pseudoaneurysm,\\ndissection, penetrating ulcer, intramural hematoma, or traumatic\\ndisruption); each additional proximal extension (List separatel\\n$ 1,385.57\\n33886\\n33886\\nPlacement of distal extension prosthesis(s) delayed after\\nendovascular repair of descending thoracic aorta\\n$ 3,119.61\\n33889\\n33889\\nOpen subclavian to carotid artery transposition performed in\\nconjunction with endovascular repair of descending thoracic aorta,\\nby neck incision, unilateral\\n$ 2,690.56\\n33891\\n33891\\nBypass graft, with other than vein, transcervical retropharyngeal\\ncarotid-carotid, performed in conjunction with endovascular repair\\nof descending thoracic aorta, by neck incision\\n$ 3,430.57\\n33910\\n33910\\nPulmonary artery embolectomy; with cardiopulmonary bypass\\n$ 6,566.40\\n33915\\n33915\\nPulmonary artery embolectomy; without cardiopulmonary bypass\\n$ 3,965.40\\n33916\\n33916\\nPulmonary endarterectomy, with or without embolectomy, with\\ncardiopulmonary bypass\\n$ 4,653.00\\n33917\\n33917\\nRepair of pulmonary artery stenosis by reconstruction with patch or\\ngraft\\n$ 6,633.90\\n33920\\n33920\\nRepair of pulmonary atresia with ventricular septal defect, by\\nconstruction or replacement of conduit from right or left ventricle\\nto pulmonary artery\\n$ 6,891.30\\n33922\\n33922\\nTransection of pulmonary artery with cardiopulmonary bypass\\n$ 5,562.00\\n33924\\n33924\\nLigation and takedown of a systemic-to-pulmonary artery shunt,\\nperformed in conjunction with a congenital heart procedure (List\\nseparately in addition to code for primary procedure)\\n$ 1,096.26\\n33925\\n33925\\nRepair of pulmonary artery arborization anomalies by\\nunifocalization; without cardiopulmonary bypass\\n$ 6,455.33\\n33926\\n33926\\nRepair of pulmonary artery arborization anomalies by\\nunifocalization; with cardiopulmonary bypass\\n$ 8,708.02\\n33930\\n33930\\nDonor cardiectomy-pneumonectomy (including cold preservation)\\n$ -\\n33933\\n33933\\nBackbench standard preparation of cadaver donor heart\/lung\\nallograft prior to transplantation, including dissection of allograft\\nfrom surrounding soft tissues to prepare aorta, superior vena cava,\\ninferior vena cava, and trachea for implantation\\n$ -\\n33935\\n33935\\nHeart-lung transplant with recipient cardiectomy-pneumonectomy\\n$ 12,504.94\\n33940\\n33940\\nDonor cardiectomy (including cold preservation)\\n$ 4,149.00\\n33944\\n33944\\nBackbench standard preparation of cadaver donor heart allograft\\nprior to transplantation, including dissection of allograft from\\nsurrounding soft tissues to prepare aorta, superior vena cava,\\ninferior vena cava, pulmonary artery, and left atrium for impla\\n$ -\\n33945\\n33945\\nHeart transplant, with or without recipient cardiectomy\\n$ 11,331.00\\n33960\\n33960\\nProlonged extracorporeal circulation for cardiopulmonary\\ninsufficiency; initial day\\n$ 2,981.70\\n33961\\n33961\\nProlonged extracorporeal circulation for cardiopulmonary\\ninsufficiency; each subsequent day\\n$ 1,626.30\\n33967\\n33967\\nInsertion of intra-aortic balloon assist device, percutaneous\\n$ 681.97\\n33968\\n33968\\nRemoval of intra-aortic balloon assist device, percutaneous\\n$ 98.27\\n33970\\n33970\\nInsertion of intra-aortic balloon assist device through the femoral\\nartery, open approach\\n$ 2,032.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n151\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n152\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n33971\\n33971\\nRemoval of intra-aortic balloon assist device including repair of\\nfemoral artery, with or without graft\\n$ 1,911.60\\n33973\\n33973\\nInsertion of intra-aortic balloon assist device through the ascending\\naorta\\n$ 2,047.50\\n33974\\n33974\\nRemoval of intra-aortic balloon assist device from the ascending\\naorta, including repair of the ascending aorta, with or without graft\\n$ 2,317.50\\n33975\\n33975\\nInsertion of ventricular assist device; extracorporeal, single ventricle $ 4,377.60\\n33976\\n33976\\nInsertion of ventricular assist device; extracorporeal, biventricular\\n$ 4,364.10\\n33977\\n33977\\nRemoval of ventricular assist device; extracorporeal, single ventricle\\n$ 3,388.50\\n33978\\n33978\\nRemoval of ventricular assist device; extracorporeal, biventricular\\n$ 3,780.00\\n33979\\n33979\\nInsertion of ventricular assist device, implantable intracorporeal,\\nsingle ventricle\\n$ 6,113.20\\n33980\\n33980\\nRemoval of ventricular assist device, implantable intracorporeal,\\nsingle ventricle\\n$ 9,056.83\\n33981\\n33981\\nReplacement of extracorporeal ventricular assist device, single or\\nbiventricular, pump(s), single or each pump\\n$ 2,099.36\\n33982\\n33982\\nReplacement of ventricular assist device pump(s); implantable\\nintracorporeal, single ventricle, without cardiopulmonary bypass\\n$ 5,143.44\\n33983\\n33983\\nReplacement of ventricular assist device pump(s); implantable\\nintracorporeal, single ventricle, with cardiopulmonary bypass\\n$ 5,744.73\\n33999\\n33999\\nUnlisted procedure, cardiac surgery\\n$ -\\n34001\\n34001\\nEmbolectomy or thrombectomy, with or without catheter; carotid,\\nsubclavian or innominate artery, by neck incision\\n$ 2,654.10\\n34051\\n34051\\nEmbolectomy or thrombectomy, with or without catheter;\\ninnominate, subclavian artery, by thoracic incision\\n$ 2,909.70\\n34101\\n34101\\nEmbolectomy or thrombectomy, with or without catheter; axillary,\\nbrachial, innominate, subclavian artery, by arm incision\\n$ 2,623.50\\n34111\\n34111\\nEmbolectomy or thrombectomy, with or without catheter; radial or\\nulnar artery, by arm incision\\n$ 2,964.60\\n34151\\n34151\\nEmbolectomy or thrombectomy, with or without catheter; renal,\\nceliac, mesentery, aortoiliac artery, by abdominal incision\\n$ 3,651.30\\n34201\\n34201\\nEmbolectomy or thrombectomy, with or without catheter;\\nfemoropopliteal, aortoiliac artery, by leg incision\\n$ 2,886.30\\n34203\\n34203\\nEmbolectomy or thrombectomy, with or without catheter; popliteal-\\ntibio-peroneal artery, by leg incision\\n$ 2,952.90\\n34401\\n34401\\nThrombectomy, direct or with catheter; vena cava, iliac vein, by\\nabdominal incision\\n$ 2,884.50\\n34421\\n34421\\nThrombectomy, direct or with catheter; vena cava, iliac,\\nfemoropopliteal vein, by leg incision\\n$ 2,549.70\\n34451\\n34451\\nThrombectomy, direct or with catheter; vena cava, iliac,\\nfemoropopliteal vein, by abdominal and leg incision\\n$ 2,923.20\\n34471\\n34471\\nThrombectomy, direct or with catheter; subclavian vein, by neck\\nincision\\n$ 2,317.50\\n34490\\n34490\\nThrombectomy, direct or with catheter; axillary and subclavian vein,\\nby arm incision\\n$ 2,148.30\\n34501\\n34501\\nValvuloplasty, femoral vein\\n$ 2,421.00\\n34502\\n34502\\nReconstruction of vena cava, any method\\n$ 5,296.50\\n34510\\n34510\\nVenous valve transposition, any vein donor\\n$ 2,574.90\\n34520\\n34520\\nCross-over vein graft to venous system\\n$ 3,444.30\\n34530\\n34530\\nSaphenopopliteal vein anastomosis\\n$ 2,738.70\\n34800\\n34800\\nEndovascular repair of infrarenal abdominal aortic aneurysm or\\ndissection; using aorto-aortic tube prosthesis\\n$ 3,621.60\\n34802\\n34802\\nEndovascular repair of infrarenal abdominal aortic aneurysm or\\ndissection; using modular bifurcated prosthesis (1 docking limb)\\n$ 3,996.90\\n34803\\n34803\\nEndovascular repair of infrarenal abdominal aortic aneurysm or\\ndissection; using modular bifurcated prosthesis (2 docking limbs)\\n$ 4,301.78\\n34804\\n34804\\nEndovascular repair of infrarenal abdominal aortic aneurysm or\\ndissection; using unibody bifurcated prosthesis\\n$ 3,996.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n153\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n154\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n34805\\n34805\\nEndovascular repair of infrarenal abdominal aortic aneurysm or\\ndissection; using aorto-uniiliac or aorto-unifemoral prosthesis\\n$ 3,987.05\\n34806\\n34806\\nTranscatheter placement of wireless physiologic sensor in\\naneurysmal sac during endovascular repair, including radiological\\nsupervision and interpretation, instrument calibration, and\\ncollection of pressure data (List separately in addition to code for pr $ 420.95\\n34808\\n34808\\nEndovascular placement of iliac artery occlusion device (List\\nseparately in addition to code for primary procedure)\\n$ 688.50\\n34812\\n34812\\nOpen femoral artery exposure for delivery of endovascular\\nprosthesis, by groin incision, unilateral\\n$ 1,125.90\\n34813\\n34813\\nPlacement of femoral-femoral prosthetic graft during endovascular\\naortic aneurysm repair (List separately in addition to code for\\nprimary procedure)\\n$ 800.10\\n34820\\n34820\\nOpen iliac artery exposure for delivery of endovascular prosthesis or\\niliac occlusion during endovascular therapy, by abdominal or\\nretroperitoneal incision, unilateral\\n$ 1,626.30\\n34825\\n34825\\nPlacement of proximal or distal extension prosthesis for\\nendovascular repair of infrarenal abdominal aortic or iliac\\naneurysm, false aneurysm, or dissection; initial vessel\\n$ 2,162.70\\n34826\\n34826\\nPlacement of proximal or distal extension prosthesis for\\nendovascular repair of infrarenal abdominal aortic or iliac\\naneurysm, false aneurysm, or dissection; each additional vessel (List\\nseparately in addition to code for primary procedure)\\n$ 688.50\\n34830\\n34830\\nOpen repair of infrarenal aortic aneurysm or dissection, plus repair\\nof associated arterial trauma, following unsuccessful endovascular\\nrepair; tube prosthesis\\n$ 5,635.80\\n34831\\n34831\\nOpen repair of infrarenal aortic aneurysm or dissection, plus repair\\nof associated arterial trauma, following unsuccessful endovascular\\nrepair; aorto-bi-iliac prosthesis\\n$ 6,093.00\\n34832\\n34832\\nOpen repair of infrarenal aortic aneurysm or dissection, plus repair\\nof associated arterial trauma, following unsuccessful endovascular\\nrepair; aorto-bifemoral prosthesis\\n$ 6,093.00\\n34833\\n34833\\nOpen iliac artery exposure with creation of conduit for delivery of\\naortic or iliac endovascular prosthesis, by abdominal or\\nretroperitoneal incision, unilateral\\n$ 1,682.17\\n34834\\n34834\\nOpen brachial artery exposure to assist in the deployment of aortic\\nor iliac endovascular prosthesis by arm incision, unilateral\\n$ 965.20\\n34900\\n34900\\nEndovascular repair of iliac artery (eg, aneurysm, pseudoaneurysm,\\narteriovenous malformation, trauma) using ilio-iliac tube\\nendoprosthesis\\n$ 2,239.64\\n35001\\n35001\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm\\nand associated occlusive disease, carotid, subclavian artery, by neck\\nincision\\n$ 3,978.00\\n35002\\n35002\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, carotid, subclavian artery, by neck incision\\n$ 4,092.30\\n35005\\n35005\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, vertebral artery\\n$ 3,744.00\\n35011\\n35011\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm\\nand associated occlusive disease, axillary-brachial artery, by arm\\nincision\\n$ 3,550.50\\n35013\\n35013\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, axillary-brachial artery, by arm incision\\n$ 3,780.90\\n35021\\n35021\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, innominate,\\nsubclavian artery, by thoracic incision\\n$ 4,011.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n155\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n156\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n35022\\n35022\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, innominate, subclavian artery, by thoracic incision\\n$ 4,035.60\\n35045\\n35045\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, radial or ulnar\\nartery\\n$ 3,766.50\\n35081\\n35081\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, abdominal\\naorta\\n$ 5,967.00\\n35082\\n35082\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, abdominal aorta\\n$ 7,056.00\\n35091\\n35091\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, abdominal\\naorta involving visceral vessels (mesenteric, celiac, ren\\n$ 6,876.00\\n35092\\n35092\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, abdominal aorta involving visceral vessels (mesenteric,\\nceliac, renal)\\n$ 7,870.50\\n35102\\n35102\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, abdominal\\naorta involving iliac vessels (common, hypogastric, exter\\n$ 6,484.50\\n35103\\n35103\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, abdominal aorta involving iliac vessels (common,\\nhypogastric, external)\\n$ 6,972.30\\n35111\\n35111\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, splenic artery\\n$ 4,826.70\\n35112\\n35112\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, splenic artery\\n$ 3,327.30\\n35121\\n35121\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, hepatic, celiac,\\nrenal, or mesenteric artery\\n$ 4,541.40\\n35122\\n35122\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, hepatic, celiac, renal, or mesenteric artery\\n$ 4,851.90\\n35131\\n35131\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, iliac artery\\n(common, hypogastric, external)\\n$ 4,762.80\\n35132\\n35132\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, iliac artery (common, hypogastric, external)\\n$ 4,635.00\\n35141\\n35141\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, common\\nfemoral artery (profunda femoris, superficial femoral)\\n$ 4,068.90\\n35142\\n35142\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, common femoral artery (profunda femoris, superficial\\nfemoral)\\n$ 4,619.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n157\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n158\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n35151\\n35151\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for aneurysm,\\npseudoaneurysm, and associated occlusive disease, popliteal artery\\n$ 4,226.40\\n35152\\n35152\\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\\ntotal) and graft insertion, with or without patch graft; for ruptured\\naneurysm, popliteal artery\\n$ 3,790.80\\n35180\\n35180\\nRepair, congenital arteriovenous fistula; head and neck\\n$ 3,141.90\\n35182\\n35182\\nRepair, congenital arteriovenous fistula; thorax and abdomen\\n$ 4,532.40\\n35184\\n35184\\nRepair, congenital arteriovenous fistula; extremities\\n$ 3,888.00\\n35188\\n35188\\nRepair, acquired or traumatic arteriovenous fistula; head and neck\\n$ 3,234.60\\n35189\\n35189\\nRepair, acquired or traumatic arteriovenous fistula; thorax and\\nabdomen\\n$ 4,228.20\\n35190\\n35190\\nRepair, acquired or traumatic arteriovenous fistula; extremities\\n$ 3,682.80\\n35201\\n35201\\nRepair blood vessel, direct; neck\\n$ 3,811.50\\n35206\\n35206\\nRepair blood vessel, direct; upper extremity\\n$ 3,393.00\\n35207\\n35207\\nRepair blood vessel, direct; hand, finger\\n$ 3,836.70\\n35211\\n35211\\nRepair blood vessel, direct; intrathoracic, with bypass\\n$ 4,775.40\\n35216\\n35216\\nRepair blood vessel, direct; intrathoracic, without bypass\\n$ 4,719.60\\n35221\\n35221\\nRepair blood vessel, direct; intra-abdominal\\n$ 4,332.60\\n35226\\n35226\\nRepair blood vessel, direct; lower extremity\\n$ 4,322.70\\n35231\\n35231\\nRepair blood vessel with vein graft; neck\\n$ 3,770.10\\n35236\\n35236\\nRepair blood vessel with vein graft; upper extremity\\n$ 5,035.50\\n35241\\n35241\\nRepair blood vessel with vein graft; intrathoracic, with bypass\\n$ 4,771.80\\n35246\\n35246\\nRepair blood vessel with vein graft; intrathoracic, without bypass\\n$ 4,289.40\\n35251\\n35251\\nRepair blood vessel with vein graft; intra-abdominal\\n$ 5,365.80\\n35256\\n35256\\nRepair blood vessel with vein graft; lower extremity\\n$ 4,428.90\\n35261\\n35261\\nRepair blood vessel with graft other than vein; neck\\n$ 3,811.50\\n35266\\n35266\\nRepair blood vessel with graft other than vein; upper extremity\\n$ 3,907.80\\n35271\\n35271\\nRepair blood vessel with graft other than vein; intrathoracic, with\\nbypass\\n$ 5,134.50\\n35276\\n35276\\nRepair blood vessel with graft other than vein; intrathoracic,\\nwithout bypass\\n$ 3,682.80\\n35281\\n35281\\nRepair blood vessel with graft other than vein; intra-abdominal\\n$ 4,377.60\\n35286\\n35286\\nRepair blood vessel with graft other than vein; lower extremity\\n$ 4,189.50\\n35301\\n35301\\nThromboendarterectomy, including patch graft, if performed;\\ncarotid, vertebral, subclavian, by neck incision\\n$ 4,066.20\\n35302\\n35302\\nThromboendarterectomy, including patch graft, if performed;\\nsuperficial femoral artery\\n$ 3,050.03\\n35303\\n35303\\nThromboendarterectomy, including patch graft, if performed;\\npopliteal artery\\n$ 3,211.06\\n35304\\n35304\\nThromboendarterectomy, including patch graft, if performed;\\ntibioperoneal trunk artery\\n$ 3,248.55\\n35305\\n35305\\nThromboendarterectomy, including patch graft, if performed; tibial\\nor peroneal artery, initial vessel\\n$ 3,210.32\\n35306\\n35306\\nThromboendarterectomy, including patch graft, if performed; each\\nadditional tibial or peroneal artery (List separately in addition to\\ncode for primary procedure)\\n$ 1,331.62\\n35311\\n35311\\nThromboendarterectomy, including patch graft, if performed;\\nsubclavian, innominate, by thoracic incision\\n$ 3,872.70\\n35321\\n35321\\nThromboendarterectomy, including patch graft, if performed;\\naxillary-brachial\\n$ 3,862.80\\n35331\\n35331\\nThromboendarterectomy, including patch graft, if performed;\\nabdominal aorta\\n$ 5,119.20\\n35341\\n35341\\nThromboendarterectomy, including patch graft, if performed;\\nmesenteric, celiac, or renal\\n$ 4,953.60\\n35351\\n35351\\nThromboendarterectomy, including patch graft, if performed; iliac\\n$ 4,340.70\\n35355\\n35355\\nThromboendarterectomy, including patch graft, if performed;\\niliofemoral\\n$ 4,176.00\\n35361\\n35361\\nThromboendarterectomy, including patch graft, if performed;\\ncombined aortoiliac\\n$ 5,794.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n159\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n160\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n35363\\n35363\\nThromboendarterectomy, including patch graft, if performed;\\ncombined aortoiliofemoral\\n$ 4,686.30\\n35371\\n35371\\nThromboendarterectomy, including patch graft, if performed;\\ncommon femoral\\n$ 3,605.40\\n35372\\n35372\\nThromboendarterectomy, including patch graft, if performed; deep\\n(profunda) femoral\\n$ 4,039.20\\n35390\\n35390\\nReoperation, carotid, thromboendarterectomy, more than 1 month\\nafter original operation (List separately in addition to code for\\nprimary procedure)\\n$ 855.00\\n35400\\n35400\\nAngioscopy (non-coronary vessels or grafts) during therapeutic\\nintervention (List separately in addition to code for primary\\nprocedure)\\n$ 570.60\\n35450\\n35450\\nTransluminal balloon angioplasty, open; renal or other visceral\\nartery\\n$ 2,514.60\\n35452\\n35452\\nTransluminal balloon angioplasty, open; aortic\\n$ 1,345.50\\n35458\\n35458\\nTransluminal balloon angioplasty, open; brachiocephalic trunk or\\nbranches, each vessel\\n$ 2,317.50\\n35460\\n35460\\nTransluminal balloon angioplasty, open; venous\\n$ 1,596.60\\n35471\\n35471\\nTransluminal balloon angioplasty, percutaneous; renal or visceral\\nartery\\n$ 2,348.10\\n35472\\n35472\\nTransluminal balloon angioplasty, percutaneous; aortic\\n$ 2,743.20\\n35475\\n35475\\nTransluminal balloon angioplasty, percutaneous; brachiocephalic\\ntrunk or branches, each vessel\\n$ 2,426.40\\n35476\\n35476\\nTransluminal balloon angioplasty, percutaneous; venous\\n$ 1,415.70\\n35500\\n35500\\nHarvest of upper extremity vein, 1 segment, for lower extremity or\\ncoronary artery bypass procedure (List separately in addition to\\ncode for primary procedure)\\n$ 871.62\\n35501\\n35501\\nBypass graft, with vein; common carotid-ipsilateral internal carotid\\n$ 3,636.00\\n35506\\n35506\\nBypass graft, with vein; carotid-subclavian or subclavian-carotid\\n$ 4,938.30\\n35508\\n35508\\nBypass graft, with vein; carotid-vertebral\\n$ 3,759.30\\n35509\\n35509\\nBypass graft, with vein; carotid-contralateral carotid\\n$ 3,682.80\\n35510\\n35510\\nBypass graft, with vein; carotid-brachial\\n$ 3,271.58\\n35511\\n35511\\nBypass graft, with vein; subclavian-subclavian\\n$ 3,365.10\\n35512\\n35512\\nBypass graft, with vein; subclavian-brachial\\n$ 3,264.42\\n35515\\n35515\\nBypass graft, with vein; subclavian-vertebral\\n$ 3,420.00\\n35516\\n35516\\nBypass graft, with vein; subclavian-axillary\\n$ 3,505.50\\n35518\\n35518\\nBypass graft, with vein; axillary-axillary\\n$ 4,264.20\\n35521\\n35521\\nBypass graft, with vein; axillary-femoral\\n$ 4,596.30\\n35522\\n35522\\nBypass graft, with vein; axillary-brachial\\n$ 3,209.65\\n35523\\n35523\\nBypass graft, with vein; brachial-ulnar or -radial\\n$ 3,277.08\\n35525\\n35525\\nBypass graft, with vein; brachial-brachial\\n$ 3,187.18\\n35526\\n35526\\nBypass graft, with vein; aortosubclavian, aortoinnominate, or\\naortocarotid\\n$ 4,275.00\\n35531\\n35531\\nBypass graft, with vein; aortoceliac or aortomesenteric\\n$ 4,910.40\\n35533\\n35533\\nBypass graft, with vein; axillary-femoral-femoral\\n$ 4,089.60\\n35535\\n35535\\nBypass graft, with vein; hepatorenal\\n$ 4,060.85\\n35536\\n35536\\nBypass graft, with vein; splenorenal\\n$ 4,485.60\\n35537\\n35537\\nBypass graft, with vein; aortoiliac\\n$ 4,523.50\\n35538\\n35538\\nBypass graft, with vein; aortobi-iliac\\n$ 5,514.25\\n35539\\n35539\\nBypass graft, with vein; aortofemoral\\n$ 5,177.02\\n35540\\n35540\\nBypass graft, with vein; aortobifemoral\\n$ 5,915.40\\n35556\\n35556\\nBypass graft, with vein; femoral-popliteal\\n$ 4,336.20\\n35558\\n35558\\nBypass graft, with vein; femoral-femoral\\n$ 4,312.80\\n35560\\n35560\\nBypass graft, with vein; aortorenal\\n$ 4,439.70\\n35563\\n35563\\nBypass graft, with vein; ilioiliac\\n$ 3,582.90\\n35565\\n35565\\nBypass graft, with vein; iliofemoral\\n$ 4,176.90\\n35566\\n35566\\nBypass graft, with vein; femoral-anterior tibial, posterior tibial,\\nperoneal artery or other distal vessels\\n$ 5,097.60\\n35570\\n35570\\nBypass graft, with vein; tibial-tibial, peroneal-tibial, or\\ntibial\/peroneal trunk-tibial\\n$ 3,570.22\\n35571\\n35571\\nBypass graft, with vein; popliteal-tibial, -peroneal artery or other\\ndistal vessels\\n$ 4,784.40\\n35572\\n35572\\nHarvest of femoropopliteal vein, 1 segment, for vascular\\nreconstruction procedure (eg, aortic, vena caval, coronary,\\nperipheral artery) (List separately in addition to code for primary\\nprocedure)\\n$ 878.05\\n35583\\n35583\\nIn-situ vein bypass; femoral-popliteal\\n$ 4,646.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n161\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n162\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n35585\\n35585\\nIn-situ vein bypass; femoral-anterior tibial, posterior tibial, or\\nperoneal artery\\n$ 5,580.90\\n35587\\n35587\\nIn-situ vein bypass; popliteal-tibial, peroneal\\n$ 5,259.60\\n35600\\n35600\\nHarvest of upper extremity artery, 1 segment, for coronary artery\\nbypass procedure (List separately in addition to code for primary\\nprocedure)\\n$ 922.50\\n35601\\n35601\\nBypass graft, with other than vein; common carotid-ipsilateral\\ninternal carotid\\n$ 3,828.60\\n35606\\n35606\\nBypass graft, with other than vein; carotid-subclavian\\n$ 4,417.20\\n35612\\n35612\\nBypass graft, with other than vein; subclavian-subclavian\\n$ 4,006.80\\n35616\\n35616\\nBypass graft, with other than vein; subclavian-axillary\\n$ 3,502.80\\n35621\\n35621\\nBypass graft, with other than vein; axillary-femoral\\n$ 4,295.70\\n35623\\n35623\\nBypass graft, with other than vein; axillary-popliteal or -tibial\\n$ 4,099.50\\n35626\\n35626\\nBypass graft, with other than vein; aortosubclavian,\\naortoinnominate, or aortocarotid\\n$ 5,134.50\\n35631\\n35631\\nBypass graft, with other than vein; aortoceliac, aortomesenteric,\\naortorenal\\n$ 4,752.00\\n35632\\n35632\\nBypass graft, with other than vein; ilio-celiac\\n$ 3,986.67\\n35633\\n35633\\nBypass graft, with other than vein; ilio-mesenteric\\n$ 4,261.60\\n35634\\n35634\\nBypass graft, with other than vein; iliorenal\\n$ 3,929.70\\n35636\\n35636\\nBypass graft, with other than vein; splenorenal (splenic to renal\\narterial anastomosis)\\n$ 4,275.00\\n35637\\n35637\\nBypass graft, with other than vein; aortoiliac\\n$ 3,861.68\\n35638\\n35638\\nBypass graft, with other than vein; aortobi-iliac\\n$ 3,898.02\\n35642\\n35642\\nBypass graft, with other than vein; carotid-vertebral\\n$ 3,672.00\\n35645\\n35645\\nBypass graft, with other than vein; subclavian-vertebral\\n$ 3,720.60\\n35646\\n35646\\nBypass graft, with other than vein; aortobifemoral\\n$ 5,142.60\\n35647\\n35647\\nBypass graft, with other than vein; aortofemoral\\n$ 3,664.37\\n35650\\n35650\\nBypass graft, with other than vein; axillary-axillary\\n$ 4,328.10\\n35654\\n35654\\nBypass graft, with other than vein; axillary-femoral-femoral\\n$ 5,381.10\\n35656\\n35656\\nBypass graft, with other than vein; femoral-popliteal\\n$ 4,311.00\\n35661\\n35661\\nBypass graft, with other than vein; femoral-femoral\\n$ 4,134.60\\n35663\\n35663\\nBypass graft, with other than vein; ilioiliac\\n$ 3,662.10\\n35665\\n35665\\nBypass graft, with other than vein; iliofemoral\\n$ 4,484.70\\n35666\\n35666\\nBypass graft, with other than vein; femoral-anterior tibial, posterior\\ntibial, or peroneal artery\\n$ 4,851.90\\n35671\\n35671\\nBypass graft, with other than vein; popliteal-tibial or -peroneal\\nartery\\n$ 4,197.60\\n35681\\n35681\\nBypass graft; composite, prosthetic and vein (List separately in\\naddition to code for primary procedure)\\n$ 3,032.10\\n35682\\n35682\\nBypass graft; autogenous composite, 2 segments of veins from 2\\nlocations (List separately in addition to code for primary procedure)\\n$ 1,248.30\\n35683\\n35683\\nBypass graft; autogenous composite, 3 or more segments of vein\\nfrom 2 or more locations (List separately in addition to code for\\nprimary procedure)\\n$ 1,425.60\\n35685\\n35685\\nPlacement of vein patch or cuff at distal anastomosis of bypass\\ngraft, synthetic conduit (List separately in addition to code for\\nprimary procedure)\\n$ 840.77\\n35686\\n35686\\nCreation of distal arteriovenous fistula during lower extremity\\nbypass surgery (non-hemodialysis) (List separately in addition to\\ncode for primary procedure)\\n$ 858.30\\n35691\\n35691\\nTransposition and\/or reimplantation; vertebral to carotid artery\\n$ 3,834.00\\n35693\\n35693\\nTransposition and\/or reimplantation; vertebral to subclavian artery\\n$ 3,316.50\\n35694\\n35694\\nTransposition and\/or reimplantation; subclavian to carotid artery\\n$ 3,399.30\\n35695\\n35695\\nTransposition and\/or reimplantation; carotid to subclavian artery\\n$ 3,321.00\\n35697\\n35697\\nReimplantation, visceral artery to infrarenal aortic prosthesis, each\\nartery (List separately in addition to code for primary procedure)\\n$ 1,617.23\\n35700\\n35700\\nReoperation, femoral-popliteal or femoral (popliteal)-anterior tibial,\\nposterior tibial, peroneal artery, or other distal vessels, more than 1\\nmonth after original operation (List separately in addition to code\\nfor primary procedure)\\n$ 978.30\\n35701\\n35701\\nExploration (not followed by surgical repair), with or without lysis of\\nartery; carotid artery\\n$ 1,827.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n163\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n164\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n35721\\n35721\\nExploration (not followed by surgical repair), with or without lysis of\\nartery; femoral artery\\n$ 1,711.80\\n35741\\n35741\\nExploration (not followed by surgical repair), with or without lysis of\\nartery; popliteal artery\\n$ 1,733.40\\n35761\\n35761\\nExploration (not followed by surgical repair), with or without lysis of\\nartery; other vessels\\n$ 1,645.20\\n35800\\n35800\\nExploration for postoperative hemorrhage, thrombosis or infection;\\nneck\\n$ 1,757.70\\n35820\\n35820\\nExploration for postoperative hemorrhage, thrombosis or infection;\\nchest\\n$ 2,691.90\\n35840\\n35840\\nExploration for postoperative hemorrhage, thrombosis or infection;\\nabdomen\\n$ 2,632.50\\n35860\\n35860\\nExploration for postoperative hemorrhage, thrombosis or infection;\\nextremity\\n$ 1,816.20\\n35870\\n35870\\nRepair of graft-enteric fistula\\n$ 5,026.50\\n35875\\n35875\\nThrombectomy of arterial or venous graft (other than hemodialysis\\ngraft or fistula);\\n$ 2,820.60\\n35876\\n35876\\nThrombectomy of arterial or venous graft (other than hemodialysis\\ngraft or fistula); with revision of arterial or venous graft\\n$ 3,186.90\\n35879\\n35879\\nRevision, lower extremity arterial bypass, without thrombectomy,\\nopen; with vein patch angioplasty\\n$ 3,326.40\\n35881\\n35881\\nRevision, lower extremity arterial bypass, without thrombectomy,\\nopen; with segmental vein interposition\\n$ 3,647.70\\n35883\\n35883\\nRevision, femoral anastomosis of synthetic arterial bypass graft in\\ngroin, open; with nonautogenous patch graft (eg, Dacron, ePTFE,\\nbovine pericardium)\\n$ 3,256.61\\n35884\\n35884\\nRevision, femoral anastomosis of synthetic arterial bypass graft in\\ngroin, open; with autogenous vein patch graft\\n$ 3,453.76\\n35901\\n35901\\nExcision of infected graft; neck\\n$ 2,307.60\\n35903\\n35903\\nExcision of infected graft; extremity\\n$ 2,663.10\\n35905\\n35905\\nExcision of infected graft; thorax\\n$ 2,797.20\\n35907\\n35907\\nExcision of infected graft; abdomen\\n$ 3,213.90\\n36000\\n36000\\nIntroduction of needle or intracatheter, vein\\n$ 128.91\\n36002\\n36002\\nInjection procedures (eg, thrombin) for percutaneous treatment of\\nextremity pseudoaneurysm\\n$ 282.31\\n36005\\n36005\\nInjection procedure for extremity venography (including\\nintroduction of needle or intracatheter)\\n$ 186.30\\n36010\\n36010\\nIntroduction of catheter, superior or inferior vena cava\\n$ 647.10\\n36011\\n36011\\nSelective catheter placement, venous system; first order branch (eg,\\nrenal vein, jugular vein)\\n$ 510.30\\n36012\\n36012\\nSelective catheter placement, venous system; second order, or\\nmore selective, branch (eg, left adrenal vein, petrosal sinus)\\n$ 679.50\\n36013\\n36013\\nIntroduction of catheter, right heart or main pulmonary artery\\n$ 789.30\\n36014\\n36014\\nSelective catheter placement, left or right pulmonary artery\\n$ 591.30\\n36015\\n36015\\nSelective catheter placement, segmental or subsegmental\\npulmonary artery\\n$ 628.20\\n36100\\n36100\\nIntroduction of needle or intracatheter, carotid or vertebral artery\\n$ 628.20\\n36120\\n36120\\nIntroduction of needle or intracatheter; retrograde brachial artery\\n$ 741.60\\n36140\\n36140\\nIntroduction of needle or intracatheter; extremity artery\\n$ 503.10\\n36147\\n36147\\nIntroduction of needle and\/or catheter, arteriovenous shunt\\ncreated for dialysis (graft\/fistula); initial access with complete\\nradiological evaluation of dialysis access, including fluoroscopy,\\nimage documentation and report (includes access of shunt, inj\\n$ 1,052.96\\n36148\\n36148\\nIntroduction of needle and\/or catheter, arteriovenous shunt\\ncreated for dialysis (graft\/fistula); additional access for therapeutic\\nintervention (List separately in addition to code for primary\\nprocedure)\\n$ 325.12\\n36160\\n36160\\nIntroduction of needle or intracatheter, aortic, translumbar\\n$ 650.70\\n36200\\n36200\\nIntroduction of catheter, aorta\\n$ 624.60\\n36215\\n36215\\nSelective catheter placement, arterial system; each first order\\nthoracic or brachiocephalic branch, within a vascular family\\n$ 710.10\\n36216\\n36216\\nSelective catheter placement, arterial system; initial second order\\nthoracic or brachiocephalic branch, within a vascular family\\n$ 729.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n165\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n166\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n36217\\n36217\\nSelective catheter placement, arterial system; initial third order or\\nmore selective thoracic or brachiocephalic branch, within a vascular\\nfamily\\n$ 978.30\\n36218\\n36218\\nSelective catheter placement, arterial system; additional second\\norder, third order, and beyond, thoracic or brachiocephalic branch,\\nwithin a vascular family (List in addition to code for initial second or\\nthird order vessel as appropriate)\\n$ 232.20\\n36221\\n36221\\nNon-selective catheter placement, thoracic aorta, with angiography\\nof the extracranial carotid, vertebral, and\/or intracranial vessels,\\nunilateral or bilateral, and all associated radiological supervision\\nand interpretation, includes angiography of the ce\\n$ 2,880.37\\n36222\\n36222\\nSelective catheter placement, common carotid or innominate\\nartery, unilateral, any approach, with angiography of the ipsilateral\\nextracranial carotid circulation and all associated radiological\\nsupervision and interpretation, includes angiography of the c\\n$ 3,561.38\\n36223\\n36223\\nSelective catheter placement, common carotid or innominate\\nartery, unilateral, any approach, with angiography of the ipsilateral\\nintracranial carotid circulation and all associated radiological\\nsupervision and interpretation, includes angiography of the e\\n$ 3,896.31\\n36224\\n36224\\nSelective catheter placement, internal carotid artery, unilateral,\\nwith angiography of the ipsilateral intracranial carotid circulation\\nand all associated radiological supervision and interpretation,\\nincludes angiography of the extracranial carotid and ce\\n$ 4,230.34\\n36225\\n36225\\nSelective catheter placement, subclavian or innominate artery,\\nunilateral, with angiography of the ipsilateral vertebral circulation\\nand all associated radiological supervision and interpretation,\\nincludes angiography of the cervicocerebral arch, when per\\n$ 3,867.22\\n36226\\n36226\\nSelective catheter placement, vertebral artery, unilateral, with\\nangiography of the ipsilateral vertebral circulation and all associated\\nradiological supervision and interpretation, includes angiography of\\nthe cervicocerebral arch, when performed\\n$ 4,313.16\\n36227\\n36227\\nSelective catheter placement, external carotid artery, unilateral,\\nwith angiography of the ipsilateral external carotid circulation and\\nall associated radiological supervision and interpretation (List\\nseparately in addition to code for primary procedure)\\n$ 614.41\\n36245\\n36245\\nSelective catheter placement, arterial system; each first order\\nabdominal, pelvic, or lower extremity artery branch, within a\\nvascular family\\n$ 768.60\\n36246\\n36246\\nSelective catheter placement, arterial system; initial second order\\nabdominal, pelvic, or lower extremity artery branch, within a\\nvascular family\\n$ 875.70\\n36247\\n36247\\nSelective catheter placement, arterial system; initial third order or\\nmore selective abdominal, pelvic, or lower extremity artery branch,\\nwithin a vascular family\\n$ 1,114.20\\n36248\\n36248\\nSelective catheter placement, arterial system; additional second\\norder, third order, and beyond, abdominal, pelvic, or lower\\nextremity artery branch, within a vascular family (List in addition to\\ncode for initial second or third order vessel as appropriat\\n$ 236.70\\n36252\\n36252\\nSelective catheter placement (first-order), main renal artery and\\nany accessory renal artery(s) for renal angiography, including\\narterial puncture and catheter placement(s), fluoroscopy, contrast\\ninjection(s), image postprocessing, permanent recording of\\n$ 4,101.15\\n36254\\n36254\\nSuperselective catheter placement (one or more second order or\\nhigher renal artery branches) renal artery and any accessory renal\\nartery(s) for renal angiography, including arterial puncture,\\ncatheterization, fluoroscopy, contrast injection(s), image post\\n$ 5,947.12\\n36260\\n36260\\nInsertion of implantable intra-arterial infusion pump (eg, for\\nchemotherapy of liver)\\n$ 2,344.50\\n36261\\n36261\\nRevision of implanted intra-arterial infusion pump\\n$ 919.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n167\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n168\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n36262\\n36262\\nRemoval of implanted intra-arterial infusion pump\\n$ 849.60\\n36299\\n36299\\nUnlisted procedure, vascular injection\\nCost\\n36400\\n36400\\nVenipuncture, younger than age 3 years, necessitating the skill of a\\nphysician or other qualified health care professional, not to be used\\nfor routine venipuncture; femoral or jugular vein\\n$ 57.60\\n36405\\n36405\\nVenipuncture, younger than age 3 years, necessitating the skill of a\\nphysician or other qualified health care professional, not to be used\\nfor routine venipuncture; scalp vein\\n$ 87.30\\n36406\\n36406\\nVenipuncture, younger than age 3 years, necessitating the skill of a\\nphysician or other qualified health care professional, not to be used\\nfor routine venipuncture; other vein\\n$ 93.20\\n36410\\n36410\\nVenipuncture, age 3 years or older, necessitating the skill of a\\nphysician or other qualified health care professional (separate\\nprocedure), for diagnostic or therapeutic purposes (not to be used\\nfor routine venipuncture)\\n$ 75.26\\n36415\\n36415\\nCollection of venous blood by venipuncture\\n$ 17.04\\n36416\\n36416\\nCollection of capillary blood specimen (eg, finger, heel, ear stick)\\n$ -\\n36420\\n36420\\nVenipuncture, cutdown; younger than age 1 year\\n$ 212.40\\n36425\\n36425\\nVenipuncture, cutdown; age 1 or over\\n$ 236.70\\n36430\\n36430\\nTransfusion, blood or blood components\\n$ 122.40\\n36440\\n36440\\nPush transfusion, blood, 2 years or younger\\n$ 212.40\\n36450\\n36450\\nExchange transfusion, blood; newborn\\n$ 824.40\\n36455\\n36455\\nExchange transfusion, blood; other than newborn\\n$ 875.70\\n36460\\n36460\\nTransfusion, intrauterine, fetal\\n$ 1,153.80\\n36468\\n36468\\nSingle or multiple injections of sclerosing solutions, spider veins\\n(telangiectasia); limb or trunk\\n$ 327.60\\n36469\\n36469\\nSingle or multiple injections of sclerosing solutions, spider veins\\n(telangiectasia); face\\n$ 202.50\\n36470\\n36470\\nInjection of sclerosing solution; single vein\\n$ 152.52\\n36471\\n36471\\nInjection of sclerosing solution; multiple veins, same leg\\n$ 246.87\\n36475\\n36475\\nEndovenous ablation therapy of incompetent vein, extremity,\\ninclusive of all imaging guidance and monitoring, percutaneous,\\nradiofrequency; first vein treated\\n$ 3,072.75\\n36476\\n36476\\nEndovenous ablation therapy of incompetent vein, extremity,\\ninclusive of all imaging guidance and monitoring, percutaneous,\\nradiofrequency; second and subsequent veins treated in a single\\nextremity, each through separate access sites (List separately in a\\n$ 1,042.37\\n36478\\n36478\\nEndovenous ablation therapy of incompetent vein, extremity,\\ninclusive of all imaging guidance and monitoring, percutaneous,\\nlaser; first vein treated\\n$ 2,978.33\\n36479\\n36479\\nEndovenous ablation therapy of incompetent vein, extremity,\\ninclusive of all imaging guidance and monitoring, percutaneous,\\nlaser; second and subsequent veins treated in a single extremity,\\neach through separate access sites (List separately in addition t\\n$ 1,045.01\\n36481\\n36481\\nPercutaneous portal vein catheterization by any method\\n$ 1,143.00\\n36500\\n36500\\nVenous catheterization for selective organ blood sampling\\n$ 475.20\\n36510\\n36510\\nCatheterization of umbilical vein for diagnosis or therapy, newborn\\n$ 265.50\\n36511\\n36511\\nTherapeutic apheresis; for white blood cells\\n$ 274.52\\n36512\\n36512\\nTherapeutic apheresis; for red blood cells\\n$ 273.39\\n36513\\n36513\\nTherapeutic apheresis; for platelets\\n$ 276.08\\n36515\\n36515\\nTherapeutic apheresis; with extracorporeal immunoadsorption and\\nplasma reinfusion\\n$ 2,040.30\\n36516\\n36516\\nTherapeutic apheresis; with extracorporeal selective adsorption or\\nselective filtration and plasma reinfusion\\n$ 2,129.80\\n36522\\n36522\\nPhotopheresis, extracorporeal\\n$ 550.80\\n36555\\n36555\\nInsertion of non-tunneled centrally inserted central venous\\ncatheter; younger than 5 years of age\\n$ 500.71\\n36556\\n36556\\nInsertion of non-tunneled centrally inserted central venous\\ncatheter; age 5 years or older\\n$ 373.52\\n36557\\n36557\\nInsertion of tunneled centrally inserted central venous catheter,\\nwithout subcutaneous port or pump; younger than 5 years of age\\n$ 1,519.07\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n169\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n170\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n36558\\n36558\\nInsertion of tunneled centrally inserted central venous catheter,\\nwithout subcutaneous port or pump; age 5 years or older\\n$ 1,287.53\\n36560\\n36560\\nInsertion of tunneled centrally inserted central venous access\\ndevice, with subcutaneous port; younger than 5 years of age\\n$ 1,595.76\\n36561\\n36561\\nInsertion of tunneled centrally inserted central venous access\\ndevice, with subcutaneous port; age 5 years or older\\n$ 1,280.08\\n36563\\n36563\\nInsertion of tunneled centrally inserted central venous access device\\nwith subcutaneous pump\\n$ 1,557.18\\n36565\\n36565\\nInsertion of tunneled centrally inserted central venous access\\ndevice, requiring 2 catheters via 2 separate venous access sites;\\nwithout subcutaneous port or pump (eg, Tesio type catheter)\\n$ 1,535.22\\n36566\\n36566\\nInsertion of tunneled centrally inserted central venous access\\ndevice, requiring 2 catheters via 2 separate venous access sites;\\nwith subcutaneous port(s)\\n$ 2,580.53\\n36568\\n36568\\nInsertion of peripherally inserted central venous catheter (PICC),\\nwithout subcutaneous port or pump; younger than 5 years of age\\n$ 548.20\\n36569\\n36569\\nInsertion of peripherally inserted central venous catheter (PICC),\\nwithout subcutaneous port or pump; age 5 years or older\\n$ 459.11\\n36570\\n36570\\nInsertion of peripherally inserted central venous access device, with\\nsubcutaneous port; younger than 5 years of age\\n$ 1,264.84\\n36571\\n36571\\nInsertion of peripherally inserted central venous access device, with\\nsubcutaneous port; age 5 years or older\\n$ 1,302.40\\n36575\\n36575\\nRepair of tunneled or non-tunneled central venous access catheter,\\nwithout subcutaneous port or pump, central or peripheral insertion\\nsite\\n$ 294.90\\n36576\\n36576\\nRepair of central venous access device, with subcutaneous port or\\npump, central or peripheral insertion site\\n$ 671.12\\n36578\\n36578\\nReplacement, catheter only, of central venous access device, with\\nsubcutaneous port or pump, central or peripheral insertion site\\n$ 1,052.89\\n36580\\n36580\\nReplacement, complete, of a non-tunneled centrally inserted\\ncentral venous catheter, without subcutaneous port or pump,\\nthrough same venous access\\n$ 402.39\\n36581\\n36581\\nReplacement, complete, of a tunneled centrally inserted central\\nvenous catheter, without subcutaneous port or pump, through\\nsame venous access\\n$ 1,347.18\\n36582\\n36582\\nReplacement, complete, of a tunneled centrally inserted central\\nvenous access device, with subcutaneous port, through same\\nvenous access\\n$ 1,777.44\\n36583\\n36583\\nReplacement, complete, of a tunneled centrally inserted central\\nvenous access device, with subcutaneous pump, through same\\nvenous access\\n$ 1,809.20\\n36584\\n36584\\nReplacement, complete, of a peripherally inserted central venous\\ncatheter (PICC), without subcutaneous port or pump, through same\\nvenous access\\n$ 423.34\\n36585\\n36585\\nReplacement, complete, of a peripherally inserted central venous\\naccess device, with subcutaneous port, through same venous access\\n$ 1,778.45\\n36589\\n36589\\nRemoval of tunneled central venous catheter, without\\nsubcutaneous port or pump\\n$ 388.65\\n36590\\n36590\\nRemoval of tunneled central venous access device, with\\nsubcutaneous port or pump, central or peripheral insertion\\n$ 579.93\\n36591\\n36591\\nCollection of blood specimen from a completely implantable venous\\naccess device\\n$ 40.50\\n36592\\n36592\\nCollection of blood specimen using established central or peripheral\\ncatheter, venous, not otherwise specified\\n$ 52.78\\n36593\\n36593\\nDeclotting by thrombolytic agent of implanted vascular access\\ndevice or catheter\\n$ 146.47\\n36595\\n36595\\nMechanical removal of pericatheter obstructive material (eg, fibrin\\nsheath) from central venous device via separate venous access\\n$ 1,257.21\\n36596\\n36596\\nMechanical removal of intraluminal (intracatheter) obstructive\\nmaterial from central venous device through device lumen\\n$ 265.15\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n171\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n172\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n36597\\n36597\\nRepositioning of previously placed central venous catheter under\\nfluoroscopic guidance\\n$ 238.99\\n36598\\n36598\\nContrast injection(s) for radiologic evaluation of existing central\\nvenous access device, including fluoroscopy, image documentation\\nand report\\n$ 282.77\\n36600\\n36600\\nArterial puncture, withdrawal of blood for diagnosis\\n$ 91.80\\n36620\\n36620\\nArterial catheterization or cannulation for sampling, monitoring or\\ntransfusion (separate procedure); percutaneous\\n$ 256.50\\n36625\\n36625\\nArterial catheterization or cannulation for sampling, monitoring or\\ntransfusion (separate procedure); cutdown\\n$ 391.50\\n36640\\n36640\\nArterial catheterization for prolonged infusion therapy\\n(chemotherapy), cutdown\\n$ 550.80\\n36660\\n36660\\nCatheterization, umbilical artery, newborn, for diagnosis or therapy\\n$ 322.20\\n36680\\n36680\\nPlacement of needle for intraosseous infusion\\n$ 256.50\\n36800\\n36800\\nInsertion of cannula for hemodialysis, other purpose (separate\\nprocedure); vein to vein\\n$ 885.60\\n36810\\n36810\\nInsertion of cannula for hemodialysis, other purpose (separate\\nprocedure); arteriovenous, external (Scribner type)\\n$ 1,357.20\\n36815\\n36815\\nInsertion of cannula for hemodialysis, other purpose (separate\\nprocedure); arteriovenous, external revision, or closure\\n$ 1,125.90\\n36818\\n36818\\nArteriovenous anastomosis, open; by upper arm cephalic vein\\ntransposition\\n$ 1,990.48\\n36819\\n36819\\nArteriovenous anastomosis, open; by upper arm basilic vein\\ntransposition\\n$ 4,174.20\\n36820\\n36820\\nArteriovenous anastomosis, open; by forearm vein transposition\\n$ 2,132.80\\n36821\\n36821\\nArteriovenous anastomosis, open; direct, any site (eg, Cimino type)\\n(separate procedure)\\n$ 2,295.00\\n36823\\n36823\\nInsertion of arterial and venous cannula(s) for isolated\\nextracorporeal circulation including regional chemotherapy\\nperfusion to an extremity, with or without hyperthermia, with\\nremoval of cannula(s) and repair of arteriotomy and venotomy sites\\n$ 3,310.72\\n36825\\n36825\\nCreation of arteriovenous fistula by other than direct arteriovenous\\nanastomosis (separate procedure); autogenous graft\\n$ 3,141.90\\n36831\\n36831\\nThrombectomy, open, arteriovenous fistula without revision,\\nautogenous or nonautogenous dialysis graft (separate procedure)\\n$ 1,346.40\\n36832\\n36832\\nRevision, open, arteriovenous fistula; without thrombectomy,\\nautogenous or nonautogenous dialysis graft (separate procedure)\\n$ 2,439.90\\n36833\\n36833\\nRevision, open, arteriovenous fistula; with thrombectomy,\\nautogenous or nonautogenous dialysis graft (separate procedure)\\n$ 1,944.90\\n36835\\n36835\\nInsertion of Thomas shunt (separate procedure)\\n$ 1,480.23\\n36838\\n36838\\nDistal revascularization and interval ligation (DRIL), upper extremity\\nhemodialysis access (steal syndrome)\\n$ 3,556.18\\n36860\\n36860\\nExternal cannula declotting (separate procedure); without balloon\\ncatheter\\n$ 412.20\\n36861\\n36861\\nExternal cannula declotting (separate procedure); with balloon\\ncatheter\\n$ 891.00\\n36870\\n36870\\nThrombectomy, percutaneous, arteriovenous fistula, autogenous or\\nnonautogenous graft (includes mechanical thrombus extraction and\\nintra-graft thrombolysis)\\n$ 3,973.50\\n37140\\n37140\\nVenous anastomosis, open; portocaval\\n$ 5,608.80\\n37145\\n37145\\nVenous anastomosis, open; renoportal\\n$ 3,990.60\\n37160\\n37160\\nVenous anastomosis, open; caval-mesenteric\\n$ 5,255.10\\n37180\\n37180\\nVenous anastomosis, open; splenorenal, proximal\\n$ 4,969.80\\n37181\\n37181\\nVenous anastomosis, open; splenorenal, distal (selective\\ndecompression of esophagogastric varices, any technique)\\n$ 5,961.60\\n37182\\n37182\\nInsertion of transvenous intrahepatic portosystemic shunt(s) (TIPS)\\n(includes venous access, hepatic and portal vein catheterization,\\nportography with hemodynamic evaluation, intrahepatic tract\\nformation\/dilatation, stent placement and all associated imag\\n$ 1,959.09\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n173\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n174\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n37183\\n37183\\nRevision of transvenous intrahepatic portosystemic shunt(s) (TIPS)\\n(includes venous access, hepatic and portal vein catheterization,\\nportography with hemodynamic evaluation, intrahepatic tract\\nrecanulization\/dilatation, stent placement and all associated\\n$ 15,255.65\\n37184\\n37184\\nPrimary percutaneous transluminal mechanical thrombectomy,\\nnoncoronary, arterial or arterial bypass graft, including fluoroscopic\\nguidance and intraprocedural pharmacological thrombolytic\\ninjection(s); initial vessel\\n$ 2,214.84\\n37185\\n37185\\nPrimary percutaneous transluminal mechanical thrombectomy,\\nnoncoronary, arterial or arterial bypass graft, including fluoroscopic\\nguidance and intraprocedural pharmacological thrombolytic\\ninjection(s); second and all subsequent vessel(s) within the same v\\n$ 872.39\\n37186\\n37186\\nSecondary percutaneous transluminal thrombectomy (eg,\\nnonprimary mechanical, snare basket, suction technique),\\nnoncoronary, arterial or arterial bypass graft, including fluoroscopic\\nguidance and intraprocedural pharmacological thrombolytic\\ninjections, pro\\n$ 1,250.30\\n37187\\n37187\\nPercutaneous transluminal mechanical thrombectomy, vein(s),\\nincluding intraprocedural pharmacological thrombolytic injections\\nand fluoroscopic guidance\\n$ 1,941.11\\n37188\\n37188\\nPercutaneous transluminal mechanical thrombectomy, vein(s),\\nincluding intraprocedural pharmacological thrombolytic injections\\nand fluoroscopic guidance, repeat treatment on subsequent day\\nduring course of thrombolytic therapy\\n$ 1,473.77\\n37191\\n37191\\nInsertion of intravascular vena cava filter, endovascular approach\\nincluding vascular access, vessel selection, and radiological\\nsupervision and interpretation, intraprocedural roadmapping, and\\nimaging guidance (ultrasound and fluoroscopy), when performed\\n$ 6,918.36\\n37192\\n37192\\nRepositioning of intravascular vena cava filter, endovascular\\napproach including vascular access, vessel selection, and\\nradiological supervision and interpretation, intraprocedural\\nroadmapping, and imaging guidance (ultrasound and fluoroscopy),\\nwhen performed\\n$ 4,487.46\\n37193\\n37193\\nRetrieval (removal) of intravascular vena cava filter, endovascular\\napproach including vascular access, vessel selection, and\\nradiological supervision and interpretation, intraprocedural\\nroadmapping, and imaging guidance (ultrasound and fluoroscopy),\\nwhen performed\\n$ 4,282.95\\n37195\\n37195\\nThrombolysis, cerebral, by intravenous infusion\\n$ 846.90\\n37197\\n37197\\nTranscatheter retrieval, percutaneous, of intravascular foreign body\\n(eg, fractured venous or arterial catheter), includes radiological\\nsupervision and interpretation, and imaging guidance (ultrasound or\\nfluoroscopy), when performed\\n$ 3,887.58\\n37200\\n37200\\nTranscatheter biopsy\\n$ 814.79\\n37202\\n37202\\nTranscatheter therapy, infusion other than for thrombolysis, any\\ntype (eg, spasmolytic, vasoconstrictive)\\n$ 973.80\\n37211\\n37211\\nTranscatheter therapy, arterial infusion for thrombolysis other than\\ncoronary, any method, including radiological supervision and\\ninterpretation, initial treatment day\\n$ 972.47\\n37212\\n37212\\nTranscatheter therapy, venous infusion for thrombolysis, any\\nmethod, including radiological supervision and interpretation, initial\\ntreatment day\\n$ 858.67\\n37213\\n37213\\nTranscatheter therapy, arterial or venous infusion for thrombolysis\\nother than coronary, any method, including radiological supervision\\nand interpretation, continued treatment on subsequent day during\\ncourse of thrombolytic therapy, including follow-up ca\\n$ 599.49\\n37214\\n37214\\nTranscatheter therapy, arterial or venous infusion for thrombolysis\\nother than coronary, any method, including radiological supervision\\nand interpretation, continued treatment on subsequent day during\\ncourse of thrombolytic therapy, including follow-up ca\\n$ 353.25\\n37215\\n37215\\nTranscatheter placement of intravascular stent(s), cervical carotid\\nartery, percutaneous; with distal embolic protection\\n$ 3,812.78\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n175\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n176\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n37216\\n37216\\nTranscatheter placement of intravascular stent(s), cervical carotid\\nartery, percutaneous; without distal embolic protection\\n$ 3,498.17\\n37220\\n37220\\nRevascularization, endovascular, open or percutaneous, iliac artery,\\nunilateral, initial vessel; with transluminal angioplasty\\n$ 2,257.95\\n37221\\n37221\\nRevascularization, endovascular, open or percutaneous, iliac artery,\\nunilateral, initial vessel; with transluminal stent placement(s),\\nincludes angioplasty within the same vessel, when performed\\n$ 3,035.71\\n37222\\n37222\\nRevascularization, endovascular, open or percutaneous, iliac artery,\\neach additional ipsilateral iliac vessel; with transluminal angioplasty\\n(List separately in addition to code for primary procedure)\\n$ 861.42\\n37223\\n37223\\nRevascularization, endovascular, open or percutaneous, iliac artery,\\neach additional ipsilateral iliac vessel; with transluminal stent\\nplacement(s), includes angioplasty within the same vessel, when\\nperformed (List separately in addition to code for prima\\n$ 1,606.46\\n37224\\n37224\\nRevascularization, endovascular, open or percutaneous, femoral,\\npopliteal artery(s), unilateral; with transluminal angioplasty\\n$ 2,605.53\\n37225\\n37225\\nRevascularization, endovascular, open or percutaneous, femoral,\\npopliteal artery(s), unilateral; with atherectomy, includes\\nangioplasty within the same vessel, when performed\\n$ 5,405.06\\n37226\\n37226\\nRevascularization, endovascular, open or percutaneous, femoral,\\npopliteal artery(s), unilateral; with transluminal stent placement(s),\\nincludes angioplasty within the same vessel, when performed\\n$ 4,490.45\\n37227\\n37227\\nRevascularization, endovascular, open or percutaneous, femoral,\\npopliteal artery(s), unilateral; with transluminal stent placement(s)\\nand atherectomy, includes angioplasty within the same vessel,\\nwhen performed\\n$ 7,098.85\\n37228\\n37228\\nRevascularization, endovascular, open or percutaneous, tibial,\\nperoneal artery, unilateral, initial vessel; with transluminal\\nangioplasty\\n$ 3,436.34\\n37229\\n37229\\nRevascularization, endovascular, open or percutaneous, tibial,\\nperoneal artery, unilateral, initial vessel; with atherectomy, includes\\nangioplasty within the same vessel, when performed\\n$ 5,676.63\\n37230\\n37230\\nRevascularization, endovascular, open or percutaneous, tibial,\\nperoneal artery, unilateral, initial vessel; with transluminal stent\\nplacement(s), includes angioplasty within the same vessel, when\\nperformed\\n$ 4,780.81\\n37231\\n37231\\nRevascularization, endovascular, open or percutaneous, tibial,\\nperoneal artery, unilateral, initial vessel; with transluminal stent\\nplacement(s) and atherectomy, includes angioplasty within the\\nsame vessel, when performed\\n$ 6,604.22\\n37232\\n37232\\nRevascularization, endovascular, open or percutaneous,\\ntibial\/peroneal artery, unilateral, each additional vessel; with\\ntransluminal angioplasty (List separately in addition to code for\\nprimary procedure)\\n$ 1,046.39\\n37233\\n37233\\nRevascularization, endovascular, open or percutaneous,\\ntibial\/peroneal artery, unilateral, each additional vessel; with\\natherectomy, includes angioplasty within the same vessel, when\\nperformed (List separately in addition to code for primary\\nprocedure)\\n$ 1,367.77\\n37234\\n37234\\nRevascularization, endovascular, open or percutaneous,\\ntibial\/peroneal artery, unilateral, each additional vessel; with\\ntransluminal stent placement(s), includes angioplasty within the\\nsame vessel, when performed (List separately in addition to code\\nfor p\\n$ 2,092.73\\n37235\\n37235\\nRevascularization, endovascular, open or percutaneous,\\ntibial\/peroneal artery, unilateral, each additional vessel; with\\ntransluminal stent placement(s) and atherectomy, includes\\nangioplasty within the same vessel, when performed (List separately\\nin additi\\n$ 2,470.73\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n177\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n178\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n37236\\n37236\\nTranscatheter placement of an intravascular stent(s) (except lower\\nextremity, cervical carotid, extracranial vertebral or intrathoracic\\ncarotid, intracranial, or coronary), open or percutaneous, including\\nradiological supervision and interpretation and in\\n$ 9,119.70\\n37237\\n37237\\nTranscatheter placement of an intravascular stent(s) (except lower\\nextremity, cervical carotid, extracranial vertebral or intrathoracic\\ncarotid, intracranial, or coronary), open or percutaneous, including\\nradiological supervision and interpretation and in\\n$ 4,410.41\\n37238\\n37238\\nTranscatheter placement of an intravascular stent(s), open or\\npercutaneous, including radiological supervision and interpretation\\nand including angioplasty within the same vessel, when performed;\\ninitial vein\\n$ 9,119.70\\n37239\\n37239\\nTranscatheter placement of an intravascular stent(s), open or\\npercutaneous, including radiological supervision and interpretation\\nand including angioplasty within the same vessel, when performed;\\neach additional vein (List separately in addition to code f\\n$ 4,410.41\\n37241\\n37241\\nVascular embolization or occlusion, inclusive of all radiological\\nsupervision and interpretation, intraprocedural roadmapping, and\\nimaging guidance necessary to complete the intervention; venous,\\nother than hemorrhage (eg, congenital or acquired venous ma\\n$ 8,842.66\\n37242\\n37242\\nVascular embolization or occlusion, inclusive of all radiological\\nsupervision and interpretation, intraprocedural roadmapping, and\\nimaging guidance necessary to complete the intervention; arterial,\\nother than hemorrhage or tumor (eg, congenital or acquire\\n$ 8,842.66\\n37243\\n37243\\nVascular embolization or occlusion, inclusive of all radiological\\nsupervision and interpretation, intraprocedural roadmapping, and\\nimaging guidance necessary to complete the intervention; for\\ntumors, organ ischemia, or infarction\\n$ 8,842.66\\n37244\\n37244\\nVascular embolization or occlusion, inclusive of all radiological\\nsupervision and interpretation, intraprocedural roadmapping, and\\nimaging guidance necessary to complete the intervention; for\\narterial or venous hemorrhage or lymphatic extravasation\\n$ 8,842.66\\n37250\\n37250\\nIntravascular ultrasound (non-coronary vessel) during diagnostic\\nevaluation and\/or therapeutic intervention; initial vessel (List\\nseparately in addition to code for primary procedure)\\n$ 408.08\\n37251\\n37251\\nIntravascular ultrasound (non-coronary vessel) during diagnostic\\nevaluation and\/or therapeutic intervention; each additional vessel\\n(List separately in addition to code for primary procedure)\\n$ 319.58\\n37500\\n37500\\nVascular endoscopy, surgical, with ligation of perforator veins,\\nsubfascial (SEPS)\\n$ 2,240.80\\n37501\\n37501\\nUnlisted vascular endoscopy procedure\\nCost\\n37565\\n37565\\nLigation, internal jugular vein\\n$ 1,462.50\\n37600\\n37600\\nLigation; external carotid artery\\n$ 1,596.60\\n37605\\n37605\\nLigation; internal or common carotid artery\\n$ 1,402.20\\n37606\\n37606\\nLigation; internal or common carotid artery, with gradual occlusion,\\nas with Selverstone or Crutchfield clamp\\n$ 1,670.40\\n37607\\n37607\\nLigation or banding of angioaccess arteriovenous fistula\\n$ 1,293.30\\n37609\\n37609\\nLigation or biopsy, temporal artery\\n$ 689.40\\n37615\\n37615\\nLigation, major artery (eg, post-traumatic, rupture); neck\\n$ 1,608.30\\n37616\\n37616\\nLigation, major artery (eg, post-traumatic, rupture); chest\\n$ 2,796.30\\n37617\\n37617\\nLigation, major artery (eg, post-traumatic, rupture); abdomen\\n$ 2,619.00\\n37618\\n37618\\nLigation, major artery (eg, post-traumatic, rupture); extremity\\n$ 1,545.30\\n37619\\n37619\\nLigation of inferior vena cava\\n$ 4,215.75\\n37650\\n37650\\nLigation of femoral vein\\n$ 1,337.40\\n37660\\n37660\\nLigation of common iliac vein\\n$ 1,606.50\\n37700\\n37700\\nLigation and division of long saphenous vein at saphenofemoral\\njunction, or distal interruptions\\n$ 998.10\\n37718\\n37718\\nLigation, division, and stripping, short saphenous vein\\n$ 1,006.21\\n37722\\n37722\\nLigation, division, and stripping, long (greater) saphenous veins\\nfrom saphenofemoral junction to knee or below\\n$ 1,208.89\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n179\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n180\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n37735\\n37735\\nLigation and division and complete stripping of long or short\\nsaphenous veins with radical excision of ulcer and skin graft and\/or\\ninterruption of communicating veins of lower leg, with excision of\\ndeep fascia\\n$ 2,844.00\\n37760\\n37760\\nLigation of perforator veins, subfascial, radical (Linton type),\\nincluding skin graft, when performed, open, 1 leg\\n$ 2,987.10\\n37761\\n37761\\nLigation of perforator vein(s), subfascial, open, including ultrasound\\nguidance, when performed, 1 leg\\n$ 1,390.71\\n37765\\n37765\\nStab phlebectomy of varicose veins, 1 extremity; 10-20 stab\\nincisions\\n$ 1,167.91\\n37766\\n37766\\nStab phlebectomy of varicose veins, 1 extremity; more than 20\\nincisions\\n$ 1,416.38\\n37780\\n37780\\nLigation and division of short saphenous vein at saphenopopliteal\\njunction (separate procedure)\\n$ 641.70\\n37785\\n37785\\nLigation, division, and\/or excision of varicose vein cluster(s), 1 leg\\n$ 739.80\\n37788\\n37788\\nPenile revascularization, artery, with or without vein graft\\n$ 4,092.33\\n37790\\n37790\\nPenile venous occlusive procedure\\n$ 1,527.94\\n37799\\n37799\\nUnlisted procedure, vascular surgery\\nCost\\n38100\\n38100\\nSplenectomy; total (separate procedure)\\n$ 2,660.40\\n38101\\n38101\\nSplenectomy; partial (separate procedure)\\n$ 2,975.40\\n38102\\n38102\\nSplenectomy; total, en bloc for extensive disease, in conjunction\\nwith other procedure (List in addition to code for primary\\nprocedure)\\n$ 1,835.10\\n38115\\n38115\\nRepair of ruptured spleen (splenorrhaphy) with or without partial\\nsplenectomy\\n$ 2,743.20\\n38120\\n38120\\nLaparoscopy, surgical, splenectomy\\n$ 3,954.23\\n38129\\n38129\\nUnlisted laparoscopy procedure, spleen\\nCost\\n38200\\n38200\\nInjection procedure for splenoportography\\n$ 351.00\\n38204\\n38204\\nManagement of recipient hematopoietic progenitor cell donor\\nsearch and cell acquisition\\n$ 232.57\\n38205\\n38205\\nBlood-derived hematopoietic progenitor cell harvesting for\\ntransplantation, per collection; allogeneic\\n$ 718.59\\n38206\\n38206\\nBlood-derived hematopoietic progenitor cell harvesting for\\ntransplantation, per collection; autologous\\n$ 718.94\\n38207\\n38207\\nTransplant preparation of hematopoietic progenitor cells;\\ncryopreservation and storage\\n$ 78.09\\n38208\\n38208\\nTransplant preparation of hematopoietic progenitor cells; thawing\\nof previously frozen harvest, without washing, per donor\\n$ 50.46\\n38209\\n38209\\nTransplant preparation of hematopoietic progenitor cells; thawing\\nof previously frozen harvest, with washing, per donor\\n$ 20.85\\n38210\\n38210\\nTransplant preparation of hematopoietic progenitor cells; specific\\ncell depletion within harvest, T-cell depletion\\n$ 140.03\\n38211\\n38211\\nTransplant preparation of hematopoietic progenitor cells; tumor\\ncell depletion\\n$ 128.01\\n38212\\n38212\\nTransplant preparation of hematopoietic progenitor cells; red blood\\ncell removal\\n$ 82.28\\n38213\\n38213\\nTransplant preparation of hematopoietic progenitor cells; platelet\\ndepletion\\n$ 20.85\\n38214\\n38214\\nTransplant preparation of hematopoietic progenitor cells; plasma\\n(volume) depletion\\n$ 71.84\\n38215\\n38215\\nTransplant preparation of hematopoietic progenitor cells; cell\\nconcentration in plasma, mononuclear, or buffy coat layer\\n$ 82.28\\n38220\\n38220\\nBone marrow; aspiration only\\n$ 293.47\\n38221\\n38221\\nBone marrow; biopsy, needle or trocar\\n$ 316.63\\n38230\\n38230\\nBone marrow harvesting for transplantation; allogeneic\\n$ 1,390.50\\n38240\\n38240\\nHematopoietic progenitor cell (HPC); allogeneic transplantation per\\ndonor\\n$ 1,089.69\\n38241\\n38241\\nHematopoietic progenitor cell (HPC); autologous transplantation\\n$ 986.52\\n38242\\n38242\\nAllogeneic lymphocyte infusions\\n$ 1,082.79\\n38300\\n38300\\nDrainage of lymph node abscess or lymphadenitis; simple\\n$ 293.40\\n38305\\n38305\\nDrainage of lymph node abscess or lymphadenitis; extensive\\n$ 729.00\\n38308\\n38308\\nLymphangiotomy or other operations on lymphatic channels\\n$ 884.70\\n38380\\n38380\\nSuture and\/or ligation of thoracic duct; cervical approach\\n$ 1,355.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n181\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n182\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n38381\\n38381\\nSuture and\/or ligation of thoracic duct; thoracic approach\\n$ 2,421.00\\n38382\\n38382\\nSuture and\/or ligation of thoracic duct; abdominal approach\\n$ 2,037.60\\n38500\\n38500\\nBiopsy or excision of lymph node(s); open, superficial\\n$ 587.77\\n38505\\n38505\\nBiopsy or excision of lymph node(s); by needle, superficial (eg,\\ncervical, inguinal, axillary)\\n$ 399.60\\n38510\\n38510\\nBiopsy or excision of lymph node(s); open, deep cervical node(s)\\n$ 850.50\\n38520\\n38520\\nBiopsy or excision of lymph node(s); open, deep cervical node(s)\\nwith excision scalene fat pad\\n$ 918.90\\n38525\\n38525\\nBiopsy or excision of lymph node(s); open, deep axillary node(s)\\n$ 1,233.90\\n38542\\n38542\\nDissection, deep jugular node(s)\\n$ 1,244.70\\n38550\\n38550\\nExcision of cystic hygroma, axillary or cervical; without deep\\nneurovascular dissection\\n$ 1,267.20\\n38555\\n38555\\nExcision of cystic hygroma, axillary or cervical; with deep\\nneurovascular dissection\\n$ 2,374.20\\n38562\\n38562\\nLimited lymphadenectomy for staging (separate procedure); pelvic\\nand para-aortic\\n$ 2,771.10\\n38564\\n38564\\nLimited lymphadenectomy for staging (separate procedure);\\nretroperitoneal (aortic and\/or splenic)\\n$ 2,665.80\\n38570\\n38570\\nLaparoscopy, surgical; with retroperitoneal lymph node sampling\\n(biopsy), single or multiple\\n$ 2,667.60\\n38571\\n38571\\nLaparoscopy, surgical; with bilateral total pelvic lymphadenectomy\\n$ 3,213.90\\n38572\\n38572\\nLaparoscopy, surgical; with bilateral total pelvic lymphadenectomy\\nand peri-aortic lymph node sampling (biopsy), single or multiple\\n$ 3,295.80\\n38589\\n38589\\nUnlisted laparoscopy procedure, lymphatic system\\nCost\\n38700\\n38700\\nSuprahyoid lymphadenectomy\\n$ 2,449.80\\n38720\\n38720\\nCervical lymphadenectomy (complete)\\n$ 3,872.70\\n38724\\n38724\\nCervical lymphadenectomy (modified radical neck dissection)\\n$ 3,672.00\\n38740\\n38740\\nAxillary lymphadenectomy; superficial\\n$ 1,797.30\\n38745\\n38745\\nAxillary lymphadenectomy; complete\\n$ 2,779.20\\n38746\\n38746\\nThoracic lymphadenectomy by thoracotomy, mediastinal and\\nregional lymphadenectomy (List separately in addition to code for\\nprimary procedure)\\n$ 846.00\\n38747\\n38747\\nAbdominal lymphadenectomy, regional, including celiac, gastric,\\nportal, peripancreatic, with or without para-aortic and vena caval\\nnodes (List separately in addition to code for primary procedure)\\n$ 1,178.10\\n38760\\n38760\\nInguinofemoral lymphadenectomy, superficial, including Cloquets\\nnode (separate procedure)\\n$ 2,240.10\\n38765\\n38765\\nInguinofemoral lymphadenectomy, superficial, in continuity with\\npelvic lymphadenectomy, including external iliac, hypogastric, and\\nobturator nodes (separate procedure)\\n$ 3,024.90\\n38770\\n38770\\nPelvic lymphadenectomy, including external iliac, hypogastric, and\\nobturator nodes (separate procedure)\\n$ 3,276.00\\n38780\\n38780\\nRetroperitoneal transabdominal lymphadenectomy, extensive,\\nincluding pelvic, aortic, and renal nodes (separate procedure)\\n$ 4,169.70\\n38790\\n38790\\nInjection procedure; lymphangiography\\n$ 396.90\\n38792\\n38792\\nInjection procedure; radioactive tracer for identification of sentinel\\nnode\\n$ 174.37\\n38794\\n38794\\nCannulation, thoracic duct\\n$ 1,099.47\\n38999\\n38999\\nUnlisted procedure, hemic or lymphatic system\\nCost\\n39000\\n39000\\nMediastinotomy with exploration, drainage, removal of foreign\\nbody, or biopsy; cervical approach\\n$ 1,619.10\\n39200\\n39200\\nResection of mediastinal cyst\\n$ 2,801.70\\n39220\\n39220\\nResection of mediastinal tumor\\n$ 3,410.10\\n39400\\n39400\\nMediastinoscopy, includes biopsy(ies), when performed\\n$ 1,290.60\\n39499\\n39499\\nUnlisted procedure, mediastinum\\nCost\\n39501\\n39501\\nRepair, laceration of diaphragm, any approach\\n$ 2,970.00\\n39503\\n39503\\nRepair, neonatal diaphragmatic hernia, with or without chest tube\\ninsertion and with or without creation of ventral hernia\\n$ 3,626.10\\n39540\\n39540\\nRepair, diaphragmatic hernia (other than neonatal), traumatic;\\nacute\\n$ 3,577.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n183\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n184\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n39541\\n39541\\nRepair, diaphragmatic hernia (other than neonatal), traumatic;\\nchronic\\n$ 3,515.40\\n39545\\n39545\\nImbrication of diaphragm for eventration, transthoracic or\\ntransabdominal, paralytic or nonparalytic\\n$ 3,464.10\\n39560\\n39560\\nResection, diaphragm; with simple repair (eg, primary suture)\\n$ 3,485.19\\n39561\\n39561\\nResection, diaphragm; with complex repair (eg, prosthetic material,\\nlocal muscle flap)\\n$ 5,241.89\\n39599\\n39599\\nUnlisted procedure, diaphragm\\nCost\\n40490\\n40490\\nBiopsy of lip\\n$ 206.10\\n40500\\n40500\\nVermilionectomy (lip shave), with mucosal advancement\\n$ 1,545.30\\n40510\\n40510\\nExcision of lip; transverse wedge excision with primary closure\\n$ 1,710.90\\n40520\\n40520\\nExcision of lip; V-excision with primary direct linear closure\\n$ 1,390.50\\n40525\\n40525\\nExcision of lip; full thickness, reconstruction with local flap (eg,\\nEstlander or fan)\\n$ 3,300.30\\n40527\\n40527\\nExcision of lip; full thickness, reconstruction with cross lip flap (Abbe-\\nEstlander)\\n$ 3,558.60\\n40530\\n40530\\nResection of lip, more than one-fourth, without reconstruction\\n$ 1,647.90\\n40650\\n40650\\nRepair lip, full thickness; vermilion only\\n$ 1,409.40\\n40652\\n40652\\nRepair lip, full thickness; up to half vertical height\\n$ 1,440.00\\n40654\\n40654\\nRepair lip, full thickness; over one-half vertical height, or complex\\n$ 1,681.20\\n40700\\n40700\\nPlastic repair of cleft lip\/nasal deformity; primary, partial or\\ncomplete, unilateral\\n$ 2,646.90\\n40701\\n40701\\nPlastic repair of cleft lip\/nasal deformity; primary bilateral, 1-stage\\nprocedure\\n$ 4,107.60\\n40702\\n40702\\nPlastic repair of cleft lip\/nasal deformity; primary bilateral, 1 of 2\\nstages\\n$ 2,590.20\\n40720\\n40720\\nPlastic repair of cleft lip\/nasal deformity; secondary, by recreation\\nof defect and reclosure\\n$ 2,788.20\\n40761\\n40761\\nPlastic repair of cleft lip\/nasal deformity; with cross lip pedicle flap\\n(Abbe-Estlander type), including sectioning and inserting of pedicle\\n$ 3,038.40\\n40799\\n40799\\nUnlisted procedure, lips\\nCost\\n40800\\n40800\\nDrainage of abscess, cyst, hematoma, vestibule of mouth; simple\\n$ 201.60\\n40801\\n40801\\nDrainage of abscess, cyst, hematoma, vestibule of mouth;\\ncomplicated\\n$ 579.60\\n40804\\n40804\\nRemoval of embedded foreign body, vestibule of mouth; simple\\n$ 236.70\\n40805\\n40805\\nRemoval of embedded foreign body, vestibule of mouth;\\ncomplicated\\n$ 657.90\\n40806\\n40806\\nIncision of labial frenum (frenotomy)\\n$ 315.90\\n40808\\n40808\\nBiopsy, vestibule of mouth\\n$ 202.50\\n40810\\n40810\\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\\nwithout repair\\n$ 262.80\\n40812\\n40812\\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\\nwith simple repair\\n$ 398.70\\n40814\\n40814\\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\\nwith complex repair\\n$ 870.30\\n40816\\n40816\\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\\ncomplex, with excision of underlying muscle\\n$ 1,030.50\\n40818\\n40818\\nExcision of mucosa of vestibule of mouth as donor graft\\n$ 627.30\\n40819\\n40819\\nExcision of frenum, labial or buccal (frenumectomy, frenulectomy,\\nfrenectomy)\\n$ 414.00\\n40820\\n40820\\nDestruction of lesion or scar of vestibule of mouth by physical\\nmethods (eg, laser, thermal, cryo, chemical)\\n$ 349.20\\n40830\\n40830\\nClosure of laceration, vestibule of mouth; 2.5 cm or less\\n$ 232.24\\n40831\\n40831\\nClosure of laceration, vestibule of mouth; over 2.5 cm or complex\\n$ 528.30\\n40840\\n40840\\nVestibuloplasty; anterior\\n$ 1,712.70\\n40842\\n40842\\nVestibuloplasty; posterior, unilateral\\n$ 1,566.90\\n40843\\n40843\\nVestibuloplasty; posterior, bilateral\\n$ 2,436.30\\n40844\\n40844\\nVestibuloplasty; entire arch\\n$ 3,133.80\\n40845\\n40845\\nVestibuloplasty; complex (including ridge extension, muscle\\nrepositioning)\\n$ 3,672.90\\n40899\\n40899\\nUnlisted procedure, vestibule of mouth\\nCost\\n41000\\n41000\\nIntraoral incision and drainage of abscess, cyst, or hematoma of\\ntongue or floor of mouth; lingual\\n$ 256.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n185\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n186\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n41005\\n41005\\nIntraoral incision and drainage of abscess, cyst, or hematoma of\\ntongue or floor of mouth; sublingual, superficial\\n$ 286.20\\n41006\\n41006\\nIntraoral incision and drainage of abscess, cyst, or hematoma of\\ntongue or floor of mouth; sublingual, deep, supramylohyoid\\n$ 610.20\\n41007\\n41007\\nIntraoral incision and drainage of abscess, cyst, or hematoma of\\ntongue or floor of mouth; submental space\\n$ 703.80\\n41008\\n41008\\nIntraoral incision and drainage of abscess, cyst, or hematoma of\\ntongue or floor of mouth; submandibular space\\n$ 718.20\\n41009\\n41009\\nIntraoral incision and drainage of abscess, cyst, or hematoma of\\ntongue or floor of mouth; masticator space\\n$ 810.00\\n41010\\n41010\\nIncision of lingual frenum (frenotomy)\\n$ 247.50\\n41015\\n41015\\nExtraoral incision and drainage of abscess, cyst, or hematoma of\\nfloor of mouth; sublingual\\n$ 772.20\\n41016\\n41016\\nExtraoral incision and drainage of abscess, cyst, or hematoma of\\nfloor of mouth; submental\\n$ 839.70\\n41017\\n41017\\nExtraoral incision and drainage of abscess, cyst, or hematoma of\\nfloor of mouth; submandibular\\n$ 829.80\\n41018\\n41018\\nExtraoral incision and drainage of abscess, cyst, or hematoma of\\nfloor of mouth; masticator space\\n$ 956.70\\n41019\\n41019\\nPlacement of needles, catheters, or other device(s) into the head\\nand\/or neck region (percutaneous, transoral, or transnasal) for\\nsubsequent interstitial radioelement application\\n$ 1,028.05\\n41100\\n41100\\nBiopsy of tongue; anterior two-thirds\\n$ 261.00\\n41105\\n41105\\nBiopsy of tongue; posterior one-third\\n$ 309.60\\n41108\\n41108\\nBiopsy of floor of mouth\\n$ 239.40\\n41110\\n41110\\nExcision of lesion of tongue without closure\\n$ 393.30\\n41112\\n41112\\nExcision of lesion of tongue with closure; anterior two-thirds\\n$ 642.60\\n41113\\n41113\\nExcision of lesion of tongue with closure; posterior one-third\\n$ 954.00\\n41114\\n41114\\nExcision of lesion of tongue with closure; with local tongue flap\\n$ 2,168.10\\n41115\\n41115\\nExcision of lingual frenum (frenectomy)\\n$ 426.60\\n41116\\n41116\\nExcision, lesion of floor of mouth\\n$ 715.50\\n41120\\n41120\\nGlossectomy; less than one-half tongue\\n$ 1,905.30\\n41130\\n41130\\nGlossectomy; hemiglossectomy\\n$ 2,204.10\\n41135\\n41135\\nGlossectomy; partial, with unilateral radical neck dissection\\n$ 4,789.80\\n41140\\n41140\\nGlossectomy; complete or total, with or without tracheostomy,\\nwithout radical neck dissection\\n$ 4,610.70\\n41145\\n41145\\nGlossectomy; complete or total, with or without tracheostomy, with\\nunilateral radical neck dissection\\n$ 5,366.70\\n41150\\n41150\\nGlossectomy; composite procedure with resection floor of mouth\\nand mandibular resection, without radical neck dissection\\n$ 4,663.80\\n41153\\n41153\\nGlossectomy; composite procedure with resection floor of mouth,\\nwith suprahyoid neck dissection\\n$ 4,880.70\\n41155\\n41155\\nGlossectomy; composite procedure with resection floor of mouth,\\nmandibular resection, and radical neck dissection (Commando type)\\n$ 6,470.10\\n41250\\n41250\\nRepair of laceration 2.5 cm or less; floor of mouth and\/or anterior\\ntwo-thirds of tongue\\n$ 361.80\\n41251\\n41251\\nRepair of laceration 2.5 cm or less; posterior one-third of tongue\\n$ 513.00\\n41252\\n41252\\nRepair of laceration of tongue, floor of mouth, over 2.6 cm or\\ncomplex\\n$ 838.80\\n41500\\n41500\\nFixation of tongue, mechanical, other than suture (eg, K-wire)\\n$ 766.80\\n41510\\n41510\\nSuture of tongue to lip for micrognathia (Douglas type procedure)\\n$ 1,354.50\\n41512\\n41512\\nTongue base suspension, permanent suture technique\\n$ 1,094.85\\n41520\\n41520\\nFrenoplasty (surgical revision of frenum, eg, with Z-plasty)\\n$ 647.10\\n41530\\n41530\\nSubmucosal ablation of the tongue base, radiofrequency, 1 or more\\nsites, per session\\n$ 6,950.37\\n41599\\n41599\\nUnlisted procedure, tongue, floor of mouth\\nCost\\n41800\\n41800\\nDrainage of abscess, cyst, hematoma from dentoalveolar structures\\n$ 229.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n187\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n188\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n41805\\n41805\\nRemoval of embedded foreign body from dentoalveolar structures;\\nsoft tissues\\n$ 298.80\\n41806\\n41806\\nRemoval of embedded foreign body from dentoalveolar structures;\\nbone\\n$ 493.20\\n41821\\n41821\\nOperculectomy, excision pericoronal tissues\\n$ -\\n41822\\n41822\\nExcision of fibrous tuberosities, dentoalveolar structures\\n$ 429.30\\n41823\\n41823\\nExcision of osseous tuberosities, dentoalveolar structures\\n$ 705.60\\n41825\\n41825\\nExcision of lesion or tumor (except listed above), dentoalveolar\\nstructures; without repair\\n$ 369.00\\n41826\\n41826\\nExcision of lesion or tumor (except listed above), dentoalveolar\\nstructures; with simple repair\\n$ 546.30\\n41827\\n41827\\nExcision of lesion or tumor (except listed above), dentoalveolar\\nstructures; with complex repair\\n$ 849.60\\n41828\\n41828\\nExcision of hyperplastic alveolar mucosa, each quadrant (specify)\\n$ 726.30\\n41830\\n41830\\nAlveolectomy, including curettage of osteitis or sequestrectomy\\n$ 849.60\\n41850\\n41850\\nDestruction of lesion (except excision), dentoalveolar structures\\n$ 180.00\\n41870\\n41870\\nPeriodontal mucosal grafting\\n$ 726.30\\n41872\\n41872\\nGingivoplasty, each quadrant (specify)\\n$ 669.60\\n41874\\n41874\\nAlveoloplasty, each quadrant (specify)\\n$ 756.90\\n41899\\n41899\\nUnlisted procedure, dentoalveolar structures\\nCost\\n42000\\n42000\\nDrainage of abscess of palate, uvula\\n$ 236.70\\n42100\\n42100\\nBiopsy of palate, uvula\\n$ 273.60\\n42104\\n42104\\nExcision, lesion of palate, uvula; without closure\\n$ 478.80\\n42106\\n42106\\nExcision, lesion of palate, uvula; with simple primary closure\\n$ 618.30\\n42107\\n42107\\nExcision, lesion of palate, uvula; with local flap closure\\n$ 1,787.40\\n42120\\n42120\\nResection of palate or extensive resection of lesion\\n$ 2,958.30\\n42140\\n42140\\nUvulectomy, excision of uvula\\n$ 470.70\\n42145\\n42145\\nPalatopharyngoplasty (eg, uvulopalatopharyngoplasty,\\nuvulopharyngoplasty)\\n$ 2,509.20\\n42160\\n42160\\nDestruction of lesion, palate or uvula (thermal, cryo or chemical)\\n$ 448.20\\n42180\\n42180\\nRepair, laceration of palate; up to 2 cm\\n$ 416.96\\n42182\\n42182\\nRepair, laceration of palate; over 2 cm or complex\\n$ 825.30\\n42200\\n42200\\nPalatoplasty for cleft palate, soft and\/or hard palate only\\n$ 2,801.70\\n42205\\n42205\\nPalatoplasty for cleft palate, with closure of alveolar ridge; soft\\ntissue only\\n$ 3,186.00\\n42210\\n42210\\nPalatoplasty for cleft palate, with closure of alveolar ridge; with\\nbone graft to alveolar ridge (includes obtaining graft)\\n$ 4,377.60\\n42215\\n42215\\nPalatoplasty for cleft palate; major revision\\n$ 2,664.90\\n42220\\n42220\\nPalatoplasty for cleft palate; secondary lengthening procedure\\n$ 2,497.50\\n42225\\n42225\\nPalatoplasty for cleft palate; attachment pharyngeal flap\\n$ 2,811.60\\n42226\\n42226\\nLengthening of palate, and pharyngeal flap\\n$ 3,475.80\\n42227\\n42227\\nLengthening of palate, with island flap\\n$ 2,935.80\\n42235\\n42235\\nRepair of anterior palate, including vomer flap\\n$ 2,310.30\\n42260\\n42260\\nRepair of nasolabial fistula\\n$ 1,653.30\\n42280\\n42280\\nMaxillary impression for palatal prosthesis\\n$ 309.60\\n42281\\n42281\\nInsertion of pin-retained palatal prosthesis\\n$ 355.50\\n42299\\n42299\\nUnlisted procedure, palate, uvula\\nCost\\n42300\\n42300\\nDrainage of abscess; parotid, simple\\n$ 324.90\\n42305\\n42305\\nDrainage of abscess; parotid, complicated\\n$ 806.40\\n42310\\n42310\\nDrainage of abscess; submaxillary or sublingual, intraoral\\n$ 360.90\\n42320\\n42320\\nDrainage of abscess; submaxillary, external\\n$ 597.60\\n42330\\n42330\\nSialolithotomy; submandibular (submaxillary), sublingual or parotid,\\nuncomplicated, intraoral\\n$ 415.95\\n42335\\n42335\\nSialolithotomy; submandibular (submaxillary), complicated,\\nintraoral\\n$ 789.30\\n42340\\n42340\\nSialolithotomy; parotid, extraoral or complicated intraoral\\n$ 1,092.60\\n42400\\n42400\\nBiopsy of salivary gland; needle\\n$ 250.20\\n42405\\n42405\\nBiopsy of salivary gland; incisional\\n$ 578.70\\n42408\\n42408\\nExcision of sublingual salivary cyst (ranula)\\n$ 1,061.10\\n42409\\n42409\\nMarsupialization of sublingual salivary cyst (ranula)\\n$ 772.20\\n42410\\n42410\\nExcision of parotid tumor or parotid gland; lateral lobe, without\\nnerve dissection\\n$ 2,012.40\\n42415\\n42415\\nExcision of parotid tumor or parotid gland; lateral lobe, with\\ndissection and preservation of facial nerve\\n$ 3,630.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n189\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n190\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n42420\\n42420\\nExcision of parotid tumor or parotid gland; total, with dissection\\nand preservation of facial nerve\\n$ 4,627.80\\n42425\\n42425\\nExcision of parotid tumor or parotid gland; total, en bloc removal\\nwith sacrifice of facial nerve\\n$ 3,363.30\\n42426\\n42426\\nExcision of parotid tumor or parotid gland; total, with unilateral\\nradical neck dissection\\n$ 6,180.30\\n42440\\n42440\\nExcision of submandibular (submaxillary) gland\\n$ 2,312.10\\n42450\\n42450\\nExcision of sublingual gland\\n$ 1,911.60\\n42500\\n42500\\nPlastic repair of salivary duct, sialodochoplasty; primary or simple\\n$ 1,374.30\\n42505\\n42505\\nPlastic repair of salivary duct, sialodochoplasty; secondary or\\ncomplicated\\n$ 1,757.70\\n42507\\n42507\\nParotid duct diversion, bilateral (Wilke type procedure);\\n$ 2,302.20\\n42508\\n42508\\nParotid duct diversion, bilateral (Wilke type procedure); with\\nexcision of 1 submandibular gland\\n$ 2,601.00\\n42509\\n42509\\nParotid duct diversion, bilateral (Wilke type procedure); with\\nexcision of both submandibular glands\\n$ 3,194.10\\n42510\\n42510\\nParotid duct diversion, bilateral (Wilke type procedure); with\\nligation of both submandibular (Wharton's) ducts\\n$ 2,726.10\\n42550\\n42550\\nInjection procedure for sialography\\n$ 193.50\\n42600\\n42600\\nClosure salivary fistula\\n$ 1,476.00\\n42650\\n42650\\nDilation salivary duct\\n$ 143.10\\n42660\\n42660\\nDilation and catheterization of salivary duct, with or without\\ninjection\\n$ 215.10\\n42665\\n42665\\nLigation salivary duct, intraoral\\n$ 456.30\\n42699\\n42699\\nUnlisted procedure, salivary glands or ducts\\nCost\\n42700\\n42700\\nIncision and drainage abscess; peritonsillar\\n$ 318.60\\n42720\\n42720\\nIncision and drainage abscess; retropharyngeal or parapharyngeal,\\nintraoral approach\\n$ 688.50\\n42725\\n42725\\nIncision and drainage abscess; retropharyngeal or parapharyngeal,\\nexternal approach\\n$ 1,467.00\\n42800\\n42800\\nBiopsy; oropharynx\\n$ 250.20\\n42804\\n42804\\nBiopsy; nasopharynx, visible lesion, simple\\n$ 308.70\\n42806\\n42806\\nBiopsy; nasopharynx, survey for unknown primary lesion\\n$ 373.50\\n42808\\n42808\\nExcision or destruction of lesion of pharynx, any method\\n$ 592.20\\n42809\\n42809\\nRemoval of foreign body from pharynx\\n$ 312.30\\n42810\\n42810\\nExcision branchial cleft cyst or vestige, confined to skin and\\nsubcutaneous tissues\\n$ 878.40\\n42815\\n42815\\nExcision branchial cleft cyst, vestige, or fistula, extending beneath\\nsubcutaneous tissues and\/or into pharynx\\n$ 1,880.10\\n42820\\n42820\\nTonsillectomy and adenoidectomy; younger than age 12\\n$ 816.61\\n42821\\n42821\\nTonsillectomy and adenoidectomy; age 12 or over\\n$ 1,031.40\\n42825\\n42825\\nTonsillectomy, primary or secondary; younger than age 12\\n$ 820.80\\n42826\\n42826\\nTonsillectomy, primary or secondary; age 12 or over\\n$ 841.50\\n42830\\n42830\\nAdenoidectomy, primary; younger than age 12\\n$ 581.64\\n42831\\n42831\\nAdenoidectomy, primary; age 12 or over\\n$ 675.00\\n42835\\n42835\\nAdenoidectomy, secondary; younger than age 12\\n$ 536.40\\n42836\\n42836\\nAdenoidectomy, secondary; age 12 or over\\n$ 669.60\\n42842\\n42842\\nRadical resection of tonsil, tonsillar pillars, and\/or retromolar\\ntrigone; without closure\\n$ 2,421.00\\n42844\\n42844\\nRadical resection of tonsil, tonsillar pillars, and\/or retromolar\\ntrigone; closure with local flap (eg, tongue, buccal)\\n$ 3,346.20\\n42845\\n42845\\nRadical resection of tonsil, tonsillar pillars, and\/or retromolar\\ntrigone; closure with other flap\\n$ 4,507.20\\n42860\\n42860\\nExcision of tonsil tags\\n$ 570.60\\n42870\\n42870\\nExcision or destruction lingual tonsil, any method (separate\\nprocedure)\\n$ 844.20\\n42890\\n42890\\nLimited pharyngectomy\\n$ 2,689.20\\n42892\\n42892\\nResection of lateral pharyngeal wall or pyriform sinus, direct closure\\nby advancement of lateral and posterior pharyngeal walls\\n$ 3,450.60\\n42894\\n42894\\nResection of pharyngeal wall requiring closure with myocutaneous\\nor fasciocutaneous flap or free muscle, skin, or fascial flap with\\nmicrovascular anastomosis\\n$ 4,776.30\\n42900\\n42900\\nSuture pharynx for wound or injury\\n$ 977.40\\n42950\\n42950\\nPharyngoplasty (plastic or reconstructive operation on pharynx)\\n$ 1,989.90\\n42953\\n42953\\nPharyngoesophageal repair\\n$ 2,523.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n191\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n192\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n42955\\n42955\\nPharyngostomy (fistulization of pharynx, external for feeding)\\n$ 1,579.50\\n42960\\n42960\\nControl oropharyngeal hemorrhage, primary or secondary (eg, post-\\ntonsillectomy); simple\\n$ 366.30\\n42961\\n42961\\nControl oropharyngeal hemorrhage, primary or secondary (eg, post-\\ntonsillectomy); complicated, requiring hospitalization\\n$ 600.30\\n42962\\n42962\\nControl oropharyngeal hemorrhage, primary or secondary (eg, post-\\ntonsillectomy); with secondary surgical intervention\\n$ 947.70\\n42970\\n42970\\nControl of nasopharyngeal hemorrhage, primary or secondary (eg,\\npostadenoidectomy); simple, with posterior nasal packs, with or\\nwithout anterior packs and\/or cautery\\n$ 629.10\\n42971\\n42971\\nControl of nasopharyngeal hemorrhage, primary or secondary (eg,\\npostadenoidectomy); complicated, requiring hospitalization\\n$ 945.00\\n42972\\n42972\\nControl of nasopharyngeal hemorrhage, primary or secondary (eg,\\npostadenoidectomy); with secondary surgical intervention\\n$ 1,179.00\\n42999\\n42999\\nUnlisted procedure, pharynx, adenoids, or tonsils\\nCost\\n43020\\n43020\\nEsophagotomy, cervical approach, with removal of foreign body\\n$ 1,996.20\\n43030\\n43030\\nCricopharyngeal myotomy\\n$ 2,510.10\\n43045\\n43045\\nEsophagotomy, thoracic approach, with removal of foreign body\\n$ 3,352.50\\n43100\\n43100\\nExcision of lesion, esophagus, with primary repair; cervical approach $ 2,568.60\\n43101\\n43101\\nExcision of lesion, esophagus, with primary repair; thoracic or\\nabdominal approach\\n$ 3,299.40\\n43107\\n43107\\nTotal or near total esophagectomy, without thoracotomy; with\\npharyngogastrostomy or cervical esophagogastrostomy, with or\\nwithout pyloroplasty (transhiatal)\\n$ 5,637.60\\n43108\\n43108\\nTotal or near total esophagectomy, without thoracotomy; with\\ncolon interposition or small intestine reconstruction, including\\nintestine mobilization, preparation and anastomosis(es)\\n$ 6,282.90\\n43112\\n43112\\nTotal or near total esophagectomy, with thoracotomy; with\\npharyngogastrostomy or cervical esophagogastrostomy, with or\\nwithout pyloroplasty\\n$ 6,437.70\\n43113\\n43113\\nTotal or near total esophagectomy, with thoracotomy; with colon\\ninterposition or small intestine reconstruction, including intestine\\nmobilization, preparation, and anastomosis(es)\\n$ 5,426.85\\n43116\\n43116\\nPartial esophagectomy, cervical, with free intestinal graft, including\\nmicrovascular anastomosis, obtaining the graft and intestinal\\nreconstruction\\n$ 6,171.24\\n43117\\n43117\\nPartial esophagectomy, distal two-thirds, with thoracotomy and\\nseparate abdominal incision, with or without proximal gastrectomy;\\nwith thoracic esophagogastrostomy, with or without pyloroplasty\\n(Ivor Lewis)\\n$ 6,574.50\\n43118\\n43118\\nPartial esophagectomy, distal two-thirds, with thoracotomy and\\nseparate abdominal incision, with or without proximal gastrectomy;\\nwith colon interposition or small intestine reconstruction, including\\nintestine mobilization, preparation, and anastomosis(es\\n$ 5,531.39\\n43121\\n43121\\nPartial esophagectomy, distal two-thirds, with thoracotomy only,\\nwith or without proximal gastrectomy, with thoracic\\nesophagogastrostomy, with or without pyloroplasty\\n$ 6,251.40\\n43122\\n43122\\nPartial esophagectomy, thoracoabdominal or abdominal approach,\\nwith or without proximal gastrectomy; with esophagogastrostomy,\\nwith or without pyloroplasty\\n$ 5,902.20\\n43123\\n43123\\nPartial esophagectomy, thoracoabdominal or abdominal approach,\\nwith or without proximal gastrectomy; with colon interposition or\\nsmall intestine reconstruction, including intestine mobilization,\\npreparation, and anastomosis(es)\\n$ 6,437.70\\n43124\\n43124\\nTotal or partial esophagectomy, without reconstruction (any\\napproach), with cervical esophagostomy\\n$ 4,452.63\\n43130\\n43130\\nDiverticulectomy of hypopharynx or esophagus, with or without\\nmyotomy; cervical approach\\n$ 2,642.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n193\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n194\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n43135\\n43135\\nDiverticulectomy of hypopharynx or esophagus, with or without\\nmyotomy; thoracic approach\\n$ 3,141.90\\n43200\\n43200\\nEsophagoscopy, flexible, transoral; diagnostic, including collection\\nof specimen(s) by brushing or washing, when performed (separate\\nprocedure)\\n$ 567.90\\n43201\\n43201\\nEsophagoscopy, flexible, transoral; with directed submucosal\\ninjection(s), any substance\\n$ 754.53\\n43202\\n43202\\nEsophagoscopy, flexible, transoral; with biopsy, single or multiple\\n$ 654.30\\n43204\\n43204\\nEsophagoscopy, flexible, transoral; with injection sclerosis of\\nesophageal varices\\n$ 973.80\\n43205\\n43205\\nEsophagoscopy, flexible, transoral; with band ligation of esophageal\\nvarices\\n$ 978.30\\n43212\\n43212\\nEsophagoscopy, flexible, transoral; with placement of endoscopic\\nstent (includes pre- and post-dilation and guide wire passage, when\\nperformed)\\n$2,371.40\\n43215\\n43215\\nEsophagoscopy, flexible, transoral; with removal of foreign body\\n$ 832.50\\n43216\\n43216\\nEsophagoscopy, flexible, transoral; with removal of tumor(s),\\npolyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery\\n$ 839.70\\n43217\\n43217\\nEsophagoscopy, flexible, transoral; with removal of tumor(s),\\npolyp(s), or other lesion(s) by snare technique\\n$ 929.70\\n43220\\n43220\\nEsophagoscopy, flexible, transoral; with transendoscopic balloon\\ndilation (less than 30 mm diameter)\\n$ 760.50\\n43226\\n43226\\nEsophagoscopy, flexible, transoral; with insertion of guide wire\\nfollowed by passage of dilator(s) over guide wire\\n$ 681.30\\n43227\\n43227\\nEsophagoscopy, flexible, transoral; with control of bleeding, any\\nmethod\\n$ 1,059.30\\n43229\\n43229\\nEsophagoscopy, flexible, transoral; with ablation of tumor(s),\\npolyp(s), or other lesion(s) (includes pre- and post-dilation and\\nguide wire passage, when performed)\\n$1,968.75\\n43231\\n43231\\nEsophagoscopy, flexible, transoral; with endoscopic ultrasound\\nexamination\\n$ 762.30\\n43232\\n43232\\nEsophagoscopy, flexible, transoral; with transendoscopic ultrasound-\\nguided intramural or transmural fine needle aspiration\/biopsy(s)\\n$ 782.57\\n43235\\n43235\\nEsophagogastroduodenoscopy, flexible, transoral; diagnostic,\\nincluding collection of specimen(s) by brushing or washing, when\\nperformed (separate procedure)\\n$ 575.48\\n43236\\n43236\\nEsophagogastroduodenoscopy, flexible, transoral; with directed\\nsubmucosal injection(s), any substance\\n$ 833.87\\n43237\\n43237\\nEsophagogastroduodenoscopy, flexible, transoral; with endoscopic\\nultrasound examination limited to the esophagus, stomach or\\nduodenum, and adjacent structures\\n$ 605.29\\n43238\\n43238\\nEsophagogastroduodenoscopy, flexible, transoral; with\\ntransendoscopic ultrasound-guided intramural or transmural fine\\nneedle aspiration\/biopsy(s), (includes endoscopic ultrasound\\nexamination limited to the esophagus, stomach or duodenum, and\\nadjacent stru\\n$ 712.37\\n43239\\n43239\\nEsophagogastroduodenoscopy, flexible, transoral; with biopsy,\\nsingle or multiple\\n$ 645.72\\n43240\\n43240\\nEsophagogastroduodenoscopy, flexible, transoral; with transmural\\ndrainage of pseudocyst (includes placement of transmural drainage\\ncatheter[s]\/stent[s], when performed, and endoscopic ultrasound,\\nwhen performed)\\n$ 1,233.90\\n43241\\n43241\\nEsophagogastroduodenoscopy, flexible, transoral; with insertion of\\nintraluminal tube or catheter\\n$ 972.00\\n43242\\n43242\\nEsophagogastroduodenoscopy, flexible, transoral; with\\ntransendoscopic ultrasound-guided intramural or transmural fine\\nneedle aspiration\/biopsy(s) (includes endoscopic ultrasound\\nexamination of the esophagus, stomach, and either the duodenum\\nor a surgicall\\n$ 968.40\\n43243\\n43243\\nEsophagogastroduodenoscopy, flexible, transoral; with injection\\nsclerosis of esophageal\/gastric varices\\n$ 953.10\\n43244\\n43244\\nEsophagogastroduodenoscopy, flexible, transoral; with band\\nligation of esophageal\/gastric varices\\n$ 978.30\\n43245\\n43245\\nEsophagogastroduodenoscopy, flexible, transoral; with dilation of\\ngastric\/duodenal stricture(s) (eg, balloon, bougie)\\n$ 822.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n195\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n196\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n43246\\n43246\\nEsophagogastroduodenoscopy, flexible, transoral; with directed\\nplacement of percutaneous gastrostomy tube\\n$ 1,133.10\\n43247\\n43247\\nEsophagogastroduodenoscopy, flexible, transoral; with removal of\\nforeign body\\n$ 828.90\\n43248\\n43248\\nEsophagogastroduodenoscopy, flexible, transoral; with insertion of\\nguide wire followed by passage of dilator(s) through esophagus over\\nguide wire\\n$ 733.50\\n43249\\n43249\\nEsophagogastroduodenoscopy, flexible, transoral; with\\ntransendoscopic balloon dilation of esophagus (less than 30 mm\\ndiameter)\\n$ 747.00\\n43250\\n43250\\nEsophagogastroduodenoscopy, flexible, transoral; with removal of\\ntumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or\\nbipolar cautery\\n$ 972.00\\n43251\\n43251\\nEsophagogastroduodenoscopy, flexible, transoral; with removal of\\ntumor(s), polyp(s), or other lesion(s) by snare technique\\n$ 953.10\\n43255\\n43255\\nEsophagogastroduodenoscopy, flexible, transoral; with control of\\nbleeding, any method\\n$ 992.70\\n43257\\n43257\\nEsophagogastroduodenoscopy, flexible, transoral; with delivery of\\nthermal energy to the muscle of lower esophageal sphincter and\/or\\ngastric cardia, for treatment of gastroesophageal reflux disease\\n$ 1,070.28\\n43259\\n43259\\nEsophagogastroduodenoscopy, flexible, transoral; with endoscopic\\nultrasound examination, including the esophagus, stomach, and\\neither the duodenum or a surgically altered stomach where the\\njejunum is examined distal to the anastomosis\\n$ 844.20\\n43260\\n43260\\nEndoscopic retrograde cholangiopancreatography (ERCP);\\ndiagnostic, including collection of specimen(s) by brushing or\\nwashing, when performed (separate procedure)\\n$ 1,159.20\\n43261\\n43261\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\nbiopsy, single or multiple\\n$ 1,349.10\\n43262\\n43262\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\nsphincterotomy\/papillotomy\\n$ 1,642.50\\n43263\\n43263\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\npressure measurement of sphincter of Oddi\\n$ 1,542.60\\n43264\\n43264\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\nremoval of calculi\/debris from biliary\/pancreatic duct(s)\\n$ 1,781.10\\n43265\\n43265\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\ndestruction of calculi, any method (eg, mechanical, electrohydraulic,\\nlithotripsy)\\n$ 1,833.30\\n43266\\n43266\\nEsophagogastroduodenoscopy, flexible, transoral; with placement\\nof endoscopic stent (includes pre- and post-dilation and guide wire\\npassage, when performed)\\n$2,371.40\\n43270\\n43270\\nEsophagogastroduodenoscopy, flexible, transoral; with ablation of\\ntumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation\\nand guide wire passage, when performed)\\n$1,013.05\\n43273\\n43273\\nEndoscopic cannulation of papilla with direct visualization of\\npancreatic\/common bile duct(s) (List separately in addition to\\ncode(s) for primary procedure)\\n$ 320.58\\n43274\\n43274\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\nplacement of endoscopic stent into biliary or pancreatic duct,\\nincluding pre- and post-dilation and guide wire passage, when\\nperformed, including sphincterotomy, when performed, each stent\\n$ 1,933.69\\n43275\\n43275\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\nremoval of foreign body(s) or stent(s) from biliary\/pancreatic\\nduct(s)\\n$ 1,933.69\\n43276\\n43276\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\nremoval and exchange of stent(s), biliary or pancreatic duct,\\nincluding pre- and post-dilation and guide wire passage, when\\nperformed, including sphincterotomy, when performed, each stent\\nexchang\\n$ 1,933.69\\n43277\\n43277\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\ntrans-endoscopic balloon dilation of biliary\/pancreatic duct(s) or of\\nampulla (sphincteroplasty), including sphincterotomy, when\\nperformed, each duct\\n$ 1,933.69\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n197\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n198\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n43278\\n43278\\nEndoscopic retrograde cholangiopancreatography (ERCP); with\\nablation of tumor(s), polyp(s), or other lesion(s), including pre- and\\npost-dilation and guide wire passage, when performed\\n$ 1,933.69\\n43279\\n43279\\nLaparoscopy, surgical, esophagomyotomy (Heller type), with\\nfundoplasty, when performed\\n$ 2,872.69\\n43280\\n43280\\nLaparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen,\\nToupet procedures)\\n$ 3,501.90\\n43281\\n43281\\nLaparoscopy, surgical, repair of paraesophageal hernia, includes\\nfundoplasty, when performed; without implantation of mesh\\n$ 3,859.31\\n43282\\n43282\\nLaparoscopy, surgical, repair of paraesophageal hernia, includes\\nfundoplasty, when performed; with implantation of mesh\\n$ 4,088.80\\n43289\\n43289\\nUnlisted laparoscopy procedure, esophagus\\nCost\\n43300\\n43300\\nEsophagoplasty (plastic repair or reconstruction), cervical approach;\\nwithout repair of tracheoesophageal fistula\\n$ 3,110.40\\n43305\\n43305\\nEsophagoplasty (plastic repair or reconstruction), cervical approach;\\nwith repair of tracheoesophageal fistula\\n$ 3,627.90\\n43310\\n43310\\nEsophagoplasty (plastic repair or reconstruction), thoracic\\napproach; without repair of tracheoesophageal fistula\\n$ 4,030.20\\n43312\\n43312\\nEsophagoplasty (plastic repair or reconstruction), thoracic\\napproach; with repair of tracheoesophageal fistula\\n$ 4,640.40\\n43313\\n43313\\nEsophagoplasty for congenital defect (plastic repair or\\nreconstruction), thoracic approach; without repair of congenital\\ntracheoesophageal fistula\\n$ 5,873.36\\n43314\\n43314\\nEsophagoplasty for congenital defect (plastic repair or\\nreconstruction), thoracic approach; with repair of congenital\\ntracheoesophageal fistula\\n$ 6,478.08\\n43320\\n43320\\nEsophagogastrostomy (cardioplasty), with or without vagotomy and\\npyloroplasty, transabdominal or transthoracic approach\\n$ 3,590.10\\n43325\\n43325\\nEsophagogastric fundoplasty; with fundic patch (Thal-Nissen\\nprocedure)\\n$ 3,429.90\\n43330\\n43330\\nEsophagomyotomy (Heller type); abdominal approach\\n$ 2,917.80\\n43331\\n43331\\nEsophagomyotomy (Heller type); thoracic approach\\n$ 3,198.60\\n43332\\n43332\\nRepair, paraesophageal hiatal hernia (including fundoplication), via\\nlaparotomy, except neonatal; without implantation of mesh or\\nother prosthesis\\n$ 2,635.13\\n43333\\n43333\\nRepair, paraesophageal hiatal hernia (including fundoplication), via\\nlaparotomy, except neonatal; with implantation of mesh or other\\nprosthesis\\n$ 2,873.14\\n43334\\n43334\\nRepair, paraesophageal hiatal hernia (including fundoplication), via\\nthoracotomy, except neonatal; without implantation of mesh or\\nother prosthesis\\n$ 2,906.96\\n43335\\n43335\\nRepair, paraesophageal hiatal hernia (including fundoplication), via\\nthoracotomy, except neonatal; with implantation of mesh or other\\nprosthesis\\n$ 3,144.71\\n43336\\n43336\\nRepair, paraesophageal hiatal hernia (including fundoplication), via\\nthoracoabdominal incision, except neonatal; without implantation\\nof mesh or other prosthesis\\n$ 3,422.52\\n43337\\n43337\\nRepair, paraesophageal hiatal hernia (including fundoplication), via\\nthoracoabdominal incision, except neonatal; with implantation of\\nmesh or other prosthesis\\n$ 3,761.84\\n43340\\n43340\\nEsophagojejunostomy (without total gastrectomy); abdominal\\napproach\\n$ 3,551.40\\n43350\\n43350\\nEsophagostomy, fistulization of esophagus, external; abdominal\\napproach\\n$ 2,381.40\\n43351\\n43351\\nEsophagostomy, fistulization of esophagus, external; thoracic\\napproach\\n$ 2,477.70\\n43352\\n43352\\nEsophagostomy, fistulization of esophagus, external; cervical\\napproach\\n$ 2,368.80\\n43360\\n43360\\nGastrointestinal reconstruction for previous esophagectomy, for\\nobstructing esophageal lesion or fistula, or for previous esophageal\\nexclusion; with stomach, with or without pyloroplasty\\n$ 5,664.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n199\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n200\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n43361\\n43361\\nGastrointestinal reconstruction for previous esophagectomy, for\\nobstructing esophageal lesion or fistula, or for previous esophageal\\nexclusion; with colon interposition or small intestine reconstruction,\\nincluding intestine mobilization, preparation, and\\n$ 6,695.10\\n43400\\n43400\\nLigation, direct, esophageal varices\\n$ 3,172.50\\n43401\\n43401\\nTransection of esophagus with repair, for esophageal varices\\n$ 3,348.00\\n43405\\n43405\\nLigation or stapling at gastroesophageal junction for pre-existing\\nesophageal perforation\\n$ 3,349.80\\n43410\\n43410\\nSuture of esophageal wound or injury; cervical approach\\n$ 2,574.90\\n43415\\n43415\\nSuture of esophageal wound or injury; transthoracic or\\ntransabdominal approach\\n$ 3,114.00\\n43420\\n43420\\nClosure of esophagostomy or fistula; cervical approach\\n$ 1,954.80\\n43425\\n43425\\nClosure of esophagostomy or fistula; transthoracic or\\ntransabdominal approach\\n$ 3,115.80\\n43450\\n43450\\nDilation of esophagus, by unguided sound or bougie, single or\\nmultiple passes\\n$ 285.30\\n43453\\n43453\\nDilation of esophagus, over guide wire\\n$ 414.90\\n43460\\n43460\\nEsophagogastric tamponade, with balloon (Sengstaken type)\\n$ 697.50\\n43496\\n43496\\nFree jejunum transfer with microvascular anastomosis\\n$ -\\n43499\\n43499\\nUnlisted procedure, esophagus\\nCost\\n43500\\n43500\\nGastrotomy; with exploration or foreign body removal\\n$ 1,981.80\\n43501\\n43501\\nGastrotomy; with suture repair of bleeding ulcer\\n$ 2,765.70\\n43502\\n43502\\nGastrotomy; with suture repair of pre-existing esophagogastric\\nlaceration (eg, Mallory-Weiss)\\n$ 2,601.00\\n43510\\n43510\\nGastrotomy; with esophageal dilation and insertion of permanent\\nintraluminal tube (eg, Celestin or Mousseaux-Barbin)\\n$ 2,067.30\\n43520\\n43520\\nPyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type\\noperation)\\n$ 1,850.40\\n43605\\n43605\\nBiopsy of stomach, by laparotomy\\n$ 1,977.30\\n43610\\n43610\\nExcision, local; ulcer or benign tumor of stomach\\n$ 2,572.20\\n43611\\n43611\\nExcision, local; malignant tumor of stomach\\n$ 2,837.70\\n43620\\n43620\\nGastrectomy, total; with esophagoenterostomy\\n$ 4,644.90\\n43621\\n43621\\nGastrectomy, total; with Roux-en-Y reconstruction\\n$ 4,995.90\\n43622\\n43622\\nGastrectomy, total; with formation of intestinal pouch, any type\\n$ 5,047.20\\n43631\\n43631\\nGastrectomy, partial, distal; with gastroduodenostomy\\n$ 3,541.50\\n43632\\n43632\\nGastrectomy, partial, distal; with gastrojejunostomy\\n$ 3,864.60\\n43633\\n43633\\nGastrectomy, partial, distal; with Roux-en-Y reconstruction\\n$ 3,953.70\\n43634\\n43634\\nGastrectomy, partial, distal; with formation of intestinal pouch\\n$ 4,851.90\\n43635\\n43635\\nVagotomy when performed with partial distal gastrectomy (List\\nseparately in addition to code[s] for primary procedure)\\n$ 1,287.90\\n43640\\n43640\\nVagotomy including pyloroplasty, with or without gastrostomy;\\ntruncal or selective\\n$ 3,064.50\\n43641\\n43641\\nVagotomy including pyloroplasty, with or without gastrostomy;\\nparietal cell (highly selective)\\n$ 2,904.30\\n43644\\n43644\\nLaparoscopy, surgical, gastric restrictive procedure; with gastric\\nbypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)\\n$ 5,644.84\\n43645\\n43645\\nLaparoscopy, surgical, gastric restrictive procedure; with gastric\\nbypass and small intestine reconstruction to limit absorption\\n$ 6,078.45\\n43647\\n43647\\nLaparoscopy, surgical; implantation or replacement of gastric\\nneurostimulator electrodes, antrum\\n$ -\\n43648\\n43648\\nLaparoscopy, surgical; revision or removal of gastric\\nneurostimulator electrodes, antrum\\n$ -\\n43651\\n43651\\nLaparoscopy, surgical; transection of vagus nerves, truncal\\n$ 2,584.61\\n43652\\n43652\\nLaparoscopy, surgical; transection of vagus nerves, selective or\\nhighly selective\\n$ 2,984.62\\n43653\\n43653\\nLaparoscopy, surgical; gastrostomy, without construction of gastric\\ntube (eg, Stamm procedure) (separate procedure)\\n$ 1,909.82\\n43659\\n43659\\nUnlisted laparoscopy procedure, stomach\\nCost\\n43752\\n43752\\nNaso- or oro-gastric tube placement, requiring physician's skill and\\nfluoroscopic guidance (includes fluoroscopy, image documentation\\nand report)\\n$ 87.45\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n201\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n202\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n43753\\n43753\\nGastric intubation and aspiration(s) therapeutic, necessitating\\nphysician's skill (eg, for gastrointestinal hemorrhage), including\\nlavage if performed\\n$ 51.44\\n43754\\n43754\\nGastric intubation and aspiration, diagnostic; single specimen (eg,\\nacid analysis)\\n$ 92.15\\n43755\\n43755\\nGastric intubation and aspiration, diagnostic; collection of multiple\\nfractional specimens with gastric stimulation, single or double\\nlumen tube (gastric secretory study) (eg, histamine, insulin,\\npentagastrin, calcium, secretin), includes drug administrat\\n$ 216.19\\n43760\\n43760\\nChange of gastrostomy tube, percutaneous, without imaging or\\nendoscopic guidance\\n$ 192.60\\n43761\\n43761\\nRepositioning of a naso- or oro-gastric feeding tube, through the\\nduodenum for enteric nutrition\\n$ 320.40\\n43770\\n43770\\nLaparoscopy, surgical, gastric restrictive procedure; placement of\\nadjustable gastric restrictive device (eg, gastric band and\\nsubcutaneous port components)\\n$ 3,192.15\\n43771\\n43771\\nLaparoscopy, surgical, gastric restrictive procedure; revision of\\nadjustable gastric restrictive device component only\\n$ 2,947.87\\n43772\\n43772\\nLaparoscopy, surgical, gastric restrictive procedure; removal of\\nadjustable gastric restrictive device component only\\n$ 2,562.77\\n43773\\n43773\\nLaparoscopy, surgical, gastric restrictive procedure; removal and\\nreplacement of adjustable gastric restrictive device component only\\n$ 3,259.75\\n43774\\n43774\\nLaparoscopy, surgical, gastric restrictive procedure; removal of\\nadjustable gastric restrictive device and subcutaneous port\\ncomponents\\n$ 2,594.55\\n43775\\n43775\\nLaparoscopy, surgical, gastric restrictive procedure; longitudinal\\ngastrectomy (ie, sleeve gastrectomy)\\n$ 3,427.22\\n43800\\n43800\\nPyloroplasty\\n$ 2,172.60\\n43810\\n43810\\nGastroduodenostomy\\n$ 2,296.80\\n43820\\n43820\\nGastrojejunostomy; without vagotomy\\n$ 2,688.30\\n43825\\n43825\\nGastrojejunostomy; with vagotomy, any type\\n$ 3,096.00\\n43830\\n43830\\nGastrostomy, open; without construction of gastric tube (eg, Stamm\\nprocedure) (separate procedure)\\n$ 1,784.70\\n43831\\n43831\\nGastrostomy, open; neonatal, for feeding\\n$ 1,642.50\\n43832\\n43832\\nGastrostomy, open; with construction of gastric tube (eg, Janeway\\nprocedure)\\n$ 2,553.30\\n43840\\n43840\\nGastrorrhaphy, suture of perforated duodenal or gastric ulcer,\\nwound, or injury\\n$ 2,344.50\\n43842\\n43842\\nGastric restrictive procedure, without gastric bypass, for morbid\\nobesity; vertical-banded gastroplasty\\n$ 3,656.70\\n43843\\n43843\\nGastric restrictive procedure, without gastric bypass, for morbid\\nobesity; other than vertical-banded gastroplasty\\n$ 3,605.40\\n43845\\n43845\\nGastric restrictive procedure with partial gastrectomy, pylorus-\\npreserving duodenoileostomy and ileoileostomy (50 to 100 cm\\ncommon channel) to limit absorption (biliopancreatic diversion with\\nduodenal switch)\\n$ 5,446.89\\n43846\\n43846\\nGastric restrictive procedure, with gastric bypass for morbid\\nobesity; with short limb (150 cm or less) Roux-en-Y\\ngastroenterostomy\\n$ 4,532.40\\n43847\\n43847\\nGastric restrictive procedure, with gastric bypass for morbid\\nobesity; with small intestine reconstruction to limit absorption\\n$ 5,096.43\\n43848\\n43848\\nRevision, open, of gastric restrictive procedure for morbid obesity,\\nother than adjustable gastric restrictive device (separate procedure) $ 5,284.93\\n43850\\n43850\\nRevision of gastroduodenal anastomosis (gastroduodenostomy)\\nwith reconstruction; without vagotomy\\n$ 4,078.80\\n43855\\n43855\\nRevision of gastroduodenal anastomosis (gastroduodenostomy)\\nwith reconstruction; with vagotomy\\n$ 4,171.50\\n43860\\n43860\\nRevision of gastrojejunal anastomosis (gastrojejunostomy) with\\nreconstruction, with or without partial gastrectomy or intestine\\nresection; without vagotomy\\n$ 4,131.90\\n43865\\n43865\\nRevision of gastrojejunal anastomosis (gastrojejunostomy) with\\nreconstruction, with or without partial gastrectomy or intestine\\nresection; with vagotomy\\n$ 3,879.90\\n43870\\n43870\\nClosure of gastrostomy, surgical\\n$ 1,687.50\\n43880\\n43880\\nClosure of gastrocolic fistula\\n$ 3,295.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n203\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n204\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n43881\\n43881\\nImplantation or replacement of gastric neurostimulator electrodes,\\nantrum, open\\n$ -\\n43882\\n43882\\nRevision or removal of gastric neurostimulator electrodes, antrum,\\nopen\\n$ -\\n43886\\n43886\\nGastric restrictive procedure, open; revision of subcutaneous port\\ncomponent only\\n$ 925.03\\n43887\\n43887\\nGastric restrictive procedure, open; removal of subcutaneous port\\ncomponent only\\n$ 886.07\\n43888\\n43888\\nGastric restrictive procedure, open; removal and replacement of\\nsubcutaneous port component only\\n$ 1,353.63\\n43999\\n43999\\nUnlisted procedure, stomach\\nCost\\n44005\\n44005\\nEnterolysis (freeing of intestinal adhesion) (separate procedure)\\n$ 2,305.69\\n44010\\n44010\\nDuodenotomy, for exploration, biopsy(s), or foreign body removal\\n$ 2,306.70\\n44015\\n44015\\nTube or needle catheter jejunostomy for enteral alimentation,\\nintraoperative, any method (List separately in addition to primary\\nprocedure)\\n$ 1,448.10\\n44020\\n44020\\nEnterotomy, small intestine, other than duodenum; for exploration,\\nbiopsy(s), or foreign body removal\\n$ 2,232.00\\n44021\\n44021\\nEnterotomy, small intestine, other than duodenum; for\\ndecompression (eg, Baker tube)\\n$ 2,319.30\\n44025\\n44025\\nColotomy, for exploration, biopsy(s), or foreign body removal\\n$ 2,389.50\\n44050\\n44050\\nReduction of volvulus, intussusception, internal hernia, by\\nlaparotomy\\n$ 2,321.10\\n44055\\n44055\\nCorrection of malrotation by lysis of duodenal bands and\/or\\nreduction of midgut volvulus (eg, Ladd procedure)\\n$ 2,601.00\\n44100\\n44100\\nBiopsy of intestine by capsule, tube, peroral (1 or more specimens)\\n$ 485.10\\n44110\\n44110\\nExcision of 1 or more lesions of small or large intestine not requiring\\nanastomosis, exteriorization, or fistulization; single enterotomy\\n$ 2,351.70\\n44111\\n44111\\nExcision of 1 or more lesions of small or large intestine not requiring\\nanastomosis, exteriorization, or fistulization; multiple enterotomies\\n$ 3,157.20\\n44120\\n44120\\nEnterectomy, resection of small intestine; single resection and\\nanastomosis\\n$ 2,880.00\\n44121\\n44121\\nEnterectomy, resection of small intestine; each additional resection\\nand anastomosis (List separately in addition to code for primary\\nprocedure)\\n$ 918.90\\n44125\\n44125\\nEnterectomy, resection of small intestine; with enterostomy\\n$ 3,114.00\\n44126\\n44126\\nEnterectomy, resection of small intestine for congenital atresia,\\nsingle resection and anastomosis of proximal segment of intestine;\\nwithout tapering\\n$ 5,370.66\\n44127\\n44127\\nEnterectomy, resection of small intestine for congenital atresia,\\nsingle resection and anastomosis of proximal segment of intestine;\\nwith tapering\\n$ 5,598.46\\n44128\\n44128\\nEnterectomy, resection of small intestine for congenital atresia,\\nsingle resection and anastomosis of proximal segment of intestine;\\neach additional resection and anastomosis (List separately in\\naddition to code for primary procedure)\\n$ 1,016.67\\n44130\\n44130\\nEnteroenterostomy, anastomosis of intestine, with or without\\ncutaneous enterostomy (separate procedure)\\n$ 2,694.60\\n44132\\n44132\\nDonor enterectomy (including cold preservation), open; from\\ncadaver donor\\n$ -\\n44133\\n44133\\nDonor enterectomy (including cold preservation), open; partial,\\nfrom living donor\\n$ -\\n44136\\n44136\\nIntestinal allotransplantation; from living donor\\n$ -\\n44137\\n44137\\nRemoval of transplanted intestinal allograft, complete\\n$ -\\n44139\\n44139\\nMobilization (take-down) of splenic flexure performed in\\nconjunction with partial colectomy (List separately in addition to\\nprimary procedure)\\n$ 514.80\\n44140\\n44140\\nColectomy, partial; with anastomosis\\n$ 3,340.80\\n44141\\n44141\\nColectomy, partial; with skin level cecostomy or colostomy\\n$ 3,333.65\\n44143\\n44143\\nColectomy, partial; with end colostomy and closure of distal\\nsegment (Hartmann type procedure)\\n$ 3,331.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n205\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n206\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n44144\\n44144\\nColectomy, partial; with resection, with colostomy or ileostomy and\\ncreation of mucofistula\\n$ 3,348.00\\n44145\\n44145\\nColectomy, partial; with coloproctostomy (low pelvic anastomosis)\\n$ 3,887.10\\n44146\\n44146\\nColectomy, partial; with coloproctostomy (low pelvic anastomosis),\\nwith colostomy\\n$ 4,293.90\\n44147\\n44147\\nColectomy, partial; abdominal and transanal approach\\n$ 4,626.90\\n44150\\n44150\\nColectomy, total, abdominal, without proctectomy; with ileostomy\\nor ileoproctostomy\\n$ 4,718.70\\n44151\\n44151\\nColectomy, total, abdominal, without proctectomy; with continent\\nileostomy\\n$ 5,408.10\\n44155\\n44155\\nColectomy, total, abdominal, with proctectomy; with ileostomy\\n$ 5,751.90\\n44156\\n44156\\nColectomy, total, abdominal, with proctectomy; with continent\\nileostomy\\n$ 5,768.10\\n44157\\n44157\\nColectomy, total, abdominal, with proctectomy; with ileoanal\\nanastomosis, includes loop ileostomy, and rectal mucosectomy,\\nwhen performed\\n$ 4,865.79\\n44158\\n44158\\nColectomy, total, abdominal, with proctectomy; with ileoanal\\nanastomosis, creation of ileal reservoir (S or J), includes loop\\nileostomy, and rectal mucosectomy, when performed\\n$ 5,014.80\\n44160\\n44160\\nColectomy, partial, with removal of terminal ileum with\\nileocolostomy\\n$ 4,014.90\\n44180\\n44180\\nLaparoscopy, surgical, enterolysis (freeing of intestinal adhesion)\\n(separate procedure)\\n$ 1,859.50\\n44186\\n44186\\nLaparoscopy, surgical; jejunostomy (eg, for decompression or\\nfeeding)\\n$ 1,441.07\\n44187\\n44187\\nLaparoscopy, surgical; ileostomy or jejunostomy, non-tube\\n$ 2,229.44\\n44188\\n44188\\nLaparoscopy, surgical, colostomy or skin level cecostomy\\n$ 2,477.27\\n44202\\n44202\\nLaparoscopy, surgical; enterectomy, resection of small intestine,\\nsingle resection and anastomosis\\n$ 4,013.10\\n44203\\n44203\\nLaparoscopy, surgical; each additional small intestine resection and\\nanastomosis (List separately in addition to code for primary\\nprocedure)\\n$ 742.32\\n44204\\n44204\\nLaparoscopy, surgical; colectomy, partial, with anastomosis\\n$ 3,237.04\\n44205\\n44205\\nLaparoscopy, surgical; colectomy, partial, with removal of terminal\\nileum with ileocolostomy\\n$ 3,053.39\\n44206\\n44206\\nLaparoscopy, surgical; colectomy, partial, with end colostomy and\\nclosure of distal segment (Hartmann type procedure)\\n$ 3,562.31\\n44207\\n44207\\nLaparoscopy, surgical; colectomy, partial, with anastomosis, with\\ncoloproctostomy (low pelvic anastomosis)\\n$ 3,989.43\\n44208\\n44208\\nLaparoscopy, surgical; colectomy, partial, with anastomosis, with\\ncoloproctostomy (low pelvic anastomosis) with colostomy\\n$ 4,162.98\\n44210\\n44210\\nLaparoscopy, surgical; colectomy, total, abdominal, without\\nproctectomy, with ileostomy or ileoproctostomy\\n$ 3,925.87\\n44211\\n44211\\nLaparoscopy, surgical; colectomy, total, abdominal, with\\nproctectomy, with ileoanal anastomosis, creation of ileal reservoir\\n(S or J), with loop ileostomy, includes rectal mucosectomy, when\\nperformed\\n$ 5,320.26\\n44212\\n44212\\nLaparoscopy, surgical; colectomy, total, abdominal, with\\nproctectomy, with ileostomy\\n$ 4,588.99\\n44213\\n44213\\nLaparoscopy, surgical, mobilization (take-down) of splenic flexure\\nperformed in conjunction with partial colectomy (List separately in\\naddition to primary procedure)\\n$ 455.45\\n44227\\n44227\\nLaparoscopy, surgical, closure of enterostomy, large or small\\nintestine, with resection and anastomosis\\n$ 3,432.69\\n44238\\n44238\\nUnlisted laparoscopy procedure, intestine (except rectum)\\n$ -\\n44300\\n44300\\nPlacement, enterostomy or cecostomy, tube open (eg, for feeding\\nor decompression) (separate procedure)\\n$ 2,121.30\\n44310\\n44310\\nIleostomy or jejunostomy, non-tube\\n$ 2,271.60\\n44312\\n44312\\nRevision of ileostomy; simple (release of superficial scar) (separate\\nprocedure)\\n$ 1,269.00\\n44314\\n44314\\nRevision of ileostomy; complicated (reconstruction in-depth)\\n(separate procedure)\\n$ 2,343.60\\n44316\\n44316\\nContinent ileostomy (Kock procedure) (separate procedure)\\n$ 3,295.80\\n44320\\n44320\\nColostomy or skin level cecostomy;\\n$ 2,201.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n207\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n208\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n44322\\n44322\\nColostomy or skin level cecostomy; with multiple biopsies (eg, for\\ncongenital megacolon) (separate procedure)\\n$ 2,568.60\\n44340\\n44340\\nRevision of colostomy; simple (release of superficial scar) (separate\\nprocedure)\\n$ 918.00\\n44345\\n44345\\nRevision of colostomy; complicated (reconstruction in-depth)\\n(separate procedure)\\n$ 2,093.40\\n44346\\n44346\\nRevision of colostomy; with repair of paracolostomy hernia\\n(separate procedure)\\n$ 2,365.20\\n44360\\n44360\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; diagnostic, with or without\\ncollection of specimen(s) by brushing or washing (separate\\nprocedure)\\n$ 864.90\\n44361\\n44361\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with biopsy, single or multiple\\n$ 863.10\\n44363\\n44363\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with removal of foreign body\\n$ 804.60\\n44364\\n44364\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with removal of tumor(s), polyp(s),\\nor other lesion(s) by snare technique\\n$ 978.30\\n44365\\n44365\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with removal of tumor(s), polyp(s),\\nor other lesion(s) by hot biopsy forceps or bipolar cautery\\n$ 978.30\\n44366\\n44366\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with control of bleeding (eg,\\ninjection, bipolar cautery, unipolar cautery, laser, heater probe,\\nstapler, plasma coagulator)\\n$ 1,076.40\\n44369\\n44369\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with ablation of tumor(s), polyp(s),\\nor other lesion(s) not amenable to removal by hot biopsy forceps,\\nbipolar cautery or snare technique\\n$ 1,133.10\\n44370\\n44370\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with transendoscopic stent\\nplacement (includes predilation)\\n$ 760.50\\n44372\\n44372\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with placement of percutaneous\\njejunostomy tube\\n$ 1,199.70\\n44373\\n44373\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, not including ileum; with conversion of percutaneous\\ngastrostomy tube to percutaneous jejunostomy tube\\n$ 904.50\\n44376\\n44376\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, including ileum; diagnostic, with or without collection of\\nspecimen(s) by brushing or washing (separate procedure)\\n$ 1,007.10\\n44377\\n44377\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, including ileum; with biopsy, single or multiple\\n$ 1,061.10\\n44378\\n44378\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, including ileum; with control of bleeding (eg, injection,\\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\\nplasma coagulator)\\n$ 1,359.90\\n44379\\n44379\\nSmall intestinal endoscopy, enteroscopy beyond second portion of\\nduodenum, including ileum; with transendoscopic stent placement\\n(includes predilation)\\n$ 1,137.60\\n44380\\n44380\\nIleoscopy, through stoma; diagnostic, with or without collection of\\nspecimen(s) by brushing or washing (separate procedure)\\n$ 546.30\\n44382\\n44382\\nIleoscopy, through stoma; with biopsy, single or multiple\\n$ 681.30\\n44383\\n44383\\nIleoscopy, through stoma; with transendoscopic stent placement\\n(includes predilation)\\n$ 917.99\\n44385\\n44385\\nEndoscopic evaluation of small intestinal (abdominal or pelvic)\\npouch; diagnostic, with or without collection of specimen(s) by\\nbrushing or washing (separate procedure)\\n$ 715.50\\n44386\\n44386\\nEndoscopic evaluation of small intestinal (abdominal or pelvic)\\npouch; with biopsy, single or multiple\\n$ 741.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n209\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n210\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n44388\\n44388\\nColonoscopy through stoma; diagnostic, with or without collection\\nof specimen(s) by brushing or washing (separate procedure)\\n$ 739.80\\n44389\\n44389\\nColonoscopy through stoma; with biopsy, single or multiple\\n$ 796.50\\n44390\\n44390\\nColonoscopy through stoma; with removal of foreign body\\n$ 841.50\\n44391\\n44391\\nColonoscopy through stoma; with control of bleeding (eg, injection,\\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\\nplasma coagulator)\\n$ 1,166.40\\n44392\\n44392\\nColonoscopy through stoma; with removal of tumor(s), polyp(s), or\\nother lesion(s) by hot biopsy forceps or bipolar cautery\\n$ 1,255.50\\n44393\\n44393\\nColonoscopy through stoma; with ablation of tumor(s), polyp(s), or\\nother lesion(s) not amenable to removal by hot biopsy forceps,\\nbipolar cautery or snare technique\\n$ 1,321.20\\n44394\\n44394\\nColonoscopy through stoma; with removal of tumor(s), polyp(s), or\\nother lesion(s) by snare technique\\n$ 1,102.50\\n44397\\n44397\\nColonoscopy through stoma; with transendoscopic stent placement\\n(includes predilation)\\n$ 596.70\\n44500\\n44500\\nIntroduction of long gastrointestinal tube (eg, Miller-Abbott)\\n(separate procedure)\\n$ 123.30\\n44602\\n44602\\nSuture of small intestine (enterorrhaphy) for perforated ulcer,\\ndiverticulum, wound, injury or rupture; single perforation\\n$ 2,248.20\\n44603\\n44603\\nSuture of small intestine (enterorrhaphy) for perforated ulcer,\\ndiverticulum, wound, injury or rupture; multiple perforations\\n$ 2,656.80\\n44604\\n44604\\nSuture of large intestine (colorrhaphy) for perforated ulcer,\\ndiverticulum, wound, injury or rupture (single or multiple\\nperforations); without colostomy\\n$ 2,258.45\\n44605\\n44605\\nSuture of large intestine (colorrhaphy) for perforated ulcer,\\ndiverticulum, wound, injury or rupture (single or multiple\\nperforations); with colostomy\\n$ 2,991.60\\n44615\\n44615\\nIntestinal stricturoplasty (enterotomy and enterorrhaphy) with or\\nwithout dilation, for intestinal obstruction\\n$ 2,626.20\\n44620\\n44620\\nClosure of enterostomy, large or small intestine;\\n$ 1,713.65\\n44625\\n44625\\nClosure of enterostomy, large or small intestine; with resection and\\nanastomosis other than colorectal\\n$ 3,033.90\\n44626\\n44626\\nClosure of enterostomy, large or small intestine; with resection and\\ncolorectal anastomosis (eg, closure of Hartmann type procedure)\\n$ 3,744.90\\n44640\\n44640\\nClosure of intestinal cutaneous fistula\\n$ 2,372.40\\n44650\\n44650\\nClosure of enteroenteric or enterocolic fistula\\n$ 3,090.60\\n44660\\n44660\\nClosure of enterovesical fistula; without intestinal or bladder\\nresection\\n$ 2,729.70\\n44661\\n44661\\nClosure of enterovesical fistula; with intestine and\/or bladder\\nresection\\n$ 3,927.60\\n44680\\n44680\\nIntestinal plication (separate procedure)\\n$ 2,871.90\\n44700\\n44700\\nExclusion of small intestine from pelvis by mesh or other prosthesis,\\nor native tissue (eg, bladder or omentum)\\n$ 2,709.90\\n44701\\n44701\\nIntraoperative colonic lavage (List separately in addition to code for\\nprimary procedure)\\n$ 305.32\\n44715\\n44715\\nBackbench standard preparation of cadaver or living donor intestine\\nallograft prior to transplantation, including mobilization and\\nfashioning of the superior mesenteric artery and vein\\n$ -\\n44720\\n44720\\nBackbench reconstruction of cadaver or living donor intestine\\nallograft prior to transplantation; venous anastomosis, each\\n$ 581.85\\n44721\\n44721\\nBackbench reconstruction of cadaver or living donor intestine\\nallograft prior to transplantation; arterial anastomosis, each\\n$ 929.76\\n44799\\n44799\\nUnlisted procedure, intestine\\nCost\\n44800\\n44800\\nExcision of Meckel's diverticulum (diverticulectomy) or\\nomphalomesenteric duct\\n$ 1,913.40\\n44820\\n44820\\nExcision of lesion of mesentery (separate procedure)\\n$ 2,034.00\\n44850\\n44850\\nSuture of mesentery (separate procedure)\\n$ 1,802.70\\n44899\\n44899\\nUnlisted procedure, Meckel's diverticulum and the mesentery\\nCost\\n44900\\n44900\\nIncision and drainage of appendiceal abscess, open\\n$ 1,545.30\\n44950\\n44950\\nAppendectomy;\\n$ 1,537.19\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n211\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n212\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n44955\\n44955\\nAppendectomy; when done for indicated purpose at time of other\\nmajor procedure (not as separate procedure) (List separately in\\naddition to code for primary procedure)\\n$ 1,133.10\\n44960\\n44960\\nAppendectomy; for ruptured appendix with abscess or generalized\\nperitonitis\\n$ 2,357.10\\n44970\\n44970\\nLaparoscopy, surgical, appendectomy\\n$ 2,130.30\\n44979\\n44979\\nUnlisted laparoscopy procedure, appendix\\nCost\\n45000\\n45000\\nTransrectal drainage of pelvic abscess\\n$ 953.10\\n45005\\n45005\\nIncision and drainage of submucosal abscess, rectum\\n$ 522.90\\n45020\\n45020\\nIncision and drainage of deep supralevator, pelvirectal, or\\nretrorectal abscess\\n$ 893.70\\n45100\\n45100\\nBiopsy of anorectal wall, anal approach (eg, congenital megacolon)\\n$ 767.70\\n45108\\n45108\\nAnorectal myomectomy\\n$ 1,184.40\\n45110\\n45110\\nProctectomy; complete, combined abdominoperineal, with\\ncolostomy\\n$ 4,392.90\\n45111\\n45111\\nProctectomy; partial resection of rectum, transabdominal approach\\n$ 3,498.30\\n45112\\n45112\\nProctectomy, combined abdominoperineal, pull-through procedure\\n(eg, colo-anal anastomosis)\\n$ 4,645.80\\n45113\\n45113\\nProctectomy, partial, with rectal mucosectomy, ileoanal\\nanastomosis, creation of ileal reservoir (S or J), with or without loop\\nileostomy\\n$ 4,837.19\\n45114\\n45114\\nProctectomy, partial, with anastomosis; abdominal and transsacral\\napproach\\n$ 4,489.20\\n45116\\n45116\\nProctectomy, partial, with anastomosis; transsacral approach only\\n(Kraske type)\\n$ 3,295.80\\n45119\\n45119\\nProctectomy, combined abdominoperineal pull-through procedure\\n(eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-\\npouch), with diverting enterostomy when performed\\n$ 4,377.60\\n45120\\n45120\\nProctectomy, complete (for congenital megacolon), abdominal and\\nperineal approach; with pull-through procedure and anastomosis\\n(eg, Swenson, Duhamel, or Soave type operation)\\n$ 4,650.30\\n45121\\n45121\\nProctectomy, complete (for congenital megacolon), abdominal and\\nperineal approach; with subtotal or total colectomy, with multiple\\nbiopsies\\n$ 4,738.50\\n45123\\n45123\\nProctectomy, partial, without anastomosis, perineal approach\\n$ 3,149.10\\n45126\\n45126\\nPelvic exenteration for colorectal malignancy, with proctectomy\\n(with or without colostomy), with removal of bladder and ureteral\\ntransplantations, and\/or hysterectomy, or cervicectomy, with or\\nwithout removal of tube(s), with or without removal of ovary(\\n$ 6,470.10\\n45130\\n45130\\nExcision of rectal procidentia, with anastomosis; perineal approach\\n$ 2,864.70\\n45135\\n45135\\nExcision of rectal procidentia, with anastomosis; abdominal and\\nperineal approach\\n$ 4,033.80\\n45136\\n45136\\nExcision of ileoanal reservoir with ileostomy\\n$ 4,548.02\\n45150\\n45150\\nDivision of stricture of rectum\\n$ 1,278.00\\n45160\\n45160\\nExcision of rectal tumor by proctotomy, transsacral or\\ntranscoccygeal approach\\n$ 2,827.80\\n45171\\n45171\\nExcision of rectal tumor, transanal approach; not including\\nmuscularis propria (ie, partial thickness)\\n$ 1,349.29\\n45172\\n45172\\nExcision of rectal tumor, transanal approach; including muscularis\\npropria (ie, full thickness)\\n$ 1,853.35\\n45190\\n45190\\nDestruction of rectal tumor (eg, electrodesiccation, electrosurgery,\\nlaser ablation, laser resection, cryosurgery) transanal approach\\n$ 1,441.80\\n45300\\n45300\\nProctosigmoidoscopy, rigid; diagnostic, with or without collection of\\nspecimen(s) by brushing or washing (separate procedure)\\n$ 142.39\\n45303\\n45303\\nProctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire,\\nbougie)\\n$ 220.50\\n45305\\n45305\\nProctosigmoidoscopy, rigid; with biopsy, single or multiple\\n$ 257.40\\n45307\\n45307\\nProctosigmoidoscopy, rigid; with removal of foreign body\\n$ 386.10\\n45308\\n45308\\nProctosigmoidoscopy, rigid; with removal of single tumor, polyp, or\\nother lesion by hot biopsy forceps or bipolar cautery\\n$ 417.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n213\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n214\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n45309\\n45309\\nProctosigmoidoscopy, rigid; with removal of single tumor, polyp, or\\nother lesion by snare technique\\n$ 430.20\\n45315\\n45315\\nProctosigmoidoscopy, rigid; with removal of multiple tumors,\\npolyps, or other lesions by hot biopsy forceps, bipolar cautery or\\nsnare technique\\n$ 582.30\\n45317\\n45317\\nProctosigmoidoscopy, rigid; with control of bleeding (eg, injection,\\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\\nplasma coagulator)\\n$ 585.00\\n45320\\n45320\\nProctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or\\nother lesion(s) not amenable to removal by hot biopsy forceps,\\nbipolar cautery or snare technique (eg, laser)\\n$ 639.00\\n45321\\n45321\\nProctosigmoidoscopy, rigid; with decompression of volvulus\\n$ 534.60\\n45327\\n45327\\nProctosigmoidoscopy, rigid; with transendoscopic stent placement\\n(includes predilation)\\n$ 219.12\\n45330\\n45330\\nSigmoidoscopy, flexible; diagnostic, with or without collection of\\nspecimen(s) by brushing or washing (separate procedure)\\n$ 253.73\\n45331\\n45331\\nSigmoidoscopy, flexible; with biopsy, single or multiple\\n$ 339.86\\n45332\\n45332\\nSigmoidoscopy, flexible; with removal of foreign body\\n$ 449.10\\n45333\\n45333\\nSigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other\\nlesion(s) by hot biopsy forceps or bipolar cautery\\n$ 558.90\\n45334\\n45334\\nSigmoidoscopy, flexible; with control of bleeding (eg, injection,\\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\\nplasma coagulator)\\n$ 570.60\\n45335\\n45335\\nSigmoidoscopy, flexible; with directed submucosal injection(s), any\\nsubstance\\n$ 714.94\\n45337\\n45337\\nSigmoidoscopy, flexible; with decompression of volvulus, any\\nmethod\\n$ 772.20\\n45338\\n45338\\nSigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other\\nlesion(s) by snare technique\\n$ 605.70\\n45339\\n45339\\nSigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other\\nlesion(s) not amenable to removal by hot biopsy forceps, bipolar\\ncautery or snare technique\\n$ 604.80\\n45340\\n45340\\nSigmoidoscopy, flexible; with dilation by balloon, 1 or more\\nstrictures\\n$ 400.18\\n45341\\n45341\\nSigmoidoscopy, flexible; with endoscopic ultrasound examination\\n$ 607.50\\n45342\\n45342\\nSigmoidoscopy, flexible; with transendoscopic ultrasound guided\\nintramural or transmural fine needle aspiration\/biopsy(s)\\n$ 700.20\\n45345\\n45345\\nSigmoidoscopy, flexible; with transendoscopic stent placement\\n(includes predilation)\\n$ 468.90\\n45355\\n45355\\nColonoscopy, rigid or flexible, transabdominal via colotomy, single\\nor multiple\\n$ 785.70\\n45378\\n45378\\nColonoscopy, flexible, proximal to splenic flexure; diagnostic, with\\nor without collection of specimen(s) by brushing or washing, with or\\nwithout colon decompression (separate procedure)\\n$ 858.15\\n45378-53 53\\n45378\\nColonoscopy, flexible, proximal to splenic flexure; diagnostic, with\\nor without collection of specimen(s) by brushing or washing, with or\\nwithout colon decompression (separate procedure)\\n$ 304.71\\n45379\\n45379\\nColonoscopy, flexible, proximal to splenic flexure; with removal of\\nforeign body\\n$ 1,099.80\\n45380\\n45380\\nColonoscopy, flexible, proximal to splenic flexure; with biopsy,\\nsingle or multiple\\n$ 961.77\\n45381\\n45381\\nColonoscopy, flexible, proximal to splenic flexure; with directed\\nsubmucosal injection(s), any substance\\n$ 975.00\\n45382\\n45382\\nColonoscopy, flexible, proximal to splenic flexure; with control of\\nbleeding (eg, injection, bipolar cautery, unipolar cautery, laser,\\nheater probe, stapler, plasma coagulator)\\n$ 1,107.00\\n45383\\n45383\\nColonoscopy, flexible, proximal to splenic flexure; with ablation of\\ntumor(s), polyp(s), or other lesion(s) not amenable to removal by\\nhot biopsy forceps, bipolar cautery or snare technique\\n$ 1,203.49\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n215\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n216\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n45384\\n45384\\nColonoscopy, flexible, proximal to splenic flexure; with removal of\\ntumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or\\nbipolar cautery\\n$ 1,162.09\\n45385\\n45385\\nColonoscopy, flexible, proximal to splenic flexure; with removal of\\ntumor(s), polyp(s), or other lesion(s) by snare technique\\n$ 1,287.91\\n45386\\n45386\\nColonoscopy, flexible, proximal to splenic flexure; with dilation by\\nballoon, 1 or more strictures\\n$ 958.72\\n45387\\n45387\\nColonoscopy, flexible, proximal to splenic flexure; with\\ntransendoscopic stent placement (includes predilation)\\n$ 950.40\\n45391\\n45391\\nColonoscopy, flexible, proximal to splenic flexure; with endoscopic\\nultrasound examination\\n$ 568.04\\n45392\\n45392\\nColonoscopy, flexible, proximal to splenic flexure; with\\ntransendoscopic ultrasound guided intramural or transmural fine\\nneedle aspiration\/biopsy(s)\\n$ 718.20\\n45395\\n45395\\nLaparoscopy, surgical; proctectomy, complete, combined\\nabdominoperineal, with colostomy\\n$ 3,966.46\\n45397\\n45397\\nLaparoscopy, surgical; proctectomy, combined abdominoperineal\\npull-through procedure (eg, colo-anal anastomosis), with creation of\\ncolonic reservoir (eg, J-pouch), with diverting enterostomy, when\\nperformed\\n$ 4,303.15\\n45400\\n45400\\nLaparoscopy, surgical; proctopexy (for prolapse)\\n$ 2,322.57\\n45402\\n45402\\nLaparoscopy, surgical; proctopexy (for prolapse), with sigmoid\\nresection\\n$ 3,124.42\\n45499\\n45499\\nUnlisted laparoscopy procedure, rectum\\nCost\\n45500\\n45500\\nProctoplasty; for stenosis\\n$ 1,570.50\\n45505\\n45505\\nProctoplasty; for prolapse of mucous membrane\\n$ 1,647.90\\n45520\\n45520\\nPerirectal injection of sclerosing solution for prolapse\\n$ 144.00\\n45540\\n45540\\nProctopexy (eg, for prolapse); abdominal approach\\n$ 3,206.70\\n45541\\n45541\\nProctopexy (eg, for prolapse); perineal approach\\n$ 2,523.60\\n45550\\n45550\\nProctopexy (eg, for prolapse); with sigmoid resection, abdominal\\napproach\\n$ 3,591.00\\n45560\\n45560\\nRepair of rectocele (separate procedure)\\n$ 1,494.00\\n45562\\n45562\\nExploration, repair, and presacral drainage for rectal injury;\\n$ 2,657.70\\n45563\\n45563\\nExploration, repair, and presacral drainage for rectal injury; with\\ncolostomy\\n$ 3,095.10\\n45800\\n45800\\nClosure of rectovesical fistula;\\n$ 3,066.30\\n45805\\n45805\\nClosure of rectovesical fistula; with colostomy\\n$ 3,103.20\\n45820\\n45820\\nClosure of rectourethral fistula;\\n$ 2,729.70\\n45825\\n45825\\nClosure of rectourethral fistula; with colostomy\\n$ 3,057.30\\n45900\\n45900\\nReduction of procidentia (separate procedure) under anesthesia\\n$ 497.70\\n45905\\n45905\\nDilation of anal sphincter (separate procedure) under anesthesia\\nother than local\\n$ 360.90\\n45910\\n45910\\nDilation of rectal stricture (separate procedure) under anesthesia\\nother than local\\n$ 384.30\\n45915\\n45915\\nRemoval of fecal impaction or foreign body (separate procedure)\\nunder anesthesia\\n$ 425.70\\n45990\\n45990\\nAnorectal exam, surgical, requiring anesthesia (general, spinal, or\\nepidural), diagnostic\\n$ 219.72\\n45999\\n45999\\nUnlisted procedure, rectum\\nCost\\n46020\\n46020\\nPlacement of seton\\n$ 230.01\\n46030\\n46030\\nRemoval of anal seton, other marker\\n$ 293.40\\n46040\\n46040\\nIncision and drainage of ischiorectal and\/or perirectal abscess\\n(separate procedure)\\n$ 703.80\\n46045\\n46045\\nIncision and drainage of intramural, intramuscular, or submucosal\\nabscess, transanal, under anesthesia\\n$ 775.80\\n46050\\n46050\\nIncision and drainage, perianal abscess, superficial\\n$ 282.60\\n46060\\n46060\\nIncision and drainage of ischiorectal or intramural abscess, with\\nfistulectomy or fistulotomy, submuscular, with or without\\nplacement of seton\\n$ 1,665.00\\n46070\\n46070\\nIncision, anal septum (infant)\\n$ 432.90\\n46080\\n46080\\nSphincterotomy, anal, division of sphincter (separate procedure)\\n$ 820.80\\n46083\\n46083\\nIncision of thrombosed hemorrhoid, external\\n$ 214.20\\n46200\\n46200\\nFissurectomy, including sphincterotomy, when performed\\n$ 867.60\\n46220\\n46220\\nExcision of single external papilla or tag, anus\\n$ 343.80\\n46221\\n46221\\nHemorrhoidectomy, internal, by rubber band ligation(s)\\n$ 391.50\\n46230\\n46230\\nExcision of multiple external papillae or tags, anus\\n$ 380.70\\n46250\\n46250\\nHemorrhoidectomy, external, 2 or more columns\/groups\\n$ 952.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n217\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n218\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n46255\\n46255\\nHemorrhoidectomy, internal and external, single column\/group;\\n$ 1,133.02\\n46257\\n46257\\nHemorrhoidectomy, internal and external, single column\/group;\\nwith fissurectomy\\n$ 1,395.90\\n46258\\n46258\\nHemorrhoidectomy, internal and external, single column\/group;\\nwith fistulectomy, including fissurectomy, when performed\\n$ 1,494.90\\n46260\\n46260\\nHemorrhoidectomy, internal and external, 2 or more\\ncolumns\/groups;\\n$ 1,744.20\\n46261\\n46261\\nHemorrhoidectomy, internal and external, 2 or more\\ncolumns\/groups; with fissurectomy\\n$ 1,469.73\\n46262\\n46262\\nHemorrhoidectomy, internal and external, 2 or more\\ncolumns\/groups; with fistulectomy, including fissurectomy, when\\nperformed\\n$ 1,658.70\\n46270\\n46270\\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy);\\nsubcutaneous\\n$ 813.60\\n46275\\n46275\\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy);\\nintersphincteric\\n$ 1,426.50\\n46280\\n46280\\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy);\\ntranssphincteric, suprasphincteric, extrasphincteric or multiple,\\nincluding placement of seton, when performed\\n$ 1,668.60\\n46285\\n46285\\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy); second\\nstage\\n$ 578.70\\n46288\\n46288\\nClosure of anal fistula with rectal advancement flap\\n$ 1,596.60\\n46320\\n46320\\nExcision of thrombosed hemorrhoid, external\\n$ 252.07\\n46500\\n46500\\nInjection of sclerosing solution, hemorrhoids\\n$ 104.40\\n46505\\n46505\\nChemodenervation of internal anal sphincter\\n$ 620.82\\n46600\\n46600\\nAnoscopy; diagnostic, with or without collection of specimen(s) by\\nbrushing or washing (separate procedure)\\n$ 70.85\\n46604\\n46604\\nAnoscopy; with dilation (eg, balloon, guide wire, bougie)\\n$ 197.10\\n46606\\n46606\\nAnoscopy; with biopsy, single or multiple\\n$ 156.60\\n46608\\n46608\\nAnoscopy; with removal of foreign body\\n$ 236.70\\n46610\\n46610\\nAnoscopy; with removal of single tumor, polyp, or other lesion by\\nhot biopsy forceps or bipolar cautery\\n$ 277.20\\n46611\\n46611\\nAnoscopy; with removal of single tumor, polyp, or other lesion by\\nsnare technique\\n$ 283.50\\n46612\\n46612\\nAnoscopy; with removal of multiple tumors, polyps, or other lesions\\nby hot biopsy forceps, bipolar cautery or snare technique\\n$ 343.80\\n46614\\n46614\\nAnoscopy; with control of bleeding (eg, injection, bipolar cautery,\\nunipolar cautery, laser, heater probe, stapler, plasma coagulator)\\n$ 407.70\\n46615\\n46615\\nAnoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not\\namenable to removal by hot biopsy forceps, bipolar cautery or\\nsnare technique\\n$ 414.00\\n46700\\n46700\\nAnoplasty, plastic operation for stricture; adult\\n$ 1,498.68\\n46705\\n46705\\nAnoplasty, plastic operation for stricture; infant\\n$ 1,416.60\\n46706\\n46706\\nRepair of anal fistula with fibrin glue\\n$ 389.22\\n46707\\n46707\\nRepair of anorectal fistula with plug (eg, porcine small intestine\\nsubmucosa [SIS])\\n$ 1,162.37\\n46710\\n46710\\nRepair of ileoanal pouch fistula\/sinus (eg, perineal or vaginal),\\npouch advancement; transperineal approach\\n$ 2,534.97\\n46712\\n46712\\nRepair of ileoanal pouch fistula\/sinus (eg, perineal or vaginal),\\npouch advancement; combined transperineal and transabdominal\\napproach\\n$ 4,490.29\\n46715\\n46715\\nRepair of low imperforate anus; with anoperineal fistula (cut-back\\nprocedure)\\n$ 1,563.30\\n46716\\n46716\\nRepair of low imperforate anus; with transposition of anoperineal\\nor anovestibular fistula\\n$ 1,954.80\\n46730\\n46730\\nRepair of high imperforate anus without fistula; perineal or\\nsacroperineal approach\\n$ 3,294.00\\n46735\\n46735\\nRepair of high imperforate anus without fistula; combined\\ntransabdominal and sacroperineal approaches\\n$ 3,994.20\\n46740\\n46740\\nRepair of high imperforate anus with rectourethral or rectovaginal\\nfistula; perineal or sacroperineal approach\\n$ 4,257.00\\n46742\\n46742\\nRepair of high imperforate anus with rectourethral or rectovaginal\\nfistula; combined transabdominal and sacroperineal approaches\\n$ 5,047.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n219\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n220\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n46744\\n46744\\nRepair of cloacal anomaly by anorectovaginoplasty and\\nurethroplasty, sacroperineal approach\\n$ 5,304.60\\n46746\\n46746\\nRepair of cloacal anomaly by anorectovaginoplasty and\\nurethroplasty, combined abdominal and sacroperineal approach;\\n$ 6,437.70\\n46748\\n46748\\nRepair of cloacal anomaly by anorectovaginoplasty and\\nurethroplasty, combined abdominal and sacroperineal approach;\\nwith vaginal lengthening by intestinal graft or pedicle flaps\\n$ 7,020.00\\n46750\\n46750\\nSphincteroplasty, anal, for incontinence or prolapse; adult\\n$ 1,944.72\\n46751\\n46751\\nSphincteroplasty, anal, for incontinence or prolapse; child\\n$ 1,653.30\\n46753\\n46753\\nGraft (Thiersch operation) for rectal incontinence and\/or prolapse\\n$ 1,352.70\\n46754\\n46754\\nRemoval of Thiersch wire or suture, anal canal\\n$ 287.10\\n46760\\n46760\\nSphincteroplasty, anal, for incontinence, adult; muscle transplant\\n$ 1,932.30\\n46761\\n46761\\nSphincteroplasty, anal, for incontinence, adult; levator muscle\\nimbrication (Park posterior anal repair)\\n$ 2,142.41\\n46762\\n46762\\nSphincteroplasty, anal, for incontinence, adult; implantation\\nartificial sphincter\\n$ 2,033.00\\n46900\\n46900\\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\\ncontagiosum, herpetic vesicle), simple; chemical\\n$ 190.80\\n46910\\n46910\\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\\ncontagiosum, herpetic vesicle), simple; electrodesiccation\\n$ 325.80\\n46916\\n46916\\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\\ncontagiosum, herpetic vesicle), simple; cryosurgery\\n$ 330.30\\n46917\\n46917\\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\\ncontagiosum, herpetic vesicle), simple; laser surgery\\n$ 570.60\\n46922\\n46922\\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\\ncontagiosum, herpetic vesicle), simple; surgical excision\\n$ 441.90\\n46924\\n46924\\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\\ncontagiosum, herpetic vesicle), extensive (eg, laser surgery,\\nelectrosurgery, cryosurgery, chemosurgery)\\n$ 861.30\\n46930\\n46930\\nDestruction of internal hemorrhoid(s) by thermal energy (eg,\\ninfrared coagulation, cautery, radiofrequency)\\n$ 309.16\\n46940\\n46940\\nCurettage or cautery of anal fissure, including dilation of anal\\nsphincter (separate procedure); initial\\n$ 342.90\\n46942\\n46942\\nCurettage or cautery of anal fissure, including dilation of anal\\nsphincter (separate procedure); subsequent\\n$ 241.20\\n46945\\n46945\\nHemorrhoidectomy, internal, by ligation other than rubber band;\\nsingle hemorrhoid column\/group\\n$ 319.50\\n46946\\n46946\\nHemorrhoidectomy, internal, by ligation other than rubber band; 2\\nor more hemorrhoid columns\/groups\\n$ 372.60\\n46947\\n46947\\nHemorrhoidopexy (eg, for prolapsing internal hemorrhoids) by\\nstapling\\n$ 578.58\\n46999\\n46999\\nUnlisted procedure, anus\\n$ 472.86\\n47000\\n47000\\nBiopsy of liver, needle; percutaneous\\n$ 378.90\\n47001\\n47001\\nBiopsy of liver, needle; when done for indicated purpose at time of\\nother major procedure (List separately in addition to code for\\nprimary procedure)\\n$ 362.70\\n47010\\n47010\\nHepatotomy, for open drainage of abscess or cyst, 1 or 2 stages\\n$ 2,399.40\\n47015\\n47015\\nLaparotomy, with aspiration and\/or injection of hepatic parasitic\\n(eg, amoebic or echinococcal) cyst(s) or abscess(es)\\n$ 1,859.40\\n47120\\n47120\\nHepatectomy, resection of liver; partial lobectomy\\n$ 4,094.10\\n47122\\n47122\\nHepatectomy, resection of liver; trisegmentectomy\\n$ 5,055.30\\n47125\\n47125\\nHepatectomy, resection of liver; total left lobectomy\\n$ 5,123.70\\n47130\\n47130\\nHepatectomy, resection of liver; total right lobectomy\\n$ 5,660.10\\n47133\\n47133\\nDonor hepatectomy (including cold preservation), from cadaver\\ndonor\\n$ -\\n47135\\n47135\\nLiver allotransplantation; orthotopic, partial or whole, from cadaver\\nor living donor, any age\\n$ 11,907.94\\n47136\\n47136\\nLiver allotransplantation; heterotopic, partial or whole, from\\ncadaver or living donor, any age\\n$ 10,222.38\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n221\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n222\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n47140\\n47140\\nDonor hepatectomy (including cold preservation), from living donor;\\nleft lateral segment only (segments II and III)\\n$ 8,705.32\\n47141\\n47141\\nDonor hepatectomy (including cold preservation), from living donor;\\ntotal left lobectomy (segments II, III and IV)\\n$ 9,173.83\\n47142\\n47142\\nDonor hepatectomy (including cold preservation), from living donor;\\ntotal right lobectomy (segments V, VI, VII and VIII)\\n$ 11,446.63\\n47143\\n47143\\nBackbench standard preparation of cadaver donor whole liver graft\\nprior to allotransplantation, including cholecystectomy, if necessary,\\nand dissection and removal of surrounding soft tissues to prepare\\nthe vena cava, portal vein, hepatic artery, and comm\\n$ -\\n47144\\n47144\\nBackbench standard preparation of cadaver donor whole liver graft\\nprior to allotransplantation, including cholecystectomy, if necessary,\\nand dissection and removal of surrounding soft tissues to prepare\\nthe vena cava, portal vein, hepatic artery, and comm\\n$ -\\n47145\\n47145\\nBackbench standard preparation of cadaver donor whole liver graft\\nprior to allotransplantation, including cholecystectomy, if necessary,\\nand dissection and removal of surrounding soft tissues to prepare\\nthe vena cava, portal vein, hepatic artery, and comm\\n$ -\\n47146\\n47146\\nBackbench reconstruction of cadaver or living donor liver graft prior\\nto allotransplantation; venous anastomosis, each\\n$ 795.89\\n47147\\n47147\\nBackbench reconstruction of cadaver or living donor liver graft prior\\nto allotransplantation; arterial anastomosis, each\\n$ 928.21\\n47300\\n47300\\nMarsupialization of cyst or abscess of liver\\n$ 2,345.40\\n47350\\n47350\\nManagement of liver hemorrhage; simple suture of liver wound or\\ninjury\\n$ 2,863.80\\n47360\\n47360\\nManagement of liver hemorrhage; complex suture of liver wound or\\ninjury, with or without hepatic artery ligation\\n$ 3,404.70\\n47361\\n47361\\nManagement of liver hemorrhage; exploration of hepatic wound,\\nextensive debridement, coagulation and\/or suture, with or without\\npacking of liver\\n$ 5,294.70\\n47362\\n47362\\nManagement of liver hemorrhage; re-exploration of hepatic wound\\nfor removal of packing\\n$ 2,229.30\\n47370\\n47370\\nLaparoscopy, surgical, ablation of 1 or more liver tumor(s);\\nradiofrequency\\n$ 3,013.06\\n47371\\n47371\\nLaparoscopy, surgical, ablation of 1 or more liver tumor(s);\\ncryosurgical\\n$ 3,066.51\\n47379\\n47379\\nUnlisted laparoscopic procedure, liver\\nCost\\n47380\\n47380\\nAblation, open, of 1 or more liver tumor(s); radiofrequency\\n$ 3,485.82\\n47381\\n47381\\nAblation, open, of 1 or more liver tumor(s); cryosurgical\\n$ 3,608.38\\n47382\\n47382\\nAblation, 1 or more liver tumor(s), percutaneous, radiofrequency\\n$ 12,779.28\\n47399\\n47399\\nUnlisted procedure, liver\\nCost\\n47400\\n47400\\nHepaticotomy or hepaticostomy with exploration, drainage, or\\nremoval of calculus\\n$ 2,941.20\\n47420\\n47420\\nCholedochotomy or choledochostomy with exploration, drainage,\\nor removal of calculus, with or without cholecystotomy; without\\ntransduodenal sphincterotomy or sphincteroplasty\\n$ 2,731.50\\n47425\\n47425\\nCholedochotomy or choledochostomy with exploration, drainage,\\nor removal of calculus, with or without cholecystotomy; with\\ntransduodenal sphincterotomy or sphincteroplasty\\n$ 3,064.50\\n47460\\n47460\\nTransduodenal sphincterotomy or sphincteroplasty, with or without\\ntransduodenal extraction of calculus (separate procedure)\\n$ 3,170.70\\n47480\\n47480\\nCholecystotomy or cholecystostomy, open, with exploration,\\ndrainage, or removal of calculus (separate procedure)\\n$ 1,964.70\\n47490\\n47490\\nCholecystostomy, percutaneous, complete procedure, including\\nimaging guidance, catheter placement, cholecystogram when\\nperformed, and radiological supervision and interpretation\\n$ 947.70\\n47500\\n47500\\nInjection procedure for percutaneous transhepatic cholangiography\\n$ 501.30\\n47505\\n47505\\nInjection procedure for cholangiography through an existing\\ncatheter (eg, percutaneous transhepatic or T-tube)\\n$ 239.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n223\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n224\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n47510\\n47510\\nIntroduction of percutaneous transhepatic catheter for biliary\\ndrainage\\n$ 825.30\\n47511\\n47511\\nIntroduction of percutaneous transhepatic stent for internal and\\nexternal biliary drainage\\n$ 932.40\\n47525\\n47525\\nChange of percutaneous biliary drainage catheter\\n$ 473.40\\n47530\\n47530\\nRevision and\/or reinsertion of transhepatic tube\\n$ 613.80\\n47550\\n47550\\nBiliary endoscopy, intraoperative (choledochoscopy) (List separately\\nin addition to code for primary procedure)\\n$ 785.70\\n47552\\n47552\\nBiliary endoscopy, percutaneous via T-tube or other tract;\\ndiagnostic, with collection of specimen(s) by brushing and\/or\\nwashing, when performed (separate procedure)\\n$ 1,030.50\\n47553\\n47553\\nBiliary endoscopy, percutaneous via T-tube or other tract; with\\nbiopsy, single or multiple\\n$ 978.30\\n47554\\n47554\\nBiliary endoscopy, percutaneous via T-tube or other tract; with\\nremoval of calculus\/calculi\\n$ 1,421.10\\n47555\\n47555\\nBiliary endoscopy, percutaneous via T-tube or other tract; with\\ndilation of biliary duct stricture(s) without stent\\n$ 1,138.50\\n47556\\n47556\\nBiliary endoscopy, percutaneous via T-tube or other tract; with\\ndilation of biliary duct stricture(s) with stent\\n$ 1,133.10\\n47560\\n47560\\nLaparoscopy, surgical; with guided transhepatic cholangiography,\\nwithout biopsy\\n$ 1,510.58\\n47561\\n47561\\nLaparoscopy, surgical; with guided transhepatic cholangiography\\nwith biopsy\\n$ 1,159.20\\n47562\\n47562\\nLaparoscopy, surgical; cholecystectomy\\n$ 2,884.50\\n47563\\n47563\\nLaparoscopy, surgical; cholecystectomy with cholangiography\\n$ 2,978.08\\n47564\\n47564\\nLaparoscopy, surgical; cholecystectomy with exploration of common\\nduct\\n$ 3,501.90\\n47570\\n47570\\nLaparoscopy, surgical; cholecystoenterostomy\\n$ 2,934.90\\n47579\\n47579\\nUnlisted laparoscopy procedure, biliary tract\\nCost\\n47600\\n47600\\nCholecystectomy;\\n$ 2,425.73\\n47605\\n47605\\nCholecystectomy; with cholangiography\\n$ 2,408.40\\n47610\\n47610\\nCholecystectomy with exploration of common duct;\\n$ 3,090.60\\n47612\\n47612\\nCholecystectomy with exploration of common duct; with\\ncholedochoenterostomy\\n$ 3,743.10\\n47620\\n47620\\nCholecystectomy with exploration of common duct; with\\ntransduodenal sphincterotomy or sphincteroplasty, with or without\\ncholangiography\\n$ 3,605.40\\n47630\\n47630\\nBiliary duct stone extraction, percutaneous via T-tube tract, basket,\\nor snare (eg, Burhenne technique)\\n$ 1,591.20\\n47700\\n47700\\nExploration for congenital atresia of bile ducts, without repair, with\\nor without liver biopsy, with or without cholangiography\\n$ 2,565.00\\n47701\\n47701\\nPortoenterostomy (eg, Kasai procedure)\\n$ 3,919.50\\n47711\\n47711\\nExcision of bile duct tumor, with or without primary repair of bile\\nduct; extrahepatic\\n$ 3,893.40\\n47712\\n47712\\nExcision of bile duct tumor, with or without primary repair of bile\\nduct; intrahepatic\\n$ 4,233.60\\n47715\\n47715\\nExcision of choledochal cyst\\n$ 2,894.40\\n47720\\n47720\\nCholecystoenterostomy; direct\\n$ 2,518.20\\n47721\\n47721\\nCholecystoenterostomy; with gastroenterostomy\\n$ 3,141.90\\n47740\\n47740\\nCholecystoenterostomy; Roux-en-Y\\n$ 3,231.00\\n47741\\n47741\\nCholecystoenterostomy; Roux-en-Y with gastroenterostomy\\n$ 3,558.60\\n47760\\n47760\\nAnastomosis, of extrahepatic biliary ducts and gastrointestinal tract\\n$ 3,577.50\\n47765\\n47765\\nAnastomosis, of intrahepatic ducts and gastrointestinal tract\\n$ 3,862.80\\n47780\\n47780\\nAnastomosis, Roux-en-Y, of extrahepatic biliary ducts and\\ngastrointestinal tract\\n$ 4,051.80\\n47785\\n47785\\nAnastomosis, Roux-en-Y, of intrahepatic biliary ducts and\\ngastrointestinal tract\\n$ 4,861.80\\n47800\\n47800\\nReconstruction, plastic, of extrahepatic biliary ducts with end-to-\\nend anastomosis\\n$ 3,579.30\\n47801\\n47801\\nPlacement of choledochal stent\\n$ 2,097.00\\n47802\\n47802\\nU-tube hepaticoenterostomy\\n$ 3,399.30\\n47900\\n47900\\nSuture of extrahepatic biliary duct for pre-existing injury (separate\\nprocedure)\\n$ 3,095.10\\n47999\\n47999\\nUnlisted procedure, biliary tract\\nCost\\n48000\\n48000\\nPlacement of drains, peripancreatic, for acute pancreatitis;\\n$ 2,626.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n225\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n226\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n48001\\n48001\\nPlacement of drains, peripancreatic, for acute pancreatitis; with\\ncholecystostomy, gastrostomy, and jejunostomy\\n$ 2,832.30\\n48020\\n48020\\nRemoval of pancreatic calculus\\n$ 2,904.30\\n48100\\n48100\\nBiopsy of pancreas, open (eg, fine needle aspiration, needle core\\nbiopsy, wedge biopsy)\\n$ 2,138.40\\n48102\\n48102\\nBiopsy of pancreas, percutaneous needle\\n$ 634.50\\n48105\\n48105\\nResection or debridement of pancreas and peripancreatic tissue for\\nacute necrotizing pancreatitis\\n$ 5,451.85\\n48120\\n48120\\nExcision of lesion of pancreas (eg, cyst, adenoma)\\n$ 2,574.90\\n48140\\n48140\\nPancreatectomy, distal subtotal, with or without splenectomy;\\nwithout pancreaticojejunostomy\\n$ 3,533.40\\n48145\\n48145\\nPancreatectomy, distal subtotal, with or without splenectomy; with\\npancreaticojejunostomy\\n$ 3,700.80\\n48146\\n48146\\nPancreatectomy, distal, near-total with preservation of duodenum\\n(Child-type procedure)\\n$ 3,965.40\\n48148\\n48148\\nExcision of ampulla of Vater\\n$ 3,132.00\\n48150\\n48150\\nPancreatectomy, proximal subtotal with total duodenectomy,\\npartial gastrectomy, choledochoenterostomy and\\ngastrojejunostomy (Whipple-type procedure); with\\npancreatojejunostomy\\n$ 6,010.20\\n48152\\n48152\\nPancreatectomy, proximal subtotal with total duodenectomy,\\npartial gastrectomy, choledochoenterostomy and\\ngastrojejunostomy (Whipple-type procedure); without\\npancreatojejunostomy\\n$ 5,525.10\\n48153\\n48153\\nPancreatectomy, proximal subtotal with near-total duodenectomy,\\ncholedochoenterostomy and duodenojejunostomy (pylorus-sparing,\\nWhipple-type procedure); with pancreatojejunostomy\\n$ 6,282.90\\n48154\\n48154\\nPancreatectomy, proximal subtotal with near-total duodenectomy,\\ncholedochoenterostomy and duodenojejunostomy (pylorus-sparing,\\nWhipple-type procedure); without pancreatojejunostomy\\n$ 5,545.84\\n48155\\n48155\\nPancreatectomy, total\\n$ 5,987.70\\n48160\\n48160\\nPancreatectomy, total or subtotal, with autologous transplantation\\nof pancreas or pancreatic islet cells\\n$ -\\n48400\\n48400\\nInjection procedure for intraoperative pancreatography (List\\nseparately in addition to code for primary procedure)\\n$ 278.10\\n48500\\n48500\\nMarsupialization of pancreatic cyst\\n$ 2,574.90\\n48510\\n48510\\nExternal drainage, pseudocyst of pancreas, open\\n$ 3,393.00\\n48520\\n48520\\nInternal anastomosis of pancreatic cyst to gastrointestinal tract;\\ndirect\\n$ 3,391.20\\n48540\\n48540\\nInternal anastomosis of pancreatic cyst to gastrointestinal tract;\\nRoux-en-Y\\n$ 3,727.80\\n48545\\n48545\\nPancreatorrhaphy for injury\\n$ 2,807.10\\n48547\\n48547\\nDuodenal exclusion with gastrojejunostomy for pancreatic injury\\n$ 4,583.70\\n48548\\n48548\\nPancreaticojejunostomy, side-to-side anastomosis (Puestow-type\\noperation)\\n$ 3,894.97\\n48550\\n48550\\nDonor pancreatectomy (including cold preservation), with or\\nwithout duodenal segment for transplantation\\n$ -\\n48551\\n48551\\nBackbench standard preparation of cadaver donor pancreas\\nallograft prior to transplantation, including dissection of allograft\\nfrom surrounding soft tissues, splenectomy, duodenotomy, ligation\\nof bile duct, ligation of mesenteric vessels, and Y-graft arte\\n$ -\\n48552\\n48552\\nBackbench reconstruction of cadaver donor pancreas allograft prior\\nto transplantation, venous anastomosis, each\\n$ 568.43\\n48554\\n48554\\nTransplantation of pancreatic allograft\\n$ 5,886.90\\n48556\\n48556\\nRemoval of transplanted pancreatic allograft\\n$ 2,919.60\\n48999\\n48999\\nUnlisted procedure, pancreas\\nCost\\n49000\\n49000\\nExploratory laparotomy, exploratory celiotomy with or without\\nbiopsy(s) (separate procedure)\\n$ 2,088.85\\n49002\\n49002\\nReopening of recent laparotomy\\n$ 1,898.10\\n49010\\n49010\\nExploration, retroperitoneal area with or without biopsy(s)\\n(separate procedure)\\n$ 2,083.50\\n49020\\n49020\\nDrainage of peritoneal abscess or localized peritonitis, exclusive of\\nappendiceal abscess, open\\n$ 1,682.10\\n49040\\n49040\\nDrainage of subdiaphragmatic or subphrenic abscess, open\\n$ 1,975.50\\n49060\\n49060\\nDrainage of retroperitoneal abscess, open\\n$ 1,845.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n227\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n228\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n49062\\n49062\\nDrainage of extraperitoneal lymphocele to peritoneal cavity, open\\n$ 1,874.70\\n49082\\n49082\\nAbdominal paracentesis (diagnostic or therapeutic); without\\nimaging guidance\\n$ 439.20\\n49083\\n49083\\nAbdominal paracentesis (diagnostic or therapeutic); with imaging\\nguidance\\n$ 793.44\\n49084\\n49084\\nPeritoneal lavage, including imaging guidance, when performed\\n$ 237.37\\n49180\\n49180\\nBiopsy, abdominal or retroperitoneal mass, percutaneous needle\\n$ 811.80\\n49203\\n49203\\nExcision or destruction, open, intra-abdominal tumors, cysts or\\nendometriomas, 1 or more peritoneal, mesenteric, or\\nretroperitoneal primary or secondary tumors; largest tumor 5 cm\\ndiameter or less\\n$ 2,801.62\\n49204\\n49204\\nExcision or destruction, open, intra-abdominal tumors, cysts or\\nendometriomas, 1 or more peritoneal, mesenteric, or\\nretroperitoneal primary or secondary tumors; largest tumor 5.1-\\n10.0 cm diameter\\n$ 3,508.35\\n49205\\n49205\\nExcision or destruction, open, intra-abdominal tumors, cysts or\\nendometriomas, 1 or more peritoneal, mesenteric, or\\nretroperitoneal primary or secondary tumors; largest tumor greater\\nthan 10.0 cm diameter\\n$ 4,192.01\\n49215\\n49215\\nExcision of presacral or sacrococcygeal tumor\\n$ 3,955.50\\n49220\\n49220\\nStaging laparotomy for Hodgkins disease or lymphoma (includes\\nsplenectomy, needle or open biopsies of both liver lobes, possibly\\nalso removal of abdominal nodes, abdominal node and\/or bone\\nmarrow biopsies, ovarian repositioning)\\n$ 3,829.50\\n49250\\n49250\\nUmbilectomy, omphalectomy, excision of umbilicus (separate\\nprocedure)\\n$ 1,416.60\\n49255\\n49255\\nOmentectomy, epiploectomy, resection of omentum (separate\\nprocedure)\\n$ 1,802.70\\n49320\\n49320\\nLaparoscopy, abdomen, peritoneum, and omentum, diagnostic,\\nwith or without collection of specimen(s) by brushing or washing\\n(separate procedure)\\n$ 1,557.11\\n49321\\n49321\\nLaparoscopy, surgical; with biopsy (single or multiple)\\n$ 1,716.30\\n49322\\n49322\\nLaparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian\\ncyst) (single or multiple)\\n$ 1,802.70\\n49323\\n49323\\nLaparoscopy, surgical; with drainage of lymphocele to peritoneal\\ncavity\\n$ 1,908.90\\n49324\\n49324\\nLaparoscopy, surgical; with insertion of tunneled intraperitoneal\\ncatheter\\n$ 943.82\\n49325\\n49325\\nLaparoscopy, surgical; with revision of previously placed\\nintraperitoneal cannula or catheter, with removal of intraluminal\\nobstructive material if performed\\n$ 950.46\\n49326\\n49326\\nLaparoscopy, surgical; with omentopexy (omental tacking\\nprocedure) (List separately in addition to code for primary\\nprocedure)\\n$ 706.80\\n49329\\n49329\\nUnlisted laparoscopy procedure, abdomen, peritoneum and\\nomentum\\nCost\\n49400\\n49400\\nInjection of air or contrast into peritoneal cavity (separate\\nprocedure)\\n$ 233.10\\n49402\\n49402\\nRemoval of peritoneal foreign body from peritoneal cavity\\n$ 1,902.20\\n49405\\n49405\\nImage-guided fluid collection drainage by catheter (eg, abscess,\\nhematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver,\\nspleen, lung\/mediastinum), percutaneous\\n$ 1,223.25\\n49406\\n49406\\nImage-guided fluid collection drainage by catheter (eg, abscess,\\nhematoma, seroma, lymphocele, cyst); peritoneal or\\nretroperitoneal, percutaneous\\n$ 1,223.25\\n49407\\n49407\\nImage-guided fluid collection drainage by catheter (eg, abscess,\\nhematoma, seroma, lymphocele, cyst); peritoneal or\\nretroperitoneal, transvaginal or transrectal\\n$ 757.76\\n49411\\n49411\\nPlacement of interstitial device(s) for radiation therapy guidance\\n(eg, fiducial markers, dosimeter), percutaneous, intra-abdominal,\\nintra-pelvic (except prostate), and\/or retroperitoneum, single or\\nmultiple\\n$ 880.63\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n229\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n230\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n49418\\n49418\\nInsertion of tunneled intraperitoneal catheter (eg, dialysis,\\nintraperitoneal chemotherapy instillation, management of ascites),\\ncomplete procedure, including imaging guidance, catheter\\nplacement, contrast injection when performed, and radiological\\nsuperv\\n$ 1,335.02\\n49419\\n49419\\nInsertion of tunneled intraperitoneal catheter, with subcutaneous\\nport (ie, totally implantable)\\n$ 985.96\\n49421\\n49421\\nInsertion of tunneled intraperitoneal catheter for dialysis, open\\n$ 1,449.00\\n49422\\n49422\\nRemoval of tunneled intraperitoneal catheter\\n$ 1,191.60\\n49423\\n49423\\nExchange of previously placed abscess or cyst drainage catheter\\nunder radiological guidance (separate procedure)\\n$ 277.20\\n49424\\n49424\\nContrast injection for assessment of abscess or cyst via previously\\nplaced drainage catheter or tube (separate procedure)\\n$ 144.00\\n49425\\n49425\\nInsertion of peritoneal-venous shunt\\n$ 2,162.70\\n49426\\n49426\\nRevision of peritoneal-venous shunt\\n$ 1,984.50\\n49427\\n49427\\nInjection procedure (eg, contrast media) for evaluation of previously\\nplaced peritoneal-venous shunt\\n$ 216.00\\n49428\\n49428\\nLigation of peritoneal-venous shunt\\n$ 953.79\\n49429\\n49429\\nRemoval of peritoneal-venous shunt\\n$ 1,148.24\\n49435\\n49435\\nInsertion of subcutaneous extension to intraperitoneal cannula or\\ncatheter with remote chest exit site (List separately in addition to\\ncode for primary procedure)\\n$ 343.46\\n49436\\n49436\\nDelayed creation of exit site from embedded subcutaneous\\nsegment of intraperitoneal cannula or catheter\\n$ 485.16\\n49440\\n49440\\nInsertion of gastrostomy tube, percutaneous, under fluoroscopic\\nguidance including contrast injection(s), image documentation and\\nreport\\n$ 2,849.89\\n49441\\n49441\\nInsertion of duodenostomy or jejunostomy tube, percutaneous,\\nunder fluoroscopic guidance including contrast injection(s), image\\ndocumentation and report\\n$ 3,205.41\\n49442\\n49442\\nInsertion of cecostomy or other colonic tube, percutaneous, under\\nfluoroscopic guidance including contrast injection(s), image\\ndocumentation and report\\n$ 2,719.49\\n49446\\n49446\\nConversion of gastrostomy tube to gastro-jejunostomy tube,\\npercutaneous, under fluoroscopic guidance including contrast\\ninjection(s), image documentation and report\\n$ 2,770.54\\n49450\\n49450\\nReplacement of gastrostomy or cecostomy (or other colonic) tube,\\npercutaneous, under fluoroscopic guidance including contrast\\ninjection(s), image documentation and report\\n$ 2,007.64\\n49451\\n49451\\nReplacement of duodenostomy or jejunostomy tube, percutaneous,\\nunder fluoroscopic guidance including contrast injection(s), image\\ndocumentation and report\\n$ 2,121.12\\n49452\\n49452\\nReplacement of gastro-jejunostomy tube, percutaneous, under\\nfluoroscopic guidance including contrast injection(s), image\\ndocumentation and report\\n$ 2,487.98\\n49460\\n49460\\nMechanical removal of obstructive material from gastrostomy,\\nduodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or\\nother colonic) tube, any method, under fluoroscopic guidance\\nincluding contrast injection(s), if performed, image documentation\\nan\\n$ 2,124.43\\n49465\\n49465\\nContrast injection(s) for radiological evaluation of existing\\ngastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or\\ncecostomy (or other colonic) tube, from a percutaneous approach\\nincluding image documentation and report\\n$ 492.81\\n49491\\n49491\\nRepair, initial inguinal hernia, preterm infant (younger than 37\\nweeks gestation at birth), performed from birth up to 50 weeks\\npostconception age, with or without hydrocelectomy; reducible\\n$ 1,510.04\\n49492\\n49492\\nRepair, initial inguinal hernia, preterm infant (younger than 37\\nweeks gestation at birth), performed from birth up to 50 weeks\\npostconception age, with or without hydrocelectomy; incarcerated\\nor strangulated\\n$ 1,735.71\\n49495\\n49495\\nRepair, initial inguinal hernia, full term infant younger than age 6\\nmonths, or preterm infant older than 50 weeks postconception age\\nand younger than age 6 months at the time of surgery, with or\\nwithout hydrocelectomy; reducible\\n$ 1,575.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n231\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n232\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n49496\\n49496\\nRepair, initial inguinal hernia, full term infant younger than age 6\\nmonths, or preterm infant older than 50 weeks postconception age\\nand younger than age 6 months at the time of surgery, with or\\nwithout hydrocelectomy; incarcerated or strangulated\\n$ 1,755.00\\n49500\\n49500\\nRepair initial inguinal hernia, age 6 months to younger than 5 years,\\nwith or without hydrocelectomy; reducible\\n$ 1,390.50\\n49501\\n49501\\nRepair initial inguinal hernia, age 6 months to younger than 5 years,\\nwith or without hydrocelectomy; incarcerated or strangulated\\n$ 1,555.20\\n49505\\n49505\\nRepair initial inguinal hernia, age 5 years or older; reducible\\n$ 1,547.55\\n49507\\n49507\\nRepair initial inguinal hernia, age 5 years or older; incarcerated or\\nstrangulated\\n$ 1,889.72\\n49520\\n49520\\nRepair recurrent inguinal hernia, any age; reducible\\n$ 2,031.30\\n49521\\n49521\\nRepair recurrent inguinal hernia, any age; incarcerated or\\nstrangulated\\n$ 2,214.90\\n49525\\n49525\\nRepair inguinal hernia, sliding, any age\\n$ 1,647.90\\n49540\\n49540\\nRepair lumbar hernia\\n$ 1,574.10\\n49550\\n49550\\nRepair initial femoral hernia, any age; reducible\\n$ 1,616.40\\n49553\\n49553\\nRepair initial femoral hernia, any age; incarcerated or strangulated\\n$ 1,931.40\\n49555\\n49555\\nRepair recurrent femoral hernia; reducible\\n$ 1,916.10\\n49557\\n49557\\nRepair recurrent femoral hernia; incarcerated or strangulated\\n$ 2,497.50\\n49560\\n49560\\nRepair initial incisional or ventral hernia; reducible\\n$ 1,978.57\\n49561\\n49561\\nRepair initial incisional or ventral hernia; incarcerated or\\nstrangulated\\n$ 2,116.80\\n49565\\n49565\\nRepair recurrent incisional or ventral hernia; reducible\\n$ 2,480.40\\n49566\\n49566\\nRepair recurrent incisional or ventral hernia; incarcerated or\\nstrangulated\\n$ 2,693.70\\n49568\\n49568\\nImplantation of mesh or other prosthesis for open incisional or\\nventral hernia repair or mesh for closure of debridement for\\nnecrotizing soft tissue infection (List separately in addition to code\\nfor the incisional or ventral hernia repair)\\n$ 736.24\\n49570\\n49570\\nRepair epigastric hernia (eg, preperitoneal fat); reducible (separate\\nprocedure)\\n$ 1,421.10\\n49572\\n49572\\nRepair epigastric hernia (eg, preperitoneal fat); incarcerated or\\nstrangulated\\n$ 1,670.40\\n49580\\n49580\\nRepair umbilical hernia, younger than age 5 years; reducible\\n$ 1,189.80\\n49582\\n49582\\nRepair umbilical hernia, younger than age 5 years; incarcerated or\\nstrangulated\\n$ 1,545.30\\n49585\\n49585\\nRepair umbilical hernia, age 5 years or older; reducible\\n$ 1,441.80\\n49587\\n49587\\nRepair umbilical hernia, age 5 years or older; incarcerated or\\nstrangulated\\n$ 1,646.00\\n49590\\n49590\\nRepair spigelian hernia\\n$ 1,654.20\\n49600\\n49600\\nRepair of small omphalocele, with primary closure\\n$ 1,622.70\\n49605\\n49605\\nRepair of large omphalocele or gastroschisis; with or without\\nprosthesis\\n$ 3,263.40\\n49606\\n49606\\nRepair of large omphalocele or gastroschisis; with removal of\\nprosthesis, final reduction and closure, in operating room\\n$ 2,832.30\\n49610\\n49610\\nRepair of omphalocele (Gross type operation); first stage\\n$ 2,008.80\\n49611\\n49611\\nRepair of omphalocele (Gross type operation); second stage\\n$ 1,946.70\\n49650\\n49650\\nLaparoscopy, surgical; repair initial inguinal hernia\\n$ 1,924.20\\n49651\\n49651\\nLaparoscopy, surgical; repair recurrent inguinal hernia\\n$ 2,074.50\\n49652\\n49652\\nLaparoscopy, surgical, repair, ventral, umbilical, spigelian or\\nepigastric hernia (includes mesh insertion, when performed);\\nreducible\\n$ 2,109.14\\n49653\\n49653\\nLaparoscopy, surgical, repair, ventral, umbilical, spigelian or\\nepigastric hernia (includes mesh insertion, when performed);\\nincarcerated or strangulated\\n$ 2,603.68\\n49654\\n49654\\nLaparoscopy, surgical, repair, incisional hernia (includes mesh\\ninsertion, when performed); reducible\\n$ 2,373.28\\n49655\\n49655\\nLaparoscopy, surgical, repair, incisional hernia (includes mesh\\ninsertion, when performed); incarcerated or strangulated\\n$ 2,891.21\\n49656\\n49656\\nLaparoscopy, surgical, repair, recurrent incisional hernia (includes\\nmesh insertion, when performed); reducible\\n$ 2,400.68\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n233\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n234\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n49657\\n49657\\nLaparoscopy, surgical, repair, recurrent incisional hernia (includes\\nmesh insertion, when performed); incarcerated or strangulated\\n$ 3,469.04\\n49659\\n49659\\nUnlisted laparoscopy procedure, hernioplasty, herniorrhaphy,\\nherniotomy\\nCost\\n49900\\n49900\\nSuture, secondary, of abdominal wall for evisceration or dehiscence\\n$ 1,555.20\\n49904\\n49904\\nOmental flap, extra-abdominal (eg, for reconstruction of sternal and\\nchest wall defects)\\n$ 3,010.88\\n49905\\n49905\\nOmental flap, intra-abdominal (List separately in addition to code\\nfor primary procedure)\\n$ 1,532.70\\n49906\\n49906\\nFree omental flap with microvascular anastomosis\\n$ -\\n49999\\n49999\\nUnlisted procedure, abdomen, peritoneum and omentum\\nCost\\n50010\\n50010\\nRenal exploration, not necessitating other specific procedures\\n$ 2,369.70\\n50020\\n50020\\nDrainage of perirenal or renal abscess, open\\n$ 2,348.10\\n50040\\n50040\\nNephrostomy, nephrotomy with drainage\\n$ 2,388.60\\n50045\\n50045\\nNephrotomy, with exploration\\n$ 2,695.50\\n50060\\n50060\\nNephrolithotomy; removal of calculus\\n$ 3,464.10\\n50065\\n50065\\nNephrolithotomy; secondary surgical operation for calculus\\n$ 3,301.20\\n50070\\n50070\\nNephrolithotomy; complicated by congenital kidney abnormality\\n$ 3,739.50\\n50075\\n50075\\nNephrolithotomy; removal of large staghorn calculus filling renal\\npelvis and calyces (including anatrophic pyelolithotomy)\\n$ 3,556.80\\n50080\\n50080\\nPercutaneous nephrostolithotomy or pyelostolithotomy, with or\\nwithout dilation, endoscopy, lithotripsy, stenting, or basket\\nextraction; up to 2 cm\\n$ 3,374.10\\n50081\\n50081\\nPercutaneous nephrostolithotomy or pyelostolithotomy, with or\\nwithout dilation, endoscopy, lithotripsy, stenting, or basket\\nextraction; over 2 cm\\n$ 3,953.70\\n50100\\n50100\\nTransection or repositioning of aberrant renal vessels (separate\\nprocedure)\\n$ 2,421.00\\n50120\\n50120\\nPyelotomy; with exploration\\n$ 2,788.20\\n50125\\n50125\\nPyelotomy; with drainage, pyelostomy\\n$ 2,860.20\\n50130\\n50130\\nPyelotomy; with removal of calculus (pyelolithotomy,\\npelviolithotomy, including coagulum pyelolithotomy)\\n$ 3,258.00\\n50135\\n50135\\nPyelotomy; complicated (eg, secondary operation, congenital\\nkidney abnormality)\\n$ 3,535.20\\n50200\\n50200\\nRenal biopsy; percutaneous, by trocar or needle\\n$ 563.40\\n50205\\n50205\\nRenal biopsy; by surgical exposure of kidney\\n$ 1,523.70\\n50220\\n50220\\nNephrectomy, including partial ureterectomy, any open approach\\nincluding rib resection;\\n$ 3,236.40\\n50225\\n50225\\nNephrectomy, including partial ureterectomy, any open approach\\nincluding rib resection; complicated because of previous surgery on\\nsame kidney\\n$ 3,862.80\\n50230\\n50230\\nNephrectomy, including partial ureterectomy, any open approach\\nincluding rib resection; radical, with regional lymphadenectomy\\nand\/or vena caval thrombectomy\\n$ 4,735.80\\n50234\\n50234\\nNephrectomy with total ureterectomy and bladder cuff; through\\nsame incision\\n$ 4,532.40\\n50236\\n50236\\nNephrectomy with total ureterectomy and bladder cuff; through\\nseparate incision\\n$ 4,327.20\\n50240\\n50240\\nNephrectomy, partial\\n$ 3,764.70\\n50250\\n50250\\nAblation, open, 1 or more renal mass lesion(s), cryosurgical,\\nincluding intraoperative ultrasound guidance and monitoring, if\\nperformed\\n$ 3,098.95\\n50280\\n50280\\nExcision or unroofing of cyst(s) of kidney\\n$ 2,828.70\\n50290\\n50290\\nExcision of perinephric cyst\\n$ 2,653.20\\n50300\\n50300\\nDonor nephrectomy (including cold preservation); from cadaver\\ndonor, unilateral or bilateral\\n$ 2,830.50\\n50320\\n50320\\nDonor nephrectomy (including cold preservation); open, from living\\ndonor\\n$ 4,686.30\\n50323\\n50323\\nBackbench standard preparation of cadaver donor renal allograft\\nprior to transplantation, including dissection and removal of\\nperinephric fat, diaphragmatic and retroperitoneal attachments,\\nexcision of adrenal gland, and preparation of ureter(s), renal ve\\n$ -\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n235\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n236\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n50325\\n50325\\nBackbench standard preparation of living donor renal allograft\\n(open or laparoscopic) prior to transplantation, including dissection\\nand removal of perinephric fat and preparation of ureter(s), renal\\nvein(s), and renal artery(s), ligating branches, as nec\\n$ -\\n50327\\n50327\\nBackbench reconstruction of cadaver or living donor renal allograft\\nprior to transplantation; venous anastomosis, each\\n$ 518.41\\n50328\\n50328\\nBackbench reconstruction of cadaver or living donor renal allograft\\nprior to transplantation; arterial anastomosis, each\\n$ 452.32\\n50329\\n50329\\nBackbench reconstruction of cadaver or living donor renal allograft\\nprior to transplantation; ureteral anastomosis, each\\n$ 410.96\\n50340\\n50340\\nRecipient nephrectomy (separate procedure)\\n$ 2,797.20\\n50360\\n50360\\nRenal allotransplantation, implantation of graft; without recipient\\nnephrectomy\\n$ 6,304.50\\n50365\\n50365\\nRenal allotransplantation, implantation of graft; with recipient\\nnephrectomy\\n$ 7,696.80\\n50370\\n50370\\nRemoval of transplanted renal allograft\\n$ 2,430.90\\n50380\\n50380\\nRenal autotransplantation, reimplantation of kidney\\n$ 4,360.50\\n50382\\n50382\\nRemoval (via snare\/capture) and replacement of internally dwelling\\nureteral stent via percutaneous approach, including radiological\\nsupervision and interpretation\\n$ 1,292.64\\n50384\\n50384\\nRemoval (via snare\/capture) of internally dwelling ureteral stent via\\npercutaneous approach, including radiological supervision and\\ninterpretation\\n$ 1,139.86\\n50385\\n50385\\nRemoval (via snare\/capture) and replacement of internally dwelling\\nureteral stent via transurethral approach, without use of\\ncystoscopy, including radiological supervision and interpretation\\n$ 1,174.03\\n50386\\n50386\\nRemoval (via snare\/capture) of internally dwelling ureteral stent via\\ntransurethral approach, without use of cystoscopy, including\\nradiological supervision and interpretation\\n$ 916.76\\n50387\\n50387\\nRemoval and replacement of externally accessible transnephric\\nureteral stent (eg, external\/internal stent) requiring fluoroscopic\\nguidance, including radiological supervision and interpretation\\n$ 540.10\\n50389\\n50389\\nRemoval of nephrostomy tube, requiring fluoroscopic guidance (eg,\\nwith concurrent indwelling ureteral stent)\\n$ 344.26\\n50390\\n50390\\nAspiration and\/or injection of renal cyst or pelvis by needle,\\npercutaneous\\n$ 465.30\\n50391\\n50391\\nInstillation(s) of therapeutic agent into renal pelvis and\/or ureter\\nthrough established nephrostomy, pyelostomy or ureterostomy\\ntube (eg, anticarcinogenic or antifungal agent)\\n$ 374.44\\n50392\\n50392\\nIntroduction of intracatheter or catheter into renal pelvis for\\ndrainage and\/or injection, percutaneous\\n$ 666.00\\n50393\\n50393\\nIntroduction of ureteral catheter or stent into ureter through renal\\npelvis for drainage and\/or injection, percutaneous\\n$ 703.80\\n50394\\n50394\\nInjection procedure for pyelography (as nephrostogram,\\npyelostogram, antegrade pyeloureterograms) through nephrostomy\\nor pyelostomy tube, or indwelling ureteral catheter\\n$ 221.40\\n50395\\n50395\\nIntroduction of guide into renal pelvis and\/or ureter with dilation to\\nestablish nephrostomy tract, percutaneous\\n$ 870.30\\n50396\\n50396\\nManometric studies through nephrostomy or pyelostomy tube, or\\nindwelling ureteral catheter\\n$ 164.70\\n50398\\n50398\\nChange of nephrostomy or pyelostomy tube\\n$ 257.40\\n50400\\n50400\\nPyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis,\\nwith or without plastic operation on ureter, nephropexy,\\nnephrostomy, pyelostomy, or ureteral splinting; simple\\n$ 3,541.50\\n50405\\n50405\\nPyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis,\\nwith or without plastic operation on ureter, nephropexy,\\nnephrostomy, pyelostomy, or ureteral splinting; complicated\\n(congenital kidney abnormality, secondary pyeloplasty, solitary kidn\\n$ 3,802.50\\n50500\\n50500\\nNephrorrhaphy, suture of kidney wound or injury\\n$ 3,298.50\\n50520\\n50520\\nClosure of nephrocutaneous or pyelocutaneous fistula\\n$ 2,853.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n237\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n238\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n50525\\n50525\\nClosure of nephrovisceral fistula (eg, renocolic), including visceral\\nrepair; abdominal approach\\n$ 3,438.00\\n50526\\n50526\\nClosure of nephrovisceral fistula (eg, renocolic), including visceral\\nrepair; thoracic approach\\n$ 3,501.90\\n50540\\n50540\\nSymphysiotomy for horseshoe kidney with or without pyeloplasty\\nand\/or other plastic procedure, unilateral or bilateral (1 operation)\\n$ 4,071.60\\n50541\\n50541\\nLaparoscopy, surgical; ablation of renal cysts\\n$ 2,673.90\\n50542\\n50542\\nLaparoscopy, surgical; ablation of renal mass lesion(s), including\\nintraoperative ultrasound guidance and monitoring, when\\nperformed\\n$ 2,662.34\\n50543\\n50543\\nLaparoscopy, surgical; partial nephrectomy\\n$ 3,268.75\\n50544\\n50544\\nLaparoscopy, surgical; pyeloplasty\\n$ 3,692.70\\n50545\\n50545\\nLaparoscopy, surgical; radical nephrectomy (includes removal of\\nGerota's fascia and surrounding fatty tissue, removal of regional\\nlymph nodes, and adrenalectomy)\\n$ 3,990.60\\n50546\\n50546\\nLaparoscopy, surgical; nephrectomy, including partial ureterectomy\\n$ 3,727.80\\n50547\\n50547\\nLaparoscopy, surgical; donor nephrectomy (including cold\\npreservation), from living donor\\n$ 4,762.80\\n50548\\n50548\\nLaparoscopy, surgical; nephrectomy with total ureterectomy\\n$ 5,098.50\\n50549\\n50549\\nUnlisted laparoscopy procedure, renal\\nCost\\n50551\\n50551\\nRenal endoscopy through established nephrostomy or pyelostomy,\\nwith or without irrigation, instillation, or ureteropyelography,\\nexclusive of radiologic service;\\n$ 777.60\\n50553\\n50553\\nRenal endoscopy through established nephrostomy or pyelostomy,\\nwith or without irrigation, instillation, or ureteropyelography,\\nexclusive of radiologic service; with ureteral catheterization, with or\\nwithout dilation of ureter\\n$ 774.00\\n50555\\n50555\\nRenal endoscopy through established nephrostomy or pyelostomy,\\nwith or without irrigation, instillation, or ureteropyelography,\\nexclusive of radiologic service; with biopsy\\n$ 995.40\\n50557\\n50557\\nRenal endoscopy through established nephrostomy or pyelostomy,\\nwith or without irrigation, instillation, or ureteropyelography,\\nexclusive of radiologic service; with fulguration and\/or incision, with\\nor without biopsy\\n$ 1,017.90\\n50561\\n50561\\nRenal endoscopy through established nephrostomy or pyelostomy,\\nwith or without irrigation, instillation, or ureteropyelography,\\nexclusive of radiologic service; with removal of foreign body or\\ncalculus\\n$ 1,484.10\\n50562\\n50562\\nRenal endoscopy through established nephrostomy or pyelostomy,\\nwith or without irrigation, instillation, or ureteropyelography,\\nexclusive of radiologic service; with resection of tumor\\n$ 1,158.89\\n50570\\n50570\\nRenal endoscopy through nephrotomy or pyelotomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service;\\n$ 1,117.80\\n50572\\n50572\\nRenal endoscopy through nephrotomy or pyelotomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with ureteral catheterization, with or without\\ndilation of ureter\\n$ 2,024.10\\n50574\\n50574\\nRenal endoscopy through nephrotomy or pyelotomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with biopsy\\n$ 2,061.00\\n50575\\n50575\\nRenal endoscopy through nephrotomy or pyelotomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with endopyelotomy (includes cystoscopy,\\nureteroscopy, dilation of ureter and ureteral pelvic junction, inci\\n$ 2,292.30\\n50576\\n50576\\nRenal endoscopy through nephrotomy or pyelotomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with fulguration and\/or incision, with or without\\nbiopsy\\n$ 1,647.90\\n50580\\n50580\\nRenal endoscopy through nephrotomy or pyelotomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with removal of foreign body or calculus\\n$ 2,277.00\\n50590\\n50590\\nLithotripsy, extracorporeal shock wave\\n$ 3,424.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n239\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n240\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n50592\\n50592\\nAblation, 1 or more renal tumor(s), percutaneous, unilateral,\\nradiofrequency\\n$ 2,900.54\\n50593\\n50593\\nAblation, renal tumor(s), unilateral, percutaneous, cryotherapy\\n$ 3,501.52\\n50600\\n50600\\nUreterotomy with exploration or drainage (separate procedure)\\n$ 2,530.80\\n50605\\n50605\\nUreterotomy for insertion of indwelling stent, all types\\n$ 2,730.60\\n50610\\n50610\\nUreterolithotomy; upper one-third of ureter\\n$ 3,156.30\\n50620\\n50620\\nUreterolithotomy; middle one-third of ureter\\n$ 3,373.20\\n50630\\n50630\\nUreterolithotomy; lower one-third of ureter\\n$ 3,577.50\\n50650\\n50650\\nUreterectomy, with bladder cuff (separate procedure)\\n$ 3,143.70\\n50660\\n50660\\nUreterectomy, total, ectopic ureter, combination abdominal,\\nvaginal and\/or perineal approach\\n$ 3,429.00\\n50684\\n50684\\nInjection procedure for ureterography or ureteropyelography\\nthrough ureterostomy or indwelling ureteral catheter\\n$ 153.90\\n50686\\n50686\\nManometric studies through ureterostomy or indwelling ureteral\\ncatheter\\n$ 120.60\\n50688\\n50688\\nChange of ureterostomy tube or externally accessible ureteral stent\\nvia ileal conduit\\n$ 162.00\\n50690\\n50690\\nInjection procedure for visualization of ileal conduit and\/or\\nureteropyelography, exclusive of radiologic service\\n$ 143.10\\n50700\\n50700\\nUreteroplasty, plastic operation on ureter (eg, stricture)\\n$ 2,943.00\\n50715\\n50715\\nUreterolysis, with or without repositioning of ureter for\\nretroperitoneal fibrosis\\n$ 2,781.00\\n50722\\n50722\\nUreterolysis for ovarian vein syndrome\\n$ 2,421.00\\n50725\\n50725\\nUreterolysis for retrocaval ureter, with reanastomosis of upper\\nurinary tract or vena cava\\n$ 3,769.20\\n50727\\n50727\\nRevision of urinary-cutaneous anastomosis (any type urostomy);\\n$ 1,869.30\\n50728\\n50728\\nRevision of urinary-cutaneous anastomosis (any type urostomy);\\nwith repair of fascial defect and hernia\\n$ 2,663.10\\n50740\\n50740\\nUreteropyelostomy, anastomosis of ureter and renal pelvis\\n$ 3,374.10\\n50750\\n50750\\nUreterocalycostomy, anastomosis of ureter to renal calyx\\n$ 3,605.40\\n50760\\n50760\\nUreteroureterostomy\\n$ 3,244.50\\n50770\\n50770\\nTransureteroureterostomy, anastomosis of ureter to contralateral\\nureter\\n$ 3,445.20\\n50780\\n50780\\nUreteroneocystostomy; anastomosis of single ureter to bladder\\n$ 3,356.10\\n50782\\n50782\\nUreteroneocystostomy; anastomosis of duplicated ureter to bladder $ 3,492.90\\n50783\\n50783\\nUreteroneocystostomy; with extensive ureteral tailoring\\n$ 3,594.60\\n50785\\n50785\\nUreteroneocystostomy; with vesico-psoas hitch or bladder flap\\n$ 3,877.20\\n50800\\n50800\\nUreteroenterostomy, direct anastomosis of ureter to intestine\\n$ 3,301.20\\n50810\\n50810\\nUreterosigmoidostomy, with creation of sigmoid bladder and\\nestablishment of abdominal or perineal colostomy, including\\nintestine anastomosis\\n$ 4,635.00\\n50815\\n50815\\nUreterocolon conduit, including intestine anastomosis\\n$ 4,789.80\\n50820\\n50820\\nUreteroileal conduit (ileal bladder), including intestine anastomosis\\n(Bricker operation)\\n$ 5,985.00\\n50825\\n50825\\nContinent diversion, including intestine anastomosis using any\\nsegment of small and\/or large intestine (Kock pouch or Camey\\nenterocystoplasty)\\n$ 5,768.10\\n50830\\n50830\\nUrinary undiversion (eg, taking down of ureteroileal conduit,\\nureterosigmoidostomy or ureteroenterostomy with\\nureteroureterostomy or ureteroneocystostomy)\\n$ 5,469.30\\n50840\\n50840\\nReplacement of all or part of ureter by intestine segment, including\\nintestine anastomosis\\n$ 3,718.80\\n50845\\n50845\\nCutaneous appendico-vesicostomy\\n$ 4,222.80\\n50860\\n50860\\nUreterostomy, transplantation of ureter to skin\\n$ 2,807.10\\n50900\\n50900\\nUreterorrhaphy, suture of ureter (separate procedure)\\n$ 2,652.30\\n50920\\n50920\\nClosure of ureterocutaneous fistula\\n$ 2,907.90\\n50930\\n50930\\nClosure of ureterovisceral fistula (including visceral repair)\\n$ 3,404.70\\n50940\\n50940\\nDeligation of ureter\\n$ 2,729.70\\n50945\\n50945\\nLaparoscopy, surgical; ureterolithotomy\\n$ 2,889.90\\n50947\\n50947\\nLaparoscopy, surgical; ureteroneocystostomy with cystoscopy and\\nureteral stent placement\\n$ 4,301.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n241\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n242\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n50948\\n50948\\nLaparoscopy, surgical; ureteroneocystostomy without cystoscopy\\nand ureteral stent placement\\n$ 3,933.00\\n50949\\n50949\\nUnlisted laparoscopy procedure, ureter\\nCost\\n50951\\n50951\\nUreteral endoscopy through established ureterostomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service;\\n$ 607.50\\n50953\\n50953\\nUreteral endoscopy through established ureterostomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with ureteral catheterization, with or without\\ndilation of ureter\\n$ 669.60\\n50955\\n50955\\nUreteral endoscopy through established ureterostomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with biopsy\\n$ 731.70\\n50957\\n50957\\nUreteral endoscopy through established ureterostomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with fulguration and\/or incision, with or without\\nbiopsy\\n$ 751.50\\n50961\\n50961\\nUreteral endoscopy through established ureterostomy, with or\\nwithout irrigation, instillation, or ureteropyelography, exclusive of\\nradiologic service; with removal of foreign body or calculus\\n$ 978.30\\n50970\\n50970\\nUreteral endoscopy through ureterotomy, with or without\\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\\nservice;\\n$ 824.40\\n50972\\n50972\\nUreteral endoscopy through ureterotomy, with or without\\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\\nservice; with ureteral catheterization, with or without dilation of\\nureter\\n$ 791.10\\n50974\\n50974\\nUreteral endoscopy through ureterotomy, with or without\\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\\nservice; with biopsy\\n$ 1,133.10\\n50976\\n50976\\nUreteral endoscopy through ureterotomy, with or without\\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\\nservice; with fulguration and\/or incision, with or without biopsy\\n$ 1,040.40\\n50980\\n50980\\nUreteral endoscopy through ureterotomy, with or without\\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\\nservice; with removal of foreign body or calculus\\n$ 936.90\\n51020\\n51020\\nCystotomy or cystostomy; with fulguration and\/or insertion of\\nradioactive material\\n$ 1,968.30\\n51030\\n51030\\nCystotomy or cystostomy; with cryosurgical destruction of\\nintravesical lesion\\n$ 1,923.30\\n51040\\n51040\\nCystostomy, cystotomy with drainage\\n$ 1,717.20\\n51045\\n51045\\nCystotomy, with insertion of ureteral catheter or stent (separate\\nprocedure)\\n$ 1,909.80\\n51050\\n51050\\nCystolithotomy, cystotomy with removal of calculus, without vesical\\nneck resection\\n$ 2,162.70\\n51060\\n51060\\nTransvesical ureterolithotomy\\n$ 2,581.20\\n51065\\n51065\\nCystotomy, with calculus basket extraction and\/or ultrasonic or\\nelectrohydraulic fragmentation of ureteral calculus\\n$ 2,421.00\\n51080\\n51080\\nDrainage of perivesical or prevesical space abscess\\n$ 1,701.90\\n51100\\n51100\\nAspiration of bladder; by needle\\n$ 178.51\\n51101\\n51101\\nAspiration of bladder; by trocar or intracatheter\\n$ 271.08\\n51102\\n51102\\nAspiration of bladder; with insertion of suprapubic catheter\\n$ 591.70\\n51500\\n51500\\nExcision of urachal cyst or sinus, with or without umbilical hernia\\nrepair\\n$ 2,151.00\\n51520\\n51520\\nCystotomy; for simple excision of vesical neck (separate procedure)\\n$ 2,277.00\\n51525\\n51525\\nCystotomy; for excision of bladder diverticulum, single or multiple\\n(separate procedure)\\n$ 2,837.70\\n51530\\n51530\\nCystotomy; for excision of bladder tumor\\n$ 2,457.00\\n51535\\n51535\\nCystotomy for excision, incision, or repair of ureterocele\\n$ 2,631.60\\n51550\\n51550\\nCystectomy, partial; simple\\n$ 2,953.80\\n51555\\n51555\\nCystectomy, partial; complicated (eg, postradiation, previous\\nsurgery, difficult location)\\n$ 3,749.40\\n51565\\n51565\\nCystectomy, partial, with reimplantation of ureter(s) into bladder\\n(ureteroneocystostomy)\\n$ 4,053.60\\n51570\\n51570\\nCystectomy, complete; (separate procedure)\\n$ 5,027.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n243\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n244\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n51575\\n51575\\nCystectomy, complete; with bilateral pelvic lymphadenectomy,\\nincluding external iliac, hypogastric, and obturator nodes\\n$ 6,365.70\\n51580\\n51580\\nCystectomy, complete, with ureterosigmoidostomy or\\nureterocutaneous transplantations;\\n$ 5,994.00\\n51585\\n51585\\nCystectomy, complete, with ureterosigmoidostomy or\\nureterocutaneous transplantations; with bilateral pelvic\\nlymphadenectomy, including external iliac, hypogastric, and\\nobturator nodes\\n$ 6,684.30\\n51590\\n51590\\nCystectomy, complete, with ureteroileal conduit or sigmoid bladder,\\nincluding intestine anastomosis;\\n$ 7,559.10\\n51595\\n51595\\nCystectomy, complete, with ureteroileal conduit or sigmoid bladder,\\nincluding intestine anastomosis; with bilateral pelvic\\nlymphadenectomy, including external iliac, hypogastric, and\\nobturator nodes\\n$ 8,475.30\\n51596\\n51596\\nCystectomy, complete, with continent diversion, any open\\ntechnique, using any segment of small and\/or large intestine to\\nconstruct neobladder\\n$ 8,883.90\\n51597\\n51597\\nPelvic exenteration, complete, for vesical, prostatic or urethral\\nmalignancy, with removal of bladder and ureteral transplantations,\\nwith or without hysterectomy and\/or abdominoperineal resection\\nof rectum and colon and colostomy, or any combination there\\n$ 10,661.40\\n51600\\n51600\\nInjection procedure for cystography or voiding urethrocystography\\n$ 147.60\\n51605\\n51605\\nInjection procedure and placement of chain for contrast and\/or\\nchain urethrocystography\\n$ 128.70\\n51610\\n51610\\nInjection procedure for retrograde urethrocystography\\n$ 185.40\\n51700\\n51700\\nBladder irrigation, simple, lavage and\/or instillation\\n$ 116.10\\n51701\\n51701\\nInsertion of non-indwelling bladder catheter (eg, straight\\ncatheterization for residual urine)\\n$ 119.17\\n51702\\n51702\\nInsertion of temporary indwelling bladder catheter; simple (eg,\\nFoley)\\n$ 222.55\\n51705\\n51705\\nChange of cystostomy tube; simple\\n$ 105.30\\n51710\\n51710\\nChange of cystostomy tube; complicated\\n$ 319.50\\n51715\\n51715\\nEndoscopic injection of implant material into the submucosal\\ntissues of the urethra and\/or bladder neck\\n$ 925.20\\n51720\\n51720\\nBladder instillation of anticarcinogenic agent (including retention\\ntime)\\n$ 173.70\\n51725\\n51725\\nSimple cystometrogram (CMG) (eg, spinal manometer)\\n$ 301.50\\n51725-26 26\\n51725\\nSimple cystometrogram (CMG) (eg, spinal manometer)\\n$ 253.80\\n51725-TC TC\\n51725\\nSimple cystometrogram (CMG) (eg, spinal manometer)\\n$ 187.19\\n51726\\n51726\\nComplex cystometrogram (ie, calibrated electronic equipment);\\n$ 369.00\\n51726-26 26\\n51726\\nComplex cystometrogram (ie, calibrated electronic equipment);\\n$ 369.00\\n51726-TC TC\\n51726\\nComplex cystometrogram (ie, calibrated electronic equipment);\\n$ 369.00\\n51727\\n51727\\nComplex cystometrogram (ie, calibrated electronic equipment);\\nwith urethral pressure profile studies (ie, urethral closure pressure\\nprofile), any technique\\n$ 686.90\\n51728\\n51728\\nComplex cystometrogram (ie, calibrated electronic equipment);\\nwith voiding pressure studies (ie, bladder voiding pressure), any\\ntechnique\\n$ 686.02\\n51729\\n51729\\nComplex cystometrogram (ie, calibrated electronic equipment);\\nwith voiding pressure studies (ie, bladder voiding pressure) and\\nurethral pressure profile studies (ie, urethral closure pressure\\nprofile), any technique\\n$ 704.40\\n51736\\n51736\\nSimple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical\\nuroflowmeter)\\n$ 157.50\\n51736-26 26\\n51736\\nSimple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical\\nuroflowmeter)\\n$ 131.40\\n51736-TC TC\\n51736\\nSimple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical\\nuroflowmeter)\\n$ 77.28\\n51741\\n51741\\nComplex uroflowmetry (eg, calibrated electronic equipment)\\n$ 159.30\\n51741-26 26\\n51741\\nComplex uroflowmetry (eg, calibrated electronic equipment)\\n$ 134.10\\n51741-TC TC\\n51741\\nComplex uroflowmetry (eg, calibrated electronic equipment)\\n$ 79.98\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n245\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n246\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n51784\\n51784\\nElectromyography studies (EMG) of anal or urethral sphincter, other\\nthan needle, any technique\\n$ 236.70\\n51784-26 26\\n51784\\nElectromyography studies (EMG) of anal or urethral sphincter, other\\nthan needle, any technique\\n$ 201.60\\n51784-TC TC\\n51784\\nElectromyography studies (EMG) of anal or urethral sphincter, other\\nthan needle, any technique\\n$ 148.69\\n51785\\n51785\\nNeedle electromyography studies (EMG) of anal or urethral\\nsphincter, any technique\\n$ 247.50\\n51785-26 26\\n51785\\nNeedle electromyography studies (EMG) of anal or urethral\\nsphincter, any technique\\n$ 207.00\\n51785-TC TC\\n51785\\nNeedle electromyography studies (EMG) of anal or urethral\\nsphincter, any technique\\n$ 175.98\\n51792\\n51792\\nStimulus evoked response (eg, measurement of bulbocavernosus\\nreflex latency time)\\n$ 239.40\\n51792-26 26\\n51792\\nStimulus evoked response (eg, measurement of bulbocavernosus\\nreflex latency time)\\n$ 202.50\\n51792-TC TC\\n51792\\nStimulus evoked response (eg, measurement of bulbocavernosus\\nreflex latency time)\\n$ 181.58\\n51797\\n51797\\nVoiding pressure studies, intra-abdominal (ie, rectal, gastric,\\nintraperitoneal) (List separately in addition to code for primary\\nprocedure)\\n$ 247.50\\n51797-26 26\\n51797\\nVoiding pressure studies, intra-abdominal (ie, rectal, gastric,\\nintraperitoneal) (List separately in addition to code for primary\\nprocedure)\\n$ 207.00\\n51797-TC TC\\n51797\\nVoiding pressure studies, intra-abdominal (ie, rectal, gastric,\\nintraperitoneal) (List separately in addition to code for primary\\nprocedure)\\n$ 166.46\\n51798\\n51798\\nMeasurement of post-voiding residual urine and\/or bladder\\ncapacity by ultrasound, non-imaging\\n$ 51.15\\n51800\\n51800\\nCystoplasty or cystourethroplasty, plastic operation on bladder\\nand\/or vesical neck (anterior Y-plasty, vesical fundus resection), any\\nprocedure, with or without wedge resection of posterior vesical\\nneck\\n$ 2,849.40\\n51820\\n51820\\nCystourethroplasty with unilateral or bilateral\\nureteroneocystostomy\\n$ 3,780.00\\n51840\\n51840\\nAnterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-\\nKrantz, Burch); simple\\n$ 2,495.70\\n51841\\n51841\\nAnterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-\\nKrantz, Burch); complicated (eg, secondary repair)\\n$ 2,781.00\\n51845\\n51845\\nAbdomino-vaginal vesical neck suspension, with or without\\nendoscopic control (eg, Stamey, Raz, modified Pereyra)\\n$ 2,781.00\\n51860\\n51860\\nCystorrhaphy, suture of bladder wound, injury or rupture; simple\\n$ 2,200.50\\n51865\\n51865\\nCystorrhaphy, suture of bladder wound, injury or rupture;\\ncomplicated\\n$ 2,982.60\\n51880\\n51880\\nClosure of cystostomy (separate procedure)\\n$ 1,339.20\\n51900\\n51900\\nClosure of vesicovaginal fistula, abdominal approach\\n$ 3,454.20\\n51920\\n51920\\nClosure of vesicouterine fistula;\\n$ 2,559.60\\n51925\\n51925\\nClosure of vesicouterine fistula; with hysterectomy\\n$ 3,301.20\\n51940\\n51940\\nClosure, exstrophy of bladder\\n$ 4,738.50\\n51960\\n51960\\nEnterocystoplasty, including intestinal anastomosis\\n$ 4,652.10\\n51980\\n51980\\nCutaneous vesicostomy\\n$ 2,439.00\\n51990\\n51990\\nLaparoscopy, surgical; urethral suspension for stress incontinence\\n$ 2,447.10\\n51992\\n51992\\nLaparoscopy, surgical; sling operation for stress incontinence (eg,\\nfascia or synthetic)\\n$ 2,637.00\\n51999\\n51999\\nUnlisted laparoscopy procedure, bladder\\nCost\\n52000\\n52000\\nCystourethroscopy (separate procedure)\\n$ 405.34\\n52001\\n52001\\nCystourethroscopy with irrigation and evacuation of multiple\\nobstructing clots\\n$ 676.66\\n52005\\n52005\\nCystourethroscopy, with ureteral catheterization, with or without\\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\\nservice;\\n$ 579.60\\n52007\\n52007\\nCystourethroscopy, with ureteral catheterization, with or without\\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\\nservice; with brush biopsy of ureter and\/or renal pelvis\\n$ 640.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n247\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n248\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n52010\\n52010\\nCystourethroscopy, with ejaculatory duct catheterization, with or\\nwithout irrigation, instillation, or duct radiography, exclusive of\\nradiologic service\\n$ 576.00\\n52204\\n52204\\nCystourethroscopy, with biopsy(s)\\n$ 595.75\\n52214\\n52214\\nCystourethroscopy, with fulguration (including cryosurgery or laser\\nsurgery) of trigone, bladder neck, prostatic fossa, urethra, or\\nperiurethral glands\\n$ 769.50\\n52224\\n52224\\nCystourethroscopy, with fulguration (including cryosurgery or laser\\nsurgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or\\nwithout biopsy\\n$ 747.00\\n52234\\n52234\\nCystourethroscopy, with fulguration (including cryosurgery or laser\\nsurgery) and\/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0\\ncm)\\n$ 1,017.90\\n52235\\n52235\\nCystourethroscopy, with fulguration (including cryosurgery or laser\\nsurgery) and\/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0\\ncm)\\n$ 1,761.30\\n52240\\n52240\\nCystourethroscopy, with fulguration (including cryosurgery or laser\\nsurgery) and\/or resection of; LARGE bladder tumor(s)\\n$ 2,543.40\\n52250\\n52250\\nCystourethroscopy with insertion of radioactive substance, with or\\nwithout biopsy or fulguration\\n$ 849.60\\n52260\\n52260\\nCystourethroscopy, with dilation of bladder for interstitial cystitis;\\ngeneral or conduction (spinal) anesthesia\\n$ 592.18\\n52265\\n52265\\nCystourethroscopy, with dilation of bladder for interstitial cystitis;\\nlocal anesthesia\\n$ 540.90\\n52270\\n52270\\nCystourethroscopy, with internal urethrotomy; female\\n$ 819.00\\n52275\\n52275\\nCystourethroscopy, with internal urethrotomy; male\\n$ 882.00\\n52276\\n52276\\nCystourethroscopy with direct vision internal urethrotomy\\n$ 1,261.80\\n52277\\n52277\\nCystourethroscopy, with resection of external sphincter\\n(sphincterotomy)\\n$ 1,206.90\\n52281\\n52281\\nCystourethroscopy, with calibration and\/or dilation of urethral\\nstricture or stenosis, with or without meatotomy, with or without\\ninjection procedure for cystography, male or female\\n$ 580.93\\n52282\\n52282\\nCystourethroscopy, with insertion of permanent urethral stent\\n$ 1,030.50\\n52283\\n52283\\nCystourethroscopy, with steroid injection into stricture\\n$ 563.40\\n52285\\n52285\\nCystourethroscopy for treatment of the female urethral syndrome\\nwith any or all of the following: urethral meatotomy, urethral\\ndilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis,\\nlateral incisions of the bladder neck, and fulguration\\n$ 686.56\\n52290\\n52290\\nCystourethroscopy; with ureteral meatotomy, unilateral or bilateral\\n$ 737.10\\n52300\\n52300\\nCystourethroscopy; with resection or fulguration of orthotopic\\nureterocele(s), unilateral or bilateral\\n$ 975.60\\n52301\\n52301\\nCystourethroscopy; with resection or fulguration of ectopic\\nureterocele(s), unilateral or bilateral\\n$ 1,035.00\\n52305\\n52305\\nCystourethroscopy; with incision or resection of orifice of bladder\\ndiverticulum, single or multiple\\n$ 1,019.70\\n52310\\n52310\\nCystourethroscopy, with removal of foreign body, calculus, or\\nureteral stent from urethra or bladder (separate procedure); simple $ 751.50\\n52315\\n52315\\nCystourethroscopy, with removal of foreign body, calculus, or\\nureteral stent from urethra or bladder (separate procedure);\\ncomplicated\\n$ 1,328.40\\n52317\\n52317\\nLitholapaxy: crushing or fragmentation of calculus by any means in\\nbladder and removal of fragments; simple or small (less than 2.5\\ncm)\\n$ 1,377.90\\n52318\\n52318\\nLitholapaxy: crushing or fragmentation of calculus by any means in\\nbladder and removal of fragments; complicated or large (over 2.5\\ncm)\\n$ 1,948.50\\n52320\\n52320\\nCystourethroscopy (including ureteral catheterization); with\\nremoval of ureteral calculus\\n$ 1,344.60\\n52325\\n52325\\nCystourethroscopy (including ureteral catheterization); with\\nfragmentation of ureteral calculus (eg, ultrasonic or electro-\\nhydraulic technique)\\n$ 1,559.70\\n52327\\n52327\\nCystourethroscopy (including ureteral catheterization); with\\nsubureteric injection of implant material\\n$ 1,081.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n249\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n250\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n52330\\n52330\\nCystourethroscopy (including ureteral catheterization); with\\nmanipulation, without removal of ureteral calculus\\n$ 953.10\\n52332\\n52332\\nCystourethroscopy, with insertion of indwelling ureteral stent (eg,\\nGibbons or double-J type)\\n$ 924.30\\n52334\\n52334\\nCystourethroscopy with insertion of ureteral guide wire through\\nkidney to establish a percutaneous nephrostomy, retrograde\\n$ 875.70\\n52341\\n52341\\nCystourethroscopy; with treatment of ureteral stricture (eg, balloon\\ndilation, laser, electrocautery, and incision)\\n$ 1,350.00\\n52342\\n52342\\nCystourethroscopy; with treatment of ureteropelvic junction\\nstricture (eg, balloon dilation, laser, electrocautery, and incision)\\n$ 1,461.60\\n52343\\n52343\\nCystourethroscopy; with treatment of intra-renal stricture (eg,\\nballoon dilation, laser, electrocautery, and incision)\\n$ 1,619.10\\n52344\\n52344\\nCystourethroscopy with ureteroscopy; with treatment of ureteral\\nstricture (eg, balloon dilation, laser, electrocautery, and incision)\\n$ 1,776.60\\n52345\\n52345\\nCystourethroscopy with ureteroscopy; with treatment of\\nureteropelvic junction stricture (eg, balloon dilation, laser,\\nelectrocautery, and incision)\\n$ 1,845.00\\n52346\\n52346\\nCystourethroscopy with ureteroscopy; with treatment of intra-renal\\nstricture (eg, balloon dilation, laser, electrocautery, and incision)\\n$ 2,074.50\\n52351\\n52351\\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy;\\ndiagnostic\\n$ 1,377.90\\n52352\\n52352\\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\\nremoval or manipulation of calculus (ureteral catheterization is\\nincluded)\\n$ 1,629.42\\n52353\\n52353\\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\\nlithotripsy (ureteral catheterization is included)\\n$ 2,027.72\\n52354\\n52354\\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\\nbiopsy and\/or fulguration of ureteral or renal pelvic lesion\\n$ 1,728.00\\n52355\\n52355\\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\\nresection of ureteral or renal pelvic tumor\\n$ 2,030.40\\n52400\\n52400\\nCystourethroscopy with incision, fulguration, or resection of\\ncongenital posterior urethral valves, or congenital obstructive\\nhypertrophic mucosal folds\\n$ 2,414.70\\n52402\\n52402\\nCystourethroscopy with transurethral resection or incision of\\nejaculatory ducts\\n$ 641.48\\n52450\\n52450\\nTransurethral incision of prostate\\n$ 1,562.40\\n52500\\n52500\\nTransurethral resection of bladder neck (separate procedure)\\n$ 1,719.90\\n52601\\n52601\\nTransurethral electrosurgical resection of prostate, including control\\nof postoperative bleeding, complete (vasectomy, meatotomy,\\ncystourethroscopy, urethral calibration and\/or dilation, and internal\\nurethrotomy are included)\\n$ 2,701.80\\n52630\\n52630\\nTransurethral resection; residual or regrowth of obstructive\\nprostate tissue including control of postoperative bleeding,\\ncomplete (vasectomy, meatotomy, cystourethroscopy, urethral\\ncalibration and\/or dilation, and internal urethrotomy are included)\\n$ 2,482.20\\n52640\\n52640\\nTransurethral resection; of postoperative bladder neck contracture\\n$ 2,140.20\\n52647\\n52647\\nLaser coagulation of prostate, including control of postoperative\\nbleeding, complete (vasectomy, meatotomy, cystourethroscopy,\\nurethral calibration and\/or dilation, and internal urethrotomy are\\nincluded if performed)\\n$ 2,169.90\\n52648\\n52648\\nLaser vaporization of prostate, including control of postoperative\\nbleeding, complete (vasectomy, meatotomy, cystourethroscopy,\\nurethral calibration and\/or dilation, internal urethrotomy and\\ntransurethral resection of prostate are included if performed)\\n$ 2,472.30\\n52649\\n52649\\nLaser enucleation of the prostate with morcellation, including\\ncontrol of postoperative bleeding, complete (vasectomy,\\nmeatotomy, cystourethroscopy, urethral calibration and\/or dilation,\\ninternal urethrotomy and transurethral resection of prostate are inc $ 2,156.95\\n52700\\n52700\\nTransurethral drainage of prostatic abscess\\n$ 1,305.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n251\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n252\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n53000\\n53000\\nUrethrotomy or urethrostomy, external (separate procedure);\\npendulous urethra\\n$ 414.90\\n53010\\n53010\\nUrethrotomy or urethrostomy, external (separate procedure);\\nperineal urethra, external\\n$ 914.40\\n53020\\n53020\\nMeatotomy, cutting of meatus (separate procedure); except infant\\n$ 583.86\\n53025\\n53025\\nMeatotomy, cutting of meatus (separate procedure); infant\\n$ 236.70\\n53040\\n53040\\nDrainage of deep periurethral abscess\\n$ 692.10\\n53060\\n53060\\nDrainage of Skene's gland abscess or cyst\\n$ 322.20\\n53080\\n53080\\nDrainage of perineal urinary extravasation; uncomplicated (separate\\nprocedure)\\n$ 761.40\\n53085\\n53085\\nDrainage of perineal urinary extravasation; complicated\\n$ 1,825.20\\n53200\\n53200\\nBiopsy of urethra\\n$ 473.40\\n53210\\n53210\\nUrethrectomy, total, including cystostomy; female\\n$ 2,104.20\\n53215\\n53215\\nUrethrectomy, total, including cystostomy; male\\n$ 2,781.00\\n53220\\n53220\\nExcision or fulguration of carcinoma of urethra\\n$ 1,617.30\\n53230\\n53230\\nExcision of urethral diverticulum (separate procedure); female\\n$ 2,214.90\\n53235\\n53235\\nExcision of urethral diverticulum (separate procedure); male\\n$ 2,060.10\\n53240\\n53240\\nMarsupialization of urethral diverticulum, male or female\\n$ 852.30\\n53250\\n53250\\nExcision of bulbourethral gland (Cowper's gland)\\n$ 1,313.10\\n53260\\n53260\\nExcision or fulguration; urethral polyp(s), distal urethra\\n$ 520.20\\n53265\\n53265\\nExcision or fulguration; urethral caruncle\\n$ 530.10\\n53270\\n53270\\nExcision or fulguration; Skene's glands\\n$ 564.30\\n53275\\n53275\\nExcision or fulguration; urethral prolapse\\n$ 622.80\\n53400\\n53400\\nUrethroplasty; first stage, for fistula, diverticulum, or stricture (eg,\\nJohannsen type)\\n$ 1,926.90\\n53405\\n53405\\nUrethroplasty; second stage (formation of urethra), including\\nurinary diversion\\n$ 2,250.90\\n53410\\n53410\\nUrethroplasty, 1-stage reconstruction of male anterior urethra\\n$ 2,686.50\\n53415\\n53415\\nUrethroplasty, transpubic or perineal, 1-stage, for reconstruction or\\nrepair of prostatic or membranous urethra\\n$ 3,239.10\\n53420\\n53420\\nUrethroplasty, 2-stage reconstruction or repair of prostatic or\\nmembranous urethra; first stage\\n$ 2,888.10\\n53425\\n53425\\nUrethroplasty, 2-stage reconstruction or repair of prostatic or\\nmembranous urethra; second stage\\n$ 2,995.20\\n53430\\n53430\\nUrethroplasty, reconstruction of female urethra\\n$ 2,496.60\\n53431\\n53431\\nUrethroplasty with tubularization of posterior urethra and\/or lower\\nbladder for incontinence (eg, Tenago, Leadbetter procedure)\\n$ 2,797.78\\n53440\\n53440\\nSling operation for correction of male urinary incontinence (eg,\\nfascia or synthetic)\\n$ 2,991.60\\n53442\\n53442\\nRemoval or revision of sling for male urinary incontinence (eg, fascia\\nor synthetic)\\n$ 1,171.80\\n53444\\n53444\\nInsertion of tandem cuff (dual cuff)\\n$ 2,081.89\\n53445\\n53445\\nInsertion of inflatable urethral\/bladder neck sphincter, including\\nplacement of pump, reservoir, and cuff\\n$ 5,150.70\\n53446\\n53446\\nRemoval of inflatable urethral\/bladder neck sphincter, including\\npump, reservoir, and cuff\\n$ 1,825.77\\n53447\\n53447\\nRemoval and replacement of inflatable urethral\/bladder neck\\nsphincter including pump, reservoir, and cuff at the same operative\\nsession\\n$ 2,507.40\\n53448\\n53448\\nRemoval and replacement of inflatable urethral\/bladder neck\\nsphincter including pump, reservoir, and cuff through an infected\\nfield at the same operative session including irrigation and\\ndebridement of infected tissue\\n$ 3,364.59\\n53449\\n53449\\nRepair of inflatable urethral\/bladder neck sphincter, including\\npump, reservoir, and cuff\\n$ 1,864.80\\n53450\\n53450\\nUrethromeatoplasty, with mucosal advancement\\n$ 720.90\\n53460\\n53460\\nUrethromeatoplasty, with partial excision of distal urethral segment\\n(Richardson type procedure)\\n$ 726.30\\n53500\\n53500\\nUrethrolysis, transvaginal, secondary, open, including\\ncystourethroscopy (eg, postsurgical obstruction, scarring)\\n$ 1,914.08\\n53502\\n53502\\nUrethrorrhaphy, suture of urethral wound or injury, female\\n$ 1,486.80\\n53505\\n53505\\nUrethrorrhaphy, suture of urethral wound or injury; penile\\n$ 1,532.70\\n53510\\n53510\\nUrethrorrhaphy, suture of urethral wound or injury; perineal\\n$ 1,917.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n253\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n254\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n53515\\n53515\\nUrethrorrhaphy, suture of urethral wound or injury;\\nprostatomembranous\\n$ 2,654.10\\n53520\\n53520\\nClosure of urethrostomy or urethrocutaneous fistula, male\\n(separate procedure)\\n$ 1,213.20\\n53600\\n53600\\nDilation of urethral stricture by passage of sound or urethral dilator,\\nmale; initial\\n$ 154.80\\n53601\\n53601\\nDilation of urethral stricture by passage of sound or urethral dilator,\\nmale; subsequent\\n$ 149.40\\n53605\\n53605\\nDilation of urethral stricture or vesical neck by passage of sound or\\nurethral dilator, male, general or conduction (spinal) anesthesia\\n$ 230.40\\n53620\\n53620\\nDilation of urethral stricture by passage of filiform and follower,\\nmale; initial\\n$ 218.70\\n53621\\n53621\\nDilation of urethral stricture by passage of filiform and follower,\\nmale; subsequent\\n$ 137.70\\n53660\\n53660\\nDilation of female urethra including suppository and\/or instillation;\\ninitial\\n$ 114.30\\n53661\\n53661\\nDilation of female urethra including suppository and\/or instillation;\\nsubsequent\\n$ 120.60\\n53665\\n53665\\nDilation of female urethra, general or conduction (spinal) anesthesia $ 215.10\\n53850\\n53850\\nTransurethral destruction of prostate tissue; by microwave\\nthermotherapy\\n$ 1,637.10\\n53852\\n53852\\nTransurethral destruction of prostate tissue; by radiofrequency\\nthermotherapy\\n$ 1,448.10\\n53855\\n53855\\nInsertion of a temporary prostatic urethral stent, including urethral\\nmeasurement\\n$ 1,749.79\\n53899\\n53899\\nUnlisted procedure, urinary system\\nCost\\n54000\\n54000\\nSlitting of prepuce, dorsal or lateral (separate procedure); newborn\\n$ 164.70\\n54001\\n54001\\nSlitting of prepuce, dorsal or lateral (separate procedure); except\\nnewborn\\n$ 314.10\\n54015\\n54015\\nIncision and drainage of penis, deep\\n$ 437.40\\n54050\\n54050\\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\\nmolluscum contagiosum, herpetic vesicle), simple; chemical\\n$ 134.50\\n54055\\n54055\\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\\nmolluscum contagiosum, herpetic vesicle), simple;\\nelectrodesiccation\\n$ 271.58\\n54056\\n54056\\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\\nmolluscum contagiosum, herpetic vesicle), simple; cryosurgery\\n$ 239.88\\n54057\\n54057\\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\\nmolluscum contagiosum, herpetic vesicle), simple; laser surgery\\n$ 601.20\\n54060\\n54060\\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\\nmolluscum contagiosum, herpetic vesicle), simple; surgical excision\\n$ 481.62\\n54065\\n54065\\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\\nmolluscum contagiosum, herpetic vesicle), extensive (eg, laser\\nsurgery, electrosurgery, cryosurgery, chemosurgery)\\n$ 906.65\\n54100\\n54100\\nBiopsy of penis; (separate procedure)\\n$ 266.40\\n54105\\n54105\\nBiopsy of penis; deep structures\\n$ 447.30\\n54110\\n54110\\nExcision of penile plaque (Peyronie disease);\\n$ 1,395.90\\n54111\\n54111\\nExcision of penile plaque (Peyronie disease); with graft to 5 cm in\\nlength\\n$ 2,362.50\\n54112\\n54112\\nExcision of penile plaque (Peyronie disease); with graft greater than\\n5 cm in length\\n$ 2,682.90\\n54115\\n54115\\nRemoval foreign body from deep penile tissue (eg, plastic implant)\\n$ 1,062.00\\n54120\\n54120\\nAmputation of penis; partial\\n$ 2,043.00\\n54125\\n54125\\nAmputation of penis; complete\\n$ 2,709.00\\n54130\\n54130\\nAmputation of penis, radical; with bilateral inguinofemoral\\nlymphadenectomy\\n$ 3,754.80\\n54135\\n54135\\nAmputation of penis, radical; in continuity with bilateral pelvic\\nlymphadenectomy, including external iliac, hypogastric and\\nobturator nodes\\n$ 4,963.50\\n54150\\n54150\\nCircumcision, using clamp or other device with regional dorsal\\npenile or ring block\\n$ 272.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n255\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n256\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n54160\\n54160\\nCircumcision, surgical excision other than clamp, device, or dorsal\\nslit; neonate (28 days of age or less)\\n$ 403.94\\n54161\\n54161\\nCircumcision, surgical excision other than clamp, device, or dorsal\\nslit; older than 28 days of age\\n$ 860.79\\n54162\\n54162\\nLysis or excision of penile post-circumcision adhesions\\n$ 426.82\\n54163\\n54163\\nRepair incomplete circumcision\\n$ 415.19\\n54164\\n54164\\nFrenulotomy of penis\\n$ 409.15\\n54200\\n54200\\nInjection procedure for Peyronie disease;\\n$ 129.60\\n54205\\n54205\\nInjection procedure for Peyronie disease; with surgical exposure of\\nplaque\\n$ 1,035.00\\n54220\\n54220\\nIrrigation of corpora cavernosa for priapism\\n$ 500.40\\n54230\\n54230\\nInjection procedure for corpora cavernosography\\n$ 298.80\\n54231\\n54231\\nDynamic cavernosometry, including intracavernosal injection of\\nvasoactive drugs (eg, papaverine, phentolamine)\\n$ 468.90\\n54235\\n54235\\nInjection of corpora cavernosa with pharmacologic agent(s) (eg,\\npapaverine, phentolamine)\\n$ 206.10\\n54240\\n54240\\nPenile plethysmography\\n$ 298.80\\n54240-26 26\\n54240\\nPenile plethysmography\\n$ 250.20\\n54240-TC TC\\n54240\\nPenile plethysmography\\n$ 114.40\\n54250\\n54250\\nNocturnal penile tumescence and\/or rigidity test\\n$ 354.60\\n54250-26 26\\n54250\\nNocturnal penile tumescence and\/or rigidity test\\n$ 300.60\\n54250-TC TC\\n54250\\nNocturnal penile tumescence and\/or rigidity test\\n$ 36.49\\n54300\\n54300\\nPlastic operation of penis for straightening of chordee (eg,\\nhypospadias), with or without mobilization of urethra\\n$ 1,865.70\\n54304\\n54304\\nPlastic operation on penis for correction of chordee or for first stage\\nhypospadias repair with or without transplantation of prepuce\\nand\/or skin flaps\\n$ 2,242.80\\n54308\\n54308\\nUrethroplasty for second stage hypospadias repair (including\\nurinary diversion); less than 3 cm\\n$ 2,268.00\\n54312\\n54312\\nUrethroplasty for second stage hypospadias repair (including\\nurinary diversion); greater than 3 cm\\n$ 2,523.60\\n54316\\n54316\\nUrethroplasty for second stage hypospadias repair (including\\nurinary diversion) with free skin graft obtained from site other than\\ngenitalia\\n$ 3,016.80\\n54318\\n54318\\nUrethroplasty for third stage hypospadias repair to release penis\\nfrom scrotum (eg, third stage Cecil repair)\\n$ 1,798.20\\n54322\\n54322\\n1-stage distal hypospadias repair (with or without chordee or\\ncircumcision); with simple meatal advancement (eg, Magpi, V-flap)\\n$ 2,155.50\\n54324\\n54324\\n1-stage distal hypospadias repair (with or without chordee or\\ncircumcision); with urethroplasty by local skin flaps (eg, flip-flap,\\nprepucial flap)\\n$ 2,382.30\\n54326\\n54326\\n1-stage distal hypospadias repair (with or without chordee or\\ncircumcision); with urethroplasty by local skin flaps and mobilization\\nof urethra\\n$ 2,894.40\\n54328\\n54328\\n1-stage distal hypospadias repair (with or without chordee or\\ncircumcision); with extensive dissection to correct chordee and\\nurethroplasty with local skin flaps, skin graft patch, and\/or island\\nflap\\n$ 3,250.80\\n54332\\n54332\\n1-stage proximal penile or penoscrotal hypospadias repair requiring\\nextensive dissection to correct chordee and urethroplasty by use of\\nskin graft tube and\/or island flap\\n$ 3,355.20\\n54336\\n54336\\n1-stage perineal hypospadias repair requiring extensive dissection\\nto correct chordee and urethroplasty by use of skin graft tube\\nand\/or island flap\\n$ 3,821.40\\n54340\\n54340\\nRepair of hypospadias complications (ie, fistula, stricture,\\ndiverticula); by closure, incision, or excision, simple\\n$ 1,658.70\\n54344\\n54344\\nRepair of hypospadias complications (ie, fistula, stricture,\\ndiverticula); requiring mobilization of skin flaps and urethroplasty\\nwith flap or patch graft\\n$ 2,642.40\\n54348\\n54348\\nRepair of hypospadias complications (ie, fistula, stricture,\\ndiverticula); requiring extensive dissection and urethroplasty with\\nflap, patch or tubed graft (includes urinary diversion)\\n$ 2,793.60\\n54352\\n54352\\nRepair of hypospadias cripple requiring extensive dissection and\\nexcision of previously constructed structures including re-release of\\nchordee and reconstruction of urethra and penis by use of local skin\\nas grafts and island flaps and skin brought in as f\\n$ 4,481.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n257\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n258\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n54360\\n54360\\nPlastic operation on penis to correct angulation\\n$ 2,171.70\\n54380\\n54380\\nPlastic operation on penis for epispadias distal to external sphincter; $ 1,931.40\\n54385\\n54385\\nPlastic operation on penis for epispadias distal to external sphincter;\\nwith incontinence\\n$ 2,791.80\\n54390\\n54390\\nPlastic operation on penis for epispadias distal to external sphincter;\\nwith exstrophy of bladder\\n$ 3,728.70\\n54400\\n54400\\nInsertion of penile prosthesis; non-inflatable (semi-rigid)\\n$ 2,731.50\\n54401\\n54401\\nInsertion of penile prosthesis; inflatable (self-contained)\\n$ 3,038.40\\n54405\\n54405\\nInsertion of multi-component, inflatable penile prosthesis, including\\nplacement of pump, cylinders, and reservoir\\n$ 4,616.10\\n54406\\n54406\\nRemoval of all components of a multi-component, inflatable penile\\nprosthesis without replacement of prosthesis\\n$ 1,880.16\\n54408\\n54408\\nRepair of component(s) of a multi-component, inflatable penile\\nprosthesis\\n$ 1,921.58\\n54410\\n54410\\nRemoval and replacement of all component(s) of a multi-\\ncomponent, inflatable penile prosthesis at the same operative\\nsession\\n$ 2,100.99\\n54411\\n54411\\nRemoval and replacement of all components of a multi-component\\ninflatable penile prosthesis through an infected field at the same\\noperative session, including irrigation and debridement of infected\\ntissue\\n$ 2,627.25\\n54415\\n54415\\nRemoval of non-inflatable (semi-rigid) or inflatable (self-contained)\\npenile prosthesis, without replacement of prosthesis\\n$ 1,371.75\\n54416\\n54416\\nRemoval and replacement of non-inflatable (semi-rigid) or inflatable\\n(self-contained) penile prosthesis at the same operative session\\n$ 1,604.70\\n54417\\n54417\\nRemoval and replacement of non-inflatable (semi-rigid) or inflatable\\n(self-contained) penile prosthesis through an infected field at the\\nsame operative session, including irrigation and debridement of\\ninfected tissue\\n$ 2,244.96\\n54420\\n54420\\nCorpora cavernosa-saphenous vein shunt (priapism operation),\\nunilateral or bilateral\\n$ 2,497.50\\n54430\\n54430\\nCorpora cavernosa-corpus spongiosum shunt (priapism operation),\\nunilateral or bilateral\\n$ 2,107.80\\n54435\\n54435\\nCorpora cavernosa-glans penis fistulization (eg, biopsy needle,\\nWinter procedure, rongeur, or punch) for priapism\\n$ 1,043.10\\n54440\\n54440\\nPlastic operation of penis for injury\\n$ 2,582.10\\n54450\\n54450\\nForeskin manipulation including lysis of preputial adhesions and\\nstretching\\n$ 306.90\\n54500\\n54500\\nBiopsy of testis, needle (separate procedure)\\n$ 216.90\\n54505\\n54505\\nBiopsy of testis, incisional (separate procedure)\\n$ 644.40\\n54512\\n54512\\nExcision of extraparenchymal lesion of testis\\n$ 1,581.30\\n54520\\n54520\\nOrchiectomy, simple (including subcapsular), with or without\\ntesticular prosthesis, scrotal or inguinal approach\\n$ 1,175.40\\n54522\\n54522\\nOrchiectomy, partial\\n$ 1,944.00\\n54530\\n54530\\nOrchiectomy, radical, for tumor; inguinal approach\\n$ 1,833.30\\n54535\\n54535\\nOrchiectomy, radical, for tumor; with abdominal exploration\\n$ 2,160.00\\n54550\\n54550\\nExploration for undescended testis (inguinal or scrotal area)\\n$ 1,594.80\\n54560\\n54560\\nExploration for undescended testis with abdominal exploration\\n$ 1,918.80\\n54600\\n54600\\nReduction of torsion of testis, surgical, with or without fixation of\\ncontralateral testis\\n$ 1,393.65\\n54620\\n54620\\nFixation of contralateral testis (separate procedure)\\n$ 835.20\\n54640\\n54640\\nOrchiopexy, inguinal approach, with or without hernia repair\\n$ 1,790.10\\n54650\\n54650\\nOrchiopexy, abdominal approach, for intra-abdominal testis (eg,\\nFowler-Stephens)\\n$ 2,026.80\\n54660\\n54660\\nInsertion of testicular prosthesis (separate procedure)\\n$ 810.90\\n54670\\n54670\\nSuture or repair of testicular injury\\n$ 1,364.40\\n54680\\n54680\\nTransplantation of testis(es) to thigh (because of scrotal\\ndestruction)\\n$ 1,658.70\\n54690\\n54690\\nLaparoscopy, surgical; orchiectomy\\n$ 1,737.90\\n54692\\n54692\\nLaparoscopy, surgical; orchiopexy for intra-abdominal testis\\n$ 1,801.80\\n54699\\n54699\\nUnlisted laparoscopy procedure, testis\\nCost\\n54700\\n54700\\nIncision and drainage of epididymis, testis and\/or scrotal space (eg,\\nabscess or hematoma)\\n$ 458.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n259\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n260\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n54800\\n54800\\nBiopsy of epididymis, needle\\n$ 265.50\\n54830\\n54830\\nExcision of local lesion of epididymis\\n$ 927.90\\n54840\\n54840\\nExcision of spermatocele, with or without epididymectomy\\n$ 1,296.00\\n54860\\n54860\\nEpididymectomy; unilateral\\n$ 1,228.50\\n54861\\n54861\\nEpididymectomy; bilateral\\n$ 1,728.00\\n54865\\n54865\\nExploration of epididymis, with or without biopsy\\n$ 355.87\\n54900\\n54900\\nEpididymovasostomy, anastomosis of epididymis to vas deferens;\\nunilateral\\n$ 2,325.60\\n54901\\n54901\\nEpididymovasostomy, anastomosis of epididymis to vas deferens;\\nbilateral\\n$ 3,038.40\\n55000\\n55000\\nPuncture aspiration of hydrocele, tunica vaginalis, with or without\\ninjection of medication\\n$ 195.30\\n55040\\n55040\\nExcision of hydrocele; unilateral\\n$ 1,405.80\\n55041\\n55041\\nExcision of hydrocele; bilateral\\n$ 2,132.10\\n55060\\n55060\\nRepair of tunica vaginalis hydrocele (Bottle type)\\n$ 1,287.90\\n55100\\n55100\\nDrainage of scrotal wall abscess\\n$ 311.40\\n55110\\n55110\\nScrotal exploration\\n$ 1,147.50\\n55120\\n55120\\nRemoval of foreign body in scrotum\\n$ 633.60\\n55150\\n55150\\nResection of scrotum\\n$ 1,387.80\\n55175\\n55175\\nScrotoplasty; simple\\n$ 1,220.40\\n55180\\n55180\\nScrotoplasty; complicated\\n$ 2,162.70\\n55200\\n55200\\nVasotomy, cannulization with or without incision of vas, unilateral\\nor bilateral (separate procedure)\\n$ 648.90\\n55250\\n55250\\nVasectomy, unilateral or bilateral (separate procedure), including\\npostoperative semen examination(s)\\n$ 699.30\\n55300\\n55300\\nVasotomy for vasograms, seminal vesiculograms, or\\nepididymograms, unilateral or bilateral\\n$ 647.10\\n55400\\n55400\\nVasovasostomy, vasovasorrhaphy\\n$ 2,832.30\\n55450\\n55450\\nLigation (percutaneous) of vas deferens, unilateral or bilateral\\n(separate procedure)\\n$ 628.20\\n55500\\n55500\\nExcision of hydrocele of spermatic cord, unilateral (separate\\nprocedure)\\n$ 1,228.50\\n55520\\n55520\\nExcision of lesion of spermatic cord (separate procedure)\\n$ 1,085.40\\n55530\\n55530\\nExcision of varicocele or ligation of spermatic veins for varicocele;\\n(separate procedure)\\n$ 1,527.30\\n55535\\n55535\\nExcision of varicocele or ligation of spermatic veins for varicocele;\\nabdominal approach\\n$ 1,635.30\\n55540\\n55540\\nExcision of varicocele or ligation of spermatic veins for varicocele;\\nwith hernia repair\\n$ 1,801.80\\n55550\\n55550\\nLaparoscopy, surgical, with ligation of spermatic veins for varicocele\\n$ 1,717.20\\n55559\\n55559\\nUnlisted laparoscopy procedure, spermatic cord\\nCost\\n55600\\n55600\\nVesiculotomy;\\n$ 1,231.20\\n55605\\n55605\\nVesiculotomy; complicated\\n$ 1,653.30\\n55650\\n55650\\nVesiculectomy, any approach\\n$ 2,868.30\\n55680\\n55680\\nExcision of Mullerian duct cyst\\n$ 2,533.50\\n55700\\n55700\\nBiopsy, prostate; needle or punch, single or multiple, any approach\\n$ 395.58\\n55705\\n55705\\nBiopsy, prostate; incisional, any approach\\n$ 1,171.80\\n55706\\n55706\\nBiopsies, prostate, needle, transperineal, stereotactic template\\nguided saturation sampling, including imaging guidance\\n$ 1,380.90\\n55720\\n55720\\nProstatotomy, external drainage of prostatic abscess, any approach;\\nsimple\\n$ 1,424.70\\n55725\\n55725\\nProstatotomy, external drainage of prostatic abscess, any approach;\\ncomplicated\\n$ 1,768.50\\n55801\\n55801\\nProstatectomy, perineal, subtotal (including control of\\npostoperative bleeding, vasectomy, meatotomy, urethral calibration\\nand\/or dilation, and internal urethrotomy)\\n$ 2,970.00\\n55810\\n55810\\nProstatectomy, perineal radical;\\n$ 3,842.10\\n55812\\n55812\\nProstatectomy, perineal radical; with lymph node biopsy(s) (limited\\npelvic lymphadenectomy)\\n$ 4,482.00\\n55815\\n55815\\nProstatectomy, perineal radical; with bilateral pelvic\\nlymphadenectomy, including external iliac, hypogastric and\\nobturator nodes\\n$ 6,071.40\\n55821\\n55821\\nProstatectomy (including control of postoperative bleeding,\\nvasectomy, meatotomy, urethral calibration and\/or dilation, and\\ninternal urethrotomy); suprapubic, subtotal, 1 or 2 stages\\n$ 3,183.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n261\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n262\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n55831\\n55831\\nProstatectomy (including control of postoperative bleeding,\\nvasectomy, meatotomy, urethral calibration and\/or dilation, and\\ninternal urethrotomy); retropubic, subtotal\\n$ 3,345.30\\n55840\\n55840\\nProstatectomy, retropubic radical, with or without nerve sparing;\\n$ 3,969.90\\n55842\\n55842\\nProstatectomy, retropubic radical, with or without nerve sparing;\\nwith lymph node biopsy(s) (limited pelvic lymphadenectomy)\\n$ 4,228.20\\n55845\\n55845\\nProstatectomy, retropubic radical, with or without nerve sparing;\\nwith bilateral pelvic lymphadenectomy, including external iliac,\\nhypogastric, and obturator nodes\\n$ 5,271.39\\n55860\\n55860\\nExposure of prostate, any approach, for insertion of radioactive\\nsubstance;\\n$ 2,182.50\\n55862\\n55862\\nExposure of prostate, any approach, for insertion of radioactive\\nsubstance; with lymph node biopsy(s) (limited pelvic\\nlymphadenectomy)\\n$ 3,091.50\\n55865\\n55865\\nExposure of prostate, any approach, for insertion of radioactive\\nsubstance; with bilateral pelvic lymphadenectomy, including\\nexternal iliac, hypogastric and obturator nodes\\n$ 3,793.50\\n55866\\n55866\\nLaparoscopy, surgical prostatectomy, retropubic radical, including\\nnerve sparing, includes robotic assistance, when performed\\n$ 4,611.87\\n55870\\n55870\\nElectroejaculation\\n$ 236.70\\n55873\\n55873\\nCryosurgical ablation of the prostate (includes ultrasonic guidance\\nand monitoring)\\n$ 2,685.60\\n55875\\n55875\\nTransperineal placement of needles or catheters into prostate for\\ninterstitial radioelement application, with or without cystoscopy\\n$ 1,796.65\\n55876\\n55876\\nPlacement of interstitial device(s) for radiation therapy guidance\\n(eg, fiducial markers, dosimeter), prostate (via needle, any\\napproach), single or multiple\\n$ 323.66\\n55899\\n55899\\nUnlisted procedure, male genital system\\nCost\\n55920\\n55920\\nPlacement of needles or catheters into pelvic organs and\/or\\ngenitalia (except prostate) for subsequent interstitial radioelement\\napplication\\n$ 1,072.06\\n55970\\n55970\\nIntersex surgery; male to female\\n$ -\\n55980\\n55980\\nIntersex surgery; female to male\\n$ -\\n56405\\n56405\\nIncision and drainage of vulva or perineal abscess\\n$ 259.20\\n56420\\n56420\\nIncision and drainage of Bartholin's gland abscess\\n$ 243.90\\n56440\\n56440\\nMarsupialization of Bartholin's gland cyst\\n$ 718.20\\n56441\\n56441\\nLysis of labial adhesions\\n$ 456.30\\n56442\\n56442\\nHymenotomy, simple incision\\n$ 126.23\\n56501\\n56501\\nDestruction of lesion(s), vulva; simple (eg, laser surgery,\\nelectrosurgery, cryosurgery, chemosurgery)\\n$ 259.47\\n56515\\n56515\\nDestruction of lesion(s), vulva; extensive (eg, laser surgery,\\nelectrosurgery, cryosurgery, chemosurgery)\\n$ 850.10\\n56605\\n56605\\nBiopsy of vulva or perineum (separate procedure); 1 lesion\\n$ 199.48\\n56606\\n56606\\nBiopsy of vulva or perineum (separate procedure); each separate\\nadditional lesion (List separately in addition to code for primary\\nprocedure)\\n$ 102.60\\n56620\\n56620\\nVulvectomy simple; partial\\n$ 2,186.10\\n56625\\n56625\\nVulvectomy simple; complete\\n$ 2,652.30\\n56630\\n56630\\nVulvectomy, radical, partial;\\n$ 3,249.90\\n56631\\n56631\\nVulvectomy, radical, partial; with unilateral inguinofemoral\\nlymphadenectomy\\n$ 4,042.80\\n56632\\n56632\\nVulvectomy, radical, partial; with bilateral inguinofemoral\\nlymphadenectomy\\n$ 4,846.50\\n56633\\n56633\\nVulvectomy, radical, complete;\\n$ 4,097.70\\n56634\\n56634\\nVulvectomy, radical, complete; with unilateral inguinofemoral\\nlymphadenectomy\\n$ 4,748.40\\n56637\\n56637\\nVulvectomy, radical, complete; with bilateral inguinofemoral\\nlymphadenectomy\\n$ 5,682.60\\n56640\\n56640\\nVulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic\\nlymphadenectomy\\n$ 5,745.60\\n56700\\n56700\\nPartial hymenectomy or revision of hymenal ring\\n$ 637.20\\n56740\\n56740\\nExcision of Bartholin's gland or cyst\\n$ 920.70\\n56800\\n56800\\nPlastic repair of introitus\\n$ 898.20\\n56805\\n56805\\nClitoroplasty for intersex state\\n$ 2,296.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n263\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n264\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n56810\\n56810\\nPerineoplasty, repair of perineum, nonobstetrical (separate\\nprocedure)\\n$ 1,035.90\\n56820\\n56820\\nColposcopy of the vulva;\\n$ 198.44\\n56821\\n56821\\nColposcopy of the vulva; with biopsy(s)\\n$ 293.12\\n57000\\n57000\\nColpotomy; with exploration\\n$ 914.40\\n57010\\n57010\\nColpotomy; with drainage of pelvic abscess\\n$ 1,030.50\\n57020\\n57020\\nColpocentesis (separate procedure)\\n$ 249.30\\n57022\\n57022\\nIncision and drainage of vaginal hematoma; obstetrical\/postpartum\\n$ 398.70\\n57023\\n57023\\nIncision and drainage of vaginal hematoma; non-obstetrical (eg,\\npost-trauma, spontaneous bleeding)\\n$ 398.70\\n57061\\n57061\\nDestruction of vaginal lesion(s); simple (eg, laser surgery,\\nelectrosurgery, cryosurgery, chemosurgery)\\n$ 442.80\\n57065\\n57065\\nDestruction of vaginal lesion(s); extensive (eg, laser surgery,\\nelectrosurgery, cryosurgery, chemosurgery)\\n$ 1,008.47\\n57100\\n57100\\nBiopsy of vaginal mucosa; simple (separate procedure)\\n$ 232.20\\n57105\\n57105\\nBiopsy of vaginal mucosa; extensive, requiring suture (including\\ncysts)\\n$ 724.50\\n57106\\n57106\\nVaginectomy, partial removal of vaginal wall;\\n$ 1,195.20\\n57107\\n57107\\nVaginectomy, partial removal of vaginal wall; with removal of\\nparavaginal tissue (radical vaginectomy)\\n$ 3,107.70\\n57109\\n57109\\nVaginectomy, partial removal of vaginal wall; with removal of\\nparavaginal tissue (radical vaginectomy) with bilateral total pelvic\\nlymphadenectomy and para-aortic lymph node sampling (biopsy)\\n$ 3,578.40\\n57110\\n57110\\nVaginectomy, complete removal of vaginal wall;\\n$ 2,316.60\\n57111\\n57111\\nVaginectomy, complete removal of vaginal wall; with removal of\\nparavaginal tissue (radical vaginectomy)\\n$ 3,666.60\\n57112\\n57112\\nVaginectomy, complete removal of vaginal wall; with removal of\\nparavaginal tissue (radical vaginectomy) with bilateral total pelvic\\nlymphadenectomy and para-aortic lymph node sampling (biopsy)\\n$ 3,849.30\\n57120\\n57120\\nColpocleisis (Le Fort type)\\n$ 2,274.30\\n57130\\n57130\\nExcision of vaginal septum\\n$ 940.50\\n57135\\n57135\\nExcision of vaginal cyst or tumor\\n$ 710.87\\n57150\\n57150\\nIrrigation of vagina and\/or application of medicament for treatment\\nof bacterial, parasitic, or fungoid disease\\n$ 100.80\\n57155\\n57155\\nInsertion of uterine tandem and\/or vaginal ovoids for clinical\\nbrachytherapy\\n$ 1,064.04\\n57160\\n57160\\nFitting and insertion of pessary or other intravaginal support device\\n$ 113.40\\n57170\\n57170\\nDiaphragm or cervical cap fitting with instructions\\n$ 99.00\\n57180\\n57180\\nIntroduction of any hemostatic agent or pack for spontaneous or\\ntraumatic nonobstetrical vaginal hemorrhage (separate procedure)\\n$ 322.20\\n57200\\n57200\\nColporrhaphy, suture of injury of vagina (nonobstetrical)\\n$ 978.30\\n57210\\n57210\\nColpoperineorrhaphy, suture of injury of vagina and\/or perineum\\n(nonobstetrical)\\n$ 1,352.70\\n57220\\n57220\\nPlastic operation on urethral sphincter, vaginal approach (eg, Kelly\\nurethral plication)\\n$ 1,349.10\\n57230\\n57230\\nPlastic repair of urethrocele\\n$ 1,215.90\\n57240\\n57240\\nAnterior colporrhaphy, repair of cystocele with or without repair of\\nurethrocele\\n$ 1,586.70\\n57250\\n57250\\nPosterior colporrhaphy, repair of rectocele with or without\\nperineorrhaphy\\n$ 1,559.70\\n57260\\n57260\\nCombined anteroposterior colporrhaphy;\\n$ 2,090.70\\n57265\\n57265\\nCombined anteroposterior colporrhaphy; with enterocele repair\\n$ 2,418.62\\n57267\\n57267\\nInsertion of mesh or other prosthesis for repair of pelvic floor\\ndefect, each site (anterior, posterior compartment), vaginal\\napproach (List separately in addition to code for primary procedure) $ 693.09\\n57268\\n57268\\nRepair of enterocele, vaginal approach (separate procedure)\\n$ 1,725.30\\n57270\\n57270\\nRepair of enterocele, abdominal approach (separate procedure)\\n$ 2,124.90\\n57280\\n57280\\nColpopexy, abdominal approach\\n$ 2,472.30\\n57282\\n57282\\nColpopexy, vaginal; extra-peritoneal approach (sacrospinous,\\niliococcygeus)\\n$ 2,729.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n265\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n266\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n57283\\n57283\\nColpopexy, vaginal; intra-peritoneal approach (uterosacral, levator\\nmyorrhaphy)\\n$ 1,612.15\\n57284\\n57284\\nParavaginal defect repair (including repair of cystocele, if\\nperformed); open abdominal approach\\n$ 2,523.60\\n57287\\n57287\\nRemoval or revision of sling for stress incontinence (eg, fascia or\\nsynthetic)\\n$ 2,081.70\\n57288\\n57288\\nSling operation for stress incontinence (eg, fascia or synthetic)\\n$ 2,816.10\\n57289\\n57289\\nPereyra procedure, including anterior colporrhaphy\\n$ 2,429.10\\n57291\\n57291\\nConstruction of artificial vagina; without graft\\n$ 3,295.80\\n57292\\n57292\\nConstruction of artificial vagina; with graft\\n$ 3,924.90\\n57295\\n57295\\nRevision (including removal) of prosthetic vaginal graft; vaginal\\napproach\\n$ 1,167.58\\n57296\\n57296\\nRevision (including removal) of prosthetic vaginal graft; open\\nabdominal approach\\n$ 2,490.17\\n57300\\n57300\\nClosure of rectovaginal fistula; vaginal or transanal approach\\n$ 1,933.20\\n57305\\n57305\\nClosure of rectovaginal fistula; abdominal approach\\n$ 2,477.70\\n57307\\n57307\\nClosure of rectovaginal fistula; abdominal approach, with\\nconcomitant colostomy\\n$ 2,581.20\\n57308\\n57308\\nClosure of rectovaginal fistula; transperineal approach, with\\nperineal body reconstruction, with or without levator plication\\n$ 2,317.50\\n57310\\n57310\\nClosure of urethrovaginal fistula;\\n$ 2,374.20\\n57311\\n57311\\nClosure of urethrovaginal fistula; with bulbocavernosus transplant\\n$ 2,729.70\\n57320\\n57320\\nClosure of vesicovaginal fistula; vaginal approach\\n$ 2,652.30\\n57330\\n57330\\nClosure of vesicovaginal fistula; transvesical and vaginal approach\\n$ 2,680.20\\n57335\\n57335\\nVaginoplasty for intersex state\\n$ 3,069.90\\n57400\\n57400\\nDilation of vagina under anesthesia (other than local)\\n$ 370.80\\n57410\\n57410\\nPelvic examination under anesthesia (other than local)\\n$ 318.60\\n57415\\n57415\\nRemoval of impacted vaginal foreign body (separate procedure)\\nunder anesthesia (other than local)\\n$ 415.80\\n57420\\n57420\\nColposcopy of the entire vagina, with cervix if present;\\n$ 238.08\\n57421\\n57421\\nColposcopy of the entire vagina, with cervix if present; with\\nbiopsy(s) of vagina\/cervix\\n$ 339.81\\n57423\\n57423\\nParavaginal defect repair (including repair of cystocele, if\\nperformed), laparoscopic approach\\n$ 2,061.99\\n57425\\n57425\\nLaparoscopy, surgical, colpopexy (suspension of vaginal apex)\\n$ 2,099.02\\n57426\\n57426\\nRevision (including removal) of prosthetic vaginal graft, laparoscopic\\napproach\\n$ 1,885.00\\n57452\\n57452\\nColposcopy of the cervix including upper\/adjacent vagina;\\n$ 242.93\\n57454\\n57454\\nColposcopy of the cervix including upper\/adjacent vagina; with\\nbiopsy(s) of the cervix and endocervical curettage\\n$ 343.46\\n57455\\n57455\\nColposcopy of the cervix including upper\/adjacent vagina; with\\nbiopsy(s) of the cervix\\n$ 169.72\\n57456\\n57456\\nColposcopy of the cervix including upper\/adjacent vagina; with\\nendocervical curettage\\n$ 187.31\\n57460\\n57460\\nColposcopy of the cervix including upper\/adjacent vagina; with loop\\nelectrode biopsy(s) of the cervix\\n$ 953.23\\n57461\\n57461\\nColposcopy of the cervix including upper\/adjacent vagina; with loop\\nelectrode conization of the cervix\\n$ 893.18\\n57500\\n57500\\nBiopsy of cervix, single or multiple, or local excision of lesion, with\\nor without fulguration (separate procedure)\\n$ 251.05\\n57505\\n57505\\nEndocervical curettage (not done as part of a dilation and\\ncurettage)\\n$ 221.40\\n57510\\n57510\\nCautery of cervix; electro or thermal\\n$ 308.03\\n57511\\n57511\\nCautery of cervix; cryocautery, initial or repeat\\n$ 287.10\\n57513\\n57513\\nCautery of cervix; laser ablation\\n$ 1,030.50\\n57520\\n57520\\nConization of cervix, with or without fulguration, with or without\\ndilation and curettage, with or without repair; cold knife or laser\\n$ 1,079.10\\n57522\\n57522\\nConization of cervix, with or without fulguration, with or without\\ndilation and curettage, with or without repair; loop electrode\\nexcision\\n$ 1,080.48\\n57530\\n57530\\nTrachelectomy (cervicectomy), amputation of cervix (separate\\nprocedure)\\n$ 979.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n267\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n268\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n57531\\n57531\\nRadical trachelectomy, with bilateral total pelvic lymphadenectomy\\nand para-aortic lymph node sampling biopsy, with or without\\nremoval of tube(s), with or without removal of ovary(s)\\n$ 4,499.10\\n57540\\n57540\\nExcision of cervical stump, abdominal approach;\\n$ 2,022.30\\n57545\\n57545\\nExcision of cervical stump, abdominal approach; with pelvic floor\\nrepair\\n$ 2,276.10\\n57550\\n57550\\nExcision of cervical stump, vaginal approach;\\n$ 1,606.50\\n57555\\n57555\\nExcision of cervical stump, vaginal approach; with anterior and\/or\\nposterior repair\\n$ 2,096.10\\n57556\\n57556\\nExcision of cervical stump, vaginal approach; with repair of\\nenterocele\\n$ 2,295.90\\n57558\\n57558\\nDilation and curettage of cervical stump\\n$ 286.85\\n57700\\n57700\\nCerclage of uterine cervix, nonobstetrical\\n$ 1,133.10\\n57720\\n57720\\nTrachelorrhaphy, plastic repair of uterine cervix, vaginal approach\\n$ 1,098.90\\n57800\\n57800\\nDilation of cervical canal, instrumental (separate procedure)\\n$ 262.80\\n58100\\n58100\\nEndometrial sampling (biopsy) with or without endocervical\\nsampling (biopsy), without cervical dilation, any method (separate\\nprocedure)\\n$ 266.06\\n58110\\n58110\\nEndometrial sampling (biopsy) performed in conjunction with\\ncolposcopy (List separately in addition to code for primary\\nprocedure)\\n$ 146.06\\n58120\\n58120\\nDilation and curettage, diagnostic and\/or therapeutic\\n(nonobstetrical)\\n$ 903.20\\n58140\\n58140\\nMyomectomy, excision of fibroid tumor(s) of uterus, 1 to 4\\nintramural myoma(s) with total weight of 250 g or less and\/or\\nremoval of surface myomas; abdominal approach\\n$ 2,851.59\\n58145\\n58145\\nMyomectomy, excision of fibroid tumor(s) of uterus, 1 to 4\\nintramural myoma(s) with total weight of 250 g or less and\/or\\nremoval of surface myomas; vaginal approach\\n$ 2,299.50\\n58146\\n58146\\nMyomectomy, excision of fibroid tumor(s) of uterus, 5 or more\\nintramural myomas and\/or intramural myomas with total weight\\ngreater than 250 g, abdominal approach\\n$ 2,845.00\\n58150\\n58150\\nTotal abdominal hysterectomy (corpus and cervix), with or without\\nremoval of tube(s), with or without removal of ovary(s);\\n$ 3,175.21\\n58152\\n58152\\nTotal abdominal hysterectomy (corpus and cervix), with or without\\nremoval of tube(s), with or without removal of ovary(s); with colpo-\\nurethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)\\n$ 3,904.20\\n58180\\n58180\\nSupracervical abdominal hysterectomy (subtotal hysterectomy),\\nwith or without removal of tube(s), with or without removal of\\novary(s)\\n$ 3,280.50\\n58200\\n58200\\nTotal abdominal hysterectomy, including partial vaginectomy, with\\npara-aortic and pelvic lymph node sampling, with or without\\nremoval of tube(s), with or without removal of ovary(s)\\n$ 3,940.20\\n58210\\n58210\\nRadical abdominal hysterectomy, with bilateral total pelvic\\nlymphadenectomy and para-aortic lymph node sampling (biopsy),\\nwith or without removal of tube(s), with or without removal of\\novary(s)\\n$ 6,048.90\\n58240\\n58240\\nPelvic exenteration for gynecologic malignancy, with total\\nabdominal hysterectomy or cervicectomy, with or without removal\\nof tube(s), with or without removal of ovary(s), with removal of\\nbladder and ureteral transplantations, and\/or abdominoperineal\\nrese\\n$ 8,435.70\\n58260\\n58260\\nVaginal hysterectomy, for uterus 250 g or less;\\n$ 3,085.20\\n58262\\n58262\\nVaginal hysterectomy, for uterus 250 g or less; with removal of\\ntube(s), and\/or ovary(s)\\n$ 3,554.10\\n58263\\n58263\\nVaginal hysterectomy, for uterus 250 g or less; with removal of\\ntube(s), and\/or ovary(s), with repair of enterocele\\n$ 3,879.90\\n58267\\n58267\\nVaginal hysterectomy, for uterus 250 g or less; with colpo-\\nurethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type)\\nwith or without endoscopic control\\n$ 3,544.20\\n58270\\n58270\\nVaginal hysterectomy, for uterus 250 g or less; with repair of\\nenterocele\\n$ 3,762.90\\n58275\\n58275\\nVaginal hysterectomy, with total or partial vaginectomy;\\n$ 3,759.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n269\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n270\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n58280\\n58280\\nVaginal hysterectomy, with total or partial vaginectomy; with repair\\nof enterocele\\n$ 3,493.80\\n58285\\n58285\\nVaginal hysterectomy, radical (Schauta type operation)\\n$ 3,948.30\\n58290\\n58290\\nVaginal hysterectomy, for uterus greater than 250 g;\\n$ 3,249.20\\n58291\\n58291\\nVaginal hysterectomy, for uterus greater than 250 g; with removal\\nof tube(s) and\/or ovary(s)\\n$ 3,588.32\\n58292\\n58292\\nVaginal hysterectomy, for uterus greater than 250 g; with removal\\nof tube(s) and\/or ovary(s), with repair of enterocele\\n$ 3,867.52\\n58293\\n58293\\nVaginal hysterectomy, for uterus greater than 250 g; with colpo-\\nurethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type)\\nwith or without endoscopic control\\n$ 4,011.49\\n58294\\n58294\\nVaginal hysterectomy, for uterus greater than 250 g; with repair of\\nenterocele\\n$ 3,502.18\\n58300\\n58300\\nInsertion of intrauterine device (IUD)\\n$ 308.70\\n58301\\n58301\\nRemoval of intrauterine device (IUD)\\n$ 124.20\\n58321\\n58321\\nArtificial insemination; intra-cervical\\n$ 183.60\\n58322\\n58322\\nArtificial insemination; intra-uterine\\n$ 226.80\\n58323\\n58323\\nSperm washing for artificial insemination\\n$ 200.70\\n58340\\n58340\\nCatheterization and introduction of saline or contrast material for\\nsaline infusion sonohysterography (SIS) or hysterosalpingography\\n$ 279.39\\n58345\\n58345\\nTranscervical introduction of fallopian tube catheter for diagnosis\\nand\/or re-establishing patency (any method), with or without\\nhysterosalpingography\\n$ 1,163.70\\n58346\\n58346\\nInsertion of Heyman capsules for clinical brachytherapy\\n$ 1,416.42\\n58350\\n58350\\nChromotubation of oviduct, including materials\\n$ 360.90\\n58353\\n58353\\nEndometrial ablation, thermal, without hysteroscopic guidance\\n$ 681.30\\n58356\\n58356\\nEndometrial cryoablation with ultrasonic guidance, including\\nendometrial curettage, when performed\\n$ 2,930.73\\n58400\\n58400\\nUterine suspension, with or without shortening of round ligaments,\\nwith or without shortening of sacrouterine ligaments; (separate\\nprocedure)\\n$ 1,903.50\\n58410\\n58410\\nUterine suspension, with or without shortening of round ligaments,\\nwith or without shortening of sacrouterine ligaments; with\\npresacral sympathectomy\\n$ 2,566.80\\n58520\\n58520\\nHysterorrhaphy, repair of ruptured uterus (nonobstetrical)\\n$ 1,658.70\\n58540\\n58540\\nHysteroplasty, repair of uterine anomaly (Strassman type)\\n$ 2,497.50\\n58541\\n58541\\nLaparoscopy, surgical, supracervical hysterectomy, for uterus 250 g\\nor less;\\n$ 2,275.20\\n58542\\n58542\\nLaparoscopy, surgical, supracervical hysterectomy, for uterus 250 g\\nor less; with removal of tube(s) and\/or ovary(s)\\n$ 2,512.31\\n58543\\n58543\\nLaparoscopy, surgical, supracervical hysterectomy, for uterus\\ngreater than 250 g;\\n$ 2,546.70\\n58544\\n58544\\nLaparoscopy, surgical, supracervical hysterectomy, for uterus\\ngreater than 250 g; with removal of tube(s) and\/or ovary(s)\\n$ 2,839.57\\n58545\\n58545\\nLaparoscopy, surgical, myomectomy, excision; 1 to 4 intramural\\nmyomas with total weight of 250 g or less and\/or removal of\\nsurface myomas\\n$ 2,496.86\\n58546\\n58546\\nLaparoscopy, surgical, myomectomy, excision; 5 or more intramural\\nmyomas and\/or intramural myomas with total weight greater than\\n250 g\\n$ 3,009.13\\n58548\\n58548\\nLaparoscopy, surgical, with radical hysterectomy, with bilateral total\\npelvic lymphadenectomy and para-aortic lymph node sampling\\n(biopsy), with removal of tube(s) and ovary(s), if performed\\n$ 4,382.63\\n58550\\n58550\\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g\\nor less;\\n$ 3,277.49\\n58552\\n58552\\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g\\nor less; with removal of tube(s) and\/or ovary(s)\\n$ 2,608.28\\n58553\\n58553\\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus greater\\nthan 250 g;\\n$ 3,010.69\\n58554\\n58554\\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus greater\\nthan 250 g; with removal of tube(s) and\/or ovary(s)\\n$ 3,357.56\\n58555\\n58555\\nHysteroscopy, diagnostic (separate procedure)\\n$ 857.70\\n58558\\n58558\\nHysteroscopy, surgical; with sampling (biopsy) of endometrium\\nand\/or polypectomy, with or without D & C\\n$ 1,402.27\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n271\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n272\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n58559\\n58559\\nHysteroscopy, surgical; with lysis of intrauterine adhesions (any\\nmethod)\\n$ 1,555.20\\n58560\\n58560\\nHysteroscopy, surgical; with division or resection of intrauterine\\nseptum (any method)\\n$ 1,865.70\\n58561\\n58561\\nHysteroscopy, surgical; with removal of leiomyomata\\n$ 2,065.50\\n58562\\n58562\\nHysteroscopy, surgical; with removal of impacted foreign body\\n$ 1,035.00\\n58563\\n58563\\nHysteroscopy, surgical; with endometrial ablation (eg, endometrial\\nresection, electrosurgical ablation, thermoablation)\\n$ 2,528.26\\n58565\\n58565\\nHysteroscopy, surgical; with bilateral fallopian tube cannulation to\\ninduce occlusion by placement of permanent implants\\n$ 4,424.15\\n58570\\n58570\\nLaparoscopy, surgical, with total hysterectomy, for uterus 250 g or\\nless;\\n$ 2,503.83\\n58571\\n58571\\nLaparoscopy, surgical, with total hysterectomy, for uterus 250 g or\\nless; with removal of tube(s) and\/or ovary(s)\\n$ 2,801.61\\n58572\\n58572\\nLaparoscopy, surgical, with total hysterectomy, for uterus greater\\nthan 250 g;\\n$ 3,013.79\\n58573\\n58573\\nLaparoscopy, surgical, with total hysterectomy, for uterus greater\\nthan 250 g; with removal of tube(s) and\/or ovary(s)\\n$ 3,509.08\\n58578\\n58578\\nUnlisted laparoscopy procedure, uterus\\nCost\\n58579\\n58579\\nUnlisted hysteroscopy procedure, uterus\\nCost\\n58600\\n58600\\nLigation or transection of fallopian tube(s), abdominal or vaginal\\napproach, unilateral or bilateral\\n$ 1,508.40\\n58605\\n58605\\nLigation or transection of fallopian tube(s), abdominal or vaginal\\napproach, postpartum, unilateral or bilateral, during same\\nhospitalization (separate procedure)\\n$ 1,312.20\\n58611\\n58611\\nLigation or transection of fallopian tube(s) when done at the time of\\ncesarean delivery or intra-abdominal surgery (not a separate\\nprocedure) (List separately in addition to code for primary\\nprocedure)\\n$ 861.75\\n58615\\n58615\\nOcclusion of fallopian tube(s) by device (eg, band, clip, Falope ring)\\nvaginal or suprapubic approach\\n$ 1,441.80\\n58660\\n58660\\nLaparoscopy, surgical; with lysis of adhesions (salpingolysis,\\novariolysis) (separate procedure)\\n$ 2,250.71\\n58661\\n58661\\nLaparoscopy, surgical; with removal of adnexal structures (partial or\\ntotal oophorectomy and\/or salpingectomy)\\n$ 2,277.00\\n58662\\n58662\\nLaparoscopy, surgical; with fulguration or excision of lesions of the\\novary, pelvic viscera, or peritoneal surface by any method\\n$ 2,523.37\\n58670\\n58670\\nLaparoscopy, surgical; with fulguration of oviducts (with or without\\ntransection)\\n$ 1,802.70\\n58671\\n58671\\nLaparoscopy, surgical; with occlusion of oviducts by device (eg,\\nband, clip, or Falope ring)\\n$ 1,802.70\\n58672\\n58672\\nLaparoscopy, surgical; with fimbrioplasty\\n$ 2,601.00\\n58673\\n58673\\nLaparoscopy, surgical; with salpingostomy (salpingoneostomy)\\n$ 1,854.00\\n58679\\n58679\\nUnlisted laparoscopy procedure, oviduct, ovary\\nCost\\n58700\\n58700\\nSalpingectomy, complete or partial, unilateral or bilateral (separate\\nprocedure)\\n$ 2,060.10\\n58720\\n58720\\nSalpingo-oophorectomy, complete or partial, unilateral or bilateral\\n(separate procedure)\\n$ 2,178.51\\n58740\\n58740\\nLysis of adhesions (salpingolysis, ovariolysis)\\n$ 2,415.84\\n58750\\n58750\\nTubotubal anastomosis\\n$ 3,936.60\\n58752\\n58752\\nTubouterine implantation\\n$ 3,450.60\\n58760\\n58760\\nFimbrioplasty\\n$ 3,038.40\\n58770\\n58770\\nSalpingostomy (salpingoneostomy)\\n$ 3,193.20\\n58800\\n58800\\nDrainage of ovarian cyst(s), unilateral or bilateral (separate\\nprocedure); vaginal approach\\n$ 1,184.40\\n58805\\n58805\\nDrainage of ovarian cyst(s), unilateral or bilateral (separate\\nprocedure); abdominal approach\\n$ 1,800.90\\n58820\\n58820\\nDrainage of ovarian abscess; vaginal approach, open\\n$ 1,287.90\\n58822\\n58822\\nDrainage of ovarian abscess; abdominal approach\\n$ 1,772.10\\n58825\\n58825\\nTransposition, ovary(s)\\n$ 1,837.80\\n58900\\n58900\\nBiopsy of ovary, unilateral or bilateral (separate procedure)\\n$ 1,833.30\\n58920\\n58920\\nWedge resection or bisection of ovary, unilateral or bilateral\\n$ 2,329.20\\n58925\\n58925\\nOvarian cystectomy, unilateral or bilateral\\n$ 2,331.00\\n58940\\n58940\\nOophorectomy, partial or total, unilateral or bilateral;\\n$ 2,069.10\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n273\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n274\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n58943\\n58943\\nOophorectomy, partial or total, unilateral or bilateral; for ovarian,\\ntubal or primary peritoneal malignancy, with para-aortic and pelvic\\nlymph node biopsies, peritoneal washings, peritoneal biopsies,\\ndiaphragmatic assessments, with or without salpingecto\\n$ 3,457.80\\n58950\\n58950\\nResection (initial) of ovarian, tubal or primary peritoneal malignancy\\nwith bilateral salpingo-oophorectomy and omentectomy;\\n$ 3,549.60\\n58951\\n58951\\nResection (initial) of ovarian, tubal or primary peritoneal malignancy\\nwith bilateral salpingo-oophorectomy and omentectomy; with total\\nabdominal hysterectomy, pelvic and limited para-aortic\\nlymphadenectomy\\n$ 4,583.70\\n58952\\n58952\\nResection (initial) of ovarian, tubal or primary peritoneal malignancy\\nwith bilateral salpingo-oophorectomy and omentectomy; with\\nradical dissection for debulking (ie, radical excision or destruction,\\nintra-abdominal or retroperitoneal tumors)\\n$ 5,935.50\\n58953\\n58953\\nBilateral salpingo-oophorectomy with omentectomy, total\\nabdominal hysterectomy and radical dissection for debulking;\\n$ 7,745.77\\n58954\\n58954\\nBilateral salpingo-oophorectomy with omentectomy, total\\nabdominal hysterectomy and radical dissection for debulking; with\\npelvic lymphadenectomy and limited para-aortic lymphadenectomy\\n$ 8,407.75\\n58956\\n58956\\nBilateral salpingo-oophorectomy with total omentectomy, total\\nabdominal hysterectomy for malignancy\\n$ 5,467.49\\n58957\\n58957\\nResection (tumor debulking) of recurrent ovarian, tubal, primary\\nperitoneal, uterine malignancy (intra-abdominal, retroperitoneal\\ntumors), with omentectomy, if performed;\\n$ 5,807.52\\n58958\\n58958\\nResection (tumor debulking) of recurrent ovarian, tubal, primary\\nperitoneal, uterine malignancy (intra-abdominal, retroperitoneal\\ntumors), with omentectomy, if performed; with pelvic\\nlymphadenectomy and limited para-aortic lymphadenectomy\\n$ 6,432.44\\n58960\\n58960\\nLaparotomy, for staging or restaging of ovarian, tubal, or primary\\nperitoneal malignancy (second look), with or without omentectomy,\\nperitoneal washing, biopsy of abdominal and pelvic peritoneum,\\ndiaphragmatic assessment with pelvic and limited para-aorti\\n$ 3,839.96\\n58970\\n58970\\nFollicle puncture for oocyte retrieval, any method\\n$ 1,406.70\\n58974\\n58974\\nEmbryo transfer, intrauterine\\n$ 537.30\\n58976\\n58976\\nGamete, zygote, or embryo intrafallopian transfer, any method\\n$ 1,545.30\\n58999\\n58999\\nUnlisted procedure, female genital system (nonobstetrical)\\nCost\\n59000\\n59000\\nAmniocentesis; diagnostic\\n$ 332.21\\n59001\\n59001\\nAmniocentesis; therapeutic amniotic fluid reduction (includes\\nultrasound guidance)\\n$ 440.43\\n59012\\n59012\\nCordocentesis (intrauterine), any method\\n$ 669.60\\n59015\\n59015\\nChorionic villus sampling, any method\\n$ 360.90\\n59020\\n59020\\nFetal contraction stress test\\n$ 178.81\\n59020-26 26\\n59020\\nFetal contraction stress test\\n$ 90.59\\n59020-TC TC\\n59020\\nFetal contraction stress test\\n$ 88.22\\n59025\\n59025\\nFetal non-stress test\\n$ 115.69\\n59025-26 26\\n59025\\nFetal non-stress test\\n$ 69.45\\n59025-TC TC\\n59025\\nFetal non-stress test\\n$ 46.24\\n59030\\n59030\\nFetal scalp blood sampling\\n$ 194.40\\n59050\\n59050\\nFetal monitoring during labor by consulting physician (ie, non-\\nattending physician) with written report; supervision and\\ninterpretation\\n$ 285.30\\n59051\\n59051\\nFetal monitoring during labor by consulting physician (ie, non-\\nattending physician) with written report; interpretation only\\n$ 109.29\\n59070\\n59070\\nTransabdominal amnioinfusion, including ultrasound guidance\\n$ 959.77\\n59072\\n59072\\nFetal umbilical cord occlusion, including ultrasound guidance\\n$ 1,227.78\\n59074\\n59074\\nFetal fluid drainage (eg, vesicocentesis, thoracocentesis,\\nparacentesis), including ultrasound guidance\\n$ 935.82\\n59076\\n59076\\nFetal shunt placement, including ultrasound guidance\\n$ 1,204.41\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n275\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n276\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n59100\\n59100\\nHysterotomy, abdominal (eg, for hydatidiform mole, abortion)\\n$ 1,908.00\\n59120\\n59120\\nSurgical treatment of ectopic pregnancy; tubal or ovarian, requiring\\nsalpingectomy and\/or oophorectomy, abdominal or vaginal\\napproach\\n$ 2,453.40\\n59121\\n59121\\nSurgical treatment of ectopic pregnancy; tubal or ovarian, without\\nsalpingectomy and\/or oophorectomy\\n$ 2,041.20\\n59130\\n59130\\nSurgical treatment of ectopic pregnancy; abdominal pregnancy\\n$ 2,061.90\\n59135\\n59135\\nSurgical treatment of ectopic pregnancy; interstitial, uterine\\npregnancy requiring total hysterectomy\\n$ 2,800.80\\n59136\\n59136\\nSurgical treatment of ectopic pregnancy; interstitial, uterine\\npregnancy with partial resection of uterus\\n$ 2,285.10\\n59140\\n59140\\nSurgical treatment of ectopic pregnancy; cervical, with evacuation\\n$ 1,562.40\\n59150\\n59150\\nLaparoscopic treatment of ectopic pregnancy; without\\nsalpingectomy and\/or oophorectomy\\n$ 2,317.50\\n59151\\n59151\\nLaparoscopic treatment of ectopic pregnancy; with salpingectomy\\nand\/or oophorectomy\\n$ 2,414.78\\n59160\\n59160\\nCurettage, postpartum\\n$ 765.00\\n59200\\n59200\\nInsertion of cervical dilator (eg, laminaria, prostaglandin) (separate\\nprocedure)\\n$ 276.79\\n59300\\n59300\\nEpisiotomy or vaginal repair, by other than attending\\n$ 566.10\\n59320\\n59320\\nCerclage of cervix, during pregnancy; vaginal\\n$ 1,122.47\\n59325\\n59325\\nCerclage of cervix, during pregnancy; abdominal\\n$ 1,416.60\\n59350\\n59350\\nHysterorrhaphy of ruptured uterus\\n$ 2,176.20\\n59400\\n59400\\nRoutine obstetric care including antepartum care, vaginal delivery\\n(with or without episiotomy, and\/or forceps) and postpartum care\\n$ 2,781.00\\n59409\\n59409\\nVaginal delivery only (with or without episiotomy and\/or forceps);\\n$ 1,588.98\\n59410\\n59410\\nVaginal delivery only (with or without episiotomy and\/or forceps);\\nincluding postpartum care\\n$ 1,924.97\\n59412\\n59412\\nExternal cephalic version, with or without tocolysis\\n$ 540.90\\n59414\\n59414\\nDelivery of placenta (separate procedure)\\n$ 484.20\\n59425\\n59425\\nAntepartum care only; 4-6 visits\\n$ 747.00\\n59426\\n59426\\nAntepartum care only; 7 or more visits\\n$ 1,168.00\\n59430\\n59430\\nPostpartum care only (separate procedure)\\n$ 240.30\\n59514\\n59514\\nCesarean delivery only;\\n$ 2,233.35\\n59515\\n59515\\nCesarean delivery only; including postpartum care\\n$ 2,676.17\\n59525\\n59525\\nSubtotal or total hysterectomy after cesarean delivery (List\\nseparately in addition to code for primary procedure)\\n$ 1,751.40\\n59610\\n59610\\nRoutine obstetric care including antepartum care, vaginal delivery\\n(with or without episiotomy, and\/or forceps) and postpartum care,\\nafter previous cesarean delivery\\n$ 3,295.80\\n59612\\n59612\\nVaginal delivery only, after previous cesarean delivery (with or\\nwithout episiotomy and\/or forceps);\\n$ 2,271.60\\n59614\\n59614\\nVaginal delivery only, after previous cesarean delivery (with or\\nwithout episiotomy and\/or forceps); including postpartum care\\n$ 2,339.10\\n59618\\n59618\\nRoutine obstetric care including antepartum care, cesarean delivery,\\nand postpartum care, following attempted vaginal delivery after\\nprevious cesarean delivery\\n$ 3,965.40\\n59620\\n59620\\nCesarean delivery only, following attempted vaginal delivery after\\nprevious cesarean delivery;\\n$ 2,781.00\\n59622\\n59622\\nCesarean delivery only, following attempted vaginal delivery after\\nprevious cesarean delivery; including postpartum care\\n$ 2,632.19\\n59812\\n59812\\nTreatment of incomplete abortion, any trimester, completed\\nsurgically\\n$ 800.34\\n59820\\n59820\\nTreatment of missed abortion, completed surgically; first trimester\\n$ 815.24\\n59821\\n59821\\nTreatment of missed abortion, completed surgically; second\\ntrimester\\n$ 1,081.80\\n59830\\n59830\\nTreatment of septic abortion, completed surgically\\n$ 1,153.80\\n59840\\n59840\\nInduced abortion, by dilation and curettage\\n$ 947.70\\n59841\\n59841\\nInduced abortion, by dilation and evacuation\\n$ 1,118.90\\n59850\\n59850\\nInduced abortion, by 1 or more intra-amniotic injections\\n(amniocentesis-injections), including hospital admission and visits,\\ndelivery of fetus and secundines;\\n$ 1,398.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n277\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n278\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n59851\\n59851\\nInduced abortion, by 1 or more intra-amniotic injections\\n(amniocentesis-injections), including hospital admission and visits,\\ndelivery of fetus and secundines; with dilation and curettage and\/or\\nevacuation\\n$ 1,555.20\\n59852\\n59852\\nInduced abortion, by 1 or more intra-amniotic injections\\n(amniocentesis-injections), including hospital admission and visits,\\ndelivery of fetus and secundines; with hysterotomy (failed intra-\\namniotic injection)\\n$ 1,869.30\\n59855\\n59855\\nInduced abortion, by 1 or more vaginal suppositories (eg,\\nprostaglandin) with or without cervical dilation (eg, laminaria),\\nincluding hospital admission and visits, delivery of fetus and\\nsecundines;\\n$ 1,235.70\\n59856\\n59856\\nInduced abortion, by 1 or more vaginal suppositories (eg,\\nprostaglandin) with or without cervical dilation (eg, laminaria),\\nincluding hospital admission and visits, delivery of fetus and\\nsecundines; with dilation and curettage and\/or evacuation\\n$ 1,441.80\\n59857\\n59857\\nInduced abortion, by 1 or more vaginal suppositories (eg,\\nprostaglandin) with or without cervical dilation (eg, laminaria),\\nincluding hospital admission and visits, delivery of fetus and\\nsecundines; with hysterotomy (failed medical evacuation)\\n$ 1,810.80\\n59866\\n59866\\nMultifetal pregnancy reduction(s) (MPR)\\n$ 796.50\\n59870\\n59870\\nUterine evacuation and curettage for hydatidiform mole\\n$ 1,081.80\\n59871\\n59871\\nRemoval of cerclage suture under anesthesia (other than local)\\n$ 444.60\\n59897\\n59897\\nUnlisted fetal invasive procedure, including ultrasound guidance,\\nwhen performed\\nCost\\n59898\\n59898\\nUnlisted laparoscopy procedure, maternity care and delivery\\nCost\\n59899\\n59899\\nUnlisted procedure, maternity care and delivery\\nCost\\n60000\\n60000\\nIncision and drainage of thyroglossal duct cyst, infected\\n$ 305.10\\n60100\\n60100\\nBiopsy thyroid, percutaneous core needle\\n$ 279.00\\n60200\\n60200\\nExcision of cyst or adenoma of thyroid, or transection of isthmus\\n$ 1,590.30\\n60210\\n60210\\nPartial thyroid lobectomy, unilateral; with or without\\nisthmusectomy\\n$ 2,587.50\\n60212\\n60212\\nPartial thyroid lobectomy, unilateral; with contralateral subtotal\\nlobectomy, including isthmusectomy\\n$ 3,165.30\\n60220\\n60220\\nTotal thyroid lobectomy, unilateral; with or without isthmusectomy\\n$ 2,613.60\\n60225\\n60225\\nTotal thyroid lobectomy, unilateral; with contralateral subtotal\\nlobectomy, including isthmusectomy\\n$ 3,329.10\\n60240\\n60240\\nThyroidectomy, total or complete\\n$ 3,250.80\\n60252\\n60252\\nThyroidectomy, total or subtotal for malignancy; with limited neck\\ndissection\\n$ 3,743.10\\n60254\\n60254\\nThyroidectomy, total or subtotal for malignancy; with radical neck\\ndissection\\n$ 5,427.00\\n60260\\n60260\\nThyroidectomy, removal of all remaining thyroid tissue following\\nprevious removal of a portion of thyroid\\n$ 2,396.70\\n60270\\n60270\\nThyroidectomy, including substernal thyroid; sternal split or\\ntransthoracic approach\\n$ 4,066.20\\n60271\\n60271\\nThyroidectomy, including substernal thyroid; cervical approach\\n$ 3,284.10\\n60280\\n60280\\nExcision of thyroglossal duct cyst or sinus;\\n$ 2,004.30\\n60281\\n60281\\nExcision of thyroglossal duct cyst or sinus; recurrent\\n$ 2,155.50\\n60300\\n60001\\nAspiration and\/or injection, thyroid cyst\\n$ 304.43\\n60500\\n60500\\nParathyroidectomy or exploration of parathyroid(s);\\n$ 3,088.80\\n60502\\n60502\\nParathyroidectomy or exploration of parathyroid(s); re-exploration\\n$ 3,404.70\\n60505\\n60505\\nParathyroidectomy or exploration of parathyroid(s); with\\nmediastinal exploration, sternal split or transthoracic approach\\n$ 3,624.30\\n60512\\n60512\\nParathyroid autotransplantation (List separately in addition to code\\nfor primary procedure)\\n$ 802.80\\n60520\\n60520\\nThymectomy, partial or total; transcervical approach (separate\\nprocedure)\\n$ 3,260.70\\n60521\\n60521\\nThymectomy, partial or total; sternal split or transthoracic\\napproach, without radical mediastinal dissection (separate\\nprocedure)\\n$ 3,193.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n279\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n280\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n60522\\n60522\\nThymectomy, partial or total; sternal split or transthoracic\\napproach, with radical mediastinal dissection (separate procedure)\\n$ 4,230.00\\n60540\\n60540\\nAdrenalectomy, partial or complete, or exploration of adrenal gland\\nwith or without biopsy, transabdominal, lumbar or dorsal (separate\\nprocedure);\\n$ 3,249.90\\n60545\\n60545\\nAdrenalectomy, partial or complete, or exploration of adrenal gland\\nwith or without biopsy, transabdominal, lumbar or dorsal (separate\\nprocedure); with excision of adjacent retroperitoneal tumor\\n$ 3,646.80\\n60600\\n60600\\nExcision of carotid body tumor; without excision of carotid artery\\n$ 3,170.70\\n60605\\n60605\\nExcision of carotid body tumor; with excision of carotid artery\\n$ 3,828.60\\n60650\\n60650\\nLaparoscopy, surgical, with adrenalectomy, partial or complete, or\\nexploration of adrenal gland with or without biopsy,\\ntransabdominal, lumbar or dorsal\\n$ 2,901.27\\n60659\\n60659\\nUnlisted laparoscopy procedure, endocrine system\\nCost\\n60699\\n60699\\nUnlisted procedure, endocrine system\\nCost\\n61000\\n61000\\nSubdural tap through fontanelle, or suture, infant, unilateral or\\nbilateral; initial\\n$ 347.40\\n61001\\n61001\\nSubdural tap through fontanelle, or suture, infant, unilateral or\\nbilateral; subsequent taps\\n$ 268.20\\n61020\\n61020\\nVentricular puncture through previous burr hole, fontanelle, suture,\\nor implanted ventricular catheter\/reservoir; without injection\\n$ 477.00\\n61026\\n61026\\nVentricular puncture through previous burr hole, fontanelle, suture,\\nor implanted ventricular catheter\/reservoir; with injection of\\nmedication or other substance for diagnosis or treatment\\n$ 539.10\\n61050\\n61050\\nCisternal or lateral cervical (C1-C2) puncture; without injection\\n(separate procedure)\\n$ 422.10\\n61055\\n61055\\nCisternal or lateral cervical (C1-C2) puncture; with injection of\\nmedication or other substance for diagnosis or treatment (eg, C1-\\nC2)\\n$ 605.70\\n61070\\n61070\\nPuncture of shunt tubing or reservoir for aspiration or injection\\nprocedure\\n$ 314.10\\n61105\\n61105\\nTwist drill hole for subdural or ventricular puncture\\n$ 1,647.90\\n61107\\n61107\\nTwist drill hole(s) for subdural, intracerebral, or ventricular\\npuncture; for implanting ventricular catheter, pressure recording\\ndevice, or other intracerebral monitoring device\\n$ 2,286.90\\n61108\\n61108\\nTwist drill hole(s) for subdural, intracerebral, or ventricular\\npuncture; for evacuation and\/or drainage of subdural hematoma\\n$ 3,141.90\\n61120\\nBurr hole(s) for ventricular puncture (including injection of gas,\\ncontrast media, dye, or radioactive material)\\n$ 1,748.70\\n61140\\nBurr hole(s) or trephine; with biopsy of brain or intracranial lesion\\n$ 3,785.40\\n61150\\nBurr hole(s) or trephine; with drainage of brain abscess or cyst\\n$ 3,656.70\\n61151\\nBurr hole(s) or trephine; with subsequent tapping (aspiration) of\\nintracranial abscess or cyst\\n$ 1,149.30\\n61154\\n61154\\nBurr hole(s) with evacuation and\/or drainage of hematoma,\\nextradural or subdural\\n$ 4,333.50\\n61156\\n61156\\nBurr hole(s); with aspiration of hematoma or cyst, intracerebral\\n$ 3,850.20\\n61210\\nBurr hole(s); for implanting ventricular catheter, reservoir, EEG\\nelectrode(s), pressure recording device, or other cerebral\\nmonitoring device (separate procedure)\\n$ 2,266.20\\n61215\\nInsertion of subcutaneous reservoir, pump or continuous infusion\\nsystem for connection to ventricular catheter\\n$ 2,421.00\\n61250\\nBurr hole(s) or trephine, supratentorial, exploratory, not followed\\nby other surgery\\n$ 2,483.10\\n61253\\n61253\\nBurr hole(s) or trephine, infratentorial, unilateral or bilateral\\n$ 3,609.90\\n61304\\nCraniectomy or craniotomy, exploratory; supratentorial\\n$ 5,562.00\\n61305\\nCraniectomy or craniotomy, exploratory; infratentorial (posterior\\nfossa)\\n$ 5,964.30\\n61312\\n61312\\nCraniectomy or craniotomy for evacuation of hematoma,\\nsupratentorial; extradural or subdural\\n$ 6,644.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n281\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n282\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n61313\\nCraniectomy or craniotomy for evacuation of hematoma,\\nsupratentorial; intracerebral\\n$ 6,731.10\\n61314\\nCraniectomy or craniotomy for evacuation of hematoma,\\ninfratentorial; extradural or subdural\\n$ 6,798.60\\n61315\\nCraniectomy or craniotomy for evacuation of hematoma,\\ninfratentorial; intracerebellar\\n$ 7,305.30\\n61316\\n61316\\nIncision and subcutaneous placement of cranial bone graft (List\\nseparately in addition to code for primary procedure)\\n$ 1,146.13\\n61320\\nCraniectomy or craniotomy, drainage of intracranial abscess;\\nsupratentorial\\n$ 6,000.30\\n61321\\nCraniectomy or craniotomy, drainage of intracranial abscess;\\ninfratentorial\\n$ 5,699.70\\n61322\\nCraniectomy or craniotomy, decompressive, with or without\\nduraplasty, for treatment of intracranial hypertension, without\\nevacuation of associated intraparenchymal hematoma; without\\nlobectomy\\n$ 5,756.79\\n61323\\nCraniectomy or craniotomy, decompressive, with or without\\nduraplasty, for treatment of intracranial hypertension, without\\nevacuation of associated intraparenchymal hematoma; with\\nlobectomy\\n$ 6,798.55\\n61330\\nDecompression of orbit only, transcranial approach\\n$ 4,500.90\\n61332\\nExploration of orbit (transcranial approach); with biopsy\\n$ 5,355.00\\n61333\\nExploration of orbit (transcranial approach); with removal of lesion\\n$ 5,422.50\\n61334\\nExploration of orbit (transcranial approach); with removal of foreign\\nbody\\n$ 5,355.00\\n61340\\nSubtemporal cranial decompression (pseudotumor cerebri, slit\\nventricle syndrome)\\n$ 4,254.30\\n61343\\nCraniectomy, suboccipital with cervical laminectomy for\\ndecompression of medulla and spinal cord, with or without dural\\ngraft (eg, Arnold-Chiari malformation)\\n$ 7,812.00\\n61345\\n61345\\nOther cranial decompression, posterior fossa\\n$ 3,861.00\\n61440\\n61440\\nCraniotomy for section of tentorium cerebelli (separate procedure)\\n$ 3,904.20\\n61450\\n61450\\nCraniectomy, subtemporal, for section, compression, or\\ndecompression of sensory root of gasserian ganglion\\n$ 5,769.00\\n61458\\n61458\\nCraniectomy, suboccipital; for exploration or decompression of\\ncranial nerves\\n$ 6,541.20\\n61460\\n61460\\nCraniectomy, suboccipital; for section of 1 or more cranial nerves\\n$ 6,573.60\\n61470\\n61470\\nCraniectomy, suboccipital; for medullary tractotomy\\n$ 5,194.80\\n61480\\n61480\\nCraniectomy, suboccipital; for mesencephalic tractotomy or\\npedunculotomy\\n$ 4,833.00\\n61490\\n61490\\nCraniotomy for lobotomy, including cingulotomy\\n$ 3,848.40\\n61500\\n61500\\nCraniectomy; with excision of tumor or other bone lesion of skull\\n$ 5,799.60\\n61501\\n61501\\nCraniectomy; for osteomyelitis\\n$ 5,518.80\\n61510\\n61510\\nCraniectomy, trephination, bone flap craniotomy; for excision of\\nbrain tumor, supratentorial, except meningioma\\n$ 7,210.80\\n61512\\n61512\\nCraniectomy, trephination, bone flap craniotomy; for excision of\\nmeningioma, supratentorial\\n$ 7,498.80\\n61514\\n61514\\nCraniectomy, trephination, bone flap craniotomy; for excision of\\nbrain abscess, supratentorial\\n$ 6,441.30\\n61516\\n61516\\nCraniectomy, trephination, bone flap craniotomy; for excision or\\nfenestration of cyst, supratentorial\\n$ 6,448.50\\n61517\\n61517\\nImplantation of brain intracavitary chemotherapy agent (List\\nseparately in addition to code for primary procedure)\\n$ 317.57\\n61518\\n61518\\nCraniectomy for excision of brain tumor, infratentorial or posterior\\nfossa; except meningioma, cerebellopontine angle tumor, or\\nmidline tumor at base of skull\\n$ 7,177.50\\n61519\\n61519\\nCraniectomy for excision of brain tumor, infratentorial or posterior\\nfossa; meningioma\\n$ 7,713.00\\n61520\\n61520\\nCraniectomy for excision of brain tumor, infratentorial or posterior\\nfossa; cerebellopontine angle tumor\\n$ 8,054.10\\n61521\\n61521\\nCraniectomy for excision of brain tumor, infratentorial or posterior\\nfossa; midline tumor at base of skull\\n$ 8,868.60\\n61522\\n61522\\nCraniectomy, infratentorial or posterior fossa; for excision of brain\\nabscess\\n$ 6,534.00\\n61524\\n61524\\nCraniectomy, infratentorial or posterior fossa; for excision or\\nfenestration of cyst\\n$ 6,491.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n283\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n284\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n61526\\n61526\\nCraniectomy, bone flap craniotomy, transtemporal (mastoid) for\\nexcision of cerebellopontine angle tumor;\\n$ 7,533.00\\n61530\\n61530\\nCraniectomy, bone flap craniotomy, transtemporal (mastoid) for\\nexcision of cerebellopontine angle tumor; combined with\\nmiddle\/posterior fossa craniotomy\/craniectomy\\n$ 7,915.50\\n61531\\n61531\\nSubdural implantation of strip electrodes through 1 or more burr or\\ntrephine hole(s) for long-term seizure monitoring\\n$ 4,017.60\\n61533\\n61533\\nCraniotomy with elevation of bone flap; for subdural implantation\\nof an electrode array, for long-term seizure monitoring\\n$ 5,459.40\\n61534\\n61534\\nCraniotomy with elevation of bone flap; for excision of\\nepileptogenic focus without electrocorticography during surgery\\n$ 5,832.00\\n61535\\n61535\\nCraniotomy with elevation of bone flap; for removal of epidural or\\nsubdural electrode array, without excision of cerebral tissue\\n(separate procedure)\\n$ 3,613.50\\n61536\\n61536\\nCraniotomy with elevation of bone flap; for excision of cerebral\\nepileptogenic focus, with electrocorticography during surgery\\n(includes removal of electrode array)\\n$ 6,593.40\\n61537\\n61537\\nCraniotomy with elevation of bone flap; for lobectomy, temporal\\nlobe, without electrocorticography during surgery\\n$ 5,691.54\\n61538\\n61538\\nCraniotomy with elevation of bone flap; for lobectomy, temporal\\nlobe, with electrocorticography during surgery\\n$ 7,169.40\\n61539\\n61539\\nCraniotomy with elevation of bone flap; for lobectomy, other than\\ntemporal lobe, partial or total, with electrocorticography during\\nsurgery\\n$ 6,920.10\\n61540\\n61540\\nCraniotomy with elevation of bone flap; for lobectomy, other than\\ntemporal lobe, partial or total, without electrocorticography during\\nsurgery\\n$ 6,750.11\\n61541\\n61541\\nCraniotomy with elevation of bone flap; for transection of corpus\\ncallosum\\n$ 7,540.20\\n61542\\n61542\\nCraniotomy with elevation of bone flap; for total hemispherectomy\\n$ 7,416.00\\n61543\\n61543\\nCraniotomy with elevation of bone flap; for partial or subtotal\\n(functional) hemispherectomy\\n$ 6,798.60\\n61544\\n61544\\nCraniotomy with elevation of bone flap; for excision or coagulation\\nof choroid plexus\\n$ 5,931.00\\n61545\\n61545\\nCraniotomy with elevation of bone flap; for excision of\\ncraniopharyngioma\\n$ 9,750.60\\n61546\\n61546\\nCraniotomy for hypophysectomy or excision of pituitary tumor,\\nintracranial approach\\n$ 7,222.50\\n61548\\n61548\\nHypophysectomy or excision of pituitary tumor, transnasal or\\ntransseptal approach, nonstereotactic\\n$ 6,168.60\\n61550\\n61550\\nCraniectomy for craniosynostosis; single cranial suture\\n$ 3,863.70\\n61552\\n61552\\nCraniectomy for craniosynostosis; multiple cranial sutures\\n$ 4,626.90\\n61556\\n61556\\nCraniotomy for craniosynostosis; frontal or parietal bone flap\\n$ 4,708.80\\n61557\\n61557\\nCraniotomy for craniosynostosis; bifrontal bone flap\\n$ 5,355.90\\n61558\\n61558\\nExtensive craniectomy for multiple cranial suture craniosynostosis\\n(eg, cloverleaf skull); not requiring bone grafts\\n$ 6,180.30\\n61559\\n61559\\nExtensive craniectomy for multiple cranial suture craniosynostosis\\n(eg, cloverleaf skull); recontouring with multiple osteotomies and\\nbone autografts (eg, barrel-stave procedure) (includes obtaining\\ngrafts)\\n$ 7,004.70\\n61563\\n61563\\nExcision, intra and extracranial, benign tumor of cranial bone (eg,\\nfibrous dysplasia); without optic nerve decompression\\n$ 5,598.00\\n61564\\n61564\\nExcision, intra and extracranial, benign tumor of cranial bone (eg,\\nfibrous dysplasia); with optic nerve decompression\\n$ 7,004.70\\n61566\\n61566\\nCraniotomy with elevation of bone flap; for selective\\namygdalohippocampectomy\\n$ 6,648.74\\n61567\\n61567\\nCraniotomy with elevation of bone flap; for multiple subpial\\ntransections, with electrocorticography during surgery\\n$ 7,585.18\\n61570\\n61570\\nCraniectomy or craniotomy; with excision of foreign body from\\nbrain\\n$ 6,655.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n285\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n286\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n61571\\n61571\\nCraniectomy or craniotomy; with treatment of penetrating wound\\nof brain\\n$ 7,112.70\\n61575\\n61575\\nTransoral approach to skull base, brain stem or upper spinal cord\\nfor biopsy, decompression or excision of lesion;\\n$ 5,925.60\\n61576\\n61576\\nTransoral approach to skull base, brain stem or upper spinal cord\\nfor biopsy, decompression or excision of lesion; requiring splitting of\\ntongue and\/or mandible (including tracheostomy)\\n$ 6,066.00\\n61580\\n61580\\nCraniofacial approach to anterior cranial fossa; extradural, including\\nlateral rhinotomy, ethmoidectomy, sphenoidectomy, without\\nmaxillectomy or orbital exenteration\\n$ 5,279.40\\n61581\\n61581\\nCraniofacial approach to anterior cranial fossa; extradural, including\\nlateral rhinotomy, orbital exenteration, ethmoidectomy,\\nsphenoidectomy and\/or maxillectomy\\n$ 6,869.70\\n61582\\n61582\\nCraniofacial approach to anterior cranial fossa; extradural, including\\nunilateral or bifrontal craniotomy, elevation of frontal lobe(s),\\nosteotomy of base of anterior cranial fossa\\n$ 6,235.20\\n61583\\n61583\\nCraniofacial approach to anterior cranial fossa; intradural, including\\nunilateral or bifrontal craniotomy, elevation or resection of frontal\\nlobe, osteotomy of base of anterior cranial fossa\\n$ 6,881.40\\n61584\\n61584\\nOrbitocranial approach to anterior cranial fossa, extradural,\\nincluding supraorbital ridge osteotomy and elevation of frontal\\nand\/or temporal lobe(s); without orbital exenteration\\n$ 6,746.40\\n61585\\n61585\\nOrbitocranial approach to anterior cranial fossa, extradural,\\nincluding supraorbital ridge osteotomy and elevation of frontal\\nand\/or temporal lobe(s); with orbital exenteration\\n$ 7,112.70\\n61586\\n61586\\nBicoronal, transzygomatic and\/or LeFort I osteotomy approach to\\nanterior cranial fossa with or without internal fixation, without\\nbone graft\\n$ 4,247.10\\n61590\\n61590\\nInfratemporal pre-auricular approach to middle cranial fossa\\n(parapharyngeal space, infratemporal and midline skull base,\\nnasopharynx), with or without disarticulation of the mandible,\\nincluding parotidectomy, craniotomy, decompression and\/or\\nmobilization\\n$ 8,847.90\\n61591\\n61591\\nInfratemporal post-auricular approach to middle cranial fossa\\n(internal auditory meatus, petrous apex, tentorium, cavernous\\nsinus, parasellar area, infratemporal fossa) including\\nmastoidectomy, resection of sigmoid sinus, with or without\\ndecompression and\\n$ 9,154.80\\n61592\\n61592\\nOrbitocranial zygomatic approach to middle cranial fossa\\n(cavernous sinus and carotid artery, clivus, basilar artery or petrous\\napex) including osteotomy of zygoma, craniotomy, extra- or\\nintradural elevation of temporal lobe\\n$ 7,725.60\\n61595\\n61595\\nTranstemporal approach to posterior cranial fossa, jugular foramen\\nor midline skull base, including mastoidectomy, decompression of\\nsigmoid sinus and\/or facial nerve, with or without mobilization\\n$ 6,030.00\\n61596\\n61596\\nTranscochlear approach to posterior cranial fossa, jugular foramen\\nor midline skull base, including labyrinthectomy, decompression,\\nwith or without mobilization of facial nerve and\/or petrous carotid\\nartery\\n$ 6,489.00\\n61597\\n61597\\nTranscondylar (far lateral) approach to posterior cranial fossa,\\njugular foramen or midline skull base, including occipital\\ncondylectomy, mastoidectomy, resection of C1-C3 vertebral\\nbody(s), decompression of vertebral artery, with or without\\nmobilization\\n$ 7,729.20\\n61598\\n61598\\nTranspetrosal approach to posterior cranial fossa, clivus or foramen\\nmagnum, including ligation of superior petrosal sinus and\/or\\nsigmoid sinus\\n$ 6,545.70\\n61600\\n61600\\nResection or excision of neoplastic, vascular or infectious lesion of\\nbase of anterior cranial fossa; extradural\\n$ 5,345.10\\n61601\\n61601\\nResection or excision of neoplastic, vascular or infectious lesion of\\nbase of anterior cranial fossa; intradural, including dural repair, with\\nor without graft\\n$ 6,008.40\\n61605\\n61605\\nResection or excision of neoplastic, vascular or infectious lesion of\\ninfratemporal fossa, parapharyngeal space, petrous apex;\\nextradural\\n$ 5,562.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n287\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n288\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n61606\\n61606\\nResection or excision of neoplastic, vascular or infectious lesion of\\ninfratemporal fossa, parapharyngeal space, petrous apex;\\nintradural, including dural repair, with or without graft\\n$ 7,875.00\\n61607\\n61607\\nResection or excision of neoplastic, vascular or infectious lesion of\\nparasellar area, cavernous sinus, clivus or midline skull base;\\nextradural\\n$ 7,877.70\\n61608\\n61608\\nResection or excision of neoplastic, vascular or infectious lesion of\\nparasellar area, cavernous sinus, clivus or midline skull base;\\nintradural, including dural repair, with or without graft\\n$ 8,641.80\\n61609\\n61609\\nTransection or ligation, carotid artery in cavernous sinus; without\\nrepair (List separately in addition to code for primary procedure)\\n$ 2,159.10\\n61610\\n61610\\nTransection or ligation, carotid artery in cavernous sinus; with\\nrepair by anastomosis or graft (List separately in addition to code\\nfor primary procedure)\\n$ 5,758.20\\n61611\\n61611\\nTransection or ligation, carotid artery in petrous canal; without\\nrepair (List separately in addition to code for primary procedure)\\n$ 1,481.40\\n61612\\n61612\\nTransection or ligation, carotid artery in petrous canal; with repair\\nby anastomosis or graft (List separately in addition to code for\\nprimary procedure)\\n$ 5,562.00\\n61613\\n61613\\nObliteration of carotid aneurysm, arteriovenous malformation, or\\ncarotid-cavernous fistula by dissection within cavernous sinus\\n$ 8,973.90\\n61615\\n61615\\nResection or excision of neoplastic, vascular or infectious lesion of\\nbase of posterior cranial fossa, jugular foramen, foramen magnum,\\nor C1-C3 vertebral bodies; extradural\\n$ 6,874.20\\n61616\\nResection or excision of neoplastic, vascular or infectious lesion of\\nbase of posterior cranial fossa, jugular foramen, foramen magnum,\\nor C1-C3 vertebral bodies; intradural, including dural repair, with or\\nwithout graft\\n$ 8,987.40\\n61618\\n61618\\nSecondary repair of dura for cerebrospinal fluid leak, anterior,\\nmiddle or posterior cranial fossa following surgery of the skull base;\\nby free tissue graft (eg, pericranium, fascia, tensor fascia lata,\\nadipose tissue, homologous or synthetic grafts)\\n$ 3,795.30\\n61619\\n61619\\nSecondary repair of dura for cerebrospinal fluid leak, anterior,\\nmiddle or posterior cranial fossa following surgery of the skull base;\\nby local or regionalized vascularized pedicle flap or myocutaneous\\nflap (including galea, temporalis, frontalis or occi\\n$ 6,327.00\\n61623\\n61623\\nEndovascular temporary balloon arterial occlusion, head or neck\\n(extracranial\/intracranial) including selective catheterization of\\nvessel to be occluded, positioning and inflation of occlusion balloon,\\nconcomitant neurological monitoring, and radiologic s\\n$ 2,587.65\\n61624\\n61624\\nTranscatheter permanent occlusion or embolization (eg, for tumor\\ndestruction, to achieve hemostasis, to occlude a vascular\\nmalformation), percutaneous, any method; central nervous system\\n(intracranial, spinal cord)\\n$ 4,705.20\\n61626\\n61626\\nTranscatheter permanent occlusion or embolization (eg, for tumor\\ndestruction, to achieve hemostasis, to occlude a vascular\\nmalformation), percutaneous, any method; non-central nervous\\nsystem, head or neck (extracranial, brachiocephalic branch)\\n$ 3,346.20\\n61630\\n61630\\nBalloon angioplasty, intracranial (eg, atherosclerotic stenosis),\\npercutaneous\\n$ 4,445.59\\n61635\\n61635\\nTranscatheter placement of intravascular stent(s), intracranial (eg,\\natherosclerotic stenosis), including balloon angioplasty, if\\nperformed\\n$ 5,059.80\\n61640\\n61640\\nBalloon dilatation of intracranial vasospasm, percutaneous; initial\\nvessel\\n$ 3,692.54\\n61641\\n61641\\nBalloon dilatation of intracranial vasospasm, percutaneous; each\\nadditional vessel in same vascular family (List separately in addition\\nto code for primary procedure)\\n$ 1,825.26\\n61642\\n61642\\nBalloon dilatation of intracranial vasospasm, percutaneous; each\\nadditional vessel in different vascular family (List separately in\\naddition to code for primary procedure)\\n$ 1,874.98\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n289\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n290\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n61680\\n61680\\nSurgery of intracranial arteriovenous malformation; supratentorial,\\nsimple\\n$ 7,841.70\\n61682\\n61682\\nSurgery of intracranial arteriovenous malformation; supratentorial,\\ncomplex\\n$ 9,553.50\\n61684\\n61684\\nSurgery of intracranial arteriovenous malformation; infratentorial,\\nsimple\\n$ 8,433.00\\n61686\\n61686\\nSurgery of intracranial arteriovenous malformation; infratentorial,\\ncomplex\\n$ 10,935.90\\n61690\\n61690\\nSurgery of intracranial arteriovenous malformation; dural, simple\\n$ 7,769.70\\n61692\\n61692\\nSurgery of intracranial arteriovenous malformation; dural, complex\\n$ 8,279.10\\n61697\\n61697\\nSurgery of complex intracranial aneurysm, intracranial approach;\\ncarotid circulation\\n$ 8,145.00\\n61698\\n61698\\nSurgery of complex intracranial aneurysm, intracranial approach;\\nvertebrobasilar circulation\\n$ 7,839.00\\n61700\\n61700\\nSurgery of simple intracranial aneurysm, intracranial approach;\\ncarotid circulation\\n$ 8,034.30\\n61702\\n61702\\nSurgery of simple intracranial aneurysm, intracranial approach;\\nvertebrobasilar circulation\\n$ 7,725.60\\n61703\\n61703\\nSurgery of intracranial aneurysm, cervical approach by application\\nof occluding clamp to cervical carotid artery (Selverstone-\\nCrutchfield type)\\n$ 3,445.20\\n61705\\n61705\\nSurgery of aneurysm, vascular malformation or carotid-cavernous\\nfistula; by intracranial and cervical occlusion of carotid artery\\n$ 8,181.00\\n61708\\n61708\\nSurgery of aneurysm, vascular malformation or carotid-cavernous\\nfistula; by intracranial electrothrombosis\\n$ 6,218.10\\n61710\\n61710\\nSurgery of aneurysm, vascular malformation or carotid-cavernous\\nfistula; by intra-arterial embolization, injection procedure, or\\nballoon catheter\\n$ 5,119.20\\n61711\\n61711\\nAnastomosis, arterial, extracranial-intracranial (eg, middle\\ncerebral\/cortical) arteries\\n$ 6,508.80\\n61720\\n61720\\nCreation of lesion by stereotactic method, including burr hole(s) and\\nlocalizing and recording techniques, single or multiple stages;\\nglobus pallidus or thalamus\\n$ 4,897.80\\n61735\\n61735\\nCreation of lesion by stereotactic method, including burr hole(s) and\\nlocalizing and recording techniques, single or multiple stages;\\nsubcortical structure(s) other than globus pallidus or thalamus\\n$ 5,054.40\\n61750\\n61750\\nStereotactic biopsy, aspiration, or excision, including burr hole(s),\\nfor intracranial lesion;\\n$ 5,047.20\\n61751\\n61751\\nStereotactic biopsy, aspiration, or excision, including burr hole(s),\\nfor intracranial lesion; with computed tomography and\/or magnetic\\nresonance guidance\\n$ 5,544.00\\n61760\\n61760\\nStereotactic implantation of depth electrodes into the cerebrum for\\nlong-term seizure monitoring\\n$ 5,960.70\\n61770\\n61770\\nStereotactic localization, including burr hole(s), with insertion of\\ncatheter(s) or probe(s) for placement of radiation source\\n$ 5,312.70\\n61790\\n61790\\nCreation of lesion by stereotactic method, percutaneous, by\\nneurolytic agent (eg, alcohol, thermal, electrical, radiofrequency);\\ngasserian ganglion\\n$ 4,118.40\\n61791\\n61791\\nCreation of lesion by stereotactic method, percutaneous, by\\nneurolytic agent (eg, alcohol, thermal, electrical, radiofrequency);\\ntrigeminal medullary tract\\n$ 3,960.90\\n61796\\n61796\\nStereotactic radiosurgery (particle beam, gamma ray, or linear\\naccelerator); 1 simple cranial lesion\\n$ 4,260.08\\n61797\\n61797\\nStereotactic radiosurgery (particle beam, gamma ray, or linear\\naccelerator); each additional cranial lesion, simple (List separately in\\naddition to code for primary procedure)\\n$ 1,148.15\\n61798\\n61798\\nStereotactic radiosurgery (particle beam, gamma ray, or linear\\naccelerator); 1 complex cranial lesion\\n$ 4,339.38\\n61799\\n61799\\nStereotactic radiosurgery (particle beam, gamma ray, or linear\\naccelerator); each additional cranial lesion, complex (List separately\\nin addition to code for primary procedure)\\n$ 1,612.19\\n61800\\n61800\\nApplication of stereotactic headframe for stereotactic radiosurgery\\n(List separately in addition to code for primary procedure)\\n$ 806.16\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n291\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n292\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n61850\\n61850\\nTwist drill or burr hole(s) for implantation of neurostimulator\\nelectrodes, cortical\\n$ 3,304.80\\n61860\\n61860\\nCraniectomy or craniotomy for implantation of neurostimulator\\nelectrodes, cerebral, cortical\\n$ 4,075.20\\n61863\\n61863\\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\\nimplantation of neurostimulator electrode array in subcortical site\\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\\nperiaqueductal gray), without use of intraoperat\\n$ 3,473.61\\n61864\\n61864\\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\\nimplantation of neurostimulator electrode array in subcortical site\\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\\nperiaqueductal gray), without use of intraoperat\\n$ 1,609.63\\n61867\\n61867\\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\\nimplantation of neurostimulator electrode array in subcortical site\\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\\nperiaqueductal gray), with use of intraoperative\\n$ 5,176.91\\n61868\\n61868\\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\\nimplantation of neurostimulator electrode array in subcortical site\\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\\nperiaqueductal gray), with use of intraoperative\\n$ 2,433.01\\n61870\\n61870\\nCraniectomy for implantation of neurostimulator electrodes,\\ncerebellar; cortical\\n$ 3,723.30\\n61875\\n61875\\nCraniectomy for implantation of neurostimulator electrodes,\\ncerebellar; subcortical\\n$ 3,501.90\\n61880\\n61880\\nRevision or removal of intracranial neurostimulator electrodes\\n$ 2,471.40\\n61885\\n61885\\nInsertion or replacement of cranial neurostimulator pulse generator\\nor receiver, direct or inductive coupling; with connection to a single\\nelectrode array\\n$ 943.20\\n61886\\n61886\\nInsertion or replacement of cranial neurostimulator pulse generator\\nor receiver, direct or inductive coupling; with connection to 2 or\\nmore electrode arrays\\n$ 1,390.50\\n61888\\n61888\\nRevision or removal of cranial neurostimulator pulse generator or\\nreceiver\\n$ 1,009.80\\n62000\\n62000\\nElevation of depressed skull fracture; simple, extradural\\n$ 3,420.00\\n62005\\nElevation of depressed skull fracture; compound or comminuted,\\nextradural\\n$ 4,185.00\\n62010\\n62010\\nElevation of depressed skull fracture; with repair of dura and\/or\\ndebridement of brain\\n$ 5,310.00\\n62100\\n62100\\nCraniotomy for repair of dural\/cerebrospinal fluid leak, including\\nsurgery for rhinorrhea\/otorrhea\\n$ 5,804.10\\n62115\\n62115\\nReduction of craniomegalic skull (eg, treated hydrocephalus); not\\nrequiring bone grafts or cranioplasty\\n$ 2,946.76\\n62116\\n62116\\nReduction of craniomegalic skull (eg, treated hydrocephalus); with\\nsimple cranioplasty\\n$ 4,497.88\\n62117\\n62117\\nReduction of craniomegalic skull (eg, treated hydrocephalus);\\nrequiring craniotomy and reconstruction with or without bone graft\\n(includes obtaining grafts)\\n$ 4,892.40\\n62120\\n62120\\nRepair of encephalocele, skull vault, including cranioplasty\\n$ 4,874.40\\n62121\\n62121\\nCraniotomy for repair of encephalocele, skull base\\n$ 4,878.00\\n62140\\n62140\\nCranioplasty for skull defect; up to 5 cm diameter\\n$ 4,598.10\\n62141\\n62141\\nCranioplasty for skull defect; larger than 5 cm diameter\\n$ 4,816.80\\n62142\\n62142\\nRemoval of bone flap or prosthetic plate of skull\\n$ 3,197.70\\n62143\\n62143\\nReplacement of bone flap or prosthetic plate of skull\\n$ 3,862.80\\n62145\\n62145\\nCranioplasty for skull defect with reparative brain surgery\\n$ 4,948.20\\n62146\\n62146\\nCranioplasty with autograft (includes obtaining bone grafts); up to 5\\ncm diameter\\n$ 4,377.60\\n62147\\n62147\\nCranioplasty with autograft (includes obtaining bone grafts); larger\\nthan 5 cm diameter\\n$ 4,841.10\\n62148\\n62148\\nIncision and retrieval of subcutaneous cranial bone graft for\\ncranioplasty (List separately in addition to code for primary\\nprocedure)\\n$ 445.59\\n62160\\nNeuroendoscopy, intracranial, for placement or replacement of\\nventricular catheter and attachment to shunt system or external\\ndrainage (List separately in addition to code for primary procedure)\\n$ 479.08\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n293\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n294\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n62161\\nNeuroendoscopy, intracranial; with dissection of adhesions,\\nfenestration of septum pellucidum or intraventricular cysts\\n(including placement, replacement, or removal of ventricular\\ncatheter)\\n$ 5,992.94\\n62162\\nNeuroendoscopy, intracranial; with fenestration or excision of\\ncolloid cyst, including placement of external ventricular catheter for\\ndrainage\\n$ 6,085.95\\n62163\\nNeuroendoscopy, intracranial; with retrieval of foreign body\\n$ 6,926.90\\n62164\\nNeuroendoscopy, intracranial; with excision of brain tumor,\\nincluding placement of external ventricular catheter for drainage\\n$ 7,165.41\\n62165\\nNeuroendoscopy, intracranial; with excision of pituitary tumor,\\ntransnasal or trans-sphenoidal approach\\n$ 6,442.36\\n62180\\nVentriculocisternostomy (Torkildsen type operation)\\n$ 4,006.80\\n62190\\nCreation of shunt; subarachnoid\/subdural-atrial, -jugular, -auricular\\n$ 3,469.50\\n62192\\nCreation of shunt; subarachnoid\/subdural-peritoneal, -pleural,\\nother terminus\\n$ 3,523.50\\n62194\\nReplacement or irrigation, subarachnoid\/subdural catheter\\n$ 1,296.90\\n62200\\nVentriculocisternostomy, third ventricle;\\n$ 4,726.80\\n62201\\nVentriculocisternostomy, third ventricle; stereotactic,\\nneuroendoscopic method\\n$ 4,996.62\\n62220\\nCreation of shunt; ventriculo-atrial, -jugular, -auricular\\n$ 4,307.40\\n62223\\nCreation of shunt; ventriculo-peritoneal, -pleural, other terminus\\n$ 4,331.70\\n62225\\nReplacement or irrigation, ventricular catheter\\n$ 1,852.20\\n62230\\nReplacement or revision of cerebrospinal fluid shunt, obstructed\\nvalve, or distal catheter in shunt system\\n$ 3,162.60\\n62252\\n62252\\nReprogramming of programmable cerebrospinal shunt\\n$ 236.70\\n62252-26 26\\n62252\\nReprogramming of programmable cerebrospinal shunt\\n$ 122.96\\n62252-TC TC\\n62252\\nReprogramming of programmable cerebrospinal shunt\\n$ 113.74\\n62256\\nRemoval of complete cerebrospinal fluid shunt system; without\\nreplacement\\n$ 1,863.00\\n62258\\nRemoval of complete cerebrospinal fluid shunt system; with\\nreplacement by similar or other shunt at same operation\\n$ 4,531.50\\n62263\\n62263\\nPercutaneous lysis of epidural adhesions using solution injection\\n(eg, hypertonic saline, enzyme) or mechanical means (eg, catheter)\\nincluding radiologic localization (includes contrast when\\nadministered), multiple adhesiolysis sessions; 2 or more days\\n$ 1,090.80\\n62264\\n62264\\nPercutaneous lysis of epidural adhesions using solution injection\\n(eg, hypertonic saline, enzyme) or mechanical means (eg, catheter)\\nincluding radiologic localization (includes contrast when\\nadministered), multiple adhesiolysis sessions; 1 day\\n$ 1,042.86\\n62267\\nPercutaneous aspiration within the nucleus pulposus, intervertebral\\ndisc, or paravertebral tissue for diagnostic purposes\\n$ 816.24\\n62268\\nPercutaneous aspiration, spinal cord cyst or syrinx\\n$ 1,906.20\\n62269\\nBiopsy of spinal cord, percutaneous needle\\n$ 1,579.50\\n62270\\n62270\\nSpinal puncture, lumbar, diagnostic\\n$ 215.10\\n62272\\n62272\\nSpinal puncture, therapeutic, for drainage of cerebrospinal fluid (by\\nneedle or catheter)\\n$ 283.50\\n62273\\n62273\\nInjection, epidural, of blood or clot patch\\n$ 512.10\\n62280\\nInjection\/infusion of neurolytic substance (eg, alcohol, phenol, iced\\nsaline solutions), with or without other therapeutic substance;\\nsubarachnoid\\n$ 483.30\\n62281\\nInjection\/infusion of neurolytic substance (eg, alcohol, phenol, iced\\nsaline solutions), with or without other therapeutic substance;\\nepidural, cervical or thoracic\\n$ 566.10\\n62282\\nInjection\/infusion of neurolytic substance (eg, alcohol, phenol, iced\\nsaline solutions), with or without other therapeutic substance;\\nepidural, lumbar, sacral (caudal)\\n$ 636.30\\n62284\\n62284\\nInjection procedure for myelography and\/or computed\\ntomography, spinal (other than C1-C2 and posterior fossa)\\n$ 522.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n295\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n296\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n62287\\nDecompression procedure, percutaneous, of nucleus pulposus of\\nintervertebral disc, any method utilizing needle based technique to\\nremove disc material under fluoroscopic imaging or other form of\\nindirect visualization, with the use of an endoscope, with d\\n$ 3,543.30\\n62290\\n62290\\nInjection procedure for discography, each level; lumbar\\n$ 551.70\\n62291\\n62291\\nInjection procedure for discography, each level; cervical or thoracic\\n$ 524.70\\n62292\\n62292\\nInjection procedure for chemonucleolysis, including discography,\\nintervertebral disc, single or multiple levels, lumbar\\n$ 2,452.50\\n62294\\n62294\\nInjection procedure, arterial, for occlusion of arteriovenous\\nmalformation, spinal\\n$ 1,232.10\\n62310\\n62310\\nInjection(s), of diagnostic or therapeutic substance(s) (including\\nanesthetic, antispasmodic, opioid, steroid, other solution), not\\nincluding neurolytic substances, including needle or catheter\\nplacement, includes contrast for localization when performed,\\n$ 875.70\\n62311\\nInjection(s), of diagnostic or therapeutic substance(s) (including\\nanesthetic, antispasmodic, opioid, steroid, other solution), not\\nincluding neurolytic substances, including needle or catheter\\nplacement, includes contrast for localization when performed,\\n$ 933.30\\n62318\\n62318\\nInjection(s), including indwelling catheter placement, continuous\\ninfusion or intermittent bolus, of diagnostic or therapeutic\\nsubstance(s) (including anesthetic, antispasmodic, opioid, steroid,\\nother solution), not including neurolytic substances, includ\\n$ 968.40\\n62319\\n62319\\nInjection(s), including indwelling catheter placement, continuous\\ninfusion or intermittent bolus, of diagnostic or therapeutic\\nsubstance(s) (including anesthetic, antispasmodic, opioid, steroid,\\nother solution), not including neurolytic substances, includ\\n$ 942.30\\n62350\\n62350\\nImplantation, revision or repositioning of tunneled intrathecal or\\nepidural catheter, for long-term medication administration via an\\nexternal pump or implantable reservoir\/infusion pump; without\\nlaminectomy\\n$ 1,545.30\\n62351\\n62351\\nImplantation, revision or repositioning of tunneled intrathecal or\\nepidural catheter, for long-term medication administration via an\\nexternal pump or implantable reservoir\/infusion pump; with\\nlaminectomy\\n$ 2,763.90\\n62355\\n62355\\nRemoval of previously implanted intrathecal or epidural catheter\\n$ 1,368.00\\n62360\\n62360\\nImplantation or replacement of device for intrathecal or epidural\\ndrug infusion; subcutaneous reservoir\\n$ 566.10\\n62361\\nImplantation or replacement of device for intrathecal or epidural\\ndrug infusion; nonprogrammable pump\\n$ 1,849.28\\n62362\\n62362\\nImplantation or replacement of device for intrathecal or epidural\\ndrug infusion; programmable pump, including preparation of pump,\\nwith or without programming\\n$ 1,653.30\\n62365\\n62365\\nRemoval of subcutaneous reservoir or pump, previously implanted\\nfor intrathecal or epidural infusion\\n$ 1,313.10\\n62367\\n62367\\nElectronic analysis of programmable, implanted pump for\\nintrathecal or epidural drug infusion (includes evaluation of\\nreservoir status, alarm status, drug prescription status); without\\nreprogramming or refill\\n$ 103.05\\n62368\\n62368\\nElectronic analysis of programmable, implanted pump for\\nintrathecal or epidural drug infusion (includes evaluation of\\nreservoir status, alarm status, drug prescription status); with\\nreprogramming\\n$ 136.97\\n63001\\n63001\\nLaminectomy with exploration and\/or decompression of spinal cord\\nand\/or cauda equina, without facetectomy, foraminotomy or\\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical\\n$ 4,944.60\\n63003\\n63003\\nLaminectomy with exploration and\/or decompression of spinal cord\\nand\/or cauda equina, without facetectomy, foraminotomy or\\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic\\n$ 5,364.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n297\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n298\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n63005\\n63005\\nLaminectomy with exploration and\/or decompression of spinal cord\\nand\/or cauda equina, without facetectomy, foraminotomy or\\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar,\\nexcept for spondylolisthesis\\n$ 4,862.70\\n63011\\n63011\\nLaminectomy with exploration and\/or decompression of spinal cord\\nand\/or cauda equina, without facetectomy, foraminotomy or\\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral\\n$ 4,583.70\\n63012\\n63012\\nLaminectomy with removal of abnormal facets and\/or pars inter-\\narticularis with decompression of cauda equina and nerve roots for\\nspondylolisthesis, lumbar (Gill type procedure)\\n$ 4,892.40\\n63015\\n63015\\nLaminectomy with exploration and\/or decompression of spinal cord\\nand\/or cauda equina, without facetectomy, foraminotomy or\\ndiscectomy (eg, spinal stenosis), more than 2 vertebral segments;\\ncervical\\n$ 6,095.70\\n63016\\n63016\\nLaminectomy with exploration and\/or decompression of spinal cord\\nand\/or cauda equina, without facetectomy, foraminotomy or\\ndiscectomy (eg, spinal stenosis), more than 2 vertebral segments;\\nthoracic\\n$ 5,768.10\\n63017\\n63017\\nLaminectomy with exploration and\/or decompression of spinal cord\\nand\/or cauda equina, without facetectomy, foraminotomy or\\ndiscectomy (eg, spinal stenosis), more than 2 vertebral segments;\\nlumbar\\n$ 5,402.70\\n63020\\n63020\\nLaminotomy (hemilaminectomy), with decompression of nerve\\nroot(s), including partial facetectomy, foraminotomy and\/or\\nexcision of herniated intervertebral disc; 1 interspace, cervical\\n$ 4,932.00\\n63030\\n63030\\nLaminotomy (hemilaminectomy), with decompression of nerve\\nroot(s), including partial facetectomy, foraminotomy and\/or\\nexcision of herniated intervertebral disc; 1 interspace, lumbar\\n$ 5,275.80\\n63035\\n63035\\nLaminotomy (hemilaminectomy), with decompression of nerve\\nroot(s), including partial facetectomy, foraminotomy and\/or\\nexcision of herniated intervertebral disc; each additional interspace,\\ncervical or lumbar (List separately in addition to code for primar\\n$ 1,433.70\\n63040\\n63040\\nLaminotomy (hemilaminectomy), with decompression of nerve\\nroot(s), including partial facetectomy, foraminotomy and\/or\\nexcision of herniated intervertebral disc, reexploration, single\\ninterspace; cervical\\n$ 5,602.50\\n63042\\n63042\\nLaminotomy (hemilaminectomy), with decompression of nerve\\nroot(s), including partial facetectomy, foraminotomy and\/or\\nexcision of herniated intervertebral disc, reexploration, single\\ninterspace; lumbar\\n$ 6,077.70\\n63043\\nLaminotomy (hemilaminectomy), with decompression of nerve\\nroot(s), including partial facetectomy, foraminotomy and\/or\\nexcision of herniated intervertebral disc, reexploration, single\\ninterspace; each additional cervical interspace (List separately in\\naddi\\n$ 304.43\\n63044\\n63044\\nLaminotomy (hemilaminectomy), with decompression of nerve\\nroot(s), including partial facetectomy, foraminotomy and\/or\\nexcision of herniated intervertebral disc, reexploration, single\\ninterspace; each additional lumbar interspace (List separately in\\nadditi\\n$ -\\n63045\\n63045\\nLaminectomy, facetectomy and foraminotomy (unilateral or\\nbilateral with decompression of spinal cord, cauda equina and\/or\\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\\nsegment; cervical\\n$ 5,896.80\\n63046\\n63046\\nLaminectomy, facetectomy and foraminotomy (unilateral or\\nbilateral with decompression of spinal cord, cauda equina and\/or\\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\\nsegment; thoracic\\n$ 5,850.90\\n63047\\n63047\\nLaminectomy, facetectomy and foraminotomy (unilateral or\\nbilateral with decompression of spinal cord, cauda equina and\/or\\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\\nsegment; lumbar\\n$ 6,197.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n299\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n300\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n63048\\n63048\\nLaminectomy, facetectomy and foraminotomy (unilateral or\\nbilateral with decompression of spinal cord, cauda equina and\/or\\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\\nsegment; each additional segment, cervical, thoracic, or lu\\n$ 2,574.90\\n63050\\nLaminoplasty, cervical, with decompression of the spinal cord, 2 or\\nmore vertebral segments;\\n$ 5,247.21\\n63051\\nLaminoplasty, cervical, with decompression of the spinal cord, 2 or\\nmore vertebral segments; with reconstruction of the posterior bony\\nelements (including the application of bridging bone graft and non-\\nsegmental fixation devices [eg, wire, suture, mini-pl\\n$ 5,950.77\\n63055\\n63055\\nTranspedicular approach with decompression of spinal cord, equina\\nand\/or nerve root(s) (eg, herniated intervertebral disc), single\\nsegment; thoracic\\n$ 6,694.20\\n63056\\n63056\\nTranspedicular approach with decompression of spinal cord, equina\\nand\/or nerve root(s) (eg, herniated intervertebral disc), single\\nsegment; lumbar (including transfacet, or lateral extraforaminal\\napproach) (eg, far lateral herniated intervertebral disc)\\n$ 5,550.30\\n63057\\n63057\\nTranspedicular approach with decompression of spinal cord, equina\\nand\/or nerve root(s) (eg, herniated intervertebral disc), single\\nsegment; each additional segment, thoracic or lumbar (List\\nseparately in addition to code for primary procedure)\\n$ 1,699.20\\n63064\\n63064\\nCostovertebral approach with decompression of spinal cord or\\nnerve root(s) (eg, herniated intervertebral disc), thoracic; single\\nsegment\\n$ 5,833.80\\n63066\\n63066\\nCostovertebral approach with decompression of spinal cord or\\nnerve root(s) (eg, herniated intervertebral disc), thoracic; each\\nadditional segment (List separately in addition to code for primary\\nprocedure)\\n$ 1,287.90\\n63075\\n63075\\nDiscectomy, anterior, with decompression of spinal cord and\/or\\nnerve root(s), including osteophytectomy; cervical, single interspace $ 5,081.40\\n63076\\n63076\\nDiscectomy, anterior, with decompression of spinal cord and\/or\\nnerve root(s), including osteophytectomy; cervical, each additional\\ninterspace (List separately in addition to code for primary\\nprocedure)\\n$ 1,952.10\\n63077\\n63077\\nDiscectomy, anterior, with decompression of spinal cord and\/or\\nnerve root(s), including osteophytectomy; thoracic, single\\ninterspace\\n$ 4,871.70\\n63078\\n63078\\nDiscectomy, anterior, with decompression of spinal cord and\/or\\nnerve root(s), including osteophytectomy; thoracic, each additional\\ninterspace (List separately in addition to code for primary\\nprocedure)\\n$ 1,342.80\\n63081\\n63081\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, anterior approach with decompression of spinal cord\\nand\/or nerve root(s); cervical, single segment\\n$ 6,626.70\\n63082\\n63082\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, anterior approach with decompression of spinal cord\\nand\/or nerve root(s); cervical, each additional segment (List\\nseparately in addition to code for primary procedure)\\n$ 1,591.20\\n63085\\n63085\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, transthoracic approach with decompression of spinal\\ncord and\/or nerve root(s); thoracic, single segment\\n$ 7,022.70\\n63086\\n63086\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, transthoracic approach with decompression of spinal\\ncord and\/or nerve root(s); thoracic, each additional segment (List\\nseparately in addition to code for primary procedure)\\n$ 1,986.30\\n63087\\n63087\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, combined thoracolumbar approach with decompression\\nof spinal cord, cauda equina or nerve root(s), lower thoracic or\\nlumbar; single segment\\n$ 6,282.90\\n63088\\n63088\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, combined thoracolumbar approach with decompression\\nof spinal cord, cauda equina or nerve root(s), lower thoracic or\\nlumbar; each additional segment (List separately in addition to code\\n$ 1,699.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n301\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n302\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n63090\\n63090\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, transperitoneal or retroperitoneal approach with\\ndecompression of spinal cord, cauda equina or nerve root(s), lower\\nthoracic, lumbar, or sacral; single segment\\n$ 6,551.10\\n63091\\n63091\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, transperitoneal or retroperitoneal approach with\\ndecompression of spinal cord, cauda equina or nerve root(s), lower\\nthoracic, lumbar, or sacral; each additional segment (List separately\\n$ 1,787.40\\n63101\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, lateral extracavitary approach with decompression of\\nspinal cord and\/or nerve root(s) (eg, for tumor or retropulsed bone\\nfragments); thoracic, single segment\\n$ 6,101.26\\n63102\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, lateral extracavitary approach with decompression of\\nspinal cord and\/or nerve root(s) (eg, for tumor or retropulsed bone\\nfragments); lumbar, single segment\\n$ 6,074.85\\n63103\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, lateral extracavitary approach with decompression of\\nspinal cord and\/or nerve root(s) (eg, for tumor or retropulsed bone\\nfragments); thoracic or lumbar, each additional segment (List se\\n$ 1,901.26\\n63170\\n63170\\nLaminectomy with myelotomy (eg, Bischof or DREZ type), cervical,\\nthoracic, or thoracolumbar\\n$ 5,840.10\\n63172\\n63172\\nLaminectomy with drainage of intramedullary cyst\/syrinx; to\\nsubarachnoid space\\n$ 5,694.30\\n63173\\n63173\\nLaminectomy with drainage of intramedullary cyst\/syrinx; to\\nperitoneal or pleural space\\n$ 5,922.90\\n63180\\n63180\\nLaminectomy and section of dentate ligaments, with or without\\ndural graft, cervical; 1 or 2 segments\\n$ 5,348.70\\n63182\\n63182\\nLaminectomy and section of dentate ligaments, with or without\\ndural graft, cervical; more than 2 segments\\n$ 5,603.40\\n63185\\n63185\\nLaminectomy with rhizotomy; 1 or 2 segments\\n$ 4,599.00\\n63190\\n63190\\nLaminectomy with rhizotomy; more than 2 segments\\n$ 5,452.20\\n63191\\n63191\\nLaminectomy with section of spinal accessory nerve\\n$ 3,994.20\\n63194\\n63194\\nLaminectomy with cordotomy, with section of 1 spinothalamic tract,\\n1 stage; cervical\\n$ 4,356.90\\n63195\\n63195\\nLaminectomy with cordotomy, with section of 1 spinothalamic tract,\\n1 stage; thoracic\\n$ 4,849.20\\n63196\\n63196\\nLaminectomy with cordotomy, with section of both spinothalamic\\ntracts, 1 stage; cervical\\n$ 4,980.60\\n63197\\n63197\\nLaminectomy with cordotomy, with section of both spinothalamic\\ntracts, 1 stage; thoracic\\n$ 5,346.00\\n63198\\n63198\\nLaminectomy with cordotomy with section of both spinothalamic\\ntracts, 2 stages within 14 days; cervical\\n$ 5,892.30\\n63199\\n63199\\nLaminectomy with cordotomy with section of both spinothalamic\\ntracts, 2 stages within 14 days; thoracic\\n$ 5,892.30\\n63200\\n63200\\nLaminectomy, with release of tethered spinal cord, lumbar\\n$ 4,874.40\\n63250\\n63250\\nLaminectomy for excision or occlusion of arteriovenous\\nmalformation of spinal cord; cervical\\n$ 6,437.70\\n63251\\n63251\\nLaminectomy for excision or occlusion of arteriovenous\\nmalformation of spinal cord; thoracic\\n$ 6,669.90\\n63252\\n63252\\nLaminectomy for excision or occlusion of arteriovenous\\nmalformation of spinal cord; thoracolumbar\\n$ 7,471.80\\n63265\\n63265\\nLaminectomy for excision or evacuation of intraspinal lesion other\\nthan neoplasm, extradural; cervical\\n$ 5,824.80\\n63266\\n63266\\nLaminectomy for excision or evacuation of intraspinal lesion other\\nthan neoplasm, extradural; thoracic\\n$ 6,412.50\\n63267\\n63267\\nLaminectomy for excision or evacuation of intraspinal lesion other\\nthan neoplasm, extradural; lumbar\\n$ 5,632.20\\n63268\\n63268\\nLaminectomy for excision or evacuation of intraspinal lesion other\\nthan neoplasm, extradural; sacral\\n$ 4,805.10\\n63270\\n63270\\nLaminectomy for excision of intraspinal lesion other than neoplasm,\\nintradural; cervical\\n$ 5,739.30\\n63271\\n63271\\nLaminectomy for excision of intraspinal lesion other than neoplasm,\\nintradural; thoracic\\n$ 5,804.10\\n63272\\n63272\\nLaminectomy for excision of intraspinal lesion other than neoplasm,\\nintradural; lumbar\\n$ 5,796.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n303\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n304\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n63273\\n63273\\nLaminectomy for excision of intraspinal lesion other than neoplasm,\\nintradural; sacral\\n$ 5,023.80\\n63275\\n63275\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nextradural, cervical\\n$ 6,346.80\\n63276\\n63276\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nextradural, thoracic\\n$ 6,246.90\\n63277\\n63277\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nextradural, lumbar\\n$ 5,616.90\\n63278\\n63278\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nextradural, sacral\\n$ 5,306.40\\n63280\\n63280\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nintradural, extramedullary, cervical\\n$ 6,412.50\\n63281\\n63281\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nintradural, extramedullary, thoracic\\n$ 6,556.50\\n63282\\n63282\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nintradural, extramedullary, lumbar\\n$ 6,702.30\\n63283\\n63283\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nintradural, sacral\\n$ 5,282.10\\n63285\\n63285\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nintradural, intramedullary, cervical\\n$ 6,808.50\\n63286\\n63286\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nintradural, intramedullary, thoracic\\n$ 7,128.00\\n63287\\n63287\\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\\nintradural, intramedullary, thoracolumbar\\n$ 7,533.00\\n63290\\n63290\\nLaminectomy for biopsy\/excision of intraspinal neoplasm; combined\\nextradural-intradural lesion, any level\\n$ 7,120.80\\n63295\\nOsteoplastic reconstruction of dorsal spinal elements, following\\nprimary intraspinal procedure (List separately in addition to code\\nfor primary procedure)\\n$ 876.68\\n63300\\n63300\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nextradural, cervical\\n$ 6,033.60\\n63301\\n63301\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nextradural, thoracic by transthoracic approach\\n$ 6,150.60\\n63302\\n63302\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nextradural, thoracic by thoracolumbar approach\\n$ 6,551.10\\n63303\\n63303\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nextradural, lumbar or sacral by transperitoneal or retroperitoneal\\napproach\\n$ 6,489.00\\n63304\\n63304\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nintradural, cervical\\n$ 6,502.50\\n63305\\n63305\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nintradural, thoracic by transthoracic approach\\n$ 6,653.70\\n63306\\n63306\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nintradural, thoracic by thoracolumbar approach\\n$ 6,643.80\\n63307\\n63307\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment;\\nintradural, lumbar or sacral by transperitoneal or retroperitoneal\\napproach\\n$ 7,065.90\\n63308\\n63308\\nVertebral corpectomy (vertebral body resection), partial or\\ncomplete, for excision of intraspinal lesion, single segment; each\\nadditional segment (List separately in addition to codes for single\\nsegment)\\n$ 1,661.40\\n63600\\n63600\\nCreation of lesion of spinal cord by stereotactic method,\\npercutaneous, any modality (including stimulation and\/or\\nrecording)\\n$ 3,244.50\\n63610\\n63610\\nStereotactic stimulation of spinal cord, percutaneous, separate\\nprocedure not followed by other surgery\\n$ 2,502.90\\n63615\\n63615\\nStereotactic biopsy, aspiration, or excision of lesion, spinal cord\\n$ 3,785.40\\n63620\\n63620\\nStereotactic radiosurgery (particle beam, gamma ray, or linear\\naccelerator); 1 spinal lesion\\n$ 1,894.72\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n305\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n306\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n63621\\n63621\\nStereotactic radiosurgery (particle beam, gamma ray, or linear\\naccelerator); each additional spinal lesion (List separately in\\naddition to code for primary procedure)\\n$ 590.80\\n63650\\n63650\\nPercutaneous implantation of neurostimulator electrode array,\\nepidural\\n$ 3,397.50\\n63655\\n63655\\nLaminectomy for implantation of neurostimulator electrodes,\\nplate\/paddle, epidural\\n$ 4,462.20\\n63661\\nRemoval of spinal neurostimulator electrode percutaneous array(s),\\nincluding fluoroscopy, when performed\\n$ 1,863.09\\n63662\\nRemoval of spinal neurostimulator electrode plate\/paddle(s) placed\\nvia laminotomy or laminectomy, including fluoroscopy, when\\nperformed\\n$ 3,176.79\\n63663\\nRevision including replacement, when performed, of spinal\\nneurostimulator electrode percutaneous array(s), including\\nfluoroscopy, when performed\\n$ 2,705.03\\n63664\\nRevision including replacement, when performed, of spinal\\nneurostimulator electrode plate\/paddle(s) placed via laminotomy or\\nlaminectomy, including fluoroscopy, when performed\\n$ 3,472.26\\n63685\\n63685\\nInsertion or replacement of spinal neurostimulator pulse generator\\nor receiver, direct or inductive coupling\\n$ 2,304.90\\n63688\\nRevision or removal of implanted spinal neurostimulator pulse\\ngenerator or receiver\\n$ 1,452.60\\n63700\\n63700\\nRepair of meningocele; less than 5 cm diameter\\n$ 3,715.20\\n63702\\n63702\\nRepair of meningocele; larger than 5 cm diameter\\n$ 3,716.10\\n63704\\n63704\\nRepair of myelomeningocele; less than 5 cm diameter\\n$ 4,053.60\\n63706\\n63706\\nRepair of myelomeningocele; larger than 5 cm diameter\\n$ 4,401.00\\n63707\\n63707\\nRepair of dural\/cerebrospinal fluid leak, not requiring laminectomy\\n$ 4,411.80\\n63709\\n63709\\nRepair of dural\/cerebrospinal fluid leak or pseudomeningocele, with\\nlaminectomy\\n$ 5,055.30\\n63710\\n63710\\nDural graft, spinal\\n$ 4,424.40\\n63740\\n63740\\nCreation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or\\nother; including laminectomy\\n$ 4,424.40\\n63741\\n63741\\nCreation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or\\nother; percutaneous, not requiring laminectomy\\n$ 2,841.30\\n63744\\n63744\\nReplacement, irrigation or revision of lumbosubarachnoid shunt\\n$ 2,214.90\\n63746\\n63746\\nRemoval of entire lumbosubarachnoid shunt system without\\nreplacement\\n$ 1,661.40\\n64400\\nInjection, anesthetic agent; trigeminal nerve, any division or branch\\n$ 369.00\\n64402\\n64402\\nInjection, anesthetic agent; facial nerve\\n$ 243.90\\n64405\\n64405\\nInjection, anesthetic agent; greater occipital nerve\\n$ 242.10\\n64408\\n64408\\nInjection, anesthetic agent; vagus nerve\\n$ 284.40\\n64410\\n64410\\nInjection, anesthetic agent; phrenic nerve\\n$ 250.20\\n64412\\n64412\\nInjection, anesthetic agent; spinal accessory nerve\\n$ 242.10\\n64413\\n64413\\nInjection, anesthetic agent; cervical plexus\\n$ 299.70\\n64415\\n64415\\nInjection, anesthetic agent; brachial plexus, single\\n$ 268.20\\n64416\\n64416\\nInjection, anesthetic agent; brachial plexus, continuous infusion by\\ncatheter (including catheter placement)\\n$ 305.64\\n64417\\n64417\\nInjection, anesthetic agent; axillary nerve\\n$ 250.20\\n64418\\n64418\\nInjection, anesthetic agent; suprascapular nerve\\n$ 274.07\\n64420\\n64420\\nInjection, anesthetic agent; intercostal nerve, single\\n$ 261.90\\n64421\\n64421\\nInjection, anesthetic agent; intercostal nerves, multiple, regional\\nblock\\n$ 486.90\\n64425\\n64425\\nInjection, anesthetic agent; ilioinguinal, iliohypogastric nerves\\n$ 257.40\\n64430\\n64430\\nInjection, anesthetic agent; pudendal nerve\\n$ 261.00\\n64435\\n64435\\nInjection, anesthetic agent; paracervical (uterine) nerve\\n$ 234.90\\n64445\\n64445\\nInjection, anesthetic agent; sciatic nerve, single\\n$ 326.70\\n64446\\n64446\\nInjection, anesthetic agent; sciatic nerve, continuous infusion by\\ncatheter (including catheter placement)\\n$ 305.97\\n64447\\n64447\\nInjection, anesthetic agent; femoral nerve, single\\n$ 228.81\\n64448\\n64448\\nInjection, anesthetic agent; femoral nerve, continuous infusion by\\ncatheter (including catheter placement)\\n$ 275.13\\n64449\\n64449\\nInjection, anesthetic agent; lumbar plexus, posterior approach,\\ncontinuous infusion by catheter (including catheter placement)\\n$ 306.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n307\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n308\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n64450\\n64450\\nInjection, anesthetic agent; other peripheral nerve or branch\\n$ 185.40\\n64455\\n64455\\nInjection(s), anesthetic agent and\/or steroid, plantar common\\ndigital nerve(s) (eg, Morton's neuroma)\\n$ 157.67\\n64479\\n64479\\nInjection(s), anesthetic agent and\/or steroid, transforaminal\\nepidural, with imaging guidance (fluoroscopy or CT); cervical or\\nthoracic, single level\\n$ 485.10\\n64480\\n64480\\nInjection(s), anesthetic agent and\/or steroid, transforaminal\\nepidural, with imaging guidance (fluoroscopy or CT); cervical or\\nthoracic, each additional level (List separately in addition to code for\\nprimary procedure)\\n$ 436.50\\n64483\\n64483\\nInjection(s), anesthetic agent and\/or steroid, transforaminal\\nepidural, with imaging guidance (fluoroscopy or CT); lumbar or\\nsacral, single level\\n$ 398.11\\n64484\\n64484\\nInjection(s), anesthetic agent and\/or steroid, transforaminal\\nepidural, with imaging guidance (fluoroscopy or CT); lumbar or\\nsacral, each additional level (List separately in addition to code for\\nprimary procedure)\\n$ 447.30\\n64490\\n64490\\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\\n(zygapophyseal) joint (or nerves innervating that joint) with image\\nguidance (fluoroscopy or CT), cervical or thoracic; single level\\n$ 404.72\\n64491\\n64491\\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\\n(zygapophyseal) joint (or nerves innervating that joint) with image\\nguidance (fluoroscopy or CT), cervical or thoracic; second level (List\\nseparately in addition to code for primary proced\\n$ 287.25\\n64492\\n64492\\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\\n(zygapophyseal) joint (or nerves innervating that joint) with image\\nguidance (fluoroscopy or CT), cervical or thoracic; third and any\\nadditional level(s) (List separately in addition to co\\n$ 287.36\\n64493\\n64493\\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\\n(zygapophyseal) joint (or nerves innervating that joint) with image\\nguidance (fluoroscopy or CT), lumbar or sacral; single level\\n$ 398.98\\n64494\\n64494\\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\\n(zygapophyseal) joint (or nerves innervating that joint) with image\\nguidance (fluoroscopy or CT), lumbar or sacral; second level (List\\nseparately in addition to code for primary procedure)\\n$ 227.39\\n64495\\n64495\\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\\n(zygapophyseal) joint (or nerves innervating that joint) with image\\nguidance (fluoroscopy or CT), lumbar or sacral; third and any\\nadditional level(s) (List separately in addition to code f\\n$ 227.49\\n64505\\n64505\\nInjection, anesthetic agent; sphenopalatine ganglion\\n$ 244.80\\n64508\\n64508\\nInjection, anesthetic agent; carotid sinus (separate procedure)\\n$ 262.80\\n64510\\n64510\\nInjection, anesthetic agent; stellate ganglion (cervical sympathetic)\\n$ 295.20\\n64517\\n64517\\nInjection, anesthetic agent; superior hypogastric plexus\\n$ 385.18\\n64520\\n64520\\nInjection, anesthetic agent; lumbar or thoracic (paravertebral\\nsympathetic)\\n$ 490.41\\n64530\\n64530\\nInjection, anesthetic agent; celiac plexus, with or without radiologic\\nmonitoring\\n$ 540.90\\n64550\\n64550\\nApplication of surface (transcutaneous) neurostimulator\\n$ 123.54\\n64553\\n64553\\nPercutaneous implantation of neurostimulator electrode array;\\ncranial nerve\\n$ 360.90\\n64555\\n64555\\nPercutaneous implantation of neurostimulator electrode array;\\nperipheral nerve (excludes sacral nerve)\\n$ 309.60\\n64561\\n64561\\nPercutaneous implantation of neurostimulator electrode array;\\nsacral nerve (transforaminal placement) including image guidance,\\nif performed\\n$ 1,611.28\\n64565\\n64565\\nPercutaneous implantation of neurostimulator electrode array;\\nneuromuscular\\n$ 293.40\\n64566\\n64566\\nPosterior tibial neurostimulation, percutaneous needle electrode,\\nsingle treatment, includes programming\\n$ 266.83\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n309\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n310\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n64568\\n64568\\nIncision for implantation of cranial nerve (eg, vagus nerve)\\nneurostimulator electrode array and pulse generator\\n$ 1,127.59\\n64569\\n64569\\nRevision or replacement of cranial nerve (eg, vagus nerve)\\nneurostimulator electrode array, including connection to existing\\npulse generator\\n$ 1,130.12\\n64570\\n64570\\nRemoval of cranial nerve (eg, vagus nerve) neurostimulator\\nelectrode array and pulse generator\\n$ 999.18\\n64575\\n64575\\nIncision for implantation of neurostimulator electrode array;\\nperipheral nerve (excludes sacral nerve)\\n$ 963.90\\n64580\\n64580\\nIncision for implantation of neurostimulator electrode array;\\nneuromuscular\\n$ 793.80\\n64581\\n64581\\nIncision for implantation of neurostimulator electrode array; sacral\\nnerve (transforaminal placement)\\n$ 1,141.09\\n64585\\n64585\\nRevision or removal of peripheral neurostimulator electrode array\\n$ 678.60\\n64590\\n64590\\nInsertion or replacement of peripheral or gastric neurostimulator\\npulse generator or receiver, direct or inductive coupling\\n$ 738.90\\n64595\\n64595\\nRevision or removal of peripheral or gastric neurostimulator pulse\\ngenerator or receiver\\n$ 530.10\\n64600\\n64600\\nDestruction by neurolytic agent, trigeminal nerve; supraorbital,\\ninfraorbital, mental, or inferior alveolar branch\\n$ 540.90\\n64605\\n64605\\nDestruction by neurolytic agent, trigeminal nerve; second and third\\ndivision branches at foramen ovale\\n$ 669.60\\n64610\\n64610\\nDestruction by neurolytic agent, trigeminal nerve; second and third\\ndivision branches at foramen ovale under radiologic monitoring\\n$ 1,837.80\\n64612\\n64612\\nChemodenervation of muscle(s); muscle(s) innervated by facial\\nnerve, unilateral (eg, for blepharospasm, hemifacial spasm)\\n$ 377.10\\n64616\\n64616\\nChemodenervation of muscle(s); neck muscle(s), excluding muscles\\nof the larynx, unilateral (eg, for cervical dystonia, spasmodic\\ntorticollis)\\n$ 202.21\\n64617\\n64617\\nChemodenervation of muscle(s); larynx, unilateral, percutaneous\\n(eg, for spasmodic dysphonia), includes guidance by needle\\nelectromyography, when performed\\n$ 353.99\\n64620\\n64620\\nDestruction by neurolytic agent, intercostal nerve\\n$ 417.60\\n64630\\n64630\\nDestruction by neurolytic agent; pudendal nerve\\n$ 391.50\\n64632\\n64632\\nDestruction by neurolytic agent; plantar common digital nerve\\n$ 278.02\\n64633\\n64633\\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\\nwith imaging guidance (fluoroscopy or CT); cervical or thoracic,\\nsingle facet joint\\n$ 1,004.45\\n64634\\n64634\\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\\nwith imaging guidance (fluoroscopy or CT); cervical or thoracic, each\\nadditional facet joint (List separately in addition to code for primary\\nprocedure)\\n$ 457.76\\n64635\\n64635\\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\\nwith imaging guidance (fluoroscopy or CT); lumbar or sacral, single\\nfacet joint\\n$ 986.15\\n64636\\n64636\\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\\nwith imaging guidance (fluoroscopy or CT); lumbar or sacral, each\\nadditional facet joint (List separately in addition to code for primary\\nprocedure)\\n$ 412.31\\n64640\\n64640\\nDestruction by neurolytic agent; other peripheral nerve or branch\\n$ 394.20\\n64642\\n64642\\nChemodenervation of one extremity; 1-4 muscle(s)\\n$ 353.99\\n64643\\n64643\\nChemodenervation of one extremity; each additional extremity, 1-4\\nmuscle(s) (List separately in addition to code for primary procedure) $ 73.55\\n64644\\n64644\\nChemodenervation of one extremity; 5 or more muscle(s)\\n$ 353.99\\n64645\\n64645\\nChemodenervation of one extremity; each additional extremity, 5\\nor more muscle(s) (List separately in addition to code for primary\\nprocedure)\\n$ 84.31\\n64646\\n64646\\nChemodenervation of trunk muscle(s); 1-5 muscle(s)\\n$ 353.99\\n64647\\n64647\\nChemodenervation of trunk muscle(s); 6 or more muscle(s)\\n$ 353.99\\n64650\\n64650\\nChemodenervation of eccrine glands; both axillae\\n$ 106.28\\n64653\\n64653\\nChemodenervation of eccrine glands; other area(s) (eg, scalp, face,\\nneck), per day\\n$ 139.04\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n311\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n312\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n64680\\n64680\\nDestruction by neurolytic agent, with or without radiologic\\nmonitoring; celiac plexus\\n$ 685.80\\n64681\\n64681\\nDestruction by neurolytic agent, with or without radiologic\\nmonitoring; superior hypogastric plexus\\n$ 734.56\\n64702\\n64702\\nNeuroplasty; digital, 1 or both, same digit\\n$ 1,325.70\\n64704\\n64704\\nNeuroplasty; nerve of hand or foot\\n$ 1,467.90\\n64708\\n64708\\nNeuroplasty, major peripheral nerve, arm or leg, open; other than\\nspecified\\n$ 1,944.90\\n64712\\n64712\\nNeuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve\\n$ 2,121.30\\n64713\\n64713\\nNeuroplasty, major peripheral nerve, arm or leg, open; brachial\\nplexus\\n$ 2,725.20\\n64714\\n64714\\nNeuroplasty, major peripheral nerve, arm or leg, open; lumbar\\nplexus\\n$ 2,422.80\\n64716\\n64716\\nNeuroplasty and\/or transposition; cranial nerve (specify)\\n$ 2,464.20\\n64718\\n64718\\nNeuroplasty and\/or transposition; ulnar nerve at elbow\\n$ 2,523.60\\n64719\\n64719\\nNeuroplasty and\/or transposition; ulnar nerve at wrist\\n$ 1,989.90\\n64721\\n64721\\nNeuroplasty and\/or transposition; median nerve at carpal tunnel\\n$ 1,854.00\\n64722\\n64722\\nDecompression; unspecified nerve(s) (specify)\\n$ 2,050.20\\n64726\\n64726\\nDecompression; plantar digital nerve\\n$ 751.50\\n64727\\n64727\\nInternal neurolysis, requiring use of operating microscope (List\\nseparately in addition to code for neuroplasty) (Neuroplasty\\nincludes external neurolysis)\\n$ 2,111.40\\n64732\\n64732\\nTransection or avulsion of; supraorbital nerve\\n$ 1,287.90\\n64734\\n64734\\nTransection or avulsion of; infraorbital nerve\\n$ 1,476.00\\n64736\\n64736\\nTransection or avulsion of; mental nerve\\n$ 1,255.50\\n64738\\n64738\\nTransection or avulsion of; inferior alveolar nerve by osteotomy\\n$ 1,447.20\\n64740\\n64740\\nTransection or avulsion of; lingual nerve\\n$ 1,586.70\\n64742\\n64742\\nTransection or avulsion of; facial nerve, differential or complete\\n$ 1,668.60\\n64744\\n64744\\nTransection or avulsion of; greater occipital nerve\\n$ 1,597.50\\n64746\\n64746\\nTransection or avulsion of; phrenic nerve\\n$ 803.70\\n64752\\n64752\\nTransection or avulsion of; vagus nerve (vagotomy), transthoracic\\n$ 2,326.50\\n64755\\n64755\\nTransection or avulsion of; vagus nerves limited to proximal\\nstomach (selective proximal vagotomy, proximal gastric vagotomy,\\nparietal cell vagotomy, supra- or highly selective vagotomy)\\n$ 3,316.50\\n64760\\n64760\\nTransection or avulsion of; vagus nerve (vagotomy), abdominal\\n$ 1,964.70\\n64761\\n64761\\nTransection or avulsion of; pudendal nerve\\n$ 855.00\\n64763\\n64763\\nTransection or avulsion of obturator nerve, extrapelvic, with or\\nwithout adductor tenotomy\\n$ 1,021.50\\n64766\\n64766\\nTransection or avulsion of obturator nerve, intrapelvic, with or\\nwithout adductor tenotomy\\n$ 1,606.50\\n64771\\n64771\\nTransection or avulsion of other cranial nerve, extradural\\n$ 1,647.90\\n64772\\n64772\\nTransection or avulsion of other spinal nerve, extradural\\n$ 2,052.90\\n64774\\n64774\\nExcision of neuroma; cutaneous nerve, surgically identifiable\\n$ 922.50\\n64776\\n64776\\nExcision of neuroma; digital nerve, 1 or both, same digit\\n$ 1,074.60\\n64778\\n64778\\nExcision of neuroma; digital nerve, each additional digit (List\\nseparately in addition to code for primary procedure)\\n$ 461.70\\n64782\\n64782\\nExcision of neuroma; hand or foot, except digital nerve\\n$ 1,261.80\\n64783\\n64783\\nExcision of neuroma; hand or foot, each additional nerve, except\\nsame digit (List separately in addition to code for primary\\nprocedure)\\n$ 669.60\\n64784\\n64784\\nExcision of neuroma; major peripheral nerve, except sciatic\\n$ 1,841.40\\n64786\\n64786\\nExcision of neuroma; sciatic nerve\\n$ 2,403.00\\n64787\\n64787\\nImplantation of nerve end into bone or muscle (List separately in\\naddition to neuroma excision)\\n$ 1,390.50\\n64788\\n64788\\nExcision of neurofibroma or neurolemmoma; cutaneous nerve\\n$ 1,159.20\\n64790\\n64790\\nExcision of neurofibroma or neurolemmoma; major peripheral\\nnerve\\n$ 2,151.90\\n64792\\n64792\\nExcision of neurofibroma or neurolemmoma; extensive (including\\nmalignant type)\\n$ 2,224.80\\n64795\\n64795\\nBiopsy of nerve\\n$ 914.40\\n64802\\n64802\\nSympathectomy, cervical\\n$ 2,657.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n313\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n314\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n64804\\n64804\\nSympathectomy, cervicothoracic\\n$ 3,587.40\\n64809\\n64809\\nSympathectomy, thoracolumbar\\n$ 2,945.70\\n64818\\n64818\\nSympathectomy, lumbar\\n$ 2,699.10\\n64820\\n64820\\nSympathectomy; digital arteries, each digit\\n$ 1,219.55\\n64821\\n64821\\nSympathectomy; radial artery\\n$ 1,203.16\\n64822\\n64822\\nSympathectomy; ulnar artery\\n$ 1,201.92\\n64823\\n64823\\nSympathectomy; superficial palmar arch\\n$ 1,223.47\\n64831\\n64831\\nSuture of digital nerve, hand or foot; 1 nerve\\n$ 1,704.60\\n64832\\n64832\\nSuture of digital nerve, hand or foot; each additional digital nerve\\n(List separately in addition to code for primary procedure)\\n$ 927.90\\n64834\\n64834\\nSuture of 1 nerve; hand or foot, common sensory nerve\\n$ 1,899.00\\n64835\\n64835\\nSuture of 1 nerve; median motor thenar\\n$ 1,967.40\\n64836\\n64836\\nSuture of 1 nerve; ulnar motor\\n$ 2,360.70\\n64837\\n64837\\nSuture of each additional nerve, hand or foot (List separately in\\naddition to code for primary procedure)\\n$ 1,134.90\\n64840\\n64840\\nSuture of posterior tibial nerve\\n$ 2,778.30\\n64856\\n64856\\nSuture of major peripheral nerve, arm or leg, except sciatic;\\nincluding transposition\\n$ 2,831.40\\n64857\\n64857\\nSuture of major peripheral nerve, arm or leg, except sciatic; without\\ntransposition\\n$ 2,518.20\\n64858\\n64858\\nSuture of sciatic nerve\\n$ 2,503.80\\n64859\\n64859\\nSuture of each additional major peripheral nerve (List separately in\\naddition to code for primary procedure)\\n$ 1,147.50\\n64861\\n64861\\nSuture of; brachial plexus\\n$ 2,703.60\\n64862\\n64862\\nSuture of; lumbar plexus\\n$ 3,292.20\\n64864\\n64864\\nSuture of facial nerve; extracranial\\n$ 2,355.30\\n64865\\n64865\\nSuture of facial nerve; infratemporal, with or without grafting\\n$ 3,441.60\\n64866\\n64866\\nAnastomosis; facial-spinal accessory\\n$ 3,690.90\\n64868\\n64868\\nAnastomosis; facial-hypoglossal\\n$ 4,108.50\\n64870\\n64870\\nAnastomosis; facial-phrenic\\n$ 3,644.10\\n64872\\n64872\\nSuture of nerve; requiring secondary or delayed suture (List\\nseparately in addition to code for primary neurorrhaphy)\\n$ 1,768.50\\n64874\\n64874\\nSuture of nerve; requiring extensive mobilization, or transposition\\nof nerve (List separately in addition to code for nerve suture)\\n$ 2,524.50\\n64876\\n64876\\nSuture of nerve; requiring shortening of bone of extremity (List\\nseparately in addition to code for nerve suture)\\n$ 441.19\\n64885\\nNerve graft (includes obtaining graft), head or neck; up to 4 cm in\\nlength\\n$ 3,759.30\\n64886\\nNerve graft (includes obtaining graft), head or neck; more than 4 cm\\nlength\\n$ 3,234.60\\n64890\\nNerve graft (includes obtaining graft), single strand, hand or foot;\\nup to 4 cm length\\n$ 3,495.60\\n64891\\nNerve graft (includes obtaining graft), single strand, hand or foot;\\nmore than 4 cm length\\n$ 2,845.80\\n64892\\nNerve graft (includes obtaining graft), single strand, arm or leg; up\\nto 4 cm length\\n$ 2,796.30\\n64893\\nNerve graft (includes obtaining graft), single strand, arm or leg;\\nmore than 4 cm length\\n$ 3,074.40\\n64895\\nNerve graft (includes obtaining graft), multiple strands (cable), hand\\nor foot; up to 4 cm length\\n$ 3,388.50\\n64896\\nNerve graft (includes obtaining graft), multiple strands (cable), hand\\nor foot; more than 4 cm length\\n$ 3,841.20\\n64897\\nNerve graft (includes obtaining graft), multiple strands (cable), arm\\nor leg; up to 4 cm length\\n$ 3,540.60\\n64898\\nNerve graft (includes obtaining graft), multiple strands (cable), arm\\nor leg; more than 4 cm length\\n$ 3,940.20\\n64901\\nNerve graft, each additional nerve; single strand (List separately in\\naddition to code for primary procedure)\\n$ 2,362.50\\n64902\\n64902\\nNerve graft, each additional nerve; multiple strands (cable) (List\\nseparately in addition to code for primary procedure)\\n$ 2,455.20\\n64905\\nNerve pedicle transfer; first stage\\n$ 2,021.40\\n64907\\nNerve pedicle transfer; second stage\\n$ 2,226.60\\n64910\\nNerve repair; with synthetic conduit or vein allograft (eg, nerve\\ntube), each nerve\\n$ 1,599.15\\n64911\\nNerve repair; with autogenous vein graft (includes harvest of vein\\ngraft), each nerve\\n$ 1,901.18\\n64999\\n64999\\nUnlisted procedure, nervous system\\n$ 468.58\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n315\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n316\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n65091\\n65091\\nEvisceration of ocular contents; without implant\\n$ 1,363.50\\n65093\\n65093\\nEvisceration of ocular contents; with implant\\n$ 1,705.50\\n65101\\n65101\\nEnucleation of eye; without implant\\n$ 2,083.44\\n65103\\n65103\\nEnucleation of eye; with implant, muscles not attached to implant\\n$ 1,895.40\\n65105\\n65105\\nEnucleation of eye; with implant, muscles attached to implant\\n$ 2,379.60\\n65110\\n65110\\nExenteration of orbit (does not include skin graft), removal of\\norbital contents; only\\n$ 3,046.50\\n65112\\n65112\\nExenteration of orbit (does not include skin graft), removal of\\norbital contents; with therapeutic removal of bone\\n$ 3,127.50\\n65114\\n65114\\nExenteration of orbit (does not include skin graft), removal of\\norbital contents; with muscle or myocutaneous flap\\n$ 3,379.50\\n65125\\n65125\\nModification of ocular implant with placement or replacement of\\npegs (eg, drilling receptacle for prosthesis appendage) (separate\\nprocedure)\\n$ 772.20\\n65130\\n65130\\nInsertion of ocular implant secondary; after evisceration, in scleral\\nshell\\n$ 1,467.90\\n65135\\n65135\\nInsertion of ocular implant secondary; after enucleation, muscles\\nnot attached to implant\\n$ 1,566.00\\n65140\\n65140\\nInsertion of ocular implant secondary; after enucleation, muscles\\nattached to implant\\n$ 2,068.20\\n65150\\n65150\\nReinsertion of ocular implant; with or without conjunctival graft\\n$ 1,441.80\\n65155\\n65155\\nReinsertion of ocular implant; with use of foreign material for\\nreinforcement and\/or attachment of muscles to implant\\n$ 1,653.30\\n65175\\n65175\\nRemoval of ocular implant\\n$ 1,166.40\\n65205\\n65205\\nRemoval of foreign body, external eye; conjunctival superficial\\n$ 116.74\\n65210\\n65210\\nRemoval of foreign body, external eye; conjunctival embedded\\n(includes concretions), subconjunctival, or scleral nonperforating\\n$ 131.60\\n65220\\n65220\\nRemoval of foreign body, external eye; corneal, without slit lamp\\n$ 112.50\\n65222\\n65222\\nRemoval of foreign body, external eye; corneal, with slit lamp\\n$ 163.91\\n65235\\n65235\\nRemoval of foreign body, intraocular; from anterior chamber of eye\\nor lens\\n$ 1,715.40\\n65260\\n65260\\nRemoval of foreign body, intraocular; from posterior segment,\\nmagnetic extraction, anterior or posterior route\\n$ 1,864.80\\n65265\\n65265\\nRemoval of foreign body, intraocular; from posterior segment,\\nnonmagnetic extraction\\n$ 2,199.60\\n65270\\n65270\\nRepair of laceration; conjunctiva, with or without nonperforating\\nlaceration sclera, direct closure\\n$ 275.02\\n65272\\n65272\\nRepair of laceration; conjunctiva, by mobilization and\\nrearrangement, without hospitalization\\n$ 494.10\\n65273\\n65273\\nRepair of laceration; conjunctiva, by mobilization and\\nrearrangement, with hospitalization\\n$ 726.30\\n65275\\n65275\\nRepair of laceration; cornea, nonperforating, with or without\\nremoval foreign body\\n$ 821.70\\n65280\\n65280\\nRepair of laceration; cornea and\/or sclera, perforating, not involving\\nuveal tissue\\n$ 2,082.60\\n65285\\n65285\\nRepair of laceration; cornea and\/or sclera, perforating, with\\nreposition or resection of uveal tissue\\n$ 3,026.69\\n65286\\n65286\\nRepair of laceration; application of tissue glue, wounds of cornea\\nand\/or sclera\\n$ 927.00\\n65290\\n65290\\nRepair of wound, extraocular muscle, tendon and\/or Tenon's\\ncapsule\\n$ 1,153.80\\n65400\\n65400\\nExcision of lesion, cornea (keratectomy, lamellar, partial), except\\npterygium\\n$ 1,133.10\\n65410\\n65410\\nBiopsy of cornea\\n$ 466.20\\n65420\\n65420\\nExcision or transposition of pterygium; without graft\\n$ 944.78\\n65426\\n65426\\nExcision or transposition of pterygium; with graft\\n$ 1,369.33\\n65430\\n65430\\nScraping of cornea, diagnostic, for smear and\/or culture\\n$ 122.40\\n65435\\n65435\\nRemoval of corneal epithelium; with or without chemocauterization\\n(abrasion, curettage)\\n$ 157.50\\n65436\\n65436\\nRemoval of corneal epithelium; with application of chelating agent\\n(eg, EDTA)\\n$ 463.50\\n65450\\n65450\\nDestruction of lesion of cornea by cryotherapy, photocoagulation or\\nthermocauterization\\n$ 483.30\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n317\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n318\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n65600\\n65600\\nMultiple punctures of anterior cornea (eg, for corneal erosion,\\ntattoo)\\n$ 817.20\\n65710\\n65710\\nKeratoplasty (corneal transplant); anterior lamellar\\n$ 3,068.10\\n65730\\n65730\\nKeratoplasty (corneal transplant); penetrating (except in aphakia or\\npseudophakia)\\n$ 3,759.30\\n65750\\n65750\\nKeratoplasty (corneal transplant); penetrating (in aphakia)\\n$ 3,811.50\\n65755\\n65755\\nKeratoplasty (corneal transplant); penetrating (in pseudophakia)\\n$ 3,698.10\\n65756\\n65756\\nKeratoplasty (corneal transplant); endothelial\\n$ 2,478.45\\n65757\\n65757\\nBackbench preparation of corneal endothelial allograft prior to\\ntransplantation (List separately in addition to code for primary\\nprocedure)\\n$ -\\n65760\\n65760\\nKeratomileusis\\n$ 3,709.80\\n65765\\n65765\\nKeratophakia\\n$ 3,844.80\\n65767\\n65767\\nEpikeratoplasty\\n$ 3,079.80\\n65770\\n65770\\nKeratoprosthesis\\n$ 3,605.40\\n65771\\n65771\\nRadial keratotomy\\n$ 1,617.30\\n65772\\n65772\\nCorneal relaxing incision for correction of surgically induced\\nastigmatism\\n$ 1,199.70\\n65775\\n65775\\nCorneal wedge resection for correction of surgically induced\\nastigmatism\\n$ 1,380.60\\n65780\\n65780\\nOcular surface reconstruction; amniotic membrane transplantation,\\nmultiple layers\\n$ 1,555.66\\n65781\\n65781\\nOcular surface reconstruction; limbal stem cell allograft (eg,\\ncadaveric or living donor)\\n$ 2,458.31\\n65782\\n65782\\nOcular surface reconstruction; limbal conjunctival autograft\\n(includes obtaining graft)\\n$ 1,989.88\\n65800\\n65800\\nParacentesis of anterior chamber of eye (separate procedure); with\\nremoval of aqueous\\n$ 360.90\\n65810\\n65810\\nParacentesis of anterior chamber of eye (separate procedure); with\\nremoval of vitreous and\/or discission of anterior hyaloid membrane,\\nwith or without air injection\\n$ 1,247.40\\n65815\\n65815\\nParacentesis of anterior chamber of eye (separate procedure); with\\nremoval of blood, with or without irrigation and\/or air injection\\n$ 1,110.60\\n65820\\n65820\\nGoniotomy\\n$ 1,758.60\\n65850\\n65850\\nTrabeculotomy ab externo\\n$ 2,154.60\\n65855\\n65855\\nTrabeculoplasty by laser surgery, 1 or more sessions (defined\\ntreatment series)\\n$ 1,647.90\\n65860\\n65860\\nSevering adhesions of anterior segment, laser technique (separate\\nprocedure)\\n$ 1,277.10\\n65865\\n65865\\nSevering adhesions of anterior segment of eye, incisional technique\\n(with or without injection of air or liquid) (separate procedure);\\ngoniosynechiae\\n$ 1,256.40\\n65870\\n65870\\nSevering adhesions of anterior segment of eye, incisional technique\\n(with or without injection of air or liquid) (separate procedure);\\nanterior synechiae, except goniosynechiae\\n$ 1,376.10\\n65875\\n65875\\nSevering adhesions of anterior segment of eye, incisional technique\\n(with or without injection of air or liquid) (separate procedure);\\nposterior synechiae\\n$ 1,417.50\\n65880\\n65880\\nSevering adhesions of anterior segment of eye, incisional technique\\n(with or without injection of air or liquid) (separate procedure);\\ncorneovitreal adhesions\\n$ 1,403.10\\n65900\\n65900\\nRemoval of epithelial downgrowth, anterior chamber of eye\\n$ 1,668.60\\n65920\\n65920\\nRemoval of implanted material, anterior segment of eye\\n$ 1,873.17\\n65930\\n65930\\nRemoval of blood clot, anterior segment of eye\\n$ 1,298.70\\n66020\\n66020\\nInjection, anterior chamber of eye (separate procedure); air or\\nliquid\\n$ 360.90\\n66030\\n66030\\nInjection, anterior chamber of eye (separate procedure); medication $ 232.20\\n66130\\n66130\\nExcision of lesion, sclera\\n$ 1,153.80\\n66150\\n66150\\nFistulization of sclera for glaucoma; trephination with iridectomy\\n$ 1,913.40\\n66155\\n66155\\nFistulization of sclera for glaucoma; thermocauterization with\\niridectomy\\n$ 1,854.00\\n66160\\n66160\\nFistulization of sclera for glaucoma; sclerectomy with punch or\\nscissors, with iridectomy\\n$ 1,874.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n319\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n320\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n66165\\n66165\\nFistulization of sclera for glaucoma; iridencleisis or iridotasis\\n$ 1,788.30\\n66170\\n66170\\nFistulization of sclera for glaucoma; trabeculectomy ab externo in\\nabsence of previous surgery\\n$ 2,064.60\\n66172\\n66172\\nFistulization of sclera for glaucoma; trabeculectomy ab externo with\\nscarring from previous ocular surgery or trauma (includes injection\\nof antifibrotic agents)\\n$ 2,304.00\\n66180\\n66180\\nAqueous shunt to extraocular reservoir (eg, Molteno, Schocket,\\nDenver-Krupin)\\n$ 2,621.70\\n66185\\n66185\\nRevision of aqueous shunt to extraocular reservoir\\n$ 1,754.10\\n66220\\n66220\\nRepair of scleral staphyloma; without graft\\n$ 2,317.50\\n66225\\n66225\\nRepair of scleral staphyloma; with graft\\n$ 3,115.80\\n66250\\n66250\\nRevision or repair of operative wound of anterior segment, any\\ntype, early or late, major or minor procedure\\n$ 1,555.20\\n66500\\n66500\\nIridotomy by stab incision (separate procedure); except transfixion\\n$ 891.00\\n66505\\n66505\\nIridotomy by stab incision (separate procedure); with transfixion as\\nfor iris bombe\\n$ 844.20\\n66600\\n66600\\nIridectomy, with corneoscleral or corneal section; for removal of\\nlesion\\n$ 1,434.60\\n66605\\n66605\\nIridectomy, with corneoscleral or corneal section; with cyclectomy\\n$ 2,086.20\\n66625\\n66625\\nIridectomy, with corneoscleral or corneal section; peripheral for\\nglaucoma (separate procedure)\\n$ 1,401.30\\n66630\\n66630\\nIridectomy, with corneoscleral or corneal section; sector for\\nglaucoma (separate procedure)\\n$ 1,356.30\\n66635\\n66635\\nIridectomy, with corneoscleral or corneal section; optical (separate\\nprocedure)\\n$ 1,356.30\\n66680\\n66680\\nRepair of iris, ciliary body (as for iridodialysis)\\n$ 1,522.80\\n66682\\n66682\\nSuture of iris, ciliary body (separate procedure) with retrieval of\\nsuture through small incision (eg, McCannel suture)\\n$ 1,645.20\\n66700\\n66700\\nCiliary body destruction; diathermy\\n$ 1,231.20\\n66710\\n66710\\nCiliary body destruction; cyclophotocoagulation, transscleral\\n$ 1,313.10\\n66711\\n66711\\nCiliary body destruction; cyclophotocoagulation, endoscopic\\n$ 1,283.69\\n66720\\n66720\\nCiliary body destruction; cryotherapy\\n$ 1,313.10\\n66740\\n66740\\nCiliary body destruction; cyclodialysis\\n$ 1,275.30\\n66761\\n66761\\nIridotomy\/iridectomy by laser surgery (eg, for glaucoma) (per\\nsession)\\n$ 1,380.60\\n66762\\n66762\\nIridoplasty by photocoagulation (1 or more sessions) (eg, for\\nimprovement of vision, for widening of anterior chamber angle)\\n$ 1,241.10\\n66770\\n66770\\nDestruction of cyst or lesion iris or ciliary body (nonexcisional\\nprocedure)\\n$ 1,347.30\\n66820\\n66820\\nDiscission of secondary membranous cataract (opacified posterior\\nlens capsule and\/or anterior hyaloid); stab incision technique\\n(Ziegler or Wheeler knife)\\n$ 1,007.10\\n66821\\n66821\\nDiscission of secondary membranous cataract (opacified posterior\\nlens capsule and\/or anterior hyaloid); laser surgery (eg, YAG laser)\\n(1 or more stages)\\n$ 1,117.54\\n66825\\n66825\\nRepositioning of intraocular lens prosthesis, requiring an incision\\n(separate procedure)\\n$ 1,701.90\\n66830\\n66830\\nRemoval of secondary membranous cataract (opacified posterior\\nlens capsule and\/or anterior hyaloid) with corneo-scleral section,\\nwith or without iridectomy (iridocapsulotomy, iridocapsulectomy)\\n$ 1,787.40\\n66840\\n66840\\nRemoval of lens material; aspiration technique, 1 or more stages\\n$ 2,086.20\\n66850\\n66850\\nRemoval of lens material; phacofragmentation technique\\n(mechanical or ultrasonic) (eg, phacoemulsification), with aspiration\\n$ 2,266.20\\n66852\\n66852\\nRemoval of lens material; pars plana approach, with or without\\nvitrectomy\\n$ 2,191.50\\n66920\\n66920\\nRemoval of lens material; intracapsular\\n$ 2,442.60\\n66930\\n66930\\nRemoval of lens material; intracapsular, for dislocated lens\\n$ 2,337.30\\n66940\\n66940\\nRemoval of lens material; extracapsular (other than 66840, 66850,\\n66852)\\n$ 2,358.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n321\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n322\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n66982\\n66982\\nExtracapsular cataract removal with insertion of intraocular lens\\nprosthesis (1-stage procedure), manual or mechanical technique\\n(eg, irrigation and aspiration or phacoemulsification), complex,\\nrequiring devices or techniques not generally used in routine\\n$ 2,692.80\\n66983\\n66983\\nIntracapsular cataract extraction with insertion of intraocular lens\\nprosthesis (1 stage procedure)\\n$ 2,913.30\\n66984\\n66984\\nExtracapsular cataract removal with insertion of intraocular lens\\nprosthesis (1 stage procedure), manual or mechanical technique\\n(eg, irrigation and aspiration or phacoemulsification)\\n$ 2,961.00\\n66985\\n66985\\nInsertion of intraocular lens prosthesis (secondary implant), not\\nassociated with concurrent cataract removal\\n$ 2,276.10\\n66986\\n66986\\nExchange of intraocular lens\\n$ 2,513.70\\n66990\\n66990\\nUse of ophthalmic endoscope (List separately in addition to code for\\nprimary procedure)\\n$ 208.58\\n66999\\n66999\\nUnlisted procedure, anterior segment of eye\\nCost\\n67005\\n67005\\nRemoval of vitreous, anterior approach (open sky technique or\\nlimbal incision); partial removal\\n$ 2,368.80\\n67010\\n67010\\nRemoval of vitreous, anterior approach (open sky technique or\\nlimbal incision); subtotal removal with mechanical vitrectomy\\n$ 3,078.00\\n67015\\n67015\\nAspiration or release of vitreous, subretinal or choroidal fluid, pars\\nplana approach (posterior sclerotomy)\\n$ 1,328.40\\n67025\\n67025\\nInjection of vitreous substitute, pars plana or limbal approach (fluid-\\ngas exchange), with or without aspiration (separate procedure)\\n$ 1,447.20\\n67027\\n67027\\nImplantation of intravitreal drug delivery system (eg, ganciclovir\\nimplant), includes concomitant removal of vitreous\\n$ 2,884.50\\n67028\\n67028\\nIntravitreal injection of a pharmacologic agent (separate procedure) $ 677.70\\n67030\\n67030\\nDiscission of vitreous strands (without removal), pars plana\\napproach\\n$ 1,555.20\\n67031\\n67031\\nSevering of vitreous strands, vitreous face adhesions, sheets,\\nmembranes or opacities, laser surgery (1 or more stages)\\n$ 1,725.30\\n67036\\n67036\\nVitrectomy, mechanical, pars plana approach;\\n$ 3,816.00\\n67039\\n67039\\nVitrectomy, mechanical, pars plana approach; with focal endolaser\\nphotocoagulation\\n$ 4,336.20\\n67040\\n67040\\nVitrectomy, mechanical, pars plana approach; with endolaser\\npanretinal photocoagulation\\n$ 4,686.30\\n67041\\n67041\\nVitrectomy, mechanical, pars plana approach; with removal of\\npreretinal cellular membrane (eg, macular pucker)\\n$ 3,643.85\\n67042\\n67042\\nVitrectomy, mechanical, pars plana approach; with removal of\\ninternal limiting membrane of retina (eg, for repair of macular hole,\\ndiabetic macular edema), includes, if performed, intraocular\\ntamponade (ie, air, gas or silicone oil)\\n$ 4,430.03\\n67043\\n67043\\nVitrectomy, mechanical, pars plana approach; with removal of\\nsubretinal membrane (eg, choroidal neovascularization), includes, if\\nperformed, intraocular tamponade (ie, air, gas or silicone oil) and\\nlaser photocoagulation\\n$ 4,581.88\\n67101\\n67101\\nRepair of retinal detachment, 1 or more sessions; cryotherapy or\\ndiathermy, with or without drainage of subretinal fluid\\n$ 2,293.20\\n67105\\n67105\\nRepair of retinal detachment, 1 or more sessions; photocoagulation,\\nwith or without drainage of subretinal fluid\\n$ 2,421.00\\n67107\\n67107\\nRepair of retinal detachment; scleral buckling (such as lamellar\\nscleral dissection, imbrication or encircling procedure), with or\\nwithout implant, with or without cryotherapy, photocoagulation,\\nand drainage of subretinal fluid\\n$ 3,351.60\\n67108\\n67108\\nRepair of retinal detachment; with vitrectomy, any method, with or\\nwithout air or gas tamponade, focal endolaser photocoagulation,\\ncryotherapy, drainage of subretinal fluid, scleral buckling, and\/or\\nremoval of lens by same technique\\n$ 4,954.50\\n67110\\n67110\\nRepair of retinal detachment; by injection of air or other gas (eg,\\npneumatic retinopexy)\\n$ 2,899.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n323\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n324\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n67112\\n67112\\nRepair of retinal detachment; by scleral buckling or vitrectomy, on\\npatient having previous ipsilateral retinal detachment repair(s)\\nusing scleral buckling or vitrectomy techniques\\n$ 3,100.50\\n67113\\n67113\\nRepair of complex retinal detachment (eg, proliferative\\nvitreoretinopathy, stage C-1 or greater, diabetic traction retinal\\ndetachment, retinopathy of prematurity, retinal tear of greater than\\n90 degrees), with vitrectomy and membrane peeling, may include\\n$ 4,729.72\\n67115\\n67115\\nRelease of encircling material (posterior segment)\\n$ 1,184.40\\n67120\\n67120\\nRemoval of implanted material, posterior segment; extraocular\\n$ 1,269.90\\n67121\\n67121\\nRemoval of implanted material, posterior segment; intraocular\\n$ 1,663.20\\n67141\\n67141\\nProphylaxis of retinal detachment (eg, retinal break, lattice\\ndegeneration) without drainage, 1 or more sessions; cryotherapy,\\ndiathermy\\n$ 1,359.90\\n67145\\n67145\\nProphylaxis of retinal detachment (eg, retinal break, lattice\\ndegeneration) without drainage, 1 or more sessions;\\nphotocoagulation (laser or xenon arc)\\n$ 1,518.03\\n67208\\n67208\\nDestruction of localized lesion of retina (eg, macular edema,\\ntumors), 1 or more sessions; cryotherapy, diathermy\\n$ 1,661.40\\n67210\\n67210\\nDestruction of localized lesion of retina (eg, macular edema,\\ntumors), 1 or more sessions; photocoagulation\\n$ 1,524.43\\n67218\\n67218\\nDestruction of localized lesion of retina (eg, macular edema,\\ntumors), 1 or more sessions; radiation by implantation of source\\n(includes removal of source)\\n$ 2,276.10\\n67220\\n67220\\nDestruction of localized lesion of choroid (eg, choroidal\\nneovascularization); photocoagulation (eg, laser), 1 or more\\nsessions\\n$ 1,760.40\\n67221\\n67221\\nDestruction of localized lesion of choroid (eg, choroidal\\nneovascularization); photodynamic therapy (includes intravenous\\ninfusion)\\n$ 1,009.80\\n67225\\n67225\\nDestruction of localized lesion of choroid (eg, choroidal\\nneovascularization); photodynamic therapy, second eye, at single\\nsession (List separately in addition to code for primary eye\\ntreatment)\\n$ 424.48\\n67227\\n67227\\nDestruction of extensive or progressive retinopathy (eg, diabetic\\nretinopathy), 1 or more sessions, cryotherapy, diathermy\\n$ 1,713.60\\n67228\\n67228\\nTreatment of extensive or progressive retinopathy, 1 or more\\nsessions; (eg, diabetic retinopathy), photocoagulation\\n$ 1,702.39\\n67229\\n67229\\nTreatment of extensive or progressive retinopathy, 1 or more\\nsessions; preterm infant (less than 37 weeks gestation at birth),\\nperformed from birth up to 1 year of age (eg, retinopathy of\\nprematurity), photocoagulation or cryotherapy\\n$ 1,631.69\\n67250\\n67250\\nScleral reinforcement (separate procedure); without graft\\n$ 1,955.70\\n67255\\n67255\\nScleral reinforcement (separate procedure); with graft\\n$ 2,400.30\\n67299\\n67299\\nUnlisted procedure, posterior segment\\nCost\\n67311\\n67311\\nStrabismus surgery, recession or resection procedure; 1 horizontal\\nmuscle\\n$ 1,532.70\\n67312\\n67312\\nStrabismus surgery, recession or resection procedure; 2 horizontal\\nmuscles\\n$ 2,008.80\\n67314\\n67314\\nStrabismus surgery, recession or resection procedure; 1 vertical\\nmuscle (excluding superior oblique)\\n$ 1,854.00\\n67316\\n67316\\nStrabismus surgery, recession or resection procedure; 2 or more\\nvertical muscles (excluding superior oblique)\\n$ 2,276.10\\n67318\\n67318\\nStrabismus surgery, any procedure, superior oblique muscle\\n$ 2,106.90\\n67320\\n67320\\nTransposition procedure (eg, for paretic extraocular muscle), any\\nextraocular muscle (specify) (List separately in addition to code for\\nprimary procedure)\\n$ 2,286.90\\n67331\\n67331\\nStrabismus surgery on patient with previous eye surgery or injury\\nthat did not involve the extraocular muscles (List separately in\\naddition to code for primary procedure)\\n$ 1,467.90\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n325\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n326\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n67332\\n67332\\nStrabismus surgery on patient with scarring of extraocular muscles\\n(eg, prior ocular injury, strabismus or retinal detachment surgery)\\nor restrictive myopathy (eg, dysthyroid ophthalmopathy) (List\\nseparately in addition to code for primary procedure)\\n$ 2,152.80\\n67334\\n67334\\nStrabismus surgery by posterior fixation suture technique, with or\\nwithout muscle recession (List separately in addition to code for\\nprimary procedure)\\n$ 1,441.80\\n67335\\n67335\\nPlacement of adjustable suture(s) during strabismus surgery,\\nincluding postoperative adjustment(s) of suture(s) (List separately in\\naddition to code for specific strabismus surgery)\\n$ 720.90\\n67340\\n67340\\nStrabismus surgery involving exploration and\/or repair of detached\\nextraocular muscle(s) (List separately in addition to code for\\nprimary procedure)\\n$ 1,802.70\\n67343\\n67343\\nRelease of extensive scar tissue without detaching extraocular\\nmuscle (separate procedure)\\n$ 1,390.50\\n67345\\n67345\\nChemodenervation of extraocular muscle\\n$ 539.10\\n67346\\n67346\\nBiopsy of extraocular muscle\\n$ 544.18\\n67399\\n67399\\nUnlisted procedure, ocular muscle\\nCost\\n67400\\n67400\\nOrbitotomy without bone flap (frontal or transconjunctival\\napproach); for exploration, with or without biopsy\\n$ 2,160.00\\n67405\\n67405\\nOrbitotomy without bone flap (frontal or transconjunctival\\napproach); with drainage only\\n$ 1,980.90\\n67412\\n67412\\nOrbitotomy without bone flap (frontal or transconjunctival\\napproach); with removal of lesion\\n$ 2,352.60\\n67413\\n67413\\nOrbitotomy without bone flap (frontal or transconjunctival\\napproach); with removal of foreign body\\n$ 2,716.20\\n67414\\n67414\\nOrbitotomy without bone flap (frontal or transconjunctival\\napproach); with removal of bone for decompression\\n$ 2,228.40\\n67415\\n67415\\nFine needle aspiration of orbital contents\\n$ 437.40\\n67420\\n67420\\nOrbitotomy with bone flap or window, lateral approach (eg,\\nKroenlein); with removal of lesion\\n$ 3,352.50\\n67430\\n67430\\nOrbitotomy with bone flap or window, lateral approach (eg,\\nKroenlein); with removal of foreign body\\n$ 2,887.20\\n67440\\n67440\\nOrbitotomy with bone flap or window, lateral approach (eg,\\nKroenlein); with drainage\\n$ 3,031.20\\n67445\\n67445\\nOrbitotomy with bone flap or window, lateral approach (eg,\\nKroenlein); with removal of bone for decompression\\n$ 2,722.50\\n67450\\n67450\\nOrbitotomy with bone flap or window, lateral approach (eg,\\nKroenlein); for exploration, with or without biopsy\\n$ 2,966.40\\n67500\\n67500\\nRetrobulbar injection; medication (separate procedure, does not\\ninclude supply of medication)\\n$ 175.50\\n67505\\n67505\\nRetrobulbar injection; alcohol\\n$ 280.80\\n67515\\n67515\\nInjection of medication or other substance into Tenon's capsule\\n$ 139.50\\n67550\\n67550\\nOrbital implant (implant outside muscle cone); insertion\\n$ 1,802.70\\n67560\\n67560\\nOrbital implant (implant outside muscle cone); removal or revision\\n$ 1,784.70\\n67570\\n67570\\nOptic nerve decompression (eg, incision or fenestration of optic\\nnerve sheath)\\n$ 2,440.80\\n67599\\n67599\\nUnlisted procedure, orbit\\nCost\\n67700\\n67700\\nBlepharotomy, drainage of abscess, eyelid\\n$ 184.47\\n67710\\n67710\\nSevering of tarsorrhaphy\\n$ 311.40\\n67715\\n67715\\nCanthotomy (separate procedure)\\n$ 366.30\\n67800\\n67800\\nExcision of chalazion; single\\n$ 218.88\\n67801\\n67801\\nExcision of chalazion; multiple, same lid\\n$ 304.59\\n67805\\n67805\\nExcision of chalazion; multiple, different lids\\n$ 356.44\\n67808\\n67808\\nExcision of chalazion; under general anesthesia and\/or requiring\\nhospitalization, single or multiple\\n$ 565.20\\n67810\\n67810\\nIncisional biopsy of eyelid skin including lid margin\\n$ 250.20\\n67820\\n67820\\nCorrection of trichiasis; epilation, by forceps only\\n$ 94.99\\n67825\\n67825\\nCorrection of trichiasis; epilation by other than forceps (eg, by\\nelectrosurgery, cryotherapy, laser surgery)\\n$ 178.20\\n67830\\n67830\\nCorrection of trichiasis; incision of lid margin\\n$ 503.10\\n67835\\n67835\\nCorrection of trichiasis; incision of lid margin, with free mucous\\nmembrane graft\\n$ 1,691.10\\n67840\\n67840\\nExcision of lesion of eyelid (except chalazion) without closure or\\nwith simple direct closure\\n$ 353.47\\n67850\\n67850\\nDestruction of lesion of lid margin (up to 1 cm)\\n$ 252.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n327\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n328\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n67875\\n67875\\nTemporary closure of eyelids by suture (eg, Frost suture)\\n$ 442.80\\n67880\\n67880\\nConstruction of intermarginal adhesions, median tarsorrhaphy, or\\ncanthorrhaphy;\\n$ 864.00\\n67882\\n67882\\nConstruction of intermarginal adhesions, median tarsorrhaphy, or\\ncanthorrhaphy; with transposition of tarsal plate\\n$ 1,364.40\\n67900\\n67900\\nRepair of brow ptosis (supraciliary, mid-forehead or coronal\\napproach)\\n$ 1,399.50\\n67901\\n67901\\nRepair of blepharoptosis; frontalis muscle technique with suture or\\nother material (eg, banked fascia)\\n$ 2,169.00\\n67902\\n67902\\nRepair of blepharoptosis; frontalis muscle technique with\\nautologous fascial sling (includes obtaining fascia)\\n$ 2,372.40\\n67903\\n67903\\nRepair of blepharoptosis; (tarso) levator resection or advancement,\\ninternal approach\\n$ 2,374.20\\n67904\\n67904\\nRepair of blepharoptosis; (tarso) levator resection or advancement,\\nexternal approach\\n$ 2,879.10\\n67906\\n67906\\nRepair of blepharoptosis; superior rectus technique with fascial sling\\n(includes obtaining fascia)\\n$ 2,122.20\\n67908\\n67908\\nRepair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator\\nresection (eg, Fasanella-Servat type)\\n$ 1,909.80\\n67909\\n67909\\nReduction of overcorrection of ptosis\\n$ 1,689.30\\n67911\\n67911\\nCorrection of lid retraction\\n$ 2,162.70\\n67912\\n67912\\nCorrection of lagophthalmos, with implantation of upper eyelid lid\\nload (eg, gold weight)\\n$ 2,145.90\\n67914\\n67914\\nRepair of ectropion; suture\\n$ 977.40\\n67915\\n67915\\nRepair of ectropion; thermocauterization\\n$ 483.30\\n67916\\n67916\\nRepair of ectropion; excision tarsal wedge\\n$ 1,341.90\\n67917\\n67917\\nRepair of ectropion; extensive (eg, tarsal strip operations)\\n$ 1,854.00\\n67921\\n67921\\nRepair of entropion; suture\\n$ 769.50\\n67922\\n67922\\nRepair of entropion; thermocauterization\\n$ 378.90\\n67923\\n67923\\nRepair of entropion; excision tarsal wedge\\n$ 1,467.90\\n67924\\n67924\\nRepair of entropion; extensive (eg, tarsal strip or capsulopalpebral\\nfascia repairs operation)\\n$ 1,857.60\\n67930\\n67930\\nSuture of recent wound, eyelid, involving lid margin, tarsus, and\/or\\npalpebral conjunctiva direct closure; partial thickness\\n$ 949.50\\n67935\\n67935\\nSuture of recent wound, eyelid, involving lid margin, tarsus, and\/or\\npalpebral conjunctiva direct closure; full thickness\\n$ 1,545.30\\n67938\\n67938\\nRemoval of embedded foreign body, eyelid\\n$ 222.30\\n67950\\n67950\\nCanthoplasty (reconstruction of canthus)\\n$ 1,822.50\\n67961\\n67961\\nExcision and repair of eyelid, involving lid margin, tarsus,\\nconjunctiva, canthus, or full thickness, may include preparation for\\nskin graft or pedicle flap with adjacent tissue transfer or\\nrearrangement; up to one-fourth of lid margin\\n$ 2,062.80\\n67966\\n67966\\nExcision and repair of eyelid, involving lid margin, tarsus,\\nconjunctiva, canthus, or full thickness, may include preparation for\\nskin graft or pedicle flap with adjacent tissue transfer or\\nrearrangement; over one-fourth of lid margin\\n$ 2,368.80\\n67971\\n67971\\nReconstruction of eyelid, full thickness by transfer of\\ntarsoconjunctival flap from opposing eyelid; up to two-thirds of\\neyelid, 1 stage or first stage\\n$ 2,272.50\\n67973\\n67973\\nReconstruction of eyelid, full thickness by transfer of\\ntarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1\\nstage or first stage\\n$ 3,181.50\\n67974\\n67974\\nReconstruction of eyelid, full thickness by transfer of\\ntarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1\\nstage or first stage\\n$ 3,420.90\\n67975\\n67975\\nReconstruction of eyelid, full thickness by transfer of\\ntarsoconjunctival flap from opposing eyelid; second stage\\n$ 1,535.40\\n67999\\n67999\\nUnlisted procedure, eyelids\\nCost\\n68020\\n68020\\nIncision of conjunctiva, drainage of cyst\\n$ 166.30\\n68040\\n68040\\nExpression of conjunctival follicles (eg, for trachoma)\\n$ 128.70\\n68100\\n68100\\nBiopsy of conjunctiva\\n$ 187.20\\n68110\\n68110\\nExcision of lesion, conjunctiva; up to 1 cm\\n$ 365.72\\n68115\\n68115\\nExcision of lesion, conjunctiva; over 1 cm\\n$ 454.50\\n68130\\n68130\\nExcision of lesion, conjunctiva; with adjacent sclera\\n$ 813.60\\n68135\\n68135\\nDestruction of lesion, conjunctiva\\n$ 247.50\\n68200\\n68200\\nSubconjunctival injection\\n$ 178.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n329\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n330\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n68320\\n68320\\nConjunctivoplasty; with conjunctival graft or extensive\\nrearrangement\\n$ 1,654.20\\n68325\\n68325\\nConjunctivoplasty; with buccal mucous membrane graft (includes\\nobtaining graft)\\n$ 2,090.70\\n68326\\n68326\\nConjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft\\nor extensive rearrangement\\n$ 2,130.30\\n68328\\n68328\\nConjunctivoplasty, reconstruction cul-de-sac; with buccal mucous\\nmembrane graft (includes obtaining graft)\\n$ 2,104.20\\n68330\\n68330\\nRepair of symblepharon; conjunctivoplasty, without graft\\n$ 1,292.40\\n68335\\n68335\\nRepair of symblepharon; with free graft conjunctiva or buccal\\nmucous membrane (includes obtaining graft)\\n$ 1,466.10\\n68340\\n68340\\nRepair of symblepharon; division of symblepharon, with or without\\ninsertion of conformer or contact lens\\n$ 1,123.20\\n68360\\n68360\\nConjunctival flap; bridge or partial (separate procedure)\\n$ 978.30\\n68362\\n68362\\nConjunctival flap; total (such as Gunderson thin flap or purse string\\nflap)\\n$ 1,544.40\\n68371\\n68371\\nHarvesting conjunctival allograft, living donor\\n$ 817.41\\n68399\\n68399\\nUnlisted procedure, conjunctiva\\nCost\\n68400\\n68400\\nIncision, drainage of lacrimal gland\\n$ 301.50\\n68420\\n68420\\nIncision, drainage of lacrimal sac (dacryocystotomy or\\ndacryocystostomy)\\n$ 362.70\\n68440\\n68440\\nSnip incision of lacrimal punctum\\n$ 276.30\\n68500\\n68500\\nExcision of lacrimal gland (dacryoadenectomy), except for tumor;\\ntotal\\n$ 1,859.40\\n68505\\n68505\\nExcision of lacrimal gland (dacryoadenectomy), except for tumor;\\npartial\\n$ 1,574.10\\n68510\\n68510\\nBiopsy of lacrimal gland\\n$ 674.10\\n68520\\n68520\\nExcision of lacrimal sac (dacryocystectomy)\\n$ 1,632.60\\n68525\\n68525\\nBiopsy of lacrimal sac\\n$ 518.40\\n68530\\n68530\\nRemoval of foreign body or dacryolith, lacrimal passages\\n$ 947.70\\n68540\\n68540\\nExcision of lacrimal gland tumor; frontal approach\\n$ 2,062.80\\n68550\\n68550\\nExcision of lacrimal gland tumor; involving osteotomy\\n$ 2,482.20\\n68700\\n68700\\nPlastic repair of canaliculi\\n$ 1,694.70\\n68705\\n68705\\nCorrection of everted punctum, cautery\\n$ 265.50\\n68720\\n68720\\nDacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)\\n$ 2,123.10\\n68745\\n68745\\nConjunctivorhinostomy (fistulization of conjunctiva to nasal cavity);\\nwithout tube\\n$ 2,060.10\\n68750\\n68750\\nConjunctivorhinostomy (fistulization of conjunctiva to nasal cavity);\\nwith insertion of tube or stent\\n$ 2,332.80\\n68760\\n68760\\nClosure of the lacrimal punctum; by thermocauterization, ligation,\\nor laser surgery\\n$ 283.50\\n68761\\n68761\\nClosure of the lacrimal punctum; by plug, each\\n$ 256.50\\n68770\\n68770\\nClosure of lacrimal fistula (separate procedure)\\n$ 925.20\\n68801\\n68801\\nDilation of lacrimal punctum, with or without irrigation\\n$ 136.80\\n68810\\n68810\\nProbing of nasolacrimal duct, with or without irrigation;\\n$ 195.30\\n68811\\n68811\\nProbing of nasolacrimal duct, with or without irrigation; requiring\\ngeneral anesthesia\\n$ 422.10\\n68815\\n68815\\nProbing of nasolacrimal duct, with or without irrigation; with\\ninsertion of tube or stent\\n$ 532.80\\n68816\\n68816\\nProbing of nasolacrimal duct, with or without irrigation; with\\ntransluminal balloon catheter dilation\\n$ 1,322.33\\n68840\\n68840\\nProbing of lacrimal canaliculi, with or without irrigation\\n$ 178.20\\n68850\\n68850\\nInjection of contrast medium for dacryocystography\\n$ 170.10\\n68899\\n68899\\nUnlisted procedure, lacrimal system\\nCost\\n69000\\n69000\\nDrainage external ear, abscess or hematoma; simple\\n$ 190.80\\n69005\\n69005\\nDrainage external ear, abscess or hematoma; complicated\\n$ 526.50\\n69020\\n69020\\nDrainage external auditory canal, abscess\\n$ 200.70\\n69090\\n69090\\nEar piercing\\n$ 105.30\\n69100\\n69100\\nBiopsy external ear\\n$ 164.70\\n69105\\n69105\\nBiopsy external auditory canal\\n$ 234.90\\n69110\\n69110\\nExcision external ear; partial, simple repair\\n$ 848.70\\n69120\\n69120\\nExcision external ear; complete amputation\\n$ 1,729.80\\n69140\\n69140\\nExcision exostosis(es), external auditory canal\\n$ 1,996.20\\n69145\\n69145\\nExcision soft tissue lesion, external auditory canal\\n$ 643.50\\n69150\\n69150\\nRadical excision external auditory canal lesion; without neck\\ndissection\\n$ 2,611.80\\n69155\\n69155\\nRadical excision external auditory canal lesion; with neck dissection\\n$ 4,492.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n331\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n332\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n69200\\n69200\\nRemoval foreign body from external auditory canal; without general\\nanesthesia\\n$ 128.70\\n69205\\n69205\\nRemoval foreign body from external auditory canal; with general\\nanesthesia\\n$ 525.89\\n69210\\n69210\\nRemoval impacted cerumen requiring instrumentation, unilateral\\n$ 64.34\\n69220\\n69220\\nDebridement, mastoidectomy cavity, simple (eg, routine cleaning)\\n$ 104.73\\n69222\\n69222\\nDebridement, mastoidectomy cavity, complex (eg, with anesthesia\\nor more than routine cleaning)\\n$ 315.90\\n69300\\n69300\\nOtoplasty, protruding ear, with or without size reduction\\n$ 2,126.70\\n69310\\n69310\\nReconstruction of external auditory canal (meatoplasty) (eg, for\\nstenosis due to injury, infection) (separate procedure)\\n$ 3,252.60\\n69320\\n69320\\nReconstruction external auditory canal for congenital atresia, single\\nstage\\n$ 3,473.10\\n69399\\n69399\\nUnlisted procedure, external ear\\nCost\\n69400\\n69400\\nEustachian tube inflation, transnasal; with catheterization\\n$ 144.90\\n69401\\n69401\\nEustachian tube inflation, transnasal; without catheterization\\n$ 108.90\\n69405\\n69405\\nEustachian tube catheterization, transtympanic\\n$ 154.80\\n69420\\n69420\\nMyringotomy including aspiration and\/or eustachian tube inflation\\n$ 268.20\\n69421\\n69421\\nMyringotomy including aspiration and\/or eustachian tube inflation\\nrequiring general anesthesia\\n$ 380.70\\n69424\\n69424\\nVentilating tube removal requiring general anesthesia\\n$ 226.80\\n69433\\n69433\\nTympanostomy (requiring insertion of ventilating tube), local or\\ntopical anesthesia\\n$ 426.42\\n69436\\n69436\\nTympanostomy (requiring insertion of ventilating tube), general\\nanesthesia\\n$ 621.90\\n69440\\n69440\\nMiddle ear exploration through postauricular or ear canal incision\\n$ 2,028.60\\n69450\\n69450\\nTympanolysis, transcanal\\n$ 2,083.50\\n69501\\n69501\\nTransmastoid antrotomy (simple mastoidectomy)\\n$ 2,442.60\\n69502\\n69502\\nMastoidectomy; complete\\n$ 3,323.70\\n69505\\n69505\\nMastoidectomy; modified radical\\n$ 3,462.30\\n69511\\n69511\\nMastoidectomy; radical\\n$ 3,429.00\\n69530\\n69530\\nPetrous apicectomy including radical mastoidectomy\\n$ 4,139.10\\n69535\\n69535\\nResection temporal bone, external approach\\n$ 6,341.40\\n69540\\n69540\\nExcision aural polyp\\n$ 322.20\\n69550\\n69550\\nExcision aural glomus tumor; transcanal\\n$ 3,636.90\\n69552\\n69552\\nExcision aural glomus tumor; transmastoid\\n$ 4,195.80\\n69554\\n69554\\nExcision aural glomus tumor; extended (extratemporal)\\n$ 5,842.80\\n69601\\n69601\\nRevision mastoidectomy; resulting in complete mastoidectomy\\n$ 3,073.50\\n69602\\n69602\\nRevision mastoidectomy; resulting in modified radical\\nmastoidectomy\\n$ 3,607.20\\n69603\\n69603\\nRevision mastoidectomy; resulting in radical mastoidectomy\\n$ 3,481.20\\n69604\\n69604\\nRevision mastoidectomy; resulting in tympanoplasty\\n$ 3,876.30\\n69605\\n69605\\nRevision mastoidectomy; with apicectomy\\n$ 3,746.70\\n69610\\n69610\\nTympanic membrane repair, with or without site preparation of\\nperforation for closure, with or without patch\\n$ 432.90\\n69620\\n69620\\nMyringoplasty (surgery confined to drumhead and donor area)\\n$ 2,461.50\\n69631\\n69631\\nTympanoplasty without mastoidectomy (including canalplasty,\\natticotomy and\/or middle ear surgery), initial or revision; without\\nossicular chain reconstruction\\n$ 3,134.70\\n69632\\n69632\\nTympanoplasty without mastoidectomy (including canalplasty,\\natticotomy and\/or middle ear surgery), initial or revision; with\\nossicular chain reconstruction (eg, postfenestration)\\n$ 3,681.00\\n69633\\n69633\\nTympanoplasty without mastoidectomy (including canalplasty,\\natticotomy and\/or middle ear surgery), initial or revision; with\\nossicular chain reconstruction and synthetic prosthesis (eg, partial\\nossicular replacement prosthesis [PORP], total ossicular repl\\n$ 3,594.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n333\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n334\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n69635\\n69635\\nTympanoplasty with antrotomy or mastoidotomy (including\\ncanalplasty, atticotomy, middle ear surgery, and\/or tympanic\\nmembrane repair); without ossicular chain reconstruction\\n$ 3,904.20\\n69636\\n69636\\nTympanoplasty with antrotomy or mastoidotomy (including\\ncanalplasty, atticotomy, middle ear surgery, and\/or tympanic\\nmembrane repair); with ossicular chain reconstruction\\n$ 4,133.70\\n69637\\n69637\\nTympanoplasty with antrotomy or mastoidotomy (including\\ncanalplasty, atticotomy, middle ear surgery, and\/or tympanic\\nmembrane repair); with ossicular chain reconstruction and synthetic\\nprosthesis (eg, partial ossicular replacement prosthesis [PORP], total $ 4,131.90\\n69641\\n69641\\nTympanoplasty with mastoidectomy (including canalplasty, middle\\near surgery, tympanic membrane repair); without ossicular chain\\nreconstruction\\n$ 3,818.70\\n69642\\n69642\\nTympanoplasty with mastoidectomy (including canalplasty, middle\\near surgery, tympanic membrane repair); with ossicular chain\\nreconstruction\\n$ 4,161.60\\n69643\\n69643\\nTympanoplasty with mastoidectomy (including canalplasty, middle\\near surgery, tympanic membrane repair); with intact or\\nreconstructed wall, without ossicular chain reconstruction\\n$ 4,333.50\\n69644\\n69644\\nTympanoplasty with mastoidectomy (including canalplasty, middle\\near surgery, tympanic membrane repair); with intact or\\nreconstructed canal wall, with ossicular chain reconstruction\\n$ 4,814.10\\n69645\\n69645\\nTympanoplasty with mastoidectomy (including canalplasty, middle\\near surgery, tympanic membrane repair); radical or complete,\\nwithout ossicular chain reconstruction\\n$ 4,619.70\\n69646\\n69646\\nTympanoplasty with mastoidectomy (including canalplasty, middle\\near surgery, tympanic membrane repair); radical or complete, with\\nossicular chain reconstruction\\n$ 5,045.40\\n69650\\n69650\\nStapes mobilization\\n$ 2,429.10\\n69660\\n69660\\nStapedectomy or stapedotomy with reestablishment of ossicular\\ncontinuity, with or without use of foreign material;\\n$ 3,344.40\\n69661\\n69661\\nStapedectomy or stapedotomy with reestablishment of ossicular\\ncontinuity, with or without use of foreign material; with footplate\\ndrill out\\n$ 3,737.70\\n69662\\n69662\\nRevision of stapedectomy or stapedotomy\\n$ 4,239.90\\n69666\\n69666\\nRepair oval window fistula\\n$ 3,217.50\\n69667\\n69667\\nRepair round window fistula\\n$ 3,156.30\\n69670\\n69670\\nMastoid obliteration (separate procedure)\\n$ 3,295.80\\n69676\\n69676\\nTympanic neurectomy\\n$ 2,268.90\\n69700\\n69700\\nClosure postauricular fistula, mastoid (separate procedure)\\n$ 1,625.40\\n69710\\n69710\\nImplantation or replacement of electromagnetic bone conduction\\nhearing device in temporal bone\\n$ 1,761.30\\n69711\\n69711\\nRemoval or repair of electromagnetic bone conduction hearing\\ndevice in temporal bone\\n$ 1,287.90\\n69714\\n69714\\nImplantation, osseointegrated implant, temporal bone, with\\npercutaneous attachment to external speech processor\/cochlear\\nstimulator; without mastoidectomy\\n$ 2,985.05\\n69715\\n69715\\nImplantation, osseointegrated implant, temporal bone, with\\npercutaneous attachment to external speech processor\/cochlear\\nstimulator; with mastoidectomy\\n$ 3,580.56\\n69717\\n69717\\nReplacement (including removal of existing device), osseointegrated\\nimplant, temporal bone, with percutaneous attachment to external\\nspeech processor\/cochlear stimulator; without mastoidectomy\\n$ 3,079.84\\n69718\\n69718\\nReplacement (including removal of existing device), osseointegrated\\nimplant, temporal bone, with percutaneous attachment to external\\nspeech processor\/cochlear stimulator; with mastoidectomy\\n$ 3,691.07\\n69720\\n69720\\nDecompression facial nerve, intratemporal; lateral to geniculate\\nganglion\\n$ 3,883.50\\n69725\\n69725\\nDecompression facial nerve, intratemporal; including medial to\\ngeniculate ganglion\\n$ 5,624.10\\n69740\\n69740\\nSuture facial nerve, intratemporal, with or without graft or\\ndecompression; lateral to geniculate ganglion\\n$ 4,449.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n335\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n336\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n69745\\n69745\\nSuture facial nerve, intratemporal, with or without graft or\\ndecompression; including medial to geniculate ganglion\\n$ 5,244.30\\n69799\\n69799\\nUnlisted procedure, middle ear\\nCost\\n69801\\n69801\\nLabyrinthotomy, with perfusion of vestibuloactive drug(s);\\ntranscanal\\n$ 3,175.20\\n69805\\n69805\\nEndolymphatic sac operation; without shunt\\n$ 3,862.80\\n69806\\n69806\\nEndolymphatic sac operation; with shunt\\n$ 4,377.60\\n69820\\n69820\\nFenestration semicircular canal\\n$ 3,438.00\\n69840\\n69840\\nRevision fenestration operation\\n$ 2,353.50\\n69905\\n69905\\nLabyrinthectomy; transcanal\\n$ 3,857.40\\n69910\\n69910\\nLabyrinthectomy; with mastoidectomy\\n$ 4,439.70\\n69915\\n69915\\nVestibular nerve section, translabyrinthine approach\\n$ 5,052.60\\n69930\\n69930\\nCochlear device implantation, with or without mastoidectomy\\n$ 5,318.10\\n69949\\n69949\\nUnlisted procedure, inner ear\\nCost\\n69950\\n69950\\nVestibular nerve section, transcranial approach\\n$ 5,448.60\\n69955\\n69955\\nTotal facial nerve decompression and\/or repair (may include graft)\\n$ 5,846.40\\n69960\\n69960\\nDecompression internal auditory canal\\n$ 5,529.60\\n69970\\n69970\\nRemoval of tumor, temporal bone\\n$ 6,309.00\\n69979\\n69979\\nUnlisted procedure, temporal bone, middle fossa approach\\nCost\\n69990\\n69990\\nMicrosurgical techniques, requiring use of operating microscope\\n(List separately in addition to code for primary procedure)\\n$ 834.30\\n90291\\n90291\\nCytomegalovirus immune globulin (CMV-IgIV), human, for\\nintravenous use\\n$ 72.90\\n90296\\n90296\\nDiphtheria antitoxin, equine, any route\\n$ 77.40\\n90474\\n90474\\nImmunization administration by intranasal or oral route; each\\nadditional vaccine (single or combination vaccine\/toxoid) (List\\nseparately in addition to code for primary procedure)\\n$ 17.03\\n90703\\n90703\\nTetanus toxoid adsorbed, for intramuscular use\\n$ 19.30\\n90785\\n90785\\nInteractive complexity (List separately in addition to the code for\\nprimary procedure)\\n$ 8.74\\n90791\\n90791\\nPsychiatric diagnostic evaluation\\n$ 276.51\\n90792\\n90792\\nPsychiatric diagnostic evaluation with medical services\\n$ 222.74\\n90832\\n90832\\nPsychotherapy, 30 minutes with patient and\/or family member\\n$ 114.22\\n90833\\n90833\\nPsychotherapy, 30 minutes with patient and\/or family member\\nwhen performed with an evaluation and management service (List\\nseparately in addition to the code for primary procedure)\\n$ 74.62\\n90834\\n90834\\nPsychotherapy, 45 minutes with patient and\/or family member\\n$ 144.87\\n90836\\n90836\\nPsychotherapy, 45 minutes with patient and\/or family member\\nwhen performed with an evaluation and management service (List\\nseparately in addition to the code for primary procedure)\\n$ 120.89\\n90837\\n90837\\nPsychotherapy, 60 minutes with patient and\/or family member\\n$ 211.77\\n90838\\n90838\\nPsychotherapy, 60 minutes with patient and\/or family member\\nwhen performed with an evaluation and management service (List\\nseparately in addition to the code for primary procedure)\\n$ 195.68\\n90845\\n90845\\nPsychoanalysis\\n$ 166.50\\n90846\\n90846\\nFamily psychotherapy (without the patient present)\\n$ 159.30\\n90847\\n90847\\nFamily psychotherapy (conjoint psychotherapy) (with patient\\npresent)\\n$ 151.62\\n90849\\n90849\\nMultiple-family group psychotherapy\\n$ 129.60\\n90853\\n90853\\nGroup psychotherapy (other than of a multiple-family group)\\n$ 87.30\\n90863\\n90863\\nPharmacologic management, including prescription and review of\\nmedication, when performed with psychotherapy services (List\\nseparately in addition to the code for primary procedure)\\n$ 93.77\\n90865\\n90865\\nNarcosynthesis for psychiatric diagnostic and therapeutic purposes\\n(eg, sodium amobarbital (Amytal) interview)\\n$ 271.80\\n90870\\n90870\\nElectroconvulsive therapy (includes necessary monitoring)\\n$ 209.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n337\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n338\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n90875\\n90875\\nIndividual psychophysiological therapy incorporating biofeedback\\ntraining by any modality (face-to-face with the patient), with\\npsychotherapy (eg, insight oriented, behavior modifying or\\nsupportive psychotherapy); 30 minutes\\n$ 117.06\\n90876\\n90876\\nIndividual psychophysiological therapy incorporating biofeedback\\ntraining by any modality (face-to-face with the patient), with\\npsychotherapy (eg, insight oriented, behavior modifying or\\nsupportive psychotherapy); 45 minutes\\n$ 226.80\\n90880\\n90880\\nHypnotherapy\\n$ 183.60\\n90882\\n90882\\nEnvironmental intervention for medical management purposes on a\\npsychiatric patient's behalf with agencies, employers, or institutions $ 118.80\\n90885\\n90885\\nPsychiatric evaluation of hospital records, other psychiatric reports,\\npsychometric and\/or projective tests, and other accumulated data\\nfor medical diagnostic purposes\\n$ 120.97\\n90887\\n90887\\nInterpretation or explanation of results of psychiatric, other medical\\nexaminations and procedures, or other accumulated data to family\\nor other responsible persons, or advising them how to assist patient $ 159.30\\n90889\\n90889\\nPreparation of report of patient's psychiatric status, history,\\ntreatment, or progress (other than for legal or consultative\\npurposes) for other individuals, agencies, or insurance carriers\\n$ 171.00\\n90899\\n90899\\nUnlisted psychiatric service or procedure\\nCost\\n90901\\n90901\\nBiofeedback training by any modality\\n$ 123.30\\n90911\\n90911\\nBiofeedback training, perineal muscles, anorectal or urethral\\nsphincter, including EMG and\/or manometry\\n$ 180.00\\n90935\\n90935\\nHemodialysis procedure with single evaluation by a physician or\\nother qualified health care professional\\n$ 249.80\\n90937\\n90937\\nHemodialysis procedure requiring repeated evaluation(s) with or\\nwithout substantial revision of dialysis prescription\\n$ 566.10\\n90940\\n90940\\nHemodialysis access flow study to determine blood flow in grafts\\nand arteriovenous fistulae by an indicator method\\n$ -\\n90945\\n90945\\nDialysis procedure other than hemodialysis (eg, peritoneal dialysis,\\nhemofiltration, or other continuous renal replacement therapies),\\nwith single evaluation by a physician or other qualified health care\\nprofessional\\n$ 300.60\\n90947\\n90947\\nDialysis procedure other than hemodialysis (eg, peritoneal dialysis,\\nhemofiltration, or other continuous renal replacement therapies)\\nrequiring repeated evaluations by a physician or other qualified\\nhealth care professional, with or without substantial re\\n$ 482.40\\n90951\\n90951\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients younger than 2 years of age to include monitoring for the\\nadequacy of nutrition, assessment of growth and development, and\\ncounseling of parents; with 4 or more face-to-face visits by a\\n$ 1,568.42\\n90952\\n90952\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients younger than 2 years of age to include monitoring for the\\nadequacy of nutrition, assessment of growth and development, and\\ncounseling of parents; with 2-3 face-to-face visits by a physi\\n$ -\\n90953\\n90953\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients younger than 2 years of age to include monitoring for the\\nadequacy of nutrition, assessment of growth and development, and\\ncounseling of parents; with 1 face-to-face visit by a physicia\\n$ -\\n90954\\n90954\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 2-11 years of age to include monitoring for the adequacy of\\nnutrition, assessment of growth and development, and counseling\\nof parents; with 4 or more face-to-face visits by a physician\\n$ 1,325.75\\n90955\\n90955\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 2-11 years of age to include monitoring for the adequacy of\\nnutrition, assessment of growth and development, and counseling\\nof parents; with 2-3 face-to-face visits by a physician or ot\\n$ 742.53\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n339\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n340\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n90956\\n90956\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 2-11 years of age to include monitoring for the adequacy of\\nnutrition, assessment of growth and development, and counseling\\nof parents; with 1 face-to-face visit by a physician or other\\n$ 521.08\\n90957\\n90957\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 12-19 years of age to include monitoring for the adequacy\\nof nutrition, assessment of growth and development, and\\ncounseling of parents; with 4 or more face-to-face visits by a\\nphysicia\\n$ 1,046.60\\n90958\\n90958\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 12-19 years of age to include monitoring for the adequacy\\nof nutrition, assessment of growth and development, and\\ncounseling of parents; with 2-3 face-to-face visits by a physician or o $ 702.47\\n90959\\n90959\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 12-19 years of age to include monitoring for the adequacy\\nof nutrition, assessment of growth and development, and\\ncounseling of parents; with 1 face-to-face visit by a physician or\\nothe\\n$ 462.30\\n90960\\n90960\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 20 years of age and older; with 4 or more face-to-face visits\\nby a physician or other qualified health care professional per month $ 515.18\\n90961\\n90961\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 20 years of age and older; with 2-3 face-to-face visits by a\\nphysician or other qualified health care professional per month\\n$ 413.70\\n90962\\n90962\\nEnd-stage renal disease (ESRD) related services monthly, for\\npatients 20 years of age and older; with 1 face-to-face visit by a\\nphysician or other qualified health care professional per month\\n$ 301.29\\n90963\\n90963\\nEnd-stage renal disease (ESRD) related services for home dialysis per\\nfull month, for patients younger than 2 years of age to include\\nmonitoring for the adequacy of nutrition, assessment of growth and\\ndevelopment, and counseling of parents\\n$ 898.85\\n90964\\n90964\\nEnd-stage renal disease (ESRD) related services for home dialysis\\nper full month, for patients 2-11 years of age to include monitoring\\nfor the adequacy of nutrition, assessment of growth and\\ndevelopment, and counseling of parents\\n$ 750.40\\n90965\\n90965\\nEnd-stage renal disease (ESRD) related services for home dialysis\\nper full month, for patients 12-19 years of age to include\\nmonitoring for the adequacy of nutrition, assessment of growth and\\ndevelopment, and counseling of parents\\n$ 704.13\\n90966\\n90966\\nEnd-stage renal disease (ESRD) related services for home dialysis\\nper full month, for patients 20 years of age and older\\n$ 368.71\\n90967\\n90967\\nEnd-stage renal disease (ESRD) related services for dialysis less than\\na full month of service, per day; for patients younger than 2 years of\\nage\\n$ 33.03\\n90968\\n90968\\nEnd-stage renal disease (ESRD) related services for dialysis less than\\na full month of service, per day; for patients 2-11 years of age\\n$ 26.85\\n90969\\n90969\\nEnd-stage renal disease (ESRD) related services for dialysis less than\\na full month of service, per day; for patients 12-19 years of age\\n$ 19.63\\n90970\\n90970\\nEnd-stage renal disease (ESRD) related services for dialysis less than\\na full month of service, per day; for patients 20 years of age and\\nolder\\n$ 13.50\\n90989\\n90989\\nDialysis training, patient, including helper where applicable, any\\nmode, completed course\\n$ 653.40\\n90993\\n90993\\nDialysis training, patient, including helper where applicable, any\\nmode, course not completed, per training session\\n$ 135.90\\n90997\\n90997\\nHemoperfusion (eg, with activated charcoal or resin)\\n$ 597.60\\n90999\\n90999\\nUnlisted dialysis procedure, inpatient or outpatient\\nCost\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n341\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n342\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n91010\\n91010\\nEsophageal motility (manometric study of the esophagus and\/or\\ngastroesophageal junction) study with interpretation and report;\\n$ 101.54\\n91013\\nEsophageal motility (manometric study of the esophagus and\/or\\ngastroesophageal junction) study with interpretation and report;\\nwith stimulation or perfusion (eg, stimulant, acid or alkali perfusion)\\n(List separately in addition to code for primary procedu\\n$ 68.42\\n91013-26 26\\nEsophageal motility (manometric study of the esophagus and\/or\\ngastroesophageal junction) study with interpretation and report;\\nwith stimulation or perfusion (eg, stimulant, acid or alkali perfusion)\\n(List separately in addition to code for primary procedu\\n$ 29.29\\n91013-TC TC\\n$ 39.13\\n91020\\n91020\\nGastric motility (manometric) studies\\n$ 255.60\\n91020-26 26\\n91020\\nGastric motility (manometric) studies\\n$ 74.00\\n91020-TC TC\\n91020\\nGastric motility (manometric) studies\\n$ 181.60\\n91022\\n91022\\nDuodenal motility (manometric) study\\n$ 213.12\\n91030\\n91030\\nEsophagus, acid perfusion (Bernstein) test for esophagitis\\n$ 158.40\\n91030-26 26\\n91030\\nEsophagus, acid perfusion (Bernstein) test for esophagitis\\n$ 49.29\\n91030-TC TC\\n91030\\nEsophagus, acid perfusion (Bernstein) test for esophagitis\\n$ 109.11\\n91034\\n91034\\nEsophagus, gastroesophageal reflux test; with nasal catheter pH\\nelectrode(s) placement, recording, analysis and interpretation\\n$ 170.59\\n91035\\n91035\\nEsophagus, gastroesophageal reflux test; with mucosal attached\\ntelemetry pH electrode placement, recording, analysis and\\ninterpretation\\n$ 236.07\\n91037\\n91037\\nEsophageal function test, gastroesophageal reflux test with nasal\\ncatheter intraluminal impedance electrode(s) placement, recording,\\nanalysis and interpretation;\\n$ 148.35\\n91038\\n91038\\nEsophageal function test, gastroesophageal reflux test with nasal\\ncatheter intraluminal impedance electrode(s) placement, recording,\\nanalysis and interpretation; prolonged (greater than 1 hour, up to\\n24 hours)\\n$ 163.99\\n91040\\n91040\\nEsophageal balloon distension provocation study\\n$ 142.29\\n91065\\n91065\\nBreath hydrogen or methane test (eg, for detection of lactase\\ndeficiency, fructose intolerance, bacterial overgrowth, or oro-cecal\\ngastrointestinal transit)\\n$ 16.38\\n91110\\n91110\\nGastrointestinal tract imaging, intraluminal (eg, capsule endoscopy),\\nesophagus through ileum, with interpretation and report\\n$ 522.07\\n91111\\n91111\\nGastrointestinal tract imaging, intraluminal (eg, capsule endoscopy),\\nesophagus with interpretation and report\\n$ 122.66\\n91120\\n91120\\nRectal sensation, tone, and compliance test (ie, response to graded\\nballoon distention)\\n$ 129.65\\n91122\\n91122\\nAnorectal manometry\\n$ 357.30\\n91122-26 26\\n91122\\nAnorectal manometry\\n$ 131.95\\n91122-TC TC\\n91122\\nAnorectal manometry\\n$ 225.35\\n91132\\n91132\\nElectrogastrography, diagnostic, transcutaneous;\\n$ 74.61\\n91133\\n91133\\nElectrogastrography, diagnostic, transcutaneous; with provocative\\ntesting\\n$ 110.50\\n91299\\n91299\\nUnlisted diagnostic gastroenterology procedure\\nCost\\n92002\\n92002\\nOphthalmological services: medical examination and evaluation\\nwith initiation of diagnostic and treatment program; intermediate,\\nnew patient\\n$ 87.67\\n92004\\n92004\\nOphthalmological services: medical examination and evaluation\\nwith initiation of diagnostic and treatment program;\\ncomprehensive, new patient, 1 or more visits\\n$ 103.19\\n92012\\n92012\\nOphthalmological services: medical examination and evaluation,\\nwith initiation or continuation of diagnostic and treatment\\nprogram; intermediate, established patient\\n$ 62.82\\n92014\\n92014\\nOphthalmological services: medical examination and evaluation,\\nwith initiation or continuation of diagnostic and treatment\\nprogram; comprehensive, established patient, 1 or more visits\\n$ 87.18\\n92015\\n92015\\nDetermination of refractive state\\n$ 28.58\\n92018\\n92018\\nOphthalmological examination and evaluation, under general\\nanesthesia, with or without manipulation of globe for passive range\\nof motion or other manipulation to facilitate diagnostic\\nexamination; complete\\n$ 246.60\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n343\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n344\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n92019\\n92019\\nOphthalmological examination and evaluation, under general\\nanesthesia, with or without manipulation of globe for passive range\\nof motion or other manipulation to facilitate diagnostic\\nexamination; limited\\n$ 153.90\\n92020\\n92020\\nGonioscopy (separate procedure)\\n$ 53.27\\n92025\\n92025\\nComputerized corneal topography, unilateral or bilateral, with\\ninterpretation and report\\n$ 28.67\\n92060\\n92060\\nSensorimotor examination with multiple measurements of ocular\\ndeviation (eg, restrictive or paretic muscle with diplopia) with\\ninterpretation and report (separate procedure)\\n$ 66.59\\n92060-26 26\\n92060\\nSensorimotor examination with multiple measurements of ocular\\ndeviation (eg, restrictive or paretic muscle with diplopia) with\\ninterpretation and report (separate procedure)\\n$ 37.17\\n92060-TC TC\\n92060\\nSensorimotor examination with multiple measurements of ocular\\ndeviation (eg, restrictive or paretic muscle with diplopia) with\\ninterpretation and report (separate procedure)\\n$ 29.42\\n92065\\n92065\\nOrthoptic and\/or pleoptic training, with continuing medical\\ndirection and evaluation\\n$ 56.70\\n92065-26 26\\n92065\\nOrthoptic and\/or pleoptic training, with continuing medical\\ndirection and evaluation\\n$ 16.99\\n92065-TC TC\\n92065\\nOrthoptic and\/or pleoptic training, with continuing medical\\ndirection and evaluation\\n$ 39.71\\n92071\\n92071\\nFitting of contact lens for treatment of ocular surface disease\\n$ 62.75\\n92072\\n92072\\nFitting of contact lens for management of keratoconus, initial fitting $ 238.67\\n92081\\n92081\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; limited examination (eg, tangent screen, Autoplot, arc\\nperimeter, or single stimulus level automated test, such as Octopus\\n3 or 7 equivalent)\\n$ 46.80\\n92081-26 26\\n92081\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; limited examination (eg, tangent screen, Autoplot, arc\\nperimeter, or single stimulus level automated test, such as Octopus\\n3 or 7 equivalent)\\n$ 21.54\\n92081-TC TC\\n92081\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; limited examination (eg, tangent screen, Autoplot, arc\\nperimeter, or single stimulus level automated test, such as Octopus\\n3 or 7 equivalent)\\n$ 25.26\\n92082\\n92082\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; intermediate examination (eg, at least 2 isopters on\\nGoldmann perimeter, or semiquantitative, automated\\nsuprathreshold screening program, Humphrey suprathreshold\\nautomatic\\n$ 81.78\\n92082-26 26\\n92082\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; intermediate examination (eg, at least 2 isopters on\\nGoldmann perimeter, or semiquantitative, automated\\nsuprathreshold screening program, Humphrey suprathreshold\\nautomatic\\n$ 35.28\\n92082-TC TC\\n92082\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; intermediate examination (eg, at least 2 isopters on\\nGoldmann perimeter, or semiquantitative, automated\\nsuprathreshold screening program, Humphrey suprathreshold\\nautomatic\\n$ 46.50\\n92083\\n92083\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; extended examination (eg, Goldmann visual fields with\\nat least 3 isopters plotted and static determination within the\\ncentral 30 , or quantitative, automated threshold peri\\n$ 125.94\\n92083-26 26\\n92083\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; extended examination (eg, Goldmann visual fields with\\nat least 3 isopters plotted and static determination within the\\ncentral 30 , or quantitative, automated threshold peri\\n$ 51.26\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n345\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n346\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n92083-TC TC\\n92083\\nVisual field examination, unilateral or bilateral, with interpretation\\nand report; extended examination (eg, Goldmann visual fields with\\nat least 3 isopters plotted and static determination within the\\ncentral 30 , or quantitative, automated threshold peri\\n$ 74.68\\n92100\\n92100\\nSerial tonometry (separate procedure) with multiple measurements\\nof intraocular pressure over an extended time period with\\ninterpretation and report, same day (eg, diurnal curve or medical\\ntreatment of acute elevation of intraocular pressure)\\n$ 52.70\\n92136\\n92136\\nOphthalmic biometry by partial coherence interferometry with\\nintraocular lens power calculation\\n$ 123.93\\n92136-26 26\\n92136\\nOphthalmic biometry by partial coherence interferometry with\\nintraocular lens power calculation\\n$ 44.16\\n92136-TC TC\\n92136\\nOphthalmic biometry by partial coherence interferometry with\\nintraocular lens power calculation\\n$ 79.77\\n92140\\n92140\\nProvocative tests for glaucoma, with interpretation and report,\\nwithout tonography\\n$ 57.90\\n92225\\n92225\\nOphthalmoscopy, extended, with retinal drawing (eg, for retinal\\ndetachment, melanoma), with interpretation and report; initial\\n$ 79.44\\n92226\\n92226\\nOphthalmoscopy, extended, with retinal drawing (eg, for retinal\\ndetachment, melanoma), with interpretation and report;\\nsubsequent\\n$ 70.28\\n92230\\n92230\\nFluorescein angioscopy with interpretation and report\\n$ 126.90\\n92235\\n92235\\nFluorescein angiography (includes multiframe imaging) with\\ninterpretation and report\\n$ 247.50\\n92235-26 26\\n92235\\nFluorescein angiography (includes multiframe imaging) with\\ninterpretation and report\\n$ 98.35\\n92235-TC TC\\n92235\\nFluorescein angiography (includes multiframe imaging) with\\ninterpretation and report\\n$ 149.15\\n92240\\n92240\\nIndocyanine-green angiography (includes multiframe imaging) with\\ninterpretation and report\\n$ 225.00\\n92240-26 26\\n92240\\nIndocyanine-green angiography (includes multiframe imaging) with\\ninterpretation and report\\n$ 50.91\\n92240-TC TC\\n92240\\nIndocyanine-green angiography (includes multiframe imaging) with\\ninterpretation and report\\n$ 174.09\\n92250\\n92250\\nFundus photography with interpretation and report\\n$ 79.20\\n92250-26 26\\n92250\\nFundus photography with interpretation and report\\n$ 21.57\\n92250-TC TC\\n92250\\nFundus photography with interpretation and report\\n$ 57.63\\n92260\\n92260\\nOphthalmodynamometry\\n$ 66.60\\n92265\\n92265\\nNeedle oculoelectromyography, 1 or more extraocular muscles, 1 or\\nboth eyes, with interpretation and report\\n$ 128.70\\n92265-26 26\\n92265\\nNeedle oculoelectromyography, 1 or more extraocular muscles, 1 or\\nboth eyes, with interpretation and report\\n$ 64.52\\n92265-TC TC\\n92265\\nNeedle oculoelectromyography, 1 or more extraocular muscles, 1 or\\nboth eyes, with interpretation and report\\n$ 64.18\\n92270\\n92270\\nElectro-oculography with interpretation and report\\n$ 128.70\\n92270-26 26\\n92270\\nElectro-oculography with interpretation and report\\n$ 53.38\\n92270-TC TC\\n92270\\nElectro-oculography with interpretation and report\\n$ 75.32\\n92275\\n92275\\nElectroretinography with interpretation and report\\n$ 162.90\\n92275-26 26\\n92275\\nElectroretinography with interpretation and report\\n$ 55.10\\n92275-TC TC\\n92275\\nElectroretinography with interpretation and report\\n$ 107.80\\n92283\\n92283\\nColor vision examination, extended, eg, anomaloscope or\\nequivalent\\n$ 56.70\\n92283-26 26\\n92283\\nColor vision examination, extended, eg, anomaloscope or\\nequivalent\\n$ 8.54\\n92283-TC TC\\n92283\\nColor vision examination, extended, eg, anomaloscope or\\nequivalent\\n$ 48.16\\n92284\\n92284\\nDark adaptation examination with interpretation and report\\n$ 113.40\\n92284-26 26\\n92284\\nDark adaptation examination with interpretation and report\\n$ 20.35\\n92284-TC TC\\n92284\\nDark adaptation examination with interpretation and report\\n$ 93.05\\n92285\\n92285\\nExternal ocular photography with interpretation and report for\\ndocumentation of medical progress (eg, close-up photography, slit\\nlamp photography, goniophotography, stereo-photography)\\n$ 59.40\\n92285-26 26\\n92285\\nExternal ocular photography with interpretation and report for\\ndocumentation of medical progress (eg, close-up photography, slit\\nlamp photography, goniophotography, stereo-photography)\\n$ 8.25\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n347\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n348\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n92285-TC TC\\n92285\\nExternal ocular photography with interpretation and report for\\ndocumentation of medical progress (eg, close-up photography, slit\\nlamp photography, goniophotography, stereo-photography)\\n$ 51.15\\n92286\\n92286\\nAnterior segment imaging with interpretation and report; with\\nspecular microscopy and endothelial cell analysis\\n$ 235.92\\n92286-26 26\\n92286\\nAnterior segment imaging with interpretation and report; with\\nspecular microscopy and endothelial cell analysis\\n$ 127.49\\n92286-TC TC\\n92286\\nAnterior segment imaging with interpretation and report; with\\nspecular microscopy and endothelial cell analysis\\n$ 108.43\\n92287\\n92287\\nAnterior segment imaging with interpretation and report; with\\nfluorescein angiography\\n$ 180.00\\n92287-26 26\\n92287\\nAnterior segment imaging with interpretation and report; with\\nfluorescein angiography\\n$ 56.26\\n92287-TC TC\\n92287\\nAnterior segment imaging with interpretation and report; with\\nfluorescein angiography\\n$ 123.74\\n92310\\n92310\\nPrescription of optical and physical characteristics of and fitting of\\ncontact lens, with medical supervision of adaptation; corneal lens,\\nboth eyes, except for aphakia\\n$ 268.20\\n92311\\n92311\\nPrescription of optical and physical characteristics of and fitting of\\ncontact lens, with medical supervision of adaptation; corneal lens\\nfor aphakia, 1 eye\\n$ 180.90\\n92312\\n92312\\nPrescription of optical and physical characteristics of and fitting of\\ncontact lens, with medical supervision of adaptation; corneal lens\\nfor aphakia, both eyes\\n$ 247.50\\n92313\\n92313\\nPrescription of optical and physical characteristics of and fitting of\\ncontact lens, with medical supervision of adaptation; corneoscleral\\nlens\\n$ 91.51\\n92314\\n92314\\nPrescription of optical and physical characteristics of contact lens,\\nwith medical supervision of adaptation and direction of fitting by\\nindependent technician; corneal lens, both eyes except for aphakia\\n$ 67.48\\n92315\\n92315\\nPrescription of optical and physical characteristics of contact lens,\\nwith medical supervision of adaptation and direction of fitting by\\nindependent technician; corneal lens for aphakia, 1 eye\\n$ 63.02\\n92316\\n92316\\nPrescription of optical and physical characteristics of contact lens,\\nwith medical supervision of adaptation and direction of fitting by\\nindependent technician; corneal lens for aphakia, both eyes\\n$ 98.58\\n92317\\n92317\\nPrescription of optical and physical characteristics of contact lens,\\nwith medical supervision of adaptation and direction of fitting by\\nindependent technician; corneoscleral lens\\n$ 66.07\\n92325\\n92325\\nModification of contact lens (separate procedure), with medical\\nsupervision of adaptation\\n$ 43.20\\n92326\\n92326\\nReplacement of contact lens\\n$ 118.80\\n92340\\n92340\\nFitting of spectacles, except for aphakia; monofocal\\n$ 56.70\\n92341\\n92341\\nFitting of spectacles, except for aphakia; bifocal\\n$ 40.23\\n92342\\n92342\\nFitting of spectacles, except for aphakia; multifocal, other than\\nbifocal\\n$ 52.41\\n92352\\n92352\\nFitting of spectacle prosthesis for aphakia; monofocal\\n$ 22.45\\n92353\\n92353\\nFitting of spectacle prosthesis for aphakia; multifocal\\n$ 51.30\\n92354\\n92354\\nFitting of spectacle mounted low vision aid; single element system\\n$ 28.49\\n92355\\n92355\\nFitting of spectacle mounted low vision aid; telescopic or other\\ncompound lens system\\n$ 43.94\\n92358\\n92358\\nProsthesis service for aphakia, temporary (disposable or loan,\\nincluding materials)\\n$ 23.79\\n92370\\n92370\\nRepair and refitting spectacles; except for aphakia\\n$ 48.20\\n92371\\n92371\\nRepair and refitting spectacles; spectacle prosthesis for aphakia\\n$ 70.29\\n92499\\n92499\\nUnlisted ophthalmological service or procedure\\n$ -\\n92502\\n92502\\nOtolaryngologic examination under general anesthesia\\n$ 297.00\\n92504\\n92504\\nBinocular microscopy (separate diagnostic procedure)\\n$ 61.25\\n92511\\n92511\\nNasopharyngoscopy with endoscope (separate procedure)\\n$ 229.50\\n92512\\n92512\\nNasal function studies (eg, rhinomanometry)\\n$ 144.00\\n92516\\n92516\\nFacial nerve function studies (eg, electroneuronography)\\n$ 123.30\\n92520\\n92520\\nLaryngeal function studies (ie, aerodynamic testing and acoustic\\ntesting)\\n$ 257.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n349\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n350\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n92521\\n92521\\nEvaluation of speech fluency (eg, stuttering, cluttering)\\n$ 114.48\\n92521\\n92521\\nSpeech therapy, in the home, per diem\\n$ 114.48\\n92522\\n92522\\nEvaluation of speech sound production (eg, articulation,\\nphonological process, apraxia, dysarthria);\\n$ 92.94\\n92523\\n92523\\nEvaluation of speech sound production (eg, articulation,\\nphonological process, apraxia, dysarthria); with evaluation of\\nlanguage comprehension and expression (eg, receptive and\\nexpressive language)\\n$ 193.07\\n92524\\n92524\\nBehavioral and qualitative analysis of voice and resonance\\n$ 96.89\\n92526\\n92526\\nTreatment of swallowing dysfunction and\/or oral function for\\nfeeding\\n$ 123.30\\n92531\\n92531\\nSpontaneous nystagmus, including gaze\\n$ 54.00\\n92532\\n92532\\nPositional nystagmus test\\n$ 62.10\\n92533\\n92533\\nCaloric vestibular test, each irrigation (binaural, bithermal\\nstimulation constitutes 4 tests)\\n$ 76.50\\n92534\\n92534\\nOptokinetic nystagmus test\\n$ 63.00\\n92540\\n92540\\nBasic vestibular evaluation, includes spontaneous nystagmus test\\nwith eccentric gaze fixation nystagmus, with recording, positional\\nnystagmus test, minimum of 4 positions, with recording, optokinetic\\nnystagmus test, bidirectional foveal and peripheral sti\\n$ 124.58\\n92541\\n92541\\nSpontaneous nystagmus test, including gaze and fixation\\nnystagmus, with recording\\n$ 121.50\\n92541-26 26\\n92541\\nSpontaneous nystagmus test, including gaze and fixation\\nnystagmus, with recording\\n$ 79.30\\n92541-TC TC\\n92541\\nSpontaneous nystagmus test, including gaze and fixation\\nnystagmus, with recording\\n$ 42.20\\n92542\\n92542\\nPositional nystagmus test, minimum of 4 positions, with recording\\n$ 114.30\\n92542-26 26\\n92542\\nPositional nystagmus test, minimum of 4 positions, with recording\\n$ 69.82\\n92542-TC TC\\n92542\\nPositional nystagmus test, minimum of 4 positions, with recording\\n$ 44.48\\n92543\\n92543\\nCaloric vestibular test, each irrigation (binaural, bithermal\\nstimulation constitutes 4 tests), with recording\\n$ 128.70\\n92543-26 26\\n92543\\nCaloric vestibular test, each irrigation (binaural, bithermal\\nstimulation constitutes 4 tests), with recording\\n$ 40.96\\n92543-TC TC\\n92543\\nCaloric vestibular test, each irrigation (binaural, bithermal\\nstimulation constitutes 4 tests), with recording\\n$ 87.74\\n92544\\n92544\\nOptokinetic nystagmus test, bidirectional, foveal or peripheral\\nstimulation, with recording\\n$ 77.40\\n92544-26 26\\n92544\\nOptokinetic nystagmus test, bidirectional, foveal or peripheral\\nstimulation, with recording\\n$ 43.16\\n92544-TC TC\\n92544\\nOptokinetic nystagmus test, bidirectional, foveal or peripheral\\nstimulation, with recording\\n$ 34.24\\n92545\\n92545\\nOscillating tracking test, with recording\\n$ 77.40\\n92545-26 26\\n92545\\nOscillating tracking test, with recording\\n$ 41.96\\n92545-TC TC\\n92545\\nOscillating tracking test, with recording\\n$ 35.44\\n92546\\n92546\\nSinusoidal vertical axis rotational testing\\n$ 101.70\\n92546-26 26\\n92546\\nSinusoidal vertical axis rotational testing\\n$ 12.98\\n92546-TC TC\\n92546\\nSinusoidal vertical axis rotational testing\\n$ 88.72\\n92547\\n92547\\nUse of vertical electrodes (List separately in addition to code for\\nprimary procedure)\\n$ 72.00\\n92548\\n92548\\nComputerized dynamic posturography\\n$ 216.00\\n92548-26 26\\n92548\\nComputerized dynamic posturography\\n$ 47.62\\n92548-TC TC\\n92548\\nComputerized dynamic posturography\\n$ 168.38\\n92550\\n92550\\nTympanometry and reflex threshold measurements\\n$ 38.60\\n92551\\n92551\\nScreening test, pure tone, air only\\n$ 34.20\\n92552\\n92552\\nPure tone audiometry (threshold); air only\\n$ 40.77\\n92553\\n92553\\nPure tone audiometry (threshold); air and bone\\n$ 61.69\\n92555\\n92555\\nSpeech audiometry threshold;\\n$ 36.90\\n92556\\n92556\\nSpeech audiometry threshold; with speech recognition\\n$ 54.76\\n92557\\n92557\\nComprehensive audiometry threshold evaluation and speech\\nrecognition (92553 and 92556 combined)\\n$ 92.70\\n92559\\n92559\\nAudiometric testing of groups\\n$ 41.40\\n92560\\n92560\\nBekesy audiometry; screening\\n$ 66.60\\n92561\\n92561\\nBekesy audiometry; diagnostic\\n$ 83.70\\n92562\\n92562\\nLoudness balance test, alternate binaural or monaural\\n$ 40.50\\n92563\\n92563\\nTone decay test\\n$ 45.00\\n92564\\n92564\\nShort increment sensitivity index (SISI)\\n$ 41.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n351\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n352\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n92565\\n92565\\nStenger test, pure tone\\n$ 50.40\\n92567\\n92567\\nTympanometry (impedance testing)\\n$ 43.18\\n92568\\n92568\\nAcoustic reflex testing, threshold\\n$ 41.40\\n92570\\n92570\\nAcoustic immittance testing, includes tympanometry (impedance\\ntesting), acoustic reflex threshold testing, and acoustic reflex decay\\ntesting\\n$ 58.15\\n92571\\n92571\\nFiltered speech test\\n$ 38.70\\n92572\\n92572\\nStaggered spondaic word test\\n$ 42.30\\n92575\\n92575\\nSensorineural acuity level test\\n$ 36.00\\n92576\\n92576\\nSynthetic sentence identification test\\n$ 38.70\\n92577\\n92577\\nStenger test, speech\\n$ 51.30\\n92579\\n92579\\nVisual reinforcement audiometry (VRA)\\n$ 102.60\\n92582\\n92582\\nConditioning play audiometry\\n$ 65.70\\n92583\\n92583\\nSelect picture audiometry\\n$ 72.00\\n92584\\n92584\\nElectrocochleography\\n$ 252.00\\n92585\\n92585\\nAuditory evoked potentials for evoked response audiometry and\/or\\ntesting of the central nervous system; comprehensive\\n$ 353.70\\n92585-26 26\\n92585\\nAuditory evoked potentials for evoked response audiometry and\/or\\ntesting of the central nervous system; comprehensive\\n$ 65.25\\n92585-TC TC\\n92585\\nAuditory evoked potentials for evoked response audiometry and\/or\\ntesting of the central nervous system; comprehensive\\n$ 288.45\\n92586\\n92586\\nAuditory evoked potentials for evoked response audiometry and\/or\\ntesting of the central nervous system; limited\\n$ 151.11\\n92587\\n92587\\nDistortion product evoked otoacoustic emissions; limited evaluation\\n(to confirm the presence or absence of hearing disorder, 3-6\\nfrequencies) or transient otoacoustic emissions, with interpretation\\nand report\\n$ 124.20\\n92587-26 26\\n92587\\nDistortion product evoked otoacoustic emissions; limited evaluation\\n(to confirm the presence or absence of hearing disorder, 3-6\\nfrequencies) or transient otoacoustic emissions, with interpretation\\nand report\\n$ 105.08\\n92587-TC TC\\n92587\\nDistortion product evoked otoacoustic emissions; limited evaluation\\n(to confirm the presence or absence of hearing disorder, 3-6\\nfrequencies) or transient otoacoustic emissions, with interpretation\\nand report\\n$ 19.12\\n92588\\n92588\\nDistortion product evoked otoacoustic emissions; comprehensive\\ndiagnostic evaluation (quantitative analysis of outer hair cell\\nfunction by cochlear mapping, minimum of 12 frequencies), with\\ninterpretation and report\\n$ 141.30\\n92588-26 26\\n92588\\nDistortion product evoked otoacoustic emissions; comprehensive\\ndiagnostic evaluation (quantitative analysis of outer hair cell\\nfunction by cochlear mapping, minimum of 12 frequencies), with\\ninterpretation and report\\n$ 122.06\\n92588-TC TC\\n92588\\nDistortion product evoked otoacoustic emissions; comprehensive\\ndiagnostic evaluation (quantitative analysis of outer hair cell\\nfunction by cochlear mapping, minimum of 12 frequencies), with\\ninterpretation and report\\n$ 19.24\\n92590\\n92590\\nHearing aid examination and selection; monaural\\n$ 113.40\\n92591\\n92591\\nHearing aid examination and selection; binaural\\n$ 146.70\\n92592\\n92592\\nHearing aid check; monaural\\n$ 40.50\\n92593\\n92593\\nHearing aid check; binaural\\n$ 57.60\\n92594\\n92594\\nElectroacoustic evaluation for hearing aid; monaural\\n$ 36.00\\n92595\\n92595\\nElectroacoustic evaluation for hearing aid; binaural\\n$ 38.70\\n92596\\n92596\\nEar protector attenuation measurements\\n$ 51.30\\n92597\\n92597\\nEvaluation for use and\/or fitting of voice prosthetic device to\\nsupplement oral speech\\n$ 188.10\\n92601\\n92601\\nDiagnostic analysis of cochlear implant, patient younger than 7\\nyears of age; with programming\\n$ 279.88\\n92602\\n92602\\nDiagnostic analysis of cochlear implant, patient younger than 7\\nyears of age; subsequent reprogramming\\n$ 200.79\\n92603\\n92603\\nDiagnostic analysis of cochlear implant, age 7 years or older; with\\nprogramming\\n$ 187.38\\n92604\\n92604\\nDiagnostic analysis of cochlear implant, age 7 years or older;\\nsubsequent reprogramming\\n$ 124.41\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n353\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n354\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n92605\\n92605\\nEvaluation for prescription of non-speech-generating augmentative\\nand alternative communication device, face-to-face with the\\npatient; first hour\\n$ 166.79\\n92606\\n92606\\nTherapeutic service(s) for the use of non-speech-generating device,\\nincluding programming and modification\\n$ 151.11\\n92607\\n92607\\nEvaluation for prescription for speech-generating augmentative and\\nalternative communication device, face-to-face with the patient;\\nfirst hour\\n$ 259.20\\n92608\\n92608\\nEvaluation for prescription for speech-generating augmentative and\\nalternative communication device, face-to-face with the patient;\\neach additional 30 minutes (List separately in addition to code for\\nprimary procedure)\\n$ 57.16\\n92609\\n92609\\nTherapeutic services for the use of speech-generating device,\\nincluding programming and modification\\n$ 139.99\\n92610\\n92610\\nEvaluation of oral and pharyngeal swallowing function\\n$ 270.34\\n92611\\n92611\\nMotion fluoroscopic evaluation of swallowing function by cine or\\nvideo recording\\n$ 264.89\\n92612\\n92612\\nFlexible fiberoptic endoscopic evaluation of swallowing by cine or\\nvideo recording;\\n$ 336.75\\n92613\\n92613\\nFlexible fiberoptic endoscopic evaluation of swallowing by cine or\\nvideo recording; interpretation and report only\\n$ 86.41\\n92614\\n92614\\nFlexible fiberoptic endoscopic evaluation, laryngeal sensory testing\\nby cine or video recording;\\n$ 296.87\\n92615\\n92615\\nFlexible fiberoptic endoscopic evaluation, laryngeal sensory testing\\nby cine or video recording; interpretation and report only\\n$ 78.45\\n92616\\n92616\\nFlexible fiberoptic endoscopic evaluation of swallowing and\\nlaryngeal sensory testing by cine or video recording;\\n$ 438.23\\n92617\\n92617\\nFlexible fiberoptic endoscopic evaluation of swallowing and\\nlaryngeal sensory testing by cine or video recording; interpretation\\nand report only\\n$ 103.33\\n92620\\n92620\\nEvaluation of central auditory function, with report; initial 60\\nminutes\\n$ 99.31\\n92621\\n92621\\nEvaluation of central auditory function, with report; each additional\\n15 minutes (List separately in addition to code for primary\\nprocedure)\\n$ 25.94\\n92625\\n92625\\nAssessment of tinnitus (includes pitch, loudness matching, and\\nmasking)\\n$ 93.11\\n92626\\n92626\\nEvaluation of auditory rehabilitation status; first hour\\n$ 174.65\\n92627\\n92627\\nEvaluation of auditory rehabilitation status; each additional 15\\nminutes (List separately in addition to code for primary procedure)\\n$ 43.12\\n92630\\n92630\\nAuditory rehabilitation; prelingual hearing loss\\n$ -\\n92633\\n92633\\nAuditory rehabilitation; postlingual hearing loss\\n$ -\\n92640\\n92640\\nDiagnostic analysis with programming of auditory brainstem\\nimplant, per hour\\n$ 122.67\\n92700\\n92700\\nUnlisted otorhinolaryngological service or procedure\\n$ 32.92\\n92920\\n92920\\nPercutaneous transluminal coronary angioplasty; single major\\ncoronary artery or branch\\n$ 1,048.78\\n92921\\n92921\\nPercutaneous transluminal coronary angioplasty; each additional\\nbranch of a major coronary artery (List separately in addition to\\ncode for primary procedure)\\n$ 4,410.41\\n92924\\n92924\\nPercutaneous transluminal coronary atherectomy, with coronary\\nangioplasty when performed; single major coronary artery or\\nbranch\\n$ 1,247.20\\n92925\\n92925\\nPercutaneous transluminal coronary atherectomy, with coronary\\nangioplasty when performed; each additional branch of a major\\ncoronary artery (List separately in addition to code for primary\\nprocedure)\\n$ 8,842.66\\n92928\\n92928\\nPercutaneous transcatheter placement of intracoronary stent(s),\\nwith coronary angioplasty when performed; single major coronary\\nartery or branch\\n$ 1,165.44\\n92929\\n92929\\nPercutaneous transcatheter placement of intracoronary stent(s),\\nwith coronary angioplasty when performed; each additional branch\\nof a major coronary artery (List separately in addition to code for\\nprimary procedure)\\n$ 6,363.75\\n92933\\n92933\\nPercutaneous transluminal coronary atherectomy, with\\nintracoronary stent, with coronary angioplasty when performed;\\nsingle major coronary artery or branch\\n$ 1,303.22\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n355\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n356\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n92934\\n92934\\nPercutaneous transluminal coronary atherectomy, with\\nintracoronary stent, with coronary angioplasty when performed;\\neach additional branch of a major coronary artery (List separately in\\naddition to code for primary procedure)\\n$ 6,363.75\\n92937\\n92937\\nPercutaneous transluminal revascularization of or through coronary\\nartery bypass graft (internal mammary, free arterial, venous), any\\ncombination of intracoronary stent, atherectomy and angioplasty,\\nincluding distal protection when performed; single vesse\\n$ 1,164.19\\n92938\\n92938\\nPercutaneous transluminal revascularization of or through coronary\\nartery bypass graft (internal mammary, free arterial, venous), any\\ncombination of intracoronary stent, atherectomy and angioplasty,\\nincluding distal protection when performed; each additio\\n$ 6,363.75\\n92941\\n92941\\nPercutaneous transluminal revascularization of acute total\/subtotal\\nocclusion during acute myocardial infarction, coronary artery or\\ncoronary artery bypass graft, any combination of intracoronary\\nstent, atherectomy and angioplasty, including aspiration th\\n$ 1,306.01\\n92943\\n92943\\nPercutaneous transluminal revascularization of chronic total\\nocclusion, coronary artery, coronary artery branch, or coronary\\nartery bypass graft, any combination of intracoronary stent,\\natherectomy and angioplasty; single vessel\\n$ 1,306.01\\n92944\\n92944\\nPercutaneous transluminal revascularization of chronic total\\nocclusion, coronary artery, coronary artery branch, or coronary\\nartery bypass graft, any combination of intracoronary stent,\\natherectomy and angioplasty; each additional coronary artery,\\ncoronar\\n$ 6,363.75\\n92950\\n92950\\nCardiopulmonary resuscitation (eg, in cardiac arrest)\\n$ 482.59\\n92953\\n92953\\nTemporary transcutaneous pacing\\n$ 329.40\\n92960\\n92960\\nCardioversion, elective, electrical conversion of arrhythmia; external $ 425.70\\n92961\\n92961\\nCardioversion, elective, electrical conversion of arrhythmia; internal\\n(separate procedure)\\n$ 945.23\\n92970\\n92970\\nCardioassist-method of circulatory assist; internal\\n$ 684.90\\n92971\\n92971\\nCardioassist-method of circulatory assist; external\\n$ 275.40\\n92973\\n92973\\nPercutaneous transluminal coronary thrombectomy mechanical\\n(List separately in addition to code for primary procedure)\\n$ 1,041.07\\n92974\\n92974\\nTranscatheter placement of radiation delivery device for\\nsubsequent coronary intravascular brachytherapy (List separately in\\naddition to code for primary procedure)\\n$ 801.14\\n92975\\n92975\\nThrombolysis, coronary; by intracoronary infusion, including\\nselective coronary angiography\\n$ 1,488.60\\n92977\\n92977\\nThrombolysis, coronary; by intravenous infusion\\n$ 753.30\\n92978\\n92978\\nIntravascular ultrasound (coronary vessel or graft) during diagnostic\\nevaluation and\/or therapeutic intervention including imaging\\nsupervision, interpretation and report; initial vessel (List separately\\nin addition to code for primary procedure)\\n$ 333.84\\n92979\\n92979\\nIntravascular ultrasound (coronary vessel or graft) during diagnostic\\nevaluation and\/or therapeutic intervention including imaging\\nsupervision, interpretation and report; each additional vessel (List\\nseparately in addition to code for primary procedure)\\n$ 236.88\\n92986\\n92986\\nPercutaneous balloon valvuloplasty; aortic valve\\n$ 3,656.70\\n92987\\n92987\\nPercutaneous balloon valvuloplasty; mitral valve\\n$ 3,403.45\\n92990\\n92990\\nPercutaneous balloon valvuloplasty; pulmonary valve\\n$ 2,477.70\\n92992\\n92992\\nAtrial septectomy or septostomy; transvenous method, balloon (eg,\\nRashkind type) (includes cardiac catheterization)\\n$ -\\n92993\\n92993\\nAtrial septectomy or septostomy; blade method (Park septostomy)\\n(includes cardiac catheterization)\\n$ 4,408.20\\n92997\\n92997\\nPercutaneous transluminal pulmonary artery balloon angioplasty;\\nsingle vessel\\n$ 2,449.80\\n92998\\n92998\\nPercutaneous transluminal pulmonary artery balloon angioplasty;\\neach additional vessel (List separately in addition to code for\\nprimary procedure)\\n$ 949.50\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n357\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n358\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93000\\n93000\\nElectrocardiogram, routine ECG with at least 12 leads; with\\ninterpretation and report\\n$ 71.00\\n93005\\n93005\\nElectrocardiogram, routine ECG with at least 12 leads; tracing only,\\nwithout interpretation and report\\n$ 56.70\\n93010\\n93010\\nElectrocardiogram, routine ECG with at least 12 leads;\\ninterpretation and report only\\n$ 51.30\\n93015\\n93015\\nCardiovascular stress test using maximal or submaximal treadmill or\\nbicycle exercise, continuous electrocardiographic monitoring,\\nand\/or pharmacological stress; with supervision, interpretation and\\nreport\\n$ 338.10\\n93016\\n93016\\nCardiovascular stress test using maximal or submaximal treadmill or\\nbicycle exercise, continuous electrocardiographic monitoring,\\nand\/or pharmacological stress; supervision only, without\\ninterpretation and report\\n$ 100.80\\n93017\\n93017\\nCardiovascular stress test using maximal or submaximal treadmill or\\nbicycle exercise, continuous electrocardiographic monitoring,\\nand\/or pharmacological stress; tracing only, without interpretation\\nand report\\n$ 164.70\\n93018\\n93018\\nCardiovascular stress test using maximal or submaximal treadmill or\\nbicycle exercise, continuous electrocardiographic monitoring,\\nand\/or pharmacological stress; interpretation and report only\\n$ 170.10\\n93024\\n93024\\nErgonovine provocation test\\n$ 380.70\\n93024-26 26\\n93024\\nErgonovine provocation test\\n$ 180.32\\n93024-TC TC\\n93024\\nErgonovine provocation test\\n$ 200.38\\n93025\\n93025\\nMicrovolt T-wave alternans for assessment of ventricular\\narrhythmias\\n$ 119.07\\n93040\\n93040\\nRhythm ECG, 1-3 leads; with interpretation and report\\n$ 49.49\\n93041\\n93041\\nRhythm ECG, 1-3 leads; tracing only without interpretation and\\nreport\\n$ 44.10\\n93042\\n93042\\nRhythm ECG, 1-3 leads; interpretation and report only\\n$ 36.00\\n93224\\n93224\\nExternal electrocardiographic recording up to 48 hours by\\ncontinuous rhythm recording and storage; includes recording,\\nscanning analysis with report, review and interpretation by a\\nphysician or other qualified health care professional\\n$ 481.75\\n93225\\n93225\\nExternal electrocardiographic recording up to 48 hours by\\ncontinuous rhythm recording and storage; recording (includes\\nconnection, recording, and disconnection)\\n$ 162.00\\n93226\\n93226\\nExternal electrocardiographic recording up to 48 hours by\\ncontinuous rhythm recording and storage; scanning analysis with\\nreport\\n$ 175.50\\n93227\\n93227\\nExternal electrocardiographic recording up to 48 hours by\\ncontinuous rhythm recording and storage; review and\\ninterpretation by a physician or other qualified health care\\nprofessional\\n$ 173.70\\n93228\\n93228\\nExternal mobile cardiovascular telemetry with electrocardiographic\\nrecording, concurrent computerized real time data analysis and\\ngreater than 24 hours of accessible ECG data storage (retrievable\\nwith query) with ECG triggered and patient selected events\\n$ 71.24\\n93229\\n93229\\nExternal mobile cardiovascular telemetry with electrocardiographic\\nrecording, concurrent computerized real time data analysis and\\ngreater than 24 hours of accessible ECG data storage (retrievable\\nwith query) with ECG triggered and patient selected events\\n$ 1,453.15\\n93268\\n93268\\nExternal patient and, when performed, auto activated\\nelectrocardiographic rhythm derived event recording with symptom-\\nrelated memory loop with remote download capability up to 30\\ndays, 24-hour attended monitoring; includes transmission, review\\nand interpr\\n$ 382.17\\n93270\\n93270\\nExternal patient and, when performed, auto activated\\nelectrocardiographic rhythm derived event recording with symptom-\\nrelated memory loop with remote download capability up to 30\\ndays, 24-hour attended monitoring; recording (includes connection,\\nrecording\\n$ 136.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n359\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n360\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93271\\n93271\\nExternal patient and, when performed, auto activated\\nelectrocardiographic rhythm derived event recording with symptom-\\nrelated memory loop with remote download capability up to 30\\ndays, 24-hour attended monitoring; transmission and analysis\\n$ 215.10\\n93272\\n93272\\nExternal patient and, when performed, auto activated\\nelectrocardiographic rhythm derived event recording with symptom-\\nrelated memory loop with remote download capability up to 30\\ndays, 24-hour attended monitoring; review and interpretation by a\\nphysician\\n$ 91.80\\n93278\\n93278\\nSignal-averaged electrocardiography (SAECG), with or without ECG\\n$ 211.50\\n93278-26 26\\n93278\\nSignal-averaged electrocardiography (SAECG), with or without ECG\\n$ 79.25\\n93278-TC TC\\n93278\\nSignal-averaged electrocardiography (SAECG), with or without ECG\\n$ 132.25\\n93279\\n93279\\nProgramming device evaluation (in person) with iterative\\nadjustment of the implantable device to test the function of the\\ndevice and select optimal permanent programmed values with\\nanalysis, review and report by a physician or other qualified health\\ncare\\n$ 82.45\\n93280\\n93280\\nProgramming device evaluation (in person) with iterative\\nadjustment of the implantable device to test the function of the\\ndevice and select optimal permanent programmed values with\\nanalysis, review and report by a physician or other qualified health\\ncare\\n$ 98.60\\n93281\\n93281\\nProgramming device evaluation (in person) with iterative\\nadjustment of the implantable device to test the function of the\\ndevice and select optimal permanent programmed values with\\nanalysis, review and report by a physician or other qualified health\\ncare\\n$ 114.49\\n93282\\n93282\\nProgramming device evaluation (in person) with iterative\\nadjustment of the implantable device to test the function of the\\ndevice and select optimal permanent programmed values with\\nanalysis, review and report by a physician or other qualified health\\ncare\\n$ 107.41\\n93283\\n93283\\nProgramming device evaluation (in person) with iterative\\nadjustment of the implantable device to test the function of the\\ndevice and select optimal permanent programmed values with\\nanalysis, review and report by a physician or other qualified health\\ncare\\n$ 135.22\\n93284\\n93284\\nProgramming device evaluation (in person) with iterative\\nadjustment of the implantable device to test the function of the\\ndevice and select optimal permanent programmed values with\\nanalysis, review and report by a physician or other qualified health\\ncare\\n$ 171.39\\n93285\\n93285\\nProgramming device evaluation (in person) with iterative\\nadjustment of the implantable device to test the function of the\\ndevice and select optimal permanent programmed values with\\nanalysis, review and report by a physician or other qualified health\\ncare\\n$ 67.31\\n93286\\n93286\\nPeri-procedural device evaluation (in person) and programming of\\ndevice system parameters before or after a surgery, procedure, or\\ntest with analysis, review and report by a physician or other\\nqualified health care professional; single, dual, or multiple\\n$ 31.89\\n93287\\n93287\\nPeri-procedural device evaluation (in person) and programming of\\ndevice system parameters before or after a surgery, procedure, or\\ntest with analysis, review and report by a physician or other\\nqualified health care professional; single, dual, or multiple\\n$ 56.46\\n93288\\n93288\\nInterrogation device evaluation (in person) with analysis, review and\\nreport by a physician or other qualified health care professional,\\nincludes connection, recording and disconnection per patient\\nencounter; single, dual, or multiple lead pacemaker syste\\n$ 55.14\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n361\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n362\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93289\\n93289\\nInterrogation device evaluation (in person) with analysis, review and\\nreport by a physician or other qualified health care professional,\\nincludes connection, recording and disconnection per patient\\nencounter; single, dual, or multiple lead implantable car\\n$ 100.80\\n93290\\n93290\\nInterrogation device evaluation (in person) with analysis, review and\\nreport by a physician or other qualified health care professional,\\nincludes connection, recording and disconnection per patient\\nencounter; implantable cardiovascular monitor system, inc\\n$ 52.49\\n93291\\n93291\\nInterrogation device evaluation (in person) with analysis, review and\\nreport by a physician or other qualified health care professional,\\nincludes connection, recording and disconnection per patient\\nencounter; implantable loop recorder system, including he\\n$ 55.68\\n93293\\n93293\\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\\nor multiple lead pacemaker system, includes recording with and\\nwithout magnet application with analysis, review and report(s) by a\\nphysician or other qualified health care professional, up\\n$ 38.13\\n93294\\n93294\\nInterrogation device evaluation(s) (remote), up to 90 days; single,\\ndual, or multiple lead pacemaker system with interim analysis,\\nreview(s) and report(s) by a physician or other qualified health care\\nprofessional\\n$ 94.89\\n93295\\n93295\\nInterrogation device evaluation(s) (remote), up to 90 days; single,\\ndual, or multiple lead implantable cardioverter-defibrillator system\\nwith interim analysis, review(s) and report(s) by a physician or other\\nqualified health care professional\\n$ 152.27\\n93296\\n93296\\nInterrogation device evaluation(s) (remote), up to 90 days; single,\\ndual, or multiple lead pacemaker system or implantable\\ncardioverter-defibrillator system, remote data acquisition(s), receipt\\nof transmissions and technician review, technical support and\\n$ 93.78\\n93297\\n93297\\nInterrogation device evaluation(s), (remote) up to 30 days;\\nimplantable cardiovascular monitor system, including analysis of 1\\nor more recorded physiologic cardiovascular data elements from all\\ninternal and external sensors, analysis, review(s) and report\\n$ 56.66\\n93298\\n93298\\nInterrogation device evaluation(s), (remote) up to 30 days;\\nimplantable loop recorder system, including analysis of recorded\\nheart rhythm data, analysis, review(s) and report(s) by a physician\\nor other qualified health care professional\\n$ 75.22\\n93299\\n93299\\nInterrogation device evaluation(s), (remote) up to 30 days;\\nimplantable cardiovascular monitor system or implantable loop\\nrecorder system, remote data acquisition(s), receipt of\\ntransmissions and technician review, technical support and\\ndistribution of re\\n$ -\\n93303\\n93303\\nTransthoracic echocardiography for congenital cardiac anomalies;\\ncomplete\\n$ 513.90\\n93303-26 26\\n93303\\nTransthoracic echocardiography for congenital cardiac anomalies;\\ncomplete\\n$ 152.41\\n93303-TC TC\\n93303\\nTransthoracic echocardiography for congenital cardiac anomalies;\\ncomplete\\n$ 361.49\\n93304\\n93304\\nTransthoracic echocardiography for congenital cardiac anomalies;\\nfollow-up or limited study\\n$ 280.80\\n93304-26 26\\n93304\\nTransthoracic echocardiography for congenital cardiac anomalies;\\nfollow-up or limited study\\n$ 72.52\\n93304-TC TC\\n93304\\nTransthoracic echocardiography for congenital cardiac anomalies;\\nfollow-up or limited study\\n$ 208.28\\n93306\\n93306\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\ncomplete, with spectral Doppler echocardiography, and with color\\nflow Doppler echocardiography\\n$ 230.29\\n93307\\n93307\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\ncomplete, without spectral or color Doppler echocardiography\\n$ 499.03\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n363\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n364\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93307-26 26\\n93307\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\ncomplete, without spectral or color Doppler echocardiography\\n$ 182.92\\n93307-TC TC\\n93307\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\ncomplete, without spectral or color Doppler echocardiography\\n$ 316.11\\n93308\\n93308\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\nfollow-up or limited study\\n$ 58.08\\n93312\\n93312\\nEchocardiography, transesophageal, real-time with image\\ndocumentation (2D) (with or without M-mode recording); including\\nprobe placement, image acquisition, interpretation and report\\n$ 665.35\\n93312-26 26\\n93312\\nEchocardiography, transesophageal, real-time with image\\ndocumentation (2D) (with or without M-mode recording); including\\nprobe placement, image acquisition, interpretation and report\\n$ 208.89\\n93312-TC TC\\n93312\\nEchocardiography, transesophageal, real-time with image\\ndocumentation (2D) (with or without M-mode recording); including\\nprobe placement, image acquisition, interpretation and report\\n$ 456.47\\n93313\\n93313\\nEchocardiography, transesophageal, real-time with image\\ndocumentation (2D) (with or without M-mode recording);\\nplacement of transesophageal probe only\\n$ 257.40\\n93314\\n93314\\nEchocardiography, transesophageal, real-time with image\\ndocumentation (2D) (with or without M-mode recording); image\\nacquisition, interpretation and report only\\n$ 424.80\\n93314-26 26\\n93314\\nEchocardiography, transesophageal, real-time with image\\ndocumentation (2D) (with or without M-mode recording); image\\nacquisition, interpretation and report only\\n$ 81.18\\n93314-TC TC\\n93314\\nEchocardiography, transesophageal, real-time with image\\ndocumentation (2D) (with or without M-mode recording); image\\nacquisition, interpretation and report only\\n$ 343.62\\n93315\\n93315\\nTransesophageal echocardiography for congenital cardiac\\nanomalies; including probe placement, image acquisition,\\ninterpretation and report\\n$ 663.30\\n93315-26 26\\n93315\\nTransesophageal echocardiography for congenital cardiac\\nanomalies; including probe placement, image acquisition,\\ninterpretation and report\\n$ 463.40\\n93316\\n93316\\nTransesophageal echocardiography for congenital cardiac\\nanomalies; placement of transesophageal probe only\\n$ 135.90\\n93317\\n93317\\nTransesophageal echocardiography for congenital cardiac\\nanomalies; image acquisition, interpretation and report only\\n$ 526.50\\n93317-26 26\\n93317\\nTransesophageal echocardiography for congenital cardiac\\nanomalies; image acquisition, interpretation and report only\\n$ 300.16\\n93318\\n93318\\nEchocardiography, transesophageal (TEE) for monitoring purposes,\\nincluding probe placement, real time 2-dimensional image\\nacquisition and interpretation leading to ongoing (continuous)\\nassessment of (dynamically changing) cardiac pumping function and\\nto t\\n$ 847.00\\n93320\\n93320\\nDoppler echocardiography, pulsed wave and\/or continuous wave\\nwith spectral display (List separately in addition to codes for\\nechocardiographic imaging); complete\\n$ 307.08\\n93320-26 26\\n93320\\nDoppler echocardiography, pulsed wave and\/or continuous wave\\nwith spectral display (List separately in addition to codes for\\nechocardiographic imaging); complete\\n$ 116.49\\n93320-TC TC\\n93320\\nDoppler echocardiography, pulsed wave and\/or continuous wave\\nwith spectral display (List separately in addition to codes for\\nechocardiographic imaging); complete\\n$ 190.59\\n93321\\n93321\\nDoppler echocardiography, pulsed wave and\/or continuous wave\\nwith spectral display (List separately in addition to codes for\\nechocardiographic imaging); follow-up or limited study (List\\nseparately in addition to codes for echocardiographic imaging)\\n$ 187.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n365\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n366\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93321-26 26\\n93321\\nDoppler echocardiography, pulsed wave and\/or continuous wave\\nwith spectral display (List separately in addition to codes for\\nechocardiographic imaging); follow-up or limited study (List\\nseparately in addition to codes for echocardiographic imaging)\\n$ 52.95\\n93321-TC TC\\n93321\\nDoppler echocardiography, pulsed wave and\/or continuous wave\\nwith spectral display (List separately in addition to codes for\\nechocardiographic imaging); follow-up or limited study (List\\nseparately in addition to codes for echocardiographic imaging)\\n$ 134.25\\n93325\\n93325\\nDoppler echocardiography color flow velocity mapping (List\\nseparately in addition to codes for echocardiography)\\n$ 247.27\\n93325-26 26\\n93325\\nDoppler echocardiography color flow velocity mapping (List\\nseparately in addition to codes for echocardiography)\\n$ 44.14\\n93325-TC TC\\n93325\\nDoppler echocardiography color flow velocity mapping (List\\nseparately in addition to codes for echocardiography)\\n$ 203.13\\n93350\\n93350\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\nduring rest and cardiovascular stress test using treadmill, bicycle\\nexercise and\/or pharmacologically induced stress, with\\ninterpretation\\n$ 853.56\\n93350-26 26\\n93350\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\nduring rest and cardiovascular stress test using treadmill, bicycle\\nexercise and\/or pharmacologically induced stress, with\\ninterpretation\\n$ 280.69\\n93350-TC TC\\n93350\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\nduring rest and cardiovascular stress test using treadmill, bicycle\\nexercise and\/or pharmacologically induced stress, with\\ninterpretation\\n$ 572.87\\n93351\\n93351\\nEchocardiography, transthoracic, real-time with image\\ndocumentation (2D), includes M-mode recording, when performed,\\nduring rest and cardiovascular stress test using treadmill, bicycle\\nexercise and\/or pharmacologically induced stress, with\\ninterpretation\\n$ 274.13\\n93352\\n93352\\nUse of echocardiographic contrast agent during stress\\nechocardiography (List separately in addition to code for primary\\nprocedure)\\n$ 113.06\\n93462\\n93462\\nLeft heart catheterization by transseptal puncture through intact\\nseptum or by transapical puncture (List separately in addition to\\ncode for primary procedure)\\n$ 756.48\\n93503\\n93503\\nInsertion and placement of flow directed catheter (eg, Swan-Ganz)\\nfor monitoring purposes\\n$ 725.40\\n93505\\n93505\\nEndomyocardial biopsy\\n$ 1,007.10\\n93505-26 26\\n93505\\nEndomyocardial biopsy\\n$ 290.16\\n93505-TC TC\\n93505\\nEndomyocardial biopsy\\n$ 716.94\\n93530\\n93530\\nRight heart catheterization, for congenital cardiac anomalies\\n$ -\\n93531\\n93531\\nCombined right heart catheterization and retrograde left heart\\ncatheterization, for congenital cardiac anomalies\\n$ -\\n93532\\n93532\\nCombined right heart catheterization and transseptal left heart\\ncatheterization through intact septum with or without retrograde\\nleft heart catheterization, for congenital cardiac anomalies\\n$ -\\n93533\\n93533\\nCombined right heart catheterization and transseptal left heart\\ncatheterization through existing septal opening, with or without\\nretrograde left heart catheterization, for congenital cardiac\\nanomalies\\n$ -\\n93561\\n93561\\nIndicator dilution studies such as dye or thermodilution, including\\narterial and\/or venous catheterization; with cardiac output\\nmeasurement (separate procedure)\\n$ -\\n93562\\n93562\\nIndicator dilution studies such as dye or thermodilution, including\\narterial and\/or venous catheterization; subsequent measurement of\\ncardiac output\\n$ -\\n93563\\n93563\\nInjection procedure during cardiac catheterization including imaging\\nsupervision, interpretation, and report; for selective coronary\\nangiography during congenital heart catheterization (List separately\\nin addition to code for primary procedure)\\n$ 206.77\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n367\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n368\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93564\\n93564\\nInjection procedure during cardiac catheterization including imaging\\nsupervision, interpretation, and report; for selective opacification of\\naortocoronary venous or arterial bypass graft(s) (eg, aortocoronary\\nsaphenous vein, free radial artery, or free ma\\n$ 207.05\\n93565\\n93565\\nInjection procedure during cardiac catheterization including imaging\\nsupervision, interpretation, and report; for selective left ventricular\\nor left atrial angiography (List separately in addition to code for\\nprimary procedure)\\n$ 160.18\\n93566\\n93566\\nInjection procedure during cardiac catheterization including imaging\\nsupervision, interpretation, and report; for selective right\\nventricular or right atrial angiography (List separately in addition to\\ncode for primary procedure)\\n$ 642.05\\n93567\\n93567\\nInjection procedure during cardiac catheterization including imaging\\nsupervision, interpretation, and report; for supravalvular\\naortography (List separately in addition to code for primary\\nprocedure)\\n$ 525.96\\n93568\\n93568\\nInjection procedure during cardiac catheterization including imaging\\nsupervision, interpretation, and report; for pulmonary angiography\\n(List separately in addition to code for primary procedure)\\n$ 578.40\\n93571\\n93571\\nIntravascular Doppler velocity and\/or pressure derived coronary\\nflow reserve measurement (coronary vessel or graft) during\\ncoronary angiography including pharmacologically induced stress;\\ninitial vessel (List separately in addition to code for primary pro\\n$ 693.90\\n93571-26 26\\n93571\\nIntravascular Doppler velocity and\/or pressure derived coronary\\nflow reserve measurement (coronary vessel or graft) during\\ncoronary angiography including pharmacologically induced stress;\\ninitial vessel (List separately in addition to code for primary pro\\n$ 352.53\\n93572\\n93572\\nIntravascular Doppler velocity and\/or pressure derived coronary\\nflow reserve measurement (coronary vessel or graft) during\\ncoronary angiography including pharmacologically induced stress;\\neach additional vessel (List separately in addition to code for pri\\n$ 637.20\\n93572-26 26\\n93572\\nIntravascular Doppler velocity and\/or pressure derived coronary\\nflow reserve measurement (coronary vessel or graft) during\\ncoronary angiography including pharmacologically induced stress;\\neach additional vessel (List separately in addition to code for pri\\n$ 290.14\\n93580\\n93580\\nPercutaneous transcatheter closure of congenital interatrial\\ncommunication (ie, Fontan fenestration, atrial septal defect) with\\nimplant\\n$ 10,167.89\\n93600\\n93600\\nBundle of His recording\\n$ 772.20\\n93600-26 26\\n93600\\nBundle of His recording\\n$ 310.59\\n93602\\n93602\\nIntra-atrial recording\\n$ 510.30\\n93602-26 26\\n93602\\nIntra-atrial recording\\n$ 254.62\\n93603\\n93603\\nRight ventricular recording\\n$ 605.70\\n93603-26 26\\n93603\\nRight ventricular recording\\n$ 221.61\\n93609\\n93609\\nIntraventricular and\/or intra-atrial mapping of tachycardia site(s)\\nwith catheter manipulation to record from multiple sites to identify\\norigin of tachycardia (List separately in addition to code for primary\\nprocedure)\\n$ 1,494.00\\n93609-26 26\\n93609\\nIntraventricular and\/or intra-atrial mapping of tachycardia site(s)\\nwith catheter manipulation to record from multiple sites to identify\\norigin of tachycardia (List separately in addition to code for primary\\nprocedure)\\n$ 825.96\\n93610\\n93610\\nIntra-atrial pacing\\n$ 592.20\\n93610-26 26\\n93610\\nIntra-atrial pacing\\n$ 416.14\\n93612\\n93612\\nIntraventricular pacing\\n$ 568.80\\n93612-26 26\\n93612\\nIntraventricular pacing\\n$ 327.81\\n93613\\n93613\\nIntracardiac electrophysiologic 3-dimensional mapping (List\\nseparately in addition to code for primary procedure)\\n$ 1,153.65\\n93615\\n93615\\nEsophageal recording of atrial electrogram with or without\\nventricular electrogram(s);\\n$ 134.10\\n93615-26 26\\n93615\\nEsophageal recording of atrial electrogram with or without\\nventricular electrogram(s);\\n$ 103.31\\n93616\\n93616\\nEsophageal recording of atrial electrogram with or without\\nventricular electrogram(s); with pacing\\n$ 358.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n369\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n370\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93616-26 26\\n93616\\nEsophageal recording of atrial electrogram with or without\\nventricular electrogram(s); with pacing\\n$ 165.00\\n93618\\n93618\\nInduction of arrhythmia by electrical pacing\\n$ 1,287.90\\n93618-26 26\\n93618\\nInduction of arrhythmia by electrical pacing\\n$ 730.18\\n93619\\n93619\\nComprehensive electrophysiologic evaluation with right atrial\\npacing and recording, right ventricular pacing and recording, His\\nbundle recording, including insertion and repositioning of multiple\\nelectrode catheters, without induction or attempted inducti\\n$ 2,567.70\\n93619-26 26\\n93619\\nComprehensive electrophysiologic evaluation with right atrial\\npacing and recording, right ventricular pacing and recording, His\\nbundle recording, including insertion and repositioning of multiple\\nelectrode catheters, without induction or attempted inducti\\n$ 1,141.78\\n93620\\n93620\\nComprehensive electrophysiologic evaluation including insertion\\nand repositioning of multiple electrode catheters with induction or\\nattempted induction of arrhythmia; with right atrial pacing and\\nrecording, right ventricular pacing and recording, His bund\\n$ 3,511.80\\n93620-26 26\\n93620\\nComprehensive electrophysiologic evaluation including insertion\\nand repositioning of multiple electrode catheters with induction or\\nattempted induction of arrhythmia; with right atrial pacing and\\nrecording, right ventricular pacing and recording, His bund\\n$ 1,780.00\\n93621\\n93621\\nComprehensive electrophysiologic evaluation including insertion\\nand repositioning of multiple electrode catheters with induction or\\nattempted induction of arrhythmia; with left atrial pacing and\\nrecording from coronary sinus or left atrium (List separatel\\n$ 3,800.70\\n93621-26 26\\n93621\\nComprehensive electrophysiologic evaluation including insertion\\nand repositioning of multiple electrode catheters with induction or\\nattempted induction of arrhythmia; with left atrial pacing and\\nrecording from coronary sinus or left atrium (List separatel\\n$ 425.44\\n93622\\n93622\\nComprehensive electrophysiologic evaluation including insertion\\nand repositioning of multiple electrode catheters with induction or\\nattempted induction of arrhythmia; with left ventricular pacing and\\nrecording (List separately in addition to code for prim\\n$ -\\n93623\\n93623\\nProgrammed stimulation and pacing after intravenous drug infusion\\n(List separately in addition to code for primary procedure)\\n$ 625.50\\n93623-26 26\\n93623\\nProgrammed stimulation and pacing after intravenous drug infusion\\n(List separately in addition to code for primary procedure)\\n$ 377.16\\n93624\\n93624\\nElectrophysiologic follow-up study with pacing and recording to test\\neffectiveness of therapy, including induction or attempted induction\\nof arrhythmia\\n$ 1,545.30\\n93624-26 26\\n93624\\nElectrophysiologic follow-up study with pacing and recording to test\\neffectiveness of therapy, including induction or attempted induction\\nof arrhythmia\\n$ 841.51\\n93631\\n93631\\nIntraoperative epicardial and endocardial pacing and mapping to\\nlocalize the site of tachycardia or zone of slow conduction for\\nsurgical correction\\n$ 1,283.52\\n93640\\n93640\\nElectrophysiologic evaluation of single or dual chamber pacing\\ncardioverter-defibrillator leads including defibrillation threshold\\nevaluation (induction of arrhythmia, evaluation of sensing and\\npacing for arrhythmia termination) at time of initial implant\\n$ 578.16\\n93641\\n93641\\nElectrophysiologic evaluation of single or dual chamber pacing\\ncardioverter-defibrillator leads including defibrillation threshold\\nevaluation (induction of arrhythmia, evaluation of sensing and\\npacing for arrhythmia termination) at time of initial implant\\n$ 1,702.80\\n93641-26 26\\n93641\\nElectrophysiologic evaluation of single or dual chamber pacing\\ncardioverter-defibrillator leads including defibrillation threshold\\nevaluation (induction of arrhythmia, evaluation of sensing and\\npacing for arrhythmia termination) at time of initial implant\\n$ 890.84\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n371\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n372\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93642\\n93642\\nElectrophysiologic evaluation of single or dual chamber pacing\\ncardioverter-defibrillator (includes defibrillation threshold\\nevaluation, induction of arrhythmia, evaluation of sensing and\\npacing for arrhythmia termination, and programming or\\nreprogramming\\n$ 841.38\\n93650\\n93650\\nIntracardiac catheter ablation of atrioventricular node function,\\natrioventricular conduction for creation of complete heart block,\\nwith or without temporary pacemaker placement\\n$ 3,193.20\\n93653\\n93653\\nComprehensive electrophysiologic evaluation including insertion\\nand repositioning of multiple electrode catheters with induction or\\nattempted induction of an arrhythmia with right atrial pacing and\\nrecording, right ventricular pacing and recording (when n\\n$ 1,587.14\\n93654\\n93654\\nComprehensive electrophysiologic evaluation including insertion\\nand repositioning of multiple electrode catheters with induction or\\nattempted induction of an arrhythmia with right atrial pacing and\\nrecording, right ventricular pacing and recording (when n\\n$ 2,118.20\\n93655\\n93655\\nIntracardiac catheter ablation of a discrete mechanism of\\narrhythmia which is distinct from the primary ablated mechanism,\\nincluding repeat diagnostic maneuvers, to treat a spontaneous or\\ninduced arrhythmia (List separately in addition to code for primary\\n$ 793.43\\n93656\\n93656\\nComprehensive electrophysiologic evaluation including transseptal\\ncatheterizations, insertion and repositioning of multiple electrode\\ncatheters with induction or attempted induction of an arrhythmia\\nincluding left or right atrial pacing\/recording when nec\\n$ 2,118.70\\n93657\\n93657\\nAdditional linear or focal intracardiac catheter ablation of the left or\\nright atrium for treatment of atrial fibrillation remaining after\\ncompletion of pulmonary vein isolation (List separately in addition\\nto code for primary procedure)\\n$ 794.38\\n93660\\n93660\\nEvaluation of cardiovascular function with tilt table evaluation, with\\ncontinuous ECG monitoring and intermittent blood pressure\\nmonitoring, with or without pharmacological intervention\\n$ 639.00\\n93660-26 26\\n93660\\nEvaluation of cardiovascular function with tilt table evaluation, with\\ncontinuous ECG monitoring and intermittent blood pressure\\nmonitoring, with or without pharmacological intervention\\n$ 361.25\\n93660-TC TC\\n93660\\nEvaluation of cardiovascular function with tilt table evaluation, with\\ncontinuous ECG monitoring and intermittent blood pressure\\nmonitoring, with or without pharmacological intervention\\n$ 277.75\\n93662\\n93662\\nIntracardiac echocardiography during therapeutic\/diagnostic\\nintervention, including imaging supervision and interpretation (List\\nseparately in addition to code for primary procedure)\\n$ -\\n93668\\n93668\\nPeripheral arterial disease (PAD) rehabilitation, per session\\n$ 142.65\\n93701\\n93701\\nBioimpedance-derived physiologic cardiovascular analysis\\n$ 86.57\\n93721-26 26\\n93721\\nPlethysmography for determination of lung volumes and, when\\nperformed, airway resistance\\n$ 23.56\\n93721-TC TC\\n93721\\nPlethysmography for determination of lung volumes and, when\\nperformed, airway resistance\\n$ 95.27\\n93722-26 26\\n93722\\nPlethysmography for determination of lung volumes and, when\\nperformed, airway resistance\\n$ 23.56\\n93722-TC TC\\n93722\\nPlethysmography for determination of lung volumes and, when\\nperformed, airway resistance\\n$ 95.27\\n93724\\n93724\\nElectronic analysis of antitachycardia pacemaker system (includes\\nelectrocardiographic recording, programming of device, induction\\nand termination of tachycardia via implanted pacemaker, and\\ninterpretation of recordings)\\n$ 575.15\\n93733-26 26\\n93733\\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\\nor multiple lead pacemaker system, includes recording with and\\nwithout magnet application with analysis, review and report(s) by a\\nphysician or other qualified health care professional, up\\n$ 38.13\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n373\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n374\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93733-TC TC\\n93733\\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\\nor multiple lead pacemaker system, includes recording with and\\nwithout magnet application with analysis, review and report(s) by a\\nphysician or other qualified health care professional, up\\n$ 98.63\\n93736-26 26\\n93736\\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\\nor multiple lead pacemaker system, includes recording with and\\nwithout magnet application with analysis, review and report(s) by a\\nphysician or other qualified health care professional, up\\n$ 38.13\\n93736-TC TC\\n93736\\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\\nor multiple lead pacemaker system, includes recording with and\\nwithout magnet application with analysis, review and report(s) by a\\nphysician or other qualified health care professional, up\\n$ 98.63\\n93740\\n93740\\nTemperature gradient studies\\n$ 108.00\\n93745\\n93745\\nInitial set-up and programming by a physician or other qualified\\nhealth care professional of wearable cardioverter-defibrillator\\nincludes initial programming of system, establishing baseline\\nelectronic ECG, transmission of data to data repository, patient\\n$ -\\n93750\\n93750\\nInterrogation of ventricular assist device (VAD), in person, with\\nphysician or other qualified health care professional analysis of\\ndevice parameters (eg, drivelines, alarms, power surges), review of\\ndevice function (eg, flow and volume status, septum sta\\n$ 107.14\\n93770\\n93770\\nDetermination of venous pressure\\n$ 30.60\\n93784\\n93784\\nAmbulatory blood pressure monitoring, utilizing a system such as\\nmagnetic tape and\/or computer disk, for 24 hours or longer;\\nincluding recording, scanning analysis, interpretation and report\\n$ 369.90\\n93786\\n93786\\nAmbulatory blood pressure monitoring, utilizing a system such as\\nmagnetic tape and\/or computer disk, for 24 hours or longer;\\nrecording only\\n$ 65.66\\n93788\\n93788\\nAmbulatory blood pressure monitoring, utilizing a system such as\\nmagnetic tape and\/or computer disk, for 24 hours or longer;\\nscanning analysis with report\\n$ 137.83\\n93790\\n93790\\nAmbulatory blood pressure monitoring, utilizing a system such as\\nmagnetic tape and\/or computer disk, for 24 hours or longer; review\\nwith interpretation and report\\n$ 65.76\\n93797\\n93797\\nPhysician or other qualified health care professional services for\\noutpatient cardiac rehabilitation; without continuous ECG\\nmonitoring (per session)\\n$ 46.80\\n93798\\n93798\\nPhysician or other qualified health care professional services for\\noutpatient cardiac rehabilitation; with continuous ECG monitoring\\n(per session)\\n$ 68.76\\n93799\\n93799\\nUnlisted cardiovascular service or procedure\\nCost\\n93875-26 26\\n93875\\nDuplex scan of extracranial arteries; complete bilateral study\\n$ 47.85\\n93875-TC TC\\n93875\\nDuplex scan of extracranial arteries; complete bilateral study\\n$ 383.73\\n93880\\n93880\\nDuplex scan of extracranial arteries; complete bilateral study\\n$ 431.58\\n93880-26 26\\n93880\\nDuplex scan of extracranial arteries; complete bilateral study\\n$ 47.85\\n93880-TC TC\\n93880\\nDuplex scan of extracranial arteries; complete bilateral study\\n$ 383.73\\n93882\\n93882\\nDuplex scan of extracranial arteries; unilateral or limited study\\n$ 43.57\\n93886\\n93886\\nTranscranial Doppler study of the intracranial arteries; complete\\nstudy\\n$ 53.54\\n93888\\n93888\\nTranscranial Doppler study of the intracranial arteries; limited study $ 44.63\\n93890\\n93890\\nTranscranial Doppler study of the intracranial arteries;\\nvasoreactivity study\\n$ 121.20\\n93892\\n93892\\nTranscranial Doppler study of the intracranial arteries; emboli\\ndetection without intravenous microbubble injection\\n$ 138.59\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n375\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n376\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93922\\n93922\\nLimited bilateral noninvasive physiologic studies of upper or lower\\nextremity arteries, (eg, for lower extremity: ankle\/brachial indices\\nat distal posterior tibial and anterior tibial\/dorsalis pedis arteries\\nplus bidirectional, Doppler waveform recording\\n$ 26.81\\n93923\\n93923\\nComplete bilateral noninvasive physiologic studies of upper or\\nlower extremity arteries, 3 or more levels (eg, for lower extremity:\\nankle\/brachial indices at distal posterior tibial and anterior\\ntibial\/dorsalis pedis arteries plus segmental blood pressure\\n$ 364.50\\n93923-26 26\\n93923\\nComplete bilateral noninvasive physiologic studies of upper or\\nlower extremity arteries, 3 or more levels (eg, for lower extremity:\\nankle\/brachial indices at distal posterior tibial and anterior\\ntibial\/dorsalis pedis arteries plus segmental blood pressure\\n$ 51.22\\n93923-TC TC\\n93923\\nComplete bilateral noninvasive physiologic studies of upper or\\nlower extremity arteries, 3 or more levels (eg, for lower extremity:\\nankle\/brachial indices at distal posterior tibial and anterior\\ntibial\/dorsalis pedis arteries plus segmental blood pressure\\n$ 313.28\\n93924\\n93924\\nNoninvasive physiologic studies of lower extremity arteries, at rest\\nand following treadmill stress testing, (ie, bidirectional Doppler\\nwaveform or volume plethysmography recording and analysis at\\nrest with ankle\/brachial indices immediately after and at\\n$ 369.00\\n93924-26 26\\n93924\\nNoninvasive physiologic studies of lower extremity arteries, at rest\\nand following treadmill stress testing, (ie, bidirectional Doppler\\nwaveform or volume plethysmography recording and analysis at\\nrest with ankle\/brachial indices immediately after and at\\n$ 45.73\\n93924-TC TC\\n93924\\nNoninvasive physiologic studies of lower extremity arteries, at rest\\nand following treadmill stress testing, (ie, bidirectional Doppler\\nwaveform or volume plethysmography recording and analysis at\\nrest with ankle\/brachial indices immediately after and at\\n$ 323.27\\n93925\\n93925\\nDuplex scan of lower extremity arteries or arterial bypass grafts;\\ncomplete bilateral study\\n$ 398.17\\n93925-26 26\\n93925\\nDuplex scan of lower extremity arteries or arterial bypass grafts;\\ncomplete bilateral study\\n$ 56.52\\n93925-TC TC\\n93925\\nDuplex scan of lower extremity arteries or arterial bypass grafts;\\ncomplete bilateral study\\n$ 341.65\\n93926\\n93926\\nDuplex scan of lower extremity arteries or arterial bypass grafts;\\nunilateral or limited study\\n$ 245.96\\n93926-26 26\\n93926\\nDuplex scan of lower extremity arteries or arterial bypass grafts;\\nunilateral or limited study\\n$ 38.91\\n93926-TC TC\\n93926\\nDuplex scan of lower extremity arteries or arterial bypass grafts;\\nunilateral or limited study\\n$ 207.05\\n93930\\n93930\\nDuplex scan of upper extremity arteries or arterial bypass grafts;\\ncomplete bilateral study\\n$ 432.90\\n93930-26 26\\n93930\\nDuplex scan of upper extremity arteries or arterial bypass grafts;\\ncomplete bilateral study\\n$ 37.29\\n93930-TC TC\\n93930\\nDuplex scan of upper extremity arteries or arterial bypass grafts;\\ncomplete bilateral study\\n$ 395.61\\n93931\\n93931\\nDuplex scan of upper extremity arteries or arterial bypass grafts;\\nunilateral or limited study\\n$ 270.90\\n93931-26 26\\n93931\\nDuplex scan of upper extremity arteries or arterial bypass grafts;\\nunilateral or limited study\\n$ 23.26\\n93931-TC TC\\n93931\\nDuplex scan of upper extremity arteries or arterial bypass grafts;\\nunilateral or limited study\\n$ 247.64\\n93965\\n93965\\nNoninvasive physiologic studies of extremity veins, complete\\nbilateral study (eg, Doppler waveform analysis with responses to\\ncompression and other maneuvers, phleborheography, impedance\\nplethysmography)\\n$ 243.31\\n93965-26 26\\n93965\\nNoninvasive physiologic studies of extremity veins, complete\\nbilateral study (eg, Doppler waveform analysis with responses to\\ncompression and other maneuvers, phleborheography, impedance\\nplethysmography)\\n$ 30.99\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n377\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n378\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n93965-TC TC\\n93965\\nNoninvasive physiologic studies of extremity veins, complete\\nbilateral study (eg, Doppler waveform analysis with responses to\\ncompression and other maneuvers, phleborheography, impedance\\nplethysmography)\\n$ 212.32\\n93970\\n93970\\nDuplex scan of extremity veins including responses to compression\\nand other maneuvers; complete bilateral study\\n$ 382.93\\n93970-26 26\\n93970\\nDuplex scan of extremity veins including responses to compression\\nand other maneuvers; complete bilateral study\\n$ 64.54\\n93970-TC TC\\n93970\\nDuplex scan of extremity veins including responses to compression\\nand other maneuvers; complete bilateral study\\n$ 318.39\\n93971\\n93971\\nDuplex scan of extremity veins including responses to compression\\nand other maneuvers; unilateral or limited study\\n$ 237.86\\n93971-26 26\\n93971\\nDuplex scan of extremity veins including responses to compression\\nand other maneuvers; unilateral or limited study\\n$ 41.87\\n93971-TC TC\\n93971\\nDuplex scan of extremity veins including responses to compression\\nand other maneuvers; unilateral or limited study\\n$ 195.99\\n93975\\n93975\\nDuplex scan of arterial inflow and venous outflow of abdominal,\\npelvic, scrotal contents and\/or retroperitoneal organs; complete\\nstudy\\n$ 387.90\\n93975-26 26\\n93975\\nDuplex scan of arterial inflow and venous outflow of abdominal,\\npelvic, scrotal contents and\/or retroperitoneal organs; complete\\nstudy\\n$ 86.92\\n93975-TC TC\\n93975\\nDuplex scan of arterial inflow and venous outflow of abdominal,\\npelvic, scrotal contents and\/or retroperitoneal organs; complete\\nstudy\\n$ 300.98\\n93976\\n93976\\nDuplex scan of arterial inflow and venous outflow of abdominal,\\npelvic, scrotal contents and\/or retroperitoneal organs; limited study $ 109.12\\n93978\\n93978\\nDuplex scan of aorta, inferior vena cava, iliac vasculature, or bypass\\ngrafts; complete study\\n$ 46.67\\n93979\\n93979\\nDuplex scan of aorta, inferior vena cava, iliac vasculature, or bypass\\ngrafts; unilateral or limited study\\n$ 32.53\\n93980\\n93980\\nDuplex scan of arterial inflow and venous outflow of penile vessels;\\ncomplete study\\n$ 179.39\\n93981\\n93981\\nDuplex scan of arterial inflow and venous outflow of penile vessels;\\nfollow-up or limited study\\n$ 63.58\\n93982\\n93982\\nNoninvasive physiologic study of implanted wireless pressure sensor\\nin aneurysmal sac following endovascular repair, complete study\\nincluding recording, analysis of pressure and waveform tracings,\\ninterpretation and report\\n$ 101.76\\n93990\\n93990\\nDuplex scan of hemodialysis access (including arterial inflow, body\\nof access and venous outflow)\\n$ 16.62\\n94002\\n94002\\nVentilation assist and management, initiation of pressure or volume\\npreset ventilators for assisted or controlled breathing; hospital\\ninpatient\/observation, initial day\\n$ 218.34\\n94003\\n94003\\nVentilation assist and management, initiation of pressure or volume\\npreset ventilators for assisted or controlled breathing; hospital\\ninpatient\/observation, each subsequent day\\n$ 157.25\\n94004\\n94004\\nVentilation assist and management, initiation of pressure or volume\\npreset ventilators for assisted or controlled breathing; nursing\\nfacility, per day\\n$ 114.51\\n94005\\n94005\\nHome ventilator management care plan oversight of a patient\\n(patient not present) in home, domiciliary or rest home (eg, assisted\\nliving) requiring review of status, review of laboratories and other\\nstudies and revision of orders and respiratory care plan\\n$ 203.72\\n94010\\n94010\\nSpirometry, including graphic record, total and timed vital capacity,\\nexpiratory flow rate measurement(s), with or without maximal\\nvoluntary ventilation\\n$ 92.70\\n94010-26 26\\n94010\\nSpirometry, including graphic record, total and timed vital capacity,\\nexpiratory flow rate measurement(s), with or without maximal\\nvoluntary ventilation\\n$ 18.97\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n379\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n380\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n94010-TC TC\\n94010\\nSpirometry, including graphic record, total and timed vital capacity,\\nexpiratory flow rate measurement(s), with or without maximal\\nvoluntary ventilation\\n$ 73.73\\n94011\\n94011\\nMeasurement of spirometric forced expiratory flows in an infant or\\nchild through 2 years of age\\n$ 216.23\\n94012\\n94012\\nMeasurement of spirometric forced expiratory flows, before and\\nafter bronchodilator, in an infant or child through 2 years of age\\n$ 352.90\\n94013\\n94013\\nMeasurement of lung volumes (ie, functional residual capacity\\n[FRC], forced vital capacity [FVC], and expiratory reserve volume\\n[ERV]) in an infant or child through 2 years of age\\n$ 76.21\\n94014\\n94014\\nPatient-initiated spirometric recording per 30-day period of time;\\nincludes reinforced education, transmission of spirometric tracing,\\ndata capture, analysis of transmitted data, periodic recalibration\\nand review and interpretation by a physician or other\\n$ 91.80\\n94015\\n94015\\nPatient-initiated spirometric recording per 30-day period of time;\\nrecording (includes hook-up, reinforced education, data\\ntransmission, data capture, trend analysis, and periodic\\nrecalibration)\\n$ 54.46\\n94016\\n94016\\nPatient-initiated spirometric recording per 30-day period of time;\\nreview and interpretation only by a physician or other qualified\\nhealth care professional\\n$ 58.50\\n94060\\n94060\\nBronchodilation responsiveness, spirometry as in 94010, pre- and\\npost-bronchodilator administration\\n$ 128.70\\n94060-26 26\\n94060\\nBronchodilation responsiveness, spirometry as in 94010, pre- and\\npost-bronchodilator administration\\n$ 24.14\\n94060-TC TC\\n94060\\nBronchodilation responsiveness, spirometry as in 94010, pre- and\\npost-bronchodilator administration\\n$ 104.56\\n94150\\n94150\\nVital capacity, total (separate procedure)\\n$ 5.54\\n94200\\n94200\\nMaximum breathing capacity, maximal voluntary ventilation\\n$ 11.13\\n94250\\n94250\\nExpired gas collection, quantitative, single procedure (separate\\nprocedure)\\n$ 33.30\\n94250-26 26\\n94250\\nExpired gas collection, quantitative, single procedure (separate\\nprocedure)\\n$ 6.45\\n94250-TC TC\\n94250\\nExpired gas collection, quantitative, single procedure (separate\\nprocedure)\\n$ 26.85\\n94375\\n94375\\nRespiratory flow volume loop\\n$ 99.00\\n94375-26 26\\n94375\\nRespiratory flow volume loop\\n$ 33.70\\n94375-TC TC\\n94375\\nRespiratory flow volume loop\\n$ 65.30\\n94450\\n94450\\nBreathing response to hypoxia (hypoxia response curve)\\n$ 24.61\\n94452\\n94452\\nHigh altitude simulation test (HAST), with interpretation and report\\nby a physician or other qualified health care professional;\\n$ 37.46\\n94453\\n94453\\nHigh altitude simulation test (HAST), with interpretation and report\\nby a physician or other qualified health care professional; with\\nsupplemental oxygen titration\\n$ 48.67\\n94610\\n94610\\nIntrapulmonary surfactant administration by a physician or other\\nqualified health care professional through endotracheal tube\\n$ 157.18\\n94620\\n94620\\nPulmonary stress testing; simple (eg, 6-minute walk test, prolonged\\nexercise test for bronchospasm with pre- and post-spirometry and\\noximetry)\\n$ 254.70\\n94620-26 26\\n94620\\nPulmonary stress testing; simple (eg, 6-minute walk test, prolonged\\nexercise test for bronchospasm with pre- and post-spirometry and\\noximetry)\\n$ 129.42\\n94620-TC TC\\n94620\\nPulmonary stress testing; simple (eg, 6-minute walk test, prolonged\\nexercise test for bronchospasm with pre- and post-spirometry and\\noximetry)\\n$ 125.28\\n94621\\n94621\\nPulmonary stress testing; complex (including measurements of CO2\\nproduction, O2 uptake, and electrocardiographic recordings)\\n$ 81.55\\n94640\\n94640\\nPressurized or nonpressurized inhalation treatment for acute\\nairway obstruction or for sputum induction for diagnostic purposes\\n(eg, with an aerosol generator, nebulizer, metered dose inhaler or\\nintermittent positive pressure breathing [IPPB] device)\\n$ 41.40\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n381\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n382\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n94645\\n94645\\nContinuous inhalation treatment with aerosol medication for acute\\nairway obstruction; each additional hour (List separately in addition\\nto code for primary procedure)\\n$ 32.68\\n94660\\n94660\\nContinuous positive airway pressure ventilation (CPAP), initiation\\nand management\\n$ 180.90\\n94664\\n94664\\nDemonstration and\/or evaluation of patient utilization of an aerosol\\ngenerator, nebulizer, metered dose inhaler or IPPB device\\n$ 49.61\\n94667\\n94667\\nManipulation chest wall, such as cupping, percussing, and vibration\\nto facilitate lung function; initial demonstration and\/or evaluation\\n$ 63.00\\n94668\\n94668\\nManipulation chest wall, such as cupping, percussing, and vibration\\nto facilitate lung function; subsequent\\n$ 54.90\\n94680\\n94680\\nOxygen uptake, expired gas analysis; rest and exercise, direct,\\nsimple\\n$ 26.96\\n94681\\n94681\\nOxygen uptake, expired gas analysis; including CO2 output,\\npercentage oxygen extracted\\n$ 169.20\\n94681-26 26\\n94681\\nOxygen uptake, expired gas analysis; including CO2 output,\\npercentage oxygen extracted\\n$ 28.35\\n94681-TC TC\\n94681\\nOxygen uptake, expired gas analysis; including CO2 output,\\npercentage oxygen extracted\\n$ 140.85\\n94750\\n94750\\nPulmonary compliance study (eg, plethysmography, volume and\\npressure measurements)\\n$ 98.10\\n94750-26 26\\n94750\\nPulmonary compliance study (eg, plethysmography, volume and\\npressure measurements)\\n$ 11.39\\n94750-TC TC\\n94750\\nPulmonary compliance study (eg, plethysmography, volume and\\npressure measurements)\\n$ 86.71\\n94760\\n94760\\nNoninvasive ear or pulse oximetry for oxygen saturation; single\\ndetermination\\n$ 34.98\\n94761\\n94761\\nNoninvasive ear or pulse oximetry for oxygen saturation; multiple\\ndeterminations (eg, during exercise)\\n$ 72.00\\n94774\\n94774\\nPediatric home apnea monitoring event recording including\\nrespiratory rate, pattern and heart rate per 30-day period of time;\\nincludes monitor attachment, download of data, review,\\ninterpretation, and preparation of a report by a physician or other\\nqualif\\n$ -\\n94775\\n94775\\nPediatric home apnea monitoring event recording including\\nrespiratory rate, pattern and heart rate per 30-day period of time;\\nmonitor attachment only (includes hook-up, initiation of recording\\nand disconnection)\\n$ -\\n94776\\n94776\\nPediatric home apnea monitoring event recording including\\nrespiratory rate, pattern and heart rate per 30-day period of time;\\nmonitoring, download of information, receipt of transmission(s) and\\nanalyses by computer only\\n$ -\\n94777\\n94777\\nPediatric home apnea monitoring event recording including\\nrespiratory rate, pattern and heart rate per 30-day period of time;\\nreview, interpretation and preparation of report only by a physician\\nor other qualified health care professional\\n$ -\\n94799\\n94799\\nUnlisted pulmonary service or procedure\\n$ 27.50\\n95004\\n95004\\nPercutaneous tests (scratch, puncture, prick) with allergenic\\nextracts, immediate type reaction, including test interpretation and\\nreport, specify number of tests\\n$ 7.55\\n95012\\n95012\\nNitric oxide expired gas determination\\n$ 56.16\\n95017\\n95017\\nAllergy testing, any combination of percutaneous (scratch,\\npuncture, prick) and intracutaneous (intradermal), sequential and\\nincremental, with venoms, immediate type reaction, including test\\ninterpretation and report, specify number of tests\\n$ 17.14\\n95018\\n95018\\nAllergy testing, any combination of percutaneous (scratch,\\npuncture, prick) and intracutaneous (intradermal), sequential and\\nincremental, with drugs or biologicals, immediate type reaction,\\nincluding test interpretation and report, specify number of tests\\n$ 42.06\\n95024\\n95024\\nIntracutaneous (intradermal) tests with allergenic extracts,\\nimmediate type reaction, including test interpretation and report,\\nspecify number of tests\\n$ 14.40\\n95027\\n95027\\nIntracutaneous (intradermal) tests, sequential and incremental,\\nwith allergenic extracts for airborne allergens, immediate type\\nreaction, including test interpretation and report, specify number of\\ntests\\n$ 12.83\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n383\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n384\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95028\\n95028\\nIntracutaneous (intradermal) tests with allergenic extracts, delayed\\ntype reaction, including reading, specify number of tests\\n$ 20.70\\n95044\\n95044\\nPatch or application test(s) (specify number of tests)\\n$ 19.08\\n95052\\n95052\\nPhoto patch test(s) (specify number of tests)\\n$ 13.50\\n95056\\n95056\\nPhoto tests\\n$ 12.60\\n95060\\n95060\\nOphthalmic mucous membrane tests\\n$ 23.40\\n95065\\n95065\\nDirect nasal mucous membrane test\\n$ 20.70\\n95070\\n95070\\nInhalation bronchial challenge testing (not including necessary\\npulmonary function tests); with histamine, methacholine, or similar\\ncompounds\\n$ 175.50\\n95071\\n95071\\nInhalation bronchial challenge testing (not including necessary\\npulmonary function tests); with antigens or gases, specify\\n$ 204.30\\n95076\\n95076\\nIngestion challenge test (sequential and incremental ingestion of\\ntest items, eg, food, drug or other substance); initial 120 minutes of\\ntesting\\n$ 219.54\\n95079\\n95079\\nIngestion challenge test (sequential and incremental ingestion of\\ntest items, eg, food, drug or other substance); each additional 60\\nminutes of testing (List separately in addition to code for primary\\nprocedure)\\n$ 152.06\\n95115\\n95115\\nProfessional services for allergen immunotherapy not including\\nprovision of allergenic extracts; single injection\\n$ 17.96\\n95117\\n95117\\nProfessional services for allergen immunotherapy not including\\nprovision of allergenic extracts; 2 or more injections\\n$ 23.11\\n95120\\n95120\\nProfessional services for allergen immunotherapy in the office or\\ninstitution of the prescribing physician or other qualified health care\\nprofessional, including provision of allergenic extract; single\\ninjection\\n$ 26.10\\n95125\\n95125\\nProfessional services for allergen immunotherapy in the office or\\ninstitution of the prescribing physician or other qualified health care\\nprofessional, including provision of allergenic extract; 2 or more\\ninjections\\n$ 28.80\\n95130\\n95130\\nProfessional services for allergen immunotherapy in the office or\\ninstitution of the prescribing physician or other qualified health care\\nprofessional, including provision of allergenic extract; single stinging\\ninsect venom\\n$ 34.20\\n95131\\n95131\\nProfessional services for allergen immunotherapy in the office or\\ninstitution of the prescribing physician or other qualified health care\\nprofessional, including provision of allergenic extract; 2 stinging\\ninsect venoms\\n$ 47.70\\n95132\\n95132\\nProfessional services for allergen immunotherapy in the office or\\ninstitution of the prescribing physician or other qualified health care\\nprofessional, including provision of allergenic extract; 3 stinging\\ninsect venoms\\n$ 62.10\\n95133\\n95133\\nProfessional services for allergen immunotherapy in the office or\\ninstitution of the prescribing physician or other qualified health care\\nprofessional, including provision of allergenic extract; 4 stinging\\ninsect venoms\\n$ 63.90\\n95134\\n95134\\nProfessional services for allergen immunotherapy in the office or\\ninstitution of the prescribing physician or other qualified health care\\nprofessional, including provision of allergenic extract; 5 stinging\\ninsect venoms\\n$ 65.70\\n95144\\n95144\\nProfessional services for the supervision of preparation and\\nprovision of antigens for allergen immunotherapy, single dose\\nvial(s) (specify number of vials)\\n$ 33.49\\n95145\\n95145\\nProfessional services for the supervision of preparation and\\nprovision of antigens for allergen immunotherapy (specify number\\nof doses); single stinging insect venom\\n$ 36.00\\n95146\\n95146\\nProfessional services for the supervision of preparation and\\nprovision of antigens for allergen immunotherapy (specify number\\nof doses); 2 single stinging insect venoms\\n$ 46.80\\n95147\\n95147\\nProfessional services for the supervision of preparation and\\nprovision of antigens for allergen immunotherapy (specify number\\nof doses); 3 single stinging insect venoms\\n$ 64.80\\n95148\\n95148\\nProfessional services for the supervision of preparation and\\nprovision of antigens for allergen immunotherapy (specify number\\nof doses); 4 single stinging insect venoms\\n$ 65.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n385\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n386\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95149\\n95149\\nProfessional services for the supervision of preparation and\\nprovision of antigens for allergen immunotherapy (specify number\\nof doses); 5 single stinging insect venoms\\n$ 81.00\\n95165\\n95165\\nProfessional services for the supervision of preparation and\\nprovision of antigens for allergen immunotherapy; single or multiple\\nantigens (specify number of doses)\\n$ 15.30\\n95170\\n95170\\nProfessional services for the supervision of preparation and provision\\nof antigens for allergen immunotherapy; whole body extract of\\nbiting insect or other arthropod (specify number of doses)\\n$ 33.30\\n95180\\n95180\\nRapid desensitization procedure, each hour (eg, insulin, penicillin,\\nequine serum)\\n$ 207.00\\n95199\\n95199\\nUnlisted allergy\/clinical immunologic service or procedure\\nCost\\n95250\\n95250\\nAmbulatory continuous glucose monitoring of interstitial tissue fluid\\nvia a subcutaneous sensor for a minimum of 72 hours; sensor\\nplacement, hook-up, calibration of monitor, patient training,\\nremoval of sensor, and printout of recording\\n$ 265.16\\n95251\\n95251\\nAmbulatory continuous glucose monitoring of interstitial tissue fluid\\nvia a subcutaneous sensor for a minimum of 72 hours;\\ninterpretation and report\\n$ 62.92\\n95803\\n95803\\nActigraphy testing, recording, analysis, interpretation, and report\\n(minimum of 72 hours to 14 consecutive days of recording)\\n$ 80.02\\n95805\\n95805\\nMultiple sleep latency or maintenance of wakefulness testing,\\nrecording, analysis and interpretation of physiological\\nmeasurements of sleep during multiple trials to assess sleepiness\\n$ 566.10\\n95805-26 26\\n95805\\nMultiple sleep latency or maintenance of wakefulness testing,\\nrecording, analysis and interpretation of physiological\\nmeasurements of sleep during multiple trials to assess sleepiness\\n$ 70.32\\n95805-TC TC\\n95805\\nMultiple sleep latency or maintenance of wakefulness testing,\\nrecording, analysis and interpretation of physiological\\nmeasurements of sleep during multiple trials to assess sleepiness\\n$ 495.78\\n95806\\n95806\\nSleep study, unattended, simultaneous recording of, heart rate,\\noxygen saturation, respiratory airflow, and respiratory effort (eg,\\nthoracoabdominal movement)\\n$ 66.94\\n95807\\n95807\\nSleep study, simultaneous recording of ventilation, respiratory\\neffort, ECG or heart rate, and oxygen saturation, attended by a\\ntechnologist\\n$ 713.70\\n95807-26 26\\n95807\\nSleep study, simultaneous recording of ventilation, respiratory\\neffort, ECG or heart rate, and oxygen saturation, attended by a\\ntechnologist\\n$ 80.56\\n95807-TC TC\\n95807\\nSleep study, simultaneous recording of ventilation, respiratory\\neffort, ECG or heart rate, and oxygen saturation, attended by a\\ntechnologist\\n$ 633.14\\n95808\\n95808\\nPolysomnography; any age, sleep staging with 1-3 additional\\nparameters of sleep, attended by a technologist\\n$ 756.90\\n95808-26 26\\n95808\\nPolysomnography; any age, sleep staging with 1-3 additional\\nparameters of sleep, attended by a technologist\\n$ 91.44\\n95808-TC TC\\n95808\\nPolysomnography; any age, sleep staging with 1-3 additional\\nparameters of sleep, attended by a technologist\\n$ 665.46\\n95810\\n95810\\nPolysomnography; age 6 years or older, sleep staging with 4 or\\nmore additional parameters of sleep, attended by a technologist\\n$ 747.00\\n95810-26 26\\n95810\\nPolysomnography; age 6 years or older, sleep staging with 4 or\\nmore additional parameters of sleep, attended by a technologist\\n$ 129.14\\n95810-TC TC\\n95810\\nPolysomnography; age 6 years or older, sleep staging with 4 or\\nmore additional parameters of sleep, attended by a technologist\\n$ 617.86\\n95811\\n95811\\nPolysomnography; age 6 years or older, sleep staging with 4 or\\nmore additional parameters of sleep, with initiation of continuous\\npositive airway pressure therapy or bilevel ventilation, attended by\\na technologist\\n$ 455.02\\n95812\\n95812\\nElectroencephalogram (EEG) extended monitoring; 41-60 minutes\\n$ 174.48\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n387\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n388\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95813\\n95813\\nElectroencephalogram (EEG) extended monitoring; greater than 1\\nhour\\n$ 221.97\\n95816\\n95816\\nElectroencephalogram (EEG); including recording awake and drowsy $ 266.90\\n95816-26 26\\n95816\\nElectroencephalogram (EEG); including recording awake and drowsy $ 33.98\\n95816-TC TC\\n95816\\nElectroencephalogram (EEG); including recording awake and drowsy $ 232.92\\n95819\\n95819\\nElectroencephalogram (EEG); including recording awake and asleep\\n$ 215.10\\n95819-26 26\\n95819\\nElectroencephalogram (EEG); including recording awake and asleep\\n$ 23.60\\n95819-TC TC\\n95819\\nElectroencephalogram (EEG); including recording awake and asleep\\n$ 191.50\\n95822\\n95822\\nElectroencephalogram (EEG); recording in coma or sleep only\\n$ 270.90\\n95822-26 26\\n95822\\nElectroencephalogram (EEG); recording in coma or sleep only\\n$ 33.28\\n95822-TC TC\\n95822\\nElectroencephalogram (EEG); recording in coma or sleep only\\n$ 237.62\\n95824\\n95824\\nElectroencephalogram (EEG); cerebral death evaluation only\\n$ 177.30\\n95827\\n95827\\nElectroencephalogram (EEG); all night recording\\n$ 343.80\\n95827-26 26\\n95827\\nElectroencephalogram (EEG); all night recording\\n$ 22.14\\n95827-TC TC\\n95827\\nElectroencephalogram (EEG); all night recording\\n$ 321.66\\n95829\\n95829\\nElectrocorticogram at surgery (separate procedure)\\n$ 533.70\\n95829-26 26\\n95829\\nElectrocorticogram at surgery (separate procedure)\\n$ 80.52\\n95829-TC TC\\n95829\\nElectrocorticogram at surgery (separate procedure)\\n$ 453.18\\n95830\\n95830\\nInsertion by physician or other qualified health care professional of\\nsphenoidal electrodes for electroencephalographic (EEG) recording\\n$ 241.20\\n95831\\n95831\\nMuscle testing, manual (separate procedure) with report; extremity\\n(excluding hand) or trunk\\n$ 105.30\\n95832\\n95832\\nMuscle testing, manual (separate procedure) with report; hand,\\nwith or without comparison with normal side\\n$ 72.90\\n95833\\n95833\\nMuscle testing, manual (separate procedure) with report; total\\nevaluation of body, excluding hands\\n$ 113.40\\n95834\\n95834\\nMuscle testing, manual (separate procedure) with report; total\\nevaluation of body, including hands\\n$ 139.50\\n95851\\n95851\\nRange of motion measurements and report (separate procedure);\\neach extremity (excluding hand) or each trunk section (spine)\\n$ 87.30\\n95852\\n95852\\nRange of motion measurements and report (separate procedure);\\nhand, with or without comparison with normal side\\n$ 72.00\\n95857\\n95857\\nCholinesterase inhibitor challenge test for myasthenia gravis\\n$ 122.40\\n95860\\n95860\\nNeedle electromyography; 1 extremity with or without related\\nparaspinal areas\\n$ 216.72\\n95860-26 26\\n95860\\nNeedle electromyography; 1 extremity with or without related\\nparaspinal areas\\n$ 82.27\\n95860-TC TC\\n95860\\nNeedle electromyography; 1 extremity with or without related\\nparaspinal areas\\n$ 134.45\\n95861\\n95861\\nNeedle electromyography; 2 extremities with or without related\\nparaspinal areas\\n$ 282.23\\n95861-26 26\\n95861\\nNeedle electromyography; 2 extremities with or without related\\nparaspinal areas\\n$ 125.43\\n95861-TC TC\\n95861\\nNeedle electromyography; 2 extremities with or without related\\nparaspinal areas\\n$ 156.80\\n95863\\n95863\\nNeedle electromyography; 3 extremities with or without related\\nparaspinal areas\\n$ 473.40\\n95863-26 26\\n95863\\nNeedle electromyography; 3 extremities with or without related\\nparaspinal areas\\n$ 207.62\\n95863-TC TC\\n95863\\nNeedle electromyography; 3 extremities with or without related\\nparaspinal areas\\n$ 265.78\\n95864\\n95864\\nNeedle electromyography; 4 extremities with or without related\\nparaspinal areas\\n$ 618.30\\n95864-26 26\\n95864\\nNeedle electromyography; 4 extremities with or without related\\nparaspinal areas\\n$ 251.46\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n389\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n390\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95864-TC TC\\n95864\\nNeedle electromyography; 4 extremities with or without related\\nparaspinal areas\\n$ 366.84\\n95865\\n95865\\nNeedle electromyography; larynx\\n$ 201.02\\n95866\\n95866\\nNeedle electromyography; hemidiaphragm\\n$ 154.18\\n95867\\n95867\\nNeedle electromyography; cranial nerve supplied muscle(s),\\nunilateral\\n$ 211.50\\n95867-26 26\\n95867\\nNeedle electromyography; cranial nerve supplied muscle(s),\\nunilateral\\n$ 71.74\\n95867-TC TC\\n95867\\nNeedle electromyography; cranial nerve supplied muscle(s),\\nunilateral\\n$ 139.76\\n95868\\n95868\\nNeedle electromyography; cranial nerve supplied muscles, bilateral\\n$ 257.40\\n95868-26 26\\n95868\\nNeedle electromyography; cranial nerve supplied muscles, bilateral\\n$ 104.05\\n95868-TC TC\\n95868\\nNeedle electromyography; cranial nerve supplied muscles, bilateral\\n$ 153.35\\n95869\\n95869\\nNeedle electromyography; thoracic paraspinal muscles (excluding\\nT1 or T12)\\n$ 162.34\\n95869-26 26\\n95869\\nNeedle electromyography; thoracic paraspinal muscles (excluding\\nT1 or T12)\\n$ 33.27\\n95869-TC TC\\n95869\\nNeedle electromyography; thoracic paraspinal muscles (excluding\\nT1 or T12)\\n$ 129.07\\n95870\\n95870\\nNeedle electromyography; limited study of muscles in 1 extremity\\nor non-limb (axial) muscles (unilateral or bilateral), other than\\nthoracic paraspinal, cranial nerve supplied muscles, or sphincters\\n$ 99.09\\n95870-26 26\\n95870\\nNeedle electromyography; limited study of muscles in 1 extremity\\nor non-limb (axial) muscles (unilateral or bilateral), other than\\nthoracic paraspinal, cranial nerve supplied muscles, or sphincters\\n$ 64.59\\n95870-TC TC\\n95870\\nNeedle electromyography; limited study of muscles in 1 extremity\\nor non-limb (axial) muscles (unilateral or bilateral), other than\\nthoracic paraspinal, cranial nerve supplied muscles, or sphincters\\n$ 34.50\\n95872\\n95872\\nNeedle electromyography using single fiber electrode, with\\nquantitative measurement of jitter, blocking and\/or fiber density,\\nany\/all sites of each muscle studied\\n$ 257.40\\n95872-26 26\\n95872\\nNeedle electromyography using single fiber electrode, with\\nquantitative measurement of jitter, blocking and\/or fiber density,\\nany\/all sites of each muscle studied\\n$ 186.60\\n95872-TC TC\\n95872\\nNeedle electromyography using single fiber electrode, with\\nquantitative measurement of jitter, blocking and\/or fiber density,\\nany\/all sites of each muscle studied\\n$ 70.80\\n95873\\n95873\\nElectrical stimulation for guidance in conjunction with\\nchemodenervation (List separately in addition to code for primary\\nprocedure)\\n$ 55.40\\n95874\\n95874\\nNeedle electromyography for guidance in conjunction with\\nchemodenervation (List separately in addition to code for primary\\nprocedure)\\n$ 56.80\\n95875\\n95875\\nIschemic limb exercise test with serial specimen(s) acquisition for\\nmuscle(s) metabolite(s)\\n$ 144.00\\n95875-26 26\\n95875\\nIschemic limb exercise test with serial specimen(s) acquisition for\\nmuscle(s) metabolite(s)\\n$ 61.86\\n95875-TC TC\\n95875\\nIschemic limb exercise test with serial specimen(s) acquisition for\\nmuscle(s) metabolite(s)\\n$ 82.14\\n95905\\n95905\\nMotor and\/or sensory nerve conduction, using preconfigured\\nelectrode array(s), amplitude and latency\/velocity study, each limb,\\nincludes F-wave study when performed, with interpretation and\\nreport\\n$ 7.78\\n95921\\n95921\\nTesting of autonomic nervous system function; cardiovagal\\ninnervation (parasympathetic function), including 2 or more of the\\nfollowing: heart rate response to deep breathing with recorded R-R\\ninterval, Valsalva ratio, and 30:15 ratio\\n$ 104.40\\n95921-26 26\\n95921\\nTesting of autonomic nervous system function; cardiovagal\\ninnervation (parasympathetic function), including 2 or more of the\\nfollowing: heart rate response to deep breathing with recorded R-R\\ninterval, Valsalva ratio, and 30:15 ratio\\n$ 49.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n391\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n392\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95921-TC TC\\n95921\\nTesting of autonomic nervous system function; cardiovagal\\ninnervation (parasympathetic function), including 2 or more of the\\nfollowing: heart rate response to deep breathing with recorded R-R\\ninterval, Valsalva ratio, and 30:15 ratio\\n$ 54.70\\n95922\\n95922\\nTesting of autonomic nervous system function; vasomotor\\nadrenergic innervation (sympathetic adrenergic function), including\\nbeat-to-beat blood pressure and R-R interval changes during\\nValsalva maneuver and at least 5 minutes of passive tilt\\n$ 108.90\\n95922-26 26\\n95922\\nTesting of autonomic nervous system function; vasomotor\\nadrenergic innervation (sympathetic adrenergic function), including\\nbeat-to-beat blood pressure and R-R interval changes during\\nValsalva maneuver and at least 5 minutes of passive tilt\\n$ 46.18\\n95922-TC TC\\n95922\\nTesting of autonomic nervous system function; vasomotor\\nadrenergic innervation (sympathetic adrenergic function), including\\nbeat-to-beat blood pressure and R-R interval changes during\\nValsalva maneuver and at least 5 minutes of passive tilt\\n$ 62.72\\n95923\\n95923\\nTesting of autonomic nervous system function; sudomotor,\\nincluding 1 or more of the following: quantitative sudomotor axon\\nreflex test (QSART), silastic sweat imprint, thermoregulatory sweat\\ntest, and changes in sympathetic skin potential\\n$ 100.80\\n95923-26 26\\n95923\\nTesting of autonomic nervous system function; sudomotor,\\nincluding 1 or more of the following: quantitative sudomotor axon\\nreflex test (QSART), silastic sweat imprint, thermoregulatory sweat\\ntest, and changes in sympathetic skin potential\\n$ 16.78\\n95923-TC TC\\n95923\\nTesting of autonomic nervous system function; sudomotor,\\nincluding 1 or more of the following: quantitative sudomotor axon\\nreflex test (QSART), silastic sweat imprint, thermoregulatory sweat\\ntest, and changes in sympathetic skin potential\\n$ 84.02\\n95925\\n95925\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in upper limbs\\n$ 369.00\\n95925-26 26\\n95925\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in upper limbs\\n$ 47.98\\n95925-TC TC\\n95925\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in upper limbs\\n$ 321.02\\n95926\\n95926\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in lower limbs\\n$ 298.80\\n95926-26 26\\n95926\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in lower limbs\\n$ 41.65\\n95926-TC TC\\n95926\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in lower limbs\\n$ 257.15\\n95927\\n95927\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in the trunk or head\\n$ 298.80\\n95927-26 26\\n95927\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in the trunk or head\\n$ 43.75\\n95927-TC TC\\n95927\\nShort-latency somatosensory evoked potential study, stimulation of\\nany\/all peripheral nerves or skin sites, recording from the central\\nnervous system; in the trunk or head\\n$ 255.05\\n95929\\n95929\\nCentral motor evoked potential study (transcranial motor\\nstimulation); lower limbs\\n$ 280.97\\n95930\\n95930\\nVisual evoked potential (VEP) testing central nervous system,\\ncheckerboard or flash\\n$ 339.30\\n95930-26 26\\n95930\\nVisual evoked potential (VEP) testing central nervous system,\\ncheckerboard or flash\\n$ 34.63\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n393\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n394\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95930-TC TC\\n95930\\nVisual evoked potential (VEP) testing central nervous system,\\ncheckerboard or flash\\n$ 304.67\\n95933\\n95933\\nOrbicularis oculi (blink) reflex, by electrodiagnostic testing\\n$ 175.50\\n95933-26 26\\n95933\\nOrbicularis oculi (blink) reflex, by electrodiagnostic testing\\n$ 56.06\\n95933-TC TC\\n95933\\nOrbicularis oculi (blink) reflex, by electrodiagnostic testing\\n$ 119.44\\n95937\\n95937\\nNeuromuscular junction testing (repetitive stimulation, paired\\nstimuli), each nerve, any 1 method\\n$ 180.00\\n95937-26 26\\n95937\\nNeuromuscular junction testing (repetitive stimulation, paired\\nstimuli), each nerve, any 1 method\\n$ 73.30\\n95937-TC TC\\n95937\\nNeuromuscular junction testing (repetitive stimulation, paired\\nstimuli), each nerve, any 1 method\\n$ 106.70\\n95940\\n95940\\nContinuous intraoperative neurophysiology monitoring in the\\noperating room, one on one monitoring requiring personal\\nattendance, each 15 minutes (List separately in addition to code for\\nprimary procedure)\\n$ 58.81\\n95941\\n95941\\nContinuous intraoperative neurophysiology monitoring, from\\noutside the operating room (remote or nearby) or for monitoring of\\nmore than one case while in the operating room, per hour (List\\nseparately in addition to code for primary procedure)\\n$ 414.90\\n95950\\n95950\\nMonitoring for identification and lateralization of cerebral seizure\\nfocus, electroencephalographic (eg, 8 channel EEG) recording and\\ninterpretation, each 24 hours\\n$ 655.20\\n95950-26 26\\n95950\\nMonitoring for identification and lateralization of cerebral seizure\\nfocus, electroencephalographic (eg, 8 channel EEG) recording and\\ninterpretation, each 24 hours\\n$ 138.80\\n95950-TC TC\\n95950\\nMonitoring for identification and lateralization of cerebral seizure\\nfocus, electroencephalographic (eg, 8 channel EEG) recording and\\ninterpretation, each 24 hours\\n$ 516.40\\n95951\\n95951\\nMonitoring for localization of cerebral seizure focus by cable or\\nradio, 16 or more channel telemetry, combined\\nelectroencephalographic (EEG) and video recording and\\ninterpretation (eg, for presurgical localization), each 24 hours\\n$ 906.30\\n95951-26 26\\n95951\\nMonitoring for localization of cerebral seizure focus by cable or\\nradio, 16 or more channel telemetry, combined\\nelectroencephalographic (EEG) and video recording and\\ninterpretation (eg, for presurgical localization), each 24 hours\\n$ 514.81\\n95953\\n95953\\nMonitoring for localization of cerebral seizure focus by\\ncomputerized portable 16 or more channel EEG,\\nelectroencephalographic (EEG) recording and interpretation, each\\n24 hours, unattended\\n$ 763.20\\n95953-26 26\\n95953\\nMonitoring for localization of cerebral seizure focus by\\ncomputerized portable 16 or more channel EEG,\\nelectroencephalographic (EEG) recording and interpretation, each\\n24 hours, unattended\\n$ 262.86\\n95953-TC TC\\n95953\\nMonitoring for localization of cerebral seizure focus by\\ncomputerized portable 16 or more channel EEG,\\nelectroencephalographic (EEG) recording and interpretation, each\\n24 hours, unattended\\n$ 500.34\\n95954\\n95954\\nPharmacological or physical activation requiring physician or other\\nqualified health care professional attendance during EEG recording\\nof activation phase (eg, thiopental activation test)\\n$ 355.50\\n95954-26 26\\n95954\\nPharmacological or physical activation requiring physician or other\\nqualified health care professional attendance during EEG recording\\nof activation phase (eg, thiopental activation test)\\n$ 84.88\\n95954-TC TC\\n95954\\nPharmacological or physical activation requiring physician or other\\nqualified health care professional attendance during EEG recording\\nof activation phase (eg, thiopental activation test)\\n$ 270.62\\n95955\\n95955\\nElectroencephalogram (EEG) during nonintracranial surgery (eg,\\ncarotid surgery)\\n$ 340.20\\n95955-26 26\\n95955\\nElectroencephalogram (EEG) during nonintracranial surgery (eg,\\ncarotid surgery)\\n$ 70.64\\n95955-TC TC\\n95955\\nElectroencephalogram (EEG) during nonintracranial surgery (eg,\\ncarotid surgery)\\n$ 269.56\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n395\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n396\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95956\\n95956\\nMonitoring for localization of cerebral seizure focus by cable or\\nradio, 16 or more channel telemetry, electroencephalographic (EEG)\\nrecording and interpretation, each 24 hours, attended by a\\ntechnologist or nurse\\n$ 779.40\\n95956-26 26\\n95956\\nMonitoring for localization of cerebral seizure focus by cable or\\nradio, 16 or more channel telemetry, electroencephalographic (EEG)\\nrecording and interpretation, each 24 hours, attended by a\\ntechnologist or nurse\\n$ 78.24\\n95956-TC TC\\n95956\\nMonitoring for localization of cerebral seizure focus by cable or\\nradio, 16 or more channel telemetry, electroencephalographic (EEG)\\nrecording and interpretation, each 24 hours, attended by a\\ntechnologist or nurse\\n$ 701.16\\n95957\\n95957\\nDigital analysis of electroencephalogram (EEG) (eg, for epileptic\\nspike analysis)\\n$ 166.54\\n95958\\n95958\\nWada activation test for hemispheric function, including\\nelectroencephalographic (EEG) monitoring\\n$ 654.30\\n95958-26 26\\n95958\\nWada activation test for hemispheric function, including\\nelectroencephalographic (EEG) monitoring\\n$ 232.62\\n95958-TC TC\\n95958\\nWada activation test for hemispheric function, including\\nelectroencephalographic (EEG) monitoring\\n$ 421.68\\n95961\\n95961\\nFunctional cortical and subcortical mapping by stimulation and\/or\\nrecording of electrodes on brain surface, or of depth electrodes, to\\nprovoke seizures or identify vital brain structures; initial hour of\\nattendance by a physician or other qualified health\\n$ 429.30\\n95961-26 26\\n95961\\nFunctional cortical and subcortical mapping by stimulation and\/or\\nrecording of electrodes on brain surface, or of depth electrodes, to\\nprovoke seizures or identify vital brain structures; initial hour of\\nattendance by a physician or other qualified health\\n$ 222.66\\n95961-TC TC\\n95961\\nFunctional cortical and subcortical mapping by stimulation and\/or\\nrecording of electrodes on brain surface, or of depth electrodes, to\\nprovoke seizures or identify vital brain structures; initial hour of\\nattendance by a physician or other qualified health\\n$ 206.64\\n95962\\n95962\\nFunctional cortical and subcortical mapping by stimulation and\/or\\nrecording of electrodes on brain surface, or of depth electrodes, to\\nprovoke seizures or identify vital brain structures; each additional\\nhour of attendance by a physician or other qualifie\\n$ 448.20\\n95962-26 26\\n95962\\nFunctional cortical and subcortical mapping by stimulation and\/or\\nrecording of electrodes on brain surface, or of depth electrodes, to\\nprovoke seizures or identify vital brain structures; each additional\\nhour of attendance by a physician or other qualifie\\n$ 291.69\\n95962-TC TC\\n95962\\nFunctional cortical and subcortical mapping by stimulation and\/or\\nrecording of electrodes on brain surface, or of depth electrodes, to\\nprovoke seizures or identify vital brain structures; each additional\\nhour of attendance by a physician or other qualifie\\n$ 156.51\\n95965\\n95965\\nMagnetoencephalography (MEG), recording and analysis; for\\nspontaneous brain magnetic activity (eg, epileptic cerebral cortex\\nlocalization)\\n$ -\\n95966\\n95966\\nMagnetoencephalography (MEG), recording and analysis; for\\nevoked magnetic fields, single modality (eg, sensory, motor,\\nlanguage, or visual cortex localization)\\n$ -\\n95967\\n95967\\nMagnetoencephalography (MEG), recording and analysis; for\\nevoked magnetic fields, each additional modality (eg, sensory,\\nmotor, language, or visual cortex localization) (List separately in\\naddition to code for primary procedure)\\n$ -\\n95970\\n95970\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient compliance measureme $ 47.70\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n397\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n398\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n95971\\n95971\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient compliance measureme $ 78.30\\n95972\\n95972\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient compliance measureme $ 143.10\\n95973\\n95973\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient compliance measureme $ 90.90\\n95974\\n95974\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient compliance measureme $ 292.50\\n95975\\n95975\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient compliance measureme $ 173.70\\n95978\\n95978\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude and duration, battery status,\\nelectrode selectability and polarity, impedance and patient\\ncompliance measurements), complex deep brain neurostimulator\\npulse\\n$ 527.16\\n95979\\n95979\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude and duration, battery status,\\nelectrode selectability and polarity, impedance and patient\\ncompliance measurements), complex deep brain neurostimulator\\npulse\\n$ 253.83\\n95980\\n95980\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude and duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient measurements) gastric\\nn\\n$ 114.21\\n95981\\n95981\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude and duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient measurements) gastric\\nn\\n$ 82.55\\n95982\\n95982\\nElectronic analysis of implanted neurostimulator pulse generator\\nsystem (eg, rate, pulse amplitude and duration, configuration of\\nwave form, battery status, electrode selectability, output\\nmodulation, cycling, impedance and patient measurements) gastric\\nn\\n$ 118.30\\n95990\\n95990\\nRefilling and maintenance of implantable pump or reservoir for\\ndrug delivery, spinal (intrathecal, epidural) or brain\\n(intraventricular), includes electronic analysis of pump, when\\nperformed;\\n$ 122.42\\n95992\\n95992\\nCanalith repositioning procedure(s) (eg, Epley maneuver, Semont\\nmaneuver), per day\\n$ 115.18\\n95999\\n95999\\nUnlisted neurological or neuromuscular diagnostic procedure\\nCost\\n96000\\n96000\\nComprehensive computer-based motion analysis by video-taping\\nand 3D kinematics;\\n$ 180.36\\n96001\\n96001\\nComprehensive computer-based motion analysis by video-taping\\nand 3D kinematics; with dynamic plantar pressure measurements\\nduring walking\\n$ 174.93\\n96002\\n96002\\nDynamic surface electromyography, during walking or other\\nfunctional activities, 1-12 muscles\\n$ 39.63\\n96003\\n96003\\nDynamic fine wire electromyography, during walking or other\\nfunctional activities, 1 muscle\\n$ 30.57\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n399\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n400\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n96004\\n96004\\nReview and interpretation by physician or other qualified health\\ncare professional of comprehensive computer-based motion\\nanalysis, dynamic plantar pressure measurements, dynamic surface\\nelectromyography during walking or other functional activities, and\\n$ 206.48\\n96020\\n96020\\nNeurofunctional testing selection and administration during\\nnoninvasive imaging functional brain mapping, with test\\nadministered entirely by a physician or other qualified health care\\nprofessional (ie, psychologist), with review of test results and report $ -\\n96040\\n96040\\nMedical genetics and genetic counseling services, each 30 minutes\\nface-to-face with patient\/family\\n$ 98.24\\n96101\\n96101\\nPsychological testing (includes psychodiagnostic assessment of\\nemotionality, intellectual abilities, personality and psychopathology,\\neg, MMPI, Rorschach, WAIS), per hour of the psychologist's or\\nphysician's time, both face-to-face time administering test\\n$ 191.25\\n96102\\n96102\\nPsychological testing (includes psychodiagnostic assessment of\\nemotionality, intellectual abilities, personality and psychopathology,\\neg, MMPI and WAIS), with qualified health care professional\\ninterpretation and report, administered by technician, per ho\\n$ 93.33\\n96103\\n96103\\nPsychological testing (includes psychodiagnostic assessment of\\nemotionality, intellectual abilities, personality and psychopathology,\\neg, MMPI), administered by a computer, with qualified health care\\nprofessional interpretation and report\\n$ 87.96\\n96105\\n96105\\nAssessment of aphasia (includes assessment of expressive and\\nreceptive speech and language function, language comprehension,\\nspeech production ability, reading, spelling, writing, eg, by Boston\\nDiagnostic Aphasia Examination) with interpretation and repor\\n$ 170.98\\n96110\\n96110\\nDevelopmental screening, with interpretation and report, per\\nstandardized instrument form\\n$ 41.77\\n96111\\n96111\\nDevelopmental testing, (includes assessment of motor, language,\\nsocial, adaptive, and\/or cognitive functioning by standardized\\ndevelopmental instruments) with interpretation and report\\n$ 175.28\\n96116\\n96116\\nNeurobehavioral status exam (clinical assessment of thinking,\\nreasoning and judgment, eg, acquired knowledge, attention,\\nlanguage, memory, planning and problem solving, and visual spatial\\nabilities), per hour of the psychologist's or physician's time, bot\\n$ 226.49\\n96118\\n96118\\nNeuropsychological testing (eg, Halstead-Reitan Neuropsychological\\nBattery, Wechsler Memory Scales and Wisconsin Card Sorting Test),\\nper hour of the psychologist's or physician's time, both face-to-face\\ntime administering tests to the patient and time int\\n$ 234.56\\n96119\\n96119\\nNeuropsychological testing (eg, Halstead-Reitan Neuropsychological\\nBattery, Wechsler Memory Scales and Wisconsin Card Sorting Test),\\nwith qualified health care professional interpretation and report,\\nadministered by technician, per hour of technician time\\n$ 156.24\\n96120\\n96120\\nNeuropsychological testing (eg, Wisconsin Card Sorting Test),\\nadministered by a computer, with qualified health care professional\\ninterpretation and report\\n$ 115.84\\n96125\\n96125\\nStandardized cognitive performance testing (eg, Ross Information\\nProcessing Assessment) per hour of a qualified health care\\nprofessional's time, both face-to-face time administering tests to\\nthe patient and time interpreting these test results and prepari\\n$ 208.77\\n96150\\n96150\\nHealth and behavior assessment (eg, health-focused clinical\\ninterview, behavioral observations, psychophysiological monitoring,\\nhealth-oriented questionnaires), each 15 minutes face-to-face with\\nthe patient; initial assessment\\n$ 51.14\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n401\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n402\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n96151\\n96151\\nHealth and behavior assessment (eg, health-focused clinical\\ninterview, behavioral observations, psychophysiological monitoring,\\nhealth-oriented questionnaires), each 15 minutes face-to-face with\\nthe patient; re-assessment\\n$ 27.87\\n96152\\n96152\\nHealth and behavior intervention, each 15 minutes, face-to-face;\\nindividual\\n$ 27.63\\n96153\\n96153\\nHealth and behavior intervention, each 15 minutes, face-to-face;\\ngroup (2 or more patients)\\n$ 34.17\\n96154\\n96154\\nHealth and behavior intervention, each 15 minutes, face-to-face;\\nfamily (with the patient present)\\n$ 37.46\\n96155\\n96155\\nHealth and behavior intervention, each 15 minutes, face-to-face;\\nfamily (without the patient present)\\n$ 38.51\\n96360\\n96360\\nIntravenous infusion, hydration; initial, 31 minutes to 1 hour\\n$ 115.16\\n96361\\n96361\\nIntravenous infusion, hydration; each additional hour (List\\nseparately in addition to code for primary procedure)\\n$ 46.20\\n96365\\n96365\\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\\nsubstance or drug); initial, up to 1 hour\\n$ 132.82\\n96366\\n96366\\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\\nsubstance or drug); each additional hour (List separately in addition\\nto code for primary procedure)\\n$ 58.35\\n96367\\n96367\\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\\nsubstance or drug); additional sequential infusion of a new\\ndrug\/substance, up to 1 hour (List separately in addition to code for\\nprimary procedure)\\n$ 84.16\\n96368\\n96368\\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\\nsubstance or drug); concurrent infusion (List separately in addition\\nto code for primary procedure)\\n$ 48.93\\n96369\\n96369\\nSubcutaneous infusion for therapy or prophylaxis (specify substance\\nor drug); initial, up to 1 hour, including pump set-up and\\nestablishment of subcutaneous infusion site(s)\\n$ 299.67\\n96370\\n96370\\nSubcutaneous infusion for therapy or prophylaxis (specify substance\\nor drug); each additional hour (List separately in addition to code\\nfor primary procedure)\\n$ 33.76\\n96371\\n96371\\nSubcutaneous infusion for therapy or prophylaxis (specify substance\\nor drug); additional pump set-up with establishment of new\\nsubcutaneous infusion site(s) (List separately in addition to code for\\nprimary procedure)\\n$ 126.53\\n96372\\n90772\\nTherapeutic, prophylactic, or diagnostic injection (specify substance\\nor drug); subcutaneous or intramuscular\\n$ 34.73\\n96373\\n96373\\nTherapeutic, prophylactic, or diagnostic injection (specify substance\\nor drug); intra-arterial\\n$ 31.87\\n96374\\n90774\\nTherapeutic, prophylactic, or diagnostic injection (specify substance\\nor drug); intravenous push, single or initial substance\/drug\\n$ 97.45\\n96375\\n96375\\nTherapeutic, prophylactic, or diagnostic injection (specify substance\\nor drug); each additional sequential intravenous push of a new\\nsubstance\/drug (List separately in addition to code for primary\\nprocedure)\\n$ 56.42\\n96376\\n96376\\nTherapeutic, prophylactic, or diagnostic injection (specify substance\\nor drug); each additional sequential intravenous push of the same\\nsubstance\/drug provided in a facility (List separately in addition to\\ncode for primary procedure)\\n$ -\\n96379\\n96379\\nUnlisted therapeutic, prophylactic, or diagnostic intravenous or\\nintra-arterial injection or infusion\\nCost\\n96401\\n96401\\nChemotherapy administration, subcutaneous or intramuscular; non-\\nhormonal anti-neoplastic\\n$ 153.81\\n96402\\n96402\\nChemotherapy administration, subcutaneous or intramuscular;\\nhormonal anti-neoplastic\\n$ 82.57\\n96405\\n96405\\nChemotherapy administration; intralesional, up to and including 7\\nlesions\\n$ 93.60\\n96406\\n96406\\nChemotherapy administration; intralesional, more than 7 lesions\\n$ 126.00\\n96409\\n96409\\nChemotherapy administration; intravenous, push technique, single\\nor initial substance\/drug\\n$ 278.82\\n96411\\n96411\\nChemotherapy administration; intravenous, push technique, each\\nadditional substance\/drug (List separately in addition to code for\\nprimary procedure)\\n$ 159.52\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n403\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n404\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n96413\\n96413\\nChemotherapy administration, intravenous infusion technique; up\\nto 1 hour, single or initial substance\/drug\\n$ 398.03\\n96415\\n96415\\nChemotherapy administration, intravenous infusion technique; each\\nadditional hour (List separately in addition to code for primary\\nprocedure)\\n$ 89.79\\n96416\\n96416\\nChemotherapy administration, intravenous infusion technique;\\ninitiation of prolonged chemotherapy infusion (more than 8 hours),\\nrequiring use of a portable or implantable pump\\n$ 426.61\\n96417\\n96417\\nChemotherapy administration, intravenous infusion technique; each\\nadditional sequential infusion (different substance\/drug), up to 1\\nhour (List separately in addition to code for primary procedure)\\n$ 190.54\\n96420\\n96420\\nChemotherapy administration, intra-arterial; push technique\\n$ 146.70\\n96422\\n96422\\nChemotherapy administration, intra-arterial; infusion technique, up\\nto 1 hour\\n$ 159.30\\n96423\\n96423\\nChemotherapy administration, intra-arterial; infusion technique,\\neach additional hour (List separately in addition to code for primary\\nprocedure)\\n$ 63.90\\n96425\\n96425\\nChemotherapy administration, intra-arterial; infusion technique,\\ninitiation of prolonged infusion (more than 8 hours), requiring the\\nuse of a portable or implantable pump\\n$ 108.00\\n96440\\n96440\\nChemotherapy administration into pleural cavity, requiring and\\nincluding thoracentesis\\n$ 268.20\\n96450\\n96450\\nChemotherapy administration, into CNS (eg, intrathecal), requiring\\nand including spinal puncture\\n$ 228.60\\n96521\\n96521\\nRefilling and maintenance of portable pump\\n$ 338.81\\n96522\\n96522\\nRefilling and maintenance of implantable pump or reservoir for\\ndrug delivery, systemic (eg, intravenous, intra-arterial)\\n$ 255.97\\n96523\\n96523\\nIrrigation of implanted venous access device for drug delivery\\nsystems\\n$ 79.65\\n96542\\n96542\\nChemotherapy injection, subarachnoid or intraventricular via\\nsubcutaneous reservoir, single or multiple agents\\n$ 195.30\\n96549\\n96549\\nUnlisted chemotherapy procedure\\nCost\\n96567\\n96567\\nPhotodynamic therapy by external application of light to destroy\\npremalignant and\/or malignant lesions of the skin and adjacent\\nmucosa (eg, lip) by activation of photosensitive drug(s), each\\nphototherapy exposure session\\n$ 663.01\\n96570\\n96570\\nPhotodynamic therapy by endoscopic application of light to ablate\\nabnormal tissue via activation of photosensitive drug(s); first 30\\nminutes (List separately in addition to code for endoscopy or\\nbronchoscopy procedures of lung and gastrointestinal tract)\\n$ 329.38\\n96571\\n96571\\nPhotodynamic therapy by endoscopic application of light to ablate\\nabnormal tissue via activation of photosensitive drug(s); each\\nadditional 15 minutes (List separately in addition to code for\\nendoscopy or bronchoscopy procedures of lung and gastrointestin\\n$ 163.85\\n96900\\n96900\\nActinotherapy (ultraviolet light)\\n$ 34.20\\n96902\\n96902\\nMicroscopic examination of hairs plucked or clipped by the\\nexaminer (excluding hair collected by the patient) to determine\\ntelogen and anagen counts, or structural hair shaft abnormality\\n$ 55.80\\n96904\\n96904\\nWhole body integumentary photography, for monitoring of high\\nrisk patients with dysplastic nevus syndrome or a history of\\ndysplastic nevi, or patients with a personal or familial history of\\nmelanoma\\n$ 200.24\\n96910\\n96910\\nPhotochemotherapy; tar and ultraviolet B (Goeckerman treatment)\\nor petrolatum and ultraviolet B\\n$ 45.00\\n96912\\n96912\\nPhotochemotherapy; psoralens and ultraviolet A (PUVA)\\n$ 51.30\\n96913\\n96913\\nPhotochemotherapy (Goeckerman and\/or PUVA) for severe\\nphotoresponsive dermatoses requiring at least 4-8 hours of care\\nunder direct supervision of the physician (includes application of\\nmedication and dressings)\\n$ 195.30\\n96920\\n96920\\nLaser treatment for inflammatory skin disease (psoriasis); total area\\nless than 250 sq cm\\n$ 398.75\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n405\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n406\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n96921\\n96921\\nLaser treatment for inflammatory skin disease (psoriasis); 250 sq cm\\nto 500 sq cm\\n$ 408.97\\n96922\\n96922\\nLaser treatment for inflammatory skin disease (psoriasis); over 500\\nsq cm\\n$ 620.53\\n96999\\n96999\\nUnlisted special dermatological service or procedure\\nCost\\n97001\\n97001\\nPhysical therapy evaluation\\n$ 88.97\\n97002\\n97002\\nPhysical therapy re-evaluation\\n$ 43.47\\n97003\\n97003\\nOccupational therapy evaluation\\n$ 73.80\\n97004\\n97004\\nOccupational therapy re-evaluation\\n$ 36.00\\n97005\\n97005\\nAthletic training evaluation\\n$ 63.80\\n97006\\n97006\\nAthletic training re-evaluation\\n$ 36.00\\n97010\\n97010\\nApplication of a modality to 1 or more areas; hot or cold packs\\n$ 32.94\\n97012\\n97012\\nApplication of a modality to 1 or more areas; traction, mechanical\\n$ 39.16\\n97014\\n97014\\nApplication of a modality to 1 or more areas; electrical stimulation\\n(unattended)\\n$ 35.31\\n97016\\n97016\\nApplication of a modality to 1 or more areas; vasopneumatic\\ndevices\\n$ 58.50\\n97018\\n97018\\nApplication of a modality to 1 or more areas; paraffin bath\\n$ 43.20\\n97022\\n97022\\nApplication of a modality to 1 or more areas; whirlpool\\n$ 41.40\\n97024\\n97024\\nApplication of a modality to 1 or more areas; diathermy (eg,\\nmicrowave)\\n$ 37.81\\n97032\\n97032\\nApplication of a modality to 1 or more areas; electrical stimulation\\n(manual), each 15 minutes\\n$ 44.42\\n97033\\n97033\\nApplication of a modality to 1 or more areas; iontophoresis, each 15\\nminutes\\n$ 54.90\\n97035\\n97035\\nApplication of a modality to 1 or more areas; ultrasound, each 15\\nminutes\\n$ 37.77\\n97039\\n97039\\nUnlisted modality (specify type and time if constant attendance)\\n$ 10.00\\n97110\\n97110\\nTherapeutic procedure, 1 or more areas, each 15 minutes;\\ntherapeutic exercises to develop strength and endurance, range of\\nmotion and flexibility\\n$ 46.60\\n97112\\n97112\\nTherapeutic procedure, 1 or more areas, each 15 minutes;\\nneuromuscular reeducation of movement, balance, coordination,\\nkinesthetic sense, posture, and\/or proprioception for sitting and\/or\\nstanding activities\\n$ 43.21\\n97113\\n97113\\nTherapeutic procedure, 1 or more areas, each 15 minutes; aquatic\\ntherapy with therapeutic exercises\\n$ 52.59\\n97116\\n97116\\nTherapeutic procedure, 1 or more areas, each 15 minutes; gait\\ntraining (includes stair climbing)\\n$ 43.91\\n97124\\n97124\\nTherapeutic procedure, 1 or more areas, each 15 minutes; massage,\\nincluding effleurage, petrissage and\/or tapotement (stroking,\\ncompression, percussion)\\n$ 41.79\\n97140\\n97140\\nManual therapy techniques (eg, mobilization\/ manipulation, manual\\nlymphatic drainage, manual traction), 1 or more regions, each 15\\nminutes\\n$ 48.65\\n97150\\n97150\\nTherapeutic procedure(s), group (2 or more individuals)\\n$ 27.21\\n97530\\n97530\\nTherapeutic activities, direct (one-on-one) patient contact (use of\\ndynamic activities to improve functional performance), each 15\\nminutes\\n$ 56.70\\n97532\\n97532\\nDevelopment of cognitive skills to improve attention, memory,\\nproblem solving (includes compensatory training), direct (one-on-\\none) patient contact, each 15 minutes\\n$ 36.03\\n97535\\n97535\\nSelf-care\/home management training (eg, activities of daily living\\n(ADL) and compensatory training, meal preparation, safety\\nprocedures, and instructions in use of assistive technology\\ndevices\/adaptive equipment) direct one-on-one contact, each 15\\nminutes\\n$ 56.70\\n97537\\n97537\\nCommunity\/work reintegration training (eg, shopping,\\ntransportation, money management, avocational activities and\/or\\nwork environment\/modification analysis, work task analysis, use of\\nassistive technology device\/adaptive equipment), direct one-on-one\\ncont\\n$ 39.24\\n97542\\n97542\\nWheelchair management (eg, assessment, fitting, training), each 15\\nminutes\\n$ 29.60\\n97545\\n97545\\nWork hardening\/conditioning; initial 2 hours\\n$ 190.80\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n407\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n408\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n97546\\n97546\\nWork hardening\/conditioning; each additional hour (List separately\\nin addition to code for primary procedure)\\n$ 99.90\\n97597\\n97597\\nDebridement (eg, high pressure waterjet with\/without suction,\\nsharp selective debridement with scissors, scalpel and forceps),\\nopen wound, (eg, fibrin, devitalized epidermis and\/or dermis,\\nexudate, debris, biofilm), including topical application(s), wound\\n$ 104.34\\n97598\\n97598\\nDebridement (eg, high pressure waterjet with\/without suction,\\nsharp selective debridement with scissors, scalpel and forceps),\\nopen wound, (eg, fibrin, devitalized epidermis and\/or dermis,\\nexudate, debris, biofilm), including topical application(s), wound\\n$ 114.89\\n97602\\n97602\\nRemoval of devitalized tissue from wound(s), non-selective\\ndebridement, without anesthesia (eg, wet-to-moist dressings,\\nenzymatic, abrasion), including topical application(s), wound\\nassessment, and instruction(s) for ongoing care, per session\\n$ 126.66\\n97760\\n97760\\nOrthotic(s) management and training (including assessment and\\nfitting when not otherwise reported), upper extremity(s), lower\\nextremity(s) and\/or trunk, each 15 minutes\\n$ 63.04\\n97761\\n97761\\nProsthetic training, upper and\/or lower extremity(s), each 15\\nminutes\\n$ 57.46\\n97762\\n97762\\nCheckout for orthotic\/prosthetic use, established patient, each 15\\nminutes\\n$ 57.79\\n97802\\n97802\\nMedical nutrition therapy; initial assessment and intervention,\\nindividual, face-to-face with the patient, each 15 minutes\\n$ 32.69\\n97803\\n97803\\nMedical nutrition therapy; re-assessment and intervention,\\nindividual, face-to-face with the patient, each 15 minutes\\n$ 31.73\\n97804\\n97804\\nMedical nutrition therapy; group (2 or more individuals), each 30\\nminutes\\n$ 12.42\\n97810\\n97810\\nAcupuncture, 1 or more needles; without electrical stimulation,\\ninitial 15 minutes of personal one-on-one contact with the patient\\n$ 60.96\\n97811\\n97811\\nAcupuncture, 1 or more needles; without electrical stimulation,\\neach additional 15 minutes of personal one-on-one contact with the\\npatient, with re-insertion of needle(s) (List separately in addition to\\ncode for primary procedure)\\n$ 51.38\\n97813\\n97813\\nAcupuncture, 1 or more needles; with electrical stimulation, initial\\n15 minutes of personal one-on-one contact with the patient\\n$ 66.59\\n97814\\n97814\\nAcupuncture, 1 or more needles; with electrical stimulation, each\\nadditional 15 minutes of personal one-on-one contact with the\\npatient, with re-insertion of needle(s) (List separately in addition to\\ncode for primary procedure)\\n$ 57.30\\n98925\\n98925\\nOsteopathic manipulative treatment (OMT); 1-2 body regions\\ninvolved\\n$ 53.46\\n98926\\n98926\\nOsteopathic manipulative treatment (OMT); 3-4 body regions\\ninvolved\\n$ 83.70\\n98927\\n98927\\nOsteopathic manipulative treatment (OMT); 5-6 body regions\\ninvolved\\n$ 100.80\\n98928\\n98928\\nOsteopathic manipulative treatment (OMT); 7-8 body regions\\ninvolved\\n$ 115.20\\n98929\\n98929\\nOsteopathic manipulative treatment (OMT); 9-10 body regions\\ninvolved\\n$ 135.00\\n98940\\n98940\\nChiropractic manipulative treatment (CMT); spinal, 1-2 regions\\n$ 48.32\\n98941\\n98941\\nChiropractic manipulative treatment (CMT); spinal, 3-4 regions\\n$ 63.55\\n98942\\n98942\\nChiropractic manipulative treatment (CMT); spinal, 5 regions\\n$ 91.80\\n98943\\n98943\\nChiropractic manipulative treatment (CMT); extraspinal, 1 or more\\nregions\\n$ 49.50\\n98960\\n98960\\nEducation and training for patient self-management by a qualified,\\nnonphysician health care professional using a standardized\\ncurriculum, face-to-face with the patient (could include\\ncaregiver\/family) each 30 minutes; individual patient\\n$ 63.65\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n409\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n410\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n98961\\n98961\\nEducation and training for patient self-management by a qualified,\\nnonphysician health care professional using a standardized\\ncurriculum, face-to-face with the patient (could include\\ncaregiver\/family) each 30 minutes; 2-4 patients\\n$ 49.81\\n98962\\n98962\\nEducation and training for patient self-management by a qualified,\\nnonphysician health care professional using a standardized\\ncurriculum, face-to-face with the patient (could include\\ncaregiver\/family) each 30 minutes; 5-8 patients\\n$ 36.96\\n98966\\n98966\\nTelephone assessment and management service provided by a\\nqualified nonphysician health care professional to an established\\npatient, parent, or guardian not originating from a related\\nassessment and management service provided within the previous\\n7 days n\\n$ 40.02\\n98967\\n98967\\nTelephone assessment and management service provided by a\\nqualified nonphysician health care professional to an established\\npatient, parent, or guardian not originating from a related\\nassessment and management service provided within the previous\\n7 days n\\n$ 78.06\\n98968\\n98968\\nTelephone assessment and management service provided by a\\nqualified nonphysician health care professional to an established\\npatient, parent, or guardian not originating from a related\\nassessment and management service provided within the previous\\n7 days n\\n$ 111.03\\n98969\\n98969\\nOnline assessment and management service provided by a qualified\\nnonphysician health care professional to an established patient or\\nguardian, not originating from a related assessment and\\nmanagement service provided within the previous 7 days, using the\\nI\\n$ -\\n99000\\n99000\\nHandling and\/or conveyance of specimen for transfer from the\\noffice to a laboratory\\n$ 23.40\\n99001\\n99001\\nHandling and\/or conveyance of specimen for transfer from the\\npatient in other than an office to a laboratory (distance may be\\nindicated)\\n$ 26.10\\n99002\\n99002\\nHandling, conveyance, and\/or any other service in connection with\\nthe implementation of an order involving devices (eg, designing,\\nfitting, packaging, handling, delivery or mailing) when devices such\\nas orthotics, protectives, prosthetics are fabricated b\\n$ 27.00\\n99024\\n99024\\nPostoperative follow-up visit, normally included in the surgical\\npackage, to indicate that an evaluation and management service\\nwas performed during a postoperative period for a reason(s)\\nrelated to the original procedure\\n$ -\\n99050\\n99050\\nServices provided in the office at times other than regularly\\nscheduled office hours, or days when the office is normally closed\\n(eg, holidays, Saturday or Sunday), in addition to basic service\\n$ 81.00\\n99051\\n99051\\nService(s) provided in the office during regularly scheduled evening,\\nweekend, or holiday office hours, in addition to basic service\\n$ -\\n99053\\n99053\\nService(s) provided between 10:00 PM and 8:00 AM at 24-hour\\nfacility, in addition to basic service\\n$ -\\n99056\\n99056\\nService(s) typically provided in the office, provided out of the office\\nat request of patient, in addition to basic service\\n$ 101.70\\n99058\\n99058\\nService(s) provided on an emergency basis in the office, which\\ndisrupts other scheduled office services, in addition to basic service\\n$ 96.58\\n99075\\n99075\\nMedical testimony\\n$ 627.30\\n99078\\n99078\\nPhysician or other qualified health care professional qualified by\\neducation, training, licensure\/regulation (when applicable)\\neducational services rendered to patients in a group setting (eg,\\nprenatal, obesity, or diabetic instructions)\\n$ 72.00\\n99080\\n99080\\nSpecial reports such as insurance forms, more than the information\\nconveyed in the usual medical communications or standard\\nreporting form\\n$ 102.60\\n99082\\n99082\\nUnusual travel (eg, transportation and escort of patient)\\n$ 369.00\\n99090\\n99090\\nAnalysis of clinical data stored in computers (eg, ECGs, blood\\npressures, hematologic data)\\n$ 232.20\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n411\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n412\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n99091\\n99091\\nCollection and interpretation of physiologic data (eg, ECG, blood\\npressure, glucose monitoring) digitally stored and\/or transmitted by\\nthe patient and\/or caregiver to the physician or other qualified\\nhealth care professional, qualified by education, train\\n$ 101.30\\n99100\\n99100\\nAnesthesia for patient of extreme age, younger than 1 year or older\\nthan 70 (List separately in addition to code for primary anesthesia\\nprocedure)\\n$ 88.00\\n99116\\n99116\\nAnesthesia complicated by utilization of total body hypothermia\\n(List separately in addition to code for primary anesthesia\\nprocedure)\\n$ -\\n99135\\n99135\\nAnesthesia complicated by utilization of controlled hypotension (List\\nseparately in addition to code for primary anesthesia procedure)\\n$ -\\n99140\\n99140\\nAnesthesia complicated by emergency conditions (specify) (List\\nseparately in addition to code for primary anesthesia procedure)\\n$ 192.50\\n99143\\n99143\\nModerate sedation services (other than those services described by\\ncodes 00100-01999) provided by the same physician or other\\nqualified health care professional performing the diagnostic or\\ntherapeutic service that the sedation supports, requiring the pre\\n$ 192.50\\n99144\\n99144\\nModerate sedation services (other than those services described by\\ncodes 00100-01999) provided by the same physician or other\\nqualified health care professional performing the diagnostic or\\ntherapeutic service that the sedation supports, requiring the pre\\n$ 192.50\\n99145\\n99145\\nModerate sedation services (other than those services described by\\ncodes 00100-01999) provided by the same physician or other\\nqualified health care professional performing the diagnostic or\\ntherapeutic service that the sedation supports, requiring the pre\\n$ -\\n99148\\n99148\\nModerate sedation services (other than those services described by\\ncodes 00100-01999), provided by a physician or other qualified\\nhealth care professional other than the health care professional\\nperforming the diagnostic or therapeutic service that the se\\n$ 143.00\\n99149\\n99149\\nModerate sedation services (other than those services described by\\ncodes 00100-01999), provided by a physician or other qualified\\nhealth care professional other than the health care professional\\nperforming the diagnostic or therapeutic service that the se\\n$ -\\n99150\\n99150\\nModerate sedation services (other than those services described by\\ncodes 00100-01999), provided by a physician or other qualified\\nhealth care professional other than the health care professional\\nperforming the diagnostic or therapeutic service that the se\\n$ -\\n99170\\n99170\\nAnogenital examination, magnified, in childhood for suspected\\ntrauma, including image recording when performed\\n$ 363.95\\n99173\\n99173\\nScreening test of visual acuity, quantitative, bilateral\\n$ 29.89\\n99174\\n99174\\nInstrument-based ocular screening (eg, photoscreening, automated-\\nrefraction), bilateral\\n$ 39.61\\n99175\\n99175\\nIpecac or similar administration for individual emesis and continued\\nobservation until stomach adequately emptied of poison\\n$ 106.20\\n99183\\n99183\\nPhysician or other qualified health care professional attendance and\\nsupervision of hyperbaric oxygen therapy, per session\\n$ 271.80\\n99190\\n99190\\nAssembly and operation of pump with oxygenator or heat\\nexchanger (with or without ECG and\/or pressure monitoring); each\\nhour\\n$ -\\n99191\\n99191\\nAssembly and operation of pump with oxygenator or heat\\nexchanger (with or without ECG and\/or pressure monitoring); 45\\nminutes\\n$ -\\n99192\\n99192\\nAssembly and operation of pump with oxygenator or heat\\nexchanger (with or without ECG and\/or pressure monitoring); 30\\nminutes\\n$ -\\n99195\\n99195\\nPhlebotomy, therapeutic (separate procedure)\\n$ 69.30\\n99199\\n99199\\nUnlisted special service, procedure or report\\nCost\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n413\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n414\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n99201\\n99201\\nOffice or other outpatient visit for the evaluation and management\\nof a new patient, which requires these 3 key components: A\\nproblem focused history; A problem focused examination;\\nStraightforward medical decision making. Counseling and\/or\\ncoordination o\\n$ 75.03\\n99202\\n99202\\nOffice or other outpatient visit for the evaluation and management\\nof a new patient, which requires these 3 key components: An\\nexpanded problem focused history; An expanded problem focused\\nexamination; Straightforward medical decision making. Counseling\\na\\n$ 86.93\\n99203\\n99203\\nOffice or other outpatient visit for the evaluation and management\\nof a new patient, which requires these 3 key components: A\\ndetailed history; A detailed examination; Medical decision making\\nof low complexity. Counseling and\/or coordination of care with\\n$ 119.33\\n99204\\n99204\\nOffice or other outpatient visit for the evaluation and management\\nof a new patient, which requires these 3 key components: A\\ncomprehensive history; A comprehensive examination; Medical\\ndecision making of moderate complexity. Counseling and\/or\\ncoordinatio\\n$ 157.94\\n99205\\n99205\\nOffice or other outpatient visit for the evaluation and management\\nof a new patient, which requires these 3 key components: A\\ncomprehensive history; A comprehensive examination; Medical\\ndecision making of high complexity. Counseling and\/or coordination\\nof\\n$ 207.38\\n99211\\n99211\\nOffice or other outpatient visit for the evaluation and management\\nof an established patient, that may not require the presence of a\\nphysician or other qualified health care professional. Usually, the\\npresenting problem(s) are minimal. Typically, 5 minute\\n$ 36.97\\n99212\\n99212\\nOffice or other outpatient visit for the evaluation and management\\nof an established patient, which requires at least 2 of these 3 key\\ncomponents: A problem focused history; A problem focused\\nexamination; Straightforward medical decision making. Counselin\\n$ 56.87\\n99213\\n99213\\nOffice or other outpatient visit for the evaluation and management\\nof an established patient, which requires at least 2 of these 3 key\\ncomponents: An expanded problem focused history; An expanded\\nproblem focused examination; Medical decision making of low\\n$ 74.01\\n99214\\n99214\\nOffice or other outpatient visit for the evaluation and management\\nof an established patient, which requires at least 2 of these 3 key\\ncomponents: A detailed history; A detailed examination; Medical\\ndecision making of moderate complexity. Counseling and\/o\\n$ 101.53\\n99215\\n99215\\nOffice or other outpatient visit for the evaluation and management\\nof an established patient, which requires at least 2 of these 3 key\\ncomponents: A comprehensive history; A comprehensive\\nexamination; Medical decision making of high complexity.\\nCounseling\\n$ 156.37\\n99218\\n99218\\nInitial observation care, per day, for the evaluation and\\nmanagement of a patient which requires these 3 key components: A\\ndetailed or comprehensive history; A detailed or comprehensive\\nexamination; and Medical decision making that is straightforward\\nor o\\n$ 134.10\\n99219\\n99219\\nInitial observation care, per day, for the evaluation and\\nmanagement of a patient, which requires these 3 key components:\\nA comprehensive history; A comprehensive examination; and\\nMedical decision making of moderate complexity. Counseling\\nand\/or coordinat\\n$ 185.40\\n99221\\n99221\\nInitial hospital care, per day, for the evaluation and management of\\na patient, which requires these 3 key components: A detailed or\\ncomprehensive history; A detailed or comprehensive examination;\\nand Medical decision making that is straightforward or of\\n$ 146.86\\n99222\\n99222\\nInitial hospital care, per day, for the evaluation and management of\\na patient, which requires these 3 key components: A comprehensive\\nhistory; A comprehensive examination; and Medical decision\\nmaking of moderate complexity. Counseling and\/or coordination\\n$ 215.43\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n415\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n416\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n99223\\n99223\\nInitial hospital care, per day, for the evaluation and management of\\na patient, which requires these 3 key components: A comprehensive\\nhistory; A comprehensive examination; and Medical decision\\nmaking of high complexity. Counseling and\/or coordination of\\n$ 242.77\\n99231\\n99231\\nSubsequent hospital care, per day, for the evaluation and\\nmanagement of a patient, which requires at least 2 of these 3 key\\ncomponents: A problem focused interval history; A problem focused\\nexamination; Medical decision making that is straightforward or o\\n$ 76.73\\n99232\\n99232\\nSubsequent hospital care, per day, for the evaluation and\\nmanagement of a patient, which requires at least 2 of these 3 key\\ncomponents: An expanded problem focused interval history; An\\nexpanded problem focused examination; Medical decision making\\nof moder\\n$ 99.73\\n99233\\n99233\\nSubsequent hospital care, per day, for the evaluation and\\nmanagement of a patient, which requires at least 2 of these 3 key\\ncomponents: A detailed interval history; A detailed examination;\\nMedical decision making of high complexity. Counseling and\/or coor $ 152.75\\n99234\\n99234\\nObservation or inpatient hospital care, for the evaluation and\\nmanagement of a patient including admission and discharge on the\\nsame date, which requires these 3 key components: A detailed or\\ncomprehensive history; A detailed or comprehensive examination;\\n$ 174.35\\n99235\\n99235\\nObservation or inpatient hospital care, for the evaluation and\\nmanagement of a patient including admission and discharge on the\\nsame date, which requires these 3 key components: A\\ncomprehensive history; A comprehensive examination; and Medical\\ndecision ma\\n$ 238.54\\n99236\\n99236\\nObservation or inpatient hospital care, for the evaluation and\\nmanagement of a patient including admission and discharge on the\\nsame date, which requires these 3 key components: A\\ncomprehensive history; A comprehensive examination; and Medical\\ndecision ma\\n$ 384.38\\n99238\\n99238\\nHospital discharge day management; 30 minutes or less\\n$ 133.05\\n99239\\n99239\\nHospital discharge day management; more than 30 minutes\\n$ 172.27\\n99241\\n99241\\nOffice consultation for a new or established patient, which requires\\nthese 3 key components: A problem focused history; A problem\\nfocused examination; and Straightforward medical decision making.\\nCounseling and\/or coordination of care with other physician\\n$ 105.67\\n99242\\n99242\\nOffice consultation for a new or established patient, which requires\\nthese 3 key components: An expanded problem focused history; An\\nexpanded problem focused examination; and Straightforward\\nmedical decision making. Counseling and\/or coordination of care\\n$ 143.19\\n99243\\n99243\\nOffice consultation for a new or established patient, which requires\\nthese 3 key components: A detailed history; A detailed examination;\\nand Medical decision making of low complexity. Counseling and\/or\\ncoordination of care with other physicians, other qua\\n$ 182.41\\n99244\\n99244\\nOffice consultation for a new or established patient, which requires\\nthese 3 key components: A comprehensive history; A\\ncomprehensive examination; and Medical decision making of\\nmoderate complexity. Counseling and\/or coordination of care with\\nother physic\\n$ 234.86\\n99245\\n99245\\nOffice consultation for a new or established patient, which requires\\nthese 3 key components: A comprehensive history; A\\ncomprehensive examination; and Medical decision making of high\\ncomplexity. Counseling and\/or coordination of care with other\\nphysicians\\n$ 298.54\\n99251\\n99251\\nInpatient consultation for a new or established patient, which\\nrequires these 3 key components: A problem focused history; A\\nproblem focused examination; and Straightforward medical\\ndecision making. Counseling and\/or coordination of care with other\\nphysic\\n$ 122.67\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n417\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n418\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n99252\\n99252\\nInpatient consultation for a new or established patient, which\\nrequires these 3 key components: An expanded problem focused\\nhistory; An expanded problem focused examination; and\\nStraightforward medical decision making. Counseling and\/or\\ncoordination of ca\\n$ 160.52\\n99253\\n99253\\nInpatient consultation for a new or established patient, which\\nrequires these 3 key components: A detailed history; A detailed\\nexamination; and Medical decision making of low complexity.\\nCounseling and\/or coordination of care with other physicians, other\\n$ 198.36\\n99254\\n99254\\nInpatient consultation for a new or established patient, which\\nrequires these 3 key components: A comprehensive history; A\\ncomprehensive examination; and Medical decision making of\\nmoderate complexity. Counseling and\/or coordination of care with\\nother phy\\n$ 242.77\\n99255\\n99255\\nInpatient consultation for a new or established patient, which\\nrequires these 3 key components: A comprehensive history; A\\ncomprehensive examination; and Medical decision making of high\\ncomplexity. Counseling and\/or coordination of care with other\\nphysici\\n$ 314.79\\n99281\\n99281\\nEmergency department visit for the evaluation and management of\\na patient, which requires these 3 key components: A problem\\nfocused history; A problem focused examination; and\\nStraightforward medical decision making. Counseling and\/or\\ncoordination of care\\n$ 91.71\\n99282\\n99282\\nEmergency department visit for the evaluation and management of\\na patient, which requires these 3 key components: An expanded\\nproblem focused history; An expanded problem focused\\nexamination; and Medical decision making of low complexity.\\nCounseling and\/o\\n$ 120.82\\n99283\\n99283\\nEmergency department visit for the evaluation and management of\\na patient, which requires these 3 key components: An expanded\\nproblem focused history; An expanded problem focused\\nexamination; and Medical decision making of moderate complexity.\\nCounseling\\n$ 183.70\\n99284\\n99284\\nEmergency department visit for the evaluation and management of\\na patient, which requires these 3 key components: A detailed\\nhistory; A detailed examination; and Medical decision making of\\nmoderate complexity. Counseling and\/or coordination of care with\\no\\n$ 260.67\\n99285\\n99285\\nEmergency department visit for the evaluation and management of\\na patient, which requires these 3 key components within the\\nconstraints imposed by the urgency of the patient's clinical\\ncondition and\/or mental status: A comprehensive history; A\\ncomprehensi\\n$ 355.91\\n99288\\n99288\\nPhysician or other qualified health care professional direction of\\nemergency medical systems (EMS) emergency care, advanced life\\nsupport\\n$ 125.00\\n99291\\n99291\\nCritical care, evaluation and management of the critically ill or\\ncritically injured patient; first 30-74 minutes\\n$ 370.17\\n99292\\n99292\\nCritical care, evaluation and management of the critically ill or\\ncritically injured patient; each additional 30 minutes (List separately\\nin addition to code for primary service)\\n$ 187.78\\n99304\\n99304\\nInitial nursing facility care, per day, for the evaluation and\\nmanagement of a patient, which requires these 3 key components:\\nA detailed or comprehensive history; A detailed or comprehensive\\nexamination; and Medical decision making that is straightforwar\\n$ 91.71\\n99305\\n99305\\nInitial nursing facility care, per day, for the evaluation and\\nmanagement of a patient, which requires these 3 key components:\\nA comprehensive history; A comprehensive examination; and\\nMedical decision making of moderate complexity. Counseling\\nand\/or coor\\n$ 128.46\\n99306\\n99306\\nInitial nursing facility care, per day, for the evaluation and\\nmanagement of a patient, which requires these 3 key components:\\nA comprehensive history; A comprehensive examination; and\\nMedical decision making of high complexity. Counseling and\/or\\ncoordina\\n$ 157.46\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n419\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n420\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n99341\\n99341\\nHome visit for the evaluation and management of a new patient,\\nwhich requires these 3 key components: A problem focused history;\\nA problem focused examination; and Straightforward medical\\ndecision making. Counseling and\/or coordination of care with other\\n$ 88.12\\n99342\\n99342\\nHome visit for the evaluation and management of a new patient,\\nwhich requires these 3 key components: An expanded problem\\nfocused history; An expanded problem focused examination; and\\nMedical decision making of low complexity. Counseling and\/or\\ncoordinati\\n$ 99.69\\n99343\\n99343\\nHome visit for the evaluation and management of a new patient,\\nwhich requires these 3 key components: A detailed history; A\\ndetailed examination; and Medical decision making of moderate\\ncomplexity. Counseling and\/or coordination of care with other\\nphysici\\n$ 135.42\\n99344\\n99344\\nHome visit for the evaluation and management of a new patient,\\nwhich requires these 3 key components: A comprehensive history; A\\ncomprehensive examination; and Medical decision making of\\nmoderate complexity. Counseling and\/or coordination of care with\\noth\\n$ 189.85\\n99345\\n99345\\nHome visit for the evaluation and management of a new patient,\\nwhich requires these 3 key components: A comprehensive history; A\\ncomprehensive examination; and Medical decision making of high\\ncomplexity. Counseling and\/or coordination of care with other p\\n$ 250.72\\n99347\\n99347\\nHome visit for the evaluation and management of an established\\npatient, which requires at least 2 of these 3 key components: A\\nproblem focused interval history; A problem focused examination;\\nStraightforward medical decision making. Counseling and\/or coor\\n$ 63.21\\n99354\\n99354\\nProlonged service in the office or other outpatient setting requiring\\ndirect patient contact beyond the usual service; first hour (List\\nseparately in addition to code for office or other outpatient\\nEvaluation and Management service)\\n$ 186.25\\n99356\\n99356\\nProlonged service in the inpatient or observation setting, requiring\\nunit\/floor time beyond the usual service; first hour (List separately\\nin addition to code for inpatient Evaluation and Management\\nservice)\\n$ 224.06\\n99358\\n99358\\nProlonged evaluation and management service before and\/or after\\ndirect patient care; first hour\\n$ 202.71\\n99360\\n99360\\nStandby service, requiring prolonged attendance, each 30 minutes\\n(eg, operative standby, standby for frozen section, for\\ncesarean\/high risk delivery, for monitoring EEG)\\n$ 186.05\\n99367\\n99367\\nMedical team conference with interdisciplinary team of health care\\nprofessionals, patient and\/or family not present, 30 minutes or\\nmore; participation by physician\\n$ 64.15\\n99368\\n99368\\nMedical team conference with interdisciplinary team of health care\\nprofessionals, patient and\/or family not present, 30 minutes or\\nmore; participation by nonphysician qualified health care\\nprofessional\\n$ 41.06\\n99385\\n99385\\nInitial comprehensive preventive medicine evaluation and\\nmanagement of an individual including an age and gender\\nappropriate history, examination, counseling\/anticipatory\\nguidance\/risk factor reduction interventions, and the ordering of\\nlaboratory\/diagnos\\n$ 142.18\\n99391\\n99391\\nPeriodic comprehensive preventive medicine reevaluation and\\nmanagement of an individual including an age and gender\\nappropriate history, examination, counseling\/anticipatory\\nguidance\/risk factor reduction interventions, and the ordering of\\nlaboratory\/diag\\n$ 82.75\\n99392\\n99392\\nPeriodic comprehensive preventive medicine reevaluation and\\nmanagement of an individual including an age and gender\\nappropriate history, examination, counseling\/anticipatory\\nguidance\/risk factor reduction interventions, and the ordering of\\nlaboratory\/diag\\n$ 86.88\\n99393\\n99393\\nPeriodic comprehensive preventive medicine reevaluation and\\nmanagement of an individual including an age and gender\\nappropriate history, examination, counseling\/anticipatory\\nguidance\/risk factor reduction interventions, and the ordering of\\nlaboratory\/diag\\n$ 89.13\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n421\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n422\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n99394\\n99394\\nPeriodic comprehensive preventive medicine reevaluation and\\nmanagement of an individual including an age and gender\\nappropriate history, examination, counseling\/anticipatory\\nguidance\/risk factor reduction interventions, and the ordering of\\nlaboratory\/diag\\n$ 105.22\\n99395\\n99395\\nPeriodic comprehensive preventive medicine reevaluation and\\nmanagement of an individual including an age and gender\\nappropriate history, examination, counseling\/anticipatory\\nguidance\/risk factor reduction interventions, and the ordering of\\nlaboratory\/diag\\n$ 115.76\\n99396\\n99396\\nPeriodic comprehensive preventive medicine reevaluation and\\nmanagement of an individual including an age and gender\\nappropriate history, examination, counseling\/anticipatory\\nguidance\/risk factor reduction interventions, and the ordering of\\nlaboratory\/diag\\n$ 135.29\\n99401\\n99401\\nPreventive medicine counseling and\/or risk factor reduction\\nintervention(s) provided to an individual (separate procedure);\\napproximately 15 minutes\\n$ 48.03\\n99460\\n99460\\nInitial hospital or birthing center care, per day, for evaluation and\\nmanagement of normal newborn infant\\n$ 144.33\\n99461\\n99461\\nInitial care, per day, for evaluation and management of normal\\nnewborn infant seen in other than hospital or birthing center\\n$ 98.43\\n99462\\n99462\\nSubsequent hospital care, per day, for evaluation and management\\nof normal newborn\\n$ 68.89\\n99463\\n99463\\nInitial hospital or birthing center care, per day, for evaluation and\\nmanagement of normal newborn infant admitted and discharged on\\nthe same date\\n$ 157.01\\n99464\\n99464\\nAttendance at delivery (when requested by the delivering physician\\nor other qualified health care professional) and initial stabilization\\nof newborn\\n$ 155.16\\n99465\\n99465\\nDelivery\/birthing room resuscitation, provision of positive pressure\\nventilation and\/or chest compressions in the presence of acute\\ninadequate ventilation and\/or cardiac output\\n$ 278.60\\n99466\\n99466\\nCritical care face-to-face services, during an interfacility transport of\\ncritically ill or critically injured pediatric patient, 24 months of age\\nor younger; first 30-74 minutes of hands-on care during transport\\n$ 410.44\\n99467\\n99467\\nCritical care face-to-face services, during an interfacility transport of\\ncritically ill or critically injured pediatric patient, 24 months of age\\nor younger; each additional 30 minutes (List separately in addition\\nto code for primary service)\\n$ 231.30\\n99468\\n99468\\nInitial inpatient neonatal critical care, per day, for the evaluation\\nand management of a critically ill neonate, 28 days of age or\\nyounger\\n$ 1,541.18\\n99469\\n99469\\nSubsequent inpatient neonatal critical care, per day, for the\\nevaluation and management of a critically ill neonate, 28 days of\\nage or younger\\n$ 961.49\\n99471\\n99471\\nInitial inpatient pediatric critical care, per day, for the evaluation\\nand management of a critically ill infant or young child, 29 days\\nthrough 24 months of age\\n$ 1,358.69\\n99472\\n99472\\nSubsequent inpatient pediatric critical care, per day, for the\\nevaluation and management of a critically ill infant or young child,\\n29 days through 24 months of age\\n$ 920.42\\n99475\\n99475\\nInitial inpatient pediatric critical care, per day, for the evaluation\\nand management of a critically ill infant or young child, 2 through 5\\nyears of age\\n$ 1,108.22\\n99476\\n99476\\nSubsequent inpatient pediatric critical care, per day, for the\\nevaluation and management of a critically ill infant or young child, 2\\nthrough 5 years of age\\n$ 815.58\\n99478\\n99478\\nSubsequent intensive care, per day, for the evaluation and\\nmanagement of the recovering very low birth weight infant (present\\nbody weight less than 1500 grams)\\n$ 398.22\\n99479\\n99479\\nSubsequent intensive care, per day, for the evaluation and\\nmanagement of the recovering low birth weight infant (present\\nbody weight of 1500-2500 grams)\\n$ 373.08\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n423\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n424\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\n99480\\n99480\\nSubsequent intensive care, per day, for the evaluation and\\nmanagement of the recovering infant (present body weight of 2501-\\n5000 grams)\\n$ 350.97\\n99499\\n99499\\nUnlisted evaluation and management service\\n$ 38.50\\n99500\\n99500\\nHome visit for prenatal monitoring and assessment to include fetal\\nheart rate, non-stress test, uterine monitoring, and gestational\\ndiabetes monitoring\\n$ -\\n99502\\n99502\\nHome visit for newborn care and assessment\\n$ 38.50\\n99503\\n99503\\nHome visit for respiratory therapy care (eg, bronchodilator, oxygen\\ntherapy, respiratory assessment, apnea evaluation)\\n$ -\\n99504\\n99504\\nHome visit for mechanical ventilation care\\n$ -\\n99505\\n99505\\nHome visit for stoma care and maintenance including colostomy\\nand cystostomy\\n$ -\\n99506\\n99506\\nHome visit for intramuscular injections\\n$ -\\n99507\\n99507\\nHome visit for care and maintenance of catheter(s) (eg, urinary,\\ndrainage, and enteral)\\n$ 27.50\\n99509\\n99509\\nHome visit for assistance with activities of daily living and personal\\ncare\\n$ 33.00\\n99510\\n99510\\nHome visit for individual, family, or marriage counseling\\n$ -\\n99511\\n99511\\nHome visit for fecal impaction management and enema\\nadministration\\n$ -\\n99512\\n99512\\nHome visit for hemodialysis\\n$ -\\n99600\\n99600\\nUnlisted home visit service or procedure\\nCost\\n99601\\n99601\\nHome infusion\/specialty drug administration, per visit (up to 2\\nhours);\\n$ -\\n99602\\n99602\\nHome infusion\/specialty drug administration, per visit (up to 2\\nhours); each additional hour (List separately in addition to code for\\nprimary procedure)\\n$ -\\n99605\\n99605\\nMedication therapy management service(s) provided by a\\npharmacist, individual, face-to-face with patient, with assessment\\nand intervention if provided; initial 15 minutes, new patient\\n$ -\\n99606\\n99606\\nMedication therapy management service(s) provided by a\\npharmacist, individual, face-to-face with patient, with assessment\\nand intervention if provided; initial 15 minutes, established patient\\n$ -\\n99607\\n99607\\nMedication therapy management service(s) provided by a\\npharmacist, individual, face-to-face with patient, with assessment\\nand intervention if provided; each additional 15 minutes (List\\nseparately in addition to code for primary service)\\n$ -\\nA0380\\nA0380\\nBLS mileage (per mile)\\n$ 8.25\\nA0427\\nA0427\\nAmbulance service, advanced life support, emergency transport,\\nlevel 1 (ALS1- emergency)\\n$ 187.00\\nA0428\\nA0428\\nAmbulance service, basic life support, non-emergency transport,\\n(BLS)\\n$ 137.50\\nA0430\\nA0430\\nAmbulance service, conventional air services, transport, one way\\n(fixed wing)\\n$ 220.00\\nA0998\\nA0998\\nAmbulance response and treatment, no transport\\n$ 137.50\\nD0120\\nD0120\\nPeriodic oral evaluation - established patient\\n$ 30.00\\nD0140\\nD0140\\nLimited oral evaluation - problem focused\\n$ 30.00\\nD0150\\nD0150\\nComprehensive oral evaluation - new or established patient\\n$ 60.00\\nD0160\\nD0160\\nDetailed and extensive oral evaluation - problem focused, by report\\n$ 71.50\\nD0170\\nD0170\\nRe-evaluation - limited, problem focused (established patient; not\\npost-operative visit)\\n$ 39.00\\nD0210\\nD0210\\nIntraoral - complete series of radiographic images\\n$ 85.00\\nD0220\\nD0220\\nIntraoral - periapical first radiographic image\\n$ 18.00\\nD0230\\nD0230\\nIntraoral - periapical each additional radiographic image\\n$ 8.00\\nD0240\\nD0240\\nIntraoral - occlusal radiographic image\\n$ 27.50\\nD0250\\nD0250\\nExtraoral - first radiographic image\\n$ 38.00\\nD0260\\nD0260\\nExtraoral - each additional radiographic image\\n$ 32.00\\nD0270\\nD0270\\nBitewing - single radiographic image\\n$ 18.00\\nD0272\\nD0272\\nBitewings - two radiographic images\\n$ 35.50\\nD0274\\nD0274\\nBitewings - four radiographic images\\n$ 41.00\\nD0277\\nD0277\\nVertical bitewings - 7 to 8 radiographic images\\n$ 57.00\\nD0290\\nD0290\\nPosterior-anterior or lateral skull and facial bone survey\\nradiographic image\\n$ 81.00\\nD0310\\nD0310\\nSialography\\n$ 155.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n425\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n426\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD0320\\nD0320\\nTemporomandibular joint arthrogram, including injection\\n$ 369.00\\nD0321\\nD0321\\nOther temporomandibular joint radiographic images, by report\\n$ 148.00\\nD0322\\nD0322\\nTomographic survey\\n$ 265.00\\nD0330\\nD0330\\nPanoramic radiographic image\\n$ 60.00\\nD0340\\nD0340\\nCephalometric radiographic image\\n$ 55.00\\nD0350\\nD0350\\nOral\/facial photographic images\\n$ 43.00\\nD0415\\nD0415\\nCollection of microorganisms for culture and sensitivity\\n$ 95.00\\nD0425\\nD0425\\nCaries susceptibility tests\\n$ 61.00\\nD0460\\nD0460\\nPulp vitality tests\\n$ 36.00\\nD0470\\nD0470\\nDiagnostic casts\\n$ 69.00\\nD0472\\nD0472\\nAccession of tissue, gross examination, preparation and\\ntransmission of written report\\n$ 55.00\\nD0501\\nD0501\\nHISTOPATHOLOGIC EXAMINATIONS Refers to gross and microscopic\\nevaluations of presumptively abnormal tissue(s) that have been\\npreviously excised. Includes preparation and transmission of written\\nreport.\\n$ 127.00\\nD0502\\nD0502\\nOther oral pathology procedures, by report\\n$ 114.00\\nD0999\\nD0999\\nUnspecified diagnostic procedure, by report\\nIndividual Report\\nD1110\\nD1110\\nProphylaxis - adult\\n$ 88.00\\nD1120\\nD1120\\nProphylaxis - child\\n$ 44.00\\nD1206\\nD1206\\nTopical application of fluoride varnish\\n$ 60.00\\nD1208\\nD1208\\nTopical application of fluoride\\n$ 60.00\\nD1310\\nD1310\\nNutritional counseling for control of dental disease\\n$ 47.00\\nD1320\\nD1320\\nTobacco counseling for the control and prevention of oral disease\\n$ 51.00\\nD1330\\nD1330\\nOral hygiene instructions\\n$ 70.00\\nD1351\\nD1351\\nSealant - per tooth\\n$ 55.00\\nD1510\\nD1510\\nSpace maintainer - fixed - unilateral\\n$ 221.00\\nD1515\\nD1515\\nSpace maintainer - fixed - bilateral\\n$ 311.00\\nD1520\\nD1520\\nSpace maintainer - removable - unilateral\\n$ 266.00\\nD1525\\nD1525\\nSpace maintainer - removable - bilateral\\n$ 346.00\\nD1550\\nD1550\\nRe-cementation of space maintainer\\n$ 53.00\\nD2140\\nD2140\\nAmalgam - one surface, primary or permanent\\n$ 75.00\\nD2150\\nD2150\\nAmalgam - two surfaces, primary or permanent\\n$ 108.00\\nD2160\\nD2160\\nAmalgam - three surfaces, primary or permanent\\n$ 119.00\\nD2161\\nD2161\\nAmalgam - four or more surfaces, primary or permanent\\n$ 130.00\\nD2330\\nD2330\\nResin-based composite - one surface, anterior\\n$ 132.00\\nD2331\\nD2331\\nResin-based composite - two surfaces, anterior\\n$ 198.00\\nD2332\\nD2332\\nResin-based composite - three surfaces, anterior\\n$ 220.00\\nD2335\\nD2335\\nResin-based composite - four or more surfaces or involving incisal\\nangle (anterior)\\n$ 242.00\\nD2390\\nD2390\\nResin-based composite crown, anterior\\n$ 250.00\\nD2391\\nD2391\\nResin-based composite - one surface, posterior\\n$ 66.00\\nD2392\\nD2392\\nResin-based composite - two surfaces, posterior\\n$ 99.00\\nD2393\\nD2393\\nResin-based composite - three surfaces, posterior\\n$ 110.00\\nD2394\\nD2394\\nResin-based composite - four or more surfaces, posterior\\n$ 121.00\\nD2410\\nD2410\\nGold foil - one surface\\n$ 360.00\\nD2420\\nD2420\\nGold foil - two surfaces\\n$ 443.00\\nD2430\\nD2430\\nGold foil - three surfaces\\n$ 525.00\\nD2510\\nD2510\\nInlay - metallic - one surface\\n$ 522.00\\nD2520\\nD2520\\nInlay - metallic - two surfaces\\n$ 580.00\\nD2530\\nD2530\\nInlay - metallic - three or more surfaces\\n$ 625.00\\nD2542\\nD2542\\nOnlay - metallic-two surfaces\\n$ 650.00\\nD2543\\nD2543\\nOnlay - metallic-three surfaces\\n$ 691.00\\nD2544\\nD2544\\nOnlay - metallic-four or more surfaces\\n$ 720.00\\nD2610\\nD2610\\nInlay - porcelain\/ceramic - one surface\\n$ 583.00\\nD2620\\nD2620\\nInlay - porcelain\/ceramic - two surfaces\\n$ 630.00\\nD2630\\nD2630\\nInlay - porcelain\/ceramic - three or more surfaces\\n$ 671.00\\nD2642\\nD2642\\nOnlay - porcelain\/ceramic - two surfaces\\n$ 688.00\\nD2643\\nD2643\\nOnlay - porcelain\/ceramic - three surfaces\\n$ 717.00\\nD2644\\nD2644\\nOnlay - porcelain\/ceramic - four or more surfaces\\n$ 744.00\\nD2650\\nD2650\\nInlay - resin-based composite - one surface\\n$ 526.00\\nD2651\\nD2651\\nInlay - resin-based composite - two surfaces\\n$ 569.00\\nD2652\\nD2652\\nInlay - resin-based composite - three or more surfaces\\n$ 613.00\\nD2662\\nD2662\\nOnlay - resin-based composite - two surfaces\\n$ 650.00\\nD2663\\nD2663\\nOnlay - resin-based composite - three surfaces\\n$ 669.00\\nD2664\\nD2664\\nOnlay - resin-based composite - four or more surfaces\\n$ 695.00\\nD2710\\nD2710\\nCrown - resin-based composite (indirect)\\n$ 385.00\\nD2720\\nD2720\\nCrown - resin with high noble metal\\n$ 733.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n427\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n428\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD2721\\nD2721\\nCrown - resin with predominantly base metal\\n$ 661.00\\nD2722\\nD2722\\nCrown - resin with noble metal\\n$ 703.00\\nD2740\\nD2740\\nCrown - porcelain\/ceramic substrate\\n$ 751.00\\nD2750\\nD2750\\nCrown - porcelain fused to high noble metal\\n$ 744.00\\nD2751\\nD2751\\nCrown - porcelain fused to predominantly base metal\\n$ 540.00\\nD2752\\nD2752\\nCrown - porcelain fused to noble metal\\n$ 795.00\\nD2780\\nD2780\\nCrown - 3\/4 cast high noble metal\\n$ 738.00\\nD2781\\nD2781\\nCrown - 3\/4 cast predominantly base metal\\n$ 697.00\\nD2782\\nD2782\\nCrown - 3\/4 cast noble metal\\n$ 715.00\\nD2783\\nD2783\\nCrown - 3\/4 porcelain\/ceramic\\n$ 750.00\\nD2790\\nD2790\\nCrown - full cast high noble metal\\n$ 728.00\\nD2791\\nD2791\\nCrown - full cast predominantly base metal\\n$ 675.00\\nD2792\\nD2792\\nCrown - full cast noble metal\\n$ 700.00\\nD2799\\nD2799\\nProvisional crown - further treatment or completion of diagnosis\\nnecessary prior to final impression\\n$ 215.00\\nD2910\\nD2910\\nRecement inlay, onlay, or partial coverage restoration\\n$ 77.00\\nD2915\\nD2915\\nRecement cast or prefabricated post and core\\n$ 218.00\\nD2920\\nD2920\\nRecement crown\\n$ 99.00\\nD2930\\nD2930\\nPrefabricated stainless steel crown - primary tooth\\n$ 150.00\\nD2931\\nD2931\\nPrefabricated stainless steel crown - permanent tooth\\n$ 150.00\\nD2932\\nD2932\\nPrefabricated resin crown\\n$ 200.00\\nD2933\\nD2933\\nPrefabricated stainless steel crown with resin window\\n$ 239.00\\nD2940\\nD2940\\nProtective restoration\\n$ 71.50\\nD2950\\nD2950\\nCore buildup, including any pins\\n$ 150.00\\nD2951\\nD2951\\nPin retention - per tooth, in addition to restoration\\n$ 77.00\\nD2952\\nD2952\\nPost and core in addition to crown, indirectly fabricated\\n$ 303.50\\nD2953\\nD2953\\nEach additional indirectly fabricated post - same tooth\\n$ 188.00\\nD2954\\nD2954\\nPrefabricated post and core in addition to crown\\n$ 765.00\\nD2955\\nD2955\\nPost removal\\n$ 187.00\\nD2957\\nD2957\\nEach additional prefabricated post - same tooth\\n$ 66.00\\nD2960\\nD2960\\nLabial veneer (resin laminate) - chairside\\n$ 375.00\\nD2961\\nD2961\\nLabial veneer (resin laminate) - laboratory\\n$ 450.00\\nD2962\\nD2962\\nLabial veneer (porcelain laminate) - laboratory\\n$ 495.00\\nD2970\\nD2970\\nTemporary crown (fractured tooth)\\n$ 137.50\\nD2980\\nD2980\\nCrown repair necessitated by restorative material failure\\n$ 180.00\\nD2999\\nD2999\\nUnspecified restorative procedure, by report\\nIndividual Report\\nD3110\\nD3110\\nPulp cap - direct (excluding final restoration)\\n$ 55.00\\nD3120\\nD3120\\nPulp cap - indirect (excluding final restoration)\\n$ 33.00\\nD3220\\nD3220\\nTherapeutic pulpotomy (excluding final restoration) - removal of\\npulp coronal to the dentinocemental junction and application of\\nmedicament\\n$ 77.00\\nD3221\\nD3221\\nPulpal debridement, primary and permanent teeth\\n$ 88.00\\nD3230\\nD3230\\nPulpal therapy (resorbable filling) - anterior, primary tooth\\n(excluding final restoration)\\n$ 175.00\\nD3240\\nD3240\\nPulpal therapy (resorbable filling) - posterior, primary tooth\\n(excluding final restoration)\\n$ 196.00\\nD3310\\nD3310\\nEndodontic therapy, anterior tooth (excluding final restoration)\\n$ 247.50\\nD3320\\nD3320\\nEndodontic therapy, bicuspid tooth (excluding final restoration)\\n$ 605.00\\nD3330\\nD3330\\nEndodontic therapy, molar (excluding final restoration)\\n$ 852.50\\nD3331\\nD3331\\nTreatment of root canal obstruction; non-surgical access\\n$ 210.00\\nD3332\\nD3332\\nIncomplete endodontic therapy; inoperable, unrestorable or\\nfractured tooth\\n$ 233.00\\nD3333\\nD3333\\nInternal root repair of perforation defects\\n$ 133.00\\nD3346\\nD3346\\nRetreatment of previous root canal therapy - anterior\\n$ 360.00\\nD3347\\nD3347\\nRetreatment of previous root canal therapy - bicuspid\\n$ 360.00\\nD3348\\nD3348\\nRetreatment of previous root canal therapy - molar\\n$ 360.00\\nD3351\\nD3351\\nApexification\/recalcification\/pulpal regeneration - initial visit (apical\\nclosure\/calcific repair of perforations, root resorption, pulp space\\ndisinfection, etc.)\\n$ 110.00\\nD3352\\nD3352\\nApexification\/recalcification\/pulpal regeneration - interim\\nmedication replacement (apical closure\/calcific repair of\\nperforations, root resorption, pulp space disinfection, etc.)\\n$ 110.00\\nD3353\\nD3353\\nApexification\/recalcification - final visit (includes completed root\\ncanal therapy - apical closure\/calcific repair of perforations, root\\nresorption, etc.)\\n$ 110.00\\nD3410\\nD3410\\nApicoectomy\/periradicular surgery - anterior\\n$ 330.00\\nD3421\\nD3421\\nApicoectomy\/periradicular surgery - bicuspid (first root)\\n$ 330.00\\nD3425\\nD3425\\nApicoectomy\/periradicular surgery - molar (first root)\\n$ 330.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n429\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n430\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD3426\\nD3426\\nApicoectomy\/periradicular surgery (each additional root)\\n$ 210.00\\nD3430\\nD3430\\nRetrograde filling - per root\\n$ 170.00\\nD3450\\nD3450\\nRoot amputation - per root\\n$ 300.00\\nD3460\\nD3460\\nEndodontic endosseous implant\\n$ 759.00\\nD3470\\nD3470\\nIntentional reimplantation (including necessary splinting)\\n$ 539.00\\nD3910\\nD3910\\nSurgical procedure for isolation of tooth with rubber dam\\n$ 125.00\\nD3920\\nD3920\\nHemisection (including any root removal), not including root canal\\ntherapy\\n$ 299.00\\nD3950\\nD3950\\nCanal preparation and fitting of preformed dowel or post\\n$ 160.00\\nD3999\\nD3999\\nUnspecified endodontic procedure, by report\\nIndividual Report\\nD4210\\nD4210\\nGingivectomy or gingivoplasty - four or more contiguous teeth or\\ntooth bounded spaces per quadrant\\n$ 420.00\\nD4211\\nD4211\\nGingivectomy or gingivoplasty - one to three contiguous teeth or\\ntooth bounded spaces per quadrant\\n$ 148.00\\nD4240\\nD4240\\nGingival flap procedure, including root planing - four or more\\ncontiguous teeth or tooth bounded spaces per quadrant\\n$ 493.00\\nD4241\\nD4241\\nGingival flap procedure, including root planing - one to three\\ncontiguous teeth or tooth bounded spaces per quadrant\\n$ 207.00\\nD4245\\nD4245\\nApically positioned flap\\n$ 554.00\\nD4249\\nD4249\\nClinical crown lengthening - hard tissue\\n$ 478.00\\nD4260\\nD4260\\nOsseous surgery (including flap entry and closure) - four or more\\ncontiguous teeth or tooth bounded spaces per quadrant\\n$ 724.00\\nD4263\\nD4263\\nBone replacement graft - first site in quadrant\\n$ 456.00\\nD4264\\nD4264\\nBone replacement graft - each additional site in quadrant\\n$ 335.00\\nD4266\\nD4266\\nGuided tissue regeneration - resorbable barrier, per site\\n$ 603.00\\nD4267\\nD4267\\nGuided tissue regeneration - nonresorbable barrier, per site\\n(includes membrane removal)\\n$ 688.00\\nD4268\\nD4268\\nSurgical revision procedure, per tooth\\n$ 534.00\\nD4270\\nD4270\\nPedicle soft tissue graft procedure\\n$ 536.00\\nD4273\\nD4273\\nSubepithelial connective tissue graft procedures, per tooth\\n$ 735.00\\nD4277\\nD4277\\nFree soft tissue graft procedure (including donor site surgery), first\\ntooth or edentulous tooth position in graft\\n$ 595.00\\nD4278\\nD4278\\nFree soft tissue graft procedure (including donor site surgery), each\\nadditional contiguous tooth or edentulous tooth position in same\\ngraft site\\n$ 595.00\\nD4320\\nD4320\\nProvisional splinting - intracoronal\\n$ 332.00\\nD4321\\nD4321\\nProvisional splinting - extracoronal\\n$ 300.00\\nD4341\\nD4341\\nPeriodontal scaling and root planing - four or more teeth per\\nquadrant\\n$ 132.00\\nD4355\\nD4355\\nFull mouth debridement to enable comprehensive evaluation and\\ndiagnosis\\n$ 264.00\\nD4360\\nD4360\\nTrismus appliance (not for TMD treatment)\\n$ 220.00\\nD4910\\nD4910\\nPeriodontal maintenance\\n$ 88.00\\nD4920\\nD4920\\nUnscheduled dressing change (by someone other than treating\\ndentist)\\n$ 71.00\\nD4921\\nD4921\\nGingival irrigation per quad\\n$ 207.00\\nD4999\\nD4999\\nUnspecified periodontal procedure, by report\\nIndividual Report\\nD5110\\nD5110\\nComplete denture - maxillary\\n$ 600.00\\nD5120\\nD5120\\nComplete denture - mandibular\\n$ 600.00\\nD5130\\nD5130\\nImmediate denture - maxillary\\n$ 700.00\\nD5140\\nD5140\\nImmediate denture - mandibular\\n$ 700.00\\nD5211\\nD5211\\nMaxillary partial denture - resin base (including any conventional\\nclasps, rests and teeth)\\n$ 250.00\\nD5212\\nD5212\\nMandibular partial denture - resin base (including any conventional\\nclasps, rests and teeth)\\n$ 250.00\\nD5213\\nD5213\\nMaxillary partial denture - cast metal framework with resin denture\\nbases (including any conventional clasps, rests and teeth)\\n$ 650.00\\nD5214\\nD5214\\nMandibular partial denture - cast metal framework with resin\\ndenture bases (including any conventional clasps, rests and teeth)\\n$ 650.00\\nD5226\\nD5226\\nMandibular partial denture - flexible base (including any clasps,\\nrests and teeth)\\n$ 605.00\\nD5231\\nD5231\\nMandibular partial denture - cast metal framework with resin\\ndenture bases (including any conventional clasps, rests and teeth)\\n$ 605.00\\nD5251\\nD5251\\nComplete denture - maxillary\\n$ 605.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n431\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n432\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD5281\\nD5281\\nRemovable unilateral partial denture - one piece cast metal\\n(including clasps and teeth\\n$ 625.00\\nD5310\\nD5310\\nRepair or replace broken clasp\\n$ 27.50\\nD5320\\nD5320\\nAdd tooth to existing partial denture\\n$ 27.50\\nD5410\\nD5410\\nAdjust complete denture - maxillary\\n$ 30.00\\nD5411\\nD5411\\nAdjust complete denture - mandibular\\n$ 30.00\\nD5421\\nD5421\\nAdjust partial denture - maxillary\\n$ 25.00\\nD5422\\nD5422\\nAdjust partial denture - mandibular\\n$ 25.00\\nD5510\\nD5510\\nRepair broken complete denture base\\n$ 55.00\\nD5520\\nD5520\\nReplace missing or broken teeth - complete denture (each tooth)\\n$ 55.00\\nD5610\\nD5610\\nRepair resin denture base\\n$ 50.00\\nD5620\\nD5620\\nRepair cast framework\\n$ 55.00\\nD5630\\nD5630\\nRepair or replace broken clasp\\n$ 55.00\\nD5640\\nD5640\\nReplace broken teeth - per tooth\\n$ 55.00\\nD5650\\nD5650\\nAdd tooth to existing partial denture\\n$ 55.00\\nD5660\\nD5660\\nAdd clasp to existing partial denture\\n$ 50.00\\nD5710\\nD5710\\nRebase complete maxillary denture\\n$ 379.00\\nD5711\\nD5711\\nRebase complete mandibular denture\\n$ 380.00\\nD5720\\nD5720\\nRebase maxillary partial denture\\n$ 367.00\\nD5721\\nD5721\\nRebase mandibular partial denture\\n$ 366.00\\nD5730\\nD5730\\nReline complete maxillary denture (chairside)\\n$ 248.00\\nD5731\\nD5731\\nReline complete mandibular denture (chairside)\\n$ 249.00\\nD5740\\nD5740\\nReline maxillary partial denture (chairside)\\n$ 245.00\\nD5741\\nD5741\\nReline mandibular partial denture (chairside)\\n$ 244.00\\nD5750\\nD5750\\nReline complete maxillary denture (laboratory)\\n$ 110.00\\nD5751\\nD5751\\nReline complete mandibular denture (laboratory)\\n$ 110.00\\nD5760\\nD5760\\nReline maxillary partial denture (laboratory)\\n$ 110.00\\nD5761\\nD5761\\nReline mandibular partial denture (laboratory)\\n$ 110.00\\nD5810\\nD5810\\nInterim complete denture (maxillary)\\n$ 517.00\\nD5811\\nD5811\\nInterim complete denture (mandibular)\\n$ 524.00\\nD5820\\nD5820\\nInterim partial denture (maxillary)\\n$ 442.00\\nD5821\\nD5821\\nInterim partial denture (mandibular)\\n$ 442.00\\nD5850\\nD5850\\nTissue conditioning, maxillary\\n$ 125.00\\nD5851\\nD5851\\nTissue conditioning, mandibular\\n$ 125.00\\nD5860\\nD5860\\nOverdenture - complete, by report\\n$ 660.00\\nD5861\\nD5861\\nOverdenture - partial, by report\\n$ 660.00\\nD5862\\nD5862\\nPrecision attachment, by report\\n$ 435.00\\nD5875\\nD5875\\nModification of removable prosthesis following implant surgery\\n$ 236.00\\nD5899\\nD5899\\nUnspecified removable prosthodontic procedure, by report\\nIndividual Report\\nD5911\\nD5911\\nFacial moulage (sectional)\\nIndividual Report\\nD5912\\nD5912\\nFacial moulage (complete)\\nIndividual Report\\nD5913\\nD5913\\nNasal prosthesis\\nIndividual Report\\nD5914\\nD5914\\nAuricular prosthesis\\nIndividual Report\\nD5915\\nD5915\\nOrbital prosthesis\\nIndividual Report\\nD5916\\nD5916\\nOcular prosthesis\\nIndividual Report\\nD5919\\nD5919\\nFacial prosthesis\\nIndividual Report\\nD5922\\nD5922\\nNasal septal prosthesis\\nIndividual Report\\nD5923\\nD5923\\nOcular prosthesis, interim\\nIndividual Report\\nD5924\\nD5924\\nCranial prosthesis\\nIndividual Report\\nD5925\\nD5925\\nFacial augmentation implant prosthesis\\nIndividual Report\\nD5926\\nD5926\\nNasal prosthesis, replacement\\nIndividual Report\\nD5927\\nD5927\\nAuricular prosthesis, replacement\\nIndividual Report\\nD5928\\nD5928\\nOrbital prosthesis, replacement\\nIndividual Report\\nD5929\\nD5929\\nFacial prosthesis, replacement\\nIndividual Report\\nD5931\\nD5931\\nObturator prosthesis, surgical\\nIndividual Report\\nD5932\\nD5932\\nObturator prosthesis, definitive\\nIndividual Report\\nD5933\\nD5933\\nObturator prosthesis, modification\\nIndividual Report\\nD5934\\nD5934\\nMandibular resection prosthesis with guide flange\\nIndividual Report\\nD5935\\nD5935\\nMandibular resection prosthesis without guide flange\\nIndividual Report\\nD5936\\nD5936\\nObturator prosthesis, interim\\nIndividual Report\\nD5937\\nD5937\\nTrismus appliance (not for TMD treatment)\\nIndividual Report\\nD5951\\nD5951\\nFeeding aid\\nIndividual Report\\nD5952\\nD5952\\nSpeech aid prosthesis, pediatric\\nIndividual Report\\nD5953\\nD5953\\nSpeech aid prosthesis, adult\\nIndividual Report\\nD5954\\nD5954\\nPalatal augmentation prosthesis\\nIndividual Report\\nD5955\\nD5955\\nPalatal lift prosthesis, definitive\\nIndividual Report\\nD5958\\nD5958\\nPalatal lift prosthesis, interim\\nIndividual Report\\nD5959\\nD5959\\nPalatal lift prosthesis, modification\\nIndividual Report\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n433\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n434\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD5960\\nD5960\\nSpeech aid prosthesis, modification\\nIndividual Report\\nD5982\\nD5982\\nSurgical stent\\n$ 273.00\\nD5983\\nD5983\\nRadiation carrier\\nIndividual Report\\nD5984\\nD5984\\nRadiation shield\\nIndividual Report\\nD5985\\nD5985\\nRadiation cone locator\\nIndividual Report\\nD5986\\nD5986\\nFluoride gel carrier\\n$ 115.00\\nD5987\\nD5987\\nCommissure splint\\nIndividual Report\\nD5988\\nD5988\\nSurgical splint\\n$ 549.00\\nD5992\\nD5992\\nAdjust maxillofacial prosthetic appliance, by report\\n$ 220.00\\nD5999\\nD5999\\nUnspecified maxillofacial prosthesis, by report\\nIndividual Report\\nD6010\\nD6010\\nSurgical placement of implant body: endosteal implant\\n$ 1,425.00\\nD6012\\nD6012\\nSurgical placement of interim implant body for transitional\\nprosthesis: endosteal implant\\n$ 650.00\\nD6040\\nD6040\\nSurgical placement: eposteal implant\\n$ 6,023.00\\nD6050\\nD6050\\nSurgical placement: transosteal implant\\n$ 4,153.00\\nD6055\\nD6055\\nConnecting bar - implant supported or abutment supported\\n$ 1,667.00\\nD6056\\nD6056\\nPrefabricated abutment - includes modification and placement\\n$ 429.00\\nD6057\\nD6057\\nCustom fabricated abutment - includes placement\\n$ 600.00\\nD6058\\nD6058\\nAbutment supported porcelain\/ceramic crown\\n$ 850.00\\nD6059\\nD6059\\nAbutment supported porcelain fused to metal crown (high noble\\nmetal)\\n$ 861.00\\nD6060\\nD6060\\nAbutment supported porcelain fused to metal crown\\n(predominantly base metal)\\n$ 730.00\\nD6061\\nD6061\\nAbutment supported porcelain fused to metal crown (noble metal)\\n$ 800.00\\nD6062\\nD6062\\nAbutment supported cast metal crown (high noble metal)\\n$ 844.00\\nD6063\\nD6063\\nAbutment supported cast metal crown (predominantly base metal)\\n$ 755.00\\nD6064\\nD6064\\nAbutment supported cast metal crown (noble metal)\\n$ 800.00\\nD6065\\nD6065\\nImplant supported porcelain\/ceramic crown\\n$ 960.00\\nD6066\\nD6066\\nImplant supported porcelain fused to metal crown (titanium,\\ntitanium alloy, high noble metal)\\n$ 981.00\\nD6067\\nD6067\\nImplant supported metal crown (titanium, titanium alloy, high noble\\nmetal)\\n$ 950.00\\nD6068\\nD6068\\nABUTMENT SUPPORTED RETAINER FOR PORCELAIN\/CERAMIC FPD\\n$ 844.00\\nD6069\\nD6069\\nAbutment supported retainer for porcelain fused to metal FPD (high\\nnoble metal)\\n$ 836.00\\nD6070\\nD6070\\nAbutment supported retainer for porcelain fused to metal FPD\\n(predominantly base metal)\\n$ 703.00\\nD6071\\nD6071\\nAbutment supported retainer for porcelain fused to metal FPD\\n(noble metal)\\n$ 792.00\\nD6072\\nD6072\\nAbutment supported retainer for cast metal FPD (high noble metal)\\n$ 810.00\\nD6073\\nD6073\\nAbutment supported retainer for cast metal FPD (predominantly\\nbase metal)\\n$ 760.00\\nD6074\\nD6074\\nAbutment supported retainer for cast metal FPD (noble metal)\\n$ 775.00\\nD6075\\nD6075\\nImplant supported retainer for ceramic FPD\\n$ 906.00\\nD6077\\nD6077\\nImplant supported retainer for cast metal FPD (titanium, titanium\\nalloy, or high noble metal)\\n$ 935.00\\nD6078\\nD6078\\nImplant\/abutment supported fixed denture for completely\\nedentulous arch\\n$ 2,500.00\\nD6079\\nD6079\\nImplant\/abutment supported fixed denture for partially edentulous\\narch\\n$ 1,650.00\\nD6090\\nD6090\\nRepair implant supported prosthesis, by report\\n$ 493.00\\nD6095\\nD6095\\nREPAIR IMPLANT ABUTMENT, BY REPORT\\n$ 500.00\\nD6100\\nD6100\\nImplant removal, by report\\n$ 526.00\\nD6199\\nD6199\\nUnspecified implant procedure, by report\\nIndividual Report\\nD6210\\nD6210\\nPontic - cast high noble metal\\n$ 725.00\\nD6211\\nD6211\\nPontic - cast predominantly base metal\\n$ 675.00\\nD6212\\nD6212\\nPontic - cast noble metal\\n$ 778.00\\nD6240\\nD6240\\nPontic - porcelain fused to high noble metal\\n$ 735.00\\nD6241\\nD6241\\nPontic - porcelain fused to predominantly base metal\\n$ 680.00\\nD6242\\nD6242\\nPontic - porcelain fused to noble metal\\n$ 745.00\\nD6245\\nD6245\\nPontic - porcelain\/ceramic\\n$ 749.00\\nD6250\\nD6250\\nPontic - resin with high noble metal\\n$ 727.00\\nD6251\\nD6251\\nPontic - resin with predominantly base metal\\n$ 680.00\\nD6252\\nD6252\\nPontic - resin with noble metal\\n$ 722.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n435\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n436\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD6545\\nD6545\\nRetainer - cast metal for resin bonded fixed prosthesis\\n$ 452.00\\nD6548\\nD6548\\nRetainer - porcelain\/ceramic for resin bonded fixed prosthesis\\n$ 603.00\\nD6600\\nD6600\\nInlay - porcelain\/ceramic, two surfaces\\n$ 750.00\\nD6601\\nD6601\\nInlay - porcelain\/ceramic, three or more surfaces\\n$ 750.00\\nD6608\\nD6608\\nOnlay -porcelain\/ceramic, two surfaces\\n$ 750.00\\nD6609\\nD6609\\nOnlay - porcelain\/ceramic, three or more surfaces\\n$ 750.00\\nD6710\\nD6710\\nCrown - indirect resin based composite\\n$ 250.00\\nD6720\\nD6720\\nCrown - resin with high noble metal\\n$ 750.00\\nD6721\\nD6721\\nCrown - resin with predominantly base metal\\n$ 700.00\\nD6722\\nD6722\\nCrown - resin with noble metal\\n$ 727.00\\nD6740\\nD6740\\nCrown - porcelain\/ceramic\\n$ 768.00\\nD6750\\nD6750\\nCrown - porcelain fused to high noble metal\\n$ 745.00\\nD6751\\nD6751\\nCrown - porcelain fused to predominantly base metal\\n$ 685.00\\nD6752\\nD6752\\nCrown - porcelain fused to noble metal\\n$ 745.00\\nD6780\\nD6780\\nCrown - 3\/4 cast high noble metal\\n$ 727.00\\nD6781\\nD6781\\nCrown - 3\/4 cast predominantly base metal\\n$ 718.00\\nD6782\\nD6782\\nCrown - 3\/4 cast noble metal\\n$ 748.00\\nD6783\\nD6783\\nCrown - 3\/4 porcelain\/ceramic\\n$ 773.00\\nD6790\\nD6790\\nCrown - full cast high noble metal\\n$ 778.00\\nD6791\\nD6791\\nCrown - full cast predominantly base metal\\n$ 675.00\\nD6792\\nD6792\\nCrown - full cast noble metal\\n$ 709.00\\nD6920\\nD6920\\nConnector bar\\n$ 647.00\\nD6930\\nD6930\\nRecement fixed partial denture\\n$ 95.00\\nD6940\\nD6940\\nStress breaker\\n$ 272.00\\nD6950\\nD6950\\nPrecision attachment\\n$ 427.00\\nD6975\\nD6975\\nCoping\\n$ 471.00\\nD6980\\nD6980\\nFixed partial denture repair necessitated by restorative material\\nfailure\\n$ 250.00\\nD6999\\nD6999\\nUnspecified fixed prosthodontic procedure, by report\\nIndividual Report\\nD7111\\nD7111\\nExtraction, coronal remnants - deciduous tooth\\n$ 77.00\\nD7140\\nD7140\\nExtraction, erupted tooth or exposed root (elevation and\/or forceps\\nremoval)\\n$ 77.00\\nD7210\\nD7210\\nSurgical removal of erupted tooth requiring removal of bone and\/or\\nsectioning of tooth, and including elevation of mucoperiosteal flap if\\nindicated\\n$ 300.00\\nD7220\\nD7220\\nRemoval of impacted tooth - soft tissue\\n$ 330.00\\nD7230\\nD7230\\nRemoval of impacted tooth - partially bony\\n$ 270.00\\nD7240\\nD7240\\nRemoval of impacted tooth - completely bony\\n$ 300.00\\nD7241\\nD7241\\nRemoval of impacted tooth - completely bony, with unusual surgical\\ncomplications\\n$ 395.00\\nD7250\\nD7250\\nSurgical removal of residual tooth roots (cutting procedure)\\n$ 193.00\\nD7260\\nD7260\\nOroantral fistula closure\\n$ 445.00\\nD7270\\nD7270\\nTooth reimplantation and\/or stabilization of accidentally evulsed or\\ndisplaced tooth\\n$ 334.00\\nD7272\\nD7272\\nTooth transplantation (includes reimplantation from one site to\\nanother and splinting and\/or stabilization)\\n$ 444.00\\nD7280\\nD7280\\nSurgical access of an unerupted tooth\\n$ 310.00\\nD7282\\nD7282\\nMobilization of erupted or malpositioned tooth to aid eruption\\n$ 250.00\\nD7283\\nD7283\\nPlacement of device to facilitate eruption of impacted tooth\\n$ 250.00\\nD7285\\nD7285\\nBiopsy of oral tissue - hard (bone, tooth)\\n$ 165.00\\nD7286\\nD7286\\nBiopsy of oral tissue - soft\\n$ 165.00\\nD7290\\nD7290\\nSurgical repositioning of teeth\\n$ 280.00\\nD7291\\nD7291\\nTransseptal fiberotomy\/supra crestal fiberotomy, by report\\n$ 190.00\\nD7310\\nD7310\\nAlveoloplasty in conjunction with extractions - four or more teeth or\\ntooth spaces, per quadrant\\n$ 165.00\\nD7320\\nD7320\\nAlveoloplasty not in conjunction with extractions -four or more\\nteeth or tooth spaces, per quadrant\\n$ 277.00\\nD7340\\nD7340\\nVestibuloplasty - ridge extension (secondary epithelialization)\\n$ 602.00\\nD7410\\nD7410\\nExcision of benign lesion up to 1.25 cm\\n$ 262.00\\nD7440\\nD7440\\nExcision of malignant tumor - lesion diameter up to 1.25 cm\\n$ 364.00\\nD7441\\nD7441\\nExcision of malignant tumor - lesion diameter greater than 1.25 cm\\n$ 707.00\\nD7450\\nD7450\\nRemoval of benign odontogenic cyst or tumor - lesion diameter up\\nto 1.25 cm\\n$ 323.00\\nD7451\\nD7451\\nRemoval of benign odontogenic cyst or tumor - lesion diameter\\ngreater than 1.25 cm\\n$ 448.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n437\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n438\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD7460\\nD7460\\nRemoval of benign nonodontogenic cyst or tumor - lesion diameter\\nup to 1.25 cm\\n$ 315.00\\nD7461\\nD7461\\nRemoval of benign nonodontogenic cyst or tumor - lesion diameter\\ngreater than 1.25 cm\\n$ 453.00\\nD7465\\nD7465\\nDestruction of lesion(s) by physical or chemical method, by report\\n$ 229.00\\nD7471\\nD7471\\nRemoval of lateral exostosis (maxilla or mandible)\\n$ 373.00\\nD7490\\nD7490\\nRadical resection of maxilla or mandible\\n$ 6,125.00\\nD7510\\nD7510\\nIncision and drainage of abscess - intraoral soft tissue\\n$ 145.00\\nD7520\\nD7520\\nIncision and drainage of abscess - extraoral soft tissue\\n$ 232.00\\nD7530\\nD7530\\nRemoval of foreign body from mucosa, skin, or subcutaneous\\nalveolar tissue\\n$ 223.00\\nD7540\\nD7540\\nRemoval of reaction producing foreign bodies, musculoskeletal\\nsystem\\n$ 359.00\\nD7550\\nD7550\\nPartial ostectomy\/sequestrectomy for removal of non-vital bone\\n$ 313.00\\nD7560\\nD7560\\nMaxillary sinusotomy for removal of tooth fragment or foreign body $ 679.00\\nD7610\\nD7610\\nMaxilla - open reduction (teeth immobilized, if present)\\n$ 2,989.00\\nD7620\\nD7620\\nMaxilla - closed reduction (teeth immobilized, if present)\\n$ 2,295.00\\nD7630\\nD7630\\nMandible - open reduction (teeth immobilized, if present)\\n$ 2,959.00\\nD7640\\nD7640\\nMandible - closed reduction (teeth immobilized, if present)\\n$ 2,174.00\\nD7650\\nD7650\\nMalar and\/or zygomatic arch - open reduction\\n$ 2,720.00\\nD7660\\nD7660\\nMalar and\/or zygomatic arch - closed reduction\\n$ 2,227.00\\nD7670\\nD7670\\nAlveolus closed reduction may include stabilization of teeth\\n$ 862.00\\nD7680\\nD7680\\nFacial bones - complicated reduction with fixation and multiple\\nsurgical approaches\\n$ 4,768.00\\nD7710\\nD7710\\nMaxilla open reduction\\n$ 3,259.00\\nD7720\\nD7720\\nMaxilla - closed reduction\\n$ 2,161.00\\nD7730\\nD7730\\nMandible - open reduction\\n$ 3,294.00\\nD7740\\nD7740\\nMandible - closed reduction\\n$ 2,435.00\\nD7750\\nD7750\\nMalar and\/or zygomatic arch - open reduction\\n$ 2,875.00\\nD7760\\nD7760\\nMalar and\/or zygomatic arch - closed reduction\\n$ 2,669.00\\nD7770\\nD7770\\nAlveolus - open reduction stabilization of teeth\\n$ 1,675.00\\nD7780\\nD7780\\nFacial bones - complicated reduction with fixation and multiple\\nsurgical approaches\\n$ 5,886.00\\nD7810\\nD7810\\nOpen reduction of dislocation\\n$ 2,980.00\\nD7820\\nD7820\\nClosed reduction of dislocation\\n$ 305.00\\nD7830\\nD7830\\nManipulation under anesthesia\\n$ 397.00\\nD7840\\nD7840\\nCondylectomy\\n$ 3,974.00\\nD7850\\nD7850\\nSurgical discectomy, with\/without implant\\n$ 3,935.00\\nD7852\\nD7852\\nDisc repair\\n$ 4,188.00\\nD7854\\nD7854\\nSynovectomy\\n$ 4,157.00\\nD7856\\nD7856\\nMyotomy\\nIndividual Report\\nD7858\\nD7858\\nJoint reconstruction\\nIndividual Report\\nD7860\\nD7860\\nArthrotomy\\nIndividual Report\\nD7865\\nD7865\\nArthroplasty\\nIndividual Report\\nD7870\\nD7870\\nArthrocentesis\\nIndividual Report\\nD7871\\nD7871\\nNon-arthroscopic lysis and lavage\\nIndividual Report\\nD7872\\nD7872\\nArthroscopy - diagnosis, with or without biopsy\\nIndividual Report\\nD7873\\nD7873\\nArthroscopy - surgical: lavage and lysis of adhesions\\nIndividual Report\\nD7874\\nD7874\\nArthroscopy - surgical: disc repositioning and stabilization\\nIndividual Report\\nD7875\\nD7875\\nArthroscopy - surgical: synovectomy\\nIndividual Report\\nD7876\\nD7876\\nArthroscopy - surgical: discectomy\\nIndividual Report\\nD7877\\nD7877\\nArthroscopy - surgical: debridement\\nIndividual Report\\nD7880\\nD7880\\nOcclusal orthotic device, by report\\n$ 598.00\\nD7899\\nD7899\\nUnspecified TMD therapy, by report\\nIndividual Report\\nD7910\\nD7910\\nSuture of recent small wounds up to 5 cm\\n$ 190.00\\nD7911\\nD7911\\nComplicated suture - up to 5 cm\\n$ 294.00\\nD7912\\nD7912\\nComplicated suture - greater than 5 cm\\n$ 415.00\\nD7920\\nD7920\\nSkin graft (identify defect covered, location and type of graft)\\n$ 1,611.00\\nD7940\\nD7940\\nOsteoplasty - for orthognathic deformities\\n$ 2,476.00\\nD7941\\nD7941\\nOsteotomy - mandibular rami\\n$ 6,322.00\\nD7943\\nD7943\\nOsteotomy - mandibular rami with bone graft; includes obtaining\\nthe graft\\n$ 5,948.00\\nD7944\\nD7944\\nOsteotomy - segmented or subapical\\n$ 4,735.00\\nD7945\\nD7945\\nOsteotomy - body of mandible\\n$ 4,895.00\\nD7946\\nD7946\\nLeFort I (maxilla - total)\\n$ 5,962.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n439\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n440\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD7947\\nD7947\\nLeFort I (maxilla - segmented)\\n$ 6,104.00\\nD7949\\nD7949\\nLeFort II or LeFort III - with bone graft\\n$ 8,333.00\\nD7955\\nD7955\\nRepair of maxillofacial soft and\/or hard tissue defect\\n$ 1,898.00\\nD7960\\nD7960\\nFrenulectomy - also known as frenectomy or frenotomy - separate\\nprocedure not incidental to another procedure\\n$ 275.00\\nD7970\\nD7970\\nExcision of hyperplastic tissue - per arch\\n$ 320.00\\nD7971\\nD7971\\nExcision of pericoronal gingiva\\n$ 150.00\\nD7980\\nD7980\\nSialolithotomy\\n$ 399.00\\nD7981\\nD7981\\nExcision of salivary gland, by report\\n$ 2,389.00\\nD7982\\nD7982\\nSialodochoplasty\\n$ 1,150.00\\nD7983\\nD7983\\nClosure of salivary fistula\\n$ 610.00\\nD7990\\nD7990\\nEmergency tracheotomy\\n$ 870.00\\nD7991\\nD7991\\nCoronoidectomy\\n$ 2,775.00\\nD7995\\nD7995\\nSynthetic graft - mandible or facial bones, by report\\nIndividual Report\\nD7996\\nD7996\\nImplant-mandible for augmentation purposes (excluding alveolar\\nridge), by report\\nIndividual Report\\nD7997\\nD7997\\nAppliance removal (not by dentist who placed appliance), includes\\nremoval of archbar\\nIndividual Report\\nD7999\\nD7999\\nUnspecified oral surgery procedure, by report\\nIndividual Report\\nD8010\\nD8010\\nLimited orthodontic treatment of the primary dentition\\n$ 1,200.00\\nD8020\\nD8020\\nLimited orthodontic treatment of the transitional dentition\\n$ 1,485.00\\nD8030\\nD8030\\nLimited orthodontic treatment of the adolescent dentition\\n$ 1,616.00\\nD8040\\nD8040\\nLimited orthodontic treatment of the adult dentition\\n$ 1,562.00\\nD8050\\nD8050\\nInterceptive orthodontic treatment of the primary dentition\\n$ 1,545.00\\nD8060\\nD8060\\nInterceptive orthodontic treatment of the transitional dentition\\n$ 1,775.00\\nD8070\\nD8070\\nComprehensive orthodontic treatment of the transitional dentition\\n$ 3,968.00\\nD8080\\nD8080\\nComprehensive orthodontic treatment of the adolescent dentition\\n$ 3,998.00\\nD8090\\nD8090\\nComprehensive orthodontic treatment of the adult dentition\\n$ 4,125.00\\nD8210\\nD8210\\nRemovable appliance therapy\\n$ 231.00\\nD8220\\nD8220\\nFixed appliance therapy\\n$ 231.00\\nD8660\\nD8660\\nPre-orthodontic treatment visit\\n$ 170.00\\nD8670\\nD8670\\nPeriodic orthodontic treatment visit (as part of contract)\\n$ 129.00\\nD8680\\nD8680\\nOrthodontic retention (removal of appliances, construction and\\nplacement of retainer(s))\\n$ 275.00\\nD8690\\nD8690\\nOrthodontic treatment (alternative billing to a contract fee)\\n$ 160.00\\nD8691\\nD8691\\nRepair of orthodontic appliance\\n$ 134.00\\nD8692\\nD8692\\nReplacement of lost or broken retainer\\n$ 232.00\\nD8999\\nD8999\\nUnspecified orthodontic procedure, by report\\nIndividual Report\\nD9110\\nD9110\\nPalliative (emergency) treatment of dental pain - minor procedure\\n$ 79.00\\nD9210\\nD9210\\nLocal anesthesia not in conjunction with operative or surgical\\nprocedures\\n$ 45.00\\nD9211\\nD9211\\nRegional block anesthesia\\n$ 64.00\\nD9212\\nD9212\\nTrigeminal division block anesthesia\\n$ 168.00\\nD9215\\nD9215\\nLocal anesthesia in conjunction with operative or surgical\\nprocedures\\n$ 39.00\\nD9220\\nD9220\\nDeep sedation\/general anesthesia - first 30 minutes\\n$ 250.00\\nD9221\\nD9221\\nDeep sedation\/general anesthesia - each additional 15 minutes\\n$ 105.00\\nD9230\\nD9230\\nInhalation of nitrous oxide \/ anxiolysis, analgesia\\n$ 45.00\\nD9241\\nD9241\\nIntravenous conscious sedation\/analgesia - first 30 minutes\\n$ 250.00\\nD9242\\nD9242\\nIntravenous conscious sedation\/analgesia - each additional 15\\nminutes\\n$ 95.00\\nD9248\\nD9248\\nNon-intravenous conscious sedation\\n$ 194.00\\nD9410\\nD9410\\nHouse\/extended care facility call\\n$ 129.00\\nD9420\\nD9420\\nHospital or ambulatory surgical center call\\n$ 150.00\\nD9430\\nD9430\\nOffice visit for observation (during regularly scheduled hours) - no\\nother services performed\\n$ 47.00\\nD9440\\nD9440\\nOffice visit - after regularly scheduled hours\\n$ 95.00\\nD9610\\nD9610\\nTherapeutic parenteral drug, single administration\\n$ 60.00\\nD9630\\nD9630\\nOther drugs and\/or medicaments, by report\\n$ 30.00\\nD9910\\nD9910\\nApplication of desensitizing medicament\\n$ 40.00\\nD9911\\nD9911\\nApplication of desensitizing resin for cervical and\/or root surface,\\nper tooth\\n$ 46.00\\nD9920\\nD9920\\nBehavior management, by report\\n$ 85.00\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n441\", \"num\": null, \"text\": \"Cayman Islands Health Services Authority Charge Master\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_n442\", \"num\": null, \"text\": \"Row #\\nBill Code\\nModifer\\nCPT-4\\nHCPCS\\nCPT\/HCPCS Long Description\\nPrice\\nD9930\\nD9930\\nTreatment of complications (post-surgical) - unusual circumstances,\\nby report\\n$ 91.00\\nD9940\\nD9940\\nOcclusal guard, by report\\n$ 250.00\\nD9941\\nD9941\\nFabrication of athletic mouthguard\\n$ 80.00\\nD9950\\nD9950\\nOcclusion analysis - mounted case\\n$ 210.00\\nD9951\\nD9951\\nOcclusal adjustment - limited\\n$ 110.00\\nD9952\\nD9952\\nOcclusal adjustment - complete\\n$ 220.00\\nD9970\\nD9970\\nEnamel microabrasion\\n$ 142.00\\nD9971\\nD9971\\nOdontoplasty 1 - 2 teeth; includes removal of enamel projections\\n$ 85.00\\nD9972\\nD9972\\nExternal bleaching - per arch - performed in office\\n$ 211.00\\nD9973\\nD9973\\nExternal bleaching - per tooth\\n$ 160.00\\nD9974\\nD9974\\nInternal bleaching - per tooth\\n$ 189.00\\nD9999\\nD9999\\nUnspecified adjunctive procedure, by report\\nIndividual Report\\nHS0002\\nROOM\/BED: Critical Care\\n$ 1,507.00\\nHS0003\\nROOM\/BED: High Dependancy\\n$ 440.00\\nHS0009\\nROOM\/BED: Neonatal\\n$ -\\nHS0040\\nROOM\/BED: Isolation\\n$ 330.00\\nHS0042\\nROOM\/BED: Semi Private\\n$ 330.00\\nHS0043\\nROOM\/BED: Maternal Care\\n$ 495.00\\nHS0045\\nROOM\/BED: Neonatal - High Dependency\\n$ 440.00\\nHS0046\\nROOM\/BED: Neonatal - Special Care\\n$ 330.00\\nHS0048\\nROOM\/BED: Neonatal - Intensive\\n$ 1,507.00\\nHS0050\\nROOM\/BED: Psychiatry\\n$ 330.00\\nHS0060\\nROOM\/BED: Private\\n$ 467.50\\nHS0070\\nDay Treatment\\n$ 220.00\\nHS0070\\nROOM\/BED: Day Treatment\\n$ 220.00\\nHS0080\\nROOM\/BED: Sub Acute\\n$ 220.00\\nHS0106\\nOperating Room Facility Fee 1st Hour\\n$ 660.00\\nHS0108\\nOperating Room Facility Fee Add. Hours\\n$ 192.50\\nHS1013\\nLabour & Delivery Room\\n$ 825.00\\nHS1015\\nOR Facility Fee Dental <1 Hr\\n$ 286.00\\nHS1017\\nOR Facility Fee Dental >1 Hr\\n$ 517.00\\nS9460\\nS9460\\nDiabetic management program, nurse visit\\n$ 36.97\\nS9981\\nS9981\\nMedical records copying fee, administrative\\n$ 5.50\\nS9982\\nS9982\\nMedical records copying fee, per page\\n$ 0.55\\nV5014\\nV5014\\nRepair\/modification of a hearing aid ( In- House)\\n$ 25.00\\nV5030\\nV5030\\nHearing aid, monaural, body worn, air conduction\\nCost\", \"element\": \"section\", \"heading\": null}], \"meta\": {\"notes\": null, \"workflow\": null, \"lifecycle\": {\"source\": \"#cilegis\", \"eventRef\": [{\"eId\": \"e_commence_2014_01_01\", \"date\": \"2014-01-01\", \"type\": \"generation\", \"source\": \"#cilegis\"}]}, \"references\": {\"source\": \"#canary\", \"TLCRole\": [], \"TLCEvent\": [{\"eId\": \"ev_commencement\", \"href\": \"\/akn\/ontology\/canary\/event\/commencement\", \"showAs\": \"commencement\"}], 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\"actNumber\": \"74 of 2014\", \"longTitle\": null}}, \"doc\": null, \"bill\": null, \"judgment\": null}}","akn_full_text":"CAYMAN ISLANDS\n\nSupplement No. 1 published with Extraordinary\nGazette No. 60 dated 15 August, 2014.\n\nCAYMAN ISLANDS HEALTH SERVICES AUTHORITY\nCHARGE MASTER\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifier\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1\n00100\n00100\nAnesthesia for procedures on salivary glands, including biopsy\n$ 192.50\n2\n00102\n00102\nAnesthesia for procedures involving plastic repair of cleft lip\n$ 273.00\n3\n00103\n00103\nAnesthesia for reconstructive procedures of eyelid (eg,\nblepharoplasty, ptosis surgery)\n$ 385.00\n4\n00104\n00104\nAnesthesia for electroconvulsive therapy\n$ 273.00\n5\n00120\n00120\nAnesthesia for procedures on external, middle, and inner ear\nincluding biopsy; not otherwise specified\n$ 192.50\n6\n00124\n00124\nAnesthesia for procedures on external, middle, and inner ear\nincluding biopsy; otoscopy\n$ 273.00\n7\n00126\n00126\nAnesthesia for procedures on external, middle, and inner ear\nincluding biopsy; tympanotomy\n$ 192.50\n8\n00140\n00140\nAnesthesia for procedures on eye; not otherwise specified\n$ 192.50\n9\n00142\n00142\nAnesthesia for procedures on eye; lens surgery\n$ 385.00\n10\n00144\n00144\nAnesthesia for procedures on eye; corneal transplant\n$ 385.00\n11\n00145\n00145\nAnesthesia for procedures on eye; vitreoretinal surgery\n$ 385.00\n12\n00147\n00147\nAnesthesia for procedures on eye; iridectomy\n$ 192.50\n13\n00148\n00148\nAnesthesia for procedures on eye; ophthalmoscopy\n$ 273.00\n14\n00160\n00160\nAnesthesia for procedures on nose and accessory sinuses; not\notherwise specified\n$ 192.50\n15\n00162\n00162\nAnesthesia for procedures on nose and accessory sinuses; radical\nsurgery\n$ 385.00\n16\n00164\n00164\nAnesthesia for procedures on nose and accessory sinuses; biopsy,\nsoft tissue\n$ 273.00\n17\n00170\n00170\nAnesthesia for intraoral procedures, including biopsy; not otherwise\nspecified\n$ 192.50\n18\n00172\n00172\nAnesthesia for intraoral procedures, including biopsy; repair of cleft\npalate\n$ 273.00\n19\n00174\n00174\nAnesthesia for intraoral procedures, including biopsy; excision of\nretropharyngeal tumor\n$ 273.00\n20\n00176\n00176\nAnesthesia for intraoral procedures, including biopsy; radical\nsurgery\n$ 273.00\n21\n00190\n00190\nAnesthesia for procedures on facial bones or skull; not otherwise\nspecified\n$ 385.00\n22\n00192\n00192\nAnesthesia for procedures on facial bones or skull; radical surgery\n(including prognathism)\n$ 273.00\n23\n00210\n00210\nAnesthesia for intracranial procedures; not otherwise specified\n$ 385.00\n24\n00211\n00211\nAnesthesia for intracranial procedures; craniotomy or craniectomy\nfor evacuation of hematoma\n$ 286.00\n25\n00214\n00214\nAnesthesia for intracranial procedures; burr holes, including\nventriculography\n$ 385.00\n26\n00215\n00215\nAnesthesia for intracranial procedures; cranioplasty or elevation of\ndepressed skull fracture, extradural (simple or compound)\n$ 286.00\n27\n00218\n00218\nAnesthesia for intracranial procedures; procedures in sitting\nposition\n$ 286.00\n28\n00300\n00300\nAnesthesia for all procedures on the integumentary system, muscles\nand nerves of head, neck, and posterior trunk, not otherwise\nspecified\n$ 273.00\n29\n00320\n00320\nAnesthesia for all procedures on esophagus, thyroid, larynx, trachea\nand lymphatic system of neck; not otherwise specified, age 1 year\nor older\n$ 385.00\n30\n00322\n00322\nAnesthesia for all procedures on esophagus, thyroid, larynx, trachea\nand lymphatic system of neck; needle biopsy of thyroid\n$ 273.00\n31\n00326\n00326\nAnesthesia for all procedures on the larynx and trachea in children\nyounger than 1 year of age\n$ 273.00\n32\n00350\n00350\nAnesthesia for procedures on major vessels of neck; not otherwise\nspecified\n$ 273.00\n33\n00352\n00352\nAnesthesia for procedures on major vessels of neck; simple ligation\n$ 273.00\n34\n00400\n00400\nAnesthesia for procedures on the integumentary system on the\nextremities, anterior trunk and perineum; not otherwise specified\n$ 385.00\n35\n00402\n00402\nAnesthesia for procedures on the integumentary system on the\nextremities, anterior trunk and perineum; reconstructive\nprocedures on breast (eg, reduction or augmentation\nmammoplasty, muscle flaps)\n$ 385.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifier\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n36\n00404\n00404\nAnesthesia for procedures on the integumentary system on the\nextremities, anterior trunk and perineum; radical or modified\nradical procedures on breast\n$ 385.00\n37\n00406\n00406\nAnesthesia for procedures on the integumentary system on the\nextremities, anterior trunk and perineum; radical or modified\nradical procedures on breast with internal mammary node\ndissection\n$ 385.00\n38\n00410\n00410\nAnesthesia for procedures on the integumentary system on the\nextremities, anterior trunk and perineum; electrical conversion of\narrhythmias\n$ 192.50\n39\n0042T\n0042T\nCerebral perfusion analysis using computed tomography with\ncontrast administration, including post-processing of parametric\nmaps with determination of cerebral blood flow, cerebral blood\nvolume, and mean transit time\n$ 1,133.10\n40\n00450\n00450\nAnesthesia for procedures on clavicle and scapula; not otherwise\nspecified\n$ 273.00\n41\n00452\n00452\nAnesthesia for procedures on clavicle and scapula; radical surgery\n$ 273.00\n42\n00454\n00454\nAnesthesia for procedures on clavicle and scapula; biopsy of clavicle\n$ 273.00\n43\n00500\n00500\nAnesthesia for all procedures on esophagus\n$ 192.50\n44\n00520\n00520\nAnesthesia for closed chest procedures; (including bronchoscopy)\nnot otherwise specified\n$ 192.50\n45\n00524\n00524\nAnesthesia for closed chest procedures; pneumocentesis\n$ 273.00\n46\n00530\n00530\nAnesthesia for permanent transvenous pacemaker insertion\n$ 273.00\n47\n00532\n00532\nAnesthesia for access to central venous circulation\n$ 273.00\n48\n00534\n00534\nAnesthesia for transvenous insertion or replacement of pacing\ncardioverter-defibrillator\n$ 273.00\n49\n00540\n00540\nAnesthesia for thoracotomy procedures involving lungs, pleura,\ndiaphragm, and mediastinum (including surgical thoracoscopy); not\notherwise specified\n$ 385.00\n50\n00541\n00541\nAnesthesia for thoracotomy procedures involving lungs, pleura,\ndiaphragm, and mediastinum (including surgical thoracoscopy);\nutilizing 1 lung ventilation\n$ 273.00\n51\n00542\n00542\nAnesthesia for thoracotomy procedures involving lungs, pleura,\ndiaphragm, and mediastinum (including surgical thoracoscopy);\ndecortication\n$ 273.00\n52\n00546\n00546\nAnesthesia for thoracotomy procedures involving lungs, pleura,\ndiaphragm, and mediastinum (including surgical thoracoscopy);\npulmonary resection with thoracoplasty\n$ 273.00\n53\n00548\n00548\nAnesthesia for thoracotomy procedures involving lungs, pleura,\ndiaphragm, and mediastinum (including surgical thoracoscopy);\nintrathoracic procedures on the trachea and bronchi\n$ 273.00\n54\n00550\n00550\nAnesthesia for sternal debridement\n$ 273.00\n55\n00560\n00560\nAnesthesia for procedures on heart, pericardial sac, and great\nvessels of chest; without pump oxygenator\n$ 273.00\n56\n00561\n00561\nAnesthesia for procedures on heart, pericardial sac, and great\nvessels of chest; with pump oxygenator, younger than 1 year of age\n$ 273.00\n57\n00562\n00562\nAnesthesia for procedures on heart, pericardial sac, and great\nvessels of chest; with pump oxygenator, age 1 year or older, for all\nnon-coronary bypass procedures (eg, valve procedures) or for re-\noperation for coronary bypass more than 1 month after origi\n$ 273.00\n58\n00563\n00563\nAnesthesia for procedures on heart, pericardial sac, and great\nvessels of chest; with pump oxygenator with hypothermic\ncirculatory arrest\n$ 273.00\n59\n00566\n00566\nAnesthesia for direct coronary artery bypass grafting; without pump\noxygenator\n$ 273.00\n60\n00567\n00567\nAnesthesia for direct coronary artery bypass grafting; with pump\noxygenator\n$ 273.00\n61\n00580\n00580\nAnesthesia for heart transplant or heart\/lung transplant\n$ 273.00\n62\n00600\n00600\nAnesthesia for procedures on cervical spine and cord; not otherwise\nspecified\n$ 88.00\n63\n00604\n00604\nAnesthesia for procedures on cervical spine and cord; procedures\nwith patient in the sitting position\n$ 273.00\n64\n00620\n00620\nAnesthesia for procedures on thoracic spine and cord; not\notherwise specified\n$ 273.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifier\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n65\n00622\n00622\nAnesthesia for procedures on thoracic spine and cord;\nthoracolumbar sympathectomy\n$ 273.00\n66\n00625\n00625\nAnesthesia for procedures on the thoracic spine and cord, via an\nanterior transthoracic approach; not utilizing 1 lung ventilation\n$ 273.00\n67\n00626\n00626\nAnesthesia for procedures on the thoracic spine and cord, via an\nanterior transthoracic approach; utilizing 1 lung ventilation\n$ 273.00\n68\n00630\n00630\nAnesthesia for procedures in lumbar region; not otherwise specified $ 385.00\n69\n00632\n00632\nAnesthesia for procedures in lumbar region; lumbar\nsympathectomy\n$ 273.00\n70\n00634\n00634\nAnesthesia for procedures in lumbar region; chemonucleolysis\n$ 273.00\n71\n00635\n00635\nAnesthesia for procedures in lumbar region; diagnostic or\ntherapeutic lumbar puncture\n$ 273.00\n72\n00640\n00640\nAnesthesia for manipulation of the spine or for closed procedures\non the cervical, thoracic or lumbar spine\n$ 273.00\n73\n00670\n00670\nAnesthesia for extensive spine and spinal cord procedures (eg,\nspinal instrumentation or vascular procedures)\n$ 273.00\n74\n00700\n00700\nAnesthesia for procedures on upper anterior abdominal wall; not\notherwise specified\n$ 273.00\n75\n00702\n00702\nAnesthesia for procedures on upper anterior abdominal wall;\npercutaneous liver biopsy\n$ 273.00\n76\n00730\n00730\nAnesthesia for procedures on upper posterior abdominal wall\n$ 273.00\n77\n00740\n00740\nAnesthesia for upper gastrointestinal endoscopic procedures,\nendoscope introduced proximal to duodenum\n$ 192.50\n78\n00750\n00750\nAnesthesia for hernia repairs in upper abdomen; not otherwise\nspecified\n$ 273.00\n79\n00752\n00752\nAnesthesia for hernia repairs in upper abdomen; lumbar and ventral\n(incisional) hernias and\/or wound dehiscence\n$ 273.00\n80\n00754\n00754\nAnesthesia for hernia repairs in upper abdomen; omphalocele\n$ 273.00\n81\n00756\n00756\nAnesthesia for hernia repairs in upper abdomen; transabdominal\nrepair of diaphragmatic hernia\n$ 273.00\n82\n00770\n00770\nAnesthesia for all procedures on major abdominal blood vessels\n$ 385.00\n83\n00790\n00790\nAnesthesia for intraperitoneal procedures in upper abdomen\nincluding laparoscopy; not otherwise specified\n$ 385.00\n84\n00792\n00792\nAnesthesia for intraperitoneal procedures in upper abdomen\nincluding laparoscopy; partial hepatectomy or management of liver\nhemorrhage (excluding liver biopsy)\n$ 385.00\n85\n00794\n00794\nAnesthesia for intraperitoneal procedures in upper abdomen\nincluding laparoscopy; pancreatectomy, partial or total (eg, Whipple\nprocedure)\n$ 273.00\n86\n00796\n00796\nAnesthesia for intraperitoneal procedures in upper abdomen\nincluding laparoscopy; liver transplant (recipient)\n$ 273.00\n87\n00797\n00797\nAnesthesia for intraperitoneal procedures in upper abdomen\nincluding laparoscopy; gastric restrictive procedure for morbid\nobesity\n$ 273.00\n88\n00800\n00800\nAnesthesia for procedures on lower anterior abdominal wall; not\notherwise specified\n$ 273.00\n89\n00802\n00802\nAnesthesia for procedures on lower anterior abdominal wall;\npanniculectomy\n$ 273.00\n90\n00810\n00810\nAnesthesia for lower intestinal endoscopic procedures, endoscope\nintroduced distal to duodenum\n$ 385.00\n91\n00820\n00820\nAnesthesia for procedures on lower posterior abdominal wall\n$ 273.00\n92\n00830\n00830\nAnesthesia for hernia repairs in lower abdomen; not otherwise\nspecified\n$ 385.00\n93\n00832\n00832\nAnesthesia for hernia repairs in lower abdomen; ventral and\nincisional hernias\n$ 385.00\n94\n00834\n00834\nAnesthesia for hernia repairs in the lower abdomen not otherwise\nspecified, younger than 1 year of age\n$ 273.00\n95\n00836\n00836\nAnesthesia for hernia repairs in the lower abdomen not otherwise\nspecified, infants younger than 37 weeks gestational age at birth\nand younger than 50 weeks gestational age at time of surgery\n$ 273.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifier\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n96\n00840\n00840\nAnesthesia for intraperitoneal procedures in lower abdomen\nincluding laparoscopy; not otherwise specified\n$ 385.00\n97\n00842\n00842\nAnesthesia for intraperitoneal procedures in lower abdomen\nincluding laparoscopy; amniocentesis\n$ 273.00\n98\n00844\n00844\nAnesthesia for intraperitoneal procedures in lower abdomen\nincluding laparoscopy; abdominoperineal resection\n$ 385.00\n99\n00846\n00846\nAnesthesia for intraperitoneal procedures in lower abdomen\nincluding laparoscopy; radical hysterectomy\n$ 273.00\n100\n00848\n00848\nAnesthesia for intraperitoneal procedures in lower abdomen\nincluding laparoscopy; pelvic exenteration\n$ 273.00\n101\n00851\n00851\nAnesthesia for intraperitoneal procedures in lower abdomen\nincluding laparoscopy; tubal ligation\/transection\n$ 192.50\n102\n00860\n00860\nAnesthesia for extraperitoneal procedures in lower abdomen,\nincluding urinary tract; not otherwise specified\n$ 273.00\n103\n00862\n00862\nAnesthesia for extraperitoneal procedures in lower abdomen,\nincluding urinary tract; renal procedures, including upper one-third\nof ureter, or donor nephrectomy\n$ 385.00\n104\n00864\n00864\nAnesthesia for extraperitoneal procedures in lower abdomen,\nincluding urinary tract; total cystectomy\n$ 273.00\n105\n00865\n00865\nAnesthesia for extraperitoneal procedures in lower abdomen,\nincluding urinary tract; radical prostatectomy (suprapubic,\nretropubic)\n$ 385.00\n106\n00866\n00866\nAnesthesia for extraperitoneal procedures in lower abdomen,\nincluding urinary tract; adrenalectomy\n$ 273.00\n107\n00868\n00868\nAnesthesia for extraperitoneal procedures in lower abdomen,\nincluding urinary tract; renal transplant (recipient)\n$ 273.00\n108\n00869\n00869\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); vasectomy, unilateral or bilateral\n$ 385.00\n109\n00870\n00870\nAnesthesia for extraperitoneal procedures in lower abdomen,\nincluding urinary tract; cystolithotomy\n$ 385.00\n110\n00872\n00872\nAnesthesia for lithotripsy, extracorporeal shock wave; with water\nbath\n$ 273.00\n111\n00873\n00873\nAnesthesia for lithotripsy, extracorporeal shock wave; without\nwater bath\n$ 385.00\n112\n00880\n00880\nAnesthesia for procedures on major lower abdominal vessels; not\notherwise specified\n$ 273.00\n113\n00882\n00882\nAnesthesia for procedures on major lower abdominal vessels;\ninferior vena cava ligation\n$ 273.00\n114\n00902\n00902\nAnesthesia for; anorectal procedure\n$ 192.50\n115\n00904\n00904\nAnesthesia for; radical perineal procedure\n$ 273.00\n116\n00906\n00906\nAnesthesia for; vulvectomy\n$ 273.00\n117\n00908\n00908\nAnesthesia for; perineal prostatectomy\n$ 273.00\n118\n00910\n00910\nAnesthesia for transurethral procedures (including\nurethrocystoscopy); not otherwise specified\n$ 192.50\n119\n00912\n00912\nAnesthesia for transurethral procedures (including\nurethrocystoscopy); transurethral resection of bladder tumor(s)\n$ 192.50\n120\n00914\n00914\nAnesthesia for transurethral procedures (including\nurethrocystoscopy); transurethral resection of prostate\n$ 385.00\n121\n00916\n00916\nAnesthesia for transurethral procedures (including\nurethrocystoscopy); post-transurethral resection bleeding\n$ 273.00\n122\n00918\n00918\nAnesthesia for transurethral procedures (including\nurethrocystoscopy); with fragmentation, manipulation and\/or\nremoval of ureteral calculus\n$ 192.50\n123\n00920\n00920\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); not otherwise specified\n$ 192.50\n124\n00921\n00921\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); vasectomy, unilateral or bilateral\n$ 273.00\n125\n00922\n00922\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); seminal vesicles\n$ 273.00\n126\n00924\n00924\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); undescended testis, unilateral or bilateral\n$ 192.50\n127\n00926\n00926\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); radical orchiectomy, inguinal\n$ 192.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifier\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n128\n00928\n00928\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); radical orchiectomy, abdominal\n$ 273.00\n129\n00930\n00930\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); orchiopexy, unilateral or bilateral\n$ 192.50\n130\n00932\n00932\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); complete amputation of penis\n$ 273.00\n131\n00934\n00934\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); radical amputation of penis with bilateral\ninguinal lymphadenectomy\n$ 273.00\n132\n00936\n00936\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); radical amputation of penis with bilateral\ninguinal and iliac lymphadenectomy\n$ 273.00\n133\n00938\n00938\nAnesthesia for procedures on male genitalia (including open\nurethral procedures); insertion of penile prosthesis (perineal\napproach)\n$ 273.00\n134\n00940\n00940\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\ncervix or endometrium); not otherwise specified\n$ 192.50\n135\n00942\n00942\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\ncervix or endometrium); colpotomy, vaginectomy, colporrhaphy,\nand open urethral procedures\n$ 192.50\n136\n00944\n00944\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\ncervix or endometrium); vaginal hysterectomy\n$ 385.00\n137\n00948\n00948\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\ncervix or endometrium); cervical cerclage\n$ 192.50\n138\n00950\n00950\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\ncervix or endometrium); culdoscopy\n$ 273.00\n139\n00952\n00952\nAnesthesia for vaginal procedures (including biopsy of labia, vagina,\ncervix or endometrium); hysteroscopy and\/or\nhysterosalpingography\n$ 192.50\n140\n01112\n01112\nAnesthesia for bone marrow aspiration and\/or biopsy, anterior or\nposterior iliac crest\n$ 273.00\n141\n01120\n01120\nAnesthesia for procedures on bony pelvis\n$ 273.00\n142\n01130\n01130\nAnesthesia for body cast application or revision\n$ 192.50\n143\n01140\n01140\nAnesthesia for interpelviabdominal (hindquarter) amputation\n$ 273.00\n144\n01150\n01150\nAnesthesia for radical procedures for tumor of pelvis, except\nhindquarter amputation\n$ 273.00\n145\n01160\n01160\nAnesthesia for closed procedures involving symphysis pubis or\nsacroiliac joint\n$ 273.00\n146\n01170\n01170\nAnesthesia for open procedures involving symphysis pubis or\nsacroiliac joint\n$ 273.00\n147\n01173\n01173\nAnesthesia for open repair of fracture disruption of pelvis or column\nfracture involving acetabulum\n$ 273.00\n148\n01180\n01180\nAnesthesia for obturator neurectomy; extrapelvic\n$ 273.00\n149\n01190\n01190\nAnesthesia for obturator neurectomy; intrapelvic\n$ 273.00\n150\n01200\n01200\nAnesthesia for all closed procedures involving hip joint\n$ 192.50\n151\n01202\n01202\nAnesthesia for arthroscopic procedures of hip joint\n$ 273.00\n152\n01210\n01210\nAnesthesia for open procedures involving hip joint; not otherwise\nspecified\n$ 385.00\n153\n01212\n01212\nAnesthesia for open procedures involving hip joint; hip\ndisarticulation\n$ 273.00\n154\n01214\n01214\nAnesthesia for open procedures involving hip joint; total hip\narthroplasty\n$ 385.00\n155\n01215\n01215\nAnesthesia for open procedures involving hip joint; revision of total\nhip arthroplasty\n$ 385.00\n156\n01220\n01220\nAnesthesia for all closed procedures involving upper two-thirds of\nfemur\n$ 273.00\n157\n01230\n01230\nAnesthesia for open procedures involving upper two-thirds of\nfemur; not otherwise specified\n$ 385.00\n158\n01232\n01232\nAnesthesia for open procedures involving upper two-thirds of\nfemur; amputation\n$ 273.00\n159\n01234\n01234\nAnesthesia for open procedures involving upper two-thirds of\nfemur; radical resection\n$ 273.00\n160\n01250\n01250\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\nand bursae of upper leg\n$ 385.00\n161\n01260\n01260\nAnesthesia for all procedures involving veins of upper leg, including\nexploration\n$ 385.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifier\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n162\n01270\n01270\nAnesthesia for procedures involving arteries of upper leg, including\nbypass graft; not otherwise specified\n$ 385.00\n163\n01272\n01272\nAnesthesia for procedures involving arteries of upper leg, including\nbypass graft; femoral artery ligation\n$ 273.00\n164\n01274\n01274\nAnesthesia for procedures involving arteries of upper leg, including\nbypass graft; femoral artery embolectomy\n$ 273.00\n165\n01320\n01320\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\nand bursae of knee and\/or popliteal area\n$ 385.00\n166\n01340\n01340\nAnesthesia for all closed procedures on lower one-third of femur\n$ 273.00\n167\n01360\n01360\nAnesthesia for all open procedures on lower one-third of femur\n$ 273.00\n168\n01380\n01380\nAnesthesia for all closed procedures on knee joint\n$ 273.00\n169\n01382\n01382\nAnesthesia for diagnostic arthroscopic procedures of knee joint\n$ 385.00\n170\n01390\n01390\nAnesthesia for all closed procedures on upper ends of tibia, fibula,\nand\/or patella\n$ 273.00\n171\n01392\n01392\nAnesthesia for all open procedures on upper ends of tibia, fibula,\nand\/or patella\n$ 385.00\n172\n01400\n01400\nAnesthesia for open or surgical arthroscopic procedures on knee\njoint; not otherwise specified\n$ 385.00\n173\n01402\n01402\nAnesthesia for open or surgical arthroscopic procedures on knee\njoint; total knee arthroplasty\n$ 385.00\n174\n01404\n01404\nAnesthesia for open or surgical arthroscopic procedures on knee\njoint; disarticulation at knee\n$ 273.00\n175\n01420\n01420\nAnesthesia for all cast applications, removal, or repair involving\nknee joint\n$ 273.00\n176\n01430\n01430\nAnesthesia for procedures on veins of knee and popliteal area; not\notherwise specified\n$ 273.00\n177\n01432\n01432\nAnesthesia for procedures on veins of knee and popliteal area;\narteriovenous fistula\n$ 273.00\n178\n01440\n01440\nAnesthesia for procedures on arteries of knee and popliteal area;\nnot otherwise specified\n$ 273.00\n179\n01442\n01442\nAnesthesia for procedures on arteries of knee and popliteal area;\npopliteal thromboendarterectomy, with or without patch graft\n$ 273.00\n180\n01444\n01444\nAnesthesia for procedures on arteries of knee and popliteal area;\npopliteal excision and graft or repair for occlusion or aneurysm\n$ 273.00\n181\n01462\n01462\nAnesthesia for all closed procedures on lower leg, ankle, and foot\n$ 192.50\n182\n01464\n01464\nAnesthesia for arthroscopic procedures of ankle and\/or foot\n$ 273.00\n183\n01470\n01470\nAnesthesia for procedures on nerves, muscles, tendons, and fascia\nof lower leg, ankle, and foot; not otherwise specified\n$ 385.00\n184\n01472\n01472\nAnesthesia for procedures on nerves, muscles, tendons, and fascia\nof lower leg, ankle, and foot; repair of ruptured Achilles tendon,\nwith or without graft\n$ 385.00\n185\n01474\n01474\nAnesthesia for procedures on nerves, muscles, tendons, and fascia\nof lower leg, ankle, and foot; gastrocnemius recession (eg, Strayer\nprocedure)\n$ 273.00\n186\n01480\n01480\nAnesthesia for open procedures on bones of lower leg, ankle, and\nfoot; not otherwise specified\n$ 385.00\n187\n01482\n01482\nAnesthesia for open procedures on bones of lower leg, ankle, and\nfoot; radical resection (including below knee amputation)\n$ 273.00\n188\n01484\n01484\nAnesthesia for open procedures on bones of lower leg, ankle, and\nfoot; osteotomy or osteoplasty of tibia and\/or fibula\n$ 273.00\n189\n01486\n01486\nAnesthesia for open procedures on bones of lower leg, ankle, and\nfoot; total ankle replacement\n$ 273.00\n190\n01490\n01490\nAnesthesia for lower leg cast application, removal, or repair\n$ 192.50\n191\n01500\n01500\nAnesthesia for procedures on arteries of lower leg, including bypass\ngraft; not otherwise specified\n$ 273.00\n192\n01502\n01502\nAnesthesia for procedures on arteries of lower leg, including bypass\ngraft; embolectomy, direct or with catheter\n$ 273.00\n193\n01520\n01520\nAnesthesia for procedures on veins of lower leg; not otherwise\nspecified\n$ 273.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n194\n01522\n01522\nAnesthesia for procedures on veins of lower leg; venous\nthrombectomy, direct or with catheter\n$ 385.00\n195\n01610\n01610\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\nand bursae of shoulder and axilla\n$ 385.00\n196\n01620\n01620\nAnesthesia for all closed procedures on humeral head and neck,\nsternoclavicular joint, acromioclavicular joint, and shoulder joint\n$ 273.00\n197\n01622\n01622\nAnesthesia for diagnostic arthroscopic procedures of shoulder joint\n$ 385.00\n198\n01630\n01630\nAnesthesia for open or surgical arthroscopic procedures on humeral\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\nshoulder joint; not otherwise specified\n$ 385.00\n199\n01634\n01634\nAnesthesia for open or surgical arthroscopic procedures on humeral\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\nshoulder joint; shoulder disarticulation\n$ 273.00\n200\n01636\n01636\nAnesthesia for open or surgical arthroscopic procedures on humeral\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\nshoulder joint; interthoracoscapular (forequarter) amputation\n$ 273.00\n201\n01638\n01638\nAnesthesia for open or surgical arthroscopic procedures on humeral\nhead and neck, sternoclavicular joint, acromioclavicular joint, and\nshoulder joint; total shoulder replacement\n$ 273.00\n202\n01650\n01650\nAnesthesia for procedures on arteries of shoulder and axilla; not\notherwise specified\n$ 273.00\n203\n01652\n01652\nAnesthesia for procedures on arteries of shoulder and axilla; axillary-\nbrachial aneurysm\n$ 273.00\n204\n01654\n01654\nAnesthesia for procedures on arteries of shoulder and axilla; bypass\ngraft\n$ 273.00\n205\n01656\n01656\nAnesthesia for procedures on arteries of shoulder and axilla; axillary-\nfemoral bypass graft\n$ 273.00\n206\n01670\n01670\nAnesthesia for all procedures on veins of shoulder and axilla\n$ 273.00\n207\n01680\n01680\nAnesthesia for shoulder cast application, removal or repair; not\notherwise specified\n$ 273.00\n208\n01682\n01682\nAnesthesia for shoulder cast application, removal or repair;\nshoulder spica\n$ 273.00\n209\n01710\n01710\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\nbursae of upper arm and elbow; not otherwise specified\n$ 385.00\n210\n01712\n01712\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\nbursae of upper arm and elbow; tenotomy, elbow to shoulder, open $ 273.00\n211\n01714\n01714\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\nbursae of upper arm and elbow; tenoplasty, elbow to shoulder\n$ 273.00\n212\n01716\n01716\nAnesthesia for procedures on nerves, muscles, tendons, fascia, and\nbursae of upper arm and elbow; tenodesis, rupture of long tendon\nof biceps\n$ 385.00\n213\n01730\n01730\nAnesthesia for all closed procedures on humerus and elbow\n$ 192.50\n214\n01732\n01732\nAnesthesia for diagnostic arthroscopic procedures of elbow joint\n$ 273.00\n215\n01740\n01740\nAnesthesia for open or surgical arthroscopic procedures of the\nelbow; not otherwise specified\n$ 385.00\n216\n01742\n01742\nAnesthesia for open or surgical arthroscopic procedures of the\nelbow; osteotomy of humerus\n$ 273.00\n217\n01744\n01744\nAnesthesia for open or surgical arthroscopic procedures of the\nelbow; repair of nonunion or malunion of humerus\n$ 273.00\n218\n01756\n01756\nAnesthesia for open or surgical arthroscopic procedures of the\nelbow; radical procedures\n$ 273.00\n219\n01758\n01758\nAnesthesia for open or surgical arthroscopic procedures of the\nelbow; excision of cyst or tumor of humerus\n$ 273.00\n220\n01760\n01760\nAnesthesia for open or surgical arthroscopic procedures of the\nelbow; total elbow replacement\n$ 273.00\n221\n01770\n01770\nAnesthesia for procedures on arteries of upper arm and elbow; not\notherwise specified\n$ 273.00\n222\n01772\n01772\nAnesthesia for procedures on arteries of upper arm and elbow;\nembolectomy\n$ 273.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n223\n01780\n01780\nAnesthesia for procedures on veins of upper arm and elbow; not\notherwise specified\n$ 273.00\n224\n01782\n01782\nAnesthesia for procedures on veins of upper arm and elbow;\nphleborrhaphy\n$ 273.00\n225\n01810\n01810\nAnesthesia for all procedures on nerves, muscles, tendons, fascia,\nand bursae of forearm, wrist, and hand\n$ 385.00\n226\n01820\n01820\nAnesthesia for all closed procedures on radius, ulna, wrist, or hand\nbones\n$ 192.50\n227\n01829\n01829\nAnesthesia for diagnostic arthroscopic procedures on the wrist\n$ 273.00\n228\n01830\n01830\nAnesthesia for open or surgical arthroscopic\/endoscopic procedures\non distal radius, distal ulna, wrist, or hand joints; not otherwise\nspecified\n$ 385.00\n229\n01832\n01832\nAnesthesia for open or surgical arthroscopic\/endoscopic procedures\non distal radius, distal ulna, wrist, or hand joints; total wrist\nreplacement\n$ 273.00\n230\n01840\n01840\nAnesthesia for procedures on arteries of forearm, wrist, and hand;\nnot otherwise specified\n$ 273.00\n231\n01842\n01842\nAnesthesia for procedures on arteries of forearm, wrist, and hand;\nembolectomy\n$ 385.00\n232\n01844\n01844\nAnesthesia for vascular shunt, or shunt revision, any type (eg,\ndialysis)\n$ 385.00\n233\n01850\n01850\nAnesthesia for procedures on veins of forearm, wrist, and hand; not\notherwise specified\n$ 273.00\n234\n01852\n01852\nAnesthesia for procedures on veins of forearm, wrist, and hand;\nphleborrhaphy\n$ 273.00\n235\n01860\n01860\nAnesthesia for forearm, wrist, or hand cast application, removal, or\nrepair\n$ 192.50\n236\n01916\n01916\nAnesthesia for diagnostic arteriography\/venography\n$ 273.00\n237\n01920\n01920\nAnesthesia for cardiac catheterization including coronary\nangiography and ventriculography (not to include Swan-Ganz\ncatheter)\n$ 273.00\n238\n01922\n01922\nAnesthesia for non-invasive imaging or radiation therapy\n$ 192.50\n239\n01924\n01924\nAnesthesia for therapeutic interventional radiological procedures\ninvolving the arterial system; not otherwise specified\n$ 273.00\n240\n01925\n01925\nAnesthesia for therapeutic interventional radiological procedures\ninvolving the arterial system; carotid or coronary\n$ 273.00\n241\n01926\n01926\nAnesthesia for therapeutic interventional radiological procedures\ninvolving the arterial system; intracranial, intracardiac, or aortic\n$ 273.00\n242\n01930\n01930\nAnesthesia for therapeutic interventional radiological procedures\ninvolving the venous\/lymphatic system (not to include access to the\ncentral circulation); not otherwise specified\n$ 273.00\n243\n01931\n01931\nAnesthesia for therapeutic interventional radiological procedures\ninvolving the venous\/lymphatic system (not to include access to the\ncentral circulation); intrahepatic or portal circulation (eg,\ntransvenous intrahepatic portosystemic shunt[s] [TIPS])\n$ 273.00\n244\n01932\n01932\nAnesthesia for therapeutic interventional radiological procedures\ninvolving the venous\/lymphatic system (not to include access to the\ncentral circulation); intrathoracic or jugular\n$ 273.00\n245\n01933\n01933\nAnesthesia for therapeutic interventional radiological procedures\ninvolving the venous\/lymphatic system (not to include access to the\ncentral circulation); intracranial\n$ 273.00\n246\n01935\n01935\nAnesthesia for percutaneous image guided procedures on the spine\nand spinal cord; diagnostic\n$ 273.00\n247\n01936\n01936\nAnesthesia for percutaneous image guided procedures on the spine\nand spinal cord; therapeutic\n$ 273.00\n248\n01951\n01951\nAnesthesia for second- and third-degree burn excision or\ndebridement with or without skin grafting, any site, for total body\nsurface area (TBSA) treated during anesthesia and surgery; less than\n4% total body surface area\n$ 273.00\n249\n01952\n01952\nAnesthesia for second- and third-degree burn excision or\ndebridement with or without skin grafting, any site, for total body\nsurface area (TBSA) treated during anesthesia and surgery; between\n4% and 9% of total body surface area\n$ 273.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n250\n01953\n01953\nAnesthesia for second- and third-degree burn excision or\ndebridement with or without skin grafting, any site, for total body\nsurface area (TBSA) treated during anesthesia and surgery; each\nadditional 9% total body surface area or part thereof (List separa\n$ 273.00\n251\n01958\n01958\nAnesthesia for external cephalic version procedure\n$ 273.00\n252\n01960\n01960\nAnesthesia for vaginal delivery only\n$ 273.00\n253\n01961\n01961\nAnesthesia for cesarean delivery only\n$ 214.50\n254\n01962\n01962\nAnesthesia for urgent hysterectomy following delivery\n$ 273.00\n255\n01963\n01963\nAnesthesia for cesarean hysterectomy without any labor\nanalgesia\/anesthesia care\n$ 273.00\n256\n01965\n01965\nAnesthesia for incomplete or missed abortion procedures\n$ 273.00\n257\n01966\n01966\nAnesthesia for induced abortion procedures\n$ 273.00\n258\n01967\n01967\nNeuraxial labor analgesia\/anesthesia for planned vaginal delivery\n(this includes any repeat subarachnoid needle placement and drug\ninjection and\/or any necessary replacement of an epidural catheter\nduring labor)\n$ 273.00\n259\n01968\n01968\nAnesthesia for cesarean delivery following neuraxial labor\nanalgesia\/anesthesia (List separately in addition to code for primary\nprocedure performed)\n$ 273.00\n260\n01969\n01969\nAnesthesia for cesarean hysterectomy following neuraxial labor\nanalgesia\/anesthesia (List separately in addition to code for primary\nprocedure performed)\n$ 286.00\n261\n01990\n01990\nPhysiological support for harvesting of organ(s) from brain-dead\npatient\n$ 273.00\n262\n01991\n01991\nAnesthesia for diagnostic or therapeutic nerve blocks and injections\n(when block or injection is performed by a different physician or\nother qualified health care professional); other than the prone\nposition\n$ 286.00\n263\n01992\n01992\nAnesthesia for diagnostic or therapeutic nerve blocks and injections\n(when block or injection is performed by a different physician or\nother qualified health care professional); prone position\n$ 286.00\n264\n01996\n01996\nDaily hospital management of epidural or subarachnoid continuous\ndrug administration\n$ 88.00\n265\n01999\n01999\nUnlisted anesthesia procedure(s)\n$ 286.00\n266\n0234T\n0234T\nTransluminal peripheral atherectomy, open or percutaneous,\nincluding radiological supervision and interpretation; renal artery\n$ 8,842.66\n267\n0235T\n0235T\nTransluminal peripheral atherectomy, open or percutaneous,\nincluding radiological supervision and interpretation; visceral artery\n(except renal), each vessel\n$ 2,580.30\n268\n0237T\n0237T\nTransluminal peripheral atherectomy, open or percutaneous,\nincluding radiological supervision and interpretation;\nbrachiocephalic trunk and branches, each vessel\n$ 8,842.66\n269\n0238T\n0238T\nTransluminal peripheral atherectomy, open or percutaneous,\nincluding radiological supervision and interpretation; iliac artery,\neach vessel\n$ 8,842.66\n270\n10021\n10021\nFine needle aspiration; without imaging guidance\n$ 196.46\n271\n10022\n10022\nFine needle aspiration; with imaging guidance\n$ 215.09\n272\n10040\n10040\nAcne surgery (eg, marsupialization, opening or removal of multiple\nmilia, comedones, cysts, pustules)\n$ 122.40\n273\n10060\n10060\nIncision and drainage of abscess (eg, carbuncle, suppurative\nhidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or\nparonychia); simple or single\n$ 134.44\n274\n10061\n10061\nIncision and drainage of abscess (eg, carbuncle, suppurative\nhidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or\nparonychia); complicated or multiple\n$ 358.05\n275\n10080\n10080\nIncision and drainage of pilonidal cyst; simple\n$ 190.80\n276\n10081\n10081\nIncision and drainage of pilonidal cyst; complicated\n$ 450.90\n277\n10120\n10120\nIncision and removal of foreign body, subcutaneous tissues; simple\n$ 149.67\n278\n10121\n10121\nIncision and removal of foreign body, subcutaneous tissues;\ncomplicated\n$ 413.45\n279\n10140\n10140\nIncision and drainage of hematoma, seroma or fluid collection\n$ 183.32\n280\n10160\n10160\nPuncture aspiration of abscess, hematoma, bulla, or cyst\n$ 125.34\n281\n10180\n10180\nIncision and drainage, complex, postoperative wound infection\n$ 560.32\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n282\n11004\n11004\nDebridement of skin, subcutaneous tissue, muscle and fascia for\nnecrotizing soft tissue infection; external genitalia and perineum\n$ 756.94\n283\n11005\n11005\nDebridement of skin, subcutaneous tissue, muscle and fascia for\nnecrotizing soft tissue infection; abdominal wall, with or without\nfascial closure\n$ 1,068.79\n284\n11006\n11006\nDebridement of skin, subcutaneous tissue, muscle and fascia for\nnecrotizing soft tissue infection; external genitalia, perineum and\nabdominal wall, with or without fascial closure\n$ 973.26\n285\n11008\n11008\nRemoval of prosthetic material or mesh, abdominal wall for\ninfection (eg, for chronic or recurrent mesh infection or necrotizing\nsoft tissue infection) (List separately in addition to code for primary\nprocedure)\n$ 437.12\n286\n11044\n11044\nDebridement, bone (includes epidermis, dermis, subcutaneous\ntissue, muscle and\/or fascia, if performed); first 20 sq cm or less\n$ 846.90\n287\n11100\n11100\nBiopsy of skin, subcutaneous tissue and\/or mucous membrane\n(including simple closure), unless otherwise listed; single lesion\n$ 134.31\n288\n11101\n11101\nBiopsy of skin, subcutaneous tissue and\/or mucous membrane\n(including simple closure), unless otherwise listed; each\nseparate\/additional lesion (List separately in addition to code for\nprimary procedure)\n$ 77.57\n289\n11200\n11200\nRemoval of skin tags, multiple fibrocutaneous tags, any area; up to\nand including 15 lesions\n$ 130.55\n290\n11201\n11201\nRemoval of skin tags, multiple fibrocutaneous tags, any area; each\nadditional 10 lesions, or part thereof (List separately in addition to\ncode for primary procedure)\n$ 94.70\n291\n11300\n11300\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\nlegs; lesion diameter 0.5 cm or less\n$ 113.80\n292\n11301\n11301\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\nlegs; lesion diameter 0.6 to 1.0 cm\n$ 142.45\n293\n11302\n11302\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\nlegs; lesion diameter 1.1 to 2.0 cm\n$ 178.74\n294\n11303\n11303\nShaving of epidermal or dermal lesion, single lesion, trunk, arms or\nlegs; lesion diameter over 2.0 cm\n$ 289.80\n295\n11305\n11305\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\nhands, feet, genitalia; lesion diameter 0.5 cm or less\n$ 125.15\n296\n11306\n11306\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\nhands, feet, genitalia; lesion diameter 0.6 to 1.0 cm\n$ 166.40\n297\n11307\n11307\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\nhands, feet, genitalia; lesion diameter 1.1 to 2.0 cm\n$ 232.20\n298\n11308\n11308\nShaving of epidermal or dermal lesion, single lesion, scalp, neck,\nhands, feet, genitalia; lesion diameter over 2.0 cm\n$ 261.50\n299\n11310\n11310\nShaving of epidermal or dermal lesion, single lesion, face, ears,\neyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or\nless\n$ 141.10\n300\n11311\n11311\nShaving of epidermal or dermal lesion, single lesion, face, ears,\neyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm $ 216.00\n301\n11312\n11312\nShaving of epidermal or dermal lesion, single lesion, face, ears,\neyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm $ 252.00\n302\n11313\n11313\nShaving of epidermal or dermal lesion, single lesion, face, ears,\neyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm\n$ 283.29\n303\n11400\n11400\nExcision, benign lesion including margins, except skin tag (unless\nlisted elsewhere), trunk, arms or legs; excised diameter 0.5 cm or\nless\n$ 151.78\n304\n11402\n11402\nExcision, benign lesion including margins, except skin tag (unless\nlisted elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0\ncm\n$ 304.20\n305\n11403\n11403\nExcision, benign lesion including margins, except skin tag (unless\nlisted elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0\ncm\n$ 323.56\n306\n11404\n11404\nExcision, benign lesion including margins, except skin tag (unless\nlisted elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0\ncm\n$ 435.46\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n307\n11441\n11441\nExcision, other benign lesion including margins, except skin tag\n(unless listed elsewhere), face, ears, eyelids, nose, lips, mucous\nmembrane; excised diameter 0.6 to 1.0 cm\n$ 262.16\n308\n11442\n11442\nExcision, other benign lesion including margins, except skin tag\n(unless listed elsewhere), face, ears, eyelids, nose, lips, mucous\nmembrane; excised diameter 1.1 to 2.0 cm\n$ 345.79\n309\n11604\n11604\nExcision, malignant lesion including margins, trunk, arms, or legs;\nexcised diameter 3.1 to 4.0 cm\n$ 582.43\n310\n11606\n11606\nExcision, malignant lesion including margins, trunk, arms, or legs;\nexcised diameter over 4.0 cm\n$ 780.74\n311\n11623\n11623\nExcision, malignant lesion including margins, scalp, neck, hands,\nfeet, genitalia; excised diameter 2.1 to 3.0 cm\n$ 568.31\n312\n11624\n11624\nExcision, malignant lesion including margins, scalp, neck, hands,\nfeet, genitalia; excised diameter 3.1 to 4.0 cm\n$ 820.80\n313\n11626\n11626\nExcision, malignant lesion including margins, scalp, neck, hands,\nfeet, genitalia; excised diameter over 4.0 cm\n$ 990.00\n314\n11719\n11719\nTrimming of nondystrophic nails, any number\n$ 39.46\n315\n11720\n11720\nDebridement of nail(s) by any method(s); 1 to 5\n$ 87.30\n316\n11721\n11721\nDebridement of nail(s) by any method(s); 6 or more\n$ 122.40\n317\n11740\n11740\nEvacuation of subungual hematoma\n$ 117.00\n318\n11750\n11750\nExcision of nail and nail matrix, partial or complete (eg, ingrown or\ndeformed nail), for permanent removal;\n$ 341.38\n319\n11765\n11765\nWedge excision of skin of nail fold (eg, for ingrown toenail)\n$ 226.39\n320\n11900\n11900\nInjection, intralesional; up to and including 7 lesions\n$ 68.38\n321\n11901\n11901\nInjection, intralesional; more than 7 lesions\n$ 103.02\n322\n11950\n11950\nSubcutaneous injection of filling material (eg, collagen); 1 cc or less\n$ 348.30\n323\n11951\n11951\nSubcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc $ 549.90\n324\n11952\n11952\nSubcutaneous injection of filling material (eg, collagen); 5.1 to 10.0\ncc\n$ 899.10\n325\n11954\n11954\nSubcutaneous injection of filling material (eg, collagen); over 10.0 cc\n$ 1,215.90\n326\n11976\n11976\nRemoval, implantable contraceptive capsules\n$ 318.60\n327\n11980\n11980\nSubcutaneous hormone pellet implantation (implantation of\nestradiol and\/or testosterone pellets beneath the skin)\n$ 430.20\n328\n11981\n11981\nInsertion, non-biodegradable drug delivery implant\n$ 162.00\n329\n11982\n11982\nRemoval, non-biodegradable drug delivery implant\n$ 165.40\n330\n11983\n11983\nRemoval with reinsertion, non-biodegradable drug delivery implant\n$ 193.58\n331\n12001\n12001\nSimple repair of superficial wounds of scalp, neck, axillae, external\ngenitalia, trunk and\/or extremities (including hands and feet); 2.5\ncm or less\n$ 179.15\n332\n12002\n12002\nSimple repair of superficial wounds of scalp, neck, axillae, external\ngenitalia, trunk and\/or extremities (including hands and feet); 2.6\ncm to 7.5 cm\n$ 230.42\n333\n12004\n12004\nSimple repair of superficial wounds of scalp, neck, axillae, external\ngenitalia, trunk and\/or extremities (including hands and feet); 7.6\ncm to 12.5 cm\n$ 327.60\n334\n12005\n12005\nSimple repair of superficial wounds of scalp, neck, axillae, external\ngenitalia, trunk and\/or extremities (including hands and feet); 12.6\ncm to 20.0 cm\n$ 421.20\n335\n12006\n12006\nSimple repair of superficial wounds of scalp, neck, axillae, external\ngenitalia, trunk and\/or extremities (including hands and feet); 20.1\ncm to 30.0 cm\n$ 487.80\n336\n12007\n12007\nSimple repair of superficial wounds of scalp, neck, axillae, external\ngenitalia, trunk and\/or extremities (including hands and feet); over\n30.0 cm\n$ 675.90\n337\n12011\n12011\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 2.5 cm or less\n$ 222.77\n338\n12013\n12013\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 2.6 cm to 5.0 cm\n$ 288.43\n339\n12014\n12014\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 5.1 cm to 7.5 cm\n$ 363.06\n340\n12015\n12015\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 7.6 cm to 12.5 cm\n$ 477.90\n341\n12016\n12016\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 12.6 cm to 20.0 cm\n$ 629.10\n342\n12017\n12017\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 20.1 cm to 30.0 cm\n$ 779.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n343\n12018\n12018\nSimple repair of superficial wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; over 30.0 cm\n$ 1,124.10\n344\n12020\n12020\nTreatment of superficial wound dehiscence; simple closure\n$ 388.79\n345\n12031\n12031\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\nextremities (excluding hands and feet); 2.5 cm or less\n$ 255.60\n346\n12032\n12032\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\nextremities (excluding hands and feet); 2.6 cm to 7.5 cm\n$ 343.80\n347\n12034\n12034\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\nextremities (excluding hands and feet); 7.6 cm to 12.5 cm\n$ 423.00\n348\n12035\n12035\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\nextremities (excluding hands and feet); 12.6 cm to 20.0 cm\n$ 555.30\n349\n12036\n12036\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\nextremities (excluding hands and feet); 20.1 cm to 30.0 cm\n$ 719.10\n350\n12037\n12037\nRepair, intermediate, wounds of scalp, axillae, trunk and\/or\nextremities (excluding hands and feet); over 30.0 cm\n$ 922.50\n351\n12041\n12041\nRepair, intermediate, wounds of neck, hands, feet and\/or external\ngenitalia; 2.5 cm or less\n$ 291.60\n352\n12042\n12042\nRepair, intermediate, wounds of neck, hands, feet and\/or external\ngenitalia; 2.6 cm to 7.5 cm\n$ 352.09\n353\n12044\n12044\nRepair, intermediate, wounds of neck, hands, feet and\/or external\ngenitalia; 7.6 cm to 12.5 cm\n$ 468.90\n354\n12045\n12045\nRepair, intermediate, wounds of neck, hands, feet and\/or external\ngenitalia; 12.6 cm to 20.0 cm\n$ 579.60\n355\n12046\n12046\nRepair, intermediate, wounds of neck, hands, feet and\/or external\ngenitalia; 20.1 cm to 30.0 cm\n$ 812.70\n356\n12047\n12047\nRepair, intermediate, wounds of neck, hands, feet and\/or external\ngenitalia; over 30.0 cm\n$ 963.00\n357\n12051\n12051\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 2.5 cm or less\n$ 350.10\n358\n12052\n12052\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 2.6 cm to 5.0 cm\n$ 470.70\n359\n12053\n12053\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 5.1 cm to 7.5 cm\n$ 549.00\n360\n12054\n12054\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 7.6 cm to 12.5 cm\n$ 704.70\n361\n12055\n12055\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 12.6 cm to 20.0 cm\n$ 942.30\n362\n12056\n12056\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; 20.1 cm to 30.0 cm\n$ 1,141.20\n363\n12057\n12057\nRepair, intermediate, wounds of face, ears, eyelids, nose, lips\nand\/or mucous membranes; over 30.0 cm\n$ 1,338.30\n364\n13160\n13160\nSecondary closure of surgical wound or dehiscence, extensive or\ncomplicated\n$ 1,059.69\n365\n14000\n14000\nAdjacent tissue transfer or rearrangement, trunk; defect 10 sq cm\nor less\n$ 1,088.10\n366\n14301\n14301\nAdjacent tissue transfer or rearrangement, any area; defect 30.1 sq\ncm to 60.0 sq cm\n$ 2,113.30\n367\n14302\n14302\nAdjacent tissue transfer or rearrangement, any area; each\nadditional 30.0 sq cm, or part thereof (list separately in addition to\ncode for primary procedure)\n$ 480.88\n368\n15005\n15005\nSurgical preparation or creation of recipient site by excision of open\nwounds, burn eschar, or scar (including subcutaneous tissues), or\nincisional release of scar contracture, face, scalp, eyelids, mouth,\nneck, ears, orbits, genitalia, hands, feet and\/or\n$ 265.38\n369\n15040\n15040\nHarvest of skin for tissue cultured skin autograft, 100 sq cm or less\n$ 563.25\n370\n15110\n15110\nEpidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1%\nof body area of infants and children\n$ 1,887.78\n371\n15111\n15111\nEpidermal autograft, trunk, arms, legs; each additional 100 sq cm,\nor each additional 1% of body area of infants and children, or part\nthereof (List separately in addition to code for primary procedure)\n$ 294.39\n372\n15116\n15116\nEpidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits,\ngenitalia, hands, feet, and\/or multiple digits; each additional 100 sq\ncm, or each additional 1% of body area of infants and children, or\npart thereof (List separately in addition to co\n$ 402.77\n373\n15130\n15130\nDermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of\nbody area of infants and children\n$ 1,469.33\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n374\n15131\n15131\nDermal autograft, trunk, arms, legs; each additional 100 sq cm, or\neach additional 1% of body area of infants and children, or part\nthereof (List separately in addition to code for primary procedure)\n$ 246.06\n375\n15135\n15135\nDermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits,\ngenitalia, hands, feet, and\/or multiple digits; first 100 sq cm or less,\nor 1% of body area of infants and children\n$ 1,861.86\n376\n15136\n15136\nDermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits,\ngenitalia, hands, feet, and\/or multiple digits; each additional 100 sq\ncm, or each additional 1% of body area of infants and children, or\npart thereof (List separately in addition to code\n$ 227.31\n377\n15150\n15150\nTissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or\nless\n$ 1,481.15\n378\n15151\n15151\nTissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm\nto 75 sq cm (List separately in addition to code for primary\nprocedure)\n$ 297.75\n379\n15155\n15155\nTissue cultured skin autograft, face, scalp, eyelids, mouth, neck,\nears, orbits, genitalia, hands, feet, and\/or multiple digits; first 25 sq\ncm or less\n$ 1,472.04\n380\n15156\n15156\nTissue cultured skin autograft, face, scalp, eyelids, mouth, neck,\nears, orbits, genitalia, hands, feet, and\/or multiple digits; additional\n1 sq cm to 75 sq cm (List separately in addition to code for primary\nprocedure)\n$ 424.98\n381\n15157\n15157\nTissue cultured skin autograft, face, scalp, eyelids, mouth, neck,\nears, orbits, genitalia, hands, feet, and\/or multiple digits; each\nadditional 100 sq cm, or each additional 1% of body area of infants\nand children, or part thereof (List separately in add\n$ 481.51\n382\n15200\n15200\nFull thickness graft, free, including direct closure of donor site,\ntrunk; 20 sq cm or less\n$ 1,299.60\n383\n15738\n15738\nMuscle, myocutaneous, or fasciocutaneous flap; lower extremity\n$ 5,279.40\n384\n15780\n15780\nDermabrasion; total face (eg, for acne scarring, fine wrinkling,\nrhytids, general keratosis)\n$ 2,763.90\n385\n15781\n15781\nDermabrasion; segmental, face\n$ 1,148.40\n386\n15782\n15782\nDermabrasion; regional, other than face\n$ 772.20\n387\n15783\n15783\nDermabrasion; superficial, any site (eg, tattoo removal)\n$ 772.20\n388\n15786\n15786\nAbrasion; single lesion (eg, keratosis, scar)\n$ 412.20\n389\n15787\n15787\nAbrasion; each additional 4 lesions or less (List separately in\naddition to code for primary procedure)\n$ 207.90\n390\n15788\n15788\nChemical peel, facial; epidermal\n$ 1,545.30\n391\n15789\n15789\nChemical peel, facial; dermal\n$ 1,901.70\n392\n15792\n15792\nChemical peel, nonfacial; epidermal\n$ 544.50\n393\n15793\n15793\nChemical peel, nonfacial; dermal\n$ 849.60\n394\n15820\n15820\nBlepharoplasty, lower eyelid;\n$ 2,253.60\n395\n15822\n15822\nBlepharoplasty, upper eyelid;\n$ 2,542.50\n396\n15830\n15830\nExcision, excessive skin and subcutaneous tissue (includes\nlipectomy); abdomen, infraumbilical panniculectomy\n$ 1,777.49\n397\n15847\n15847\nExcision, excessive skin and subcutaneous tissue (includes\nlipectomy), abdomen (eg, abdominoplasty) (includes umbilical\ntransposition and fascial plication) (List separately in addition to\ncode for primary procedure)\n$ 715.00\n398\n15851\n15851\nRemoval of sutures under anesthesia (other than local), other\nsurgeon\n$ 259.49\n399\n15852\n15852\nDressing change (for other than burns) under anesthesia (other\nthan local)\n$ 373.50\n400\n15877\n15877\nSuction assisted lipectomy; trunk\n$ 2,446.20\n401\n15878\n15878\nSuction assisted lipectomy; upper extremity\n$ 2,060.10\n402\n15879\n15879\nSuction assisted lipectomy; lower extremity\n$ 2,292.30\n403\n15999\n15999\nUnlisted procedure, excision pressure ulcer\nCost\n404\n16000\n16000\nInitial treatment, first degree burn, when no more than local\ntreatment is required\n$ 104.40\n405\n16020\n16020\nDressings and\/or debridement of partial-thickness burns, initial or\nsubsequent; small (less than 5% total body surface area)\n$ 115.89\n406\n16025\n16025\nDressings and\/or debridement of partial-thickness burns, initial or\nsubsequent; medium (eg, whole face or whole extremity, or 5% to\n10% total body surface area)\n$ 217.86\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n407\n16030\n16030\nDressings and\/or debridement of partial-thickness burns, initial or\nsubsequent; large (eg, more than 1 extremity, or greater than 10%\ntotal body surface area)\n$ 363.34\n408\n17000\n17000\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\nchemosurgery, surgical curettement), premalignant lesions (eg,\nactinic keratoses); first lesion\n$ 97.34\n409\n17003\n17003\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\nchemosurgery, surgical curettement), premalignant lesions (eg,\nactinic keratoses); second through 14 lesions, each (List separately\nin addition to code for first lesion)\n$ 37.26\n410\n17004\n17004\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\nchemosurgery, surgical curettement), premalignant lesions (eg,\nactinic keratoses), 15 or more lesions\n$ 540.00\n411\n17110\n17110\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\nchemosurgery, surgical curettement), of benign lesions other than\nskin tags or cutaneous vascular proliferative lesions; up to 14 lesions $ 110.03\n412\n17111\n17111\nDestruction (eg, laser surgery, electrosurgery, cryosurgery,\nchemosurgery, surgical curettement), of benign lesions other than\nskin tags or cutaneous vascular proliferative lesions; 15 or more\nlesions\n$ 178.20\n413\n17250\n17250\nChemical cauterization of granulation tissue (proud flesh, sinus or\nfistula)\n$ 152.10\n414\n17340\n17340\nCryotherapy (CO2 slush, liquid N2) for acne\n$ 74.83\n415\n17380\n17380\nElectrolysis epilation, each 30 minutes\n$ 134.10\n416\n19100\n19100\nBiopsy of breast; percutaneous, needle core, not using imaging\nguidance (separate procedure)\n$ 257.40\n417\n19105\n19105\nAblation, cryosurgical, of fibroadenoma, including ultrasound\nguidance, each fibroadenoma\n$ 3,171.04\n418\n19110\n19110\nNipple exploration, with or without excision of a solitary lactiferous\nduct or a papilloma lactiferous duct\n$ 1,235.70\n419\n19120\n19120\nExcision of cyst, fibroadenoma, or other benign or malignant tumor,\naberrant breast tissue, duct lesion, nipple or areolar lesion (except\n19300), open, male or female, 1 or more lesions\n$ 1,105.37\n420\n19125\n19125\nExcision of breast lesion identified by preoperative placement of\nradiological marker, open; single lesion\n$ 1,289.70\n421\n19281\n19281\nPlacement of breast localization device(s) (eg, clip, metallic pellet,\nwire\/needle, radioactive seeds), percutaneous; first lesion, including\nmammographic guidance\n$98.25\n422\n19296\n19296\nPlacement of radiotherapy afterloading expandable catheter (single\nor multichannel) into the breast for interstitial radioelement\napplication following partial mastectomy, includes imaging\nguidance; on date separate from partial mastectomy\n$ 9,940.72\n423\n19297\n19297\nPlacement of radiotherapy afterloading expandable catheter (single\nor multichannel) into the breast for interstitial radioelement\napplication following partial mastectomy, includes imaging\nguidance; concurrent with partial mastectomy (List separately in a\n$ 218.27\n424\n19298\n19298\nPlacement of radiotherapy afterloading brachytherapy catheters\n(multiple tube and button type) into the breast for interstitial\nradioelement application following (at the time of or subsequent to)\npartial mastectomy, includes imaging guidance\n$ 3,605.44\n425\n19301\n19301\nMastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy,\nsegmentectomy);\n$ 933.84\n426\n19303\n19303\nMastectomy, simple, complete\n$ 1,597.79\n427\n19304\n19304\nMastectomy, subcutaneous\n$ 1,169.33\n428\n19305\n19305\nMastectomy, radical, including pectoral muscles, axillary lymph\nnodes\n$ 2,032.87\n429\n19306\n19306\nMastectomy, radical, including pectoral muscles, axillary and\ninternal mammary lymph nodes (Urban type operation)\n$ 2,299.98\n430\n19318\n19318\nReduction mammaplasty\n$ 4,137.80\n431\n19325\n19325\nMammaplasty, augmentation; with prosthetic implant\n$ 2,711.70\n432\n19328\n19328\nRemoval of intact mammary implant\n$ 1,848.60\n433\n19342\n19342\nDelayed insertion of breast prosthesis following mastopexy,\nmastectomy or in reconstruction\n$ 2,786.40\n434\n19361\n19361\nBreast reconstruction with latissimus dorsi flap, without prosthetic\nimplant\n$ 5,408.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n435\n19368\n19368\nBreast reconstruction with transverse rectus abdominis\nmyocutaneous flap (TRAM), single pedicle, including closure of\ndonor site; with microvascular anastomosis (supercharging)\n$ 6,352.72\n436\n19369\n19369\nBreast reconstruction with transverse rectus abdominis\nmyocutaneous flap (TRAM), double pedicle, including closure of\ndonor site\n$ 5,552.58\n437\n19499\n19499\nUnlisted procedure, breast\nCost\n438\n20005\n20005\nIncision and drainage of soft tissue abscess, subfascial (ie, involves\nthe soft tissue below the deep fascia)\n$ 664.63\n439\n20100\n20100\nExploration of penetrating wound (separate procedure); neck\n$ 1,610.10\n440\n20101\n20101\nExploration of penetrating wound (separate procedure); chest\n$ 675.00\n441\n20102\n20102\nExploration of penetrating wound (separate procedure);\nabdomen\/flank\/back\n$ 798.30\n442\n20103\n20103\nExploration of penetrating wound (separate procedure); extremity\n$ 1,134.00\n443\n20150\n20150\nExcision of epiphyseal bar, with or without autogenous soft tissue\ngraft obtained through same fascial incision\n$ 2,912.40\n444\n20200\n20200\nBiopsy, muscle; superficial\n$ 412.20\n445\n20205\n20205\nBiopsy, muscle; deep\n$ 617.40\n446\n20206\n20206\nBiopsy, muscle, percutaneous needle\n$ 272.70\n447\n20220\n20220\nBiopsy, bone, trocar, or needle; superficial (eg, ilium, sternum,\nspinous process, ribs)\n$ 360.90\n448\n20225\n20225\nBiopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)\n$ 814.50\n449\n20240\n20240\nBiopsy, bone, open; superficial (eg, ilium, sternum, spinous process,\nribs, trochanter of femur)\n$ 654.30\n450\n20245\n20245\nBiopsy, bone, open; deep (eg, humerus, ischium, femur)\n$ 1,028.70\n451\n20250\n20250\nBiopsy, vertebral body, open; thoracic\n$ 3,141.00\n452\n20251\n20251\nBiopsy, vertebral body, open; lumbar or cervical\n$ 2,589.30\n453\n20500\n20500\nInjection of sinus tract; therapeutic (separate procedure)\n$ 114.30\n454\n20501\n20501\nInjection of sinus tract; diagnostic (sinogram)\n$ 147.60\n455\n20520\n20520\nRemoval of foreign body in muscle or tendon sheath; simple\n$ 307.46\n456\n20525\n20525\nRemoval of foreign body in muscle or tendon sheath; deep or\ncomplicated\n$ 720.90\n457\n20526\n20526\nInjection, therapeutic (eg, local anesthetic, corticosteroid), carpal\ntunnel\n$ 135.84\n458\n20550\n20550\nInjection(s); single tendon sheath, or ligament, aponeurosis (eg,\nplantar 'fascia')\n$ 108.18\n459\n20551\n20551\nInjection(s); single tendon origin\/insertion\n$ 104.87\n460\n20552\n20552\nInjection(s); single or multiple trigger point(s), 1 or 2 muscle(s)\n$ 103.78\n461\n20553\n20553\nInjection(s); single or multiple trigger point(s), 3 or more muscle(s)\n$ 121.48\n462\n20555\n20555\nPlacement of needles or catheters into muscle and\/or soft tissue for\nsubsequent interstitial radioelement application (at the time of or\nsubsequent to the procedure)\n$ 582.66\n463\n20600\n20600\nArthrocentesis, aspiration and\/or injection; small joint or bursa (eg,\nfingers, toes)\n$ 94.96\n464\n20605\n20605\nArthrocentesis, aspiration and\/or injection; intermediate joint or\nbursa (eg, temporomandibular, acromioclavicular, wrist, elbow or\nankle, olecranon bursa)\n$ 107.28\n465\n20610\n20610\nArthrocentesis, aspiration and\/or injection; major joint or bursa (eg,\nshoulder, hip, knee joint, subacromial bursa)\n$ 135.03\n466\n20612\n20612\nAspiration and\/or injection of ganglion cyst(s) any location\n$ 105.01\n467\n20615\n20615\nAspiration and injection for treatment of bone cyst\n$ 527.40\n468\n20650\n20650\nInsertion of wire or pin with application of skeletal traction,\nincluding removal (separate procedure)\n$ 468.90\n469\n20660\n20660\nApplication of cranial tongs, caliper, or stereotactic frame, including\nremoval (separate procedure)\n$ 853.20\n470\n20661\n20661\nApplication of halo, including removal; cranial\n$ 1,326.60\n471\n20662\n20662\nApplication of halo, including removal; pelvic\n$ 902.70\n472\n20663\n20663\nApplication of halo, including removal; femoral\n$ 765.00\n473\n20664\n20664\nApplication of halo, including removal, cranial, 6 or more pins\nplaced, for thin skull osteology (eg, pediatric patients,\nhydrocephalus, osteogenesis imperfecta)\n$ 1,032.30\n474\n20665\n20665\nRemoval of tongs or halo applied by another individual\n$ 234.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n475\n20670\n20670\nRemoval of implant; superficial (eg, buried wire, pin or rod)\n(separate procedure)\n$ 463.50\n476\n20680\n20680\nRemoval of implant; deep (eg, buried wire, pin, screw, metal band,\nnail, rod or plate)\n$ 857.90\n477\n20690\n20690\nApplication of a uniplane (pins or wires in 1 plane), unilateral,\nexternal fixation system\n$ 1,138.50\n478\n20692\n20692\nApplication of a multiplane (pins or wires in more than 1 plane),\nunilateral, external fixation system (eg, Ilizarov, Monticelli type)\n$ 1,752.30\n479\n20693\n20693\nAdjustment or revision of external fixation system requiring\nanesthesia (eg, new pin[s] or wire[s] and\/or new ring[s] or bar[s])\n$ 908.10\n480\n20694\n20694\nRemoval, under anesthesia, of external fixation system\n$ 824.40\n481\n20696\n20696\nApplication of multiplane (pins or wires in more than 1 plane),\nunilateral, external fixation with stereotactic computer-assisted\nadjustment (eg, spatial frame), including imaging; initial and\nsubsequent alignment(s), assessment(s), and computation(s) of\n$ 1,752.70\n482\n20697\n20697\nApplication of multiplane (pins or wires in more than 1 plane),\nunilateral, external fixation with stereotactic computer-assisted\nadjustment (eg, spatial frame), including imaging; exchange (ie,\nremoval and replacement) of strut, each\n$ 2,193.99\n483\n20802\n20802\nReplantation, arm (includes surgical neck of humerus through elbow\njoint), complete amputation\n$ 9,720.90\n484\n20805\n20805\nReplantation, forearm (includes radius and ulna to radial carpal\njoint), complete amputation\n$ 10,085.40\n485\n20808\n20808\nReplantation, hand (includes hand through metacarpophalangeal\njoints), complete amputation\n$ 11,040.30\n486\n20816\n20816\nReplantation, digit, excluding thumb (includes metacarpophalangeal\njoint to insertion of flexor sublimis tendon), complete amputation\n$ 5,793.30\n487\n20822\n20822\nReplantation, digit, excluding thumb (includes distal tip to sublimis\ntendon insertion), complete amputation\n$ 5,794.20\n488\n20824\n20824\nReplantation, thumb (includes carpometacarpal joint to MP joint),\ncomplete amputation\n$ 6,571.80\n489\n20827\n20827\nReplantation, thumb (includes distal tip to MP joint), complete\namputation\n$ 5,047.20\n490\n20838\n20838\nReplantation, foot, complete amputation\n$ 9,888.30\n491\n20900\n20900\nBone graft, any donor area; minor or small (eg, dowel or button)\n$ 947.70\n492\n20902\n20902\nBone graft, any donor area; major or large\n$ 1,587.60\n493\n20910\n20910\nCartilage graft; costochondral\n$ 1,491.30\n494\n20912\n20912\nCartilage graft; nasal septum\n$ 1,467.90\n495\n20920\n20920\nFascia lata graft; by stripper\n$ 885.60\n496\n20922\n20922\nFascia lata graft; by incision and area exposure, complex or sheet\n$ 1,241.10\n497\n20924\n20924\nTendon graft, from a distance (eg, palmaris, toe extensor, plantaris)\n$ 1,360.80\n498\n20926\n20926\nTissue grafts, other (eg, paratenon, fat, dermis)\n$ 1,014.30\n499\n20930\n20930\nAllograft, morselized, or placement of osteopromotive material, for\nspine surgery only (List separately in addition to code for primary\nprocedure)\n$ 978.30\n500\n20931\n20931\nAllograft, structural, for spine surgery only (List separately in\naddition to code for primary procedure)\n$ 618.30\n501\n20936\n20936\nAutograft for spine surgery only (includes harvesting the graft); local\n(eg, ribs, spinous process, or laminar fragments) obtained from\nsame incision (List separately in addition to code for primary\nprocedure)\n$ 1,545.30\n502\n20937\n20937\nAutograft for spine surgery only (includes harvesting the graft);\nmorselized (through separate skin or fascial incision) (List separately\nin addition to code for primary procedure)\n$ 1,235.70\n503\n20938\n20938\nAutograft for spine surgery only (includes harvesting the graft);\nstructural, bicortical or tricortical (through separate skin or fascial\nincision) (List separately in addition to code for primary procedure)\n$ 1,506.60\n504\n20950\n20950\nMonitoring of interstitial fluid pressure (includes insertion of device,\neg, wick catheter technique, needle manometer technique) in\ndetection of muscle compartment syndrome\n$ 293.40\n505\n20955\n20955\nBone graft with microvascular anastomosis; fibula\n$ 10,791.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n506\n20956\n20956\nBone graft with microvascular anastomosis; iliac crest\n$ 8,655.30\n507\n20957\n20957\nBone graft with microvascular anastomosis; metatarsal\n$ 8,967.60\n508\n20962\n20962\nBone graft with microvascular anastomosis; other than fibula, iliac\ncrest, or metatarsal\n$ 8,168.40\n509\n20969\n20969\nFree osteocutaneous flap with microvascular anastomosis; other\nthan iliac crest, metatarsal, or great toe\n$ 7,750.80\n510\n20970\n20970\nFree osteocutaneous flap with microvascular anastomosis; iliac crest $ 9,907.20\n511\n20972\n20972\nFree osteocutaneous flap with microvascular anastomosis;\nmetatarsal\n$ 8,745.30\n512\n20973\n20973\nFree osteocutaneous flap with microvascular anastomosis; great toe\nwith web space\n$ 8,745.30\n513\n20974\n20974\nElectrical stimulation to aid bone healing; noninvasive\n(nonoperative)\n$ 915.30\n514\n20975\n20975\nElectrical stimulation to aid bone healing; invasive (operative)\n$ 1,344.60\n515\n20979\n20979\nLow intensity ultrasound stimulation to aid bone healing,\nnoninvasive (nonoperative)\n$ 124.20\n516\n20982\n20982\nAblation, bone tumor(s) (eg, osteoid osteoma, metastasis)\nradiofrequency, percutaneous, including computed tomographic\nguidance\n$ 8,951.44\n517\n20985\n20985\nComputer-assisted surgical navigational procedure for\nmusculoskeletal procedures, image-less (List separately in addition\nto code for primary procedure)\n$ 207.47\n518\n20999\n20999\nUnlisted procedure, musculoskeletal system, general\nCost\n519\n21010\n21010\nArthrotomy, temporomandibular joint\n$ 2,836.80\n520\n21011\n21011\nExcision, tumor, soft tissue of face or scalp, subcutaneous; less than\n2 cm\n$ 441.95\n521\n21012\n21012\nExcision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or\ngreater\n$ 465.84\n522\n21013\n21013\nExcision, tumor, soft tissue of face and scalp, subfascial (eg,\nsubgaleal, intramuscular); less than 2 cm\n$ 767.09\n523\n21014\n21014\nExcision, tumor, soft tissue of face and scalp, subfascial (eg,\nsubgaleal, intramuscular); 2 cm or greater\n$ 813.32\n524\n21015\n21015\nRadical resection of tumor (eg, sarcoma), soft tissue of face or scalp;\nless than 2 cm\n$ 1,773.90\n525\n21016\n21016\nRadical resection of tumor (eg, sarcoma), soft tissue of face or scalp;\n2 cm or greater\n$ 1,706.33\n526\n21025\n21025\nExcision of bone (eg, for osteomyelitis or bone abscess); mandible\n$ 1,602.00\n527\n21026\n21026\nExcision of bone (eg, for osteomyelitis or bone abscess); facial\nbone(s)\n$ 1,498.50\n528\n21029\n21029\nRemoval by contouring of benign tumor of facial bone (eg, fibrous\ndysplasia)\n$ 1,532.70\n529\n21030\n21030\nExcision of benign tumor or cyst of maxilla or zygoma by\nenucleation and curettage\n$ 2,193.30\n530\n21031\n21031\nExcision of torus mandibularis\n$ 696.60\n531\n21032\n21032\nExcision of maxillary torus palatinus\n$ 1,056.60\n532\n21034\n21034\nExcision of malignant tumor of maxilla or zygoma\n$ 3,169.80\n533\n21040\n21040\nExcision of benign tumor or cyst of mandible, by enucleation and\/or\ncurettage\n$ 1,246.50\n534\n21044\n21044\nExcision of malignant tumor of mandible;\n$ 2,851.20\n535\n21045\n21045\nExcision of malignant tumor of mandible; radical resection\n$ 5,918.40\n536\n21046\n21046\nExcision of benign tumor or cyst of mandible; requiring intra-oral\nosteotomy (eg, locally aggressive or destructive lesion(s))\n$ 1,872.04\n537\n21047\n21047\nExcision of benign tumor or cyst of mandible; requiring extra-oral\nosteotomy and partial mandibulectomy (eg, locally aggressive or\ndestructive lesion(s))\n$ 2,304.17\n538\n21048\n21048\nExcision of benign tumor or cyst of maxilla; requiring intra-oral\nosteotomy (eg, locally aggressive or destructive lesion(s))\n$ 1,918.12\n539\n21049\n21049\nExcision of benign tumor or cyst of maxilla; requiring extra-oral\nosteotomy and partial maxillectomy (eg, locally aggressive or\ndestructive lesion(s))\n$ 2,210.72\n540\n21050\n21050\nCondylectomy, temporomandibular joint (separate procedure)\n$ 3,355.20\n541\n21060\n21060\nMeniscectomy, partial or complete, temporomandibular joint\n(separate procedure)\n$ 3,330.00\n542\n21070\n21070\nCoronoidectomy (separate procedure)\n$ 2,724.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n543\n21073\n21073\nManipulation of temporomandibular joint(s) (TMJ), therapeutic,\nrequiring an anesthesia service (ie, general or monitored anesthesia\ncare)\n$ 524.35\n544\n21076\n21076\nImpression and custom preparation; surgical obturator prosthesis\n$ 1,781.92\n545\n21077\n21077\nImpression and custom preparation; orbital prosthesis\n$ 4,473.18\n546\n21079\n21079\nImpression and custom preparation; interim obturator prosthesis\n$ 2,974.29\n547\n21080\n21080\nImpression and custom preparation; definitive obturator prosthesis\n$ 3,342.10\n548\n21081\n21081\nImpression and custom preparation; mandibular resection\nprosthesis\n$ 3,048.99\n549\n21083\n21083\nImpression and custom preparation; palatal lift prosthesis\n$ 2,579.92\n550\n21084\n21084\nImpression and custom preparation; speech aid prosthesis\n$ 3,019.99\n551\n21085\n21085\nImpression and custom preparation; oral surgical splint\n$ 398.70\n552\n21086\n21086\nImpression and custom preparation; auricular prosthesis\n$ 3,303.10\n553\n21087\n21087\nImpression and custom preparation; nasal prosthesis\n$ 3,302.27\n554\n21088\n21088\nImpression and custom preparation; facial prosthesis\n555\n21089\n21089\nUnlisted maxillofacial prosthetic procedure\nCost\n556\n21100\n21100\nApplication of halo type appliance for maxillofacial fixation, includes\nremoval (separate procedure)\n$ 566.10\n557\n21110\n21110\nApplication of interdental fixation device for conditions other than\nfracture or dislocation, includes removal\n$ 1,364.40\n558\n21116\n21116\nInjection procedure for temporomandibular joint arthrography\n$ 178.20\n559\n21120\n21120\nGenioplasty; augmentation (autograft, allograft, prosthetic\nmaterial)\n$ 2,880.90\n560\n21121\n21121\nGenioplasty; sliding osteotomy, single piece\n$ 2,574.90\n561\n21122\n21122\nGenioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge\nexcision or bone wedge reversal for asymmetrical chin)\n$ 2,385.00\n562\n21123\n21123\nGenioplasty; sliding, augmentation with interpositional bone grafts\n(includes obtaining autografts)\n$ 2,490.30\n563\n21125\n21125\nAugmentation, mandibular body or angle; prosthetic material\n$ 2,394.90\n564\n21127\n21127\nAugmentation, mandibular body or angle; with bone graft, onlay or\ninterpositional (includes obtaining autograft)\n$ 2,266.20\n565\n21137\n21137\nReduction forehead; contouring only\n$ 2,266.20\n566\n21138\n21138\nReduction forehead; contouring and application of prosthetic\nmaterial or bone graft (includes obtaining autograft)\n$ 2,652.30\n567\n21139\n21139\nReduction forehead; contouring and setback of anterior frontal\nsinus wall\n$ 3,278.60\n568\n21141\n21141\nReconstruction midface, LeFort I; single piece, segment movement\nin any direction (eg, for Long Face Syndrome), without bone graft\n$ 4,120.20\n569\n21142\n21142\nReconstruction midface, LeFort I; 2 pieces, segment movement in\nany direction, without bone graft\n$ 4,326.30\n570\n21143\n21143\nReconstruction midface, LeFort I; 3 or more pieces, segment\nmovement in any direction, without bone graft\n$ 4,428.90\n571\n21145\n21145\nReconstruction midface, LeFort I; single piece, segment movement\nin any direction, requiring bone grafts (includes obtaining\nautografts)\n$ 4,496.20\n572\n21146\n21146\nReconstruction midface, LeFort I; 2 pieces, segment movement in\nany direction, requiring bone grafts (includes obtaining autografts)\n(eg, ungrafted unilateral alveolar cleft)\n$ 5,983.20\n573\n21147\n21147\nReconstruction midface, LeFort I; 3 or more pieces, segment\nmovement in any direction, requiring bone grafts (includes\nobtaining autografts) (eg, ungrafted bilateral alveolar cleft or\nmultiple osteotomies)\n$ 6,391.80\n574\n21150\n21150\nReconstruction midface, LeFort II; anterior intrusion (eg, Treacher-\nCollins Syndrome)\n$ 5,568.30\n575\n21151\n21151\nReconstruction midface, LeFort II; any direction, requiring bone\ngrafts (includes obtaining autografts)\n$ 6,695.10\n576\n21154\n21154\nReconstruction midface, LeFort III (extracranial), any type, requiring\nbone grafts (includes obtaining autografts); without LeFort I\n$ 6,677.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n577\n21155\n21155\nReconstruction midface, LeFort III (extracranial), any type, requiring\nbone grafts (includes obtaining autografts); with LeFort I\n$ 6,431.40\n578\n21159\n21159\nReconstruction midface, LeFort III (extra and intracranial) with\nforehead advancement (eg, mono bloc), requiring bone grafts\n(includes obtaining autografts); without LeFort I\n$ 9,682.20\n579\n21160\n21160\nReconstruction midface, LeFort III (extra and intracranial) with\nforehead advancement (eg, mono bloc), requiring bone grafts\n(includes obtaining autografts); with LeFort I\n$ 10,815.30\n580\n21172\n21172\nReconstruction superior-lateral orbital rim and lower forehead,\nadvancement or alteration, with or without grafts (includes\nobtaining autografts)\n$ 8,767.80\n581\n21175\n21175\nReconstruction, bifrontal, superior-lateral orbital rims and lower\nforehead, advancement or alteration (eg, plagiocephaly,\ntrigonocephaly, brachycephaly), with or without grafts (includes\nobtaining autografts)\n$ 9,409.50\n582\n21179\n21179\nReconstruction, entire or majority of forehead and\/or supraorbital\nrims; with grafts (allograft or prosthetic material)\n$ 7,056.00\n583\n21180\n21180\nReconstruction, entire or majority of forehead and\/or supraorbital\nrims; with autograft (includes obtaining grafts)\n$ 6,390.00\n584\n21181\n21181\nReconstruction by contouring of benign tumor of cranial bones (eg,\nfibrous dysplasia), extracranial\n$ 1,539.90\n585\n21182\n21182\nReconstruction of orbital walls, rims, forehead, nasoethmoid\ncomplex following intra- and extracranial excision of benign tumor\nof cranial bone (eg, fibrous dysplasia), with multiple autografts\n(includes obtaining grafts); total area of bone grafting less\n$ 6,723.90\n586\n21183\n21183\nReconstruction of orbital walls, rims, forehead, nasoethmoid\ncomplex following intra- and extracranial excision of benign tumor\nof cranial bone (eg, fibrous dysplasia), with multiple autografts\n(includes obtaining grafts); total area of bone grafting grea\n$ 7,144.20\n587\n21184\n21184\nReconstruction of orbital walls, rims, forehead, nasoethmoid\ncomplex following intra- and extracranial excision of benign tumor\nof cranial bone (eg, fibrous dysplasia), with multiple autografts\n(includes obtaining grafts); total area of bone grafting grea\n$ 7,754.40\n588\n21188\n21188\nReconstruction midface, osteotomies (other than LeFort type) and\nbone grafts (includes obtaining autografts)\n$ 4,563.00\n589\n21193\n21193\nReconstruction of mandibular rami, horizontal, vertical, C, or L\nosteotomy; without bone graft\n$ 4,586.40\n590\n21194\n21194\nReconstruction of mandibular rami, horizontal, vertical, C, or L\nosteotomy; with bone graft (includes obtaining graft)\n$ 5,648.40\n591\n21195\n21195\nReconstruction of mandibular rami and\/or body, sagittal split;\nwithout internal rigid fixation\n$ 4,891.50\n592\n21196\n21196\nReconstruction of mandibular rami and\/or body, sagittal split; with\ninternal rigid fixation\n$ 5,547.60\n593\n21198\n21198\nOsteotomy, mandible, segmental;\n$ 3,804.30\n594\n21199\n21199\nOsteotomy, mandible, segmental; with genioglossus advancement\n$ 3,879.00\n595\n21206\n21206\nOsteotomy, maxilla, segmental (eg, Wassmund or Schuchard)\n$ 4,425.30\n596\n21208\n21208\nOsteoplasty, facial bones; augmentation (autograft, allograft, or\nprosthetic implant)\n$ 2,608.20\n597\n21209\n21209\nOsteoplasty, facial bones; reduction\n$ 2,713.50\n598\n21210\n21210\nGraft, bone; nasal, maxillary or malar areas (includes obtaining\ngraft)\n$ 3,510.00\n599\n21215\n21215\nGraft, bone; mandible (includes obtaining graft)\n$ 3,878.10\n600\n21230\n21230\nGraft; rib cartilage, autogenous, to face, chin, nose or ear (includes\nobtaining graft)\n$ 4,305.60\n601\n21235\n21235\nGraft; ear cartilage, autogenous, to nose or ear (includes obtaining\ngraft)\n$ 2,547.90\n602\n21240\n21240\nArthroplasty, temporomandibular joint, with or without autograft\n(includes obtaining graft)\n$ 4,120.20\n603\n21242\n21242\nArthroplasty, temporomandibular joint, with allograft\n$ 3,933.00\n604\n21243\n21243\nArthroplasty, temporomandibular joint, with prosthetic joint\nreplacement\n$ 5,049.90\n605\n21244\n21244\nReconstruction of mandible, extraoral, with transosteal bone plate\n(eg, mandibular staple bone plate)\n$ 4,204.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n606\n21245\n21245\nReconstruction of mandible or maxilla, subperiosteal implant;\npartial\n$ 3,759.30\n607\n21246\n21246\nReconstruction of mandible or maxilla, subperiosteal implant;\ncomplete\n$ 5,781.60\n608\n21247\n21247\nReconstruction of mandibular condyle with bone and cartilage\nautografts (includes obtaining grafts) (eg, for hemifacial\nmicrosomia)\n$ 5,665.50\n609\n21248\n21248\nReconstruction of mandible or maxilla, endosteal implant (eg, blade,\ncylinder); partial\n$ 3,985.20\n610\n21249\n21249\nReconstruction of mandible or maxilla, endosteal implant (eg, blade,\ncylinder); complete\n$ 7,416.00\n611\n21255\n21255\nReconstruction of zygomatic arch and glenoid fossa with bone and\ncartilage (includes obtaining autografts)\n$ 5,665.50\n612\n21256\n21256\nReconstruction of orbit with osteotomies (extracranial) and with\nbone grafts (includes obtaining autografts) (eg, micro-ophthalmia)\n$ 5,800.50\n613\n21260\n21260\nPeriorbital osteotomies for orbital hypertelorism, with bone grafts;\nextracranial approach\n$ 6,687.00\n614\n21261\n21261\nPeriorbital osteotomies for orbital hypertelorism, with bone grafts;\ncombined intra- and extracranial approach\n$ 8,191.80\n615\n21267\n21267\nOrbital repositioning, periorbital osteotomies, unilateral, with bone\ngrafts; extracranial approach\n$ 6,246.90\n616\n21268\n21268\nOrbital repositioning, periorbital osteotomies, unilateral, with bone\ngrafts; combined intra- and extracranial approach\n$ 9,558.90\n617\n21270\n21270\nMalar augmentation, prosthetic material\n$ 4,648.50\n618\n21275\n21275\nSecondary revision of orbitocraniofacial reconstruction\n$ 6,386.40\n619\n21280\n21280\nMedial canthopexy (separate procedure)\n$ 2,368.80\n620\n21282\n21282\nLateral canthopexy\n$ 1,957.50\n621\n21295\n21295\nReduction of masseter muscle and bone (eg, for treatment of\nbenign masseteric hypertrophy); extraoral approach\n$ 2,487.73\n622\n21296\n21296\nReduction of masseter muscle and bone (eg, for treatment of\nbenign masseteric hypertrophy); intraoral approach\n$ 2,095.08\n623\n21299\n21299\nUnlisted craniofacial and maxillofacial procedure\nCost\n624\n21310\n21310\nClosed treatment of nasal bone fracture without manipulation\n$ 396.90\n625\n21315\n21315\nClosed treatment of nasal bone fracture; without stabilization\n$ 489.60\n626\n21320\n21320\nClosed treatment of nasal bone fracture; with stabilization\n$ 828.90\n627\n21325\n21325\nOpen treatment of nasal fracture; uncomplicated\n$ 1,708.20\n628\n21330\n21330\nOpen treatment of nasal fracture; complicated, with internal and\/or\nexternal skeletal fixation\n$ 2,563.20\n629\n21335\n21335\nOpen treatment of nasal fracture; with concomitant open\ntreatment of fractured septum\n$ 2,959.20\n630\n21336\n21336\nOpen treatment of nasal septal fracture, with or without\nstabilization\n$ 1,738.80\n631\n21337\n21337\nClosed treatment of nasal septal fracture, with or without\nstabilization\n$ 1,325.70\n632\n21338\n21338\nOpen treatment of nasoethmoid fracture; without external fixation\n$ 2,750.40\n633\n21339\n21339\nOpen treatment of nasoethmoid fracture; with external fixation\n$ 3,019.50\n634\n21340\n21340\nPercutaneous treatment of nasoethmoid complex fracture, with\nsplint, wire or headcap fixation, including repair of canthal\nligaments and\/or the nasolacrimal apparatus\n$ 3,490.20\n635\n21343\n21343\nOpen treatment of depressed frontal sinus fracture\n$ 3,550.50\n636\n21344\n21344\nOpen treatment of complicated (eg, comminuted or involving\nposterior wall) frontal sinus fracture, via coronal or multiple\napproaches\n$ 3,872.70\n637\n21345\n21345\nClosed treatment of nasomaxillary complex fracture (LeFort II type),\nwith interdental wire fixation or fixation of denture or splint\n$ 3,108.60\n638\n21346\n21346\nOpen treatment of nasomaxillary complex fracture (LeFort II type);\nwith wiring and\/or local fixation\n$ 3,837.60\n639\n21347\n21347\nOpen treatment of nasomaxillary complex fracture (LeFort II type);\nrequiring multiple open approaches\n$ 4,275.00\n640\n21348\n21348\nOpen treatment of nasomaxillary complex fracture (LeFort II type);\nwith bone grafting (includes obtaining graft)\n$ 3,829.50\n641\n21355\n21355\nPercutaneous treatment of fracture of malar area, including\nzygomatic arch and malar tripod, with manipulation\n$ 2,138.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n642\n21356\n21356\nOpen treatment of depressed zygomatic arch fracture (eg, Gillies\napproach)\n$ 1,796.40\n643\n21360\n21360\nOpen treatment of depressed malar fracture, including zygomatic\narch and malar tripod\n$ 2,407.50\n644\n21365\n21365\nOpen treatment of complicated (eg, comminuted or involving\ncranial nerve foramina) fracture(s) of malar area, including\nzygomatic arch and malar tripod; with internal fixation and multiple\nsurgical approaches\n$ 3,566.70\n645\n21366\n21366\nOpen treatment of complicated (eg, comminuted or involving\ncranial nerve foramina) fracture(s) of malar area, including\nzygomatic arch and malar tripod; with bone grafting (includes\nobtaining graft)\n$ 3,804.30\n646\n21385\n21385\nOpen treatment of orbital floor blowout fracture; transantral\napproach (Caldwell-Luc type operation)\n$ 2,743.20\n647\n21386\n21386\nOpen treatment of orbital floor blowout fracture; periorbital\napproach\n$ 2,984.40\n648\n21387\n21387\nOpen treatment of orbital floor blowout fracture; combined\napproach\n$ 3,267.00\n649\n21390\n21390\nOpen treatment of orbital floor blowout fracture; periorbital\napproach, with alloplastic or other implant\n$ 3,502.80\n650\n21395\n21395\nOpen treatment of orbital floor blowout fracture; periorbital\napproach with bone graft (includes obtaining graft)\n$ 3,692.70\n651\n21400\n21400\nClosed treatment of fracture of orbit, except blowout; without\nmanipulation\n$ 879.30\n652\n21401\n21401\nClosed treatment of fracture of orbit, except blowout; with\nmanipulation\n$ 2,475.90\n653\n21406\n21406\nOpen treatment of fracture of orbit, except blowout; without\nimplant\n$ 2,877.30\n654\n21407\n21407\nOpen treatment of fracture of orbit, except blowout; with implant\n$ 3,400.20\n655\n21408\n21408\nOpen treatment of fracture of orbit, except blowout; with bone\ngrafting (includes obtaining graft)\n$ 3,346.20\n656\n21421\n21421\nClosed treatment of palatal or maxillary fracture (LeFort I type),\nwith interdental wire fixation or fixation of denture or splint\n$ 2,632.50\n657\n21422\n21422\nOpen treatment of palatal or maxillary fracture (LeFort I type);\n$ 3,348.90\n658\n21423\n21423\nOpen treatment of palatal or maxillary fracture (LeFort I type);\ncomplicated (comminuted or involving cranial nerve foramina),\nmultiple approaches\n$ 2,865.60\n659\n21431\n21431\nClosed treatment of craniofacial separation (LeFort III type) using\ninterdental wire fixation of denture or splint\n$ 2,807.10\n660\n21432\n21432\nOpen treatment of craniofacial separation (LeFort III type); with\nwiring and\/or internal fixation\n$ 3,594.60\n661\n21433\n21433\nOpen treatment of craniofacial separation (LeFort III type);\ncomplicated (eg, comminuted or involving cranial nerve foramina),\nmultiple surgical approaches\n$ 5,049.90\n662\n21435\n21435\nOpen treatment of craniofacial separation (LeFort III type);\ncomplicated, utilizing internal and\/or external fixation techniques\n(eg, head cap, halo device, and\/or intermaxillary fixation)\n$ 4,278.60\n663\n21436\n21436\nOpen treatment of craniofacial separation (LeFort III type);\ncomplicated, multiple surgical approaches, internal fixation, with\nbone grafting (includes obtaining graft)\n$ 5,112.00\n664\n21440\n21440\nClosed treatment of mandibular or maxillary alveolar ridge fracture\n(separate procedure)\n$ 1,808.10\n665\n21445\n21445\nOpen treatment of mandibular or maxillary alveolar ridge fracture\n(separate procedure)\n$ 2,088.00\n666\n21450\n21450\nClosed treatment of mandibular fracture; without manipulation\n$ 812.70\n667\n21451\n21451\nClosed treatment of mandibular fracture; with manipulation\n$ 2,193.30\n668\n21452\n21452\nPercutaneous treatment of mandibular fracture, with external\nfixation\n$ 1,540.80\n669\n21453\n21453\nClosed treatment of mandibular fracture with interdental fixation\n$ 2,735.10\n670\n21454\n21454\nOpen treatment of mandibular fracture with external fixation\n$ 2,820.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n671\n21461\n21461\nOpen treatment of mandibular fracture; without interdental\nfixation\n$ 2,774.70\n672\n21462\n21462\nOpen treatment of mandibular fracture; with interdental fixation\n$ 3,288.60\n673\n21465\n21465\nOpen treatment of mandibular condylar fracture\n$ 2,871.00\n674\n21470\n21470\nOpen treatment of complicated mandibular fracture by multiple\nsurgical approaches including internal fixation, interdental fixation,\nand\/or wiring of dentures or splints\n$ 4,006.80\n675\n21480\n21480\nClosed treatment of temporomandibular dislocation; initial or\nsubsequent\n$ 385.20\n676\n21485\n21485\nClosed treatment of temporomandibular dislocation; complicated\n(eg, recurrent requiring intermaxillary fixation or splinting), initial or\nsubsequent\n$ 903.60\n677\n21490\n21490\nOpen treatment of temporomandibular dislocation\n$ 2,578.50\n678\n21495\n21495\nOpen treatment of hyoid fracture\n$ 2,726.10\n679\n21497\n21497\nInterdental wiring, for condition other than fracture\n$ 2,046.60\n680\n21499\n21499\nUnlisted musculoskeletal procedure, head\nCost\n681\n21501\n21501\nIncision and drainage, deep abscess or hematoma, soft tissues of\nneck or thorax;\n$ 779.40\n682\n21502\n21502\nIncision and drainage, deep abscess or hematoma, soft tissues of\nneck or thorax; with partial rib ostectomy\n$ 946.80\n683\n21510\n21510\nIncision, deep, with opening of bone cortex (eg, for osteomyelitis or\nbone abscess), thorax\n$ 1,161.90\n684\n21550\n21550\nBiopsy, soft tissue of neck or thorax\n$ 405.00\n685\n21552\n21552\nExcision, tumor, soft tissue of neck or anterior thorax,\nsubcutaneous; 3 cm or greater\n$ 791.93\n686\n21554\n21554\nExcision, tumor, soft tissue of neck or anterior thorax, subfascial\n(eg, intramuscular); 5 cm or greater\n$ 1,366.14\n687\n21555\n21555\nExcision, tumor, soft tissue of neck or anterior thorax,\nsubcutaneous; less than 3 cm\n$ 632.14\n688\n21556\n21556\nExcision, tumor, soft tissue of neck or anterior thorax, subfascial\n(eg, intramuscular); less than 5 cm\n$ 1,127.30\n689\n21557\n21557\nRadical resection of tumor (eg, sarcoma), soft tissue of neck or\nanterior thorax; less than 5 cm\n$ 3,090.60\n690\n21558\n21558\nRadical resection of tumor (eg, sarcoma), soft tissue of neck or\nanterior thorax; 5 cm or greater\n$ 2,439.66\n691\n21600\n21600\nExcision of rib, partial\n$ 1,256.40\n692\n21610\n21610\nCostotransversectomy (separate procedure)\n$ 3,476.70\n693\n21615\n21615\nExcision first and\/or cervical rib;\n$ 3,032.10\n694\n21616\n21616\nExcision first and\/or cervical rib; with sympathectomy\n$ 2,896.20\n695\n21620\n21620\nOstectomy of sternum, partial\n$ 3,269.70\n696\n21627\n21627\nSternal debridement\n$ 1,960.20\n697\n21630\n21630\nRadical resection of sternum;\n$ 3,826.80\n698\n21632\n21632\nRadical resection of sternum; with mediastinal lymphadenectomy\n$ 4,892.40\n699\n21685\n21685\nHyoid myotomy and suspension\n$ 2,168.29\n700\n21700\n21700\nDivision of scalenus anticus; without resection of cervical rib\n$ 1,647.90\n701\n21705\n21705\nDivision of scalenus anticus; with resection of cervical rib\n$ 2,286.90\n702\n21720\n21720\nDivision of sternocleidomastoid for torticollis, open operation;\nwithout cast application\n$ 1,333.80\n703\n21725\n21725\nDivision of sternocleidomastoid for torticollis, open operation; with\ncast application\n$ 1,486.80\n704\n21740\n21740\nReconstructive repair of pectus excavatum or carinatum; open\n$ 3,577.50\n705\n21742\n21742\nReconstructive repair of pectus excavatum or carinatum; minimally\ninvasive approach (Nuss procedure), without thoracoscopy\n706\n21743\n21743\nReconstructive repair of pectus excavatum or carinatum; minimally\ninvasive approach (Nuss procedure), with thoracoscopy\n707\n21750\n21750\nClosure of median sternotomy separation with or without\ndebridement (separate procedure)\n$ 2,729.70\n708\n21800\n21800\nClosed treatment of rib fracture, uncomplicated, each\n$ 219.60\n709\n21805\n21805\nOpen treatment of rib fracture without fixation, each\n$ 1,426.50\n710\n21810\n21810\nTreatment of rib fracture requiring external fixation (flail chest)\n$ 3,409.20\n711\n21820\n21820\nClosed treatment of sternum fracture\n$ 456.30\n712\n21825\n21825\nOpen treatment of sternum fracture with or without skeletal\nfixation\n$ 1,791.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n713\n21899\n21899\nUnlisted procedure, neck or thorax\nCost\n714\n21920\n21920\nBiopsy, soft tissue of back or flank; superficial\n$ 466.20\n715\n21925\n21925\nBiopsy, soft tissue of back or flank; deep\n$ 796.50\n716\n21930\n21930\nExcision, tumor, soft tissue of back or flank, subcutaneous; less than\n3 cm\n$ 1,846.80\n717\n21931\n21931\nExcision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or\ngreater\n$ 1,124.11\n718\n21932\n21932\nExcision, tumor, soft tissue of back or flank, subfascial (eg,\nintramuscular); less than 5 cm\n$ 1,469.92\n719\n21933\n21933\nExcision, tumor, soft tissue of back or flank, subfascial (eg,\nintramuscular); 5 cm or greater\n$ 1,605.17\n720\n21935\n21935\nRadical resection of tumor (eg, sarcoma), soft tissue of back or\nflank; less than 5 cm\n$ 3,547.80\n721\n21936\n21936\nRadical resection of tumor (eg, sarcoma), soft tissue of back or\nflank; 5 cm or greater\n$ 3,109.09\n722\n22010\n22010\nIncision and drainage, open, of deep abscess (subfascial), posterior\nspine; cervical, thoracic, or cervicothoracic\n$ 1,829.44\n723\n22015\n22015\nIncision and drainage, open, of deep abscess (subfascial), posterior\nspine; lumbar, sacral, or lumbosacral\n$ 1,795.54\n724\n22100\n22100\nPartial excision of posterior vertebral component (eg, spinous\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\nsegment; cervical\n$ 1,579.50\n725\n22101\n22101\nPartial excision of posterior vertebral component (eg, spinous\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\nsegment; thoracic\n$ 1,560.60\n726\n22102\n22102\nPartial excision of posterior vertebral component (eg, spinous\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\nsegment; lumbar\n$ 1,827.00\n727\n22103\n22103\nPartial excision of posterior vertebral component (eg, spinous\nprocess, lamina or facet) for intrinsic bony lesion, single vertebral\nsegment; each additional segment (List separately in addition to\ncode for primary procedure)\n$ 421.75\n728\n22110\n22110\nPartial excision of vertebral body, for intrinsic bony lesion, without\ndecompression of spinal cord or nerve root(s), single vertebral\nsegment; cervical\n$ 2,437.20\n729\n22112\n22112\nPartial excision of vertebral body, for intrinsic bony lesion, without\ndecompression of spinal cord or nerve root(s), single vertebral\nsegment; thoracic\n$ 2,290.50\n730\n22114\n22114\nPartial excision of vertebral body, for intrinsic bony lesion, without\ndecompression of spinal cord or nerve root(s), single vertebral\nsegment; lumbar\n$ 1,809.90\n731\n22116\n22116\nPartial excision of vertebral body, for intrinsic bony lesion, without\ndecompression of spinal cord or nerve root(s), single vertebral\nsegment; each additional vertebral segment (List separately in\naddition to code for primary procedure)\n$ 510.03\n732\n22206\n22206\nOsteotomy of spine, posterior or posterolateral approach, 3\ncolumns, 1 vertebral segment (eg, pedicle\/vertebral body\nsubtraction); thoracic\n$ 8,139.79\n733\n22207\n22207\nOsteotomy of spine, posterior or posterolateral approach, 3\ncolumns, 1 vertebral segment (eg, pedicle\/vertebral body\nsubtraction); lumbar\n$ 7,918.14\n734\n22208\n22208\nOsteotomy of spine, posterior or posterolateral approach, 3\ncolumns, 1 vertebral segment (eg, pedicle\/vertebral body\nsubtraction); each additional vertebral segment (List separately in\naddition to code for primary procedure)\n$ 2,343.90\n735\n22210\n22210\nOsteotomy of spine, posterior or posterolateral approach, 1\nvertebral segment; cervical\n$ 5,474.70\n736\n22212\n22212\nOsteotomy of spine, posterior or posterolateral approach, 1\nvertebral segment; thoracic\n$ 5,826.60\n737\n22214\n22214\nOsteotomy of spine, posterior or posterolateral approach, 1\nvertebral segment; lumbar\n$ 5,076.00\n738\n22216\n22216\nOsteotomy of spine, posterior or posterolateral approach, 1\nvertebral segment; each additional vertebral segment (List\nseparately in addition to primary procedure)\n$ 1,650.31\n739\n22220\n22220\nOsteotomy of spine, including discectomy, anterior approach, single\nvertebral segment; cervical\n$ 5,062.50\n740\n22222\n22222\nOsteotomy of spine, including discectomy, anterior approach, single\nvertebral segment; thoracic\n$ 4,892.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n741\n22224\n22224\nOsteotomy of spine, including discectomy, anterior approach, single\nvertebral segment; lumbar\n$ 4,738.50\n742\n22226\n22226\nOsteotomy of spine, including discectomy, anterior approach, single\nvertebral segment; each additional vertebral segment (List\nseparately in addition to code for primary procedure)\n$ 1,576.45\n743\n22305\n22305\nClosed treatment of vertebral process fracture(s)\n$ 646.20\n744\n22310\n22310\nClosed treatment of vertebral body fracture(s), without\nmanipulation, requiring and including casting or bracing\n$ 1,089.00\n745\n22315\n22315\nClosed treatment of vertebral fracture(s) and\/or dislocation(s)\nrequiring casting or bracing, with and including casting and\/or\nbracing by manipulation or traction\n$ 1,676.70\n746\n22318\n22318\nOpen treatment and\/or reduction of odontoid fracture(s) and or\ndislocation(s) (including os odontoideum), anterior approach,\nincluding placement of internal fixation; without grafting\n$ 4,835.70\n747\n22319\n22319\nOpen treatment and\/or reduction of odontoid fracture(s) and or\ndislocation(s) (including os odontoideum), anterior approach,\nincluding placement of internal fixation; with grafting\n$ 5,462.10\n748\n22325\n22325\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\ndislocation(s), posterior approach, 1 fractured vertebra or\ndislocated segment; lumbar\n$ 3,702.60\n749\n22326\n22326\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\ndislocation(s), posterior approach, 1 fractured vertebra or\ndislocated segment; cervical\n$ 4,303.80\n750\n22327\n22327\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\ndislocation(s), posterior approach, 1 fractured vertebra or\ndislocated segment; thoracic\n$ 3,861.00\n751\n22328\n22328\nOpen treatment and\/or reduction of vertebral fracture(s) and\/or\ndislocation(s), posterior approach, 1 fractured vertebra or\ndislocated segment; each additional fractured vertebra or\ndislocated segment (List separately in addition to code for primary\nproce\n$ 1,339.20\n752\n22505\n22505\nManipulation of spine requiring anesthesia, any region\n$ 594.00\n753\n22520\n22520\nPercutaneous vertebroplasty (bone biopsy included when\nperformed), 1 vertebral body, unilateral or bilateral injection;\nthoracic\n$ 10,247.30\n754\n22521\n22521\nPercutaneous vertebroplasty (bone biopsy included when\nperformed), 1 vertebral body, unilateral or bilateral injection;\nlumbar\n$ 4,183.34\n755\n22522\n22522\nPercutaneous vertebroplasty (bone biopsy included when\nperformed), 1 vertebral body, unilateral or bilateral injection; each\nadditional thoracic or lumbar vertebral body (List separately in\naddition to code for primary procedure)\n$ 499.51\n756\n22523\nPercutaneous vertebral augmentation, including cavity creation\n(fracture reduction and bone biopsy included when performed)\nusing mechanical device, 1 vertebral body, unilateral or bilateral\ncannulation (eg, kyphoplasty); thoracic\n$ 1,477.34\n757\n22524\n22524\nPercutaneous vertebral augmentation, including cavity creation\n(fracture reduction and bone biopsy included when performed)\nusing mechanical device, 1 vertebral body, unilateral or bilateral\ncannulation (eg, kyphoplasty); lumbar\n$ 1,382.74\n758\n22525\n22525\nPercutaneous vertebral augmentation, including cavity creation\n(fracture reduction and bone biopsy included when performed)\nusing mechanical device, 1 vertebral body, unilateral or bilateral\ncannulation (eg, kyphoplasty); each additional thoracic or lumba\n$ 716.85\n759\n22526\n22526\nPercutaneous intradiscal electrothermal annuloplasty, unilateral or\nbilateral including fluoroscopic guidance; single level\n$ 3,625.48\n760\n22527\n22527\nPercutaneous intradiscal electrothermal annuloplasty, unilateral or\nbilateral including fluoroscopic guidance; 1 or more additional levels\n(List separately in addition to code for primary procedure)\n$ 2,933.60\n761\n22532\n22532\nArthrodesis, lateral extracavitary technique, including minimal\ndiscectomy to prepare interspace (other than for decompression);\nthoracic\n$ 7,248.19\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n762\n22533\n22533\nArthrodesis, lateral extracavitary technique, including minimal\ndiscectomy to prepare interspace (other than for decompression);\nlumbar\n$ 6,841.56\n763\n22534\n22534\nArthrodesis, lateral extracavitary technique, including minimal\ndiscectomy to prepare interspace (other than for decompression);\nthoracic or lumbar, each additional vertebral segment (List\nseparately in addition to code for primary procedure)\n$ 1,793.42\n764\n22548\n22548\nArthrodesis, anterior transoral or extraoral technique, clivus-C1-C2\n(atlas-axis), with or without excision of odontoid process\n$ 4,671.90\n765\n22554\n22554\nArthrodesis, anterior interbody technique, including minimal\ndiscectomy to prepare interspace (other than for decompression);\ncervical below C2\n$ 5,047.20\n766\n22556\n22556\nArthrodesis, anterior interbody technique, including minimal\ndiscectomy to prepare interspace (other than for decompression);\nthoracic\n$ 5,232.60\n767\n22558\n22558\nArthrodesis, anterior interbody technique, including minimal\ndiscectomy to prepare interspace (other than for decompression);\nlumbar\n$ 4,895.10\n768\n22585\n22585\nArthrodesis, anterior interbody technique, including minimal\ndiscectomy to prepare interspace (other than for decompression);\neach additional interspace (List separately in addition to code for\nprimary procedure)\n$ 2,109.60\n769\n22590\n22590\nArthrodesis, posterior technique, craniocervical (occiput-C2)\n$ 6,695.10\n770\n22595\n22595\nArthrodesis, posterior technique, atlas-axis (C1-C2)\n$ 5,839.20\n771\n22600\n22600\nArthrodesis, posterior or posterolateral technique, single level;\ncervical below C2 segment\n$ 4,428.90\n772\n22610\n22610\nArthrodesis, posterior or posterolateral technique, single level;\nthoracic (with lateral transverse technique, when performed)\n$ 4,143.60\n773\n22612\n22612\nArthrodesis, posterior or posterolateral technique, single level;\nlumbar (with lateral transverse technique, when performed)\n$ 4,961.70\n774\n22614\n22614\nArthrodesis, posterior or posterolateral technique, single level; each\nadditional vertebral segment (List separately in addition to code for\nprimary procedure)\n$ 1,858.50\n775\n22630\n22630\nArthrodesis, posterior interbody technique, including laminectomy\nand\/or discectomy to prepare interspace (other than for\ndecompression), single interspace; lumbar\n$ 4,412.70\n776\n22632\n22632\nArthrodesis, posterior interbody technique, including laminectomy\nand\/or discectomy to prepare interspace (other than for\ndecompression), single interspace; each additional interspace (List\nseparately in addition to code for primary procedure)\n$ 1,555.20\n777\n22800\n22800\nArthrodesis, posterior, for spinal deformity, with or without cast; up\nto 6 vertebral segments\n$ 4,953.60\n778\n22802\n22802\nArthrodesis, posterior, for spinal deformity, with or without cast; 7\nto 12 vertebral segments\n$ 6,030.00\n779\n22804\n22804\nArthrodesis, posterior, for spinal deformity, with or without cast; 13\nor more vertebral segments\n$ 6,646.50\n780\n22808\n22808\nArthrodesis, anterior, for spinal deformity, with or without cast; 2 to\n3 vertebral segments\n$ 4,555.80\n781\n22810\n22810\nArthrodesis, anterior, for spinal deformity, with or without cast; 4 to\n7 vertebral segments\n$ 4,892.40\n782\n22812\n22812\nArthrodesis, anterior, for spinal deformity, with or without cast; 8 or\nmore vertebral segments\n$ 5,985.90\n783\n22818\n22818\nKyphectomy, circumferential exposure of spine and resection of\nvertebral segment(s) (including body and posterior elements);\nsingle or 2 segments\n$ 6,687.90\n784\n22819\n22819\nKyphectomy, circumferential exposure of spine and resection of\nvertebral segment(s) (including body and posterior elements); 3 or\nmore segments\n$ 7,163.10\n785\n22830\n22830\nExploration of spinal fusion\n$ 4,411.80\n786\n22840\n22840\nPosterior non-segmental instrumentation (eg, Harrington rod\ntechnique, pedicle fixation across 1 interspace, atlantoaxial\ntransarticular screw fixation, sublaminar wiring at C1, facet screw\nfixation) (List separately in addition to code for primary proced\n$ 5,926.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n787\n22841\n22841\nInternal spinal fixation by wiring of spinous processes (List\nseparately in addition to code for primary procedure)\n$ 3,862.80\n788\n22842\n22842\nPosterior segmental instrumentation (eg, pedicle fixation, dual rods\nwith multiple hooks and sublaminar wires); 3 to 6 vertebral\nsegments (List separately in addition to code for primary procedure) $ 6,488.10\n789\n22843\n22843\nPosterior segmental instrumentation (eg, pedicle fixation, dual rods\nwith multiple hooks and sublaminar wires); 7 to 12 vertebral\nsegments (List separately in addition to code for primary procedure) $ 2,050.20\n790\n22844\n22844\nPosterior segmental instrumentation (eg, pedicle fixation, dual rods\nwith multiple hooks and sublaminar wires); 13 or more vertebral\nsegments (List separately in addition to code for primary procedure) $ 2,503.80\n791\n22845\n22845\nAnterior instrumentation; 2 to 3 vertebral segments (List separately\nin addition to code for primary procedure)\n$ 6,088.50\n792\n22846\n22846\nAnterior instrumentation; 4 to 7 vertebral segments (List separately\nin addition to code for primary procedure)\n$ 6,129.00\n793\n22847\n22847\nAnterior instrumentation; 8 or more vertebral segments (List\nseparately in addition to code for primary procedure)\n$ 4,006.54\n794\n22848\n22848\nPelvic fixation (attachment of caudal end of instrumentation to\npelvic bony structures) other than sacrum (List separately in\naddition to code for primary procedure)\n$ 1,716.14\n795\n22849\n22849\nReinsertion of spinal fixation device\n$ 3,637.80\n796\n22850\n22850\nRemoval of posterior nonsegmental instrumentation (eg,\nHarrington rod)\n$ 2,196.90\n797\n22851\n22851\nApplication of intervertebral biomechanical device(s) (eg, synthetic\ncage(s), methylmethacrylate) to vertebral defect or interspace (List\nseparately in addition to code for primary procedure)\n$ 2,188.80\n798\n22852\n22852\nRemoval of posterior segmental instrumentation\n$ 2,578.50\n799\n22855\n22855\nRemoval of anterior instrumentation\n$ 3,174.30\n800\n22856\n22856\nTotal disc arthroplasty (artificial disc), anterior approach, including\ndiscectomy with end plate preparation (includes osteophytectomy\nfor nerve root or spinal cord decompression and microdissection),\nsingle interspace, cervical\n$ 7,409.11\n801\n22857\n22857\nTotal disc arthroplasty (artificial disc), anterior approach, including\ndiscectomy to prepare interspace (other than for decompression),\nsingle interspace, lumbar\n$ 7,481.77\n802\n22861\n22861\nRevision including replacement of total disc arthroplasty (artificial\ndisc), anterior approach, single interspace; cervical\n$ 9,122.80\n803\n22862\n22862\nRevision including replacement of total disc arthroplasty (artificial\ndisc), anterior approach, single interspace; lumbar\n$ 8,973.95\n804\n22864\n22864\nRemoval of total disc arthroplasty (artificial disc), anterior approach,\nsingle interspace; cervical\n$ 8,487.18\n805\n22865\n22865\nRemoval of total disc arthroplasty (artificial disc), anterior approach,\nsingle interspace; lumbar\n$ 9,570.92\n806\n22899\n22899\nUnlisted procedure, spine\n$ 1,613.81\n807\n22900\n22900\nExcision, tumor, soft tissue of abdominal wall, subfascial (eg,\nintramuscular); less than 5 cm\n$ 1,592.10\n808\n22901\n22901\nExcision, tumor, soft tissue of abdominal wall, subfascial (eg,\nintramuscular); 5 cm or greater\n$ 1,370.05\n809\n22902\n22902\nExcision, tumor, soft tissue of abdominal wall, subcutaneous; less\nthan 3 cm\n$ 861.30\n810\n22903\n22903\nExcision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm\nor greater\n$ 901.22\n811\n22904\n22904\nRadical resection of tumor (eg, sarcoma), soft tissue of abdominal\nwall; less than 5 cm\n$ 2,178.75\n812\n22905\n22905\nRadical resection of tumor (eg, sarcoma), soft tissue of abdominal\nwall; 5 cm or greater\n$ 2,821.24\n813\n22999\n22999\nUnlisted procedure, abdomen, musculoskeletal system\nCost\n814\n23000\n23000\nRemoval of subdeltoid calcareous deposits, open\n$ 1,048.50\n815\n23020\n23020\nCapsular contracture release (eg, Sever type procedure)\n$ 1,676.70\n816\n23030\n23030\nIncision and drainage, shoulder area; deep abscess or hematoma\n$ 643.50\n817\n23031\n23031\nIncision and drainage, shoulder area; infected bursa\n$ 513.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n818\n23035\n23035\nIncision, bone cortex (eg, osteomyelitis or bone abscess), shoulder\narea\n$ 1,620.00\n819\n23040\n23040\nArthrotomy, glenohumeral joint, including exploration, drainage, or\nremoval of foreign body\n$ 1,976.40\n820\n23044\n23044\nArthrotomy, acromioclavicular, sternoclavicular joint, including\nexploration, drainage, or removal of foreign body\n$ 1,288.80\n821\n23065\n23065\nBiopsy, soft tissue of shoulder area; superficial\n$ 429.30\n822\n23066\n23066\nBiopsy, soft tissue of shoulder area; deep\n$ 772.20\n823\n23073\n23073\nExcision, tumor, soft tissue of shoulder area, subfascial (eg,\nintramuscular); 5 cm or greater\n$ 1,601.52\n824\n23075\n23075\nExcision, tumor, soft tissue of shoulder area, subcutaneous; less\nthan 3 cm\n$ 690.30\n825\n23076\n23076\nExcision, tumor, soft tissue of shoulder area, subfascial (eg,\nintramuscular); less than 5 cm\n$ 972.00\n826\n23077\n23077\nRadical resection of tumor (eg, sarcoma), soft tissue of shoulder\narea; less than 5 cm\n$ 3,457.80\n827\n23100\n23100\nArthrotomy, glenohumeral joint, including biopsy\n$ 1,900.80\n828\n23101\n23101\nArthrotomy, acromioclavicular joint or sternoclavicular joint,\nincluding biopsy and\/or excision of torn cartilage\n$ 1,510.20\n829\n23105\n23105\nArthrotomy; glenohumeral joint, with synovectomy, with or without\nbiopsy\n$ 2,547.90\n830\n23106\n23106\nArthrotomy; sternoclavicular joint, with synovectomy, with or\nwithout biopsy\n$ 1,841.40\n831\n23107\n23107\nArthrotomy, glenohumeral joint, with joint exploration, with or\nwithout removal of loose or foreign body\n$ 2,521.80\n832\n23120\n23120\nClaviculectomy; partial\n$ 1,359.90\n833\n23125\n23125\nClaviculectomy; total\n$ 2,212.20\n834\n23130\n23130\nAcromioplasty or acromionectomy, partial, with or without\ncoracoacromial ligament release\n$ 1,876.50\n835\n23140\n23140\nExcision or curettage of bone cyst or benign tumor of clavicle or\nscapula;\n$ 1,152.90\n836\n23145\n23145\nExcision or curettage of bone cyst or benign tumor of clavicle or\nscapula; with autograft (includes obtaining graft)\n$ 1,894.50\n837\n23146\n23146\nExcision or curettage of bone cyst or benign tumor of clavicle or\nscapula; with allograft\n$ 1,276.20\n838\n23150\n23150\nExcision or curettage of bone cyst or benign tumor of proximal\nhumerus;\n$ 1,902.60\n839\n23155\n23155\nExcision or curettage of bone cyst or benign tumor of proximal\nhumerus; with autograft (includes obtaining graft)\n$ 2,513.70\n840\n23156\n23156\nExcision or curettage of bone cyst or benign tumor of proximal\nhumerus; with allograft\n$ 2,136.60\n841\n23170\n23170\nSequestrectomy (eg, for osteomyelitis or bone abscess), clavicle\n$ 1,133.10\n842\n23172\n23172\nSequestrectomy (eg, for osteomyelitis or bone abscess), scapula\n$ 1,035.00\n843\n23174\n23174\nSequestrectomy (eg, for osteomyelitis or bone abscess), humeral\nhead to surgical neck\n$ 2,029.50\n844\n23180\n23180\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis), clavicle\n$ 1,142.10\n845\n23182\n23182\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis), scapula\n$ 1,146.60\n846\n23184\n23184\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis), proximal humerus\n$ 1,805.40\n847\n23190\n23190\nOstectomy of scapula, partial (eg, superior medial angle)\n$ 1,415.70\n848\n23195\n23195\nResection, humeral head\n$ 2,023.20\n849\n23200\n23200\nRadical resection of tumor; clavicle\n$ 1,987.20\n850\n23210\n23210\nRadical resection of tumor; scapula\n$ 2,709.00\n851\n23220\n23220\nRadical resection of tumor, proximal humerus\n$ 2,718.90\n852\n23330\n23330\nRemoval of foreign body, shoulder; subcutaneous\n$ 747.00\n853\n23333\n23333\nRemoval of foreign body, shoulder; deep (subfascial or\nintramuscular)\n$640.91\n854\n23350\n23350\nInjection procedure for shoulder arthrography or enhanced CT\/MRI\nshoulder arthrography\n$ 177.30\n855\n23395\n23395\nMuscle transfer, any type, shoulder or upper arm; single\n$ 2,472.30\n856\n23397\n23397\nMuscle transfer, any type, shoulder or upper arm; multiple\n$ 2,657.70\n857\n23400\n23400\nScapulopexy (eg, Sprengels deformity or for paralysis)\n$ 2,549.70\n858\n23405\n23405\nTenotomy, shoulder area; single tendon\n$ 1,497.60\n859\n23406\n23406\nTenotomy, shoulder area; multiple tendons through same incision\n$ 2,154.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n860\n23410\n23410\nRepair of ruptured musculotendinous cuff (eg, rotator cuff) open;\nacute\n$ 2,492.10\n861\n23412\n23412\nRepair of ruptured musculotendinous cuff (eg, rotator cuff) open;\nchronic\n$ 3,027.60\n862\n23415\n23415\nCoracoacromial ligament release, with or without acromioplasty\n$ 1,882.80\n863\n23420\n23420\nReconstruction of complete shoulder (rotator) cuff avulsion, chronic\n(includes acromioplasty)\n$ 3,345.30\n864\n23430\n23430\nTenodesis of long tendon of biceps\n$ 1,865.70\n865\n23440\n23440\nResection or transplantation of long tendon of biceps\n$ 1,823.40\n866\n23450\n23450\nCapsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type\noperation\n$ 3,331.80\n867\n23455\n23455\nCapsulorrhaphy, anterior; with labral repair (eg, Bankart procedure)\n$ 3,392.10\n868\n23460\n23460\nCapsulorrhaphy, anterior, any type; with bone block\n$ 3,116.70\n869\n23462\n23462\nCapsulorrhaphy, anterior, any type; with coracoid process transfer\n$ 3,337.20\n870\n23465\n23465\nCapsulorrhaphy, glenohumeral joint, posterior, with or without\nbone block\n$ 2,945.70\n871\n23466\n23466\nCapsulorrhaphy, glenohumeral joint, any type multi-directional\ninstability\n$ 3,508.20\n872\n23470\n23470\nArthroplasty, glenohumeral joint; hemiarthroplasty\n$ 3,598.20\n873\n23472\n23472\nArthroplasty, glenohumeral joint; total shoulder (glenoid and\nproximal humeral replacement (eg, total shoulder))\n$ 5,374.80\n874\n23480\n23480\nOsteotomy, clavicle, with or without internal fixation;\n$ 1,863.00\n875\n23485\n23485\nOsteotomy, clavicle, with or without internal fixation; with bone\ngraft for nonunion or malunion (includes obtaining graft and\/or\nnecessary fixation)\n$ 2,413.80\n876\n23490\n23490\nProphylactic treatment (nailing, pinning, plating or wiring) with or\nwithout methylmethacrylate; clavicle\n$ 2,123.10\n877\n23491\n23491\nProphylactic treatment (nailing, pinning, plating or wiring) with or\nwithout methylmethacrylate; proximal humerus\n$ 2,097.00\n878\n23500\n23500\nClosed treatment of clavicular fracture; without manipulation\n$ 342.90\n879\n23505\n23505\nClosed treatment of clavicular fracture; with manipulation\n$ 586.80\n880\n23515\n23515\nOpen treatment of clavicular fracture, includes internal fixation,\nwhen performed\n$ 1,595.70\n881\n23520\n23520\nClosed treatment of sternoclavicular dislocation; without\nmanipulation\n$ 387.90\n882\n23525\n23525\nClosed treatment of sternoclavicular dislocation; with manipulation\n$ 556.20\n883\n23530\n23530\nOpen treatment of sternoclavicular dislocation, acute or chronic;\n$ 1,455.30\n884\n23532\n23532\nOpen treatment of sternoclavicular dislocation, acute or chronic;\nwith fascial graft (includes obtaining graft)\n$ 1,701.90\n885\n23540\n23540\nClosed treatment of acromioclavicular dislocation; without\nmanipulation\n$ 418.50\n886\n23545\n23545\nClosed treatment of acromioclavicular dislocation; with\nmanipulation\n$ 565.20\n887\n23550\n23550\nOpen treatment of acromioclavicular dislocation, acute or chronic;\n$ 1,890.00\n888\n23552\n23552\nOpen treatment of acromioclavicular dislocation, acute or chronic;\nwith fascial graft (includes obtaining graft)\n$ 2,283.30\n889\n23570\n23570\nClosed treatment of scapular fracture; without manipulation\n$ 372.60\n890\n23575\n23575\nClosed treatment of scapular fracture; with manipulation, with or\nwithout skeletal traction (with or without shoulder joint\ninvolvement)\n$ 533.70\n891\n23585\n23585\nOpen treatment of scapular fracture (body, glenoid or acromion)\nincludes internal fixation, when performed\n$ 2,152.80\n892\n23600\n23600\nClosed treatment of proximal humeral (surgical or anatomical neck)\nfracture; without manipulation\n$ 537.30\n893\n23605\n23605\nClosed treatment of proximal humeral (surgical or anatomical neck)\nfracture; with manipulation, with or without skeletal traction\n$ 871.20\n894\n23615\n23615\nOpen treatment of proximal humeral (surgical or anatomical neck)\nfracture, includes internal fixation, when performed, includes repair\nof tuberosity(s), when performed;\n$ 2,034.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n895\n23616\n23616\nOpen treatment of proximal humeral (surgical or anatomical neck)\nfracture, includes internal fixation, when performed, includes repair\nof tuberosity(s), when performed; with proximal humeral prosthetic\nreplacement\n$ 3,965.40\n896\n23620\n23620\nClosed treatment of greater humeral tuberosity fracture; without\nmanipulation\n$ 471.60\n897\n23625\n23625\nClosed treatment of greater humeral tuberosity fracture; with\nmanipulation\n$ 744.30\n898\n23630\n23630\nOpen treatment of greater humeral tuberosity fracture, includes\ninternal fixation, when performed\n$ 1,616.40\n899\n23650\n23650\nClosed treatment of shoulder dislocation, with manipulation;\nwithout anesthesia\n$ 457.20\n900\n23655\n23655\nClosed treatment of shoulder dislocation, with manipulation;\nrequiring anesthesia\n$ 669.60\n901\n23660\n23660\nOpen treatment of acute shoulder dislocation\n$ 1,996.20\n902\n23665\n23665\nClosed treatment of shoulder dislocation, with fracture of greater\nhumeral tuberosity, with manipulation\n$ 749.70\n903\n23670\n23670\nOpen treatment of shoulder dislocation, with fracture of greater\nhumeral tuberosity, includes internal fixation, when performed\n$ 1,975.50\n904\n23675\n23675\nClosed treatment of shoulder dislocation, with surgical or\nanatomical neck fracture, with manipulation\n$ 888.30\n905\n23680\n23680\nOpen treatment of shoulder dislocation, with surgical or anatomical\nneck fracture, includes internal fixation, when performed\n$ 2,415.60\n906\n23700\n23700\nManipulation under anesthesia, shoulder joint, including application\nof fixation apparatus (dislocation excluded)\n$ 625.50\n907\n23800\n23800\nArthrodesis, glenohumeral joint;\n$ 3,604.50\n908\n23802\n23802\nArthrodesis, glenohumeral joint; with autogenous graft (includes\nobtaining graft)\n$ 3,445.20\n909\n23900\n23900\nInterthoracoscapular amputation (forequarter)\n$ 4,063.50\n910\n23920\n23920\nDisarticulation of shoulder;\n$ 3,162.60\n911\n23921\n23921\nDisarticulation of shoulder; secondary closure or scar revision\n$ 909.90\n912\n23929\n23929\nUnlisted procedure, shoulder\nCost\n913\n23930\n23930\nIncision and drainage, upper arm or elbow area; deep abscess or\nhematoma\n$ 819.90\n914\n23931\n23931\nIncision and drainage, upper arm or elbow area; bursa\n$ 675.90\n915\n23935\n23935\nIncision, deep, with opening of bone cortex (eg, for osteomyelitis or\nbone abscess), humerus or elbow\n$ 1,374.30\n916\n24000\n24000\nArthrotomy, elbow, including exploration, drainage, or removal of\nforeign body\n$ 1,805.40\n917\n24006\n24006\nArthrotomy of the elbow, with capsular excision for capsular release\n(separate procedure)\n$ 1,784.70\n918\n24065\n24065\nBiopsy, soft tissue of upper arm or elbow area; superficial\n$ 385.20\n919\n24066\n24066\nBiopsy, soft tissue of upper arm or elbow area; deep (subfascial or\nintramuscular)\n$ 707.89\n920\n24071\n24071\nExcision, tumor, soft tissue of upper arm or elbow area,\nsubcutaneous; 3 cm or greater\n$ 972.78\n921\n24073\n24073\nExcision, tumor, soft tissue of upper arm or elbow area, subfascial\n(eg, intramuscular); 5 cm or greater\n$ 1,396.93\n922\n24075\n24075\nExcision, tumor, soft tissue of upper arm or elbow area,\nsubcutaneous; less than 3 cm\n$ 686.70\n923\n24076\n24076\nExcision, tumor, soft tissue of upper arm or elbow area, subfascial\n(eg, intramuscular); less than 5 cm\n$ 1,179.00\n924\n24077\n24077\nRadical resection of tumor (eg, sarcoma), soft tissue of upper arm or\nelbow area; less than 5 cm\n$ 2,430.90\n925\n24079\n24079\nRadical resection of tumor (eg, sarcoma), soft tissue of upper arm or\nelbow area; 5 cm or greater\n$ 2,604.12\n926\n24100\n24100\nArthrotomy, elbow; with synovial biopsy only\n$ 1,082.70\n927\n24101\n24101\nArthrotomy, elbow; with joint exploration, with or without biopsy,\nwith or without removal of loose or foreign body\n$ 1,861.20\n928\n24102\n24102\nArthrotomy, elbow; with synovectomy\n$ 2,224.80\n929\n24105\n24105\nExcision, olecranon bursa\n$ 898.20\n930\n24110\n24110\nExcision or curettage of bone cyst or benign tumor, humerus;\n$ 1,581.30\n931\n24115\n24115\nExcision or curettage of bone cyst or benign tumor, humerus; with\nautograft (includes obtaining graft)\n$ 1,887.30\n932\n24116\n24116\nExcision or curettage of bone cyst or benign tumor, humerus; with\nallograft\n$ 1,841.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n933\n24120\n24120\nExcision or curettage of bone cyst or benign tumor of head or neck\nof radius or olecranon process;\n$ 1,485.00\n934\n24125\n24125\nExcision or curettage of bone cyst or benign tumor of head or neck\nof radius or olecranon process; with autograft (includes obtaining\ngraft)\n$ 1,740.60\n935\n24126\n24126\nExcision or curettage of bone cyst or benign tumor of head or neck\nof radius or olecranon process; with allograft\n$ 1,524.60\n936\n24130\n24130\nExcision, radial head\n$ 1,459.80\n937\n24134\n24134\nSequestrectomy (eg, for osteomyelitis or bone abscess), shaft or\ndistal humerus\n$ 1,854.00\n938\n24136\n24136\nSequestrectomy (eg, for osteomyelitis or bone abscess), radial head\nor neck\n$ 1,654.20\n939\n24138\n24138\nSequestrectomy (eg, for osteomyelitis or bone abscess), olecranon\nprocess\n$ 1,622.70\n940\n24140\n24140\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis), humerus\n$ 2,168.10\n941\n24145\n24145\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis), radial head or neck\n$ 1,442.70\n942\n24147\n24147\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis), olecranon process\n$ 1,296.00\n943\n24149\n24149\nRadical resection of capsule, soft tissue, and heterotopic bone,\nelbow, with contracture release (separate procedure)\n$ 2,652.30\n944\n24150\n24150\nRadical resection of tumor, shaft or distal humerus\n$ 2,443.50\n945\n24152\n24152\nRadical resection of tumor, radial head or neck\n$ 2,158.20\n946\n24155\n24155\nResection of elbow joint (arthrectomy)\n$ 2,199.60\n947\n24160\n24160\nRemoval of prosthesis, includes debridement and synovectomy\nwhen performed; humeral and ulnar components\n$ 1,489.50\n948\n24164\n24164\nRemoval of prosthesis, includes debridement and synovectomy\nwhen performed; radial head\n$ 1,359.90\n949\n24200\n24200\nRemoval of foreign body, upper arm or elbow area; subcutaneous\n$ 368.10\n950\n24201\n24201\nRemoval of foreign body, upper arm or elbow area; deep (subfascial\nor intramuscular)\n$ 962.10\n951\n24220\n24220\nInjection procedure for elbow arthrography\n$ 177.30\n952\n24300\n24300\nManipulation, elbow, under anesthesia\n$ 777.16\n953\n24301\n24301\nMuscle or tendon transfer, any type, upper arm or elbow, single\n(excluding 24320-24331)\n$ 1,998.00\n954\n24305\n24305\nTendon lengthening, upper arm or elbow, each tendon\n$ 900.90\n955\n24310\n24310\nTenotomy, open, elbow to shoulder, each tendon\n$ 955.80\n956\n24320\n24320\nTenoplasty, with muscle transfer, with or without free graft, elbow\nto shoulder, single (Seddon-Brookes type procedure)\n$ 2,311.20\n957\n24330\n24330\nFlexor-plasty, elbow (eg, Steindler type advancement);\n$ 2,269.80\n958\n24331\n24331\nFlexor-plasty, elbow (eg, Steindler type advancement); with\nextensor advancement\n$ 2,086.20\n959\n24332\n24332\nTenolysis, triceps\n$ 1,181.38\n960\n24340\n24340\nTenodesis of biceps tendon at elbow (separate procedure)\n$ 1,922.40\n961\n24341\n24341\nRepair, tendon or muscle, upper arm or elbow, each tendon or\nmuscle, primary or secondary (excludes rotator cuff)\n$ 1,816.20\n962\n24342\n24342\nReinsertion of ruptured biceps or triceps tendon, distal, with or\nwithout tendon graft\n$ 2,416.50\n963\n24343\n24343\nRepair lateral collateral ligament, elbow, with local tissue\n$ 1,858.95\n964\n24344\n24344\nReconstruction lateral collateral ligament, elbow, with tendon graft\n(includes harvesting of graft)\n$ 2,485.31\n965\n24345\n24345\nRepair medial collateral ligament, elbow, with local tissue\n$ 1,857.96\n966\n24357\n24357\nTenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow,\ngolfer's elbow); percutaneous\n$ 1,115.21\n967\n24358\n24358\nTenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow,\ngolfer's elbow); debridement, soft tissue and\/or bone, open\n$ 1,270.13\n968\n24359\n24359\nTenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow,\ngolfer's elbow); debridement, soft tissue and\/or bone, open with\ntendon repair or reattachment\n$ 1,520.03\n969\n24360\n24360\nArthroplasty, elbow; with membrane (eg, fascial)\n$ 3,267.00\n970\n24361\n24361\nArthroplasty, elbow; with distal humeral prosthetic replacement\n$ 2,970.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifier\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n971\n24362\n24362\nArthroplasty, elbow; with implant and fascia lata ligament\nreconstruction\n$ 3,446.10\n972\n24363\n24363\nArthroplasty, elbow; with distal humerus and proximal ulnar\nprosthetic replacement (eg, total elbow)\n$ 4,614.30\n973\n24365\n24365\nArthroplasty, radial head;\n$ 1,601.10\n974\n24366\n24366\nArthroplasty, radial head; with implant\n$ 2,054.70\n975\n24400\n24400\nOsteotomy, humerus, with or without internal fixation\n$ 2,451.60\n976\n24410\n24410\nMultiple osteotomies with realignment on intramedullary rod,\nhumeral shaft (Sofield type procedure)\n$ 2,646.90\n977\n24420\n24420\nOsteoplasty, humerus (eg, shortening or lengthening) (excluding\n64876)\n$ 2,397.60\n978\n24430\n24430\nRepair of nonunion or malunion, humerus; without graft (eg,\ncompression technique)\n$ 2,629.80\n979\n24435\n24435\nRepair of nonunion or malunion, humerus; with iliac or other\nautograft (includes obtaining graft)\n$ 3,298.50\n980\n24470\n24470\nHemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)\n$ 1,476.00\n981\n24495\n24495\nDecompression fasciotomy, forearm, with brachial artery\nexploration\n$ 2,070.00\n982\n24498\n24498\nProphylactic treatment (nailing, pinning, plating or wiring), with or\nwithout methylmethacrylate, humeral shaft\n$ 1,984.50\n983\n24500\n24500\nClosed treatment of humeral shaft fracture; without manipulation\n$ 503.10\n984\n24505\n24505\nClosed treatment of humeral shaft fracture; with manipulation, with\nor without skeletal traction\n$ 1,046.70\n985\n24515\n24515\nOpen treatment of humeral shaft fracture with plate\/screws, with\nor without cerclage\n$ 2,314.80\n986\n24516\n24516\nTreatment of humeral shaft fracture, with insertion of\nintramedullary implant, with or without cerclage and\/or locking\nscrews\n$ 2,646.90\n987\n24530\n24530\nClosed treatment of supracondylar or transcondylar humeral\nfracture, with or without intercondylar extension; without\nmanipulation\n$ 612.20\n988\n24535\n24535\nClosed treatment of supracondylar or transcondylar humeral\nfracture, with or without intercondylar extension; with\nmanipulation, with or without skin or skeletal traction\n$ 1,064.70\n989\n24538\n24538\nPercutaneous skeletal fixation of supracondylar or transcondylar\nhumeral fracture, with or without intercondylar extension\n$ 1,833.30\n990\n24545\n24545\nOpen treatment of humeral supracondylar or transcondylar\nfracture, includes internal fixation, when performed; without\nintercondylar extension\n$ 2,343.60\n991\n24546\n24546\nOpen treatment of humeral supracondylar or transcondylar\nfracture, includes internal fixation, when performed; with\nintercondylar extension\n$ 2,875.50\n992\n24560\n24560\nClosed treatment of humeral epicondylar fracture, medial or lateral;\nwithout manipulation\n$ 535.50\n993\n24565\n24565\nClosed treatment of humeral epicondylar fracture, medial or lateral;\nwith manipulation\n$ 788.40\n994\n24566\n24566\nPercutaneous skeletal fixation of humeral epicondylar fracture,\nmedial or lateral, with manipulation\n$ 1,277.10\n995\n24575\n24575\nOpen treatment of humeral epicondylar fracture, medial or lateral,\nincludes internal fixation, when performed\n$ 1,759.50\n996\n24576\n24576\nClosed treatment of humeral condylar fracture, medial or lateral;\nwithout manipulation\n$ 549.90\n997\n24577\n24577\nClosed treatment of humeral condylar fracture, medial or lateral;\nwith manipulation\n$ 991.80\n998\n24579\n24579\nOpen treatment of humeral condylar fracture, medial or lateral,\nincludes internal fixation, when performed\n$ 1,859.40\n999\n24582\n24582\nPercutaneous skeletal fixation of humeral condylar fracture, medial\nor lateral, with manipulation\n$ 1,494.00\n1000\n24586\n24586\nOpen treatment of periarticular fracture and\/or dislocation of the\nelbow (fracture distal humerus and proximal ulna and\/or proximal\nradius);\n$ 2,680.20\n1001\n24587\n24587\nOpen treatment of periarticular fracture and\/or dislocation of the\nelbow (fracture distal humerus and proximal ulna and\/or proximal\nradius); with implant arthroplasty\n$ 3,429.00\n1002\n24600\n24600\nTreatment of closed elbow dislocation; without anesthesia\n$ 462.60\n1003\n24605\n24605\nTreatment of closed elbow dislocation; requiring anesthesia\n$ 753.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1004\n24615\n24615\nOpen treatment of acute or chronic elbow dislocation\n$ 1,831.50\n1005\n24620\n24620\nClosed treatment of Monteggia type of fracture dislocation at\nelbow (fracture proximal end of ulna with dislocation of radial\nhead), with manipulation\n$ 952.20\n1006\n24635\n24635\nOpen treatment of Monteggia type of fracture dislocation at elbow\n(fracture proximal end of ulna with dislocation of radial head),\nincludes internal fixation, when performed\n$ 2,043.00\n1007\n24640\n24640\nClosed treatment of radial head subluxation in child, nursemaid\nelbow, with manipulation\n$ 280.80\n1008\n24650\n24650\nClosed treatment of radial head or neck fracture; without\nmanipulation\n$ 413.10\n1009\n24655\n24655\nClosed treatment of radial head or neck fracture; with manipulation $ 778.50\n1010\n24665\n24665\nOpen treatment of radial head or neck fracture, includes internal\nfixation or radial head excision, when performed;\n$ 1,544.40\n1011\n24666\n24666\nOpen treatment of radial head or neck fracture, includes internal\nfixation or radial head excision, when performed; with radial head\nprosthetic replacement\n$ 1,931.40\n1012\n24670\n24670\nClosed treatment of ulnar fracture, proximal end (eg, olecranon or\ncoronoid process[es]); without manipulation\n$ 478.80\n1013\n24675\n24675\nClosed treatment of ulnar fracture, proximal end (eg, olecranon or\ncoronoid process[es]); with manipulation\n$ 801.00\n1014\n24685\n24685\nOpen treatment of ulnar fracture, proximal end (eg, olecranon or\ncoronoid process[es]), includes internal fixation, when performed\n$ 1,825.20\n1015\n24800\n24800\nArthrodesis, elbow joint; local\n$ 2,271.60\n1016\n24802\n24802\nArthrodesis, elbow joint; with autogenous graft (includes obtaining\ngraft)\n$ 2,788.20\n1017\n24900\n24900\nAmputation, arm through humerus; with primary closure\n$ 1,834.20\n1018\n24920\n24920\nAmputation, arm through humerus; open, circular (guillotine)\n$ 1,599.30\n1019\n24925\n24925\nAmputation, arm through humerus; secondary closure or scar\nrevision\n$ 774.90\n1020\n24930\n24930\nAmputation, arm through humerus; re-amputation\n$ 1,470.60\n1021\n24931\n24931\nAmputation, arm through humerus; with implant\n$ 1,900.80\n1022\n24935\n24935\nStump elongation, upper extremity\n$ 2,499.30\n1023\n24940\n24940\nCineplasty, upper extremity, complete procedure\n$ 2,632.50\n1024\n24999\n24999\nUnlisted procedure, humerus or elbow\nCost\n1025\n25000\n25000\nIncision, extensor tendon sheath, wrist (eg, deQuervains disease)\n$ 1,080.90\n1026\n25001\n25001\nIncision, flexor tendon sheath, wrist (eg, flexor carpi radialis)\n$ 963.51\n1027\n25020\n25020\nDecompression fasciotomy, forearm and\/or wrist, flexor OR\nextensor compartment; without debridement of nonviable muscle\nand\/or nerve\n$ 1,390.50\n1028\n25023\n25023\nDecompression fasciotomy, forearm and\/or wrist, flexor OR\nextensor compartment; with debridement of nonviable muscle\nand\/or nerve\n$ 1,751.40\n1029\n25024\n25024\nDecompression fasciotomy, forearm and\/or wrist, flexor AND\nextensor compartment; without debridement of nonviable muscle\nand\/or nerve\n$ 1,555.24\n1030\n25025\n25025\nDecompression fasciotomy, forearm and\/or wrist, flexor AND\nextensor compartment; with debridement of nonviable muscle\nand\/or nerve\n$ 2,070.11\n1031\n25028\n25028\nIncision and drainage, forearm and\/or wrist; deep abscess or\nhematoma\n$ 981.00\n1032\n25031\n25031\nIncision and drainage, forearm and\/or wrist; bursa\n$ 586.80\n1033\n25035\n25035\nIncision, deep, bone cortex, forearm and\/or wrist (eg, osteomyelitis\nor bone abscess)\n$ 1,416.60\n1034\n25040\n25040\nArthrotomy, radiocarpal or midcarpal joint, with exploration,\ndrainage, or removal of foreign body\n$ 1,479.60\n1035\n25065\n25065\nBiopsy, soft tissue of forearm and\/or wrist; superficial\n$ 434.70\n1036\n25066\n25066\nBiopsy, soft tissue of forearm and\/or wrist; deep (subfascial or\nintramuscular)\n$ 710.10\n1037\n25073\n25073\nExcision, tumor, soft tissue of forearm and\/or wrist area, subfascial\n(eg, intramuscular); 3 cm or greater\n$ 1,806.54\n1038\n25075\n25075\nExcision, tumor, soft tissue of forearm and\/or wrist area,\nsubcutaneous; less than 3 cm\n$ 650.70\n1039\n25076\n25076\nExcision, tumor, soft tissue of forearm and\/or wrist area, subfascial\n(eg, intramuscular); less than 3 cm\n$ 1,148.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1040\n25077\n25077\nRadical resection of tumor (eg, sarcoma), soft tissue of forearm\nand\/or wrist area; less than 3 cm\n$ 2,590.20\n1041\n25085\n25085\nCapsulotomy, wrist (eg, contracture)\n$ 1,601.10\n1042\n25100\n25100\nArthrotomy, wrist joint; with biopsy\n$ 1,330.20\n1043\n25101\n25101\nArthrotomy, wrist joint; with joint exploration, with or without\nbiopsy, with or without removal of loose or foreign body\n$ 1,323.00\n1044\n25105\n25105\nArthrotomy, wrist joint; with synovectomy\n$ 1,722.60\n1045\n25107\n25107\nArthrotomy, distal radioulnar joint including repair of triangular\ncartilage, complex\n$ 1,453.50\n1046\n25109\n25109\nExcision of tendon, forearm and\/or wrist, flexor or extensor, each\n$ 1,481.65\n1047\n25110\n25110\nExcision, lesion of tendon sheath, forearm and\/or wrist\n$ 801.00\n1048\n25111\n25111\nExcision of ganglion, wrist (dorsal or volar); primary\n$ 943.10\n1049\n25112\n25112\nExcision of ganglion, wrist (dorsal or volar); recurrent\n$ 1,357.20\n1050\n25115\n25115\nRadical excision of bursa, synovia of wrist, or forearm tendon\nsheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas,\nrheumatoid arthritis); flexors\n$ 2,098.80\n1051\n25116\n25116\nRadical excision of bursa, synovia of wrist, or forearm tendon\nsheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas,\nrheumatoid arthritis); extensors, with or without transposition of\ndorsal retinaculum\n$ 2,058.30\n1052\n25118\n25118\nSynovectomy, extensor tendon sheath, wrist, single compartment;\n$ 1,926.00\n1053\n25119\n25119\nSynovectomy, extensor tendon sheath, wrist, single compartment;\nwith resection of distal ulna\n$ 1,556.10\n1054\n25120\n25120\nExcision or curettage of bone cyst or benign tumor of radius or ulna\n(excluding head or neck of radius and olecranon process);\n$ 1,530.90\n1055\n25125\n25125\nExcision or curettage of bone cyst or benign tumor of radius or ulna\n(excluding head or neck of radius and olecranon process); with\nautograft (includes obtaining graft)\n$ 1,812.60\n1056\n25126\n25126\nExcision or curettage of bone cyst or benign tumor of radius or ulna\n(excluding head or neck of radius and olecranon process); with\nallograft\n$ 1,601.10\n1057\n25130\n25130\nExcision or curettage of bone cyst or benign tumor of carpal bones;\n$ 1,552.50\n1058\n25135\n25135\nExcision or curettage of bone cyst or benign tumor of carpal bones;\nwith autograft (includes obtaining graft)\n$ 1,781.10\n1059\n25136\n25136\nExcision or curettage of bone cyst or benign tumor of carpal bones;\nwith allograft\n$ 1,669.50\n1060\n25145\n25145\nSequestrectomy (eg, for osteomyelitis or bone abscess), forearm\nand\/or wrist\n$ 1,837.80\n1061\n25150\n25150\nPartial excision (craterization, saucerization, or diaphysectomy) of\nbone (eg, for osteomyelitis); ulna\n$ 1,599.30\n1062\n25151\n25151\nPartial excision (craterization, saucerization, or diaphysectomy) of\nbone (eg, for osteomyelitis); radius\n$ 1,522.80\n1063\n25170\n25170\nRadical resection of tumor, radius or ulna\n$ 2,446.20\n1064\n25210\n25210\nCarpectomy; 1 bone\n$ 1,483.20\n1065\n25215\n25215\nCarpectomy; all bones of proximal row\n$ 2,278.80\n1066\n25230\n25230\nRadial styloidectomy (separate procedure)\n$ 1,163.70\n1067\n25240\n25240\nExcision distal ulna partial or complete (eg, Darrach type or\nmatched resection)\n$ 1,516.50\n1068\n25246\n25246\nInjection procedure for wrist arthrography\n$ 223.20\n1069\n25248\n25248\nExploration with removal of deep foreign body, forearm or wrist\n$ 1,003.50\n1070\n25250\n25250\nRemoval of wrist prosthesis; (separate procedure)\n$ 1,647.90\n1071\n25251\n25251\nRemoval of wrist prosthesis; complicated, including total wrist\n$ 2,194.20\n1072\n25259\n25259\nManipulation, wrist, under anesthesia\n$ 1,033.88\n1073\n25260\n25260\nRepair, tendon or muscle, flexor, forearm and\/or wrist; primary,\nsingle, each tendon or muscle\n$ 1,475.10\n1074\n25263\n25263\nRepair, tendon or muscle, flexor, forearm and\/or wrist; secondary,\nsingle, each tendon or muscle\n$ 1,476.00\n1075\n25265\n25265\nRepair, tendon or muscle, flexor, forearm and\/or wrist; secondary,\nwith free graft (includes obtaining graft), each tendon or muscle\n$ 1,890.00\n1076\n25270\n25270\nRepair, tendon or muscle, extensor, forearm and\/or wrist; primary,\nsingle, each tendon or muscle\n$ 1,206.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1077\n25272\n25272\nRepair, tendon or muscle, extensor, forearm and\/or wrist;\nsecondary, single, each tendon or muscle\n$ 1,325.70\n1078\n25274\n25274\nRepair, tendon or muscle, extensor, forearm and\/or wrist;\nsecondary, with free graft (includes obtaining graft), each tendon or\nmuscle\n$ 2,003.40\n1079\n25275\n25275\nRepair, tendon sheath, extensor, forearm and\/or wrist, with free\ngraft (includes obtaining graft) (eg, for extensor carpi ulnaris\nsubluxation)\n$ 1,683.67\n1080\n25280\n25280\nLengthening or shortening of flexor or extensor tendon, forearm\nand\/or wrist, single, each tendon\n$ 1,415.70\n1081\n25290\n25290\nTenotomy, open, flexor or extensor tendon, forearm and\/or wrist,\nsingle, each tendon\n$ 943.20\n1082\n25295\n25295\nTenolysis, flexor or extensor tendon, forearm and\/or wrist, single,\neach tendon\n$ 1,387.80\n1083\n25300\n25300\nTenodesis at wrist; flexors of fingers\n$ 1,893.60\n1084\n25301\n25301\nTenodesis at wrist; extensors of fingers\n$ 1,581.30\n1085\n25310\n25310\nTendon transplantation or transfer, flexor or extensor, forearm\nand\/or wrist, single; each tendon\n$ 1,870.20\n1086\n25312\n25312\nTendon transplantation or transfer, flexor or extensor, forearm\nand\/or wrist, single; with tendon graft(s) (includes obtaining graft),\neach tendon\n$ 2,202.30\n1087\n25315\n25315\nFlexor origin slide (eg, for cerebral palsy, Volkmann contracture),\nforearm and\/or wrist;\n$ 2,035.80\n1088\n25316\n25316\nFlexor origin slide (eg, for cerebral palsy, Volkmann contracture),\nforearm and\/or wrist; with tendon(s) transfer\n$ 2,677.50\n1089\n25320\n25320\nCapsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis,\nligament repair, tendon transfer or graft) (includes synovectomy,\ncapsulotomy and open reduction) for carpal instability\n$ 3,002.40\n1090\n25332\n25332\nArthroplasty, wrist, with or without interposition, with or without\nexternal or internal fixation\n$ 2,537.10\n1091\n25335\n25335\nCentralization of wrist on ulna (eg, radial club hand)\n$ 3,493.80\n1092\n25337\n25337\nReconstruction for stabilization of unstable distal ulna or distal\nradioulnar joint, secondary by soft tissue stabilization (eg, tendon\ntransfer, tendon graft or weave, or tenodesis) with or without open\nreduction of distal radioulnar joint\n$ 1,961.10\n1093\n25350\n25350\nOsteotomy, radius; distal third\n$ 1,881.90\n1094\n25355\n25355\nOsteotomy, radius; middle or proximal third\n$ 1,962.90\n1095\n25360\n25360\nOsteotomy; ulna\n$ 1,773.00\n1096\n25365\n25365\nOsteotomy; radius AND ulna\n$ 2,209.50\n1097\n25370\n25370\nMultiple osteotomies, with realignment on intramedullary rod\n(Sofield type procedure); radius OR ulna\n$ 2,259.00\n1098\n25375\n25375\nMultiple osteotomies, with realignment on intramedullary rod\n(Sofield type procedure); radius AND ulna\n$ 3,060.90\n1099\n25390\n25390\nOsteoplasty, radius OR ulna; shortening\n$ 2,204.10\n1100\n25391\n25391\nOsteoplasty, radius OR ulna; lengthening with autograft\n$ 2,938.50\n1101\n25392\n25392\nOsteoplasty, radius AND ulna; shortening (excluding 64876)\n$ 2,710.80\n1102\n25393\n25393\nOsteoplasty, radius AND ulna; lengthening with autograft\n$ 3,029.40\n1103\n25394\n25394\nOsteoplasty, carpal bone, shortening\n$ 1,709.09\n1104\n25400\n25400\nRepair of nonunion or malunion, radius OR ulna; without graft (eg,\ncompression technique)\n$ 1,773.90\n1105\n25405\n25405\nRepair of nonunion or malunion, radius OR ulna; with autograft\n(includes obtaining graft)\n$ 2,500.20\n1106\n25415\n25415\nRepair of nonunion or malunion, radius AND ulna; without graft (eg,\ncompression technique)\n$ 2,615.40\n1107\n25420\n25420\nRepair of nonunion or malunion, radius AND ulna; with autograft\n(includes obtaining graft)\n$ 2,688.30\n1108\n25425\n25425\nRepair of defect with autograft; radius OR ulna\n$ 2,207.70\n1109\n25426\n25426\nRepair of defect with autograft; radius AND ulna\n$ 3,141.00\n1110\n25430\n25430\nInsertion of vascular pedicle into carpal bone (eg, Hori procedure)\n$ 1,713.16\n1111\n25431\n25431\nRepair of nonunion of carpal bone (excluding carpal scaphoid\n(navicular)) (includes obtaining graft and necessary fixation), each\nbone\n$ 2,472.29\n1112\n25440\n25440\nRepair of nonunion, scaphoid carpal (navicular) bone, with or\nwithout radial styloidectomy (includes obtaining graft and necessary\nfixation)\n$ 2,318.40\n1113\n25441\n25441\nArthroplasty with prosthetic replacement; distal radius\n$ 2,338.20\n1114\n25442\n25442\nArthroplasty with prosthetic replacement; distal ulna\n$ 1,840.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1115\n25443\n25443\nArthroplasty with prosthetic replacement; scaphoid carpal\n(navicular)\n$ 2,010.60\n1116\n25444\n25444\nArthroplasty with prosthetic replacement; lunate\n$ 2,404.80\n1117\n25445\n25445\nArthroplasty with prosthetic replacement; trapezium\n$ 2,321.10\n1118\n25446\n25446\nArthroplasty with prosthetic replacement; distal radius and partial\nor entire carpus (total wrist)\n$ 3,823.20\n1119\n25447\n25447\nArthroplasty, interposition, intercarpal or carpometacarpal joints\n$ 2,806.20\n1120\n25449\n25449\nRevision of arthroplasty, including removal of implant, wrist joint\n$ 1,763.10\n1121\n25450\n25450\nEpiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna\n$ 1,053.00\n1122\n25455\n25455\nEpiphyseal arrest by epiphysiodesis or stapling; distal radius AND\nulna\n$ 1,548.00\n1123\n25490\n25490\nProphylactic treatment (nailing, pinning, plating or wiring) with or\nwithout methylmethacrylate; radius\n$ 1,586.70\n1124\n25491\n25491\nProphylactic treatment (nailing, pinning, plating or wiring) with or\nwithout methylmethacrylate; ulna\n$ 1,681.20\n1125\n25492\n25492\nProphylactic treatment (nailing, pinning, plating or wiring) with or\nwithout methylmethacrylate; radius AND ulna\n$ 1,881.90\n1126\n25500\n25500\nClosed treatment of radial shaft fracture; without manipulation\n$ 513.00\n1127\n25505\n25505\nClosed treatment of radial shaft fracture; with manipulation\n$ 775.80\n1128\n25515\n25515\nOpen treatment of radial shaft fracture, includes internal fixation,\nwhen performed\n$ 1,587.60\n1129\n25520\n25520\nClosed treatment of radial shaft fracture and closed treatment of\ndislocation of distal radioulnar joint (Galeazzi fracture\/dislocation)\n$ 1,447.20\n1130\n25525\n25525\nOpen treatment of radial shaft fracture, includes internal fixation,\nwhen performed, and closed treatment of distal radioulnar joint\ndislocation (Galeazzi fracture\/dislocation), includes percutaneous\nskeletal fixation, when performed\n$ 2,566.80\n1131\n25526\n25526\nOpen treatment of radial shaft fracture, includes internal fixation,\nwhen performed, and open treatment of distal radioulnar joint\ndislocation (Galeazzi fracture\/dislocation), includes internal fixation,\nwhen performed, includes repair of triangular fibro\n$ 2,663.10\n1132\n25530\n25530\nClosed treatment of ulnar shaft fracture; without manipulation\n$ 475.20\n1133\n25535\n25535\nClosed treatment of ulnar shaft fracture; with manipulation\n$ 811.80\n1134\n25545\n25545\nOpen treatment of ulnar shaft fracture, includes internal fixation,\nwhen performed\n$ 1,704.60\n1135\n25560\n25560\nClosed treatment of radial and ulnar shaft fractures; without\nmanipulation\n$ 612.90\n1136\n25565\n25565\nClosed treatment of radial and ulnar shaft fractures; with\nmanipulation\n$ 1,008.00\n1137\n25574\n25574\nOpen treatment of radial AND ulnar shaft fractures, with internal\nfixation, when performed; of radius OR ulna\n$ 2,353.50\n1138\n25575\n25575\nOpen treatment of radial AND ulnar shaft fractures, with internal\nfixation, when performed; of radius AND ulna\n$ 2,425.50\n1139\n25600\n25600\nClosed treatment of distal radial fracture (eg, Colles or Smith type)\nor epiphyseal separation, includes closed treatment of fracture of\nulnar styloid, when performed; without manipulation\n$ 550.80\n1140\n25605\n25605\nClosed treatment of distal radial fracture (eg, Colles or Smith type)\nor epiphyseal separation, includes closed treatment of fracture of\nulnar styloid, when performed; with manipulation\n$ 796.50\n1141\n25606\n25606\nPercutaneous skeletal fixation of distal radial fracture or epiphyseal\nseparation\n$ 1,524.64\n1142\n25607\n25607\nOpen treatment of distal radial extra-articular fracture or\nepiphyseal separation, with internal fixation\n$ 1,539.22\n1143\n25622\n25622\nClosed treatment of carpal scaphoid (navicular) fracture; without\nmanipulation\n$ 612.90\n1144\n25624\n25624\nClosed treatment of carpal scaphoid (navicular) fracture; with\nmanipulation\n$ 808.20\n1145\n25628\n25628\nOpen treatment of carpal scaphoid (navicular) fracture, includes\ninternal fixation, when performed\n$ 1,751.40\n1146\n25630\n25630\nClosed treatment of carpal bone fracture (excluding carpal scaphoid\n[navicular]); without manipulation, each bone\n$ 506.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1147\n25635\n25635\nClosed treatment of carpal bone fracture (excluding carpal scaphoid\n[navicular]); with manipulation, each bone\n$ 699.30\n1148\n25645\n25645\nOpen treatment of carpal bone fracture (other than carpal scaphoid\n[navicular]), each bone\n$ 1,376.10\n1149\n25650\n25650\nClosed treatment of ulnar styloid fracture\n$ 758.70\n1150\n25651\n25651\nPercutaneous skeletal fixation of ulnar styloid fracture\n$ 1,006.20\n1151\n25652\n25652\nOpen treatment of ulnar styloid fracture\n$ 1,318.22\n1152\n25660\n25660\nClosed treatment of radiocarpal or intercarpal dislocation, 1 or\nmore bones, with manipulation\n$ 781.20\n1153\n25670\n25670\nOpen treatment of radiocarpal or intercarpal dislocation, 1 or more\nbones\n$ 1,624.50\n1154\n25671\n25671\nPercutaneous skeletal fixation of distal radioulnar dislocation\n$ 1,128.99\n1155\n25675\n25675\nClosed treatment of distal radioulnar dislocation with manipulation\n$ 776.70\n1156\n25676\n25676\nOpen treatment of distal radioulnar dislocation, acute or chronic\n$ 1,699.20\n1157\n25680\n25680\nClosed treatment of trans-scaphoperilunar type of fracture\ndislocation, with manipulation\n$ 1,107.90\n1158\n25685\n25685\nOpen treatment of trans-scaphoperilunar type of fracture\ndislocation\n$ 2,005.20\n1159\n25690\n25690\nClosed treatment of lunate dislocation, with manipulation\n$ 1,141.20\n1160\n25695\n25695\nOpen treatment of lunate dislocation\n$ 1,864.80\n1161\n25800\n25800\nArthrodesis, wrist; complete, without bone graft (includes\nradiocarpal and\/or intercarpal and\/or carpometacarpal joints)\n$ 2,785.50\n1162\n25805\n25805\nArthrodesis, wrist; with sliding graft\n$ 2,888.10\n1163\n25810\n25810\nArthrodesis, wrist; with iliac or other autograft (includes obtaining\ngraft)\n$ 3,366.00\n1164\n25820\n25820\nArthrodesis, wrist; limited, without bone graft (eg, intercarpal or\nradiocarpal)\n$ 2,223.00\n1165\n25825\n25825\nArthrodesis, wrist; with autograft (includes obtaining graft)\n$ 2,680.20\n1166\n25830\n25830\nArthrodesis, distal radioulnar joint with segmental resection of ulna,\nwith or without bone graft (eg, Sauve-Kapandji procedure)\n$ 2,169.90\n1167\n25900\n25900\nAmputation, forearm, through radius and ulna;\n$ 1,926.00\n1168\n25905\n25905\nAmputation, forearm, through radius and ulna; open, circular\n(guillotine)\n$ 1,746.00\n1169\n25907\n25907\nAmputation, forearm, through radius and ulna; secondary closure\nor scar revision\n$ 837.00\n1170\n25909\n25909\nAmputation, forearm, through radius and ulna; re-amputation\n$ 1,625.40\n1171\n25915\n25915\nKrukenberg procedure\n$ 2,570.40\n1172\n25920\n25920\nDisarticulation through wrist;\n$ 1,611.90\n1173\n25922\n25922\nDisarticulation through wrist; secondary closure or scar revision\n$ 945.90\n1174\n25924\n25924\nDisarticulation through wrist; re-amputation\n$ 1,646.10\n1175\n25927\n25927\nTransmetacarpal amputation;\n$ 1,952.10\n1176\n25929\n25929\nTransmetacarpal amputation; secondary closure or scar revision\n$ 870.30\n1177\n25931\n25931\nTransmetacarpal amputation; re-amputation\n$ 1,794.60\n1178\n25999\n25999\nUnlisted procedure, forearm or wrist\nCost\n1179\n26010\n26010\nDrainage of finger abscess; simple\n$ 293.40\n1180\n26011\n26011\nDrainage of finger abscess; complicated (eg, felon)\n$ 568.80\n1181\n26020\n26020\nDrainage of tendon sheath, digit and\/or palm, each\n$ 1,313.10\n1182\n26025\n26025\nDrainage of palmar bursa; single, bursa\n$ 1,323.90\n1183\n26030\n26030\nDrainage of palmar bursa; multiple bursa\n$ 1,913.40\n1184\n26034\n26034\nIncision, bone cortex, hand or finger (eg, osteomyelitis or bone\nabscess)\n$ 1,782.00\n1185\n26035\n26035\nDecompression fingers and\/or hand, injection injury (eg, grease\ngun)\n$ 2,395.80\n1186\n26037\n26037\nDecompressive fasciotomy, hand (excludes 26035)\n$ 2,175.30\n1187\n26040\n26040\nFasciotomy, palmar (eg, Dupuytren's contracture); percutaneous\n$ 1,008.00\n1188\n26045\n26045\nFasciotomy, palmar (eg, Dupuytren's contracture); open, partial\n$ 1,457.10\n1189\n26055\n26055\nTendon sheath incision (eg, for trigger finger)\n$ 931.88\n1190\n26060\n26060\nTenotomy, percutaneous, single, each digit\n$ 499.50\n1191\n26070\n26070\nArthrotomy, with exploration, drainage, or removal of loose or\nforeign body; carpometacarpal joint\n$ 841.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1192\n26075\n26075\nArthrotomy, with exploration, drainage, or removal of loose or\nforeign body; metacarpophalangeal joint, each\n$ 1,145.70\n1193\n26080\n26080\nArthrotomy, with exploration, drainage, or removal of loose or\nforeign body; interphalangeal joint, each\n$ 895.50\n1194\n26100\n26100\nArthrotomy with biopsy; carpometacarpal joint, each\n$ 920.70\n1195\n26105\n26105\nArthrotomy with biopsy; metacarpophalangeal joint, each\n$ 1,050.30\n1196\n26110\n26110\nArthrotomy with biopsy; interphalangeal joint, each\n$ 842.40\n1197\n26111\n26111\nExcision, tumor or vascular malformation, soft tissue of hand or\nfinger, subcutaneous; 1.5 cm or greater\n$ 1,075.54\n1198\n26113\n26113\nExcision, tumor, soft tissue, or vascular malformation, of hand or\nfinger, subfascial (eg, intramuscular); 1.5 cm or greater\n$ 1,621.65\n1199\n26115\n26115\nExcision, tumor or vascular malformation, soft tissue of hand or\nfinger, subcutaneous; less than 1.5 cm\n$ 927.00\n1200\n26116\n26116\nExcision, tumor, soft tissue, or vascular malformation, of hand or\nfinger, subfascial (eg, intramuscular); less than 1.5 cm\n$ 1,284.30\n1201\n26117\n26117\nRadical resection of tumor (eg, sarcoma), soft tissue of hand or\nfinger; less than 3 cm\n$ 2,445.30\n1202\n26118\n26118\nRadical resection of tumor (eg, sarcoma), soft tissue of hand or\nfinger; 3 cm or greater\n$ 3,201.59\n1203\n26121\n26121\nFasciectomy, palm only, with or without Z-plasty, other local tissue\nrearrangement, or skin grafting (includes obtaining graft)\n$ 2,585.70\n1204\n26123\n26123\nFasciectomy, partial palmar with release of single digit including\nproximal interphalangeal joint, with or without Z-plasty, other local\ntissue rearrangement, or skin grafting (includes obtaining graft);\n$ 2,606.40\n1205\n26125\n26125\nFasciectomy, partial palmar with release of single digit including\nproximal interphalangeal joint, with or without Z-plasty, other local\ntissue rearrangement, or skin grafting (includes obtaining graft);\neach additional digit (List separately in addition\n$ 2,230.20\n1206\n26130\n26130\nSynovectomy, carpometacarpal joint\n$ 1,566.00\n1207\n26135\n26135\nSynovectomy, metacarpophalangeal joint including intrinsic release\nand extensor hood reconstruction, each digit\n$ 1,762.20\n1208\n26140\n26140\nSynovectomy, proximal interphalangeal joint, including extensor\nreconstruction, each interphalangeal joint\n$ 1,708.20\n1209\n26145\n26145\nSynovectomy, tendon sheath, radical (tenosynovectomy), flexor\ntendon, palm and\/or finger, each tendon\n$ 1,744.20\n1210\n26160\n26160\nExcision of lesion of tendon sheath or joint capsule (eg, cyst,\nmucous cyst, or ganglion), hand or finger\n$ 913.50\n1211\n26170\n26170\nExcision of tendon, palm, flexor or extensor, single, each tendon\n$ 945.90\n1212\n26180\n26180\nExcision of tendon, finger, flexor or extensor, each tendon\n$ 834.30\n1213\n26185\n26185\nSesamoidectomy, thumb or finger (separate procedure)\n$ 929.70\n1214\n26200\n26200\nExcision or curettage of bone cyst or benign tumor of metacarpal;\n$ 1,137.60\n1215\n26205\n26205\nExcision or curettage of bone cyst or benign tumor of metacarpal;\nwith autograft (includes obtaining graft)\n$ 1,695.60\n1216\n26210\n26210\nExcision or curettage of bone cyst or benign tumor of proximal,\nmiddle, or distal phalanx of finger;\n$ 1,234.80\n1217\n26215\n26215\nExcision or curettage of bone cyst or benign tumor of proximal,\nmiddle, or distal phalanx of finger; with autograft (includes\nobtaining graft)\n$ 1,538.10\n1218\n26230\n26230\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis); metacarpal\n$ 1,121.40\n1219\n26235\n26235\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis); proximal or middle phalanx of finger\n$ 1,081.80\n1220\n26236\n26236\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone (eg, osteomyelitis); distal phalanx of finger\n$ 931.50\n1221\n26250\n26250\nRadical resection of tumor, metacarpal\n$ 1,561.50\n1222\n26260\n26260\nRadical resection of tumor, proximal or middle phalanx of finger\n$ 1,692.00\n1223\n26262\n26262\nRadical resection of tumor, distal phalanx of finger\n$ 1,568.70\n1224\n26320\n26320\nRemoval of implant from finger or hand\n$ 956.70\n1225\n26340\n26340\nManipulation, finger joint, under anesthesia, each joint\n$ 841.74\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1226\n26350\n26350\nRepair or advancement, flexor tendon, not in zone 2 digital flexor\ntendon sheath (eg, no man's land); primary or secondary without\nfree graft, each tendon\n$ 2,094.30\n1227\n26352\n26352\nRepair or advancement, flexor tendon, not in zone 2 digital flexor\ntendon sheath (eg, no man's land); secondary with free graft\n(includes obtaining graft), each tendon\n$ 2,346.30\n1228\n26356\n26356\nRepair or advancement, flexor tendon, in zone 2 digital flexor\ntendon sheath (eg, no man's land); primary, without free graft, each\ntendon\n$ 2,266.20\n1229\n26357\n26357\nRepair or advancement, flexor tendon, in zone 2 digital flexor\ntendon sheath (eg, no man's land); secondary, without free graft,\neach tendon\n$ 2,317.50\n1230\n26358\n26358\nRepair or advancement, flexor tendon, in zone 2 digital flexor\ntendon sheath (eg, no man's land); secondary, with free graft\n(includes obtaining graft), each tendon\n$ 2,396.70\n1231\n26370\n26370\nRepair or advancement of profundus tendon, with intact\nsuperficialis tendon; primary, each tendon\n$ 1,900.80\n1232\n26372\n26372\nRepair or advancement of profundus tendon, with intact\nsuperficialis tendon; secondary with free graft (includes obtaining\ngraft), each tendon\n$ 1,975.50\n1233\n26373\n26373\nRepair or advancement of profundus tendon, with intact\nsuperficialis tendon; secondary without free graft, each tendon\n$ 1,825.20\n1234\n26390\n26390\nExcision flexor tendon, with implantation of synthetic rod for\ndelayed tendon graft, hand or finger, each rod\n$ 1,753.20\n1235\n26392\n26392\nRemoval of synthetic rod and insertion of flexor tendon graft, hand\nor finger (includes obtaining graft), each rod\n$ 2,260.80\n1236\n26410\n26410\nRepair, extensor tendon, hand, primary or secondary; without free\ngraft, each tendon\n$ 1,064.70\n1237\n26412\n26412\nRepair, extensor tendon, hand, primary or secondary; with free\ngraft (includes obtaining graft), each tendon\n$ 1,515.60\n1238\n26415\n26415\nExcision of extensor tendon, with implantation of synthetic rod for\ndelayed tendon graft, hand or finger, each rod\n$ 1,444.50\n1239\n26416\n26416\nRemoval of synthetic rod and insertion of extensor tendon graft\n(includes obtaining graft), hand or finger, each rod\n$ 1,515.60\n1240\n26418\n26418\nRepair, extensor tendon, finger, primary or secondary; without free\ngraft, each tendon\n$ 1,251.90\n1241\n26420\n26420\nRepair, extensor tendon, finger, primary or secondary; with free\ngraft (includes obtaining graft) each tendon\n$ 1,416.60\n1242\n26426\n26426\nRepair of extensor tendon, central slip, secondary (eg, boutonniere\ndeformity); using local tissue(s), including lateral band(s), each\nfinger\n$ 1,654.20\n1243\n26428\n26428\nRepair of extensor tendon, central slip, secondary (eg, boutonniere\ndeformity); with free graft (includes obtaining graft), each finger\n$ 1,773.00\n1244\n26432\n26432\nClosed treatment of distal extensor tendon insertion, with or\nwithout percutaneous pinning (eg, mallet finger)\n$ 1,139.40\n1245\n26433\n26433\nRepair of extensor tendon, distal insertion, primary or secondary;\nwithout graft (eg, mallet finger)\n$ 1,485.00\n1246\n26434\n26434\nRepair of extensor tendon, distal insertion, primary or secondary;\nwith free graft (includes obtaining graft)\n$ 1,368.00\n1247\n26437\n26437\nRealignment of extensor tendon, hand, each tendon\n$ 1,484.10\n1248\n26440\n26440\nTenolysis, flexor tendon; palm OR finger, each tendon\n$ 1,247.40\n1249\n26442\n26442\nTenolysis, flexor tendon; palm AND finger, each tendon\n$ 1,440.90\n1250\n26445\n26445\nTenolysis, extensor tendon, hand OR finger, each tendon\n$ 1,212.30\n1251\n26449\n26449\nTenolysis, complex, extensor tendon, finger, including forearm, each\ntendon\n$ 1,699.20\n1252\n26450\n26450\nTenotomy, flexor, palm, open, each tendon\n$ 733.50\n1253\n26455\n26455\nTenotomy, flexor, finger, open, each tendon\n$ 847.80\n1254\n26460\n26460\nTenotomy, extensor, hand or finger, open, each tendon\n$ 849.60\n1255\n26471\n26471\nTenodesis; of proximal interphalangeal joint, each joint\n$ 1,384.20\n1256\n26474\n26474\nTenodesis; of distal joint, each joint\n$ 981.00\n1257\n26476\n26476\nLengthening of tendon, extensor, hand or finger, each tendon\n$ 1,012.50\n1258\n26477\n26477\nShortening of tendon, extensor, hand or finger, each tendon\n$ 1,078.20\n1259\n26478\n26478\nLengthening of tendon, flexor, hand or finger, each tendon\n$ 1,345.50\n1260\n26479\n26479\nShortening of tendon, flexor, hand or finger, each tendon\n$ 1,348.20\n1261\n26480\n26480\nTransfer or transplant of tendon, carpometacarpal area or dorsum\nof hand; without free graft, each tendon\n$ 1,838.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1262\n26483\n26483\nTransfer or transplant of tendon, carpometacarpal area or dorsum\nof hand; with free tendon graft (includes obtaining graft), each\ntendon\n$ 2,086.20\n1263\n26485\n26485\nTransfer or transplant of tendon, palmar; without free tendon graft,\neach tendon\n$ 1,926.90\n1264\n26489\n26489\nTransfer or transplant of tendon, palmar; with free tendon graft\n(includes obtaining graft), each tendon\n$ 2,232.90\n1265\n26490\n26490\nOpponensplasty; superficialis tendon transfer type, each tendon\n$ 2,045.70\n1266\n26492\n26492\nOpponensplasty; tendon transfer with graft (includes obtaining\ngraft), each tendon\n$ 2,237.40\n1267\n26494\n26494\nOpponensplasty; hypothenar muscle transfer\n$ 2,032.20\n1268\n26496\n26496\nOpponensplasty; other methods\n$ 2,317.50\n1269\n26497\n26497\nTransfer of tendon to restore intrinsic function; ring and small\nfinger\n$ 2,201.40\n1270\n26498\n26498\nTransfer of tendon to restore intrinsic function; all 4 fingers\n$ 2,544.30\n1271\n26499\n26499\nCorrection claw finger, other methods\n$ 2,403.90\n1272\n26500\n26500\nReconstruction of tendon pulley, each tendon; with local tissues\n(separate procedure)\n$ 1,257.30\n1273\n26502\n26502\nReconstruction of tendon pulley, each tendon; with tendon or\nfascial graft (includes obtaining graft) (separate procedure)\n$ 1,802.70\n1274\n26508\n26508\nRelease of thenar muscle(s) (eg, thumb contracture)\n$ 1,460.70\n1275\n26510\n26510\nCross intrinsic transfer, each tendon\n$ 1,870.20\n1276\n26516\n26516\nCapsulodesis, metacarpophalangeal joint; single digit\n$ 1,593.90\n1277\n26517\n26517\nCapsulodesis, metacarpophalangeal joint; 2 digits\n$ 1,629.90\n1278\n26518\n26518\nCapsulodesis, metacarpophalangeal joint; 3 or 4 digits\n$ 2,031.30\n1279\n26520\n26520\nCapsulectomy or capsulotomy; metacarpophalangeal joint, each\njoint\n$ 1,548.00\n1280\n26525\n26525\nCapsulectomy or capsulotomy; interphalangeal joint, each joint\n$ 1,649.70\n1281\n26530\n26530\nArthroplasty, metacarpophalangeal joint; each joint\n$ 1,611.90\n1282\n26531\n26531\nArthroplasty, metacarpophalangeal joint; with prosthetic implant,\neach joint\n$ 1,847.70\n1283\n26535\n26535\nArthroplasty, interphalangeal joint; each joint\n$ 1,657.80\n1284\n26536\n26536\nArthroplasty, interphalangeal joint; with prosthetic implant, each\njoint\n$ 1,911.60\n1285\n26540\n26540\nRepair of collateral ligament, metacarpophalangeal or\ninterphalangeal joint\n$ 1,791.00\n1286\n26541\n26541\nReconstruction, collateral ligament, metacarpophalangeal joint,\nsingle; with tendon or fascial graft (includes obtaining graft)\n$ 2,261.70\n1287\n26542\n26542\nReconstruction, collateral ligament, metacarpophalangeal joint,\nsingle; with local tissue (eg, adductor advancement)\n$ 2,025.00\n1288\n26545\n26545\nReconstruction, collateral ligament, interphalangeal joint, single,\nincluding graft, each joint\n$ 1,589.40\n1289\n26546\n26546\nRepair non-union, metacarpal or phalanx (includes obtaining bone\ngraft with or without external or internal fixation)\n$ 1,758.60\n1290\n26548\n26548\nRepair and reconstruction, finger, volar plate, interphalangeal joint\n$ 1,946.70\n1291\n26550\n26550\nPollicization of a digit\n$ 3,405.60\n1292\n26551\n26551\nTransfer, toe-to-hand with microvascular anastomosis; great toe\nwrap-around with bone graft\n$ 9,160.20\n1293\n26553\n26553\nTransfer, toe-to-hand with microvascular anastomosis; other than\ngreat toe, single\n$ 9,096.30\n1294\n26554\n26554\nTransfer, toe-to-hand with microvascular anastomosis; other than\ngreat toe, double\n$ 10,847.70\n1295\n26555\n26555\nTransfer, finger to another position without microvascular\nanastomosis\n$ 2,587.50\n1296\n26556\n26556\nTransfer, free toe joint, with microvascular anastomosis\n$ 9,251.10\n1297\n26560\n26560\nRepair of syndactyly (web finger) each web space; with skin flaps\n$ 1,658.70\n1298\n26561\n26561\nRepair of syndactyly (web finger) each web space; with skin flaps\nand grafts\n$ 2,214.90\n1299\n26562\n26562\nRepair of syndactyly (web finger) each web space; complex (eg,\ninvolving bone, nails)\n$ 2,721.60\n1300\n26565\n26565\nOsteotomy; metacarpal, each\n$ 1,844.10\n1301\n26567\n26567\nOsteotomy; phalanx of finger, each\n$ 1,483.20\n1302\n26568\n26568\nOsteoplasty, lengthening, metacarpal or phalanx\n$ 2,240.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1303\n26580\n26580\nRepair cleft hand\n$ 3,350.70\n1304\n26587\n26587\nReconstruction of polydactylous digit, soft tissue and bone\n$ 1,975.50\n1305\n26590\n26590\nRepair macrodactylia, each digit\n$ 2,241.00\n1306\n26591\n26591\nRepair, intrinsic muscles of hand, each muscle\n$ 1,861.20\n1307\n26593\n26593\nRelease, intrinsic muscles of hand, each muscle\n$ 1,684.80\n1308\n26596\n26596\nExcision of constricting ring of finger, with multiple Z-plasties\n$ 1,884.60\n1309\n26600\n26600\nClosed treatment of metacarpal fracture, single; without\nmanipulation, each bone\n$ 341.10\n1310\n26605\n26605\nClosed treatment of metacarpal fracture, single; with manipulation,\neach bone\n$ 504.00\n1311\n26607\n26607\nClosed treatment of metacarpal fracture, with manipulation, with\nexternal fixation, each bone\n$ 983.70\n1312\n26608\n26608\nPercutaneous skeletal fixation of metacarpal fracture, each bone\n$ 1,079.10\n1313\n26615\n26615\nOpen treatment of metacarpal fracture, single, includes internal\nfixation, when performed, each bone\n$ 1,511.10\n1314\n26641\n26641\nClosed treatment of carpometacarpal dislocation, thumb, with\nmanipulation\n$ 526.50\n1315\n26645\n26645\nClosed treatment of carpometacarpal fracture dislocation, thumb\n(Bennett fracture), with manipulation\n$ 703.80\n1316\n26650\n26650\nPercutaneous skeletal fixation of carpometacarpal fracture\ndislocation, thumb (Bennett fracture), with manipulation\n$ 1,207.80\n1317\n26665\n26665\nOpen treatment of carpometacarpal fracture dislocation, thumb\n(Bennett fracture), includes internal fixation, when performed\n$ 1,818.90\n1318\n26670\n26670\nClosed treatment of carpometacarpal dislocation, other than\nthumb, with manipulation, each joint; without anesthesia\n$ 373.50\n1319\n26675\n26675\nClosed treatment of carpometacarpal dislocation, other than\nthumb, with manipulation, each joint; requiring anesthesia\n$ 617.66\n1320\n26676\n26676\nPercutaneous skeletal fixation of carpometacarpal dislocation, other\nthan thumb, with manipulation, each joint\n$ 885.60\n1321\n26685\n26685\nOpen treatment of carpometacarpal dislocation, other than thumb;\nincludes internal fixation, when performed, each joint\n$ 1,269.00\n1322\n26686\n26686\nOpen treatment of carpometacarpal dislocation, other than thumb;\ncomplex, multiple, or delayed reduction\n$ 1,341.00\n1323\n26700\n26700\nClosed treatment of metacarpophalangeal dislocation, single, with\nmanipulation; without anesthesia\n$ 340.20\n1324\n26705\n26705\nClosed treatment of metacarpophalangeal dislocation, single, with\nmanipulation; requiring anesthesia\n$ 525.60\n1325\n26706\n26706\nPercutaneous skeletal fixation of metacarpophalangeal dislocation,\nsingle, with manipulation\n$ 847.80\n1326\n26715\n26715\nOpen treatment of metacarpophalangeal dislocation, single,\nincludes internal fixation, when performed\n$ 1,225.80\n1327\n26720\n26720\nClosed treatment of phalangeal shaft fracture, proximal or middle\nphalanx, finger or thumb; without manipulation, each\n$ 278.10\n1328\n26725\n26725\nClosed treatment of phalangeal shaft fracture, proximal or middle\nphalanx, finger or thumb; with manipulation, with or without skin\nor skeletal traction, each\n$ 462.60\n1329\n26727\n26727\nPercutaneous skeletal fixation of unstable phalangeal shaft fracture,\nproximal or middle phalanx, finger or thumb, with manipulation,\neach\n$ 967.50\n1330\n26735\n26735\nOpen treatment of phalangeal shaft fracture, proximal or middle\nphalanx, finger or thumb, includes internal fixation, when\nperformed, each\n$ 1,345.50\n1331\n26740\n26740\nClosed treatment of articular fracture, involving\nmetacarpophalangeal or interphalangeal joint; without\nmanipulation, each\n$ 492.30\n1332\n26742\n26742\nClosed treatment of articular fracture, involving\nmetacarpophalangeal or interphalangeal joint; with manipulation,\neach\n$ 647.10\n1333\n26746\n26746\nOpen treatment of articular fracture, involving\nmetacarpophalangeal or interphalangeal joint, includes internal\nfixation, when performed, each\n$ 1,380.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1334\n26750\n26750\nClosed treatment of distal phalangeal fracture, finger or thumb;\nwithout manipulation, each\n$ 227.70\n1335\n26755\n26755\nClosed treatment of distal phalangeal fracture, finger or thumb;\nwith manipulation, each\n$ 368.40\n1336\n26756\n26756\nPercutaneous skeletal fixation of distal phalangeal fracture, finger\nor thumb, each\n$ 751.50\n1337\n26765\n26765\nOpen treatment of distal phalangeal fracture, finger or thumb,\nincludes internal fixation, when performed, each\n$ 889.20\n1338\n26770\n26770\nClosed treatment of interphalangeal joint dislocation, single, with\nmanipulation; without anesthesia\n$ 244.56\n1339\n26775\n26775\nClosed treatment of interphalangeal joint dislocation, single, with\nmanipulation; requiring anesthesia\n$ 448.20\n1340\n26776\n26776\nPercutaneous skeletal fixation of interphalangeal joint dislocation,\nsingle, with manipulation\n$ 712.80\n1341\n26785\n26785\nOpen treatment of interphalangeal joint dislocation, includes\ninternal fixation, when performed, single\n$ 990.90\n1342\n26820\n26820\nFusion in opposition, thumb, with autogenous graft (includes\nobtaining graft)\n$ 1,808.10\n1343\n26841\n26841\nArthrodesis, carpometacarpal joint, thumb, with or without internal\nfixation;\n$ 1,699.20\n1344\n26842\n26842\nArthrodesis, carpometacarpal joint, thumb, with or without internal\nfixation; with autograft (includes obtaining graft)\n$ 1,946.70\n1345\n26843\n26843\nArthrodesis, carpometacarpal joint, digit, other than thumb, each;\n$ 1,415.70\n1346\n26844\n26844\nArthrodesis, carpometacarpal joint, digit, other than thumb, each;\nwith autograft (includes obtaining graft)\n$ 1,545.30\n1347\n26850\n26850\nArthrodesis, metacarpophalangeal joint, with or without internal\nfixation;\n$ 1,919.70\n1348\n26852\n26852\nArthrodesis, metacarpophalangeal joint, with or without internal\nfixation; with autograft (includes obtaining graft)\n$ 1,494.00\n1349\n26860\n26860\nArthrodesis, interphalangeal joint, with or without internal fixation;\n$ 1,250.10\n1350\n26861\n26861\nArthrodesis, interphalangeal joint, with or without internal fixation;\neach additional interphalangeal joint (List separately in addition to\ncode for primary procedure)\n$ 540.90\n1351\n26862\n26862\nArthrodesis, interphalangeal joint, with or without internal fixation;\nwith autograft (includes obtaining graft)\n$ 1,629.90\n1352\n26863\n26863\nArthrodesis, interphalangeal joint, with or without internal fixation;\nwith autograft (includes obtaining graft), each additional joint (List\nseparately in addition to code for primary procedure)\n$ 646.20\n1353\n26910\n26910\nAmputation, metacarpal, with finger or thumb (ray amputation),\nsingle, with or without interosseous transfer\n$ 1,870.20\n1354\n26951\n26951\nAmputation, finger or thumb, primary or secondary, any joint or\nphalanx, single, including neurectomies; with direct closure\n$ 910.80\n1355\n26952\n26952\nAmputation, finger or thumb, primary or secondary, any joint or\nphalanx, single, including neurectomies; with local advancement\nflaps (V-Y, hood)\n$ 1,376.10\n1356\n26989\n26989\nUnlisted procedure, hands or fingers\n$ 658.80\n1357\n26990\n26990\nIncision and drainage, pelvis or hip joint area; deep abscess or\nhematoma\n$ 900.90\n1358\n26991\n26991\nIncision and drainage, pelvis or hip joint area; infected bursa\n$ 772.20\n1359\n26992\n26992\nIncision, bone cortex, pelvis and\/or hip joint (eg, osteomyelitis or\nbone abscess)\n$ 1,793.70\n1360\n27000\n27000\nTenotomy, adductor of hip, percutaneous (separate procedure)\n$ 498.60\n1361\n27001\n27001\nTenotomy, adductor of hip, open\n$ 912.60\n1362\n27003\n27003\nTenotomy, adductor, subcutaneous, open, with obturator\nneurectomy\n$ 1,064.70\n1363\n27005\n27005\nTenotomy, hip flexor(s), open (separate procedure)\n$ 1,452.60\n1364\n27006\n27006\nTenotomy, abductors and\/or extensor(s) of hip, open (separate\nprocedure)\n$ 1,012.50\n1365\n27025\n27025\nFasciotomy, hip or thigh, any type\n$ 1,698.30\n1366\n27027\n27027\nDecompression fasciotomy(ies), pelvic (buttock) compartment(s)\n(eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and\/or\ntensor fascia lata muscle), unilateral\n$ 1,637.28\n1367\n27030\n27030\nArthrotomy, hip, with drainage (eg, infection)\n$ 2,173.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1368\n27033\n27033\nArthrotomy, hip, including exploration or removal of loose or\nforeign body\n$ 2,332.80\n1369\n27035\n27035\nDenervation, hip joint, intrapelvic or extrapelvic intra-articular\nbranches of sciatic, femoral, or obturator nerves\n$ 2,578.50\n1370\n27036\n27036\nCapsulectomy or capsulotomy, hip, with or without excision of\nheterotopic bone, with release of hip flexor muscles (ie, gluteus\nmedius, gluteus minimus, tensor fascia latae, rectus femoris,\nsartorius, iliopsoas)\n$ 2,480.40\n1371\n27040\n27040\nBiopsy, soft tissue of pelvis and hip area; superficial\n$ 462.60\n1372\n27041\n27041\nBiopsy, soft tissue of pelvis and hip area; deep, subfascial or\nintramuscular\n$ 767.70\n1373\n27043\n27043\nExcision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3\ncm or greater\n$ 877.66\n1374\n27045\n27045\nExcision, tumor, soft tissue of pelvis and hip area, subfascial (eg,\nintramuscular); 5 cm or greater\n$ 1,380.69\n1375\n27047\n27047\nExcision, tumor, soft tissue of pelvis and hip area, subcutaneous;\nless than 3 cm\n$ 697.50\n1376\n27048\n27048\nExcision, tumor, soft tissue of pelvis and hip area, subfascial (eg,\nintramuscular); less than 5 cm\n$ 1,323.00\n1377\n27049\n27049\nRadical resection of tumor (eg, sarcoma), soft tissue of pelvis and\nhip area; less than 5 cm\n$ 3,126.60\n1378\n27050\n27050\nArthrotomy, with biopsy; sacroiliac joint\n$ 1,007.10\n1379\n27052\n27052\nArthrotomy, with biopsy; hip joint\n$ 2,218.50\n1380\n27054\n27054\nArthrotomy with synovectomy, hip joint\n$ 2,638.80\n1381\n27057\n27057\nDecompression fasciotomy(ies), pelvic (buttock) compartment(s)\n(eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and\/or\ntensor fascia lata muscle) with debridement of nonviable muscle,\nunilateral\n$ 1,660.89\n1382\n27059\n27059\nRadical resection of tumor (eg, sarcoma), soft tissue of pelvis and\nhip area; 5 cm or greater\n$ 3,359.14\n1383\n27060\n27060\nExcision; ischial bursa\n$ 999.90\n1384\n27062\n27062\nExcision; trochanteric bursa or calcification\n$ 904.50\n1385\n27065\n27065\nExcision of bone cyst or benign tumor, wing of ilium, symphysis\npubis, or greater trochanter of femur; superficial, includes\nautograft, when performed\n$ 1,318.50\n1386\n27066\n27066\nExcision of bone cyst or benign tumor, wing of ilium, symphysis\npubis, or greater trochanter of femur; deep (subfascial), includes\nautograft, when performed\n$ 1,965.60\n1387\n27067\n27067\nExcision of bone cyst or benign tumor, wing of ilium, symphysis\npubis, or greater trochanter of femur; with autograft requiring\nseparate incision\n$ 2,286.90\n1388\n27070\n27070\nPartial excision, wing of ilium, symphysis pubis, or greater\ntrochanter of femur, (craterization, saucerization) (eg, osteomyelitis\nor bone abscess); superficial\n$ 1,739.70\n1389\n27071\n27071\nPartial excision, wing of ilium, symphysis pubis, or greater\ntrochanter of femur, (craterization, saucerization) (eg, osteomyelitis\nor bone abscess); deep (subfascial or intramuscular)\n$ 1,902.60\n1390\n27075\n27075\nRadical resection of tumor; wing of ilium, 1 pubic or ischial ramus or\nsymphysis pubis\n$ 3,087.90\n1391\n27076\n27076\nRadical resection of tumor; ilium, including acetabulum, both pubic\nrami, or ischium and acetabulum\n$ 4,360.50\n1392\n27077\n27077\nRadical resection of tumor; innominate bone, total\n$ 5,816.70\n1393\n27078\n27078\nRadical resection of tumor; ischial tuberosity and greater trochanter\nof femur\n$ 1,979.10\n1394\n27080\n27080\nCoccygectomy, primary\n$ 1,275.30\n1395\n27086\n27086\nRemoval of foreign body, pelvis or hip; subcutaneous tissue\n$ 332.10\n1396\n27087\n27087\nRemoval of foreign body, pelvis or hip; deep (subfascial or\nintramuscular)\n$ 1,123.53\n1397\n27090\n27090\nRemoval of hip prosthesis; (separate procedure)\n$ 2,482.20\n1398\n27091\n27091\nRemoval of hip prosthesis; complicated, including total hip\nprosthesis, methylmethacrylate with or without insertion of spacer\n$ 5,319.90\n1399\n27093\n27093\nInjection procedure for hip arthrography; without anesthesia\n$ 275.40\n1400\n27095\n27095\nInjection procedure for hip arthrography; with anesthesia\n$ 504.00\n1401\n27096\n27096\nInjection procedure for sacroiliac joint, anesthetic\/steroid, with\nimage guidance (fluoroscopy or ct) including arthrography when\nperformed\n$ 769.50\n1402\n27097\n27097\nRelease or recession, hamstring, proximal\n$ 1,754.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1403\n27098\n27098\nTransfer, adductor to ischium\n$ 2,065.50\n1404\n27100\n27100\nTransfer external oblique muscle to greater trochanter including\nfascial or tendon extension (graft)\n$ 2,358.90\n1405\n27105\n27105\nTransfer paraspinal muscle to hip (includes fascial or tendon\nextension graft)\n$ 2,504.70\n1406\n27110\n27110\nTransfer iliopsoas; to greater trochanter of femur\n$ 2,935.80\n1407\n27111\n27111\nTransfer iliopsoas; to femoral neck\n$ 2,898.90\n1408\n27120\n27120\nAcetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type)\n$ 3,783.60\n1409\n27122\n27122\nAcetabuloplasty; resection, femoral head (eg, Girdlestone\nprocedure)\n$ 3,681.00\n1410\n27125\n27125\nHemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar\narthroplasty)\n$ 4,079.70\n1411\n27130\n27130\nArthroplasty, acetabular and proximal femoral prosthetic\nreplacement (total hip arthroplasty), with or without autograft or\nallograft\n$ 5,616.90\n1412\n27132\n27132\nConversion of previous hip surgery to total hip arthroplasty, with or\nwithout autograft or allograft\n$ 6,371.10\n1413\n27134\n27134\nRevision of total hip arthroplasty; both components, with or\nwithout autograft or allograft\n$ 8,532.18\n1414\n27137\n27137\nRevision of total hip arthroplasty; acetabular component only, with\nor without autograft or allograft\n$ 5,851.80\n1415\n27138\n27138\nRevision of total hip arthroplasty; femoral component only, with or\nwithout allograft\n$ 5,899.50\n1416\n27140\n27140\nOsteotomy and transfer of greater trochanter of femur (separate\nprocedure)\n$ 2,176.20\n1417\n27146\n27146\nOsteotomy, iliac, acetabular or innominate bone;\n$ 3,255.30\n1418\n27147\n27147\nOsteotomy, iliac, acetabular or innominate bone; with open\nreduction of hip\n$ 3,914.10\n1419\n27151\n27151\nOsteotomy, iliac, acetabular or innominate bone; with femoral\nosteotomy\n$ 3,619.80\n1420\n27156\n27156\nOsteotomy, iliac, acetabular or innominate bone; with femoral\nosteotomy and with open reduction of hip\n$ 4,401.00\n1421\n27158\n27158\nOsteotomy, pelvis, bilateral (eg, congenital malformation)\n$ 3,836.70\n1422\n27161\n27161\nOsteotomy, femoral neck (separate procedure)\n$ 3,132.00\n1423\n27165\n27165\nOsteotomy, intertrochanteric or subtrochanteric including internal\nor external fixation and\/or cast\n$ 3,549.60\n1424\n27170\n27170\nBone graft, femoral head, neck, intertrochanteric or subtrochanteric\narea (includes obtaining bone graft)\n$ 3,708.00\n1425\n27175\n27175\nTreatment of slipped femoral epiphysis; by traction, without\nreduction\n$ 1,855.80\n1426\n27176\n27176\nTreatment of slipped femoral epiphysis; by single or multiple\npinning, in situ\n$ 2,770.20\n1427\n27177\n27177\nOpen treatment of slipped femoral epiphysis; single or multiple\npinning or bone graft (includes obtaining graft)\n$ 3,270.60\n1428\n27178\n27178\nOpen treatment of slipped femoral epiphysis; closed manipulation\nwith single or multiple pinning\n$ 3,458.70\n1429\n27179\n27179\nOpen treatment of slipped femoral epiphysis; osteoplasty of\nfemoral neck (Heyman type procedure)\n$ 2,672.10\n1430\n27181\n27181\nOpen treatment of slipped femoral epiphysis; osteotomy and\ninternal fixation\n$ 3,789.90\n1431\n27185\n27185\nEpiphyseal arrest by epiphysiodesis or stapling, greater trochanter\nof femur\n$ 1,233.00\n1432\n27187\n27187\nProphylactic treatment (nailing, pinning, plating or wiring) with or\nwithout methylmethacrylate, femoral neck and proximal femur\n$ 4,241.70\n1433\n27193\n27193\nClosed treatment of pelvic ring fracture, dislocation, diastasis or\nsubluxation; without manipulation\n$ 1,030.50\n1434\n27194\n27194\nClosed treatment of pelvic ring fracture, dislocation, diastasis or\nsubluxation; with manipulation, requiring more than local\nanesthesia\n$ 1,568.70\n1435\n27200\n27200\nClosed treatment of coccygeal fracture\n$ 441.90\n1436\n27202\n27202\nOpen treatment of coccygeal fracture\n$ 897.30\n1437\n27215\n27215\nOpen treatment of iliac spine(s), tuberosity avulsion, or iliac wing\nfracture(s), unilateral, for pelvic bone fracture patterns that do not\ndisrupt the pelvic ring, includes internal fixation, when performed\n$ 2,472.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1438\n27216\n27216\nPercutaneous skeletal fixation of posterior pelvic bone fracture\nand\/or dislocation, for fracture patterns that disrupt the pelvic ring,\nunilateral (includes ipsilateral ilium, sacroiliac joint and\/or sacrum)\n$ 2,767.50\n1439\n27217\n27217\nOpen treatment of anterior pelvic bone fracture and\/or dislocation\nfor fracture patterns that disrupt the pelvic ring, unilateral, includes\ninternal fixation, when performed (includes pubic symphysis and\/or\nipsilateral superior\/inferior rami)\n$ 3,654.90\n1440\n27218\n27218\nOpen treatment of posterior pelvic bone fracture and\/or\ndislocation, for fracture patterns that disrupt the pelvic ring,\nunilateral, includes internal fixation, when performed (includes\nipsilateral ilium, sacroiliac joint and\/or sacrum)\n$ 4,345.20\n1441\n27220\n27220\nClosed treatment of acetabulum (hip socket) fracture(s); without\nmanipulation\n$ 896.40\n1442\n27222\n27222\nClosed treatment of acetabulum (hip socket) fracture(s); with\nmanipulation, with or without skeletal traction\n$ 1,599.30\n1443\n27226\n27226\nOpen treatment of posterior or anterior acetabular wall fracture,\nwith internal fixation\n$ 3,602.70\n1444\n27227\n27227\nOpen treatment of acetabular fracture(s) involving anterior or\nposterior (one) column, or a fracture running transversely across\nthe acetabulum, with internal fixation\n$ 6,057.90\n1445\n27228\n27228\nOpen treatment of acetabular fracture(s) involving anterior and\nposterior (two) columns, includes T-fracture and both column\nfracture with complete articular detachment, or single column or\ntransverse fracture with associated acetabular wall fracture, wit\n$ 6,196.50\n1446\n27230\n27230\nClosed treatment of femoral fracture, proximal end, neck; without\nmanipulation\n$ 1,077.30\n1447\n27232\n27232\nClosed treatment of femoral fracture, proximal end, neck; with\nmanipulation, with or without skeletal traction\n$ 1,769.40\n1448\n27235\n27235\nPercutaneous skeletal fixation of femoral fracture, proximal end,\nneck\n$ 3,135.60\n1449\n27236\n27236\nOpen treatment of femoral fracture, proximal end, neck, internal\nfixation or prosthetic replacement\n$ 3,712.50\n1450\n27238\n27238\nClosed treatment of intertrochanteric, peritrochanteric, or\nsubtrochanteric femoral fracture; without manipulation\n$ 1,142.10\n1451\n27240\n27240\nClosed treatment of intertrochanteric, peritrochanteric, or\nsubtrochanteric femoral fracture; with manipulation, with or\nwithout skin or skeletal traction\n$ 2,139.30\n1452\n27244\n27244\nTreatment of intertrochanteric, peritrochanteric, or subtrochanteric\nfemoral fracture; with plate\/screw type implant, with or without\ncerclage\n$ 3,339.00\n1453\n27245\n27245\nTreatment of intertrochanteric, peritrochanteric, or subtrochanteric\nfemoral fracture; with intramedullary implant, with or without\ninterlocking screws and\/or cerclage\n$ 3,947.40\n1454\n27246\n27246\nClosed treatment of greater trochanteric fracture, without\nmanipulation\n$ 903.60\n1455\n27248\n27248\nOpen treatment of greater trochanteric fracture, includes internal\nfixation, when performed\n$ 2,221.20\n1456\n27250\n27250\nClosed treatment of hip dislocation, traumatic; without anesthesia\n$ 764.10\n1457\n27252\n27252\nClosed treatment of hip dislocation, traumatic; requiring anesthesia\n$ 1,134.90\n1458\n27253\n27253\nOpen treatment of hip dislocation, traumatic, without internal\nfixation\n$ 2,451.60\n1459\n27254\n27254\nOpen treatment of hip dislocation, traumatic, with acetabular wall\nand femoral head fracture, with or without internal or external\nfixation\n$ 3,348.00\n1460\n27256\n27256\nTreatment of spontaneous hip dislocation (developmental,\nincluding congenital or pathological), by abduction, splint or\ntraction; without anesthesia, without manipulation\n$ 1,652.40\n1461\n27257\n27257\nTreatment of spontaneous hip dislocation (developmental,\nincluding congenital or pathological), by abduction, splint or\ntraction; with manipulation, requiring anesthesia\n$ 1,835.10\n1462\n27258\n27258\nOpen treatment of spontaneous hip dislocation (developmental,\nincluding congenital or pathological), replacement of femoral head\nin acetabulum (including tenotomy, etc);\n$ 2,468.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1463\n27259\n27259\nOpen treatment of spontaneous hip dislocation (developmental,\nincluding congenital or pathological), replacement of femoral head\nin acetabulum (including tenotomy, etc); with femoral shaft\nshortening\n$ 2,904.30\n1464\n27265\n27265\nClosed treatment of post hip arthroplasty dislocation; without\nanesthesia\n$ 772.20\n1465\n27266\n27266\nClosed treatment of post hip arthroplasty dislocation; requiring\nregional or general anesthesia\n$ 1,535.40\n1466\n27267\n27267\nClosed treatment of femoral fracture, proximal end, head; without\nmanipulation\n$ 864.17\n1467\n27268\n27268\nClosed treatment of femoral fracture, proximal end, head; with\nmanipulation\n$ 1,109.74\n1468\n27269\n27269\nOpen treatment of femoral fracture, proximal end, head, includes\ninternal fixation, when performed\n$ 2,878.69\n1469\n27275\n27275\nManipulation, hip joint, requiring general anesthesia\n$ 505.80\n1470\n27280\n27280\nArthrodesis, sacroiliac joint (including obtaining graft)\n$ 2,464.20\n1471\n27282\n27282\nArthrodesis, symphysis pubis (including obtaining graft)\n$ 2,461.50\n1472\n27284\n27284\nArthrodesis, hip joint (including obtaining graft);\n$ 4,975.20\n1473\n27286\n27286\nArthrodesis, hip joint (including obtaining graft); with\nsubtrochanteric osteotomy\n$ 4,097.70\n1474\n27290\n27290\nInterpelviabdominal amputation (hindquarter amputation)\n$ 5,978.70\n1475\n27295\n27295\nDisarticulation of hip\n$ 4,355.10\n1476\n27299\n27299\nUnlisted procedure, pelvis or hip joint\nCost\n1477\n27301\n27301\nIncision and drainage, deep abscess, bursa, or hematoma, thigh or\nknee region\n$ 832.94\n1478\n27303\n27303\nIncision, deep, with opening of bone cortex, femur or knee (eg,\nosteomyelitis or bone abscess)\n$ 1,818.00\n1479\n27305\n27305\nFasciotomy, iliotibial (tenotomy), open\n$ 1,055.70\n1480\n27306\n27306\nTenotomy, percutaneous, adductor or hamstring; single tendon\n(separate procedure)\n$ 681.30\n1481\n27307\n27307\nTenotomy, percutaneous, adductor or hamstring; multiple tendons\n$ 1,024.20\n1482\n27310\n27310\nArthrotomy, knee, with exploration, drainage, or removal of foreign\nbody (eg, infection)\n$ 1,787.40\n1483\n27323\n27323\nBiopsy, soft tissue of thigh or knee area; superficial\n$ 360.90\n1484\n27324\n27324\nBiopsy, soft tissue of thigh or knee area; deep (subfascial or\nintramuscular)\n$ 807.30\n1485\n27325\n27325\nNeurectomy, hamstring muscle\n$ 1,757.66\n1486\n27326\n27326\nNeurectomy, popliteal (gastrocnemius)\n$ 1,605.75\n1487\n27327\n27327\nExcision, tumor, soft tissue of thigh or knee area, subcutaneous; less\nthan 3 cm\n$ 720.00\n1488\n27328\n27328\nExcision, tumor, soft tissue of thigh or knee area, subfascial (eg,\nintramuscular); less than 5 cm\n$ 1,256.40\n1489\n27329\n27329\nRadical resection of tumor (eg, sarcoma), soft tissue of thigh or\nknee area; less than 5 cm\n$ 2,625.30\n1490\n27330\n27330\nArthrotomy, knee; with synovial biopsy only\n$ 2,022.30\n1491\n27331\n27331\nArthrotomy, knee; including joint exploration, biopsy, or removal of\nloose or foreign bodies\n$ 1,806.30\n1492\n27332\n27332\nArthrotomy, with excision of semilunar cartilage (meniscectomy)\nknee; medial OR lateral\n$ 2,399.40\n1493\n27333\n27333\nArthrotomy, with excision of semilunar cartilage (meniscectomy)\nknee; medial AND lateral\n$ 3,174.14\n1494\n27334\n27334\nArthrotomy, with synovectomy, knee; anterior OR posterior\n$ 2,421.00\n1495\n27335\n27335\nArthrotomy, with synovectomy, knee; anterior AND posterior\nincluding popliteal area\n$ 2,895.30\n1496\n27337\n27337\nExcision, tumor, soft tissue of thigh or knee area, subcutaneous; 3\ncm or greater\n$ 1,376.91\n1497\n27339\n27339\nExcision, tumor, soft tissue of thigh or knee area, subfascial (eg,\nintramuscular); 5 cm or greater\n$ 2,414.25\n1498\n27340\n27340\nExcision, prepatellar bursa\n$ 1,103.40\n1499\n27345\n27345\nExcision of synovial cyst of popliteal space (eg, Baker's cyst)\n$ 1,524.60\n1500\n27347\n27347\nExcision of lesion of meniscus or capsule (eg, cyst, ganglion), knee\n$ 784.80\n1501\n27350\n27350\nPatellectomy or hemipatellectomy\n$ 2,124.00\n1502\n27355\n27355\nExcision or curettage of bone cyst or benign tumor of femur;\n$ 1,802.70\n1503\n27356\n27356\nExcision or curettage of bone cyst or benign tumor of femur; with\nallograft\n$ 2,199.60\n1504\n27357\n27357\nExcision or curettage of bone cyst or benign tumor of femur; with\nautograft (includes obtaining graft)\n$ 2,436.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1505\n27358\n27358\nExcision or curettage of bone cyst or benign tumor of femur; with\ninternal fixation (List in addition to code for primary procedure)\n$ 2,508.30\n1506\n27360\n27360\nPartial excision (craterization, saucerization, or diaphysectomy)\nbone, femur, proximal tibia and\/or fibula (eg, osteomyelitis or bone\nabscess)\n$ 1,926.90\n1507\n27364\n27364\nRadical resection of tumor (eg, sarcoma), soft tissue of thigh or\nknee area; 5 cm or greater\n$ 4,912.84\n1508\n27365\n27365\nRadical resection of tumor, femur or knee\n$ 3,127.50\n1509\n27370\n27370\nInjection procedure for knee arthrography\n$ 197.10\n1510\n27372\n27372\nRemoval of foreign body, deep, thigh region or knee area\n$ 955.80\n1511\n27380\n27380\nSuture of infrapatellar tendon; primary\n$ 1,602.00\n1512\n27381\n27381\nSuture of infrapatellar tendon; secondary reconstruction, including\nfascial or tendon graft\n$ 2,480.40\n1513\n27385\n27385\nSuture of quadriceps or hamstring muscle rupture; primary\n$ 1,827.90\n1514\n27386\n27386\nSuture of quadriceps or hamstring muscle rupture; secondary\nreconstruction, including fascial or tendon graft\n$ 2,734.20\n1515\n27390\n27390\nTenotomy, open, hamstring, knee to hip; single tendon\n$ 1,061.10\n1516\n27391\n27391\nTenotomy, open, hamstring, knee to hip; multiple tendons, 1 leg\n$ 1,390.50\n1517\n27392\n27392\nTenotomy, open, hamstring, knee to hip; multiple tendons, bilateral\n$ 2,008.80\n1518\n27393\n27393\nLengthening of hamstring tendon; single tendon\n$ 1,071.00\n1519\n27394\n27394\nLengthening of hamstring tendon; multiple tendons, 1 leg\n$ 1,632.60\n1520\n27395\n27395\nLengthening of hamstring tendon; multiple tendons, bilateral\n$ 2,038.50\n1521\n27396\n27396\nTransplant or transfer (with muscle redirection or rerouting), thigh\n(eg, extensor to flexor); single tendon\n$ 2,131.20\n1522\n27397\n27397\nTransplant or transfer (with muscle redirection or rerouting), thigh\n(eg, extensor to flexor); multiple tendons\n$ 2,707.20\n1523\n27400\n27400\nTransfer, tendon or muscle, hamstrings to femur (eg, Egger's type\nprocedure)\n$ 1,980.00\n1524\n27403\n27403\nArthrotomy with meniscus repair, knee\n$ 2,745.00\n1525\n27405\n27405\nRepair, primary, torn ligament and\/or capsule, knee; collateral\n$ 2,272.50\n1526\n27407\n27407\nRepair, primary, torn ligament and\/or capsule, knee; cruciate\n$ 3,190.50\n1527\n27409\n27409\nRepair, primary, torn ligament and\/or capsule, knee; collateral and\ncruciate ligaments\n$ 3,634.20\n1528\n27412\n27412\nAutologous chondrocyte implantation, knee\n$ 5,606.85\n1529\n27415\n27415\nOsteochondral allograft, knee, open\n$ 4,366.31\n1530\n27416\n27416\nOsteochondral autograft(s), knee, open (eg, mosaicplasty) (includes\nharvesting of autograft[s])\n$ 2,968.11\n1531\n27418\n27418\nAnterior tibial tubercleplasty (eg, Maquet type procedure)\n$ 3,002.40\n1532\n27420\n27420\nReconstruction of dislocating patella; (eg, Hauser type procedure)\n$ 2,293.20\n1533\n27422\n27422\nReconstruction of dislocating patella; with extensor realignment\nand\/or muscle advancement or release (eg, Campbell, Goldwaite\ntype procedure)\n$ 2,475.00\n1534\n27424\n27424\nReconstruction of dislocating patella; with patellectomy\n$ 2,765.70\n1535\n27425\n27425\nLateral retinacular release, open\n$ 2,367.00\n1536\n27427\n27427\nLigamentous reconstruction (augmentation), knee; extra-articular\n$ 3,698.10\n1537\n27428\n27428\nLigamentous reconstruction (augmentation), knee; intra-articular\n(open)\n$ 3,715.20\n1538\n27429\n27429\nLigamentous reconstruction (augmentation), knee; intra-articular\n(open) and extra-articular\n$ 4,960.80\n1539\n27430\n27430\nQuadricepsplasty (eg, Bennett or Thompson type)\n$ 2,210.40\n1540\n27435\n27435\nCapsulotomy, posterior capsular release, knee\n$ 2,236.50\n1541\n27437\n27437\nArthroplasty, patella; without prosthesis\n$ 2,274.30\n1542\n27438\n27438\nArthroplasty, patella; with prosthesis\n$ 2,720.70\n1543\n27440\n27440\nArthroplasty, knee, tibial plateau;\n$ 3,292.20\n1544\n27441\n27441\nArthroplasty, knee, tibial plateau; with debridement and partial\nsynovectomy\n$ 3,002.40\n1545\n27442\n27442\nArthroplasty, femoral condyles or tibial plateau(s), knee;\n$ 3,510.00\n1546\n27443\n27443\nArthroplasty, femoral condyles or tibial plateau(s), knee; with\ndebridement and partial synovectomy\n$ 3,554.10\n1547\n27445\n27445\nArthroplasty, knee, hinge prosthesis (eg, Walldius type)\n$ 4,499.10\n1548\n27446\n27446\nArthroplasty, knee, condyle and plateau; medial OR lateral\ncompartment\n$ 4,126.63\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1549\n27447\n27447\nArthroplasty, knee, condyle and plateau; medial AND lateral\ncompartments with or without patella resurfacing (total knee\narthroplasty)\n$ 5,226.12\n1550\n27448\n27448\nOsteotomy, femur, shaft or supracondylar; without fixation\n$ 2,877.30\n1551\n27450\n27450\nOsteotomy, femur, shaft or supracondylar; with fixation\n$ 2,826.90\n1552\n27454\n27454\nOsteotomy, multiple, with realignment on intramedullary rod,\nfemoral shaft (eg, Sofield type procedure)\n$ 3,295.80\n1553\n27455\n27455\nOsteotomy, proximal tibia, including fibular excision or osteotomy\n(includes correction of genu varus [bowleg] or genu valgus [knock-\nknee]); before epiphyseal closure\n$ 2,394.90\n1554\n27457\n27457\nOsteotomy, proximal tibia, including fibular excision or osteotomy\n(includes correction of genu varus [bowleg] or genu valgus [knock-\nknee]); after epiphyseal closure\n$ 2,886.30\n1555\n27465\n27465\nOsteoplasty, femur; shortening (excluding 64876)\n$ 3,267.90\n1556\n27466\n27466\nOsteoplasty, femur; lengthening\n$ 3,707.10\n1557\n27468\n27468\nOsteoplasty, femur; combined, lengthening and shortening with\nfemoral segment transfer\n$ 4,853.70\n1558\n27470\n27470\nRepair, nonunion or malunion, femur, distal to head and neck;\nwithout graft (eg, compression technique)\n$ 3,579.30\n1559\n27472\n27472\nRepair, nonunion or malunion, femur, distal to head and neck; with\niliac or other autogenous bone graft (includes obtaining graft)\n$ 4,050.00\n1560\n27475\n27475\nArrest, epiphyseal, any method (eg, epiphysiodesis); distal femur\n$ 2,453.40\n1561\n27477\n27477\nArrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula,\nproximal\n$ 2,636.10\n1562\n27479\n27479\nArrest, epiphyseal, any method (eg, epiphysiodesis); combined\ndistal femur, proximal tibia and fibula\n$ 3,160.80\n1563\n27485\n27485\nArrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg,\ngenu varus or valgus)\n$ 1,805.40\n1564\n27486\n27486\nRevision of total knee arthroplasty, with or without allograft; 1\ncomponent\n$ 5,175.90\n1565\n27487\n27487\nRevision of total knee arthroplasty, with or without allograft;\nfemoral and entire tibial component\n$ 6,452.10\n1566\n27488\n27488\nRemoval of prosthesis, including total knee prosthesis,\nmethylmethacrylate with or without insertion of spacer, knee\n$ 3,144.60\n1567\n27495\n27495\nProphylactic treatment (nailing, pinning, plating, or wiring) with or\nwithout methylmethacrylate, femur\n$ 3,450.60\n1568\n27496\n27496\nDecompression fasciotomy, thigh and\/or knee, 1 compartment\n(flexor or extensor or adductor);\n$ 1,184.40\n1569\n27497\n27497\nDecompression fasciotomy, thigh and\/or knee, 1 compartment\n(flexor or extensor or adductor); with debridement of nonviable\nmuscle and\/or nerve\n$ 1,555.20\n1570\n27498\n27498\nDecompression fasciotomy, thigh and\/or knee, multiple\ncompartments;\n$ 2,394.90\n1571\n27499\n27499\nDecompression fasciotomy, thigh and\/or knee, multiple\ncompartments; with debridement of nonviable muscle and\/or nerve $ 2,421.00\n1572\n27500\n27500\nClosed treatment of femoral shaft fracture, without manipulation\n$ 1,207.80\n1573\n27501\n27501\nClosed treatment of supracondylar or transcondylar femoral\nfracture with or without intercondylar extension, without\nmanipulation\n$ 1,495.80\n1574\n27502\n27502\nClosed treatment of femoral shaft fracture, with manipulation, with\nor without skin or skeletal traction\n$ 1,648.80\n1575\n27503\n27503\nClosed treatment of supracondylar or transcondylar femoral\nfracture with or without intercondylar extension, with\nmanipulation, with or without skin or skeletal traction\n$ 2,035.80\n1576\n27506\n27506\nOpen treatment of femoral shaft fracture, with or without external\nfixation, with insertion of intramedullary implant, with or without\ncerclage and\/or locking screws\n$ 3,828.60\n1577\n27507\n27507\nOpen treatment of femoral shaft fracture with plate\/screws, with or\nwithout cerclage\n$ 3,386.70\n1578\n27508\n27508\nClosed treatment of femoral fracture, distal end, medial or lateral\ncondyle, without manipulation\n$ 1,017.00\n1579\n27509\n27509\nPercutaneous skeletal fixation of femoral fracture, distal end,\nmedial or lateral condyle, or supracondylar or transcondylar, with or\nwithout intercondylar extension, or distal femoral epiphyseal\nseparation\n$ 1,913.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1580\n27510\n27510\nClosed treatment of femoral fracture, distal end, medial or lateral\ncondyle, with manipulation\n$ 1,447.20\n1581\n27511\n27511\nOpen treatment of femoral supracondylar or transcondylar fracture\nwithout intercondylar extension, includes internal fixation, when\nperformed\n$ 3,213.90\n1582\n27513\n27513\nOpen treatment of femoral supracondylar or transcondylar fracture\nwith intercondylar extension, includes internal fixation, when\nperformed\n$ 3,411.90\n1583\n27514\n27514\nOpen treatment of femoral fracture, distal end, medial or lateral\ncondyle, includes internal fixation, when performed\n$ 3,283.20\n1584\n27516\n27516\nClosed treatment of distal femoral epiphyseal separation; without\nmanipulation\n$ 1,274.40\n1585\n27517\n27517\nClosed treatment of distal femoral epiphyseal separation; with\nmanipulation, with or without skin or skeletal traction\n$ 1,467.90\n1586\n27519\n27519\nOpen treatment of distal femoral epiphyseal separation, includes\ninternal fixation, when performed\n$ 3,119.40\n1587\n27520\n27520\nClosed treatment of patellar fracture, without manipulation\n$ 578.70\n1588\n27524\n27524\nOpen treatment of patellar fracture, with internal fixation and\/or\npartial or complete patellectomy and soft tissue repair\n$ 2,121.30\n1589\n27530\n27530\nClosed treatment of tibial fracture, proximal (plateau); without\nmanipulation\n$ 852.30\n1590\n27532\n27532\nClosed treatment of tibial fracture, proximal (plateau); with or\nwithout manipulation, with skeletal traction\n$ 1,169.10\n1591\n27535\n27535\nOpen treatment of tibial fracture, proximal (plateau); unicondylar,\nincludes internal fixation, when performed\n$ 2,665.80\n1592\n27536\n27536\nOpen treatment of tibial fracture, proximal (plateau); bicondylar,\nwith or without internal fixation\n$ 2,615.40\n1593\n27538\n27538\nClosed treatment of intercondylar spine(s) and\/or tuberosity\nfracture(s) of knee, with or without manipulation\n$ 950.40\n1594\n27540\n27540\nOpen treatment of intercondylar spine(s) and\/or tuberosity\nfracture(s) of the knee, includes internal fixation, when performed\n$ 2,468.70\n1595\n27550\n27550\nClosed treatment of knee dislocation; without anesthesia\n$ 669.60\n1596\n27552\n27552\nClosed treatment of knee dislocation; requiring anesthesia\n$ 1,050.30\n1597\n27556\n27556\nOpen treatment of knee dislocation, includes internal fixation, when\nperformed; without primary ligamentous repair or\naugmentation\/reconstruction\n$ 2,856.60\n1598\n27557\n27557\nOpen treatment of knee dislocation, includes internal fixation, when\nperformed; with primary ligamentous repair\n$ 3,537.90\n1599\n27558\n27558\nOpen treatment of knee dislocation, includes internal fixation, when\nperformed; with primary ligamentous repair, with\naugmentation\/reconstruction\n$ 3,331.80\n1600\n27560\n27560\nClosed treatment of patellar dislocation; without anesthesia\n$ 461.70\n1601\n27562\n27562\nClosed treatment of patellar dislocation; requiring anesthesia\n$ 789.30\n1602\n27566\n27566\nOpen treatment of patellar dislocation, with or without partial or\ntotal patellectomy\n$ 2,060.10\n1603\n27570\n27570\nManipulation of knee joint under general anesthesia (includes\napplication of traction or other fixation devices)\n$ 529.96\n1604\n27580\n27580\nArthrodesis, knee, any technique\n$ 3,822.30\n1605\n27590\n27590\nAmputation, thigh, through femur, any level;\n$ 2,446.20\n1606\n27591\n27591\nAmputation, thigh, through femur, any level; immediate fitting\ntechnique including first cast\n$ 2,583.00\n1607\n27592\n27592\nAmputation, thigh, through femur, any level; open, circular\n(guillotine)\n$ 2,543.40\n1608\n27594\n27594\nAmputation, thigh, through femur, any level; secondary closure or\nscar revision\n$ 1,235.70\n1609\n27596\n27596\nAmputation, thigh, through femur, any level; re-amputation\n$ 2,379.60\n1610\n27598\n27598\nDisarticulation at knee\n$ 2,443.50\n1611\n27599\n27599\nUnlisted procedure, femur or knee\nCost\n1612\n27600\n27600\nDecompression fasciotomy, leg; anterior and\/or lateral\ncompartments only\n$ 991.80\n1613\n27601\n27601\nDecompression fasciotomy, leg; posterior compartment(s) only\n$ 1,097.10\n1614\n27602\n27602\nDecompression fasciotomy, leg; anterior and\/or lateral, and\nposterior compartment(s)\n$ 1,403.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1615\n27603\n27603\nIncision and drainage, leg or ankle; deep abscess or hematoma\n$ 799.29\n1616\n27604\n27604\nIncision and drainage, leg or ankle; infected bursa\n$ 529.20\n1617\n27605\n27605\nTenotomy, percutaneous, Achilles tendon (separate procedure);\nlocal anesthesia\n$ 489.60\n1618\n27606\n27606\nTenotomy, percutaneous, Achilles tendon (separate procedure);\ngeneral anesthesia\n$ 918.90\n1619\n27607\n27607\nIncision (eg, osteomyelitis or bone abscess), leg or ankle\n$ 1,390.50\n1620\n27610\n27610\nArthrotomy, ankle, including exploration, drainage, or removal of\nforeign body\n$ 1,504.80\n1621\n27612\n27612\nArthrotomy, posterior capsular release, ankle, with or without\nAchilles tendon lengthening\n$ 1,591.20\n1622\n27613\n27613\nBiopsy, soft tissue of leg or ankle area; superficial\n$ 421.20\n1623\n27614\n27614\nBiopsy, soft tissue of leg or ankle area; deep (subfascial or\nintramuscular)\n$ 842.40\n1624\n27615\n27615\nRadical resection of tumor (eg, sarcoma), soft tissue of leg or ankle\narea; less than 5 cm\n$ 2,870.10\n1625\n27616\n27616\nRadical resection of tumor (eg, sarcoma), soft tissue of leg or ankle\narea; 5 cm or greater\n$ 3,296.27\n1626\n27618\n27618\nExcision, tumor, soft tissue of leg or ankle area, subcutaneous; less\nthan 3 cm\n$ 846.00\n1627\n27619\n27619\nExcision, tumor, soft tissue of leg or ankle area, subfascial (eg,\nintramuscular); less than 5 cm\n$ 1,333.80\n1628\n27620\n27620\nArthrotomy, ankle, with joint exploration, with or without biopsy,\nwith or without removal of loose or foreign body\n$ 1,577.70\n1629\n27625\n27625\nArthrotomy, with synovectomy, ankle;\n$ 2,103.30\n1630\n27626\n27626\nArthrotomy, with synovectomy, ankle; including tenosynovectomy\n$ 2,202.30\n1631\n27630\n27630\nExcision of lesion of tendon sheath or capsule (eg, cyst or ganglion),\nleg and\/or ankle\n$ 867.60\n1632\n27632\n27632\nExcision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm\nor greater\n$ 802.95\n1633\n27634\n27634\nExcision, tumor, soft tissue of leg or ankle area, subfascial (eg,\nintramuscular); 5 cm or greater\n$ 1,801.95\n1634\n27635\n27635\nExcision or curettage of bone cyst or benign tumor, tibia or fibula;\n$ 1,979.10\n1635\n27637\n27637\nExcision or curettage of bone cyst or benign tumor, tibia or fibula;\nwith autograft (includes obtaining graft)\n$ 2,095.20\n1636\n27638\n27638\nExcision or curettage of bone cyst or benign tumor, tibia or fibula;\nwith allograft\n$ 2,301.30\n1637\n27640\n27640\nPartial excision (craterization, saucerization, or diaphysectomy),\nbone (eg, osteomyelitis); tibia\n$ 2,338.20\n1638\n27641\n27641\nPartial excision (craterization, saucerization, or diaphysectomy),\nbone (eg, osteomyelitis); fibula\n$ 1,883.70\n1639\n27645\n27645\nRadical resection of tumor; tibia\n$ 2,884.50\n1640\n27646\n27646\nRadical resection of tumor; fibula\n$ 2,287.80\n1641\n27647\n27647\nRadical resection of tumor; talus or calcaneus\n$ 2,766.60\n1642\n27648\n27648\nInjection procedure for ankle arthrography\n$ 187.20\n1643\n27650\n27650\nRepair, primary, open or percutaneous, ruptured Achilles tendon;\n$ 1,908.66\n1644\n27652\n27652\nRepair, primary, open or percutaneous, ruptured Achilles tendon;\nwith graft (includes obtaining graft)\n$ 2,335.50\n1645\n27654\n27654\nRepair, secondary, Achilles tendon, with or without graft\n$ 2,672.10\n1646\n27656\n27656\nRepair, fascial defect of leg\n$ 1,035.90\n1647\n27658\n27658\nRepair, flexor tendon, leg; primary, without graft, each tendon\n$ 1,115.10\n1648\n27659\n27659\nRepair, flexor tendon, leg; secondary, with or without graft, each\ntendon\n$ 1,606.50\n1649\n27664\n27664\nRepair, extensor tendon, leg; primary, without graft, each tendon\n$ 1,085.40\n1650\n27665\n27665\nRepair, extensor tendon, leg; secondary, with or without graft, each\ntendon\n$ 1,157.40\n1651\n27675\n27675\nRepair, dislocating peroneal tendons; without fibular osteotomy\n$ 1,295.10\n1652\n27676\n27676\nRepair, dislocating peroneal tendons; with fibular osteotomy\n$ 1,339.20\n1653\n27680\n27680\nTenolysis, flexor or extensor tendon, leg and\/or ankle; single, each\ntendon\n$ 1,331.10\n1654\n27681\n27681\nTenolysis, flexor or extensor tendon, leg and\/or ankle; multiple\ntendons (through separate incision(s))\n$ 1,042.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1655\n27685\n27685\nLengthening or shortening of tendon, leg or ankle; single tendon\n(separate procedure)\n$ 1,200.60\n1656\n27686\n27686\nLengthening or shortening of tendon, leg or ankle; multiple tendons\n(through same incision), each\n$ 1,363.50\n1657\n27687\n27687\nGastrocnemius recession (eg, Strayer procedure)\n$ 1,171.80\n1658\n27690\n27690\nTransfer or transplant of single tendon (with muscle redirection or\nrerouting); superficial (eg, anterior tibial extensors into midfoot)\n$ 1,647.90\n1659\n27691\n27691\nTransfer or transplant of single tendon (with muscle redirection or\nrerouting); deep (eg, anterior tibial or posterior tibial through\ninterosseous space, flexor digitorum longus, flexor hallucis longus,\nor peroneal tendon to midfoot or hindfoot)\n$ 1,859.40\n1660\n27692\n27692\nTransfer or transplant of single tendon (with muscle redirection or\nrerouting); each additional tendon (List separately in addition to\ncode for primary procedure)\n$ 544.50\n1661\n27695\n27695\nRepair, primary, disrupted ligament, ankle; collateral\n$ 1,703.70\n1662\n27696\n27696\nRepair, primary, disrupted ligament, ankle; both collateral ligaments $ 2,338.20\n1663\n27698\n27698\nRepair, secondary, disrupted ligament, ankle, collateral (eg, Watson-\nJones procedure)\n$ 2,367.00\n1664\n27700\n27700\nArthroplasty, ankle;\n$ 2,807.10\n1665\n27702\n27702\nArthroplasty, ankle; with implant (total ankle)\n$ 4,042.80\n1666\n27703\n27703\nArthroplasty, ankle; revision, total ankle\n$ 3,919.50\n1667\n27704\n27704\nRemoval of ankle implant\n$ 2,137.50\n1668\n27705\n27705\nOsteotomy; tibia\n$ 2,241.00\n1669\n27707\n27707\nOsteotomy; fibula\n$ 1,283.40\n1670\n27709\n27709\nOsteotomy; tibia and fibula\n$ 2,755.80\n1671\n27712\n27712\nOsteotomy; multiple, with realignment on intramedullary rod (eg,\nSofield type procedure)\n$ 2,601.00\n1672\n27715\n27715\nOsteoplasty, tibia and fibula, lengthening or shortening\n$ 3,445.20\n1673\n27720\n27720\nRepair of nonunion or malunion, tibia; without graft, (eg,\ncompression technique)\n$ 2,987.10\n1674\n27722\n27722\nRepair of nonunion or malunion, tibia; with sliding graft\n$ 3,027.60\n1675\n27724\n27724\nRepair of nonunion or malunion, tibia; with iliac or other autograft\n(includes obtaining graft)\n$ 3,375.90\n1676\n27725\n27725\nRepair of nonunion or malunion, tibia; by synostosis, with fibula,\nany method\n$ 3,711.60\n1677\n27726\n27726\nRepair of fibula nonunion and\/or malunion with internal fixation\n$ 2,950.61\n1678\n27727\n27727\nRepair of congenital pseudarthrosis, tibia\n$ 2,699.10\n1679\n27730\n27730\nArrest, epiphyseal (epiphysiodesis), open; distal tibia\n$ 1,624.50\n1680\n27732\n27732\nArrest, epiphyseal (epiphysiodesis), open; distal fibula\n$ 1,235.70\n1681\n27734\n27734\nArrest, epiphyseal (epiphysiodesis), open; distal tibia and fibula\n$ 1,830.60\n1682\n27740\n27740\nArrest, epiphyseal (epiphysiodesis), any method, combined,\nproximal and distal tibia and fibula;\n$ 2,415.60\n1683\n27742\n27742\nArrest, epiphyseal (epiphysiodesis), any method, combined,\nproximal and distal tibia and fibula; and distal femur\n$ 3,129.30\n1684\n27745\n27745\nProphylactic treatment (nailing, pinning, plating or wiring) with or\nwithout methylmethacrylate, tibia\n$ 2,493.00\n1685\n27750\n27750\nClosed treatment of tibial shaft fracture (with or without fibular\nfracture); without manipulation\n$ 702.97\n1686\n27752\n27752\nClosed treatment of tibial shaft fracture (with or without fibular\nfracture); with manipulation, with or without skeletal traction\n$ 1,081.80\n1687\n27756\n27756\nPercutaneous skeletal fixation of tibial shaft fracture (with or\nwithout fibular fracture) (eg, pins or screws)\n$ 2,086.20\n1688\n27758\n27758\nOpen treatment of tibial shaft fracture (with or without fibular\nfracture), with plate\/screws, with or without cerclage\n$ 2,968.20\n1689\n27759\n27759\nTreatment of tibial shaft fracture (with or without fibular fracture)\nby intramedullary implant, with or without interlocking screws\nand\/or cerclage\n$ 3,328.20\n1690\n27760\n27760\nClosed treatment of medial malleolus fracture; without\nmanipulation\n$ 503.10\n1691\n27762\n27762\nClosed treatment of medial malleolus fracture; with manipulation,\nwith or without skin or skeletal traction\n$ 824.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1692\n27766\n27766\nOpen treatment of medial malleolus fracture, includes internal\nfixation, when performed\n$ 1,553.40\n1693\n27767\n27767\nClosed treatment of posterior malleolus fracture; without\nmanipulation\n$ 548.09\n1694\n27768\n27768\nClosed treatment of posterior malleolus fracture; with manipulation $ 868.53\n1695\n27769\n27769\nOpen treatment of posterior malleolus fracture, includes internal\nfixation, when performed\n$ 1,707.43\n1696\n27780\n27780\nClosed treatment of proximal fibula or shaft fracture; without\nmanipulation\n$ 562.50\n1697\n27781\n27781\nClosed treatment of proximal fibula or shaft fracture; with\nmanipulation\n$ 893.70\n1698\n27784\n27784\nOpen treatment of proximal fibula or shaft fracture, includes\ninternal fixation, when performed\n$ 1,605.60\n1699\n27786\n27786\nClosed treatment of distal fibular fracture (lateral malleolus);\nwithout manipulation\n$ 463.50\n1700\n27788\n27788\nClosed treatment of distal fibular fracture (lateral malleolus); with\nmanipulation\n$ 818.10\n1701\n27792\n27792\nOpen treatment of distal fibular fracture (lateral malleolus),\nincludes internal fixation, when performed\n$ 1,539.90\n1702\n27808\n27808\nClosed treatment of bimalleolar ankle fracture (eg, lateral and\nmedial malleoli, or lateral and posterior malleoli, or medial and\nposterior malleoli); without manipulation\n$ 643.50\n1703\n27810\n27810\nClosed treatment of bimalleolar ankle fracture (eg, lateral and\nmedial malleoli, or lateral and posterior malleoli, or medial and\nposterior malleoli); with manipulation\n$ 1,189.80\n1704\n27814\n27814\nOpen treatment of bimalleolar ankle fracture (eg, lateral and medial\nmalleoli, or lateral and posterior malleoli, or medial and posterior\nmalleoli), includes internal fixation, when performed\n$ 2,196.90\n1705\n27816\n27816\nClosed treatment of trimalleolar ankle fracture; without\nmanipulation\n$ 842.40\n1706\n27818\n27818\nClosed treatment of trimalleolar ankle fracture; with manipulation\n$ 1,312.20\n1707\n27822\n27822\nOpen treatment of trimalleolar ankle fracture, includes internal\nfixation, when performed, medial and\/or lateral malleolus; without\nfixation of posterior lip\n$ 2,358.90\n1708\n27823\n27823\nOpen treatment of trimalleolar ankle fracture, includes internal\nfixation, when performed, medial and\/or lateral malleolus; with\nfixation of posterior lip\n$ 2,880.90\n1709\n27824\n27824\nClosed treatment of fracture of weight bearing articular portion of\ndistal tibia (eg, pilon or tibial plafond), with or without anesthesia;\nwithout manipulation\n$ 813.60\n1710\n27825\n27825\nClosed treatment of fracture of weight bearing articular portion of\ndistal tibia (eg, pilon or tibial plafond), with or without anesthesia;\nwith skeletal traction and\/or requiring manipulation\n$ 1,673.10\n1711\n27826\n27826\nOpen treatment of fracture of weight bearing articular\nsurface\/portion of distal tibia (eg, pilon or tibial plafond), with\ninternal fixation, when performed; of fibula only\n$ 2,421.00\n1712\n27827\n27827\nOpen treatment of fracture of weight bearing articular\nsurface\/portion of distal tibia (eg, pilon or tibial plafond), with\ninternal fixation, when performed; of tibia only\n$ 2,786.40\n1713\n27828\n27828\nOpen treatment of fracture of weight bearing articular\nsurface\/portion of distal tibia (eg, pilon or tibial plafond), with\ninternal fixation, when performed; of both tibia and fibula\n$ 3,352.50\n1714\n27829\n27829\nOpen treatment of distal tibiofibular joint (syndesmosis) disruption,\nincludes internal fixation, when performed\n$ 1,629.90\n1715\n27830\n27830\nClosed treatment of proximal tibiofibular joint dislocation; without\nanesthesia\n$ 607.50\n1716\n27831\n27831\nClosed treatment of proximal tibiofibular joint dislocation; requiring\nanesthesia\n$ 695.70\n1717\n27832\n27832\nOpen treatment of proximal tibiofibular joint dislocation, includes\ninternal fixation, when performed, or with excision of proximal\nfibula\n$ 1,254.60\n1718\n27840\n27840\nClosed treatment of ankle dislocation; without anesthesia\n$ 537.30\n1719\n27842\n27842\nClosed treatment of ankle dislocation; requiring anesthesia, with or\nwithout percutaneous skeletal fixation\n$ 761.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1720\n27846\n27846\nOpen treatment of ankle dislocation, with or without percutaneous\nskeletal fixation; without repair or internal fixation\n$ 1,946.70\n1721\n27848\n27848\nOpen treatment of ankle dislocation, with or without percutaneous\nskeletal fixation; with repair or internal or external fixation\n$ 2,139.30\n1722\n27860\n27860\nManipulation of ankle under general anesthesia (includes\napplication of traction or other fixation apparatus)\n$ 425.70\n1723\n27870\n27870\nArthrodesis, ankle, open\n$ 2,708.10\n1724\n27871\n27871\nArthrodesis, tibiofibular joint, proximal or distal\n$ 2,174.40\n1725\n27880\n27880\nAmputation, leg, through tibia and fibula;\n$ 2,462.40\n1726\n27881\n27881\nAmputation, leg, through tibia and fibula; with immediate fitting\ntechnique including application of first cast\n$ 2,837.70\n1727\n27882\n27882\nAmputation, leg, through tibia and fibula; open, circular (guillotine)\n$ 2,366.10\n1728\n27884\n27884\nAmputation, leg, through tibia and fibula; secondary closure or scar\nrevision\n$ 1,488.60\n1729\n27886\n27886\nAmputation, leg, through tibia and fibula; re-amputation\n$ 2,375.10\n1730\n27888\n27888\nAmputation, ankle, through malleoli of tibia and fibula (eg, Syme,\nPirogoff type procedures), with plastic closure and resection of\nnerves\n$ 2,007.90\n1731\n27889\n27889\nAnkle disarticulation\n$ 1,886.40\n1732\n27892\n27892\nDecompression fasciotomy, leg; anterior and\/or lateral\ncompartments only, with debridement of nonviable muscle and\/or\nnerve\n$ 1,674.00\n1733\n27893\n27893\nDecompression fasciotomy, leg; posterior compartment(s) only,\nwith debridement of nonviable muscle and\/or nerve\n$ 1,622.70\n1734\n27894\n27894\nDecompression fasciotomy, leg; anterior and\/or lateral, and\nposterior compartment(s), with debridement of nonviable muscle\nand\/or nerve\n$ 1,946.70\n1735\n27899\n27899\nUnlisted procedure, leg or ankle\nCost\n1736\n28001\n28001\nIncision and drainage, bursa, foot\n$ 412.20\n1737\n28002\n28002\nIncision and drainage below fascia, with or without tendon sheath\ninvolvement, foot; single bursal space\n$ 779.40\n1738\n28003\n28003\nIncision and drainage below fascia, with or without tendon sheath\ninvolvement, foot; multiple areas\n$ 973.80\n1739\n28005\n28005\nIncision, bone cortex (eg, osteomyelitis or bone abscess), foot\n$ 991.80\n1740\n28008\n28008\nFasciotomy, foot and\/or toe\n$ 700.20\n1741\n28010\n28010\nTenotomy, percutaneous, toe; single tendon\n$ 425.70\n1742\n28011\n28011\nTenotomy, percutaneous, toe; multiple tendons\n$ 526.50\n1743\n28020\n28020\nArthrotomy, including exploration, drainage, or removal of loose or\nforeign body; intertarsal or tarsometatarsal joint\n$ 1,106.10\n1744\n28022\n28022\nArthrotomy, including exploration, drainage, or removal of loose or\nforeign body; metatarsophalangeal joint\n$ 725.40\n1745\n28024\n28024\nArthrotomy, including exploration, drainage, or removal of loose or\nforeign body; interphalangeal joint\n$ 669.60\n1746\n28035\n28035\nRelease, tarsal tunnel (posterior tibial nerve decompression)\n$ 1,653.30\n1747\n28039\n28039\nExcision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or\ngreater\n$ 805.26\n1748\n28041\n28041\nExcision, tumor, soft tissue of foot or toe, subfascial (eg,\nintramuscular); 1.5 cm or greater\n$ 941.09\n1749\n28043\n28043\nExcision, tumor, soft tissue of foot or toe, subcutaneous; less than\n1.5 cm\n$ 525.60\n1750\n28045\n28045\nExcision, tumor, soft tissue of foot or toe, subfascial (eg,\nintramuscular); less than 1.5 cm\n$ 1,077.30\n1751\n28046\n28046\nRadical resection of tumor (eg, sarcoma), soft tissue of foot or toe;\nless than 3 cm\n$ 1,923.30\n1752\n28047\n28047\nRadical resection of tumor (eg, sarcoma), soft tissue of foot or toe; 3\ncm or greater\n$ 1,845.03\n1753\n28050\n28050\nArthrotomy with biopsy; intertarsal or tarsometatarsal joint\n$ 1,000.80\n1754\n28052\n28052\nArthrotomy with biopsy; metatarsophalangeal joint\n$ 690.30\n1755\n28054\n28054\nArthrotomy with biopsy; interphalangeal joint\n$ 588.60\n1756\n28055\n28055\nNeurectomy, intrinsic musculature of foot\n$ 757.64\n1757\n28060\n28060\nFasciectomy, plantar fascia; partial (separate procedure)\n$ 1,038.60\n1758\n28062\n28062\nFasciectomy, plantar fascia; radical (separate procedure)\n$ 1,872.90\n1759\n28070\n28070\nSynovectomy; intertarsal or tarsometatarsal joint, each\n$ 1,097.10\n1760\n28072\n28072\nSynovectomy; metatarsophalangeal joint, each\n$ 727.20\n1761\n28080\n28080\nExcision, interdigital (Morton) neuroma, single, each\n$ 817.76\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1762\n28086\n28086\nSynovectomy, tendon sheath, foot; flexor\n$ 1,244.70\n1763\n28088\n28088\nSynovectomy, tendon sheath, foot; extensor\n$ 873.90\n1764\n28090\n28090\nExcision of lesion, tendon, tendon sheath, or capsule (including\nsynovectomy) (eg, cyst or ganglion); foot\n$ 762.08\n1765\n28092\n28092\nExcision of lesion, tendon, tendon sheath, or capsule (including\nsynovectomy) (eg, cyst or ganglion); toe(s), each\n$ 675.00\n1766\n28100\n28100\nExcision or curettage of bone cyst or benign tumor, talus or\ncalcaneus;\n$ 1,274.40\n1767\n28102\n28102\nExcision or curettage of bone cyst or benign tumor, talus or\ncalcaneus; with iliac or other autograft (includes obtaining graft)\n$ 1,674.00\n1768\n28103\n28103\nExcision or curettage of bone cyst or benign tumor, talus or\ncalcaneus; with allograft\n$ 1,577.70\n1769\n28104\n28104\nExcision or curettage of bone cyst or benign tumor, tarsal or\nmetatarsal, except talus or calcaneus;\n$ 1,057.50\n1770\n28106\n28106\nExcision or curettage of bone cyst or benign tumor, tarsal or\nmetatarsal, except talus or calcaneus; with iliac or other autograft\n(includes obtaining graft)\n$ 1,435.50\n1771\n28107\n28107\nExcision or curettage of bone cyst or benign tumor, tarsal or\nmetatarsal, except talus or calcaneus; with allograft\n$ 1,215.90\n1772\n28108\n28108\nExcision or curettage of bone cyst or benign tumor, phalanges of\nfoot\n$ 862.20\n1773\n28110\n28110\nOstectomy, partial excision, fifth metatarsal head (bunionette)\n(separate procedure)\n$ 828.90\n1774\n28111\n28111\nOstectomy, complete excision; first metatarsal head\n$ 1,013.40\n1775\n28112\n28112\nOstectomy, complete excision; other metatarsal head (second, third\nor fourth)\n$ 956.70\n1776\n28113\n28113\nOstectomy, complete excision; fifth metatarsal head\n$ 973.80\n1777\n28114\n28114\nOstectomy, complete excision; all metatarsal heads, with partial\nproximal phalangectomy, excluding first metatarsal (eg, Clayton\ntype procedure)\n$ 2,032.20\n1778\n28116\n28116\nOstectomy, excision of tarsal coalition\n$ 1,553.40\n1779\n28118\n28118\nOstectomy, calcaneus;\n$ 1,267.20\n1780\n28119\n28119\nOstectomy, calcaneus; for spur, with or without plantar fascial\nrelease\n$ 1,184.40\n1781\n28120\n28120\nPartial excision (craterization, saucerization, sequestrectomy, or\ndiaphysectomy) bone (eg, osteomyelitis or bossing); talus or\ncalcaneus\n$ 1,287.90\n1782\n28122\n28122\nPartial excision (craterization, saucerization, sequestrectomy, or\ndiaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or\nmetatarsal bone, except talus or calcaneus\n$ 1,105.20\n1783\n28124\n28124\nPartial excision (craterization, saucerization, sequestrectomy, or\ndiaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe\n$ 754.20\n1784\n28126\n28126\nResection, partial or complete, phalangeal base, each toe\n$ 708.30\n1785\n28130\n28130\nTalectomy (astragalectomy)\n$ 1,640.70\n1786\n28140\n28140\nMetatarsectomy\n$ 1,133.10\n1787\n28150\n28150\nPhalangectomy, toe, each toe\n$ 699.30\n1788\n28153\n28153\nResection, condyle(s), distal end of phalanx, each toe\n$ 751.50\n1789\n28160\n28160\nHemiphalangectomy or interphalangeal joint excision, toe, proximal\nend of phalanx, each\n$ 651.60\n1790\n28171\n28171\nRadical resection of tumor; tarsal (except talus or calcaneus)\n$ 1,622.70\n1791\n28173\n28173\nRadical resection of tumor; metatarsal\n$ 1,408.50\n1792\n28175\n28175\nRadical resection of tumor; phalanx of toe\n$ 999.00\n1793\n28190\n28190\nRemoval of foreign body, foot; subcutaneous\n$ 346.50\n1794\n28192\n28192\nRemoval of foreign body, foot; deep\n$ 671.40\n1795\n28193\n28193\nRemoval of foreign body, foot; complicated\n$ 1,028.70\n1796\n28200\n28200\nRepair, tendon, flexor, foot; primary or secondary, without free\ngraft, each tendon\n$ 1,134.00\n1797\n28202\n28202\nRepair, tendon, flexor, foot; secondary with free graft, each tendon\n(includes obtaining graft)\n$ 1,766.70\n1798\n28208\n28208\nRepair, tendon, extensor, foot; primary or secondary, each tendon\n$ 967.50\n1799\n28210\n28210\nRepair, tendon, extensor, foot; secondary with free graft, each\ntendon (includes obtaining graft)\n$ 1,038.60\n1800\n28222\n28222\nTenolysis, flexor, foot; multiple tendons\n$ 1,048.50\n1801\n28225\n28225\nTenolysis, extensor, foot; single tendon\n$ 580.50\n1802\n28226\n28226\nTenolysis, extensor, foot; multiple tendons\n$ 747.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1803\n28230\n28230\nTenotomy, open, tendon flexor; foot, single or multiple tendon(s)\n(separate procedure)\n$ 724.50\n1804\n28232\n28232\nTenotomy, open, tendon flexor; toe, single tendon (separate\nprocedure)\n$ 399.60\n1805\n28234\n28234\nTenotomy, open, extensor, foot or toe, each tendon\n$ 517.50\n1806\n28238\n28238\nReconstruction (advancement), posterior tibial tendon with excision\nof accessory tarsal navicular bone (eg, Kidner type procedure)\n$ 1,545.30\n1807\n28240\n28240\nTenotomy, lengthening, or release, abductor hallucis muscle\n$ 711.90\n1808\n28250\n28250\nDivision of plantar fascia and muscle (eg, Steindler stripping)\n(separate procedure)\n$ 1,148.40\n1809\n28260\n28260\nCapsulotomy, midfoot; medial release only (separate procedure)\n$ 1,608.30\n1810\n28261\n28261\nCapsulotomy, midfoot; with tendon lengthening\n$ 1,545.30\n1811\n28262\n28262\nCapsulotomy, midfoot; extensive, including posterior talotibial\ncapsulotomy and tendon(s) lengthening (eg, resistant clubfoot\ndeformity)\n$ 2,923.20\n1812\n28264\n28264\nCapsulotomy, midtarsal (eg, Heyman type procedure)\n$ 2,145.60\n1813\n28270\n28270\nCapsulotomy; metatarsophalangeal joint, with or without\ntenorrhaphy, each joint (separate procedure)\n$ 712.80\n1814\n28272\n28272\nCapsulotomy; interphalangeal joint, each joint (separate procedure) $ 654.30\n1815\n28280\n28280\nSyndactylization, toes (eg, webbing or Kelikian type procedure)\n$ 747.00\n1816\n28285\n28285\nCorrection, hammertoe (eg, interphalangeal fusion, partial or total\nphalangectomy)\n$ 813.60\n1817\n28286\n28286\nCorrection, cock-up fifth toe, with plastic skin closure (eg, Ruiz-\nMora type procedure)\n$ 875.70\n1818\n28288\n28288\nOstectomy, partial, exostectomy or condylectomy, metatarsal head,\neach metatarsal head\n$ 1,009.80\n1819\n28289\n28289\nHallux rigidus correction with cheilectomy, debridement and\ncapsular release of the first metatarsophalangeal joint\n$ 896.40\n1820\n28290\n28290\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; simple exostectomy (eg, Silver type procedure)\n$ 1,244.70\n1821\n28292\n28292\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; Keller, McBride, or Mayo type procedure\n$ 1,545.30\n1822\n28293\n28293\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; resection of joint with implant\n$ 1,776.60\n1823\n28294\n28294\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; with tendon transplants (eg, Joplin type\nprocedure)\n$ 1,939.50\n1824\n28296\n28296\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; with metatarsal osteotomy (eg, Mitchell,\nChevron, or concentric type procedures)\n$ 1,827.42\n1825\n28297\n28297\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; Lapidus-type procedure\n$ 1,831.50\n1826\n28298\n28298\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; by phalanx osteotomy\n$ 1,392.30\n1827\n28299\n28299\nCorrection, hallux valgus (bunion), with or without\nsesamoidectomy; by double osteotomy\n$ 1,931.40\n1828\n28300\n28300\nOsteotomy; calcaneus (eg, Dwyer or Chambers type procedure),\nwith or without internal fixation\n$ 1,506.60\n1829\n28302\n28302\nOsteotomy; talus\n$ 1,606.50\n1830\n28304\n28304\nOsteotomy, tarsal bones, other than calcaneus or talus;\n$ 1,385.10\n1831\n28305\n28305\nOsteotomy, tarsal bones, other than calcaneus or talus; with\nautograft (includes obtaining graft) (eg, Fowler type)\n$ 1,545.30\n1832\n28306\n28306\nOsteotomy, with or without lengthening, shortening or angular\ncorrection, metatarsal; first metatarsal\n$ 1,287.90\n1833\n28307\n28307\nOsteotomy, with or without lengthening, shortening or angular\ncorrection, metatarsal; first metatarsal with autograft (other than\nfirst toe)\n$ 1,416.60\n1834\n28308\n28308\nOsteotomy, with or without lengthening, shortening or angular\ncorrection, metatarsal; other than first metatarsal, each\n$ 1,104.30\n1835\n28309\n28309\nOsteotomy, with or without lengthening, shortening or angular\ncorrection, metatarsal; multiple (eg, Swanson type cavus foot\nprocedure)\n$ 1,880.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1836\n28310\n28310\nOsteotomy, shortening, angular or rotational correction; proximal\nphalanx, first toe (separate procedure)\n$ 986.40\n1837\n28312\n28312\nOsteotomy, shortening, angular or rotational correction; other\nphalanges, any toe\n$ 724.50\n1838\n28313\n28313\nReconstruction, angular deformity of toe, soft tissue procedures\nonly (eg, overlapping second toe, fifth toe, curly toes)\n$ 919.80\n1839\n28315\n28315\nSesamoidectomy, first toe (separate procedure)\n$ 1,097.10\n1840\n28320\n28320\nRepair, nonunion or malunion; tarsal bones\n$ 1,640.70\n1841\n28322\n28322\nRepair, nonunion or malunion; metatarsal, with or without bone\ngraft (includes obtaining graft)\n$ 1,387.80\n1842\n28340\n28340\nReconstruction, toe, macrodactyly; soft tissue resection\n$ 1,427.40\n1843\n28341\n28341\nReconstruction, toe, macrodactyly; requiring bone resection\n$ 1,542.60\n1844\n28344\n28344\nReconstruction, toe(s); polydactyly\n$ 1,073.70\n1845\n28345\n28345\nReconstruction, toe(s); syndactyly, with or without skin graft(s),\neach web\n$ 1,471.50\n1846\n28360\n28360\nReconstruction, cleft foot\n$ 2,493.00\n1847\n28400\n28400\nClosed treatment of calcaneal fracture; without manipulation\n$ 621.90\n1848\n28405\n28405\nClosed treatment of calcaneal fracture; with manipulation\n$ 1,003.50\n1849\n28406\n28406\nPercutaneous skeletal fixation of calcaneal fracture, with\nmanipulation\n$ 1,278.00\n1850\n28415\n28415\nOpen treatment of calcaneal fracture, includes internal fixation,\nwhen performed;\n$ 2,162.70\n1851\n28420\n28420\nOpen treatment of calcaneal fracture, includes internal fixation,\nwhen performed; with primary iliac or other autogenous bone graft\n(includes obtaining graft)\n$ 2,753.10\n1852\n28430\n28430\nClosed treatment of talus fracture; without manipulation\n$ 514.80\n1853\n28435\n28435\nClosed treatment of talus fracture; with manipulation\n$ 768.60\n1854\n28436\n28436\nPercutaneous skeletal fixation of talus fracture, with manipulation\n$ 918.00\n1855\n28445\n28445\nOpen treatment of talus fracture, includes internal fixation, when\nperformed\n$ 1,998.00\n1856\n28446\n28446\nOpen osteochondral autograft, talus (includes obtaining graft[s])\n$ 2,581.39\n1857\n28450\n28450\nTreatment of tarsal bone fracture (except talus and calcaneus);\nwithout manipulation, each\n$ 496.80\n1858\n28455\n28455\nTreatment of tarsal bone fracture (except talus and calcaneus); with\nmanipulation, each\n$ 643.50\n1859\n28456\n28456\nPercutaneous skeletal fixation of tarsal bone fracture (except talus\nand calcaneus), with manipulation, each\n$ 710.10\n1860\n28465\n28465\nOpen treatment of tarsal bone fracture (except talus and\ncalcaneus), includes internal fixation, when performed, each\n$ 1,416.60\n1861\n28470\n28470\nClosed treatment of metatarsal fracture; without manipulation,\neach\n$ 459.00\n1862\n28475\n28475\nClosed treatment of metatarsal fracture; with manipulation, each\n$ 514.80\n1863\n28476\n28476\nPercutaneous skeletal fixation of metatarsal fracture, with\nmanipulation, each\n$ 925.20\n1864\n28485\n28485\nOpen treatment of metatarsal fracture, includes internal fixation,\nwhen performed, each\n$ 1,177.20\n1865\n28490\n28490\nClosed treatment of fracture great toe, phalanx or phalanges;\nwithout manipulation\n$ 266.40\n1866\n28495\n28495\nClosed treatment of fracture great toe, phalanx or phalanges; with\nmanipulation\n$ 378.90\n1867\n28496\n28496\nPercutaneous skeletal fixation of fracture great toe, phalanx or\nphalanges, with manipulation\n$ 576.90\n1868\n28505\n28505\nOpen treatment of fracture, great toe, phalanx or phalanges,\nincludes internal fixation, when performed\n$ 783.90\n1869\n28510\n28510\nClosed treatment of fracture, phalanx or phalanges, other than\ngreat toe; without manipulation, each\n$ 208.80\n1870\n28515\n28515\nClosed treatment of fracture, phalanx or phalanges, other than\ngreat toe; with manipulation, each\n$ 297.00\n1871\n28525\n28525\nOpen treatment of fracture, phalanx or phalanges, other than great\ntoe, includes internal fixation, when performed, each\n$ 744.30\n1872\n28530\n28530\nClosed treatment of sesamoid fracture\n$ 348.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1873\n28531\n28531\nOpen treatment of sesamoid fracture, with or without internal\nfixation\n$ 880.47\n1874\n28540\n28540\nClosed treatment of tarsal bone dislocation, other than talotarsal;\nwithout anesthesia\n$ 410.40\n1875\n28545\n28545\nClosed treatment of tarsal bone dislocation, other than talotarsal;\nrequiring anesthesia\n$ 564.30\n1876\n28546\n28546\nPercutaneous skeletal fixation of tarsal bone dislocation, other than\ntalotarsal, with manipulation\n$ 690.30\n1877\n28555\n28555\nOpen treatment of tarsal bone dislocation, includes internal\nfixation, when performed\n$ 1,030.50\n1878\n28570\n28570\nClosed treatment of talotarsal joint dislocation; without anesthesia\n$ 425.70\n1879\n28575\n28575\nClosed treatment of talotarsal joint dislocation; requiring anesthesia $ 577.80\n1880\n28576\n28576\nPercutaneous skeletal fixation of talotarsal joint dislocation, with\nmanipulation\n$ 801.00\n1881\n28585\n28585\nOpen treatment of talotarsal joint dislocation, includes internal\nfixation, when performed\n$ 1,476.00\n1882\n28600\n28600\nClosed treatment of tarsometatarsal joint dislocation; without\nanesthesia\n$ 530.10\n1883\n28605\n28605\nClosed treatment of tarsometatarsal joint dislocation; requiring\nanesthesia\n$ 592.20\n1884\n28606\n28606\nPercutaneous skeletal fixation of tarsometatarsal joint dislocation,\nwith manipulation\n$ 1,009.80\n1885\n28615\n28615\nOpen treatment of tarsometatarsal joint dislocation, includes\ninternal fixation, when performed\n$ 1,235.70\n1886\n28630\n28630\nClosed treatment of metatarsophalangeal joint dislocation; without\nanesthesia\n$ 335.70\n1887\n28635\n28635\nClosed treatment of metatarsophalangeal joint dislocation;\nrequiring anesthesia\n$ 369.90\n1888\n28636\n28636\nPercutaneous skeletal fixation of metatarsophalangeal joint\ndislocation, with manipulation\n$ 566.10\n1889\n28645\n28645\nOpen treatment of metatarsophalangeal joint dislocation, includes\ninternal fixation, when performed\n$ 782.10\n1890\n28660\n28660\nClosed treatment of interphalangeal joint dislocation; without\nanesthesia\n$ 239.40\n1891\n28665\n28665\nClosed treatment of interphalangeal joint dislocation; requiring\nanesthesia\n$ 320.40\n1892\n28666\n28666\nPercutaneous skeletal fixation of interphalangeal joint dislocation,\nwith manipulation\n$ 564.30\n1893\n28675\n28675\nOpen treatment of interphalangeal joint dislocation, includes\ninternal fixation, when performed\n$ 684.90\n1894\n28705\n28705\nArthrodesis; pantalar\n$ 2,897.10\n1895\n28715\n28715\nArthrodesis; triple\n$ 3,185.10\n1896\n28725\n28725\nArthrodesis; subtalar\n$ 2,137.50\n1897\n28730\n28730\nArthrodesis, midtarsal or tarsometatarsal, multiple or transverse;\n$ 2,230.20\n1898\n28735\n28735\nArthrodesis, midtarsal or tarsometatarsal, multiple or transverse;\nwith osteotomy (eg, flatfoot correction)\n$ 2,173.50\n1899\n28737\n28737\nArthrodesis, with tendon lengthening and advancement, midtarsal,\ntarsal navicular-cuneiform (eg, Miller type procedure)\n$ 1,982.70\n1900\n28740\n28740\nArthrodesis, midtarsal or tarsometatarsal, single joint\n$ 1,674.00\n1901\n28750\n28750\nArthrodesis, great toe; metatarsophalangeal joint\n$ 1,392.70\n1902\n28755\n28755\nArthrodesis, great toe; interphalangeal joint\n$ 1,186.20\n1903\n28760\n28760\nArthrodesis, with extensor hallucis longus transfer to first\nmetatarsal neck, great toe, interphalangeal joint (eg, Jones type\nprocedure)\n$ 1,071.90\n1904\n28800\n28800\nAmputation, foot; midtarsal (eg, Chopart type procedure)\n$ 1,847.70\n1905\n28805\n28805\nAmputation, foot; transmetatarsal\n$ 2,238.30\n1906\n28810\n28810\nAmputation, metatarsal, with toe, single\n$ 1,152.90\n1907\n28820\n28820\nAmputation, toe; metatarsophalangeal joint\n$ 875.70\n1908\n28825\n28825\nAmputation, toe; interphalangeal joint\n$ 782.10\n1909\n28890\n28890\nExtracorporeal shock wave, high energy, performed by a physician\nor other qualified health care professional, requiring anesthesia\nother than local, including ultrasound guidance, involving the\nplantar fascia\n$ 905.09\n1910\n28899\n28899\nUnlisted procedure, foot or toes\nCost\n1911\n29000\n29000\nApplication of halo type body cast (see 20661-20663 for insertion)\n$ 608.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1912\n29010\n29010\nApplication of Risser jacket, localizer, body; only\n$ 492.30\n1913\n29015\n29015\nApplication of Risser jacket, localizer, body; including head\n$ 670.50\n1914\n29020\n29020\nApplication of turnbuckle jacket, body; only\n$ 534.60\n1915\n29025\n29025\nApplication of turnbuckle jacket, body; including head\n$ 578.70\n1916\n29035\n29035\nApplication of body cast, shoulder to hips;\n$ 475.20\n1917\n29040\n29040\nApplication of body cast, shoulder to hips; including head, Minerva\ntype\n$ 495.90\n1918\n29044\n29044\nApplication of body cast, shoulder to hips; including 1 thigh\n$ 380.70\n1919\n29046\n29046\nApplication of body cast, shoulder to hips; including both thighs\n$ 469.80\n1920\n29049\n29049\nApplication, cast; figure-of-eight\n$ 194.40\n1921\n29055\n29055\nApplication, cast; shoulder spica\n$ 389.70\n1922\n29058\n29058\nApplication, cast; plaster Velpeau\n$ 198.90\n1923\n29065\n29065\nApplication, cast; shoulder to hand (long arm)\n$ 206.10\n1924\n29075\n29075\nApplication, cast; elbow to finger (short arm)\n$ 157.50\n1925\n29085\n29085\nApplication, cast; hand and lower forearm (gauntlet)\n$ 156.05\n1926\n29086\n29086\nApplication, cast; finger (eg, contracture)\n$ 110.50\n1927\n29105\n29105\nApplication of long arm splint (shoulder to hand)\n$ 128.70\n1928\n29125\n29125\nApplication of short arm splint (forearm to hand); static\n$ 99.00\n1929\n29126\n29126\nApplication of short arm splint (forearm to hand); dynamic\n$ 134.10\n1930\n29130\n29130\nApplication of finger splint; static\n$ 82.80\n1931\n29131\n29131\nApplication of finger splint; dynamic\n$ 134.10\n1932\n29200\n29200\nStrapping; thorax\n$ 81.00\n1933\n29240\n29240\nStrapping; shoulder (eg, Velpeau)\n$ 90.00\n1934\n29260\n29260\nStrapping; elbow or wrist\n$ 65.68\n1935\n29280\n29280\nStrapping; hand or finger\n$ 86.40\n1936\n29305\n29305\nApplication of hip spica cast; 1 leg\n$ 540.90\n1937\n29325\n29325\nApplication of hip spica cast; 1 and one-half spica or both legs\n$ 494.10\n1938\n29345\n29345\nApplication of long leg cast (thigh to toes);\n$ 297.00\n1939\n29355\n29355\nApplication of long leg cast (thigh to toes); walker or ambulatory\ntype\n$ 270.90\n1940\n29358\n29358\nApplication of long leg cast brace\n$ 451.80\n1941\n29365\n29365\nApplication of cylinder cast (thigh to ankle)\n$ 236.70\n1942\n29405\n29405\nApplication of short leg cast (below knee to toes);\n$ 215.17\n1943\n29425\n29425\nApplication of short leg cast (below knee to toes); walking or\nambulatory type\n$ 237.60\n1944\n29435\n29435\nApplication of patellar tendon bearing (PTB) cast\n$ 282.60\n1945\n29440\n29440\nAdding walker to previously applied cast\n$ 83.70\n1946\n29445\n29445\nApplication of rigid total contact leg cast\n$ 339.30\n1947\n29450\n29450\nApplication of clubfoot cast with molding or manipulation, long or\nshort leg\n$ 173.70\n1948\n29505\n29505\nApplication of long leg splint (thigh to ankle or toes)\n$ 153.90\n1949\n29515\n29515\nApplication of short leg splint (calf to foot)\n$ 120.60\n1950\n29520\n29520\nStrapping; hip\n$ 98.10\n1951\n29530\n29530\nStrapping; knee\n$ 95.40\n1952\n29540\n29540\nStrapping; ankle and\/or foot\n$ 73.52\n1953\n29550\n29550\nStrapping; toes\n$ 66.60\n1954\n29580\n29580\nStrapping; Unna boot\n$ 96.09\n1955\n29581\n29581\nApplication of multi-layer compression system; leg (below knee),\nincluding ankle and foot\n$ 132.61\n1956\n29700\n29700\nRemoval or bivalving; gauntlet, boot or body cast\n$ 92.42\n1957\n29705\n29705\nRemoval or bivalving; full arm or full leg cast\n$ 90.31\n1958\n29710\n29710\nRemoval or bivalving; shoulder or hip spica, Minerva, or Risser\njacket, etc.\n$ 186.30\n1959\n29715\n29715\nRemoval or bivalving; turnbuckle jacket\n$ 124.20\n1960\n29720\n29720\nRepair of spica, body cast or jacket\n$ 87.30\n1961\n29730\n29730\nWindowing of cast\n$ 85.50\n1962\n29740\n29740\nWedging of cast (except clubfoot casts)\n$ 136.80\n1963\n29750\n29750\nWedging of clubfoot cast\n$ 97.20\n1964\n29799\n29799\nUnlisted procedure, casting or strapping\n$ 100.21\n1965\n29800\n29800\nArthroscopy, temporomandibular joint, diagnostic, with or without\nsynovial biopsy (separate procedure)\n$ 1,545.30\n1966\n29804\n29804\nArthroscopy, temporomandibular joint, surgical\n$ 2,266.20\n1967\n29805\n29805\nArthroscopy, shoulder, diagnostic, with or without synovial biopsy\n(separate procedure)\n$ 1,129.02\n1968\n29806\n29806\nArthroscopy, shoulder, surgical; capsulorrhaphy\n$ 2,796.86\n1969\n29807\n29807\nArthroscopy, shoulder, surgical; repair of SLAP lesion\n$ 2,663.48\n1970\n29819\n29819\nArthroscopy, shoulder, surgical; with removal of loose body or\nforeign body\n$ 2,304.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n1971\n29820\n29820\nArthroscopy, shoulder, surgical; synovectomy, partial\n$ 2,215.80\n1972\n29821\n29821\nArthroscopy, shoulder, surgical; synovectomy, complete\n$ 2,396.70\n1973\n29822\n29822\nArthroscopy, shoulder, surgical; debridement, limited\n$ 2,419.20\n1974\n29823\n29823\nArthroscopy, shoulder, surgical; debridement, extensive\n$ 2,801.70\n1975\n29824\n29824\nArthroscopy, shoulder, surgical; distal claviculectomy including\ndistal articular surface (Mumford procedure)\n$ 1,813.74\n1976\n29825\n29825\nArthroscopy, shoulder, surgical; with lysis and resection of\nadhesions, with or without manipulation\n$ 2,412.00\n1977\n29826\n29826\nArthroscopy, shoulder, surgical; decompression of subacromial\nspace with partial acromioplasty, with coracoacromial ligament (ie,\narch)release, when performed (List separately in addition to code\nfor primary procedure)\n$ 2,722.75\n1978\n29827\n29827\nArthroscopy, shoulder, surgical; with rotator cuff repair\n$ 2,928.75\n1979\n29828\n29828\nArthroscopy, shoulder, surgical; biceps tenodesis\n$ 2,558.94\n1980\n29830\n29830\nArthroscopy, elbow, diagnostic, with or without synovial biopsy\n(separate procedure)\n$ 1,206.00\n1981\n29834\n29834\nArthroscopy, elbow, surgical; with removal of loose body or foreign\nbody\n$ 2,052.00\n1982\n29835\n29835\nArthroscopy, elbow, surgical; synovectomy, partial\n$ 2,308.50\n1983\n29836\n29836\nArthroscopy, elbow, surgical; synovectomy, complete\n$ 2,322.90\n1984\n29837\n29837\nArthroscopy, elbow, surgical; debridement, limited\n$ 1,981.80\n1985\n29838\n29838\nArthroscopy, elbow, surgical; debridement, extensive\n$ 2,250.90\n1986\n29840\n29840\nArthroscopy, wrist, diagnostic, with or without synovial biopsy\n(separate procedure)\n$ 1,214.10\n1987\n29843\n29843\nArthroscopy, wrist, surgical; for infection, lavage and drainage\n$ 1,751.40\n1988\n29844\n29844\nArthroscopy, wrist, surgical; synovectomy, partial\n$ 1,881.00\n1989\n29845\n29845\nArthroscopy, wrist, surgical; synovectomy, complete\n$ 1,916.10\n1990\n29846\n29846\nArthroscopy, wrist, surgical; excision and\/or repair of triangular\nfibrocartilage and\/or joint debridement\n$ 2,266.20\n1991\n29847\n29847\nArthroscopy, wrist, surgical; internal fixation for fracture or\ninstability\n$ 2,093.40\n1992\n29848\n29848\nEndoscopy, wrist, surgical, with release of transverse carpal\nligament\n$ 1,758.60\n1993\n29850\n29850\nArthroscopically aided treatment of intercondylar spine(s) and\/or\ntuberosity fracture(s) of the knee, with or without manipulation;\nwithout internal or external fixation (includes arthroscopy)\n$ 2,285.10\n1994\n29851\n29851\nArthroscopically aided treatment of intercondylar spine(s) and\/or\ntuberosity fracture(s) of the knee, with or without manipulation;\nwith internal or external fixation (includes arthroscopy)\n$ 2,887.20\n1995\n29855\n29855\nArthroscopically aided treatment of tibial fracture, proximal\n(plateau); unicondylar, includes internal fixation, when performed\n(includes arthroscopy)\n$ 2,574.90\n1996\n29856\n29856\nArthroscopically aided treatment of tibial fracture, proximal\n(plateau); bicondylar, includes internal fixation, when performed\n(includes arthroscopy)\n$ 2,907.90\n1997\n29860\n29860\nArthroscopy, hip, diagnostic with or without synovial biopsy\n(separate procedure)\n$ 1,547.10\n1998\n29861\n29861\nArthroscopy, hip, surgical; with removal of loose body or foreign\nbody\n$ 2,295.90\n1999\n29862\n29862\nArthroscopy, hip, surgical; with debridement\/shaving of articular\ncartilage (chondroplasty), abrasion arthroplasty, and\/or resection of\nlabrum\n$ 2,525.40\n2000\n29863\n29863\nArthroscopy, hip, surgical; with synovectomy\n$ 2,306.70\n2001\n29866\n29866\nArthroscopy, knee, surgical; osteochondral autograft(s) (eg,\nmosaicplasty) (includes harvesting of the autograft[s])\n$ 2,666.26\n2002\n29867\n29867\nArthroscopy, knee, surgical; osteochondral allograft (eg,\nmosaicplasty)\n$ 4,120.16\n2003\n29868\n29868\nArthroscopy, knee, surgical; meniscal transplantation (includes\narthrotomy for meniscal insertion), medial or lateral\n$ 5,488.61\n2004\n29870\n29870\nArthroscopy, knee, diagnostic, with or without synovial biopsy\n(separate procedure)\n$ 1,352.70\n2005\n29871\n29871\nArthroscopy, knee, surgical; for infection, lavage and drainage\n$ 1,984.50\n2006\n29873\n29873\nArthroscopy, knee, surgical; with lateral release\n$ 1,675.37\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2007\n29874\n29874\nArthroscopy, knee, surgical; for removal of loose body or foreign\nbody (eg, osteochondritis dissecans fragmentation, chondral\nfragmentation)\n$ 2,348.10\n2008\n29875\n29875\nArthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf\nresection) (separate procedure)\n$ 2,459.70\n2009\n29876\n29876\nArthroscopy, knee, surgical; synovectomy, major, 2 or more\ncompartments (eg, medial or lateral)\n$ 2,733.79\n2010\n29877\n29877\nArthroscopy, knee, surgical; debridement\/shaving of articular\ncartilage (chondroplasty)\n$ 2,552.87\n2011\n29879\n29879\nArthroscopy, knee, surgical; abrasion arthroplasty (includes\nchondroplasty where necessary) or multiple drilling or\nmicrofracture\n$ 2,652.30\n2012\n29880\n29880\nArthroscopy, knee, surgical; with meniscectomy (medial AND\nlateral, including any meniscal shaving) including\ndebridement\/shaving of articular cartilage (chondroplasty), same or\nseparate compartment(s), when performed\n$ 3,254.71\n2013\n29882\n29882\nArthroscopy, knee, surgical; with meniscus repair (medial OR\nlateral)\n$ 2,919.72\n2014\n29883\n29883\nArthroscopy, knee, surgical; with meniscus repair (medial AND\nlateral)\n$ 3,747.60\n2015\n29884\n29884\nArthroscopy, knee, surgical; with lysis of adhesions, with or without\nmanipulation (separate procedure)\n$ 2,337.30\n2016\n29885\n29885\nArthroscopy, knee, surgical; drilling for osteochondritis dissecans\nwith bone grafting, with or without internal fixation (including\ndebridement of base of lesion)\n$ 2,697.30\n2017\n29886\n29886\nArthroscopy, knee, surgical; drilling for intact osteochondritis\ndissecans lesion\n$ 2,547.90\n2018\n29887\n29887\nArthroscopy, knee, surgical; drilling for intact osteochondritis\ndissecans lesion with internal fixation\n$ 3,380.40\n2019\n29888\n29888\nArthroscopically aided anterior cruciate ligament\nrepair\/augmentation or reconstruction\n$ 4,793.75\n2020\n29889\n29889\nArthroscopically aided posterior cruciate ligament\nrepair\/augmentation or reconstruction\n$ 4,867.20\n2021\n29891\n29891\nArthroscopy, ankle, surgical, excision of osteochondral defect of\ntalus and\/or tibia, including drilling of the defect\n$ 2,214.90\n2022\n29892\n29892\nArthroscopically aided repair of large osteochondritis dissecans\nlesion, talar dome fracture, or tibial plafond fracture, with or\nwithout internal fixation (includes arthroscopy)\n$ 2,223.90\n2023\n29893\n29893\nEndoscopic plantar fasciotomy\n$ 1,233.00\n2024\n29894\n29894\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with\nremoval of loose body or foreign body\n$ 2,206.80\n2025\n29895\n29895\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical;\nsynovectomy, partial\n$ 2,299.50\n2026\n29897\n29897\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical;\ndebridement, limited\n$ 2,115.00\n2027\n29898\n29898\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical;\ndebridement, extensive\n$ 2,721.60\n2028\n29899\n29899\nArthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with\nankle arthrodesis\n$ 2,665.75\n2029\n29900\n29900\nArthroscopy, metacarpophalangeal joint, diagnostic, includes\nsynovial biopsy\n$ 1,121.89\n2030\n29901\n29901\nArthroscopy, metacarpophalangeal joint, surgical; with\ndebridement\n$ 1,598.44\n2031\n29902\n29902\nArthroscopy, metacarpophalangeal joint, surgical; with reduction of\ndisplaced ulnar collateral ligament (eg, Stenar lesion)\n$ 1,839.03\n2032\n29904\n29904\nArthroscopy, subtalar joint, surgical; with removal of loose body or\nforeign body\n$ 2,032.59\n2033\n29905\n29905\nArthroscopy, subtalar joint, surgical; with synovectomy\n$ 2,146.58\n2034\n29906\n29906\nArthroscopy, subtalar joint, surgical; with debridement\n$ 2,078.55\n2035\n29907\n29907\nArthroscopy, subtalar joint, surgical; with subtalar arthrodesis\n$ 2,547.20\n2036\n29999\n29999\nUnlisted procedure, arthroscopy\nCost\n2037\n30000\n30000\nDrainage abscess or hematoma, nasal, internal approach\n$ 329.40\n2038\n30020\n30020\nDrainage abscess or hematoma, nasal septum\n$ 311.40\n2039\n30100\n30100\nBiopsy, intranasal\n$ 187.20\n2040\n30110\n30110\nExcision, nasal polyp(s), simple\n$ 385.20\n2041\n30115\n30115\nExcision, nasal polyp(s), extensive\n$ 992.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2042\n30117\n30117\nExcision or destruction (eg, laser), intranasal lesion; internal\napproach\n$ 871.20\n2043\n30118\n30118\nExcision or destruction (eg, laser), intranasal lesion; external\napproach (lateral rhinotomy)\n$ 2,187.00\n2044\n30120\n30120\nExcision or surgical planing of skin of nose for rhinophyma\n$ 2,003.40\n2045\n30124\n30124\nExcision dermoid cyst, nose; simple, skin, subcutaneous\n$ 774.00\n2046\n30125\n30125\nExcision dermoid cyst, nose; complex, under bone or cartilage\n$ 1,936.80\n2047\n30130\n30130\nExcision inferior turbinate, partial or complete, any method\n$ 785.70\n2048\n30140\n30140\nSubmucous resection inferior turbinate, partial or complete, any\nmethod\n$ 1,149.30\n2049\n30150\n30150\nRhinectomy; partial\n$ 2,242.80\n2050\n30160\n30160\nRhinectomy; total\n$ 2,889.00\n2051\n30200\n30200\nInjection into turbinate(s), therapeutic\n$ 129.60\n2052\n30210\n30210\nDisplacement therapy (Proetz type)\n$ 211.50\n2053\n30220\n30220\nInsertion, nasal septal prosthesis (button)\n$ 401.40\n2054\n30300\n30300\nRemoval foreign body, intranasal; office type procedure\n$ 134.21\n2055\n30310\n30310\nRemoval foreign body, intranasal; requiring general anesthesia\n$ 567.90\n2056\n30320\n30320\nRemoval foreign body, intranasal; by lateral rhinotomy\n$ 1,482.30\n2057\n30400\n30400\nRhinoplasty, primary; lateral and alar cartilages and\/or elevation of\nnasal tip\n$ 3,656.70\n2058\n30410\n30410\nRhinoplasty, primary; complete, external parts including bony\npyramid, lateral and alar cartilages, and\/or elevation of nasal tip\n$ 3,969.90\n2059\n30420\n30420\nRhinoplasty, primary; including major septal repair\n$ 4,673.70\n2060\n30430\n30430\nRhinoplasty, secondary; minor revision (small amount of nasal tip\nwork)\n$ 1,877.40\n2061\n30435\n30435\nRhinoplasty, secondary; intermediate revision (bony work with\nosteotomies)\n$ 2,531.70\n2062\n30450\n30450\nRhinoplasty, secondary; major revision (nasal tip work and\nosteotomies)\n$ 4,104.90\n2063\n30460\n30460\nRhinoplasty for nasal deformity secondary to congenital cleft lip\nand\/or palate, including columellar lengthening; tip only\n$ 2,551.50\n2064\n30462\n30462\nRhinoplasty for nasal deformity secondary to congenital cleft lip\nand\/or palate, including columellar lengthening; tip, septum,\nosteotomies\n$ 4,778.10\n2065\n30465\n30465\nRepair of nasal vestibular stenosis (eg, spreader grafting, lateral\nnasal wall reconstruction)\n$ 2,367.57\n2066\n30520\n30520\nSeptoplasty or submucous resection, with or without cartilage\nscoring, contouring or replacement with graft\n$ 2,891.27\n2067\n30540\n30540\nRepair choanal atresia; intranasal\n$ 2,054.70\n2068\n30545\n30545\nRepair choanal atresia; transpalatine\n$ 3,063.60\n2069\n30560\n30560\nLysis intranasal synechia\n$ 240.30\n2070\n30580\n30580\nRepair fistula; oromaxillary (combine with 31030 if antrotomy is\nincluded)\n$ 1,683.00\n2071\n30600\n30600\nRepair fistula; oronasal\n$ 1,819.80\n2072\n30620\n30620\nSeptal or other intranasal dermatoplasty (does not include\nobtaining graft)\n$ 2,832.30\n2073\n30630\n30630\nRepair nasal septal perforations\n$ 2,162.70\n2074\n30801\n30801\nAblation, soft tissue of inferior turbinates, unilateral or bilateral,\nany method (eg, electrocautery, radiofrequency ablation, or tissue\nvolume reduction); superficial\n$ 264.60\n2075\n30802\n30802\nAblation, soft tissue of inferior turbinates, unilateral or bilateral,\nany method (eg, electrocautery, radiofrequency ablation, or tissue\nvolume reduction); intramural (ie, submucosal)\n$ 407.70\n2076\n30901\n30901\nControl nasal hemorrhage, anterior, simple (limited cautery and\/or\npacking) any method\n$ 189.81\n2077\n30903\n30903\nControl nasal hemorrhage, anterior, complex (extensive cautery\nand\/or packing) any method\n$ 280.57\n2078\n30905\n30905\nControl nasal hemorrhage, posterior, with posterior nasal packs\nand\/or cautery, any method; initial\n$ 495.90\n2079\n30906\n30906\nControl nasal hemorrhage, posterior, with posterior nasal packs\nand\/or cautery, any method; subsequent\n$ 449.10\n2080\n30915\n30915\nLigation arteries; ethmoidal\n$ 1,781.10\n2081\n30920\n30920\nLigation arteries; internal maxillary artery, transantral\n$ 2,600.10\n2082\n30930\n30930\nFracture nasal inferior turbinate(s), therapeutic\n$ 437.40\n2083\n30999\n30999\nUnlisted procedure, nose\nCost\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2084\n31000\n31000\nLavage by cannulation; maxillary sinus (antrum puncture or natural\nostium)\n$ 134.23\n2085\n31002\n31002\nLavage by cannulation; sphenoid sinus\n$ 291.60\n2086\n31020\n31020\nSinusotomy, maxillary (antrotomy); intranasal\n$ 822.60\n2087\n31030\n31030\nSinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without\nremoval of antrochoanal polyps\n$ 1,966.50\n2088\n31032\n31032\nSinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with\nremoval of antrochoanal polyps\n$ 2,162.70\n2089\n31040\n31040\nPterygomaxillary fossa surgery, any approach\n$ 3,172.50\n2090\n31050\n31050\nSinusotomy, sphenoid, with or without biopsy;\n$ 1,484.10\n2091\n31051\n31051\nSinusotomy, sphenoid, with or without biopsy; with mucosal\nstripping or removal of polyp(s)\n$ 2,057.40\n2092\n31070\n31070\nSinusotomy frontal; external, simple (trephine operation)\n$ 1,499.40\n2093\n31075\n31075\nSinusotomy frontal; transorbital, unilateral (for mucocele or\nosteoma, Lynch type)\n$ 2,574.00\n2094\n31080\n31080\nSinusotomy frontal; obliterative without osteoplastic flap, brow\nincision (includes ablation)\n$ 3,005.10\n2095\n31081\n31081\nSinusotomy frontal; obliterative, without osteoplastic flap, coronal\nincision (includes ablation)\n$ 2,971.80\n2096\n31084\n31084\nSinusotomy frontal; obliterative, with osteoplastic flap, brow\nincision\n$ 3,605.40\n2097\n31085\n31085\nSinusotomy frontal; obliterative, with osteoplastic flap, coronal\nincision\n$ 3,885.30\n2098\n31086\n31086\nSinusotomy frontal; nonobliterative, with osteoplastic flap, brow\nincision\n$ 3,278.70\n2099\n31087\n31087\nSinusotomy frontal; nonobliterative, with osteoplastic flap, coronal\nincision\n$ 3,210.30\n2100\n31090\n31090\nSinusotomy, unilateral, 3 or more paranasal sinuses (frontal,\nmaxillary, ethmoid, sphenoid)\n$ 4,236.30\n2101\n31200\n31200\nEthmoidectomy; intranasal, anterior\n$ 1,301.40\n2102\n31201\n31201\nEthmoidectomy; intranasal, total\n$ 2,008.80\n2103\n31205\n31205\nEthmoidectomy; extranasal, total\n$ 2,160.00\n2104\n31225\n31225\nMaxillectomy; without orbital exenteration\n$ 4,426.20\n2105\n31230\n31230\nMaxillectomy; with orbital exenteration (en bloc)\n$ 5,388.30\n2106\n31231\n31231\nNasal endoscopy, diagnostic, unilateral or bilateral (separate\nprocedure)\n$ 244.28\n2107\n31233\n31233\nNasal\/sinus endoscopy, diagnostic with maxillary sinusoscopy (via\ninferior meatus or canine fossa puncture)\n$ 683.10\n2108\n31235\n31235\nNasal\/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via\npuncture of sphenoidal face or cannulation of ostium)\n$ 760.50\n2109\n31237\n31237\nNasal\/sinus endoscopy, surgical; with biopsy, polypectomy or\ndebridement (separate procedure)\n$ 871.20\n2110\n31238\n31238\nNasal\/sinus endoscopy, surgical; with control of nasal hemorrhage\n$ 909.90\n2111\n31239\n31239\nNasal\/sinus endoscopy, surgical; with dacryocystorhinostomy\n$ 2,768.40\n2112\n31240\n31240\nNasal\/sinus endoscopy, surgical; with concha bullosa resection\n$ 842.40\n2113\n31254\n31254\nNasal\/sinus endoscopy, surgical; with ethmoidectomy, partial\n(anterior)\n$ 1,690.20\n2114\n31255\n31255\nNasal\/sinus endoscopy, surgical; with ethmoidectomy, total\n(anterior and posterior)\n$ 1,789.35\n2115\n31256\n31256\nNasal\/sinus endoscopy, surgical, with maxillary antrostomy;\n$ 1,530.00\n2116\n31267\n31267\nNasal\/sinus endoscopy, surgical, with maxillary antrostomy; with\nremoval of tissue from maxillary sinus\n$ 1,867.50\n2117\n31276\n31276\nNasal\/sinus endoscopy, surgical with frontal sinus exploration, with\nor without removal of tissue from frontal sinus\n$ 1,931.40\n2118\n31287\n31287\nNasal\/sinus endoscopy, surgical, with sphenoidotomy;\n$ 1,337.40\n2119\n31288\n31288\nNasal\/sinus endoscopy, surgical, with sphenoidotomy; with removal\nof tissue from the sphenoid sinus\n$ 1,647.90\n2120\n31290\n31290\nNasal\/sinus endoscopy, surgical, with repair of cerebrospinal fluid\nleak; ethmoid region\n$ 3,514.50\n2121\n31291\n31291\nNasal\/sinus endoscopy, surgical, with repair of cerebrospinal fluid\nleak; sphenoid region\n$ 3,903.30\n2122\n31292\n31292\nNasal\/sinus endoscopy, surgical; with medial or inferior orbital wall\ndecompression\n$ 3,122.10\n2123\n31293\n31293\nNasal\/sinus endoscopy, surgical; with medial orbital wall and\ninferior orbital wall decompression\n$ 3,414.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2124\n31294\n31294\nNasal\/sinus endoscopy, surgical; with optic nerve decompression\n$ 3,854.70\n2125\n31299\n31299\nUnlisted procedure, accessory sinuses\nCost\n2126\n31300\n31300\nLaryngotomy (thyrotomy, laryngofissure); with removal of tumor or\nlaryngocele, cordectomy\n$ 2,842.20\n2127\n31320\n31320\nLaryngotomy (thyrotomy, laryngofissure); diagnostic\n$ 1,349.10\n2128\n31360\n31360\nLaryngectomy; total, without radical neck dissection\n$ 3,825.90\n2129\n31365\n31365\nLaryngectomy; total, with radical neck dissection\n$ 5,740.20\n2130\n31367\n31367\nLaryngectomy; subtotal supraglottic, without radical neck dissection\n$ 4,111.20\n2131\n31368\n31368\nLaryngectomy; subtotal supraglottic, with radical neck dissection\n$ 6,336.00\n2132\n31370\n31370\nPartial laryngectomy (hemilaryngectomy); horizontal\n$ 4,670.10\n2133\n31375\n31375\nPartial laryngectomy (hemilaryngectomy); laterovertical\n$ 3,898.80\n2134\n31380\n31380\nPartial laryngectomy (hemilaryngectomy); anterovertical\n$ 3,970.80\n2135\n31382\n31382\nPartial laryngectomy (hemilaryngectomy); antero-latero-vertical\n$ 4,020.30\n2136\n31390\n31390\nPharyngolaryngectomy, with radical neck dissection; without\nreconstruction\n$ 5,854.50\n2137\n31395\n31395\nPharyngolaryngectomy, with radical neck dissection; with\nreconstruction\n$ 6,849.90\n2138\n31400\n31400\nArytenoidectomy or arytenoidopexy, external approach\n$ 2,953.80\n2139\n31420\n31420\nEpiglottidectomy\n$ 2,694.60\n2140\n31500\n31500\nIntubation, endotracheal, emergency procedure\n$ 307.80\n2141\n31502\n31502\nTracheotomy tube change prior to establishment of fistula tract\n$ 195.30\n2142\n31505\n31505\nLaryngoscopy, indirect; diagnostic (separate procedure)\n$ 217.68\n2143\n31510\n31510\nLaryngoscopy, indirect; with biopsy\n$ 306.90\n2144\n31511\n31511\nLaryngoscopy, indirect; with removal of foreign body\n$ 391.50\n2145\n31512\n31512\nLaryngoscopy, indirect; with removal of lesion\n$ 429.30\n2146\n31513\n31513\nLaryngoscopy, indirect; with vocal cord injection\n$ 585.90\n2147\n31515\n31515\nLaryngoscopy direct, with or without tracheoscopy; for aspiration\n$ 377.10\n2148\n31520\n31520\nLaryngoscopy direct, with or without tracheoscopy; diagnostic,\nnewborn\n$ 460.04\n2149\n31525\n31525\nLaryngoscopy direct, with or without tracheoscopy; diagnostic,\nexcept newborn\n$ 647.10\n2150\n31526\n31526\nLaryngoscopy direct, with or without tracheoscopy; diagnostic, with\noperating microscope or telescope\n$ 978.30\n2151\n31527\n31527\nLaryngoscopy direct, with or without tracheoscopy; with insertion of\nobturator\n$ 1,164.60\n2152\n31528\n31528\nLaryngoscopy direct, with or without tracheoscopy; with dilation,\ninitial\n$ 824.40\n2153\n31529\n31529\nLaryngoscopy direct, with or without tracheoscopy; with dilation,\nsubsequent\n$ 772.20\n2154\n31530\n31530\nLaryngoscopy, direct, operative, with foreign body removal;\n$ 896.40\n2155\n31531\n31531\nLaryngoscopy, direct, operative, with foreign body removal; with\noperating microscope or telescope\n$ 1,302.30\n2156\n31535\n31535\nLaryngoscopy, direct, operative, with biopsy;\n$ 903.60\n2157\n31536\n31536\nLaryngoscopy, direct, operative, with biopsy; with operating\nmicroscope or telescope\n$ 1,141.20\n2158\n31540\n31540\nLaryngoscopy, direct, operative, with excision of tumor and\/or\nstripping of vocal cords or epiglottis;\n$ 1,155.60\n2159\n31541\n31541\nLaryngoscopy, direct, operative, with excision of tumor and\/or\nstripping of vocal cords or epiglottis; with operating microscope or\ntelescope\n$ 1,328.82\n2160\n31545\n31545\nLaryngoscopy, direct, operative, with operating microscope or\ntelescope, with submucosal removal of non-neoplastic lesion(s) of\nvocal cord; reconstruction with local tissue flap(s)\n$ 1,137.51\n2161\n31546\n31546\nLaryngoscopy, direct, operative, with operating microscope or\ntelescope, with submucosal removal of non-neoplastic lesion(s) of\nvocal cord; reconstruction with graft(s) (includes obtaining\nautograft)\n$ 1,746.43\n2162\n31560\n31560\nLaryngoscopy, direct, operative, with arytenoidectomy;\n$ 2,224.80\n2163\n31561\n31561\nLaryngoscopy, direct, operative, with arytenoidectomy; with\noperating microscope or telescope\n$ 2,378.70\n2164\n31570\n31570\nLaryngoscopy, direct, with injection into vocal cord(s), therapeutic;\n$ 1,323.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2165\n31571\n31571\nLaryngoscopy, direct, with injection into vocal cord(s), therapeutic;\nwith operating microscope or telescope\n$ 1,458.90\n2166\n31575\n31575\nLaryngoscopy, flexible fiberoptic; diagnostic\n$ 323.11\n2167\n31576\n31576\nLaryngoscopy, flexible fiberoptic; with biopsy\n$ 568.80\n2168\n31577\n31577\nLaryngoscopy, flexible fiberoptic; with removal of foreign body\n$ 982.80\n2169\n31578\n31578\nLaryngoscopy, flexible fiberoptic; with removal of lesion\n$ 1,133.10\n2170\n31579\n31579\nLaryngoscopy, flexible or rigid fiberoptic, with stroboscopy\n$ 626.40\n2171\n31580\n31580\nLaryngoplasty; for laryngeal web, 2- stage, with keel insertion and\nremoval\n$ 3,399.30\n2172\n31582\n31582\nLaryngoplasty; for laryngeal stenosis, with graft or core mold,\nincluding tracheotomy\n$ 4,155.30\n2173\n31584\n31584\nLaryngoplasty; with open reduction of fracture\n$ 3,971.70\n2174\n31587\n31587\nLaryngoplasty, cricoid split\n$ 2,544.30\n2175\n31588\n31588\nLaryngoplasty, not otherwise specified (eg, for burns, reconstruction\nafter partial laryngectomy)\n$ 3,209.40\n2176\n31590\n31590\nLaryngeal reinnervation by neuromuscular pedicle\n$ 2,811.60\n2177\n31595\n31595\nSection recurrent laryngeal nerve, therapeutic (separate\nprocedure), unilateral\n$ 2,338.20\n2178\n31599\n31599\nUnlisted procedure, larynx\nCost\n2179\n31600\n31600\nTracheostomy, planned (separate procedure);\n$ 1,148.40\n2180\n31601\n31601\nTracheostomy, planned (separate procedure); younger than 2 years\n$ 1,423.80\n2181\n31605\n31605\nTracheostomy, emergency procedure; cricothyroid membrane\n$ 957.60\n2182\n31610\n31610\nTracheostomy, fenestration procedure with skin flaps\n$ 1,731.60\n2183\n31611\n31611\nConstruction of tracheoesophageal fistula and subsequent insertion\nof an alaryngeal speech prosthesis (eg, voice button, Blom-Singer\nprosthesis)\n$ 1,748.70\n2184\n31612\n31612\nTracheal puncture, percutaneous with transtracheal aspiration\nand\/or injection\n$ 232.20\n2185\n31613\n31613\nTracheostoma revision; simple, without flap rotation\n$ 767.70\n2186\n31614\n31614\nTracheostoma revision; complex, with flap rotation\n$ 1,881.90\n2187\n31615\n31615\nTracheobronchoscopy through established tracheostomy incision\n$ 555.30\n2188\n31620\n31620\nEndobronchial ultrasound (EBUS) during bronchoscopic diagnostic\nor therapeutic intervention(s) (List separately in addition to code for\nprimary procedure[s])\n$ 798.23\n2189\n31622\n31622\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; diagnostic, with cell washing, when performed\n(separate procedure)\n$ 715.50\n2190\n31623\n31623\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with brushing or protected brushings\n$ 686.70\n2191\n31624\n31624\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with bronchial alveolar lavage\n$ 693.00\n2192\n31625\n31625\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with bronchial or endobronchial biopsy(s), single\nor multiple sites\n$ 822.60\n2193\n31626\n31626\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with placement of fiducial markers, single or\nmultiple\n$ 823.11\n2194\n31627\n31627\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with computer-assisted, image-guided navigation\n(List separately in addition to code for primary procedure[s])\n$ 948.86\n2195\n31628\n31628\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with transbronchial lung biopsy(s), single lobe\n$ 915.30\n2196\n31629\n31629\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with transbronchial needle aspiration biopsy(s),\ntrachea, main stem and\/or lobar bronchus(i)\n$ 922.50\n2197\n31630\n31630\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with tracheal\/bronchial dilation or closed\nreduction of fracture\n$ 874.80\n2198\n31632\n31632\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with transbronchial lung biopsy(s), each\nadditional lobe (List separately in addition to code for primary\nprocedure)\n$ 221.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2199\n31633\n31633\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with transbronchial needle aspiration biopsy(s),\neach additional lobe (List separately in addition to code for primary\nprocedure)\n$ 302.61\n2200\n31635\n31635\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with removal of foreign body\n$ 992.70\n2201\n31636\n31636\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with placement of bronchial stent(s) (includes\ntracheal\/bronchial dilation as required), initial bronchus\n$ 822.83\n2202\n31637\n31637\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; each additional major bronchus stented (List\nseparately in addition to code for primary procedure)\n$ 274.30\n2203\n31638\n31638\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with revision of tracheal or bronchial stent\ninserted at previous session (includes tracheal\/bronchial dilation as\nrequired)\n$ 907.48\n2204\n31640\n31640\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with excision of tumor\n$ 1,161.00\n2205\n31641\n31641\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with destruction of tumor or relief of stenosis by\nany method other than excision (eg, laser therapy, cryotherapy)\n$ 1,545.30\n2206\n31643\n31643\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with placement of catheter(s) for intracavitary\nradioelement application\n$ 606.60\n2207\n31645\n31645\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with therapeutic aspiration of tracheobronchial\ntree, initial (eg, drainage of lung abscess)\n$ 801.00\n2208\n31646\n31646\nBronchoscopy, rigid or flexible, including fluoroscopic guidance,\nwhen performed; with therapeutic aspiration of tracheobronchial\ntree, subsequent\n$ 706.50\n2209\n31717\n31717\nCatheterization with bronchial brush biopsy\n$ 230.40\n2210\n31720\n31720\nCatheter aspiration (separate procedure); nasotracheal\n$ 169.20\n2211\n31725\n31725\nCatheter aspiration (separate procedure); tracheobronchial with\nfiberscope, bedside\n$ 406.80\n2212\n31730\n31730\nTranstracheal (percutaneous) introduction of needle wire\ndilator\/stent or indwelling tube for oxygen therapy\n$ 668.70\n2213\n31750\n31750\nTracheoplasty; cervical\n$ 3,236.40\n2214\n31755\n31755\nTracheoplasty; tracheopharyngeal fistulization, each stage\n$ 3,572.10\n2215\n31760\n31760\nTracheoplasty; intrathoracic\n$ 3,681.00\n2216\n31766\n31766\nCarinal reconstruction\n$ 4,428.90\n2217\n31770\n31770\nBronchoplasty; graft repair\n$ 3,687.30\n2218\n31775\n31775\nBronchoplasty; excision stenosis and anastomosis\n$ 4,083.30\n2219\n31780\n31780\nExcision tracheal stenosis and anastomosis; cervical\n$ 3,804.30\n2220\n31781\n31781\nExcision tracheal stenosis and anastomosis; cervicothoracic\n$ 4,003.20\n2221\n31785\n31785\nExcision of tracheal tumor or carcinoma; cervical\n$ 3,078.00\n2222\n31786\n31786\nExcision of tracheal tumor or carcinoma; thoracic\n$ 4,113.90\n2223\n31800\n31800\nSuture of tracheal wound or injury; cervical\n$ 2,929.50\n2224\n31805\n31805\nSuture of tracheal wound or injury; intrathoracic\n$ 2,932.20\n2225\n31820\n31820\nSurgical closure tracheostomy or fistula; without plastic repair\n$ 899.10\n2226\n31825\n31825\nSurgical closure tracheostomy or fistula; with plastic repair\n$ 1,259.10\n2227\n31830\n31830\nRevision of tracheostomy scar\n$ 927.00\n2228\n31899\n31899\nUnlisted procedure, trachea, bronchi\n$ 951.62\n2229\n32035\n32035\nThoracostomy; with rib resection for empyema\n$ 1,596.60\n2230\n32036\n32036\nThoracostomy; with open flap drainage for empyema\n$ 1,944.00\n2231\n32096\n32096\nThoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg,\nwedge, incisional), unilateral\n$ 2,016.26\n2232\n32097\n32097\nThoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or\nmass(es) (eg, wedge, incisional), unilateral\n$ 2,016.26\n2233\n32098\n32098\nThoracotomy, with biopsy(ies) of pleura\n$ 1,955.37\n2234\n32100\n32100\nThoracotomy; with exploration\n$ 2,701.80\n2235\n32110\n32110\nThoracotomy; with control of traumatic hemorrhage and\/or repair\nof lung tear\n$ 3,024.90\n2236\n32120\n32120\nThoracotomy; for postoperative complications\n$ 2,522.70\n2237\n32124\n32124\nThoracotomy; with open intrapleural pneumonolysis\n$ 2,365.20\n2238\n32140\n32140\nThoracotomy; with cyst(s) removal, includes pleural procedure\nwhen performed\n$ 2,574.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2239\n32141\n32141\nThoracotomy; with resection-plication of bullae, includes any\npleural procedure when performed\n$ 2,962.80\n2240\n32150\n32150\nThoracotomy; with removal of intrapleural foreign body or fibrin\ndeposit\n$ 2,801.70\n2241\n32151\n32151\nThoracotomy; with removal of intrapulmonary foreign body\n$ 2,255.40\n2242\n32160\n32160\nThoracotomy; with cardiac massage\n$ 2,646.00\n2243\n32200\n32200\nPneumonostomy, with open drainage of abscess or cyst\n$ 2,478.60\n2244\n32215\n32215\nPleural scarification for repeat pneumothorax\n$ 2,565.90\n2245\n32220\n32220\nDecortication, pulmonary (separate procedure); total\n$ 3,480.30\n2246\n32225\n32225\nDecortication, pulmonary (separate procedure); partial\n$ 2,477.70\n2247\n32310\n32310\nPleurectomy, parietal (separate procedure)\n$ 3,073.50\n2248\n32320\n32320\nDecortication and parietal pleurectomy\n$ 4,303.80\n2249\n32400\n32400\nBiopsy, pleura; percutaneous needle\n$ 387.90\n2250\n32405\n32405\nBiopsy, lung or mediastinum, percutaneous needle;\n$ 518.40\n2251\n32440\n32440\nRemoval of lung, pneumonectomy;\n$ 4,605.30\n2252\n32442\n32442\nRemoval of lung, pneumonectomy; with resection of segment of\ntrachea followed by broncho-tracheal anastomosis (sleeve\npneumonectomy)\n$ 4,649.40\n2253\n32445\n32445\nRemoval of lung, pneumonectomy; extrapleural\n$ 4,839.30\n2254\n32480\n32480\nRemoval of lung, other than pneumonectomy; single lobe\n(lobectomy)\n$ 4,327.20\n2255\n32482\n32482\nRemoval of lung, other than pneumonectomy; 2 lobes\n(bilobectomy)\n$ 4,661.10\n2256\n32484\n32484\nRemoval of lung, other than pneumonectomy; single segment\n(segmentectomy)\n$ 4,255.20\n2257\n32486\n32486\nRemoval of lung, other than pneumonectomy; with circumferential\nresection of segment of bronchus followed by broncho-bronchial\nanastomosis (sleeve lobectomy)\n$ 4,365.00\n2258\n32488\n32488\nRemoval of lung, other than pneumonectomy; with all remaining\nlung following previous removal of a portion of lung (completion\npneumonectomy)\n$ 5,346.00\n2259\n32491\n32491\nRemoval of lung, other than pneumonectomy; with resection-\nplication of emphysematous lung(s) (bullous or non-bullous) for\nlung volume reduction, sternal split or transthoracic approach,\nincludes any pleural procedure, when performed\n$ 3,131.92\n2260\n32501\n32501\nResection and repair of portion of bronchus (bronchoplasty) when\nperformed at time of lobectomy or segmentectomy (List separately\nin addition to code for primary procedure)\n$ 529.40\n2261\n32503\n32503\nResection of apical lung tumor (eg, Pancoast tumor), including chest\nwall resection, rib(s) resection(s), neurovascular dissection, when\nperformed; without chest wall reconstruction(s)\n$ 4,016.73\n2262\n32504\n32504\nResection of apical lung tumor (eg, Pancoast tumor), including chest\nwall resection, rib(s) resection(s), neurovascular dissection, when\nperformed; with chest wall reconstruction\n$ 4,300.61\n2263\n32505\n32505\nThoracotomy; with therapeutic wedge resection (eg, mass, nodule),\ninitial\n$ 2,383.63\n2264\n32506\n32506\nThoracotomy; with therapeutic wedge resection (eg, mass or\nnodule), each additional resection, ipsilateral (List separately in\naddition to code for primary procedure)\n$ 409.31\n2265\n32507\n32507\nThoracotomy; with diagnostic wedge resection followed by\nanatomic lung resection (List separately in addition to code for\nprimary procedure)\n$ 409.31\n2266\n32540\n32540\nExtrapleural enucleation of empyema (empyemectomy)\n$ 3,656.70\n2267\n32550\n32550\nInsertion of indwelling tunneled pleural catheter with cuff\n$ 739.02\n2268\n32551\n32551\nTube thoracostomy, includes connection to drainage system (eg,\nwater seal), when performed, open (separate procedure)\n$ 397.73\n2269\n32552\n32552\nRemoval of indwelling tunneled pleural catheter with cuff\n$ 393.46\n2270\n32553\n32553\nPlacement of interstitial device(s) for radiation therapy guidance\n(eg, fiducial markers, dosimeter), percutaneous, intra-thoracic,\nsingle or multiple\n$ 603.94\n2271\n32554\n32554\nThoracentesis, needle or catheter, aspiration of the pleural space;\nwithout imaging guidance\n$ 1,393.37\n2272\n32555\n32555\nThoracentesis, needle or catheter, aspiration of the pleural space;\nwith imaging guidance\n$ 1,606.11\n2273\n32560\n32560\nInstillation, via chest tube\/catheter, agent for pleurodesis (eg, talc\nfor recurrent or persistent pneumothorax)\n$ 300.45\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2274\n32561\n32561\nInstillation(s), via chest tube\/catheter, agent for fibrinolysis (eg,\nfibrinolytic agent for break up of multiloculated effusion); initial day $ 184.63\n2275\n32562\n32562\nInstillation(s), via chest tube\/catheter, agent for fibrinolysis (eg,\nfibrinolytic agent for break up of multiloculated effusion);\nsubsequent day\n$ 170.85\n2276\n32601\n32601\nThoracoscopy, diagnostic (separate procedure); lungs, pericardial\nsac, mediastinal or pleural space, without biopsy\n$ 1,074.60\n2277\n32604\n32604\nThoracoscopy, diagnostic (separate procedure); pericardial sac, with\nbiopsy\n$ 1,803.60\n2278\n32606\n32606\nThoracoscopy, diagnostic (separate procedure); mediastinal space,\nwith biopsy\n$ 1,832.40\n2279\n32607\n32607\nThoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg,\nwedge, incisional), unilateral\n$ 795.40\n2280\n32608\n32608\nThoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or\nmass(es) (eg, wedge, incisional), unilateral\n$ 979.00\n2281\n32609\n32609\nThoracoscopy; with biopsy(ies) of pleura\n$ 675.96\n2282\n32650\n32650\nThoracoscopy, surgical; with pleurodesis (eg, mechanical or\nchemical)\n$ 2,230.20\n2283\n32651\n32651\nThoracoscopy, surgical; with partial pulmonary decortication\n$ 2,722.50\n2284\n32652\n32652\nThoracoscopy, surgical; with total pulmonary decortication,\nincluding intrapleural pneumonolysis\n$ 3,548.70\n2285\n32653\n32653\nThoracoscopy, surgical; with removal of intrapleural foreign body or\nfibrin deposit\n$ 2,567.70\n2286\n32654\n32654\nThoracoscopy, surgical; with control of traumatic hemorrhage\n$ 2,729.70\n2287\n32655\n32655\nThoracoscopy, surgical; with resection-plication of bullae, includes\nany pleural procedure when performed\n$ 2,972.70\n2288\n32656\n32656\nThoracoscopy, surgical; with parietal pleurectomy\n$ 2,995.20\n2289\n32658\n32658\nThoracoscopy, surgical; with removal of clot or foreign body from\npericardial sac\n$ 2,766.60\n2290\n32659\n32659\nThoracoscopy, surgical; with creation of pericardial window or\npartial resection of pericardial sac for drainage\n$ 2,986.20\n2291\n32661\n32661\nThoracoscopy, surgical; with excision of pericardial cyst, tumor, or\nmass\n$ 3,141.90\n2292\n32662\n32662\nThoracoscopy, surgical; with excision of mediastinal cyst, tumor, or\nmass\n$ 3,102.30\n2293\n32663\n32663\nThoracoscopy, surgical; with lobectomy (single lobe)\n$ 3,747.60\n2294\n32664\n32664\nThoracoscopy, surgical; with thoracic sympathectomy\n$ 2,699.10\n2295\n32665\n32665\nThoracoscopy, surgical; with esophagomyotomy (Heller type)\n$ 3,350.70\n2296\n32666\n32666\nThoracoscopy, surgical; with therapeutic wedge resection (eg, mass,\nnodule), initial unilateral\n$ 2,222.05\n2297\n32667\n32667\nThoracoscopy, surgical; with therapeutic wedge resection (eg, mass\nor nodule), each additional resection, ipsilateral (List separately in\naddition to code for primary procedure)\n$ 409.31\n2298\n32668\n32668\nThoracoscopy, surgical; with diagnostic wedge resection followed by\nanatomic lung resection (List separately in addition to code for\nprimary procedure)\n$ 411.71\n2299\n32669\n32669\nThoracoscopy, surgical; with removal of a single lung segment\n(segmentectomy)\n$ 3,335.83\n2300\n32670\n32670\nThoracoscopy, surgical; with removal of two lobes (bilobectomy)\n$ 3,974.02\n2301\n32671\n32671\nThoracoscopy, surgical; with removal of lung (pneumonectomy)\n$ 4,409.85\n2302\n32672\n32672\nThoracoscopy, surgical; with resection-plication for emphysematous\nlung (bullous or non-bullous) for lung volume reduction (LVRS),\nunilateral includes any pleural procedure, when performed\n$ 3,774.81\n2303\n32673\n32673\nThoracoscopy, surgical; with resection of thymus, unilateral or\nbilateral\n$ 2,957.25\n2304\n32674\n32674\nThoracoscopy, surgical; with mediastinal and regional\nlymphadenectomy (List separately in addition to code for primary\nprocedure)\n$ 531.96\n2305\n32800\n32800\nRepair lung hernia through chest wall\n$ 2,565.00\n2306\n32810\n32810\nClosure of chest wall following open flap drainage for empyema\n(Clagett type procedure)\n$ 2,710.80\n2307\n32815\n32815\nOpen closure of major bronchial fistula\n$ 4,140.90\n2308\n32820\n32820\nMajor reconstruction, chest wall (posttraumatic)\n$ 3,856.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2309\n32850\n32850\nDonor pneumonectomy(s) (including cold preservation), from\ncadaver donor\n$ -\n2310\n32851\n32851\nLung transplant, single; without cardiopulmonary bypass\n$ 8,134.00\n2311\n32852\n32852\nLung transplant, single; with cardiopulmonary bypass\n$ 8,881.42\n2312\n32853\n32853\nLung transplant, double (bilateral sequential or en bloc); without\ncardiopulmonary bypass\n$ 11,365.84\n2313\n32854\n32854\nLung transplant, double (bilateral sequential or en bloc); with\ncardiopulmonary bypass\n$ 12,075.71\n2314\n32855\n32855\nBackbench standard preparation of cadaver donor lung allograft\nprior to transplantation, including dissection of allograft from\nsurrounding soft tissues to prepare pulmonary venous\/atrial cuff,\npulmonary artery, and bronchus; unilateral\n$ -\n2315\n32856\n32856\nBackbench standard preparation of cadaver donor lung allograft\nprior to transplantation, including dissection of allograft from\nsurrounding soft tissues to prepare pulmonary venous\/atrial cuff,\npulmonary artery, and bronchus; bilateral\n$ -\n2316\n32900\n32900\nResection of ribs, extrapleural, all stages\n$ 2,188.80\n2317\n32905\n32905\nThoracoplasty, Schede type or extrapleural (all stages);\n$ 2,652.30\n2318\n32906\n32906\nThoracoplasty, Schede type or extrapleural (all stages); with closure\nof bronchopleural fistula\n$ 3,554.10\n2319\n32940\n32940\nPneumonolysis, extraperiosteal, including filling or packing\nprocedures\n$ 2,266.20\n2320\n32960\n32960\nPneumothorax, therapeutic, intrapleural injection of air\n$ 261.00\n2321\n32997\n32997\nTotal lung lavage (unilateral)\n$ 993.60\n2322\n32998\n32998\nAblation therapy for reduction or eradication of 1 or more\npulmonary tumor(s) including pleura or chest wall when involved by\ntumor extension, percutaneous, radiofrequency, unilateral\n$ 2,369.98\n2323\n32999\n32999\nUnlisted procedure, lungs and pleura\nCost\n2324\n33010\n33010\nPericardiocentesis; initial\n$ 483.30\n2325\n33011\n33011\nPericardiocentesis; subsequent\n$ 407.70\n2326\n33015\n33015\nTube pericardiostomy\n$ 1,074.60\n2327\n33020\n33020\nPericardiotomy for removal of clot or foreign body (primary\nprocedure)\n$ 2,667.60\n2328\n33025\n33025\nCreation of pericardial window or partial resection for drainage\n$ 3,193.20\n2329\n33030\n33030\nPericardiectomy, subtotal or complete; without cardiopulmonary\nbypass\n$ 4,041.00\n2330\n33031\n33031\nPericardiectomy, subtotal or complete; with cardiopulmonary\nbypass\n$ 5,037.30\n2331\n33050\n33050\nResection of pericardial cyst or tumor\n$ 3,219.30\n2332\n33120\n33120\nExcision of intracardiac tumor, resection with cardiopulmonary\nbypass\n$ 6,552.90\n2333\n33130\n33130\nResection of external cardiac tumor\n$ 4,139.10\n2334\n33140\n33140\nTransmyocardial laser revascularization, by thoracotomy; (separate\nprocedure)\n$ 3,384.56\n2335\n33141\n33141\nTransmyocardial laser revascularization, by thoracotomy;\nperformed at the time of other open cardiac procedure(s) (List\nseparately in addition to code for primary procedure)\n$ 1,649.90\n2336\n33202\n33202\nInsertion of epicardial electrode(s); open incision (eg, thoracotomy,\nmedian sternotomy, subxiphoid approach)\n$ 2,051.82\n2337\n33203\n33203\nInsertion of epicardial electrode(s); endoscopic approach (eg,\nthoracoscopy, pericardioscopy)\n$ 2,105.33\n2338\n33206\n33206\nInsertion of new or replacement of permanent pacemaker with\ntransvenous electrode(s); atrial\n$ 2,232.90\n2339\n33207\n33207\nInsertion of new or replacement of permanent pacemaker with\ntransvenous electrode(s); ventricular\n$ 2,424.60\n2340\n33208\n33208\nInsertion of new or replacement of permanent pacemaker with\ntransvenous electrode(s); atrial and ventricular\n$ 3,028.50\n2341\n33210\n33210\nInsertion or replacement of temporary transvenous single chamber\ncardiac electrode or pacemaker catheter (separate procedure)\n$ 874.80\n2342\n33211\n33211\nInsertion or replacement of temporary transvenous dual chamber\npacing electrodes (separate procedure)\n$ 1,017.90\n2343\n33212\n33212\nInsertion of pacemaker pulse generator only; with existing single\nlead\n$ 1,445.40\n2344\n33213\n33213\nInsertion of pacemaker pulse generator only; with existing dual\nleads\n$ 1,467.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2345\n33214\n33214\nUpgrade of implanted pacemaker system, conversion of single\nchamber system to dual chamber system (includes removal of\npreviously placed pulse generator, testing of existing lead, insertion\nof new lead, insertion of new pulse generator)\n$ 1,986.30\n2346\n33215\n33215\nRepositioning of previously implanted transvenous pacemaker or\npacing cardioverter-defibrillator (right atrial or right ventricular)\nelectrode\n$ 829.37\n2347\n33216\n33216\nInsertion of a single transvenous electrode, permanent pacemaker\nor cardioverter-defibrillator\n$ 1,427.40\n2348\n33217\n33217\nInsertion of 2 transvenous electrodes, permanent pacemaker or\ncardioverter-defibrillator\n$ 1,512.90\n2349\n33218\n33218\nRepair of single transvenous electrode, permanent pacemaker or\npacing cardioverter-defibrillator\n$ 1,392.30\n2350\n33220\n33220\nRepair of 2 transvenous electrodes for permanent pacemaker or\npacing cardioverter-defibrillator\n$ 1,192.50\n2351\n33222\n33222\nRelocation of skin pocket for pacemaker\n$ 1,442.70\n2352\n33223\n33223\nRelocation of skin pocket for cardioverter-defibrillator\n$ 1,238.40\n2353\n33224\n33224\nInsertion of pacing electrode, cardiac venous system, for left\nventricular pacing, with attachment to previously placed pacemaker\nor pacing cardioverter-defibrillator pulse generator (including\nrevision of pocket, removal, insertion, and\/or replacement of\n$ 1,345.09\n2354\n33225\n33225\nInsertion of pacing electrode, cardiac venous system, for left\nventricular pacing, at time of insertion of pacing cardioverter-\ndefibrillator or pacemaker pulse generator (eg, for upgrade to dual\nchamber system) (List separately in addition to code for pri\n$ 1,199.61\n2355\n33226\n33226\nRepositioning of previously implanted cardiac venous system (left\nventricular) electrode (including removal, insertion and\/or\nreplacement of existing generator)\n$ 1,296.07\n2356\n33233\n33233\nRemoval of permanent pacemaker pulse generator only\n$ 995.40\n2357\n33234\n33234\nRemoval of transvenous pacemaker electrode(s); single lead system,\natrial or ventricular\n$ 1,511.10\n2358\n33235\n33235\nRemoval of transvenous pacemaker electrode(s); dual lead system\n$ 1,649.70\n2359\n33236\n33236\nRemoval of permanent epicardial pacemaker and electrodes by\nthoracotomy; single lead system, atrial or ventricular\n$ 1,722.60\n2360\n33237\n33237\nRemoval of permanent epicardial pacemaker and electrodes by\nthoracotomy; dual lead system\n$ 2,735.10\n2361\n33238\n33238\nRemoval of permanent transvenous electrode(s) by thoracotomy\n$ 2,816.10\n2362\n33240\n33240\nInsertion of pacing cardioverter-defibrillator pulse generator only;\nwith existing single lead\n$ 1,513.80\n2363\n33241\n33241\nRemoval of pacing cardioverter-defibrillator pulse generator only\n$ 1,061.10\n2364\n33243\n33243\nRemoval of single or dual chamber pacing cardioverter-defibrillator\nelectrode(s); by thoracotomy\n$ 3,192.30\n2365\n33244\n33244\nRemoval of single or dual chamber pacing cardioverter-defibrillator\nelectrode(s); by transvenous extraction\n$ 2,707.20\n2366\n33249\n33249\nInsertion or replacement of permanent pacing cardioverter-\ndefibrillator system with transvenous lead(s), single or dual\nchamber\n$ 3,577.50\n2367\n33250\n33250\nOperative ablation of supraventricular arrhythmogenic focus or\npathway (eg, Wolff-Parkinson-White, atrioventricular node re-\nentry), tract(s) and\/or focus (foci); without cardiopulmonary bypass\n$ 3,759.30\n2368\n33251\n33251\nOperative ablation of supraventricular arrhythmogenic focus or\npathway (eg, Wolff-Parkinson-White, atrioventricular node re-\nentry), tract(s) and\/or focus (foci); with cardiopulmonary bypass\n$ 5,150.70\n2369\n33254\n33254\nOperative tissue ablation and reconstruction of atria, limited (eg,\nmodified maze procedure)\n$ 2,975.87\n2370\n33255\n33255\nOperative tissue ablation and reconstruction of atria, extensive (eg,\nmaze procedure); without cardiopulmonary bypass\n$ 3,580.01\n2371\n33256\n33256\nOperative tissue ablation and reconstruction of atria, extensive (eg,\nmaze procedure); with cardiopulmonary bypass\n$ 4,278.05\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2372\n33257\n33257\nOperative tissue ablation and reconstruction of atria, performed at\nthe time of other cardiac procedure(s), limited (eg, modified maze\nprocedure) (List separately in addition to code for primary\nprocedure)\n$ 1,362.89\n2373\n33258\n33258\nOperative tissue ablation and reconstruction of atria, performed at\nthe time of other cardiac procedure(s), extensive (eg, maze\nprocedure), without cardiopulmonary bypass (List separately in\naddition to code for primary procedure)\n$ 1,535.93\n2374\n33259\n33259\nOperative tissue ablation and reconstruction of atria, performed at\nthe time of other cardiac procedure(s), extensive (eg, maze\nprocedure), with cardiopulmonary bypass (List separately in\naddition to code for primary procedure)\n$ 2,004.34\n2375\n33261\n33261\nOperative ablation of ventricular arrhythmogenic focus with\ncardiopulmonary bypass\n$ 5,135.40\n2376\n33265\n33265\nEndoscopy, surgical; operative tissue ablation and reconstruction of\natria, limited (eg, modified maze procedure), without\ncardiopulmonary bypass\n$ 2,970.81\n2377\n33266\n33266\nEndoscopy, surgical; operative tissue ablation and reconstruction of\natria, extensive (eg, maze procedure), without cardiopulmonary\nbypass\n$ 4,068.64\n2378\n33282\n33282\nImplantation of patient-activated cardiac event recorder\n$ 786.37\n2379\n33284\n33284\nRemoval of an implantable, patient-activated cardiac event recorder $ 567.29\n2380\n33300\n33300\nRepair of cardiac wound; without bypass\n$ 3,836.70\n2381\n33305\n33305\nRepair of cardiac wound; with cardiopulmonary bypass\n$ 5,122.80\n2382\n33310\n33310\nCardiotomy, exploratory (includes removal of foreign body, atrial or\nventricular thrombus); without bypass\n$ 3,654.90\n2383\n33315\n33315\nCardiotomy, exploratory (includes removal of foreign body, atrial or\nventricular thrombus); with cardiopulmonary bypass\n$ 5,318.10\n2384\n33320\n33320\nSuture repair of aorta or great vessels; without shunt or\ncardiopulmonary bypass\n$ 4,713.30\n2385\n33321\n33321\nSuture repair of aorta or great vessels; with shunt bypass\n$ 3,833.13\n2386\n33322\n33322\nSuture repair of aorta or great vessels; with cardiopulmonary\nbypass\n$ 5,744.70\n2387\n33330\n33330\nInsertion of graft, aorta or great vessels; without shunt, or\ncardiopulmonary bypass\n$ 6,261.30\n2388\n33332\n33332\nInsertion of graft, aorta or great vessels; with shunt bypass\n$ 5,066.72\n2389\n33335\n33335\nInsertion of graft, aorta or great vessels; with cardiopulmonary\nbypass\n$ 6,984.00\n2390\n33400\n33400\nValvuloplasty, aortic valve; open, with cardiopulmonary bypass\n$ 5,665.50\n2391\n33401\n33401\nValvuloplasty, aortic valve; open, with inflow occlusion\n$ 5,706.90\n2392\n33403\n33403\nValvuloplasty, aortic valve; using transventricular dilation, with\ncardiopulmonary bypass\n$ 6,159.60\n2393\n33404\n33404\nConstruction of apical-aortic conduit\n$ 6,695.10\n2394\n33405\n33405\nReplacement, aortic valve, with cardiopulmonary bypass; with\nprosthetic valve other than homograft or stentless valve\n$ 7,717.50\n2395\n33406\n33406\nReplacement, aortic valve, with cardiopulmonary bypass; with\nallograft valve (freehand)\n$ 7,029.90\n2396\n33410\n33410\nReplacement, aortic valve, with cardiopulmonary bypass; with\nstentless tissue valve\n$ 6,661.86\n2397\n33411\n33411\nReplacement, aortic valve; with aortic annulus enlargement,\nnoncoronary sinus\n$ 7,921.80\n2398\n33412\n33412\nReplacement, aortic valve; with transventricular aortic annulus\nenlargement (Konno procedure)\n$ 8,019.00\n2399\n33413\n33413\nReplacement, aortic valve; by translocation of autologous\npulmonary valve with allograft replacement of pulmonary valve\n(Ross procedure)\n$ 7,622.10\n2400\n33414\n33414\nRepair of left ventricular outflow tract obstruction by patch\nenlargement of the outflow tract\n$ 6,825.57\n2401\n33415\n33415\nResection or incision of subvalvular tissue for discrete subvalvular\naortic stenosis\n$ 6,087.60\n2402\n33416\n33416\nVentriculomyotomy (-myectomy) for idiopathic hypertrophic\nsubaortic stenosis (eg, asymmetric septal hypertrophy)\n$ 6,592.50\n2403\n33417\n33417\nAortoplasty (gusset) for supravalvular stenosis\n$ 6,952.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2404\n33420\n33420\nValvotomy, mitral valve; closed heart\n$ 5,495.40\n2405\n33422\n33422\nValvotomy, mitral valve; open heart, with cardiopulmonary bypass\n$ 6,451.20\n2406\n33425\n33425\nValvuloplasty, mitral valve, with cardiopulmonary bypass;\n$ 6,628.50\n2407\n33426\n33426\nValvuloplasty, mitral valve, with cardiopulmonary bypass; with\nprosthetic ring\n$ 7,905.60\n2408\n33427\n33427\nValvuloplasty, mitral valve, with cardiopulmonary bypass; radical\nreconstruction, with or without ring\n$ 6,978.60\n2409\n33430\n33430\nReplacement, mitral valve, with cardiopulmonary bypass\n$ 7,627.50\n2410\n33460\n33460\nValvectomy, tricuspid valve, with cardiopulmonary bypass\n$ 6,223.50\n2411\n33463\n33463\nValvuloplasty, tricuspid valve; without ring insertion\n$ 7,105.50\n2412\n33464\n33464\nValvuloplasty, tricuspid valve; with ring insertion\n$ 6,801.30\n2413\n33465\n33465\nReplacement, tricuspid valve, with cardiopulmonary bypass\n$ 6,721.20\n2414\n33468\n33468\nTricuspid valve repositioning and plication for Ebstein anomaly\n$ 6,988.50\n2415\n33470\n33470\nValvotomy, pulmonary valve, closed heart; transventricular\n$ 5,030.10\n2416\n33471\n33471\nValvotomy, pulmonary valve, closed heart; via pulmonary artery\n$ 4,708.80\n2417\n33472\n33472\nValvotomy, pulmonary valve, open heart; with inflow occlusion\n$ 4,979.70\n2418\n33474\n33474\nValvotomy, pulmonary valve, open heart; with cardiopulmonary\nbypass\n$ 5,535.90\n2419\n33475\n33475\nReplacement, pulmonary valve\n$ 7,105.50\n2420\n33476\n33476\nRight ventricular resection for infundibular stenosis, with or without\ncommissurotomy\n$ 5,840.10\n2421\n33478\n33478\nOutflow tract augmentation (gusset), with or without\ncommissurotomy or infundibular resection\n$ 5,840.10\n2422\n33496\n33496\nRepair of non-structural prosthetic valve dysfunction with\ncardiopulmonary bypass (separate procedure)\n$ 5,799.60\n2423\n33500\n33500\nRepair of coronary arteriovenous or arteriocardiac chamber fistula;\nwith cardiopulmonary bypass\n$ 5,355.90\n2424\n33501\n33501\nRepair of coronary arteriovenous or arteriocardiac chamber fistula;\nwithout cardiopulmonary bypass\n$ 4,027.50\n2425\n33502\n33502\nRepair of anomalous coronary artery from pulmonary artery origin;\nby ligation\n$ 3,878.10\n2426\n33503\n33503\nRepair of anomalous coronary artery from pulmonary artery origin;\nby graft, without cardiopulmonary bypass\n$ 4,377.60\n2427\n33504\n33504\nRepair of anomalous coronary artery from pulmonary artery origin;\nby graft, with cardiopulmonary bypass\n$ 6,170.40\n2428\n33505\n33505\nRepair of anomalous coronary artery from pulmonary artery origin;\nwith construction of intrapulmonary artery tunnel (Takeuchi\nprocedure)\n$ 5,183.04\n2429\n33506\n33506\nRepair of anomalous coronary artery from pulmonary artery origin;\nby translocation from pulmonary artery to aorta\n$ 5,719.19\n2430\n33507\n33507\nRepair of anomalous (eg, intramural) aortic origin of coronary artery\nby unroofing or translocation\n$ 5,300.00\n2431\n33508\n33508\nEndoscopy, surgical, including video-assisted harvest of vein(s) for\ncoronary artery bypass procedure (List separately in addition to\ncode for primary procedure)\n$ 260.39\n2432\n33510\n33510\nCoronary artery bypass, vein only; single coronary venous graft\n$ 7,254.00\n2433\n33511\n33511\nCoronary artery bypass, vein only; 2 coronary venous grafts\n$ 7,448.40\n2434\n33512\n33512\nCoronary artery bypass, vein only; 3 coronary venous grafts\n$ 8,284.50\n2435\n33513\n33513\nCoronary artery bypass, vein only; 4 coronary venous grafts\n$ 9,268.20\n2436\n33514\n33514\nCoronary artery bypass, vein only; 5 coronary venous grafts\n$ 10,083.60\n2437\n33516\n33516\nCoronary artery bypass, vein only; 6 or more coronary venous grafts\n$ 10,809.00\n2438\n33517\n33517\nCoronary artery bypass, using venous graft(s) and arterial graft(s);\nsingle vein graft (List separately in addition to code for primary\nprocedure)\n$ 1,161.90\n2439\n33518\n33518\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 2\nvenous grafts (List separately in addition to code for primary\nprocedure)\n$ 1,747.80\n2440\n33519\n33519\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 3\nvenous grafts (List separately in addition to code for primary\nprocedure)\n$ 2,054.70\n2441\n33521\n33521\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 4\nvenous grafts (List separately in addition to code for primary\nprocedure)\n$ 2,816.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2442\n33522\n33522\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 5\nvenous grafts (List separately in addition to code for primary\nprocedure)\n$ 3,634.20\n2443\n33523\n33523\nCoronary artery bypass, using venous graft(s) and arterial graft(s); 6\nor more venous grafts (List separately in addition to code for\nprimary procedure)\n$ 4,606.20\n2444\n33530\n33530\nReoperation, coronary artery bypass procedure or valve procedure,\nmore than 1 month after original operation (List separately in\naddition to code for primary procedure)\n$ 2,003.40\n2445\n33533\n33533\nCoronary artery bypass, using arterial graft(s); single arterial graft\n$ 6,878.70\n2446\n33534\n33534\nCoronary artery bypass, using arterial graft(s); 2 coronary arterial\ngrafts\n$ 7,822.80\n2447\n33535\n33535\nCoronary artery bypass, using arterial graft(s); 3 coronary arterial\ngrafts\n$ 8,479.80\n2448\n33536\n33536\nCoronary artery bypass, using arterial graft(s); 4 or more coronary\narterial grafts\n$ 8,454.60\n2449\n33542\n33542\nMyocardial resection (eg, ventricular aneurysmectomy)\n$ 6,769.80\n2450\n33545\n33545\nRepair of postinfarction ventricular septal defect, with or without\nmyocardial resection\n$ 7,679.70\n2451\n33548\n33548\nSurgical ventricular restoration procedure, includes prosthetic\npatch, when performed (eg, ventricular remodeling, SVR, SAVER,\nDor procedures)\n$ 7,924.63\n2452\n33572\n33572\nCoronary endarterectomy, open, any method, of left anterior\ndescending, circumflex, or right coronary artery performed in\nconjunction with coronary artery bypass graft procedure, each\nvessel (List separately in addition to primary procedure)\n$ 1,008.00\n2453\n33600\n33600\nClosure of atrioventricular valve (mitral or tricuspid) by suture or\npatch\n$ 6,489.00\n2454\n33602\n33602\nClosure of semilunar valve (aortic or pulmonary) by suture or patch\n$ 6,479.10\n2455\n33606\n33606\nAnastomosis of pulmonary artery to aorta (Damus-Kaye-Stansel\nprocedure)\n$ 6,581.70\n2456\n33608\n33608\nRepair of complex cardiac anomaly other than pulmonary atresia\nwith ventricular septal defect by construction or replacement of\nconduit from right or left ventricle to pulmonary artery\n$ 6,643.80\n2457\n33610\n33610\nRepair of complex cardiac anomalies (eg, single ventricle with\nsubaortic obstruction) by surgical enlargement of ventricular septal\ndefect\n$ 6,591.66\n2458\n33611\n33611\nRepair of double outlet right ventricle with intraventricular tunnel\nrepair;\n$ 6,644.56\n2459\n33612\n33612\nRepair of double outlet right ventricle with intraventricular tunnel\nrepair; with repair of right ventricular outflow tract obstruction\n$ 7,416.00\n2460\n33615\n33615\nRepair of complex cardiac anomalies (eg, tricuspid atresia) by\nclosure of atrial septal defect and anastomosis of atria or vena cava\nto pulmonary artery (simple Fontan procedure)\n$ 7,004.70\n2461\n33617\n33617\nRepair of complex cardiac anomalies (eg, single ventricle) by\nmodified Fontan procedure\n$ 7,584.08\n2462\n33619\n33619\nRepair of single ventricle with aortic outflow obstruction and aortic\narch hypoplasia (hypoplastic left heart syndrome) (eg, Norwood\nprocedure)\n$ 8,214.30\n2463\n33641\n33641\nRepair atrial septal defect, secundum, with cardiopulmonary\nbypass, with or without patch\n$ 5,459.40\n2464\n33645\n33645\nDirect or patch closure, sinus venosus, with or without anomalous\npulmonary venous drainage\n$ 6,368.40\n2465\n33647\n33647\nRepair of atrial septal defect and ventricular septal defect, with\ndirect or patch closure\n$ 7,210.80\n2466\n33660\n33660\nRepair of incomplete or partial atrioventricular canal (ostium\nprimum atrial septal defect), with or without atrioventricular valve\nrepair\n$ 6,916.50\n2467\n33665\n33665\nRepair of intermediate or transitional atrioventricular canal, with or\nwithout atrioventricular valve repair\n$ 7,938.00\n2468\n33670\n33670\nRepair of complete atrioventricular canal, with or without\nprosthetic valve\n$ 7,625.70\n2469\n33675\n33675\nClosure of multiple ventricular septal defects;\n$ 6,647.90\n2470\n33676\n33676\nClosure of multiple ventricular septal defects; with pulmonary\nvalvotomy or infundibular resection (acyanotic)\n$ 6,341.84\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2471\n33677\n33677\nClosure of multiple ventricular septal defects; with removal of\npulmonary artery band, with or without gusset\n$ 6,334.62\n2472\n33681\n33681\nClosure of single ventricular septal defect, with or without patch;\n$ 6,144.30\n2473\n33684\n33684\nClosure of single ventricular septal defect, with or without patch;\nwith pulmonary valvotomy or infundibular resection (acyanotic)\n$ 6,494.40\n2474\n33688\n33688\nClosure of single ventricular septal defect, with or without patch;\nwith removal of pulmonary artery band, with or without gusset\n$ 6,613.20\n2475\n33690\n33690\nBanding of pulmonary artery\n$ 3,090.60\n2476\n33692\n33692\nComplete repair tetralogy of Fallot without pulmonary atresia;\n$ 6,437.70\n2477\n33694\n33694\nComplete repair tetralogy of Fallot without pulmonary atresia; with\ntransannular patch\n$ 7,090.20\n2478\n33697\n33697\nComplete repair tetralogy of Fallot with pulmonary atresia including\nconstruction of conduit from right ventricle to pulmonary artery\nand closure of ventricular septal defect\n$ 7,173.90\n2479\n33702\n33702\nRepair sinus of Valsalva fistula, with cardiopulmonary bypass;\n$ 5,951.70\n2480\n33710\n33710\nRepair sinus of Valsalva fistula, with cardiopulmonary bypass; with\nrepair of ventricular septal defect\n$ 7,786.80\n2481\n33720\n33720\nRepair sinus of Valsalva aneurysm, with cardiopulmonary bypass\n$ 6,746.40\n2482\n33722\n33722\nClosure of aortico-left ventricular tunnel\n$ 6,437.70\n2483\n33724\n33724\nRepair of isolated partial anomalous pulmonary venous return (eg,\nScimitar Syndrome)\n$ 5,384.20\n2484\n33726\n33726\nRepair of pulmonary venous stenosis\n$ 6,373.14\n2485\n33730\n33730\nComplete repair of anomalous pulmonary venous return\n(supracardiac, intracardiac, or infracardiac types)\n$ 6,602.40\n2486\n33732\n33732\nRepair of cor triatriatum or supravalvular mitral ring by resection of\nleft atrial membrane\n$ 5,942.70\n2487\n33735\n33735\nAtrial septectomy or septostomy; closed heart (Blalock-Hanlon type\noperation)\n$ 4,538.70\n2488\n33736\n33736\nAtrial septectomy or septostomy; open heart with cardiopulmonary\nbypass\n$ 5,480.10\n2489\n33737\n33737\nAtrial septectomy or septostomy; open heart, with inflow occlusion\n$ 4,892.40\n2490\n33750\n33750\nShunt; subclavian to pulmonary artery (Blalock-Taussig type\noperation)\n$ 4,233.60\n2491\n33755\n33755\nShunt; ascending aorta to pulmonary artery (Waterston type\noperation)\n$ 4,748.40\n2492\n33762\n33762\nShunt; descending aorta to pulmonary artery (Potts-Smith type\noperation)\n$ 4,645.80\n2493\n33764\n33764\nShunt; central, with prosthetic graft\n$ 4,686.30\n2494\n33766\n33766\nShunt; superior vena cava to pulmonary artery for flow to 1 lung\n(classical Glenn procedure)\n$ 4,068.90\n2495\n33767\n33767\nShunt; superior vena cava to pulmonary artery for flow to both\nlungs (bidirectional Glenn procedure)\n$ 4,686.30\n2496\n33768\n33768\nAnastomosis, cavopulmonary, second superior vena cava (List\nseparately in addition to primary procedure)\n$ 1,373.84\n2497\n33770\n33770\nRepair of transposition of the great arteries with ventricular septal\ndefect and subpulmonary stenosis; without surgical enlargement of\nventricular septal defect\n$ 7,014.60\n2498\n33771\n33771\nRepair of transposition of the great arteries with ventricular septal\ndefect and subpulmonary stenosis; with surgical enlargement of\nventricular septal defect\n$ 7,655.60\n2499\n33774\n33774\nRepair of transposition of the great arteries, atrial baffle procedure\n(eg, Mustard or Senning type) with cardiopulmonary bypass;\n$ 6,746.40\n2500\n33775\n33775\nRepair of transposition of the great arteries, atrial baffle procedure\n(eg, Mustard or Senning type) with cardiopulmonary bypass; with\nremoval of pulmonary band\n$ 6,685.20\n2501\n33776\n33776\nRepair of transposition of the great arteries, atrial baffle procedure\n(eg, Mustard or Senning type) with cardiopulmonary bypass; with\nclosure of ventricular septal defect\n$ 8,601.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2502\n33777\n33777\nRepair of transposition of the great arteries, atrial baffle procedure\n(eg, Mustard or Senning type) with cardiopulmonary bypass; with\nrepair of subpulmonic obstruction\n$ 8,343.00\n2503\n33778\n33778\nRepair of transposition of the great arteries, aortic pulmonary\nartery reconstruction (eg, Jatene type);\n$ 9,038.70\n2504\n33779\n33779\nRepair of transposition of the great arteries, aortic pulmonary\nartery reconstruction (eg, Jatene type); with removal of pulmonary\nband\n$ 8,766.00\n2505\n33780\n33780\nRepair of transposition of the great arteries, aortic pulmonary\nartery reconstruction (eg, Jatene type); with closure of ventricular\nseptal defect\n$ 8,766.00\n2506\n33781\n33781\nRepair of transposition of the great arteries, aortic pulmonary\nartery reconstruction (eg, Jatene type); with repair of subpulmonic\nobstruction\n$ 8,766.00\n2507\n33782\n33782\nAortic root translocation with ventricular septal defect and\npulmonary stenosis repair (ie, Nikaidoh procedure); without\ncoronary ostium reimplantation\n$ 12,843.24\n2508\n33783\n33783\nAortic root translocation with ventricular septal defect and\npulmonary stenosis repair (ie, Nikaidoh procedure); with\nreimplantation of 1 or both coronary ostia\n$ 13,932.80\n2509\n33786\n33786\nTotal repair, truncus arteriosus (Rastelli type operation)\n$ 7,416.00\n2510\n33788\n33788\nReimplantation of an anomalous pulmonary artery\n$ 5,548.50\n2511\n33800\n33800\nAortic suspension (aortopexy) for tracheal decompression (eg, for\ntracheomalacia) (separate procedure)\n$ 2,654.10\n2512\n33802\n33802\nDivision of aberrant vessel (vascular ring);\n$ 3,554.10\n2513\n33803\n33803\nDivision of aberrant vessel (vascular ring); with reanastomosis\n$ 3,893.40\n2514\n33813\n33813\nObliteration of aortopulmonary septal defect; without\ncardiopulmonary bypass\n$ 4,243.50\n2515\n33814\n33814\nObliteration of aortopulmonary septal defect; with\ncardiopulmonary bypass\n$ 5,994.90\n2516\n33820\n33820\nRepair of patent ductus arteriosus; by ligation\n$ 3,869.10\n2517\n33822\n33822\nRepair of patent ductus arteriosus; by division, younger than 18\nyears\n$ 3,641.40\n2518\n33824\n33824\nRepair of patent ductus arteriosus; by division, 18 years and older\n$ 4,058.10\n2519\n33840\n33840\nExcision of coarctation of aorta, with or without associated patent\nductus arteriosus; with direct anastomosis\n$ 4,342.50\n2520\n33845\n33845\nExcision of coarctation of aorta, with or without associated patent\nductus arteriosus; with graft\n$ 6,087.60\n2521\n33851\n33851\nExcision of coarctation of aorta, with or without associated patent\nductus arteriosus; repair using either left subclavian artery or\nprosthetic material as gusset for enlargement\n$ 5,986.48\n2522\n33852\n33852\nRepair of hypoplastic or interrupted aortic arch using autogenous or\nprosthetic material; without cardiopulmonary bypass\n$ 5,514.30\n2523\n33853\n33853\nRepair of hypoplastic or interrupted aortic arch using autogenous or\nprosthetic material; with cardiopulmonary bypass\n$ 6,901.20\n2524\n33860\n33860\nAscending aorta graft, with cardiopulmonary bypass, includes valve\nsuspension, when performed\n$ 7,323.30\n2525\n33863\n33863\nAscending aorta graft, with cardiopulmonary bypass, with aortic\nroot replacement using valved conduit and coronary reconstruction\n(eg, Bentall)\n$ 7,577.10\n2526\n33864\n33864\nAscending aorta graft, with cardiopulmonary bypass with valve\nsuspension, with coronary reconstruction and valve-sparing aortic\nroot remodeling (eg, David Procedure, Yacoub Procedure)\n$ 7,601.41\n2527\n33870\n33870\nTransverse arch graft, with cardiopulmonary bypass\n$ 9,652.50\n2528\n33875\n33875\nDescending thoracic aorta graft, with or without bypass\n$ 7,810.20\n2529\n33877\n33877\nRepair of thoracoabdominal aortic aneurysm with graft, with or\nwithout cardiopulmonary bypass\n$ 9,241.20\n2530\n33880\n33880\nEndovascular repair of descending thoracic aorta (eg, aneurysm,\npseudoaneurysm, dissection, penetrating ulcer, intramural\nhematoma, or traumatic disruption); involving coverage of left\nsubclavian artery origin, initial endoprosthesis plus descending\nthora\n$ 5,712.22\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2531\n33881\n33881\nEndovascular repair of descending thoracic aorta (eg, aneurysm,\npseudoaneurysm, dissection, penetrating ulcer, intramural\nhematoma, or traumatic disruption); not involving coverage of left\nsubclavian artery origin, initial endoprosthesis plus descending t\n$ 4,930.62\n2532\n33883\n33883\nPlacement of proximal extension prosthesis for endovascular repair\nof descending thoracic aorta (eg, aneurysm, pseudoaneurysm,\ndissection, penetrating ulcer, intramural hematoma, or traumatic\ndisruption); initial extension\n$ 3,643.31\n2533\n33884\n33884\nPlacement of proximal extension prosthesis for endovascular repair\nof descending thoracic aorta (eg, aneurysm, pseudoaneurysm,\ndissection, penetrating ulcer, intramural hematoma, or traumatic\ndisruption); each additional proximal extension (List separatel\n$ 1,385.57\n2534\n33886\n33886\nPlacement of distal extension prosthesis(s) delayed after\nendovascular repair of descending thoracic aorta\n$ 3,119.61\n2535\n33889\n33889\nOpen subclavian to carotid artery transposition performed in\nconjunction with endovascular repair of descending thoracic aorta,\nby neck incision, unilateral\n$ 2,690.56\n2536\n33891\n33891\nBypass graft, with other than vein, transcervical retropharyngeal\ncarotid-carotid, performed in conjunction with endovascular repair\nof descending thoracic aorta, by neck incision\n$ 3,430.57\n2537\n33910\n33910\nPulmonary artery embolectomy; with cardiopulmonary bypass\n$ 6,566.40\n2538\n33915\n33915\nPulmonary artery embolectomy; without cardiopulmonary bypass\n$ 3,965.40\n2539\n33916\n33916\nPulmonary endarterectomy, with or without embolectomy, with\ncardiopulmonary bypass\n$ 4,653.00\n2540\n33917\n33917\nRepair of pulmonary artery stenosis by reconstruction with patch or\ngraft\n$ 6,633.90\n2541\n33920\n33920\nRepair of pulmonary atresia with ventricular septal defect, by\nconstruction or replacement of conduit from right or left ventricle\nto pulmonary artery\n$ 6,891.30\n2542\n33922\n33922\nTransection of pulmonary artery with cardiopulmonary bypass\n$ 5,562.00\n2543\n33924\n33924\nLigation and takedown of a systemic-to-pulmonary artery shunt,\nperformed in conjunction with a congenital heart procedure (List\nseparately in addition to code for primary procedure)\n$ 1,096.26\n2544\n33925\n33925\nRepair of pulmonary artery arborization anomalies by\nunifocalization; without cardiopulmonary bypass\n$ 6,455.33\n2545\n33926\n33926\nRepair of pulmonary artery arborization anomalies by\nunifocalization; with cardiopulmonary bypass\n$ 8,708.02\n2546\n33930\n33930\nDonor cardiectomy-pneumonectomy (including cold preservation)\n$ -\n2547\n33933\n33933\nBackbench standard preparation of cadaver donor heart\/lung\nallograft prior to transplantation, including dissection of allograft\nfrom surrounding soft tissues to prepare aorta, superior vena cava,\ninferior vena cava, and trachea for implantation\n$ -\n2548\n33935\n33935\nHeart-lung transplant with recipient cardiectomy-pneumonectomy\n$ 12,504.94\n2549\n33940\n33940\nDonor cardiectomy (including cold preservation)\n$ 4,149.00\n2550\n33944\n33944\nBackbench standard preparation of cadaver donor heart allograft\nprior to transplantation, including dissection of allograft from\nsurrounding soft tissues to prepare aorta, superior vena cava,\ninferior vena cava, pulmonary artery, and left atrium for impla\n$ -\n2551\n33945\n33945\nHeart transplant, with or without recipient cardiectomy\n$ 11,331.00\n2552\n33960\n33960\nProlonged extracorporeal circulation for cardiopulmonary\ninsufficiency; initial day\n$ 2,981.70\n2553\n33961\n33961\nProlonged extracorporeal circulation for cardiopulmonary\ninsufficiency; each subsequent day\n$ 1,626.30\n2554\n33967\n33967\nInsertion of intra-aortic balloon assist device, percutaneous\n$ 681.97\n2555\n33968\n33968\nRemoval of intra-aortic balloon assist device, percutaneous\n$ 98.27\n2556\n33970\n33970\nInsertion of intra-aortic balloon assist device through the femoral\nartery, open approach\n$ 2,032.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2557\n33971\n33971\nRemoval of intra-aortic balloon assist device including repair of\nfemoral artery, with or without graft\n$ 1,911.60\n2558\n33973\n33973\nInsertion of intra-aortic balloon assist device through the ascending\naorta\n$ 2,047.50\n2559\n33974\n33974\nRemoval of intra-aortic balloon assist device from the ascending\naorta, including repair of the ascending aorta, with or without graft\n$ 2,317.50\n2560\n33975\n33975\nInsertion of ventricular assist device; extracorporeal, single ventricle $ 4,377.60\n2561\n33976\n33976\nInsertion of ventricular assist device; extracorporeal, biventricular\n$ 4,364.10\n2562\n33977\n33977\nRemoval of ventricular assist device; extracorporeal, single ventricle\n$ 3,388.50\n2563\n33978\n33978\nRemoval of ventricular assist device; extracorporeal, biventricular\n$ 3,780.00\n2564\n33979\n33979\nInsertion of ventricular assist device, implantable intracorporeal,\nsingle ventricle\n$ 6,113.20\n2565\n33980\n33980\nRemoval of ventricular assist device, implantable intracorporeal,\nsingle ventricle\n$ 9,056.83\n2566\n33981\n33981\nReplacement of extracorporeal ventricular assist device, single or\nbiventricular, pump(s), single or each pump\n$ 2,099.36\n2567\n33982\n33982\nReplacement of ventricular assist device pump(s); implantable\nintracorporeal, single ventricle, without cardiopulmonary bypass\n$ 5,143.44\n2568\n33983\n33983\nReplacement of ventricular assist device pump(s); implantable\nintracorporeal, single ventricle, with cardiopulmonary bypass\n$ 5,744.73\n2569\n33999\n33999\nUnlisted procedure, cardiac surgery\n$ -\n2570\n34001\n34001\nEmbolectomy or thrombectomy, with or without catheter; carotid,\nsubclavian or innominate artery, by neck incision\n$ 2,654.10\n2571\n34051\n34051\nEmbolectomy or thrombectomy, with or without catheter;\ninnominate, subclavian artery, by thoracic incision\n$ 2,909.70\n2572\n34101\n34101\nEmbolectomy or thrombectomy, with or without catheter; axillary,\nbrachial, innominate, subclavian artery, by arm incision\n$ 2,623.50\n2573\n34111\n34111\nEmbolectomy or thrombectomy, with or without catheter; radial or\nulnar artery, by arm incision\n$ 2,964.60\n2574\n34151\n34151\nEmbolectomy or thrombectomy, with or without catheter; renal,\nceliac, mesentery, aortoiliac artery, by abdominal incision\n$ 3,651.30\n2575\n34201\n34201\nEmbolectomy or thrombectomy, with or without catheter;\nfemoropopliteal, aortoiliac artery, by leg incision\n$ 2,886.30\n2576\n34203\n34203\nEmbolectomy or thrombectomy, with or without catheter; popliteal-\ntibio-peroneal artery, by leg incision\n$ 2,952.90\n2577\n34401\n34401\nThrombectomy, direct or with catheter; vena cava, iliac vein, by\nabdominal incision\n$ 2,884.50\n2578\n34421\n34421\nThrombectomy, direct or with catheter; vena cava, iliac,\nfemoropopliteal vein, by leg incision\n$ 2,549.70\n2579\n34451\n34451\nThrombectomy, direct or with catheter; vena cava, iliac,\nfemoropopliteal vein, by abdominal and leg incision\n$ 2,923.20\n2580\n34471\n34471\nThrombectomy, direct or with catheter; subclavian vein, by neck\nincision\n$ 2,317.50\n2581\n34490\n34490\nThrombectomy, direct or with catheter; axillary and subclavian vein,\nby arm incision\n$ 2,148.30\n2582\n34501\n34501\nValvuloplasty, femoral vein\n$ 2,421.00\n2583\n34502\n34502\nReconstruction of vena cava, any method\n$ 5,296.50\n2584\n34510\n34510\nVenous valve transposition, any vein donor\n$ 2,574.90\n2585\n34520\n34520\nCross-over vein graft to venous system\n$ 3,444.30\n2586\n34530\n34530\nSaphenopopliteal vein anastomosis\n$ 2,738.70\n2587\n34800\n34800\nEndovascular repair of infrarenal abdominal aortic aneurysm or\ndissection; using aorto-aortic tube prosthesis\n$ 3,621.60\n2588\n34802\n34802\nEndovascular repair of infrarenal abdominal aortic aneurysm or\ndissection; using modular bifurcated prosthesis (1 docking limb)\n$ 3,996.90\n2589\n34803\n34803\nEndovascular repair of infrarenal abdominal aortic aneurysm or\ndissection; using modular bifurcated prosthesis (2 docking limbs)\n$ 4,301.78\n2590\n34804\n34804\nEndovascular repair of infrarenal abdominal aortic aneurysm or\ndissection; using unibody bifurcated prosthesis\n$ 3,996.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2591\n34805\n34805\nEndovascular repair of infrarenal abdominal aortic aneurysm or\ndissection; using aorto-uniiliac or aorto-unifemoral prosthesis\n$ 3,987.05\n2592\n34806\n34806\nTranscatheter placement of wireless physiologic sensor in\naneurysmal sac during endovascular repair, including radiological\nsupervision and interpretation, instrument calibration, and\ncollection of pressure data (List separately in addition to code for pr $ 420.95\n2593\n34808\n34808\nEndovascular placement of iliac artery occlusion device (List\nseparately in addition to code for primary procedure)\n$ 688.50\n2594\n34812\n34812\nOpen femoral artery exposure for delivery of endovascular\nprosthesis, by groin incision, unilateral\n$ 1,125.90\n2595\n34813\n34813\nPlacement of femoral-femoral prosthetic graft during endovascular\naortic aneurysm repair (List separately in addition to code for\nprimary procedure)\n$ 800.10\n2596\n34820\n34820\nOpen iliac artery exposure for delivery of endovascular prosthesis or\niliac occlusion during endovascular therapy, by abdominal or\nretroperitoneal incision, unilateral\n$ 1,626.30\n2597\n34825\n34825\nPlacement of proximal or distal extension prosthesis for\nendovascular repair of infrarenal abdominal aortic or iliac\naneurysm, false aneurysm, or dissection; initial vessel\n$ 2,162.70\n2598\n34826\n34826\nPlacement of proximal or distal extension prosthesis for\nendovascular repair of infrarenal abdominal aortic or iliac\naneurysm, false aneurysm, or dissection; each additional vessel (List\nseparately in addition to code for primary procedure)\n$ 688.50\n2599\n34830\n34830\nOpen repair of infrarenal aortic aneurysm or dissection, plus repair\nof associated arterial trauma, following unsuccessful endovascular\nrepair; tube prosthesis\n$ 5,635.80\n2600\n34831\n34831\nOpen repair of infrarenal aortic aneurysm or dissection, plus repair\nof associated arterial trauma, following unsuccessful endovascular\nrepair; aorto-bi-iliac prosthesis\n$ 6,093.00\n2601\n34832\n34832\nOpen repair of infrarenal aortic aneurysm or dissection, plus repair\nof associated arterial trauma, following unsuccessful endovascular\nrepair; aorto-bifemoral prosthesis\n$ 6,093.00\n2602\n34833\n34833\nOpen iliac artery exposure with creation of conduit for delivery of\naortic or iliac endovascular prosthesis, by abdominal or\nretroperitoneal incision, unilateral\n$ 1,682.17\n2603\n34834\n34834\nOpen brachial artery exposure to assist in the deployment of aortic\nor iliac endovascular prosthesis by arm incision, unilateral\n$ 965.20\n2604\n34900\n34900\nEndovascular repair of iliac artery (eg, aneurysm, pseudoaneurysm,\narteriovenous malformation, trauma) using ilio-iliac tube\nendoprosthesis\n$ 2,239.64\n2605\n35001\n35001\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm\nand associated occlusive disease, carotid, subclavian artery, by neck\nincision\n$ 3,978.00\n2606\n35002\n35002\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, carotid, subclavian artery, by neck incision\n$ 4,092.30\n2607\n35005\n35005\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, vertebral artery\n$ 3,744.00\n2608\n35011\n35011\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm\nand associated occlusive disease, axillary-brachial artery, by arm\nincision\n$ 3,550.50\n2609\n35013\n35013\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, axillary-brachial artery, by arm incision\n$ 3,780.90\n2610\n35021\n35021\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, innominate,\nsubclavian artery, by thoracic incision\n$ 4,011.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2611\n35022\n35022\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, innominate, subclavian artery, by thoracic incision\n$ 4,035.60\n2612\n35045\n35045\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, radial or ulnar\nartery\n$ 3,766.50\n2613\n35081\n35081\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, abdominal\naorta\n$ 5,967.00\n2614\n35082\n35082\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, abdominal aorta\n$ 7,056.00\n2615\n35091\n35091\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, abdominal\naorta involving visceral vessels (mesenteric, celiac, ren\n$ 6,876.00\n2616\n35092\n35092\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, abdominal aorta involving visceral vessels (mesenteric,\nceliac, renal)\n$ 7,870.50\n2617\n35102\n35102\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, abdominal\naorta involving iliac vessels (common, hypogastric, exter\n$ 6,484.50\n2618\n35103\n35103\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, abdominal aorta involving iliac vessels (common,\nhypogastric, external)\n$ 6,972.30\n2619\n35111\n35111\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, splenic artery\n$ 4,826.70\n2620\n35112\n35112\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, splenic artery\n$ 3,327.30\n2621\n35121\n35121\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, hepatic, celiac,\nrenal, or mesenteric artery\n$ 4,541.40\n2622\n35122\n35122\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, hepatic, celiac, renal, or mesenteric artery\n$ 4,851.90\n2623\n35131\n35131\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, iliac artery\n(common, hypogastric, external)\n$ 4,762.80\n2624\n35132\n35132\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, iliac artery (common, hypogastric, external)\n$ 4,635.00\n2625\n35141\n35141\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, common\nfemoral artery (profunda femoris, superficial femoral)\n$ 4,068.90\n2626\n35142\n35142\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, common femoral artery (profunda femoris, superficial\nfemoral)\n$ 4,619.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2627\n35151\n35151\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for aneurysm,\npseudoaneurysm, and associated occlusive disease, popliteal artery\n$ 4,226.40\n2628\n35152\n35152\nDirect repair of aneurysm, pseudoaneurysm, or excision (partial or\ntotal) and graft insertion, with or without patch graft; for ruptured\naneurysm, popliteal artery\n$ 3,790.80\n2629\n35180\n35180\nRepair, congenital arteriovenous fistula; head and neck\n$ 3,141.90\n2630\n35182\n35182\nRepair, congenital arteriovenous fistula; thorax and abdomen\n$ 4,532.40\n2631\n35184\n35184\nRepair, congenital arteriovenous fistula; extremities\n$ 3,888.00\n2632\n35188\n35188\nRepair, acquired or traumatic arteriovenous fistula; head and neck\n$ 3,234.60\n2633\n35189\n35189\nRepair, acquired or traumatic arteriovenous fistula; thorax and\nabdomen\n$ 4,228.20\n2634\n35190\n35190\nRepair, acquired or traumatic arteriovenous fistula; extremities\n$ 3,682.80\n2635\n35201\n35201\nRepair blood vessel, direct; neck\n$ 3,811.50\n2636\n35206\n35206\nRepair blood vessel, direct; upper extremity\n$ 3,393.00\n2637\n35207\n35207\nRepair blood vessel, direct; hand, finger\n$ 3,836.70\n2638\n35211\n35211\nRepair blood vessel, direct; intrathoracic, with bypass\n$ 4,775.40\n2639\n35216\n35216\nRepair blood vessel, direct; intrathoracic, without bypass\n$ 4,719.60\n2640\n35221\n35221\nRepair blood vessel, direct; intra-abdominal\n$ 4,332.60\n2641\n35226\n35226\nRepair blood vessel, direct; lower extremity\n$ 4,322.70\n2642\n35231\n35231\nRepair blood vessel with vein graft; neck\n$ 3,770.10\n2643\n35236\n35236\nRepair blood vessel with vein graft; upper extremity\n$ 5,035.50\n2644\n35241\n35241\nRepair blood vessel with vein graft; intrathoracic, with bypass\n$ 4,771.80\n2645\n35246\n35246\nRepair blood vessel with vein graft; intrathoracic, without bypass\n$ 4,289.40\n2646\n35251\n35251\nRepair blood vessel with vein graft; intra-abdominal\n$ 5,365.80\n2647\n35256\n35256\nRepair blood vessel with vein graft; lower extremity\n$ 4,428.90\n2648\n35261\n35261\nRepair blood vessel with graft other than vein; neck\n$ 3,811.50\n2649\n35266\n35266\nRepair blood vessel with graft other than vein; upper extremity\n$ 3,907.80\n2650\n35271\n35271\nRepair blood vessel with graft other than vein; intrathoracic, with\nbypass\n$ 5,134.50\n2651\n35276\n35276\nRepair blood vessel with graft other than vein; intrathoracic,\nwithout bypass\n$ 3,682.80\n2652\n35281\n35281\nRepair blood vessel with graft other than vein; intra-abdominal\n$ 4,377.60\n2653\n35286\n35286\nRepair blood vessel with graft other than vein; lower extremity\n$ 4,189.50\n2654\n35301\n35301\nThromboendarterectomy, including patch graft, if performed;\ncarotid, vertebral, subclavian, by neck incision\n$ 4,066.20\n2655\n35302\n35302\nThromboendarterectomy, including patch graft, if performed;\nsuperficial femoral artery\n$ 3,050.03\n2656\n35303\n35303\nThromboendarterectomy, including patch graft, if performed;\npopliteal artery\n$ 3,211.06\n2657\n35304\n35304\nThromboendarterectomy, including patch graft, if performed;\ntibioperoneal trunk artery\n$ 3,248.55\n2658\n35305\n35305\nThromboendarterectomy, including patch graft, if performed; tibial\nor peroneal artery, initial vessel\n$ 3,210.32\n2659\n35306\n35306\nThromboendarterectomy, including patch graft, if performed; each\nadditional tibial or peroneal artery (List separately in addition to\ncode for primary procedure)\n$ 1,331.62\n2660\n35311\n35311\nThromboendarterectomy, including patch graft, if performed;\nsubclavian, innominate, by thoracic incision\n$ 3,872.70\n2661\n35321\n35321\nThromboendarterectomy, including patch graft, if performed;\naxillary-brachial\n$ 3,862.80\n2662\n35331\n35331\nThromboendarterectomy, including patch graft, if performed;\nabdominal aorta\n$ 5,119.20\n2663\n35341\n35341\nThromboendarterectomy, including patch graft, if performed;\nmesenteric, celiac, or renal\n$ 4,953.60\n2664\n35351\n35351\nThromboendarterectomy, including patch graft, if performed; iliac\n$ 4,340.70\n2665\n35355\n35355\nThromboendarterectomy, including patch graft, if performed;\niliofemoral\n$ 4,176.00\n2666\n35361\n35361\nThromboendarterectomy, including patch graft, if performed;\ncombined aortoiliac\n$ 5,794.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2667\n35363\n35363\nThromboendarterectomy, including patch graft, if performed;\ncombined aortoiliofemoral\n$ 4,686.30\n2668\n35371\n35371\nThromboendarterectomy, including patch graft, if performed;\ncommon femoral\n$ 3,605.40\n2669\n35372\n35372\nThromboendarterectomy, including patch graft, if performed; deep\n(profunda) femoral\n$ 4,039.20\n2670\n35390\n35390\nReoperation, carotid, thromboendarterectomy, more than 1 month\nafter original operation (List separately in addition to code for\nprimary procedure)\n$ 855.00\n2671\n35400\n35400\nAngioscopy (non-coronary vessels or grafts) during therapeutic\nintervention (List separately in addition to code for primary\nprocedure)\n$ 570.60\n2672\n35450\n35450\nTransluminal balloon angioplasty, open; renal or other visceral\nartery\n$ 2,514.60\n2673\n35452\n35452\nTransluminal balloon angioplasty, open; aortic\n$ 1,345.50\n2674\n35458\n35458\nTransluminal balloon angioplasty, open; brachiocephalic trunk or\nbranches, each vessel\n$ 2,317.50\n2675\n35460\n35460\nTransluminal balloon angioplasty, open; venous\n$ 1,596.60\n2676\n35471\n35471\nTransluminal balloon angioplasty, percutaneous; renal or visceral\nartery\n$ 2,348.10\n2677\n35472\n35472\nTransluminal balloon angioplasty, percutaneous; aortic\n$ 2,743.20\n2678\n35475\n35475\nTransluminal balloon angioplasty, percutaneous; brachiocephalic\ntrunk or branches, each vessel\n$ 2,426.40\n2679\n35476\n35476\nTransluminal balloon angioplasty, percutaneous; venous\n$ 1,415.70\n2680\n35500\n35500\nHarvest of upper extremity vein, 1 segment, for lower extremity or\ncoronary artery bypass procedure (List separately in addition to\ncode for primary procedure)\n$ 871.62\n2681\n35501\n35501\nBypass graft, with vein; common carotid-ipsilateral internal carotid\n$ 3,636.00\n2682\n35506\n35506\nBypass graft, with vein; carotid-subclavian or subclavian-carotid\n$ 4,938.30\n2683\n35508\n35508\nBypass graft, with vein; carotid-vertebral\n$ 3,759.30\n2684\n35509\n35509\nBypass graft, with vein; carotid-contralateral carotid\n$ 3,682.80\n2685\n35510\n35510\nBypass graft, with vein; carotid-brachial\n$ 3,271.58\n2686\n35511\n35511\nBypass graft, with vein; subclavian-subclavian\n$ 3,365.10\n2687\n35512\n35512\nBypass graft, with vein; subclavian-brachial\n$ 3,264.42\n2688\n35515\n35515\nBypass graft, with vein; subclavian-vertebral\n$ 3,420.00\n2689\n35516\n35516\nBypass graft, with vein; subclavian-axillary\n$ 3,505.50\n2690\n35518\n35518\nBypass graft, with vein; axillary-axillary\n$ 4,264.20\n2691\n35521\n35521\nBypass graft, with vein; axillary-femoral\n$ 4,596.30\n2692\n35522\n35522\nBypass graft, with vein; axillary-brachial\n$ 3,209.65\n2693\n35523\n35523\nBypass graft, with vein; brachial-ulnar or -radial\n$ 3,277.08\n2694\n35525\n35525\nBypass graft, with vein; brachial-brachial\n$ 3,187.18\n2695\n35526\n35526\nBypass graft, with vein; aortosubclavian, aortoinnominate, or\naortocarotid\n$ 4,275.00\n2696\n35531\n35531\nBypass graft, with vein; aortoceliac or aortomesenteric\n$ 4,910.40\n2697\n35533\n35533\nBypass graft, with vein; axillary-femoral-femoral\n$ 4,089.60\n2698\n35535\n35535\nBypass graft, with vein; hepatorenal\n$ 4,060.85\n2699\n35536\n35536\nBypass graft, with vein; splenorenal\n$ 4,485.60\n2700\n35537\n35537\nBypass graft, with vein; aortoiliac\n$ 4,523.50\n2701\n35538\n35538\nBypass graft, with vein; aortobi-iliac\n$ 5,514.25\n2702\n35539\n35539\nBypass graft, with vein; aortofemoral\n$ 5,177.02\n2703\n35540\n35540\nBypass graft, with vein; aortobifemoral\n$ 5,915.40\n2704\n35556\n35556\nBypass graft, with vein; femoral-popliteal\n$ 4,336.20\n2705\n35558\n35558\nBypass graft, with vein; femoral-femoral\n$ 4,312.80\n2706\n35560\n35560\nBypass graft, with vein; aortorenal\n$ 4,439.70\n2707\n35563\n35563\nBypass graft, with vein; ilioiliac\n$ 3,582.90\n2708\n35565\n35565\nBypass graft, with vein; iliofemoral\n$ 4,176.90\n2709\n35566\n35566\nBypass graft, with vein; femoral-anterior tibial, posterior tibial,\nperoneal artery or other distal vessels\n$ 5,097.60\n2710\n35570\n35570\nBypass graft, with vein; tibial-tibial, peroneal-tibial, or\ntibial\/peroneal trunk-tibial\n$ 3,570.22\n2711\n35571\n35571\nBypass graft, with vein; popliteal-tibial, -peroneal artery or other\ndistal vessels\n$ 4,784.40\n2712\n35572\n35572\nHarvest of femoropopliteal vein, 1 segment, for vascular\nreconstruction procedure (eg, aortic, vena caval, coronary,\nperipheral artery) (List separately in addition to code for primary\nprocedure)\n$ 878.05\n2713\n35583\n35583\nIn-situ vein bypass; femoral-popliteal\n$ 4,646.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2714\n35585\n35585\nIn-situ vein bypass; femoral-anterior tibial, posterior tibial, or\nperoneal artery\n$ 5,580.90\n2715\n35587\n35587\nIn-situ vein bypass; popliteal-tibial, peroneal\n$ 5,259.60\n2716\n35600\n35600\nHarvest of upper extremity artery, 1 segment, for coronary artery\nbypass procedure (List separately in addition to code for primary\nprocedure)\n$ 922.50\n2717\n35601\n35601\nBypass graft, with other than vein; common carotid-ipsilateral\ninternal carotid\n$ 3,828.60\n2718\n35606\n35606\nBypass graft, with other than vein; carotid-subclavian\n$ 4,417.20\n2719\n35612\n35612\nBypass graft, with other than vein; subclavian-subclavian\n$ 4,006.80\n2720\n35616\n35616\nBypass graft, with other than vein; subclavian-axillary\n$ 3,502.80\n2721\n35621\n35621\nBypass graft, with other than vein; axillary-femoral\n$ 4,295.70\n2722\n35623\n35623\nBypass graft, with other than vein; axillary-popliteal or -tibial\n$ 4,099.50\n2723\n35626\n35626\nBypass graft, with other than vein; aortosubclavian,\naortoinnominate, or aortocarotid\n$ 5,134.50\n2724\n35631\n35631\nBypass graft, with other than vein; aortoceliac, aortomesenteric,\naortorenal\n$ 4,752.00\n2725\n35632\n35632\nBypass graft, with other than vein; ilio-celiac\n$ 3,986.67\n2726\n35633\n35633\nBypass graft, with other than vein; ilio-mesenteric\n$ 4,261.60\n2727\n35634\n35634\nBypass graft, with other than vein; iliorenal\n$ 3,929.70\n2728\n35636\n35636\nBypass graft, with other than vein; splenorenal (splenic to renal\narterial anastomosis)\n$ 4,275.00\n2729\n35637\n35637\nBypass graft, with other than vein; aortoiliac\n$ 3,861.68\n2730\n35638\n35638\nBypass graft, with other than vein; aortobi-iliac\n$ 3,898.02\n2731\n35642\n35642\nBypass graft, with other than vein; carotid-vertebral\n$ 3,672.00\n2732\n35645\n35645\nBypass graft, with other than vein; subclavian-vertebral\n$ 3,720.60\n2733\n35646\n35646\nBypass graft, with other than vein; aortobifemoral\n$ 5,142.60\n2734\n35647\n35647\nBypass graft, with other than vein; aortofemoral\n$ 3,664.37\n2735\n35650\n35650\nBypass graft, with other than vein; axillary-axillary\n$ 4,328.10\n2736\n35654\n35654\nBypass graft, with other than vein; axillary-femoral-femoral\n$ 5,381.10\n2737\n35656\n35656\nBypass graft, with other than vein; femoral-popliteal\n$ 4,311.00\n2738\n35661\n35661\nBypass graft, with other than vein; femoral-femoral\n$ 4,134.60\n2739\n35663\n35663\nBypass graft, with other than vein; ilioiliac\n$ 3,662.10\n2740\n35665\n35665\nBypass graft, with other than vein; iliofemoral\n$ 4,484.70\n2741\n35666\n35666\nBypass graft, with other than vein; femoral-anterior tibial, posterior\ntibial, or peroneal artery\n$ 4,851.90\n2742\n35671\n35671\nBypass graft, with other than vein; popliteal-tibial or -peroneal\nartery\n$ 4,197.60\n2743\n35681\n35681\nBypass graft; composite, prosthetic and vein (List separately in\naddition to code for primary procedure)\n$ 3,032.10\n2744\n35682\n35682\nBypass graft; autogenous composite, 2 segments of veins from 2\nlocations (List separately in addition to code for primary procedure)\n$ 1,248.30\n2745\n35683\n35683\nBypass graft; autogenous composite, 3 or more segments of vein\nfrom 2 or more locations (List separately in addition to code for\nprimary procedure)\n$ 1,425.60\n2746\n35685\n35685\nPlacement of vein patch or cuff at distal anastomosis of bypass\ngraft, synthetic conduit (List separately in addition to code for\nprimary procedure)\n$ 840.77\n2747\n35686\n35686\nCreation of distal arteriovenous fistula during lower extremity\nbypass surgery (non-hemodialysis) (List separately in addition to\ncode for primary procedure)\n$ 858.30\n2748\n35691\n35691\nTransposition and\/or reimplantation; vertebral to carotid artery\n$ 3,834.00\n2749\n35693\n35693\nTransposition and\/or reimplantation; vertebral to subclavian artery\n$ 3,316.50\n2750\n35694\n35694\nTransposition and\/or reimplantation; subclavian to carotid artery\n$ 3,399.30\n2751\n35695\n35695\nTransposition and\/or reimplantation; carotid to subclavian artery\n$ 3,321.00\n2752\n35697\n35697\nReimplantation, visceral artery to infrarenal aortic prosthesis, each\nartery (List separately in addition to code for primary procedure)\n$ 1,617.23\n2753\n35700\n35700\nReoperation, femoral-popliteal or femoral (popliteal)-anterior tibial,\nposterior tibial, peroneal artery, or other distal vessels, more than 1\nmonth after original operation (List separately in addition to code\nfor primary procedure)\n$ 978.30\n2754\n35701\n35701\nExploration (not followed by surgical repair), with or without lysis of\nartery; carotid artery\n$ 1,827.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2755\n35721\n35721\nExploration (not followed by surgical repair), with or without lysis of\nartery; femoral artery\n$ 1,711.80\n2756\n35741\n35741\nExploration (not followed by surgical repair), with or without lysis of\nartery; popliteal artery\n$ 1,733.40\n2757\n35761\n35761\nExploration (not followed by surgical repair), with or without lysis of\nartery; other vessels\n$ 1,645.20\n2758\n35800\n35800\nExploration for postoperative hemorrhage, thrombosis or infection;\nneck\n$ 1,757.70\n2759\n35820\n35820\nExploration for postoperative hemorrhage, thrombosis or infection;\nchest\n$ 2,691.90\n2760\n35840\n35840\nExploration for postoperative hemorrhage, thrombosis or infection;\nabdomen\n$ 2,632.50\n2761\n35860\n35860\nExploration for postoperative hemorrhage, thrombosis or infection;\nextremity\n$ 1,816.20\n2762\n35870\n35870\nRepair of graft-enteric fistula\n$ 5,026.50\n2763\n35875\n35875\nThrombectomy of arterial or venous graft (other than hemodialysis\ngraft or fistula);\n$ 2,820.60\n2764\n35876\n35876\nThrombectomy of arterial or venous graft (other than hemodialysis\ngraft or fistula); with revision of arterial or venous graft\n$ 3,186.90\n2765\n35879\n35879\nRevision, lower extremity arterial bypass, without thrombectomy,\nopen; with vein patch angioplasty\n$ 3,326.40\n2766\n35881\n35881\nRevision, lower extremity arterial bypass, without thrombectomy,\nopen; with segmental vein interposition\n$ 3,647.70\n2767\n35883\n35883\nRevision, femoral anastomosis of synthetic arterial bypass graft in\ngroin, open; with nonautogenous patch graft (eg, Dacron, ePTFE,\nbovine pericardium)\n$ 3,256.61\n2768\n35884\n35884\nRevision, femoral anastomosis of synthetic arterial bypass graft in\ngroin, open; with autogenous vein patch graft\n$ 3,453.76\n2769\n35901\n35901\nExcision of infected graft; neck\n$ 2,307.60\n2770\n35903\n35903\nExcision of infected graft; extremity\n$ 2,663.10\n2771\n35905\n35905\nExcision of infected graft; thorax\n$ 2,797.20\n2772\n35907\n35907\nExcision of infected graft; abdomen\n$ 3,213.90\n2773\n36000\n36000\nIntroduction of needle or intracatheter, vein\n$ 128.91\n2774\n36002\n36002\nInjection procedures (eg, thrombin) for percutaneous treatment of\nextremity pseudoaneurysm\n$ 282.31\n2775\n36005\n36005\nInjection procedure for extremity venography (including\nintroduction of needle or intracatheter)\n$ 186.30\n2776\n36010\n36010\nIntroduction of catheter, superior or inferior vena cava\n$ 647.10\n2777\n36011\n36011\nSelective catheter placement, venous system; first order branch (eg,\nrenal vein, jugular vein)\n$ 510.30\n2778\n36012\n36012\nSelective catheter placement, venous system; second order, or\nmore selective, branch (eg, left adrenal vein, petrosal sinus)\n$ 679.50\n2779\n36013\n36013\nIntroduction of catheter, right heart or main pulmonary artery\n$ 789.30\n2780\n36014\n36014\nSelective catheter placement, left or right pulmonary artery\n$ 591.30\n2781\n36015\n36015\nSelective catheter placement, segmental or subsegmental\npulmonary artery\n$ 628.20\n2782\n36100\n36100\nIntroduction of needle or intracatheter, carotid or vertebral artery\n$ 628.20\n2783\n36120\n36120\nIntroduction of needle or intracatheter; retrograde brachial artery\n$ 741.60\n2784\n36140\n36140\nIntroduction of needle or intracatheter; extremity artery\n$ 503.10\n2785\n36147\n36147\nIntroduction of needle and\/or catheter, arteriovenous shunt\ncreated for dialysis (graft\/fistula); initial access with complete\nradiological evaluation of dialysis access, including fluoroscopy,\nimage documentation and report (includes access of shunt, inj\n$ 1,052.96\n2786\n36148\n36148\nIntroduction of needle and\/or catheter, arteriovenous shunt\ncreated for dialysis (graft\/fistula); additional access for therapeutic\nintervention (List separately in addition to code for primary\nprocedure)\n$ 325.12\n2787\n36160\n36160\nIntroduction of needle or intracatheter, aortic, translumbar\n$ 650.70\n2788\n36200\n36200\nIntroduction of catheter, aorta\n$ 624.60\n2789\n36215\n36215\nSelective catheter placement, arterial system; each first order\nthoracic or brachiocephalic branch, within a vascular family\n$ 710.10\n2790\n36216\n36216\nSelective catheter placement, arterial system; initial second order\nthoracic or brachiocephalic branch, within a vascular family\n$ 729.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2791\n36217\n36217\nSelective catheter placement, arterial system; initial third order or\nmore selective thoracic or brachiocephalic branch, within a vascular\nfamily\n$ 978.30\n2792\n36218\n36218\nSelective catheter placement, arterial system; additional second\norder, third order, and beyond, thoracic or brachiocephalic branch,\nwithin a vascular family (List in addition to code for initial second or\nthird order vessel as appropriate)\n$ 232.20\n2793\n36221\n36221\nNon-selective catheter placement, thoracic aorta, with angiography\nof the extracranial carotid, vertebral, and\/or intracranial vessels,\nunilateral or bilateral, and all associated radiological supervision\nand interpretation, includes angiography of the ce\n$ 2,880.37\n2794\n36222\n36222\nSelective catheter placement, common carotid or innominate\nartery, unilateral, any approach, with angiography of the ipsilateral\nextracranial carotid circulation and all associated radiological\nsupervision and interpretation, includes angiography of the c\n$ 3,561.38\n2795\n36223\n36223\nSelective catheter placement, common carotid or innominate\nartery, unilateral, any approach, with angiography of the ipsilateral\nintracranial carotid circulation and all associated radiological\nsupervision and interpretation, includes angiography of the e\n$ 3,896.31\n2796\n36224\n36224\nSelective catheter placement, internal carotid artery, unilateral,\nwith angiography of the ipsilateral intracranial carotid circulation\nand all associated radiological supervision and interpretation,\nincludes angiography of the extracranial carotid and ce\n$ 4,230.34\n2797\n36225\n36225\nSelective catheter placement, subclavian or innominate artery,\nunilateral, with angiography of the ipsilateral vertebral circulation\nand all associated radiological supervision and interpretation,\nincludes angiography of the cervicocerebral arch, when per\n$ 3,867.22\n2798\n36226\n36226\nSelective catheter placement, vertebral artery, unilateral, with\nangiography of the ipsilateral vertebral circulation and all associated\nradiological supervision and interpretation, includes angiography of\nthe cervicocerebral arch, when performed\n$ 4,313.16\n2799\n36227\n36227\nSelective catheter placement, external carotid artery, unilateral,\nwith angiography of the ipsilateral external carotid circulation and\nall associated radiological supervision and interpretation (List\nseparately in addition to code for primary procedure)\n$ 614.41\n2800\n36245\n36245\nSelective catheter placement, arterial system; each first order\nabdominal, pelvic, or lower extremity artery branch, within a\nvascular family\n$ 768.60\n2801\n36246\n36246\nSelective catheter placement, arterial system; initial second order\nabdominal, pelvic, or lower extremity artery branch, within a\nvascular family\n$ 875.70\n2802\n36247\n36247\nSelective catheter placement, arterial system; initial third order or\nmore selective abdominal, pelvic, or lower extremity artery branch,\nwithin a vascular family\n$ 1,114.20\n2803\n36248\n36248\nSelective catheter placement, arterial system; additional second\norder, third order, and beyond, abdominal, pelvic, or lower\nextremity artery branch, within a vascular family (List in addition to\ncode for initial second or third order vessel as appropriat\n$ 236.70\n2804\n36252\n36252\nSelective catheter placement (first-order), main renal artery and\nany accessory renal artery(s) for renal angiography, including\narterial puncture and catheter placement(s), fluoroscopy, contrast\ninjection(s), image postprocessing, permanent recording of\n$ 4,101.15\n2805\n36254\n36254\nSuperselective catheter placement (one or more second order or\nhigher renal artery branches) renal artery and any accessory renal\nartery(s) for renal angiography, including arterial puncture,\ncatheterization, fluoroscopy, contrast injection(s), image post\n$ 5,947.12\n2806\n36260\n36260\nInsertion of implantable intra-arterial infusion pump (eg, for\nchemotherapy of liver)\n$ 2,344.50\n2807\n36261\n36261\nRevision of implanted intra-arterial infusion pump\n$ 919.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2808\n36262\n36262\nRemoval of implanted intra-arterial infusion pump\n$ 849.60\n2809\n36299\n36299\nUnlisted procedure, vascular injection\nCost\n2810\n36400\n36400\nVenipuncture, younger than age 3 years, necessitating the skill of a\nphysician or other qualified health care professional, not to be used\nfor routine venipuncture; femoral or jugular vein\n$ 57.60\n2811\n36405\n36405\nVenipuncture, younger than age 3 years, necessitating the skill of a\nphysician or other qualified health care professional, not to be used\nfor routine venipuncture; scalp vein\n$ 87.30\n2812\n36406\n36406\nVenipuncture, younger than age 3 years, necessitating the skill of a\nphysician or other qualified health care professional, not to be used\nfor routine venipuncture; other vein\n$ 93.20\n2813\n36410\n36410\nVenipuncture, age 3 years or older, necessitating the skill of a\nphysician or other qualified health care professional (separate\nprocedure), for diagnostic or therapeutic purposes (not to be used\nfor routine venipuncture)\n$ 75.26\n2814\n36415\n36415\nCollection of venous blood by venipuncture\n$ 17.04\n2815\n36416\n36416\nCollection of capillary blood specimen (eg, finger, heel, ear stick)\n$ -\n2816\n36420\n36420\nVenipuncture, cutdown; younger than age 1 year\n$ 212.40\n2817\n36425\n36425\nVenipuncture, cutdown; age 1 or over\n$ 236.70\n2818\n36430\n36430\nTransfusion, blood or blood components\n$ 122.40\n2819\n36440\n36440\nPush transfusion, blood, 2 years or younger\n$ 212.40\n2820\n36450\n36450\nExchange transfusion, blood; newborn\n$ 824.40\n2821\n36455\n36455\nExchange transfusion, blood; other than newborn\n$ 875.70\n2822\n36460\n36460\nTransfusion, intrauterine, fetal\n$ 1,153.80\n2823\n36468\n36468\nSingle or multiple injections of sclerosing solutions, spider veins\n(telangiectasia); limb or trunk\n$ 327.60\n2824\n36469\n36469\nSingle or multiple injections of sclerosing solutions, spider veins\n(telangiectasia); face\n$ 202.50\n2825\n36470\n36470\nInjection of sclerosing solution; single vein\n$ 152.52\n2826\n36471\n36471\nInjection of sclerosing solution; multiple veins, same leg\n$ 246.87\n2827\n36475\n36475\nEndovenous ablation therapy of incompetent vein, extremity,\ninclusive of all imaging guidance and monitoring, percutaneous,\nradiofrequency; first vein treated\n$ 3,072.75\n2828\n36476\n36476\nEndovenous ablation therapy of incompetent vein, extremity,\ninclusive of all imaging guidance and monitoring, percutaneous,\nradiofrequency; second and subsequent veins treated in a single\nextremity, each through separate access sites (List separately in a\n$ 1,042.37\n2829\n36478\n36478\nEndovenous ablation therapy of incompetent vein, extremity,\ninclusive of all imaging guidance and monitoring, percutaneous,\nlaser; first vein treated\n$ 2,978.33\n2830\n36479\n36479\nEndovenous ablation therapy of incompetent vein, extremity,\ninclusive of all imaging guidance and monitoring, percutaneous,\nlaser; second and subsequent veins treated in a single extremity,\neach through separate access sites (List separately in addition t\n$ 1,045.01\n2831\n36481\n36481\nPercutaneous portal vein catheterization by any method\n$ 1,143.00\n2832\n36500\n36500\nVenous catheterization for selective organ blood sampling\n$ 475.20\n2833\n36510\n36510\nCatheterization of umbilical vein for diagnosis or therapy, newborn\n$ 265.50\n2834\n36511\n36511\nTherapeutic apheresis; for white blood cells\n$ 274.52\n2835\n36512\n36512\nTherapeutic apheresis; for red blood cells\n$ 273.39\n2836\n36513\n36513\nTherapeutic apheresis; for platelets\n$ 276.08\n2837\n36515\n36515\nTherapeutic apheresis; with extracorporeal immunoadsorption and\nplasma reinfusion\n$ 2,040.30\n2838\n36516\n36516\nTherapeutic apheresis; with extracorporeal selective adsorption or\nselective filtration and plasma reinfusion\n$ 2,129.80\n2839\n36522\n36522\nPhotopheresis, extracorporeal\n$ 550.80\n2840\n36555\n36555\nInsertion of non-tunneled centrally inserted central venous\ncatheter; younger than 5 years of age\n$ 500.71\n2841\n36556\n36556\nInsertion of non-tunneled centrally inserted central venous\ncatheter; age 5 years or older\n$ 373.52\n2842\n36557\n36557\nInsertion of tunneled centrally inserted central venous catheter,\nwithout subcutaneous port or pump; younger than 5 years of age\n$ 1,519.07\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2843\n36558\n36558\nInsertion of tunneled centrally inserted central venous catheter,\nwithout subcutaneous port or pump; age 5 years or older\n$ 1,287.53\n2844\n36560\n36560\nInsertion of tunneled centrally inserted central venous access\ndevice, with subcutaneous port; younger than 5 years of age\n$ 1,595.76\n2845\n36561\n36561\nInsertion of tunneled centrally inserted central venous access\ndevice, with subcutaneous port; age 5 years or older\n$ 1,280.08\n2846\n36563\n36563\nInsertion of tunneled centrally inserted central venous access device\nwith subcutaneous pump\n$ 1,557.18\n2847\n36565\n36565\nInsertion of tunneled centrally inserted central venous access\ndevice, requiring 2 catheters via 2 separate venous access sites;\nwithout subcutaneous port or pump (eg, Tesio type catheter)\n$ 1,535.22\n2848\n36566\n36566\nInsertion of tunneled centrally inserted central venous access\ndevice, requiring 2 catheters via 2 separate venous access sites;\nwith subcutaneous port(s)\n$ 2,580.53\n2849\n36568\n36568\nInsertion of peripherally inserted central venous catheter (PICC),\nwithout subcutaneous port or pump; younger than 5 years of age\n$ 548.20\n2850\n36569\n36569\nInsertion of peripherally inserted central venous catheter (PICC),\nwithout subcutaneous port or pump; age 5 years or older\n$ 459.11\n2851\n36570\n36570\nInsertion of peripherally inserted central venous access device, with\nsubcutaneous port; younger than 5 years of age\n$ 1,264.84\n2852\n36571\n36571\nInsertion of peripherally inserted central venous access device, with\nsubcutaneous port; age 5 years or older\n$ 1,302.40\n2853\n36575\n36575\nRepair of tunneled or non-tunneled central venous access catheter,\nwithout subcutaneous port or pump, central or peripheral insertion\nsite\n$ 294.90\n2854\n36576\n36576\nRepair of central venous access device, with subcutaneous port or\npump, central or peripheral insertion site\n$ 671.12\n2855\n36578\n36578\nReplacement, catheter only, of central venous access device, with\nsubcutaneous port or pump, central or peripheral insertion site\n$ 1,052.89\n2856\n36580\n36580\nReplacement, complete, of a non-tunneled centrally inserted\ncentral venous catheter, without subcutaneous port or pump,\nthrough same venous access\n$ 402.39\n2857\n36581\n36581\nReplacement, complete, of a tunneled centrally inserted central\nvenous catheter, without subcutaneous port or pump, through\nsame venous access\n$ 1,347.18\n2858\n36582\n36582\nReplacement, complete, of a tunneled centrally inserted central\nvenous access device, with subcutaneous port, through same\nvenous access\n$ 1,777.44\n2859\n36583\n36583\nReplacement, complete, of a tunneled centrally inserted central\nvenous access device, with subcutaneous pump, through same\nvenous access\n$ 1,809.20\n2860\n36584\n36584\nReplacement, complete, of a peripherally inserted central venous\ncatheter (PICC), without subcutaneous port or pump, through same\nvenous access\n$ 423.34\n2861\n36585\n36585\nReplacement, complete, of a peripherally inserted central venous\naccess device, with subcutaneous port, through same venous access\n$ 1,778.45\n2862\n36589\n36589\nRemoval of tunneled central venous catheter, without\nsubcutaneous port or pump\n$ 388.65\n2863\n36590\n36590\nRemoval of tunneled central venous access device, with\nsubcutaneous port or pump, central or peripheral insertion\n$ 579.93\n2864\n36591\n36591\nCollection of blood specimen from a completely implantable venous\naccess device\n$ 40.50\n2865\n36592\n36592\nCollection of blood specimen using established central or peripheral\ncatheter, venous, not otherwise specified\n$ 52.78\n2866\n36593\n36593\nDeclotting by thrombolytic agent of implanted vascular access\ndevice or catheter\n$ 146.47\n2867\n36595\n36595\nMechanical removal of pericatheter obstructive material (eg, fibrin\nsheath) from central venous device via separate venous access\n$ 1,257.21\n2868\n36596\n36596\nMechanical removal of intraluminal (intracatheter) obstructive\nmaterial from central venous device through device lumen\n$ 265.15\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2869\n36597\n36597\nRepositioning of previously placed central venous catheter under\nfluoroscopic guidance\n$ 238.99\n2870\n36598\n36598\nContrast injection(s) for radiologic evaluation of existing central\nvenous access device, including fluoroscopy, image documentation\nand report\n$ 282.77\n2871\n36600\n36600\nArterial puncture, withdrawal of blood for diagnosis\n$ 91.80\n2872\n36620\n36620\nArterial catheterization or cannulation for sampling, monitoring or\ntransfusion (separate procedure); percutaneous\n$ 256.50\n2873\n36625\n36625\nArterial catheterization or cannulation for sampling, monitoring or\ntransfusion (separate procedure); cutdown\n$ 391.50\n2874\n36640\n36640\nArterial catheterization for prolonged infusion therapy\n(chemotherapy), cutdown\n$ 550.80\n2875\n36660\n36660\nCatheterization, umbilical artery, newborn, for diagnosis or therapy\n$ 322.20\n2876\n36680\n36680\nPlacement of needle for intraosseous infusion\n$ 256.50\n2877\n36800\n36800\nInsertion of cannula for hemodialysis, other purpose (separate\nprocedure); vein to vein\n$ 885.60\n2878\n36810\n36810\nInsertion of cannula for hemodialysis, other purpose (separate\nprocedure); arteriovenous, external (Scribner type)\n$ 1,357.20\n2879\n36815\n36815\nInsertion of cannula for hemodialysis, other purpose (separate\nprocedure); arteriovenous, external revision, or closure\n$ 1,125.90\n2880\n36818\n36818\nArteriovenous anastomosis, open; by upper arm cephalic vein\ntransposition\n$ 1,990.48\n2881\n36819\n36819\nArteriovenous anastomosis, open; by upper arm basilic vein\ntransposition\n$ 4,174.20\n2882\n36820\n36820\nArteriovenous anastomosis, open; by forearm vein transposition\n$ 2,132.80\n2883\n36821\n36821\nArteriovenous anastomosis, open; direct, any site (eg, Cimino type)\n(separate procedure)\n$ 2,295.00\n2884\n36823\n36823\nInsertion of arterial and venous cannula(s) for isolated\nextracorporeal circulation including regional chemotherapy\nperfusion to an extremity, with or without hyperthermia, with\nremoval of cannula(s) and repair of arteriotomy and venotomy sites\n$ 3,310.72\n2885\n36825\n36825\nCreation of arteriovenous fistula by other than direct arteriovenous\nanastomosis (separate procedure); autogenous graft\n$ 3,141.90\n2886\n36831\n36831\nThrombectomy, open, arteriovenous fistula without revision,\nautogenous or nonautogenous dialysis graft (separate procedure)\n$ 1,346.40\n2887\n36832\n36832\nRevision, open, arteriovenous fistula; without thrombectomy,\nautogenous or nonautogenous dialysis graft (separate procedure)\n$ 2,439.90\n2888\n36833\n36833\nRevision, open, arteriovenous fistula; with thrombectomy,\nautogenous or nonautogenous dialysis graft (separate procedure)\n$ 1,944.90\n2889\n36835\n36835\nInsertion of Thomas shunt (separate procedure)\n$ 1,480.23\n2890\n36838\n36838\nDistal revascularization and interval ligation (DRIL), upper extremity\nhemodialysis access (steal syndrome)\n$ 3,556.18\n2891\n36860\n36860\nExternal cannula declotting (separate procedure); without balloon\ncatheter\n$ 412.20\n2892\n36861\n36861\nExternal cannula declotting (separate procedure); with balloon\ncatheter\n$ 891.00\n2893\n36870\n36870\nThrombectomy, percutaneous, arteriovenous fistula, autogenous or\nnonautogenous graft (includes mechanical thrombus extraction and\nintra-graft thrombolysis)\n$ 3,973.50\n2894\n37140\n37140\nVenous anastomosis, open; portocaval\n$ 5,608.80\n2895\n37145\n37145\nVenous anastomosis, open; renoportal\n$ 3,990.60\n2896\n37160\n37160\nVenous anastomosis, open; caval-mesenteric\n$ 5,255.10\n2897\n37180\n37180\nVenous anastomosis, open; splenorenal, proximal\n$ 4,969.80\n2898\n37181\n37181\nVenous anastomosis, open; splenorenal, distal (selective\ndecompression of esophagogastric varices, any technique)\n$ 5,961.60\n2899\n37182\n37182\nInsertion of transvenous intrahepatic portosystemic shunt(s) (TIPS)\n(includes venous access, hepatic and portal vein catheterization,\nportography with hemodynamic evaluation, intrahepatic tract\nformation\/dilatation, stent placement and all associated imag\n$ 1,959.09\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2900\n37183\n37183\nRevision of transvenous intrahepatic portosystemic shunt(s) (TIPS)\n(includes venous access, hepatic and portal vein catheterization,\nportography with hemodynamic evaluation, intrahepatic tract\nrecanulization\/dilatation, stent placement and all associated\n$ 15,255.65\n2901\n37184\n37184\nPrimary percutaneous transluminal mechanical thrombectomy,\nnoncoronary, arterial or arterial bypass graft, including fluoroscopic\nguidance and intraprocedural pharmacological thrombolytic\ninjection(s); initial vessel\n$ 2,214.84\n2902\n37185\n37185\nPrimary percutaneous transluminal mechanical thrombectomy,\nnoncoronary, arterial or arterial bypass graft, including fluoroscopic\nguidance and intraprocedural pharmacological thrombolytic\ninjection(s); second and all subsequent vessel(s) within the same v\n$ 872.39\n2903\n37186\n37186\nSecondary percutaneous transluminal thrombectomy (eg,\nnonprimary mechanical, snare basket, suction technique),\nnoncoronary, arterial or arterial bypass graft, including fluoroscopic\nguidance and intraprocedural pharmacological thrombolytic\ninjections, pro\n$ 1,250.30\n2904\n37187\n37187\nPercutaneous transluminal mechanical thrombectomy, vein(s),\nincluding intraprocedural pharmacological thrombolytic injections\nand fluoroscopic guidance\n$ 1,941.11\n2905\n37188\n37188\nPercutaneous transluminal mechanical thrombectomy, vein(s),\nincluding intraprocedural pharmacological thrombolytic injections\nand fluoroscopic guidance, repeat treatment on subsequent day\nduring course of thrombolytic therapy\n$ 1,473.77\n2906\n37191\n37191\nInsertion of intravascular vena cava filter, endovascular approach\nincluding vascular access, vessel selection, and radiological\nsupervision and interpretation, intraprocedural roadmapping, and\nimaging guidance (ultrasound and fluoroscopy), when performed\n$ 6,918.36\n2907\n37192\n37192\nRepositioning of intravascular vena cava filter, endovascular\napproach including vascular access, vessel selection, and\nradiological supervision and interpretation, intraprocedural\nroadmapping, and imaging guidance (ultrasound and fluoroscopy),\nwhen performed\n$ 4,487.46\n2908\n37193\n37193\nRetrieval (removal) of intravascular vena cava filter, endovascular\napproach including vascular access, vessel selection, and\nradiological supervision and interpretation, intraprocedural\nroadmapping, and imaging guidance (ultrasound and fluoroscopy),\nwhen performed\n$ 4,282.95\n2909\n37195\n37195\nThrombolysis, cerebral, by intravenous infusion\n$ 846.90\n2910\n37197\n37197\nTranscatheter retrieval, percutaneous, of intravascular foreign body\n(eg, fractured venous or arterial catheter), includes radiological\nsupervision and interpretation, and imaging guidance (ultrasound or\nfluoroscopy), when performed\n$ 3,887.58\n2911\n37200\n37200\nTranscatheter biopsy\n$ 814.79\n2912\n37202\n37202\nTranscatheter therapy, infusion other than for thrombolysis, any\ntype (eg, spasmolytic, vasoconstrictive)\n$ 973.80\n2913\n37211\n37211\nTranscatheter therapy, arterial infusion for thrombolysis other than\ncoronary, any method, including radiological supervision and\ninterpretation, initial treatment day\n$ 972.47\n2914\n37212\n37212\nTranscatheter therapy, venous infusion for thrombolysis, any\nmethod, including radiological supervision and interpretation, initial\ntreatment day\n$ 858.67\n2915\n37213\n37213\nTranscatheter therapy, arterial or venous infusion for thrombolysis\nother than coronary, any method, including radiological supervision\nand interpretation, continued treatment on subsequent day during\ncourse of thrombolytic therapy, including follow-up ca\n$ 599.49\n2916\n37214\n37214\nTranscatheter therapy, arterial or venous infusion for thrombolysis\nother than coronary, any method, including radiological supervision\nand interpretation, continued treatment on subsequent day during\ncourse of thrombolytic therapy, including follow-up ca\n$ 353.25\n2917\n37215\n37215\nTranscatheter placement of intravascular stent(s), cervical carotid\nartery, percutaneous; with distal embolic protection\n$ 3,812.78\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2918\n37216\n37216\nTranscatheter placement of intravascular stent(s), cervical carotid\nartery, percutaneous; without distal embolic protection\n$ 3,498.17\n2919\n37220\n37220\nRevascularization, endovascular, open or percutaneous, iliac artery,\nunilateral, initial vessel; with transluminal angioplasty\n$ 2,257.95\n2920\n37221\n37221\nRevascularization, endovascular, open or percutaneous, iliac artery,\nunilateral, initial vessel; with transluminal stent placement(s),\nincludes angioplasty within the same vessel, when performed\n$ 3,035.71\n2921\n37222\n37222\nRevascularization, endovascular, open or percutaneous, iliac artery,\neach additional ipsilateral iliac vessel; with transluminal angioplasty\n(List separately in addition to code for primary procedure)\n$ 861.42\n2922\n37223\n37223\nRevascularization, endovascular, open or percutaneous, iliac artery,\neach additional ipsilateral iliac vessel; with transluminal stent\nplacement(s), includes angioplasty within the same vessel, when\nperformed (List separately in addition to code for prima\n$ 1,606.46\n2923\n37224\n37224\nRevascularization, endovascular, open or percutaneous, femoral,\npopliteal artery(s), unilateral; with transluminal angioplasty\n$ 2,605.53\n2924\n37225\n37225\nRevascularization, endovascular, open or percutaneous, femoral,\npopliteal artery(s), unilateral; with atherectomy, includes\nangioplasty within the same vessel, when performed\n$ 5,405.06\n2925\n37226\n37226\nRevascularization, endovascular, open or percutaneous, femoral,\npopliteal artery(s), unilateral; with transluminal stent placement(s),\nincludes angioplasty within the same vessel, when performed\n$ 4,490.45\n2926\n37227\n37227\nRevascularization, endovascular, open or percutaneous, femoral,\npopliteal artery(s), unilateral; with transluminal stent placement(s)\nand atherectomy, includes angioplasty within the same vessel,\nwhen performed\n$ 7,098.85\n2927\n37228\n37228\nRevascularization, endovascular, open or percutaneous, tibial,\nperoneal artery, unilateral, initial vessel; with transluminal\nangioplasty\n$ 3,436.34\n2928\n37229\n37229\nRevascularization, endovascular, open or percutaneous, tibial,\nperoneal artery, unilateral, initial vessel; with atherectomy, includes\nangioplasty within the same vessel, when performed\n$ 5,676.63\n2929\n37230\n37230\nRevascularization, endovascular, open or percutaneous, tibial,\nperoneal artery, unilateral, initial vessel; with transluminal stent\nplacement(s), includes angioplasty within the same vessel, when\nperformed\n$ 4,780.81\n2930\n37231\n37231\nRevascularization, endovascular, open or percutaneous, tibial,\nperoneal artery, unilateral, initial vessel; with transluminal stent\nplacement(s) and atherectomy, includes angioplasty within the\nsame vessel, when performed\n$ 6,604.22\n2931\n37232\n37232\nRevascularization, endovascular, open or percutaneous,\ntibial\/peroneal artery, unilateral, each additional vessel; with\ntransluminal angioplasty (List separately in addition to code for\nprimary procedure)\n$ 1,046.39\n2932\n37233\n37233\nRevascularization, endovascular, open or percutaneous,\ntibial\/peroneal artery, unilateral, each additional vessel; with\natherectomy, includes angioplasty within the same vessel, when\nperformed (List separately in addition to code for primary\nprocedure)\n$ 1,367.77\n2933\n37234\n37234\nRevascularization, endovascular, open or percutaneous,\ntibial\/peroneal artery, unilateral, each additional vessel; with\ntransluminal stent placement(s), includes angioplasty within the\nsame vessel, when performed (List separately in addition to code\nfor p\n$ 2,092.73\n2934\n37235\n37235\nRevascularization, endovascular, open or percutaneous,\ntibial\/peroneal artery, unilateral, each additional vessel; with\ntransluminal stent placement(s) and atherectomy, includes\nangioplasty within the same vessel, when performed (List separately\nin additi\n$ 2,470.73\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2935\n37236\n37236\nTranscatheter placement of an intravascular stent(s) (except lower\nextremity, cervical carotid, extracranial vertebral or intrathoracic\ncarotid, intracranial, or coronary), open or percutaneous, including\nradiological supervision and interpretation and in\n$ 9,119.70\n2936\n37237\n37237\nTranscatheter placement of an intravascular stent(s) (except lower\nextremity, cervical carotid, extracranial vertebral or intrathoracic\ncarotid, intracranial, or coronary), open or percutaneous, including\nradiological supervision and interpretation and in\n$ 4,410.41\n2937\n37238\n37238\nTranscatheter placement of an intravascular stent(s), open or\npercutaneous, including radiological supervision and interpretation\nand including angioplasty within the same vessel, when performed;\ninitial vein\n$ 9,119.70\n2938\n37239\n37239\nTranscatheter placement of an intravascular stent(s), open or\npercutaneous, including radiological supervision and interpretation\nand including angioplasty within the same vessel, when performed;\neach additional vein (List separately in addition to code f\n$ 4,410.41\n2939\n37241\n37241\nVascular embolization or occlusion, inclusive of all radiological\nsupervision and interpretation, intraprocedural roadmapping, and\nimaging guidance necessary to complete the intervention; venous,\nother than hemorrhage (eg, congenital or acquired venous ma\n$ 8,842.66\n2940\n37242\n37242\nVascular embolization or occlusion, inclusive of all radiological\nsupervision and interpretation, intraprocedural roadmapping, and\nimaging guidance necessary to complete the intervention; arterial,\nother than hemorrhage or tumor (eg, congenital or acquire\n$ 8,842.66\n2941\n37243\n37243\nVascular embolization or occlusion, inclusive of all radiological\nsupervision and interpretation, intraprocedural roadmapping, and\nimaging guidance necessary to complete the intervention; for\ntumors, organ ischemia, or infarction\n$ 8,842.66\n2942\n37244\n37244\nVascular embolization or occlusion, inclusive of all radiological\nsupervision and interpretation, intraprocedural roadmapping, and\nimaging guidance necessary to complete the intervention; for\narterial or venous hemorrhage or lymphatic extravasation\n$ 8,842.66\n2943\n37250\n37250\nIntravascular ultrasound (non-coronary vessel) during diagnostic\nevaluation and\/or therapeutic intervention; initial vessel (List\nseparately in addition to code for primary procedure)\n$ 408.08\n2944\n37251\n37251\nIntravascular ultrasound (non-coronary vessel) during diagnostic\nevaluation and\/or therapeutic intervention; each additional vessel\n(List separately in addition to code for primary procedure)\n$ 319.58\n2945\n37500\n37500\nVascular endoscopy, surgical, with ligation of perforator veins,\nsubfascial (SEPS)\n$ 2,240.80\n2946\n37501\n37501\nUnlisted vascular endoscopy procedure\nCost\n2947\n37565\n37565\nLigation, internal jugular vein\n$ 1,462.50\n2948\n37600\n37600\nLigation; external carotid artery\n$ 1,596.60\n2949\n37605\n37605\nLigation; internal or common carotid artery\n$ 1,402.20\n2950\n37606\n37606\nLigation; internal or common carotid artery, with gradual occlusion,\nas with Selverstone or Crutchfield clamp\n$ 1,670.40\n2951\n37607\n37607\nLigation or banding of angioaccess arteriovenous fistula\n$ 1,293.30\n2952\n37609\n37609\nLigation or biopsy, temporal artery\n$ 689.40\n2953\n37615\n37615\nLigation, major artery (eg, post-traumatic, rupture); neck\n$ 1,608.30\n2954\n37616\n37616\nLigation, major artery (eg, post-traumatic, rupture); chest\n$ 2,796.30\n2955\n37617\n37617\nLigation, major artery (eg, post-traumatic, rupture); abdomen\n$ 2,619.00\n2956\n37618\n37618\nLigation, major artery (eg, post-traumatic, rupture); extremity\n$ 1,545.30\n2957\n37619\n37619\nLigation of inferior vena cava\n$ 4,215.75\n2958\n37650\n37650\nLigation of femoral vein\n$ 1,337.40\n2959\n37660\n37660\nLigation of common iliac vein\n$ 1,606.50\n2960\n37700\n37700\nLigation and division of long saphenous vein at saphenofemoral\njunction, or distal interruptions\n$ 998.10\n2961\n37718\n37718\nLigation, division, and stripping, short saphenous vein\n$ 1,006.21\n2962\n37722\n37722\nLigation, division, and stripping, long (greater) saphenous veins\nfrom saphenofemoral junction to knee or below\n$ 1,208.89\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n2963\n37735\n37735\nLigation and division and complete stripping of long or short\nsaphenous veins with radical excision of ulcer and skin graft and\/or\ninterruption of communicating veins of lower leg, with excision of\ndeep fascia\n$ 2,844.00\n2964\n37760\n37760\nLigation of perforator veins, subfascial, radical (Linton type),\nincluding skin graft, when performed, open, 1 leg\n$ 2,987.10\n2965\n37761\n37761\nLigation of perforator vein(s), subfascial, open, including ultrasound\nguidance, when performed, 1 leg\n$ 1,390.71\n2966\n37765\n37765\nStab phlebectomy of varicose veins, 1 extremity; 10-20 stab\nincisions\n$ 1,167.91\n2967\n37766\n37766\nStab phlebectomy of varicose veins, 1 extremity; more than 20\nincisions\n$ 1,416.38\n2968\n37780\n37780\nLigation and division of short saphenous vein at saphenopopliteal\njunction (separate procedure)\n$ 641.70\n2969\n37785\n37785\nLigation, division, and\/or excision of varicose vein cluster(s), 1 leg\n$ 739.80\n2970\n37788\n37788\nPenile revascularization, artery, with or without vein graft\n$ 4,092.33\n2971\n37790\n37790\nPenile venous occlusive procedure\n$ 1,527.94\n2972\n37799\n37799\nUnlisted procedure, vascular surgery\nCost\n2973\n38100\n38100\nSplenectomy; total (separate procedure)\n$ 2,660.40\n2974\n38101\n38101\nSplenectomy; partial (separate procedure)\n$ 2,975.40\n2975\n38102\n38102\nSplenectomy; total, en bloc for extensive disease, in conjunction\nwith other procedure (List in addition to code for primary\nprocedure)\n$ 1,835.10\n2976\n38115\n38115\nRepair of ruptured spleen (splenorrhaphy) with or without partial\nsplenectomy\n$ 2,743.20\n2977\n38120\n38120\nLaparoscopy, surgical, splenectomy\n$ 3,954.23\n2978\n38129\n38129\nUnlisted laparoscopy procedure, spleen\nCost\n2979\n38200\n38200\nInjection procedure for splenoportography\n$ 351.00\n2980\n38204\n38204\nManagement of recipient hematopoietic progenitor cell donor\nsearch and cell acquisition\n$ 232.57\n2981\n38205\n38205\nBlood-derived hematopoietic progenitor cell harvesting for\ntransplantation, per collection; allogeneic\n$ 718.59\n2982\n38206\n38206\nBlood-derived hematopoietic progenitor cell harvesting for\ntransplantation, per collection; autologous\n$ 718.94\n2983\n38207\n38207\nTransplant preparation of hematopoietic progenitor cells;\ncryopreservation and storage\n$ 78.09\n2984\n38208\n38208\nTransplant preparation of hematopoietic progenitor cells; thawing\nof previously frozen harvest, without washing, per donor\n$ 50.46\n2985\n38209\n38209\nTransplant preparation of hematopoietic progenitor cells; thawing\nof previously frozen harvest, with washing, per donor\n$ 20.85\n2986\n38210\n38210\nTransplant preparation of hematopoietic progenitor cells; specific\ncell depletion within harvest, T-cell depletion\n$ 140.03\n2987\n38211\n38211\nTransplant preparation of hematopoietic progenitor cells; tumor\ncell depletion\n$ 128.01\n2988\n38212\n38212\nTransplant preparation of hematopoietic progenitor cells; red blood\ncell removal\n$ 82.28\n2989\n38213\n38213\nTransplant preparation of hematopoietic progenitor cells; platelet\ndepletion\n$ 20.85\n2990\n38214\n38214\nTransplant preparation of hematopoietic progenitor cells; plasma\n(volume) depletion\n$ 71.84\n2991\n38215\n38215\nTransplant preparation of hematopoietic progenitor cells; cell\nconcentration in plasma, mononuclear, or buffy coat layer\n$ 82.28\n2992\n38220\n38220\nBone marrow; aspiration only\n$ 293.47\n2993\n38221\n38221\nBone marrow; biopsy, needle or trocar\n$ 316.63\n2994\n38230\n38230\nBone marrow harvesting for transplantation; allogeneic\n$ 1,390.50\n2995\n38240\n38240\nHematopoietic progenitor cell (HPC); allogeneic transplantation per\ndonor\n$ 1,089.69\n2996\n38241\n38241\nHematopoietic progenitor cell (HPC); autologous transplantation\n$ 986.52\n2997\n38242\n38242\nAllogeneic lymphocyte infusions\n$ 1,082.79\n2998\n38300\n38300\nDrainage of lymph node abscess or lymphadenitis; simple\n$ 293.40\n2999\n38305\n38305\nDrainage of lymph node abscess or lymphadenitis; extensive\n$ 729.00\n3000\n38308\n38308\nLymphangiotomy or other operations on lymphatic channels\n$ 884.70\n3001\n38380\n38380\nSuture and\/or ligation of thoracic duct; cervical approach\n$ 1,355.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3002\n38381\n38381\nSuture and\/or ligation of thoracic duct; thoracic approach\n$ 2,421.00\n3003\n38382\n38382\nSuture and\/or ligation of thoracic duct; abdominal approach\n$ 2,037.60\n3004\n38500\n38500\nBiopsy or excision of lymph node(s); open, superficial\n$ 587.77\n3005\n38505\n38505\nBiopsy or excision of lymph node(s); by needle, superficial (eg,\ncervical, inguinal, axillary)\n$ 399.60\n3006\n38510\n38510\nBiopsy or excision of lymph node(s); open, deep cervical node(s)\n$ 850.50\n3007\n38520\n38520\nBiopsy or excision of lymph node(s); open, deep cervical node(s)\nwith excision scalene fat pad\n$ 918.90\n3008\n38525\n38525\nBiopsy or excision of lymph node(s); open, deep axillary node(s)\n$ 1,233.90\n3009\n38542\n38542\nDissection, deep jugular node(s)\n$ 1,244.70\n3010\n38550\n38550\nExcision of cystic hygroma, axillary or cervical; without deep\nneurovascular dissection\n$ 1,267.20\n3011\n38555\n38555\nExcision of cystic hygroma, axillary or cervical; with deep\nneurovascular dissection\n$ 2,374.20\n3012\n38562\n38562\nLimited lymphadenectomy for staging (separate procedure); pelvic\nand para-aortic\n$ 2,771.10\n3013\n38564\n38564\nLimited lymphadenectomy for staging (separate procedure);\nretroperitoneal (aortic and\/or splenic)\n$ 2,665.80\n3014\n38570\n38570\nLaparoscopy, surgical; with retroperitoneal lymph node sampling\n(biopsy), single or multiple\n$ 2,667.60\n3015\n38571\n38571\nLaparoscopy, surgical; with bilateral total pelvic lymphadenectomy\n$ 3,213.90\n3016\n38572\n38572\nLaparoscopy, surgical; with bilateral total pelvic lymphadenectomy\nand peri-aortic lymph node sampling (biopsy), single or multiple\n$ 3,295.80\n3017\n38589\n38589\nUnlisted laparoscopy procedure, lymphatic system\nCost\n3018\n38700\n38700\nSuprahyoid lymphadenectomy\n$ 2,449.80\n3019\n38720\n38720\nCervical lymphadenectomy (complete)\n$ 3,872.70\n3020\n38724\n38724\nCervical lymphadenectomy (modified radical neck dissection)\n$ 3,672.00\n3021\n38740\n38740\nAxillary lymphadenectomy; superficial\n$ 1,797.30\n3022\n38745\n38745\nAxillary lymphadenectomy; complete\n$ 2,779.20\n3023\n38746\n38746\nThoracic lymphadenectomy by thoracotomy, mediastinal and\nregional lymphadenectomy (List separately in addition to code for\nprimary procedure)\n$ 846.00\n3024\n38747\n38747\nAbdominal lymphadenectomy, regional, including celiac, gastric,\nportal, peripancreatic, with or without para-aortic and vena caval\nnodes (List separately in addition to code for primary procedure)\n$ 1,178.10\n3025\n38760\n38760\nInguinofemoral lymphadenectomy, superficial, including Cloquets\nnode (separate procedure)\n$ 2,240.10\n3026\n38765\n38765\nInguinofemoral lymphadenectomy, superficial, in continuity with\npelvic lymphadenectomy, including external iliac, hypogastric, and\nobturator nodes (separate procedure)\n$ 3,024.90\n3027\n38770\n38770\nPelvic lymphadenectomy, including external iliac, hypogastric, and\nobturator nodes (separate procedure)\n$ 3,276.00\n3028\n38780\n38780\nRetroperitoneal transabdominal lymphadenectomy, extensive,\nincluding pelvic, aortic, and renal nodes (separate procedure)\n$ 4,169.70\n3029\n38790\n38790\nInjection procedure; lymphangiography\n$ 396.90\n3030\n38792\n38792\nInjection procedure; radioactive tracer for identification of sentinel\nnode\n$ 174.37\n3031\n38794\n38794\nCannulation, thoracic duct\n$ 1,099.47\n3032\n38999\n38999\nUnlisted procedure, hemic or lymphatic system\nCost\n3033\n39000\n39000\nMediastinotomy with exploration, drainage, removal of foreign\nbody, or biopsy; cervical approach\n$ 1,619.10\n3034\n39200\n39200\nResection of mediastinal cyst\n$ 2,801.70\n3035\n39220\n39220\nResection of mediastinal tumor\n$ 3,410.10\n3036\n39400\n39400\nMediastinoscopy, includes biopsy(ies), when performed\n$ 1,290.60\n3037\n39499\n39499\nUnlisted procedure, mediastinum\nCost\n3038\n39501\n39501\nRepair, laceration of diaphragm, any approach\n$ 2,970.00\n3039\n39503\n39503\nRepair, neonatal diaphragmatic hernia, with or without chest tube\ninsertion and with or without creation of ventral hernia\n$ 3,626.10\n3040\n39540\n39540\nRepair, diaphragmatic hernia (other than neonatal), traumatic;\nacute\n$ 3,577.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3041\n39541\n39541\nRepair, diaphragmatic hernia (other than neonatal), traumatic;\nchronic\n$ 3,515.40\n3042\n39545\n39545\nImbrication of diaphragm for eventration, transthoracic or\ntransabdominal, paralytic or nonparalytic\n$ 3,464.10\n3043\n39560\n39560\nResection, diaphragm; with simple repair (eg, primary suture)\n$ 3,485.19\n3044\n39561\n39561\nResection, diaphragm; with complex repair (eg, prosthetic material,\nlocal muscle flap)\n$ 5,241.89\n3045\n39599\n39599\nUnlisted procedure, diaphragm\nCost\n3046\n40490\n40490\nBiopsy of lip\n$ 206.10\n3047\n40500\n40500\nVermilionectomy (lip shave), with mucosal advancement\n$ 1,545.30\n3048\n40510\n40510\nExcision of lip; transverse wedge excision with primary closure\n$ 1,710.90\n3049\n40520\n40520\nExcision of lip; V-excision with primary direct linear closure\n$ 1,390.50\n3050\n40525\n40525\nExcision of lip; full thickness, reconstruction with local flap (eg,\nEstlander or fan)\n$ 3,300.30\n3051\n40527\n40527\nExcision of lip; full thickness, reconstruction with cross lip flap (Abbe-\nEstlander)\n$ 3,558.60\n3052\n40530\n40530\nResection of lip, more than one-fourth, without reconstruction\n$ 1,647.90\n3053\n40650\n40650\nRepair lip, full thickness; vermilion only\n$ 1,409.40\n3054\n40652\n40652\nRepair lip, full thickness; up to half vertical height\n$ 1,440.00\n3055\n40654\n40654\nRepair lip, full thickness; over one-half vertical height, or complex\n$ 1,681.20\n3056\n40700\n40700\nPlastic repair of cleft lip\/nasal deformity; primary, partial or\ncomplete, unilateral\n$ 2,646.90\n3057\n40701\n40701\nPlastic repair of cleft lip\/nasal deformity; primary bilateral, 1-stage\nprocedure\n$ 4,107.60\n3058\n40702\n40702\nPlastic repair of cleft lip\/nasal deformity; primary bilateral, 1 of 2\nstages\n$ 2,590.20\n3059\n40720\n40720\nPlastic repair of cleft lip\/nasal deformity; secondary, by recreation\nof defect and reclosure\n$ 2,788.20\n3060\n40761\n40761\nPlastic repair of cleft lip\/nasal deformity; with cross lip pedicle flap\n(Abbe-Estlander type), including sectioning and inserting of pedicle\n$ 3,038.40\n3061\n40799\n40799\nUnlisted procedure, lips\nCost\n3062\n40800\n40800\nDrainage of abscess, cyst, hematoma, vestibule of mouth; simple\n$ 201.60\n3063\n40801\n40801\nDrainage of abscess, cyst, hematoma, vestibule of mouth;\ncomplicated\n$ 579.60\n3064\n40804\n40804\nRemoval of embedded foreign body, vestibule of mouth; simple\n$ 236.70\n3065\n40805\n40805\nRemoval of embedded foreign body, vestibule of mouth;\ncomplicated\n$ 657.90\n3066\n40806\n40806\nIncision of labial frenum (frenotomy)\n$ 315.90\n3067\n40808\n40808\nBiopsy, vestibule of mouth\n$ 202.50\n3068\n40810\n40810\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\nwithout repair\n$ 262.80\n3069\n40812\n40812\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\nwith simple repair\n$ 398.70\n3070\n40814\n40814\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\nwith complex repair\n$ 870.30\n3071\n40816\n40816\nExcision of lesion of mucosa and submucosa, vestibule of mouth;\ncomplex, with excision of underlying muscle\n$ 1,030.50\n3072\n40818\n40818\nExcision of mucosa of vestibule of mouth as donor graft\n$ 627.30\n3073\n40819\n40819\nExcision of frenum, labial or buccal (frenumectomy, frenulectomy,\nfrenectomy)\n$ 414.00\n3074\n40820\n40820\nDestruction of lesion or scar of vestibule of mouth by physical\nmethods (eg, laser, thermal, cryo, chemical)\n$ 349.20\n3075\n40830\n40830\nClosure of laceration, vestibule of mouth; 2.5 cm or less\n$ 232.24\n3076\n40831\n40831\nClosure of laceration, vestibule of mouth; over 2.5 cm or complex\n$ 528.30\n3077\n40840\n40840\nVestibuloplasty; anterior\n$ 1,712.70\n3078\n40842\n40842\nVestibuloplasty; posterior, unilateral\n$ 1,566.90\n3079\n40843\n40843\nVestibuloplasty; posterior, bilateral\n$ 2,436.30\n3080\n40844\n40844\nVestibuloplasty; entire arch\n$ 3,133.80\n3081\n40845\n40845\nVestibuloplasty; complex (including ridge extension, muscle\nrepositioning)\n$ 3,672.90\n3082\n40899\n40899\nUnlisted procedure, vestibule of mouth\nCost\n3083\n41000\n41000\nIntraoral incision and drainage of abscess, cyst, or hematoma of\ntongue or floor of mouth; lingual\n$ 256.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3084\n41005\n41005\nIntraoral incision and drainage of abscess, cyst, or hematoma of\ntongue or floor of mouth; sublingual, superficial\n$ 286.20\n3085\n41006\n41006\nIntraoral incision and drainage of abscess, cyst, or hematoma of\ntongue or floor of mouth; sublingual, deep, supramylohyoid\n$ 610.20\n3086\n41007\n41007\nIntraoral incision and drainage of abscess, cyst, or hematoma of\ntongue or floor of mouth; submental space\n$ 703.80\n3087\n41008\n41008\nIntraoral incision and drainage of abscess, cyst, or hematoma of\ntongue or floor of mouth; submandibular space\n$ 718.20\n3088\n41009\n41009\nIntraoral incision and drainage of abscess, cyst, or hematoma of\ntongue or floor of mouth; masticator space\n$ 810.00\n3089\n41010\n41010\nIncision of lingual frenum (frenotomy)\n$ 247.50\n3090\n41015\n41015\nExtraoral incision and drainage of abscess, cyst, or hematoma of\nfloor of mouth; sublingual\n$ 772.20\n3091\n41016\n41016\nExtraoral incision and drainage of abscess, cyst, or hematoma of\nfloor of mouth; submental\n$ 839.70\n3092\n41017\n41017\nExtraoral incision and drainage of abscess, cyst, or hematoma of\nfloor of mouth; submandibular\n$ 829.80\n3093\n41018\n41018\nExtraoral incision and drainage of abscess, cyst, or hematoma of\nfloor of mouth; masticator space\n$ 956.70\n3094\n41019\n41019\nPlacement of needles, catheters, or other device(s) into the head\nand\/or neck region (percutaneous, transoral, or transnasal) for\nsubsequent interstitial radioelement application\n$ 1,028.05\n3095\n41100\n41100\nBiopsy of tongue; anterior two-thirds\n$ 261.00\n3096\n41105\n41105\nBiopsy of tongue; posterior one-third\n$ 309.60\n3097\n41108\n41108\nBiopsy of floor of mouth\n$ 239.40\n3098\n41110\n41110\nExcision of lesion of tongue without closure\n$ 393.30\n3099\n41112\n41112\nExcision of lesion of tongue with closure; anterior two-thirds\n$ 642.60\n3100\n41113\n41113\nExcision of lesion of tongue with closure; posterior one-third\n$ 954.00\n3101\n41114\n41114\nExcision of lesion of tongue with closure; with local tongue flap\n$ 2,168.10\n3102\n41115\n41115\nExcision of lingual frenum (frenectomy)\n$ 426.60\n3103\n41116\n41116\nExcision, lesion of floor of mouth\n$ 715.50\n3104\n41120\n41120\nGlossectomy; less than one-half tongue\n$ 1,905.30\n3105\n41130\n41130\nGlossectomy; hemiglossectomy\n$ 2,204.10\n3106\n41135\n41135\nGlossectomy; partial, with unilateral radical neck dissection\n$ 4,789.80\n3107\n41140\n41140\nGlossectomy; complete or total, with or without tracheostomy,\nwithout radical neck dissection\n$ 4,610.70\n3108\n41145\n41145\nGlossectomy; complete or total, with or without tracheostomy, with\nunilateral radical neck dissection\n$ 5,366.70\n3109\n41150\n41150\nGlossectomy; composite procedure with resection floor of mouth\nand mandibular resection, without radical neck dissection\n$ 4,663.80\n3110\n41153\n41153\nGlossectomy; composite procedure with resection floor of mouth,\nwith suprahyoid neck dissection\n$ 4,880.70\n3111\n41155\n41155\nGlossectomy; composite procedure with resection floor of mouth,\nmandibular resection, and radical neck dissection (Commando type)\n$ 6,470.10\n3112\n41250\n41250\nRepair of laceration 2.5 cm or less; floor of mouth and\/or anterior\ntwo-thirds of tongue\n$ 361.80\n3113\n41251\n41251\nRepair of laceration 2.5 cm or less; posterior one-third of tongue\n$ 513.00\n3114\n41252\n41252\nRepair of laceration of tongue, floor of mouth, over 2.6 cm or\ncomplex\n$ 838.80\n3115\n41500\n41500\nFixation of tongue, mechanical, other than suture (eg, K-wire)\n$ 766.80\n3116\n41510\n41510\nSuture of tongue to lip for micrognathia (Douglas type procedure)\n$ 1,354.50\n3117\n41512\n41512\nTongue base suspension, permanent suture technique\n$ 1,094.85\n3118\n41520\n41520\nFrenoplasty (surgical revision of frenum, eg, with Z-plasty)\n$ 647.10\n3119\n41530\n41530\nSubmucosal ablation of the tongue base, radiofrequency, 1 or more\nsites, per session\n$ 6,950.37\n3120\n41599\n41599\nUnlisted procedure, tongue, floor of mouth\nCost\n3121\n41800\n41800\nDrainage of abscess, cyst, hematoma from dentoalveolar structures\n$ 229.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3122\n41805\n41805\nRemoval of embedded foreign body from dentoalveolar structures;\nsoft tissues\n$ 298.80\n3123\n41806\n41806\nRemoval of embedded foreign body from dentoalveolar structures;\nbone\n$ 493.20\n3124\n41821\n41821\nOperculectomy, excision pericoronal tissues\n$ -\n3125\n41822\n41822\nExcision of fibrous tuberosities, dentoalveolar structures\n$ 429.30\n3126\n41823\n41823\nExcision of osseous tuberosities, dentoalveolar structures\n$ 705.60\n3127\n41825\n41825\nExcision of lesion or tumor (except listed above), dentoalveolar\nstructures; without repair\n$ 369.00\n3128\n41826\n41826\nExcision of lesion or tumor (except listed above), dentoalveolar\nstructures; with simple repair\n$ 546.30\n3129\n41827\n41827\nExcision of lesion or tumor (except listed above), dentoalveolar\nstructures; with complex repair\n$ 849.60\n3130\n41828\n41828\nExcision of hyperplastic alveolar mucosa, each quadrant (specify)\n$ 726.30\n3131\n41830\n41830\nAlveolectomy, including curettage of osteitis or sequestrectomy\n$ 849.60\n3132\n41850\n41850\nDestruction of lesion (except excision), dentoalveolar structures\n$ 180.00\n3133\n41870\n41870\nPeriodontal mucosal grafting\n$ 726.30\n3134\n41872\n41872\nGingivoplasty, each quadrant (specify)\n$ 669.60\n3135\n41874\n41874\nAlveoloplasty, each quadrant (specify)\n$ 756.90\n3136\n41899\n41899\nUnlisted procedure, dentoalveolar structures\nCost\n3137\n42000\n42000\nDrainage of abscess of palate, uvula\n$ 236.70\n3138\n42100\n42100\nBiopsy of palate, uvula\n$ 273.60\n3139\n42104\n42104\nExcision, lesion of palate, uvula; without closure\n$ 478.80\n3140\n42106\n42106\nExcision, lesion of palate, uvula; with simple primary closure\n$ 618.30\n3141\n42107\n42107\nExcision, lesion of palate, uvula; with local flap closure\n$ 1,787.40\n3142\n42120\n42120\nResection of palate or extensive resection of lesion\n$ 2,958.30\n3143\n42140\n42140\nUvulectomy, excision of uvula\n$ 470.70\n3144\n42145\n42145\nPalatopharyngoplasty (eg, uvulopalatopharyngoplasty,\nuvulopharyngoplasty)\n$ 2,509.20\n3145\n42160\n42160\nDestruction of lesion, palate or uvula (thermal, cryo or chemical)\n$ 448.20\n3146\n42180\n42180\nRepair, laceration of palate; up to 2 cm\n$ 416.96\n3147\n42182\n42182\nRepair, laceration of palate; over 2 cm or complex\n$ 825.30\n3148\n42200\n42200\nPalatoplasty for cleft palate, soft and\/or hard palate only\n$ 2,801.70\n3149\n42205\n42205\nPalatoplasty for cleft palate, with closure of alveolar ridge; soft\ntissue only\n$ 3,186.00\n3150\n42210\n42210\nPalatoplasty for cleft palate, with closure of alveolar ridge; with\nbone graft to alveolar ridge (includes obtaining graft)\n$ 4,377.60\n3151\n42215\n42215\nPalatoplasty for cleft palate; major revision\n$ 2,664.90\n3152\n42220\n42220\nPalatoplasty for cleft palate; secondary lengthening procedure\n$ 2,497.50\n3153\n42225\n42225\nPalatoplasty for cleft palate; attachment pharyngeal flap\n$ 2,811.60\n3154\n42226\n42226\nLengthening of palate, and pharyngeal flap\n$ 3,475.80\n3155\n42227\n42227\nLengthening of palate, with island flap\n$ 2,935.80\n3156\n42235\n42235\nRepair of anterior palate, including vomer flap\n$ 2,310.30\n3157\n42260\n42260\nRepair of nasolabial fistula\n$ 1,653.30\n3158\n42280\n42280\nMaxillary impression for palatal prosthesis\n$ 309.60\n3159\n42281\n42281\nInsertion of pin-retained palatal prosthesis\n$ 355.50\n3160\n42299\n42299\nUnlisted procedure, palate, uvula\nCost\n3161\n42300\n42300\nDrainage of abscess; parotid, simple\n$ 324.90\n3162\n42305\n42305\nDrainage of abscess; parotid, complicated\n$ 806.40\n3163\n42310\n42310\nDrainage of abscess; submaxillary or sublingual, intraoral\n$ 360.90\n3164\n42320\n42320\nDrainage of abscess; submaxillary, external\n$ 597.60\n3165\n42330\n42330\nSialolithotomy; submandibular (submaxillary), sublingual or parotid,\nuncomplicated, intraoral\n$ 415.95\n3166\n42335\n42335\nSialolithotomy; submandibular (submaxillary), complicated,\nintraoral\n$ 789.30\n3167\n42340\n42340\nSialolithotomy; parotid, extraoral or complicated intraoral\n$ 1,092.60\n3168\n42400\n42400\nBiopsy of salivary gland; needle\n$ 250.20\n3169\n42405\n42405\nBiopsy of salivary gland; incisional\n$ 578.70\n3170\n42408\n42408\nExcision of sublingual salivary cyst (ranula)\n$ 1,061.10\n3171\n42409\n42409\nMarsupialization of sublingual salivary cyst (ranula)\n$ 772.20\n3172\n42410\n42410\nExcision of parotid tumor or parotid gland; lateral lobe, without\nnerve dissection\n$ 2,012.40\n3173\n42415\n42415\nExcision of parotid tumor or parotid gland; lateral lobe, with\ndissection and preservation of facial nerve\n$ 3,630.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3174\n42420\n42420\nExcision of parotid tumor or parotid gland; total, with dissection\nand preservation of facial nerve\n$ 4,627.80\n3175\n42425\n42425\nExcision of parotid tumor or parotid gland; total, en bloc removal\nwith sacrifice of facial nerve\n$ 3,363.30\n3176\n42426\n42426\nExcision of parotid tumor or parotid gland; total, with unilateral\nradical neck dissection\n$ 6,180.30\n3177\n42440\n42440\nExcision of submandibular (submaxillary) gland\n$ 2,312.10\n3178\n42450\n42450\nExcision of sublingual gland\n$ 1,911.60\n3179\n42500\n42500\nPlastic repair of salivary duct, sialodochoplasty; primary or simple\n$ 1,374.30\n3180\n42505\n42505\nPlastic repair of salivary duct, sialodochoplasty; secondary or\ncomplicated\n$ 1,757.70\n3181\n42507\n42507\nParotid duct diversion, bilateral (Wilke type procedure);\n$ 2,302.20\n3182\n42508\n42508\nParotid duct diversion, bilateral (Wilke type procedure); with\nexcision of 1 submandibular gland\n$ 2,601.00\n3183\n42509\n42509\nParotid duct diversion, bilateral (Wilke type procedure); with\nexcision of both submandibular glands\n$ 3,194.10\n3184\n42510\n42510\nParotid duct diversion, bilateral (Wilke type procedure); with\nligation of both submandibular (Wharton's) ducts\n$ 2,726.10\n3185\n42550\n42550\nInjection procedure for sialography\n$ 193.50\n3186\n42600\n42600\nClosure salivary fistula\n$ 1,476.00\n3187\n42650\n42650\nDilation salivary duct\n$ 143.10\n3188\n42660\n42660\nDilation and catheterization of salivary duct, with or without\ninjection\n$ 215.10\n3189\n42665\n42665\nLigation salivary duct, intraoral\n$ 456.30\n3190\n42699\n42699\nUnlisted procedure, salivary glands or ducts\nCost\n3191\n42700\n42700\nIncision and drainage abscess; peritonsillar\n$ 318.60\n3192\n42720\n42720\nIncision and drainage abscess; retropharyngeal or parapharyngeal,\nintraoral approach\n$ 688.50\n3193\n42725\n42725\nIncision and drainage abscess; retropharyngeal or parapharyngeal,\nexternal approach\n$ 1,467.00\n3194\n42800\n42800\nBiopsy; oropharynx\n$ 250.20\n3195\n42804\n42804\nBiopsy; nasopharynx, visible lesion, simple\n$ 308.70\n3196\n42806\n42806\nBiopsy; nasopharynx, survey for unknown primary lesion\n$ 373.50\n3197\n42808\n42808\nExcision or destruction of lesion of pharynx, any method\n$ 592.20\n3198\n42809\n42809\nRemoval of foreign body from pharynx\n$ 312.30\n3199\n42810\n42810\nExcision branchial cleft cyst or vestige, confined to skin and\nsubcutaneous tissues\n$ 878.40\n3200\n42815\n42815\nExcision branchial cleft cyst, vestige, or fistula, extending beneath\nsubcutaneous tissues and\/or into pharynx\n$ 1,880.10\n3201\n42820\n42820\nTonsillectomy and adenoidectomy; younger than age 12\n$ 816.61\n3202\n42821\n42821\nTonsillectomy and adenoidectomy; age 12 or over\n$ 1,031.40\n3203\n42825\n42825\nTonsillectomy, primary or secondary; younger than age 12\n$ 820.80\n3204\n42826\n42826\nTonsillectomy, primary or secondary; age 12 or over\n$ 841.50\n3205\n42830\n42830\nAdenoidectomy, primary; younger than age 12\n$ 581.64\n3206\n42831\n42831\nAdenoidectomy, primary; age 12 or over\n$ 675.00\n3207\n42835\n42835\nAdenoidectomy, secondary; younger than age 12\n$ 536.40\n3208\n42836\n42836\nAdenoidectomy, secondary; age 12 or over\n$ 669.60\n3209\n42842\n42842\nRadical resection of tonsil, tonsillar pillars, and\/or retromolar\ntrigone; without closure\n$ 2,421.00\n3210\n42844\n42844\nRadical resection of tonsil, tonsillar pillars, and\/or retromolar\ntrigone; closure with local flap (eg, tongue, buccal)\n$ 3,346.20\n3211\n42845\n42845\nRadical resection of tonsil, tonsillar pillars, and\/or retromolar\ntrigone; closure with other flap\n$ 4,507.20\n3212\n42860\n42860\nExcision of tonsil tags\n$ 570.60\n3213\n42870\n42870\nExcision or destruction lingual tonsil, any method (separate\nprocedure)\n$ 844.20\n3214\n42890\n42890\nLimited pharyngectomy\n$ 2,689.20\n3215\n42892\n42892\nResection of lateral pharyngeal wall or pyriform sinus, direct closure\nby advancement of lateral and posterior pharyngeal walls\n$ 3,450.60\n3216\n42894\n42894\nResection of pharyngeal wall requiring closure with myocutaneous\nor fasciocutaneous flap or free muscle, skin, or fascial flap with\nmicrovascular anastomosis\n$ 4,776.30\n3217\n42900\n42900\nSuture pharynx for wound or injury\n$ 977.40\n3218\n42950\n42950\nPharyngoplasty (plastic or reconstructive operation on pharynx)\n$ 1,989.90\n3219\n42953\n42953\nPharyngoesophageal repair\n$ 2,523.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3220\n42955\n42955\nPharyngostomy (fistulization of pharynx, external for feeding)\n$ 1,579.50\n3221\n42960\n42960\nControl oropharyngeal hemorrhage, primary or secondary (eg, post-\ntonsillectomy); simple\n$ 366.30\n3222\n42961\n42961\nControl oropharyngeal hemorrhage, primary or secondary (eg, post-\ntonsillectomy); complicated, requiring hospitalization\n$ 600.30\n3223\n42962\n42962\nControl oropharyngeal hemorrhage, primary or secondary (eg, post-\ntonsillectomy); with secondary surgical intervention\n$ 947.70\n3224\n42970\n42970\nControl of nasopharyngeal hemorrhage, primary or secondary (eg,\npostadenoidectomy); simple, with posterior nasal packs, with or\nwithout anterior packs and\/or cautery\n$ 629.10\n3225\n42971\n42971\nControl of nasopharyngeal hemorrhage, primary or secondary (eg,\npostadenoidectomy); complicated, requiring hospitalization\n$ 945.00\n3226\n42972\n42972\nControl of nasopharyngeal hemorrhage, primary or secondary (eg,\npostadenoidectomy); with secondary surgical intervention\n$ 1,179.00\n3227\n42999\n42999\nUnlisted procedure, pharynx, adenoids, or tonsils\nCost\n3228\n43020\n43020\nEsophagotomy, cervical approach, with removal of foreign body\n$ 1,996.20\n3229\n43030\n43030\nCricopharyngeal myotomy\n$ 2,510.10\n3230\n43045\n43045\nEsophagotomy, thoracic approach, with removal of foreign body\n$ 3,352.50\n3231\n43100\n43100\nExcision of lesion, esophagus, with primary repair; cervical approach $ 2,568.60\n3232\n43101\n43101\nExcision of lesion, esophagus, with primary repair; thoracic or\nabdominal approach\n$ 3,299.40\n3233\n43107\n43107\nTotal or near total esophagectomy, without thoracotomy; with\npharyngogastrostomy or cervical esophagogastrostomy, with or\nwithout pyloroplasty (transhiatal)\n$ 5,637.60\n3234\n43108\n43108\nTotal or near total esophagectomy, without thoracotomy; with\ncolon interposition or small intestine reconstruction, including\nintestine mobilization, preparation and anastomosis(es)\n$ 6,282.90\n3235\n43112\n43112\nTotal or near total esophagectomy, with thoracotomy; with\npharyngogastrostomy or cervical esophagogastrostomy, with or\nwithout pyloroplasty\n$ 6,437.70\n3236\n43113\n43113\nTotal or near total esophagectomy, with thoracotomy; with colon\ninterposition or small intestine reconstruction, including intestine\nmobilization, preparation, and anastomosis(es)\n$ 5,426.85\n3237\n43116\n43116\nPartial esophagectomy, cervical, with free intestinal graft, including\nmicrovascular anastomosis, obtaining the graft and intestinal\nreconstruction\n$ 6,171.24\n3238\n43117\n43117\nPartial esophagectomy, distal two-thirds, with thoracotomy and\nseparate abdominal incision, with or without proximal gastrectomy;\nwith thoracic esophagogastrostomy, with or without pyloroplasty\n(Ivor Lewis)\n$ 6,574.50\n3239\n43118\n43118\nPartial esophagectomy, distal two-thirds, with thoracotomy and\nseparate abdominal incision, with or without proximal gastrectomy;\nwith colon interposition or small intestine reconstruction, including\nintestine mobilization, preparation, and anastomosis(es\n$ 5,531.39\n3240\n43121\n43121\nPartial esophagectomy, distal two-thirds, with thoracotomy only,\nwith or without proximal gastrectomy, with thoracic\nesophagogastrostomy, with or without pyloroplasty\n$ 6,251.40\n3241\n43122\n43122\nPartial esophagectomy, thoracoabdominal or abdominal approach,\nwith or without proximal gastrectomy; with esophagogastrostomy,\nwith or without pyloroplasty\n$ 5,902.20\n3242\n43123\n43123\nPartial esophagectomy, thoracoabdominal or abdominal approach,\nwith or without proximal gastrectomy; with colon interposition or\nsmall intestine reconstruction, including intestine mobilization,\npreparation, and anastomosis(es)\n$ 6,437.70\n3243\n43124\n43124\nTotal or partial esophagectomy, without reconstruction (any\napproach), with cervical esophagostomy\n$ 4,452.63\n3244\n43130\n43130\nDiverticulectomy of hypopharynx or esophagus, with or without\nmyotomy; cervical approach\n$ 2,642.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3245\n43135\n43135\nDiverticulectomy of hypopharynx or esophagus, with or without\nmyotomy; thoracic approach\n$ 3,141.90\n3246\n43200\n43200\nEsophagoscopy, flexible, transoral; diagnostic, including collection\nof specimen(s) by brushing or washing, when performed (separate\nprocedure)\n$ 567.90\n3247\n43201\n43201\nEsophagoscopy, flexible, transoral; with directed submucosal\ninjection(s), any substance\n$ 754.53\n3248\n43202\n43202\nEsophagoscopy, flexible, transoral; with biopsy, single or multiple\n$ 654.30\n3249\n43204\n43204\nEsophagoscopy, flexible, transoral; with injection sclerosis of\nesophageal varices\n$ 973.80\n3250\n43205\n43205\nEsophagoscopy, flexible, transoral; with band ligation of esophageal\nvarices\n$ 978.30\n3251\n43212\n43212\nEsophagoscopy, flexible, transoral; with placement of endoscopic\nstent (includes pre- and post-dilation and guide wire passage, when\nperformed)\n$2,371.40\n3252\n43215\n43215\nEsophagoscopy, flexible, transoral; with removal of foreign body\n$ 832.50\n3253\n43216\n43216\nEsophagoscopy, flexible, transoral; with removal of tumor(s),\npolyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery\n$ 839.70\n3254\n43217\n43217\nEsophagoscopy, flexible, transoral; with removal of tumor(s),\npolyp(s), or other lesion(s) by snare technique\n$ 929.70\n3255\n43220\n43220\nEsophagoscopy, flexible, transoral; with transendoscopic balloon\ndilation (less than 30 mm diameter)\n$ 760.50\n3256\n43226\n43226\nEsophagoscopy, flexible, transoral; with insertion of guide wire\nfollowed by passage of dilator(s) over guide wire\n$ 681.30\n3257\n43227\n43227\nEsophagoscopy, flexible, transoral; with control of bleeding, any\nmethod\n$ 1,059.30\n3258\n43229\n43229\nEsophagoscopy, flexible, transoral; with ablation of tumor(s),\npolyp(s), or other lesion(s) (includes pre- and post-dilation and\nguide wire passage, when performed)\n$1,968.75\n3259\n43231\n43231\nEsophagoscopy, flexible, transoral; with endoscopic ultrasound\nexamination\n$ 762.30\n3260\n43232\n43232\nEsophagoscopy, flexible, transoral; with transendoscopic ultrasound-\nguided intramural or transmural fine needle aspiration\/biopsy(s)\n$ 782.57\n3261\n43235\n43235\nEsophagogastroduodenoscopy, flexible, transoral; diagnostic,\nincluding collection of specimen(s) by brushing or washing, when\nperformed (separate procedure)\n$ 575.48\n3262\n43236\n43236\nEsophagogastroduodenoscopy, flexible, transoral; with directed\nsubmucosal injection(s), any substance\n$ 833.87\n3263\n43237\n43237\nEsophagogastroduodenoscopy, flexible, transoral; with endoscopic\nultrasound examination limited to the esophagus, stomach or\nduodenum, and adjacent structures\n$ 605.29\n3264\n43238\n43238\nEsophagogastroduodenoscopy, flexible, transoral; with\ntransendoscopic ultrasound-guided intramural or transmural fine\nneedle aspiration\/biopsy(s), (includes endoscopic ultrasound\nexamination limited to the esophagus, stomach or duodenum, and\nadjacent stru\n$ 712.37\n3265\n43239\n43239\nEsophagogastroduodenoscopy, flexible, transoral; with biopsy,\nsingle or multiple\n$ 645.72\n3266\n43240\n43240\nEsophagogastroduodenoscopy, flexible, transoral; with transmural\ndrainage of pseudocyst (includes placement of transmural drainage\ncatheter[s]\/stent[s], when performed, and endoscopic ultrasound,\nwhen performed)\n$ 1,233.90\n3267\n43241\n43241\nEsophagogastroduodenoscopy, flexible, transoral; with insertion of\nintraluminal tube or catheter\n$ 972.00\n3268\n43242\n43242\nEsophagogastroduodenoscopy, flexible, transoral; with\ntransendoscopic ultrasound-guided intramural or transmural fine\nneedle aspiration\/biopsy(s) (includes endoscopic ultrasound\nexamination of the esophagus, stomach, and either the duodenum\nor a surgicall\n$ 968.40\n3269\n43243\n43243\nEsophagogastroduodenoscopy, flexible, transoral; with injection\nsclerosis of esophageal\/gastric varices\n$ 953.10\n3270\n43244\n43244\nEsophagogastroduodenoscopy, flexible, transoral; with band\nligation of esophageal\/gastric varices\n$ 978.30\n3271\n43245\n43245\nEsophagogastroduodenoscopy, flexible, transoral; with dilation of\ngastric\/duodenal stricture(s) (eg, balloon, bougie)\n$ 822.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3272\n43246\n43246\nEsophagogastroduodenoscopy, flexible, transoral; with directed\nplacement of percutaneous gastrostomy tube\n$ 1,133.10\n3273\n43247\n43247\nEsophagogastroduodenoscopy, flexible, transoral; with removal of\nforeign body\n$ 828.90\n3274\n43248\n43248\nEsophagogastroduodenoscopy, flexible, transoral; with insertion of\nguide wire followed by passage of dilator(s) through esophagus over\nguide wire\n$ 733.50\n3275\n43249\n43249\nEsophagogastroduodenoscopy, flexible, transoral; with\ntransendoscopic balloon dilation of esophagus (less than 30 mm\ndiameter)\n$ 747.00\n3276\n43250\n43250\nEsophagogastroduodenoscopy, flexible, transoral; with removal of\ntumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or\nbipolar cautery\n$ 972.00\n3277\n43251\n43251\nEsophagogastroduodenoscopy, flexible, transoral; with removal of\ntumor(s), polyp(s), or other lesion(s) by snare technique\n$ 953.10\n3278\n43255\n43255\nEsophagogastroduodenoscopy, flexible, transoral; with control of\nbleeding, any method\n$ 992.70\n3279\n43257\n43257\nEsophagogastroduodenoscopy, flexible, transoral; with delivery of\nthermal energy to the muscle of lower esophageal sphincter and\/or\ngastric cardia, for treatment of gastroesophageal reflux disease\n$ 1,070.28\n3280\n43259\n43259\nEsophagogastroduodenoscopy, flexible, transoral; with endoscopic\nultrasound examination, including the esophagus, stomach, and\neither the duodenum or a surgically altered stomach where the\njejunum is examined distal to the anastomosis\n$ 844.20\n3281\n43260\n43260\nEndoscopic retrograde cholangiopancreatography (ERCP);\ndiagnostic, including collection of specimen(s) by brushing or\nwashing, when performed (separate procedure)\n$ 1,159.20\n3282\n43261\n43261\nEndoscopic retrograde cholangiopancreatography (ERCP); with\nbiopsy, single or multiple\n$ 1,349.10\n3283\n43262\n43262\nEndoscopic retrograde cholangiopancreatography (ERCP); with\nsphincterotomy\/papillotomy\n$ 1,642.50\n3284\n43263\n43263\nEndoscopic retrograde cholangiopancreatography (ERCP); with\npressure measurement of sphincter of Oddi\n$ 1,542.60\n3285\n43264\n43264\nEndoscopic retrograde cholangiopancreatography (ERCP); with\nremoval of calculi\/debris from biliary\/pancreatic duct(s)\n$ 1,781.10\n3286\n43265\n43265\nEndoscopic retrograde cholangiopancreatography (ERCP); with\ndestruction of calculi, any method (eg, mechanical, electrohydraulic,\nlithotripsy)\n$ 1,833.30\n3287\n43266\n43266\nEsophagogastroduodenoscopy, flexible, transoral; with placement\nof endoscopic stent (includes pre- and post-dilation and guide wire\npassage, when performed)\n$2,371.40\n3288\n43270\n43270\nEsophagogastroduodenoscopy, flexible, transoral; with ablation of\ntumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation\nand guide wire passage, when performed)\n$1,013.05\n3289\n43273\n43273\nEndoscopic cannulation of papilla with direct visualization of\npancreatic\/common bile duct(s) (List separately in addition to\ncode(s) for primary procedure)\n$ 320.58\n3290\n43274\n43274\nEndoscopic retrograde cholangiopancreatography (ERCP); with\nplacement of endoscopic stent into biliary or pancreatic duct,\nincluding pre- and post-dilation and guide wire passage, when\nperformed, including sphincterotomy, when performed, each stent\n$ 1,933.69\n3291\n43275\n43275\nEndoscopic retrograde cholangiopancreatography (ERCP); with\nremoval of foreign body(s) or stent(s) from biliary\/pancreatic\nduct(s)\n$ 1,933.69\n3292\n43276\n43276\nEndoscopic retrograde cholangiopancreatography (ERCP); with\nremoval and exchange of stent(s), biliary or pancreatic duct,\nincluding pre- and post-dilation and guide wire passage, when\nperformed, including sphincterotomy, when performed, each stent\nexchang\n$ 1,933.69\n3293\n43277\n43277\nEndoscopic retrograde cholangiopancreatography (ERCP); with\ntrans-endoscopic balloon dilation of biliary\/pancreatic duct(s) or of\nampulla (sphincteroplasty), including sphincterotomy, when\nperformed, each duct\n$ 1,933.69\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3294\n43278\n43278\nEndoscopic retrograde cholangiopancreatography (ERCP); with\nablation of tumor(s), polyp(s), or other lesion(s), including pre- and\npost-dilation and guide wire passage, when performed\n$ 1,933.69\n3295\n43279\n43279\nLaparoscopy, surgical, esophagomyotomy (Heller type), with\nfundoplasty, when performed\n$ 2,872.69\n3296\n43280\n43280\nLaparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen,\nToupet procedures)\n$ 3,501.90\n3297\n43281\n43281\nLaparoscopy, surgical, repair of paraesophageal hernia, includes\nfundoplasty, when performed; without implantation of mesh\n$ 3,859.31\n3298\n43282\n43282\nLaparoscopy, surgical, repair of paraesophageal hernia, includes\nfundoplasty, when performed; with implantation of mesh\n$ 4,088.80\n3299\n43289\n43289\nUnlisted laparoscopy procedure, esophagus\nCost\n3300\n43300\n43300\nEsophagoplasty (plastic repair or reconstruction), cervical approach;\nwithout repair of tracheoesophageal fistula\n$ 3,110.40\n3301\n43305\n43305\nEsophagoplasty (plastic repair or reconstruction), cervical approach;\nwith repair of tracheoesophageal fistula\n$ 3,627.90\n3302\n43310\n43310\nEsophagoplasty (plastic repair or reconstruction), thoracic\napproach; without repair of tracheoesophageal fistula\n$ 4,030.20\n3303\n43312\n43312\nEsophagoplasty (plastic repair or reconstruction), thoracic\napproach; with repair of tracheoesophageal fistula\n$ 4,640.40\n3304\n43313\n43313\nEsophagoplasty for congenital defect (plastic repair or\nreconstruction), thoracic approach; without repair of congenital\ntracheoesophageal fistula\n$ 5,873.36\n3305\n43314\n43314\nEsophagoplasty for congenital defect (plastic repair or\nreconstruction), thoracic approach; with repair of congenital\ntracheoesophageal fistula\n$ 6,478.08\n3306\n43320\n43320\nEsophagogastrostomy (cardioplasty), with or without vagotomy and\npyloroplasty, transabdominal or transthoracic approach\n$ 3,590.10\n3307\n43325\n43325\nEsophagogastric fundoplasty; with fundic patch (Thal-Nissen\nprocedure)\n$ 3,429.90\n3308\n43330\n43330\nEsophagomyotomy (Heller type); abdominal approach\n$ 2,917.80\n3309\n43331\n43331\nEsophagomyotomy (Heller type); thoracic approach\n$ 3,198.60\n3310\n43332\n43332\nRepair, paraesophageal hiatal hernia (including fundoplication), via\nlaparotomy, except neonatal; without implantation of mesh or\nother prosthesis\n$ 2,635.13\n3311\n43333\n43333\nRepair, paraesophageal hiatal hernia (including fundoplication), via\nlaparotomy, except neonatal; with implantation of mesh or other\nprosthesis\n$ 2,873.14\n3312\n43334\n43334\nRepair, paraesophageal hiatal hernia (including fundoplication), via\nthoracotomy, except neonatal; without implantation of mesh or\nother prosthesis\n$ 2,906.96\n3313\n43335\n43335\nRepair, paraesophageal hiatal hernia (including fundoplication), via\nthoracotomy, except neonatal; with implantation of mesh or other\nprosthesis\n$ 3,144.71\n3314\n43336\n43336\nRepair, paraesophageal hiatal hernia (including fundoplication), via\nthoracoabdominal incision, except neonatal; without implantation\nof mesh or other prosthesis\n$ 3,422.52\n3315\n43337\n43337\nRepair, paraesophageal hiatal hernia (including fundoplication), via\nthoracoabdominal incision, except neonatal; with implantation of\nmesh or other prosthesis\n$ 3,761.84\n3316\n43340\n43340\nEsophagojejunostomy (without total gastrectomy); abdominal\napproach\n$ 3,551.40\n3317\n43350\n43350\nEsophagostomy, fistulization of esophagus, external; abdominal\napproach\n$ 2,381.40\n3318\n43351\n43351\nEsophagostomy, fistulization of esophagus, external; thoracic\napproach\n$ 2,477.70\n3319\n43352\n43352\nEsophagostomy, fistulization of esophagus, external; cervical\napproach\n$ 2,368.80\n3320\n43360\n43360\nGastrointestinal reconstruction for previous esophagectomy, for\nobstructing esophageal lesion or fistula, or for previous esophageal\nexclusion; with stomach, with or without pyloroplasty\n$ 5,664.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3321\n43361\n43361\nGastrointestinal reconstruction for previous esophagectomy, for\nobstructing esophageal lesion or fistula, or for previous esophageal\nexclusion; with colon interposition or small intestine reconstruction,\nincluding intestine mobilization, preparation, and\n$ 6,695.10\n3322\n43400\n43400\nLigation, direct, esophageal varices\n$ 3,172.50\n3323\n43401\n43401\nTransection of esophagus with repair, for esophageal varices\n$ 3,348.00\n3324\n43405\n43405\nLigation or stapling at gastroesophageal junction for pre-existing\nesophageal perforation\n$ 3,349.80\n3325\n43410\n43410\nSuture of esophageal wound or injury; cervical approach\n$ 2,574.90\n3326\n43415\n43415\nSuture of esophageal wound or injury; transthoracic or\ntransabdominal approach\n$ 3,114.00\n3327\n43420\n43420\nClosure of esophagostomy or fistula; cervical approach\n$ 1,954.80\n3328\n43425\n43425\nClosure of esophagostomy or fistula; transthoracic or\ntransabdominal approach\n$ 3,115.80\n3329\n43450\n43450\nDilation of esophagus, by unguided sound or bougie, single or\nmultiple passes\n$ 285.30\n3330\n43453\n43453\nDilation of esophagus, over guide wire\n$ 414.90\n3331\n43460\n43460\nEsophagogastric tamponade, with balloon (Sengstaken type)\n$ 697.50\n3332\n43496\n43496\nFree jejunum transfer with microvascular anastomosis\n$ -\n3333\n43499\n43499\nUnlisted procedure, esophagus\nCost\n3334\n43500\n43500\nGastrotomy; with exploration or foreign body removal\n$ 1,981.80\n3335\n43501\n43501\nGastrotomy; with suture repair of bleeding ulcer\n$ 2,765.70\n3336\n43502\n43502\nGastrotomy; with suture repair of pre-existing esophagogastric\nlaceration (eg, Mallory-Weiss)\n$ 2,601.00\n3337\n43510\n43510\nGastrotomy; with esophageal dilation and insertion of permanent\nintraluminal tube (eg, Celestin or Mousseaux-Barbin)\n$ 2,067.30\n3338\n43520\n43520\nPyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type\noperation)\n$ 1,850.40\n3339\n43605\n43605\nBiopsy of stomach, by laparotomy\n$ 1,977.30\n3340\n43610\n43610\nExcision, local; ulcer or benign tumor of stomach\n$ 2,572.20\n3341\n43611\n43611\nExcision, local; malignant tumor of stomach\n$ 2,837.70\n3342\n43620\n43620\nGastrectomy, total; with esophagoenterostomy\n$ 4,644.90\n3343\n43621\n43621\nGastrectomy, total; with Roux-en-Y reconstruction\n$ 4,995.90\n3344\n43622\n43622\nGastrectomy, total; with formation of intestinal pouch, any type\n$ 5,047.20\n3345\n43631\n43631\nGastrectomy, partial, distal; with gastroduodenostomy\n$ 3,541.50\n3346\n43632\n43632\nGastrectomy, partial, distal; with gastrojejunostomy\n$ 3,864.60\n3347\n43633\n43633\nGastrectomy, partial, distal; with Roux-en-Y reconstruction\n$ 3,953.70\n3348\n43634\n43634\nGastrectomy, partial, distal; with formation of intestinal pouch\n$ 4,851.90\n3349\n43635\n43635\nVagotomy when performed with partial distal gastrectomy (List\nseparately in addition to code[s] for primary procedure)\n$ 1,287.90\n3350\n43640\n43640\nVagotomy including pyloroplasty, with or without gastrostomy;\ntruncal or selective\n$ 3,064.50\n3351\n43641\n43641\nVagotomy including pyloroplasty, with or without gastrostomy;\nparietal cell (highly selective)\n$ 2,904.30\n3352\n43644\n43644\nLaparoscopy, surgical, gastric restrictive procedure; with gastric\nbypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)\n$ 5,644.84\n3353\n43645\n43645\nLaparoscopy, surgical, gastric restrictive procedure; with gastric\nbypass and small intestine reconstruction to limit absorption\n$ 6,078.45\n3354\n43647\n43647\nLaparoscopy, surgical; implantation or replacement of gastric\nneurostimulator electrodes, antrum\n$ -\n3355\n43648\n43648\nLaparoscopy, surgical; revision or removal of gastric\nneurostimulator electrodes, antrum\n$ -\n3356\n43651\n43651\nLaparoscopy, surgical; transection of vagus nerves, truncal\n$ 2,584.61\n3357\n43652\n43652\nLaparoscopy, surgical; transection of vagus nerves, selective or\nhighly selective\n$ 2,984.62\n3358\n43653\n43653\nLaparoscopy, surgical; gastrostomy, without construction of gastric\ntube (eg, Stamm procedure) (separate procedure)\n$ 1,909.82\n3359\n43659\n43659\nUnlisted laparoscopy procedure, stomach\nCost\n3360\n43752\n43752\nNaso- or oro-gastric tube placement, requiring physician's skill and\nfluoroscopic guidance (includes fluoroscopy, image documentation\nand report)\n$ 87.45\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3361\n43753\n43753\nGastric intubation and aspiration(s) therapeutic, necessitating\nphysician's skill (eg, for gastrointestinal hemorrhage), including\nlavage if performed\n$ 51.44\n3362\n43754\n43754\nGastric intubation and aspiration, diagnostic; single specimen (eg,\nacid analysis)\n$ 92.15\n3363\n43755\n43755\nGastric intubation and aspiration, diagnostic; collection of multiple\nfractional specimens with gastric stimulation, single or double\nlumen tube (gastric secretory study) (eg, histamine, insulin,\npentagastrin, calcium, secretin), includes drug administrat\n$ 216.19\n3364\n43760\n43760\nChange of gastrostomy tube, percutaneous, without imaging or\nendoscopic guidance\n$ 192.60\n3365\n43761\n43761\nRepositioning of a naso- or oro-gastric feeding tube, through the\nduodenum for enteric nutrition\n$ 320.40\n3366\n43770\n43770\nLaparoscopy, surgical, gastric restrictive procedure; placement of\nadjustable gastric restrictive device (eg, gastric band and\nsubcutaneous port components)\n$ 3,192.15\n3367\n43771\n43771\nLaparoscopy, surgical, gastric restrictive procedure; revision of\nadjustable gastric restrictive device component only\n$ 2,947.87\n3368\n43772\n43772\nLaparoscopy, surgical, gastric restrictive procedure; removal of\nadjustable gastric restrictive device component only\n$ 2,562.77\n3369\n43773\n43773\nLaparoscopy, surgical, gastric restrictive procedure; removal and\nreplacement of adjustable gastric restrictive device component only\n$ 3,259.75\n3370\n43774\n43774\nLaparoscopy, surgical, gastric restrictive procedure; removal of\nadjustable gastric restrictive device and subcutaneous port\ncomponents\n$ 2,594.55\n3371\n43775\n43775\nLaparoscopy, surgical, gastric restrictive procedure; longitudinal\ngastrectomy (ie, sleeve gastrectomy)\n$ 3,427.22\n3372\n43800\n43800\nPyloroplasty\n$ 2,172.60\n3373\n43810\n43810\nGastroduodenostomy\n$ 2,296.80\n3374\n43820\n43820\nGastrojejunostomy; without vagotomy\n$ 2,688.30\n3375\n43825\n43825\nGastrojejunostomy; with vagotomy, any type\n$ 3,096.00\n3376\n43830\n43830\nGastrostomy, open; without construction of gastric tube (eg, Stamm\nprocedure) (separate procedure)\n$ 1,784.70\n3377\n43831\n43831\nGastrostomy, open; neonatal, for feeding\n$ 1,642.50\n3378\n43832\n43832\nGastrostomy, open; with construction of gastric tube (eg, Janeway\nprocedure)\n$ 2,553.30\n3379\n43840\n43840\nGastrorrhaphy, suture of perforated duodenal or gastric ulcer,\nwound, or injury\n$ 2,344.50\n3380\n43842\n43842\nGastric restrictive procedure, without gastric bypass, for morbid\nobesity; vertical-banded gastroplasty\n$ 3,656.70\n3381\n43843\n43843\nGastric restrictive procedure, without gastric bypass, for morbid\nobesity; other than vertical-banded gastroplasty\n$ 3,605.40\n3382\n43845\n43845\nGastric restrictive procedure with partial gastrectomy, pylorus-\npreserving duodenoileostomy and ileoileostomy (50 to 100 cm\ncommon channel) to limit absorption (biliopancreatic diversion with\nduodenal switch)\n$ 5,446.89\n3383\n43846\n43846\nGastric restrictive procedure, with gastric bypass for morbid\nobesity; with short limb (150 cm or less) Roux-en-Y\ngastroenterostomy\n$ 4,532.40\n3384\n43847\n43847\nGastric restrictive procedure, with gastric bypass for morbid\nobesity; with small intestine reconstruction to limit absorption\n$ 5,096.43\n3385\n43848\n43848\nRevision, open, of gastric restrictive procedure for morbid obesity,\nother than adjustable gastric restrictive device (separate procedure) $ 5,284.93\n3386\n43850\n43850\nRevision of gastroduodenal anastomosis (gastroduodenostomy)\nwith reconstruction; without vagotomy\n$ 4,078.80\n3387\n43855\n43855\nRevision of gastroduodenal anastomosis (gastroduodenostomy)\nwith reconstruction; with vagotomy\n$ 4,171.50\n3388\n43860\n43860\nRevision of gastrojejunal anastomosis (gastrojejunostomy) with\nreconstruction, with or without partial gastrectomy or intestine\nresection; without vagotomy\n$ 4,131.90\n3389\n43865\n43865\nRevision of gastrojejunal anastomosis (gastrojejunostomy) with\nreconstruction, with or without partial gastrectomy or intestine\nresection; with vagotomy\n$ 3,879.90\n3390\n43870\n43870\nClosure of gastrostomy, surgical\n$ 1,687.50\n3391\n43880\n43880\nClosure of gastrocolic fistula\n$ 3,295.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3392\n43881\n43881\nImplantation or replacement of gastric neurostimulator electrodes,\nantrum, open\n$ -\n3393\n43882\n43882\nRevision or removal of gastric neurostimulator electrodes, antrum,\nopen\n$ -\n3394\n43886\n43886\nGastric restrictive procedure, open; revision of subcutaneous port\ncomponent only\n$ 925.03\n3395\n43887\n43887\nGastric restrictive procedure, open; removal of subcutaneous port\ncomponent only\n$ 886.07\n3396\n43888\n43888\nGastric restrictive procedure, open; removal and replacement of\nsubcutaneous port component only\n$ 1,353.63\n3397\n43999\n43999\nUnlisted procedure, stomach\nCost\n3398\n44005\n44005\nEnterolysis (freeing of intestinal adhesion) (separate procedure)\n$ 2,305.69\n3399\n44010\n44010\nDuodenotomy, for exploration, biopsy(s), or foreign body removal\n$ 2,306.70\n3400\n44015\n44015\nTube or needle catheter jejunostomy for enteral alimentation,\nintraoperative, any method (List separately in addition to primary\nprocedure)\n$ 1,448.10\n3401\n44020\n44020\nEnterotomy, small intestine, other than duodenum; for exploration,\nbiopsy(s), or foreign body removal\n$ 2,232.00\n3402\n44021\n44021\nEnterotomy, small intestine, other than duodenum; for\ndecompression (eg, Baker tube)\n$ 2,319.30\n3403\n44025\n44025\nColotomy, for exploration, biopsy(s), or foreign body removal\n$ 2,389.50\n3404\n44050\n44050\nReduction of volvulus, intussusception, internal hernia, by\nlaparotomy\n$ 2,321.10\n3405\n44055\n44055\nCorrection of malrotation by lysis of duodenal bands and\/or\nreduction of midgut volvulus (eg, Ladd procedure)\n$ 2,601.00\n3406\n44100\n44100\nBiopsy of intestine by capsule, tube, peroral (1 or more specimens)\n$ 485.10\n3407\n44110\n44110\nExcision of 1 or more lesions of small or large intestine not requiring\nanastomosis, exteriorization, or fistulization; single enterotomy\n$ 2,351.70\n3408\n44111\n44111\nExcision of 1 or more lesions of small or large intestine not requiring\nanastomosis, exteriorization, or fistulization; multiple enterotomies\n$ 3,157.20\n3409\n44120\n44120\nEnterectomy, resection of small intestine; single resection and\nanastomosis\n$ 2,880.00\n3410\n44121\n44121\nEnterectomy, resection of small intestine; each additional resection\nand anastomosis (List separately in addition to code for primary\nprocedure)\n$ 918.90\n3411\n44125\n44125\nEnterectomy, resection of small intestine; with enterostomy\n$ 3,114.00\n3412\n44126\n44126\nEnterectomy, resection of small intestine for congenital atresia,\nsingle resection and anastomosis of proximal segment of intestine;\nwithout tapering\n$ 5,370.66\n3413\n44127\n44127\nEnterectomy, resection of small intestine for congenital atresia,\nsingle resection and anastomosis of proximal segment of intestine;\nwith tapering\n$ 5,598.46\n3414\n44128\n44128\nEnterectomy, resection of small intestine for congenital atresia,\nsingle resection and anastomosis of proximal segment of intestine;\neach additional resection and anastomosis (List separately in\naddition to code for primary procedure)\n$ 1,016.67\n3415\n44130\n44130\nEnteroenterostomy, anastomosis of intestine, with or without\ncutaneous enterostomy (separate procedure)\n$ 2,694.60\n3416\n44132\n44132\nDonor enterectomy (including cold preservation), open; from\ncadaver donor\n$ -\n3417\n44133\n44133\nDonor enterectomy (including cold preservation), open; partial,\nfrom living donor\n$ -\n3418\n44136\n44136\nIntestinal allotransplantation; from living donor\n$ -\n3419\n44137\n44137\nRemoval of transplanted intestinal allograft, complete\n$ -\n3420\n44139\n44139\nMobilization (take-down) of splenic flexure performed in\nconjunction with partial colectomy (List separately in addition to\nprimary procedure)\n$ 514.80\n3421\n44140\n44140\nColectomy, partial; with anastomosis\n$ 3,340.80\n3422\n44141\n44141\nColectomy, partial; with skin level cecostomy or colostomy\n$ 3,333.65\n3423\n44143\n44143\nColectomy, partial; with end colostomy and closure of distal\nsegment (Hartmann type procedure)\n$ 3,331.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3424\n44144\n44144\nColectomy, partial; with resection, with colostomy or ileostomy and\ncreation of mucofistula\n$ 3,348.00\n3425\n44145\n44145\nColectomy, partial; with coloproctostomy (low pelvic anastomosis)\n$ 3,887.10\n3426\n44146\n44146\nColectomy, partial; with coloproctostomy (low pelvic anastomosis),\nwith colostomy\n$ 4,293.90\n3427\n44147\n44147\nColectomy, partial; abdominal and transanal approach\n$ 4,626.90\n3428\n44150\n44150\nColectomy, total, abdominal, without proctectomy; with ileostomy\nor ileoproctostomy\n$ 4,718.70\n3429\n44151\n44151\nColectomy, total, abdominal, without proctectomy; with continent\nileostomy\n$ 5,408.10\n3430\n44155\n44155\nColectomy, total, abdominal, with proctectomy; with ileostomy\n$ 5,751.90\n3431\n44156\n44156\nColectomy, total, abdominal, with proctectomy; with continent\nileostomy\n$ 5,768.10\n3432\n44157\n44157\nColectomy, total, abdominal, with proctectomy; with ileoanal\nanastomosis, includes loop ileostomy, and rectal mucosectomy,\nwhen performed\n$ 4,865.79\n3433\n44158\n44158\nColectomy, total, abdominal, with proctectomy; with ileoanal\nanastomosis, creation of ileal reservoir (S or J), includes loop\nileostomy, and rectal mucosectomy, when performed\n$ 5,014.80\n3434\n44160\n44160\nColectomy, partial, with removal of terminal ileum with\nileocolostomy\n$ 4,014.90\n3435\n44180\n44180\nLaparoscopy, surgical, enterolysis (freeing of intestinal adhesion)\n(separate procedure)\n$ 1,859.50\n3436\n44186\n44186\nLaparoscopy, surgical; jejunostomy (eg, for decompression or\nfeeding)\n$ 1,441.07\n3437\n44187\n44187\nLaparoscopy, surgical; ileostomy or jejunostomy, non-tube\n$ 2,229.44\n3438\n44188\n44188\nLaparoscopy, surgical, colostomy or skin level cecostomy\n$ 2,477.27\n3439\n44202\n44202\nLaparoscopy, surgical; enterectomy, resection of small intestine,\nsingle resection and anastomosis\n$ 4,013.10\n3440\n44203\n44203\nLaparoscopy, surgical; each additional small intestine resection and\nanastomosis (List separately in addition to code for primary\nprocedure)\n$ 742.32\n3441\n44204\n44204\nLaparoscopy, surgical; colectomy, partial, with anastomosis\n$ 3,237.04\n3442\n44205\n44205\nLaparoscopy, surgical; colectomy, partial, with removal of terminal\nileum with ileocolostomy\n$ 3,053.39\n3443\n44206\n44206\nLaparoscopy, surgical; colectomy, partial, with end colostomy and\nclosure of distal segment (Hartmann type procedure)\n$ 3,562.31\n3444\n44207\n44207\nLaparoscopy, surgical; colectomy, partial, with anastomosis, with\ncoloproctostomy (low pelvic anastomosis)\n$ 3,989.43\n3445\n44208\n44208\nLaparoscopy, surgical; colectomy, partial, with anastomosis, with\ncoloproctostomy (low pelvic anastomosis) with colostomy\n$ 4,162.98\n3446\n44210\n44210\nLaparoscopy, surgical; colectomy, total, abdominal, without\nproctectomy, with ileostomy or ileoproctostomy\n$ 3,925.87\n3447\n44211\n44211\nLaparoscopy, surgical; colectomy, total, abdominal, with\nproctectomy, with ileoanal anastomosis, creation of ileal reservoir\n(S or J), with loop ileostomy, includes rectal mucosectomy, when\nperformed\n$ 5,320.26\n3448\n44212\n44212\nLaparoscopy, surgical; colectomy, total, abdominal, with\nproctectomy, with ileostomy\n$ 4,588.99\n3449\n44213\n44213\nLaparoscopy, surgical, mobilization (take-down) of splenic flexure\nperformed in conjunction with partial colectomy (List separately in\naddition to primary procedure)\n$ 455.45\n3450\n44227\n44227\nLaparoscopy, surgical, closure of enterostomy, large or small\nintestine, with resection and anastomosis\n$ 3,432.69\n3451\n44238\n44238\nUnlisted laparoscopy procedure, intestine (except rectum)\n$ -\n3452\n44300\n44300\nPlacement, enterostomy or cecostomy, tube open (eg, for feeding\nor decompression) (separate procedure)\n$ 2,121.30\n3453\n44310\n44310\nIleostomy or jejunostomy, non-tube\n$ 2,271.60\n3454\n44312\n44312\nRevision of ileostomy; simple (release of superficial scar) (separate\nprocedure)\n$ 1,269.00\n3455\n44314\n44314\nRevision of ileostomy; complicated (reconstruction in-depth)\n(separate procedure)\n$ 2,343.60\n3456\n44316\n44316\nContinent ileostomy (Kock procedure) (separate procedure)\n$ 3,295.80\n3457\n44320\n44320\nColostomy or skin level cecostomy;\n$ 2,201.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3458\n44322\n44322\nColostomy or skin level cecostomy; with multiple biopsies (eg, for\ncongenital megacolon) (separate procedure)\n$ 2,568.60\n3459\n44340\n44340\nRevision of colostomy; simple (release of superficial scar) (separate\nprocedure)\n$ 918.00\n3460\n44345\n44345\nRevision of colostomy; complicated (reconstruction in-depth)\n(separate procedure)\n$ 2,093.40\n3461\n44346\n44346\nRevision of colostomy; with repair of paracolostomy hernia\n(separate procedure)\n$ 2,365.20\n3462\n44360\n44360\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; diagnostic, with or without\ncollection of specimen(s) by brushing or washing (separate\nprocedure)\n$ 864.90\n3463\n44361\n44361\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with biopsy, single or multiple\n$ 863.10\n3464\n44363\n44363\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with removal of foreign body\n$ 804.60\n3465\n44364\n44364\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with removal of tumor(s), polyp(s),\nor other lesion(s) by snare technique\n$ 978.30\n3466\n44365\n44365\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with removal of tumor(s), polyp(s),\nor other lesion(s) by hot biopsy forceps or bipolar cautery\n$ 978.30\n3467\n44366\n44366\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with control of bleeding (eg,\ninjection, bipolar cautery, unipolar cautery, laser, heater probe,\nstapler, plasma coagulator)\n$ 1,076.40\n3468\n44369\n44369\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with ablation of tumor(s), polyp(s),\nor other lesion(s) not amenable to removal by hot biopsy forceps,\nbipolar cautery or snare technique\n$ 1,133.10\n3469\n44370\n44370\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with transendoscopic stent\nplacement (includes predilation)\n$ 760.50\n3470\n44372\n44372\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with placement of percutaneous\njejunostomy tube\n$ 1,199.70\n3471\n44373\n44373\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, not including ileum; with conversion of percutaneous\ngastrostomy tube to percutaneous jejunostomy tube\n$ 904.50\n3472\n44376\n44376\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, including ileum; diagnostic, with or without collection of\nspecimen(s) by brushing or washing (separate procedure)\n$ 1,007.10\n3473\n44377\n44377\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, including ileum; with biopsy, single or multiple\n$ 1,061.10\n3474\n44378\n44378\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, including ileum; with control of bleeding (eg, injection,\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\nplasma coagulator)\n$ 1,359.90\n3475\n44379\n44379\nSmall intestinal endoscopy, enteroscopy beyond second portion of\nduodenum, including ileum; with transendoscopic stent placement\n(includes predilation)\n$ 1,137.60\n3476\n44380\n44380\nIleoscopy, through stoma; diagnostic, with or without collection of\nspecimen(s) by brushing or washing (separate procedure)\n$ 546.30\n3477\n44382\n44382\nIleoscopy, through stoma; with biopsy, single or multiple\n$ 681.30\n3478\n44383\n44383\nIleoscopy, through stoma; with transendoscopic stent placement\n(includes predilation)\n$ 917.99\n3479\n44385\n44385\nEndoscopic evaluation of small intestinal (abdominal or pelvic)\npouch; diagnostic, with or without collection of specimen(s) by\nbrushing or washing (separate procedure)\n$ 715.50\n3480\n44386\n44386\nEndoscopic evaluation of small intestinal (abdominal or pelvic)\npouch; with biopsy, single or multiple\n$ 741.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3481\n44388\n44388\nColonoscopy through stoma; diagnostic, with or without collection\nof specimen(s) by brushing or washing (separate procedure)\n$ 739.80\n3482\n44389\n44389\nColonoscopy through stoma; with biopsy, single or multiple\n$ 796.50\n3483\n44390\n44390\nColonoscopy through stoma; with removal of foreign body\n$ 841.50\n3484\n44391\n44391\nColonoscopy through stoma; with control of bleeding (eg, injection,\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\nplasma coagulator)\n$ 1,166.40\n3485\n44392\n44392\nColonoscopy through stoma; with removal of tumor(s), polyp(s), or\nother lesion(s) by hot biopsy forceps or bipolar cautery\n$ 1,255.50\n3486\n44393\n44393\nColonoscopy through stoma; with ablation of tumor(s), polyp(s), or\nother lesion(s) not amenable to removal by hot biopsy forceps,\nbipolar cautery or snare technique\n$ 1,321.20\n3487\n44394\n44394\nColonoscopy through stoma; with removal of tumor(s), polyp(s), or\nother lesion(s) by snare technique\n$ 1,102.50\n3488\n44397\n44397\nColonoscopy through stoma; with transendoscopic stent placement\n(includes predilation)\n$ 596.70\n3489\n44500\n44500\nIntroduction of long gastrointestinal tube (eg, Miller-Abbott)\n(separate procedure)\n$ 123.30\n3490\n44602\n44602\nSuture of small intestine (enterorrhaphy) for perforated ulcer,\ndiverticulum, wound, injury or rupture; single perforation\n$ 2,248.20\n3491\n44603\n44603\nSuture of small intestine (enterorrhaphy) for perforated ulcer,\ndiverticulum, wound, injury or rupture; multiple perforations\n$ 2,656.80\n3492\n44604\n44604\nSuture of large intestine (colorrhaphy) for perforated ulcer,\ndiverticulum, wound, injury or rupture (single or multiple\nperforations); without colostomy\n$ 2,258.45\n3493\n44605\n44605\nSuture of large intestine (colorrhaphy) for perforated ulcer,\ndiverticulum, wound, injury or rupture (single or multiple\nperforations); with colostomy\n$ 2,991.60\n3494\n44615\n44615\nIntestinal stricturoplasty (enterotomy and enterorrhaphy) with or\nwithout dilation, for intestinal obstruction\n$ 2,626.20\n3495\n44620\n44620\nClosure of enterostomy, large or small intestine;\n$ 1,713.65\n3496\n44625\n44625\nClosure of enterostomy, large or small intestine; with resection and\nanastomosis other than colorectal\n$ 3,033.90\n3497\n44626\n44626\nClosure of enterostomy, large or small intestine; with resection and\ncolorectal anastomosis (eg, closure of Hartmann type procedure)\n$ 3,744.90\n3498\n44640\n44640\nClosure of intestinal cutaneous fistula\n$ 2,372.40\n3499\n44650\n44650\nClosure of enteroenteric or enterocolic fistula\n$ 3,090.60\n3500\n44660\n44660\nClosure of enterovesical fistula; without intestinal or bladder\nresection\n$ 2,729.70\n3501\n44661\n44661\nClosure of enterovesical fistula; with intestine and\/or bladder\nresection\n$ 3,927.60\n3502\n44680\n44680\nIntestinal plication (separate procedure)\n$ 2,871.90\n3503\n44700\n44700\nExclusion of small intestine from pelvis by mesh or other prosthesis,\nor native tissue (eg, bladder or omentum)\n$ 2,709.90\n3504\n44701\n44701\nIntraoperative colonic lavage (List separately in addition to code for\nprimary procedure)\n$ 305.32\n3505\n44715\n44715\nBackbench standard preparation of cadaver or living donor intestine\nallograft prior to transplantation, including mobilization and\nfashioning of the superior mesenteric artery and vein\n$ -\n3506\n44720\n44720\nBackbench reconstruction of cadaver or living donor intestine\nallograft prior to transplantation; venous anastomosis, each\n$ 581.85\n3507\n44721\n44721\nBackbench reconstruction of cadaver or living donor intestine\nallograft prior to transplantation; arterial anastomosis, each\n$ 929.76\n3508\n44799\n44799\nUnlisted procedure, intestine\nCost\n3509\n44800\n44800\nExcision of Meckel's diverticulum (diverticulectomy) or\nomphalomesenteric duct\n$ 1,913.40\n3510\n44820\n44820\nExcision of lesion of mesentery (separate procedure)\n$ 2,034.00\n3511\n44850\n44850\nSuture of mesentery (separate procedure)\n$ 1,802.70\n3512\n44899\n44899\nUnlisted procedure, Meckel's diverticulum and the mesentery\nCost\n3513\n44900\n44900\nIncision and drainage of appendiceal abscess, open\n$ 1,545.30\n3514\n44950\n44950\nAppendectomy;\n$ 1,537.19\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3515\n44955\n44955\nAppendectomy; when done for indicated purpose at time of other\nmajor procedure (not as separate procedure) (List separately in\naddition to code for primary procedure)\n$ 1,133.10\n3516\n44960\n44960\nAppendectomy; for ruptured appendix with abscess or generalized\nperitonitis\n$ 2,357.10\n3517\n44970\n44970\nLaparoscopy, surgical, appendectomy\n$ 2,130.30\n3518\n44979\n44979\nUnlisted laparoscopy procedure, appendix\nCost\n3519\n45000\n45000\nTransrectal drainage of pelvic abscess\n$ 953.10\n3520\n45005\n45005\nIncision and drainage of submucosal abscess, rectum\n$ 522.90\n3521\n45020\n45020\nIncision and drainage of deep supralevator, pelvirectal, or\nretrorectal abscess\n$ 893.70\n3522\n45100\n45100\nBiopsy of anorectal wall, anal approach (eg, congenital megacolon)\n$ 767.70\n3523\n45108\n45108\nAnorectal myomectomy\n$ 1,184.40\n3524\n45110\n45110\nProctectomy; complete, combined abdominoperineal, with\ncolostomy\n$ 4,392.90\n3525\n45111\n45111\nProctectomy; partial resection of rectum, transabdominal approach\n$ 3,498.30\n3526\n45112\n45112\nProctectomy, combined abdominoperineal, pull-through procedure\n(eg, colo-anal anastomosis)\n$ 4,645.80\n3527\n45113\n45113\nProctectomy, partial, with rectal mucosectomy, ileoanal\nanastomosis, creation of ileal reservoir (S or J), with or without loop\nileostomy\n$ 4,837.19\n3528\n45114\n45114\nProctectomy, partial, with anastomosis; abdominal and transsacral\napproach\n$ 4,489.20\n3529\n45116\n45116\nProctectomy, partial, with anastomosis; transsacral approach only\n(Kraske type)\n$ 3,295.80\n3530\n45119\n45119\nProctectomy, combined abdominoperineal pull-through procedure\n(eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-\npouch), with diverting enterostomy when performed\n$ 4,377.60\n3531\n45120\n45120\nProctectomy, complete (for congenital megacolon), abdominal and\nperineal approach; with pull-through procedure and anastomosis\n(eg, Swenson, Duhamel, or Soave type operation)\n$ 4,650.30\n3532\n45121\n45121\nProctectomy, complete (for congenital megacolon), abdominal and\nperineal approach; with subtotal or total colectomy, with multiple\nbiopsies\n$ 4,738.50\n3533\n45123\n45123\nProctectomy, partial, without anastomosis, perineal approach\n$ 3,149.10\n3534\n45126\n45126\nPelvic exenteration for colorectal malignancy, with proctectomy\n(with or without colostomy), with removal of bladder and ureteral\ntransplantations, and\/or hysterectomy, or cervicectomy, with or\nwithout removal of tube(s), with or without removal of ovary(\n$ 6,470.10\n3535\n45130\n45130\nExcision of rectal procidentia, with anastomosis; perineal approach\n$ 2,864.70\n3536\n45135\n45135\nExcision of rectal procidentia, with anastomosis; abdominal and\nperineal approach\n$ 4,033.80\n3537\n45136\n45136\nExcision of ileoanal reservoir with ileostomy\n$ 4,548.02\n3538\n45150\n45150\nDivision of stricture of rectum\n$ 1,278.00\n3539\n45160\n45160\nExcision of rectal tumor by proctotomy, transsacral or\ntranscoccygeal approach\n$ 2,827.80\n3540\n45171\n45171\nExcision of rectal tumor, transanal approach; not including\nmuscularis propria (ie, partial thickness)\n$ 1,349.29\n3541\n45172\n45172\nExcision of rectal tumor, transanal approach; including muscularis\npropria (ie, full thickness)\n$ 1,853.35\n3542\n45190\n45190\nDestruction of rectal tumor (eg, electrodesiccation, electrosurgery,\nlaser ablation, laser resection, cryosurgery) transanal approach\n$ 1,441.80\n3543\n45300\n45300\nProctosigmoidoscopy, rigid; diagnostic, with or without collection of\nspecimen(s) by brushing or washing (separate procedure)\n$ 142.39\n3544\n45303\n45303\nProctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire,\nbougie)\n$ 220.50\n3545\n45305\n45305\nProctosigmoidoscopy, rigid; with biopsy, single or multiple\n$ 257.40\n3546\n45307\n45307\nProctosigmoidoscopy, rigid; with removal of foreign body\n$ 386.10\n3547\n45308\n45308\nProctosigmoidoscopy, rigid; with removal of single tumor, polyp, or\nother lesion by hot biopsy forceps or bipolar cautery\n$ 417.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3548\n45309\n45309\nProctosigmoidoscopy, rigid; with removal of single tumor, polyp, or\nother lesion by snare technique\n$ 430.20\n3549\n45315\n45315\nProctosigmoidoscopy, rigid; with removal of multiple tumors,\npolyps, or other lesions by hot biopsy forceps, bipolar cautery or\nsnare technique\n$ 582.30\n3550\n45317\n45317\nProctosigmoidoscopy, rigid; with control of bleeding (eg, injection,\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\nplasma coagulator)\n$ 585.00\n3551\n45320\n45320\nProctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or\nother lesion(s) not amenable to removal by hot biopsy forceps,\nbipolar cautery or snare technique (eg, laser)\n$ 639.00\n3552\n45321\n45321\nProctosigmoidoscopy, rigid; with decompression of volvulus\n$ 534.60\n3553\n45327\n45327\nProctosigmoidoscopy, rigid; with transendoscopic stent placement\n(includes predilation)\n$ 219.12\n3554\n45330\n45330\nSigmoidoscopy, flexible; diagnostic, with or without collection of\nspecimen(s) by brushing or washing (separate procedure)\n$ 253.73\n3555\n45331\n45331\nSigmoidoscopy, flexible; with biopsy, single or multiple\n$ 339.86\n3556\n45332\n45332\nSigmoidoscopy, flexible; with removal of foreign body\n$ 449.10\n3557\n45333\n45333\nSigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other\nlesion(s) by hot biopsy forceps or bipolar cautery\n$ 558.90\n3558\n45334\n45334\nSigmoidoscopy, flexible; with control of bleeding (eg, injection,\nbipolar cautery, unipolar cautery, laser, heater probe, stapler,\nplasma coagulator)\n$ 570.60\n3559\n45335\n45335\nSigmoidoscopy, flexible; with directed submucosal injection(s), any\nsubstance\n$ 714.94\n3560\n45337\n45337\nSigmoidoscopy, flexible; with decompression of volvulus, any\nmethod\n$ 772.20\n3561\n45338\n45338\nSigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other\nlesion(s) by snare technique\n$ 605.70\n3562\n45339\n45339\nSigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other\nlesion(s) not amenable to removal by hot biopsy forceps, bipolar\ncautery or snare technique\n$ 604.80\n3563\n45340\n45340\nSigmoidoscopy, flexible; with dilation by balloon, 1 or more\nstrictures\n$ 400.18\n3564\n45341\n45341\nSigmoidoscopy, flexible; with endoscopic ultrasound examination\n$ 607.50\n3565\n45342\n45342\nSigmoidoscopy, flexible; with transendoscopic ultrasound guided\nintramural or transmural fine needle aspiration\/biopsy(s)\n$ 700.20\n3566\n45345\n45345\nSigmoidoscopy, flexible; with transendoscopic stent placement\n(includes predilation)\n$ 468.90\n3567\n45355\n45355\nColonoscopy, rigid or flexible, transabdominal via colotomy, single\nor multiple\n$ 785.70\n3568\n45378\n45378\nColonoscopy, flexible, proximal to splenic flexure; diagnostic, with\nor without collection of specimen(s) by brushing or washing, with or\nwithout colon decompression (separate procedure)\n$ 858.15\n3569\n45378-53 53\n45378\nColonoscopy, flexible, proximal to splenic flexure; diagnostic, with\nor without collection of specimen(s) by brushing or washing, with or\nwithout colon decompression (separate procedure)\n$ 304.71\n3570\n45379\n45379\nColonoscopy, flexible, proximal to splenic flexure; with removal of\nforeign body\n$ 1,099.80\n3571\n45380\n45380\nColonoscopy, flexible, proximal to splenic flexure; with biopsy,\nsingle or multiple\n$ 961.77\n3572\n45381\n45381\nColonoscopy, flexible, proximal to splenic flexure; with directed\nsubmucosal injection(s), any substance\n$ 975.00\n3573\n45382\n45382\nColonoscopy, flexible, proximal to splenic flexure; with control of\nbleeding (eg, injection, bipolar cautery, unipolar cautery, laser,\nheater probe, stapler, plasma coagulator)\n$ 1,107.00\n3574\n45383\n45383\nColonoscopy, flexible, proximal to splenic flexure; with ablation of\ntumor(s), polyp(s), or other lesion(s) not amenable to removal by\nhot biopsy forceps, bipolar cautery or snare technique\n$ 1,203.49\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3575\n45384\n45384\nColonoscopy, flexible, proximal to splenic flexure; with removal of\ntumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or\nbipolar cautery\n$ 1,162.09\n3576\n45385\n45385\nColonoscopy, flexible, proximal to splenic flexure; with removal of\ntumor(s), polyp(s), or other lesion(s) by snare technique\n$ 1,287.91\n3577\n45386\n45386\nColonoscopy, flexible, proximal to splenic flexure; with dilation by\nballoon, 1 or more strictures\n$ 958.72\n3578\n45387\n45387\nColonoscopy, flexible, proximal to splenic flexure; with\ntransendoscopic stent placement (includes predilation)\n$ 950.40\n3579\n45391\n45391\nColonoscopy, flexible, proximal to splenic flexure; with endoscopic\nultrasound examination\n$ 568.04\n3580\n45392\n45392\nColonoscopy, flexible, proximal to splenic flexure; with\ntransendoscopic ultrasound guided intramural or transmural fine\nneedle aspiration\/biopsy(s)\n$ 718.20\n3581\n45395\n45395\nLaparoscopy, surgical; proctectomy, complete, combined\nabdominoperineal, with colostomy\n$ 3,966.46\n3582\n45397\n45397\nLaparoscopy, surgical; proctectomy, combined abdominoperineal\npull-through procedure (eg, colo-anal anastomosis), with creation of\ncolonic reservoir (eg, J-pouch), with diverting enterostomy, when\nperformed\n$ 4,303.15\n3583\n45400\n45400\nLaparoscopy, surgical; proctopexy (for prolapse)\n$ 2,322.57\n3584\n45402\n45402\nLaparoscopy, surgical; proctopexy (for prolapse), with sigmoid\nresection\n$ 3,124.42\n3585\n45499\n45499\nUnlisted laparoscopy procedure, rectum\nCost\n3586\n45500\n45500\nProctoplasty; for stenosis\n$ 1,570.50\n3587\n45505\n45505\nProctoplasty; for prolapse of mucous membrane\n$ 1,647.90\n3588\n45520\n45520\nPerirectal injection of sclerosing solution for prolapse\n$ 144.00\n3589\n45540\n45540\nProctopexy (eg, for prolapse); abdominal approach\n$ 3,206.70\n3590\n45541\n45541\nProctopexy (eg, for prolapse); perineal approach\n$ 2,523.60\n3591\n45550\n45550\nProctopexy (eg, for prolapse); with sigmoid resection, abdominal\napproach\n$ 3,591.00\n3592\n45560\n45560\nRepair of rectocele (separate procedure)\n$ 1,494.00\n3593\n45562\n45562\nExploration, repair, and presacral drainage for rectal injury;\n$ 2,657.70\n3594\n45563\n45563\nExploration, repair, and presacral drainage for rectal injury; with\ncolostomy\n$ 3,095.10\n3595\n45800\n45800\nClosure of rectovesical fistula;\n$ 3,066.30\n3596\n45805\n45805\nClosure of rectovesical fistula; with colostomy\n$ 3,103.20\n3597\n45820\n45820\nClosure of rectourethral fistula;\n$ 2,729.70\n3598\n45825\n45825\nClosure of rectourethral fistula; with colostomy\n$ 3,057.30\n3599\n45900\n45900\nReduction of procidentia (separate procedure) under anesthesia\n$ 497.70\n3600\n45905\n45905\nDilation of anal sphincter (separate procedure) under anesthesia\nother than local\n$ 360.90\n3601\n45910\n45910\nDilation of rectal stricture (separate procedure) under anesthesia\nother than local\n$ 384.30\n3602\n45915\n45915\nRemoval of fecal impaction or foreign body (separate procedure)\nunder anesthesia\n$ 425.70\n3603\n45990\n45990\nAnorectal exam, surgical, requiring anesthesia (general, spinal, or\nepidural), diagnostic\n$ 219.72\n3604\n45999\n45999\nUnlisted procedure, rectum\nCost\n3605\n46020\n46020\nPlacement of seton\n$ 230.01\n3606\n46030\n46030\nRemoval of anal seton, other marker\n$ 293.40\n3607\n46040\n46040\nIncision and drainage of ischiorectal and\/or perirectal abscess\n(separate procedure)\n$ 703.80\n3608\n46045\n46045\nIncision and drainage of intramural, intramuscular, or submucosal\nabscess, transanal, under anesthesia\n$ 775.80\n3609\n46050\n46050\nIncision and drainage, perianal abscess, superficial\n$ 282.60\n3610\n46060\n46060\nIncision and drainage of ischiorectal or intramural abscess, with\nfistulectomy or fistulotomy, submuscular, with or without\nplacement of seton\n$ 1,665.00\n3611\n46070\n46070\nIncision, anal septum (infant)\n$ 432.90\n3612\n46080\n46080\nSphincterotomy, anal, division of sphincter (separate procedure)\n$ 820.80\n3613\n46083\n46083\nIncision of thrombosed hemorrhoid, external\n$ 214.20\n3614\n46200\n46200\nFissurectomy, including sphincterotomy, when performed\n$ 867.60\n3615\n46220\n46220\nExcision of single external papilla or tag, anus\n$ 343.80\n3616\n46221\n46221\nHemorrhoidectomy, internal, by rubber band ligation(s)\n$ 391.50\n3617\n46230\n46230\nExcision of multiple external papillae or tags, anus\n$ 380.70\n3618\n46250\n46250\nHemorrhoidectomy, external, 2 or more columns\/groups\n$ 952.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3619\n46255\n46255\nHemorrhoidectomy, internal and external, single column\/group;\n$ 1,133.02\n3620\n46257\n46257\nHemorrhoidectomy, internal and external, single column\/group;\nwith fissurectomy\n$ 1,395.90\n3621\n46258\n46258\nHemorrhoidectomy, internal and external, single column\/group;\nwith fistulectomy, including fissurectomy, when performed\n$ 1,494.90\n3622\n46260\n46260\nHemorrhoidectomy, internal and external, 2 or more\ncolumns\/groups;\n$ 1,744.20\n3623\n46261\n46261\nHemorrhoidectomy, internal and external, 2 or more\ncolumns\/groups; with fissurectomy\n$ 1,469.73\n3624\n46262\n46262\nHemorrhoidectomy, internal and external, 2 or more\ncolumns\/groups; with fistulectomy, including fissurectomy, when\nperformed\n$ 1,658.70\n3625\n46270\n46270\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy);\nsubcutaneous\n$ 813.60\n3626\n46275\n46275\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy);\nintersphincteric\n$ 1,426.50\n3627\n46280\n46280\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy);\ntranssphincteric, suprasphincteric, extrasphincteric or multiple,\nincluding placement of seton, when performed\n$ 1,668.60\n3628\n46285\n46285\nSurgical treatment of anal fistula (fistulectomy\/fistulotomy); second\nstage\n$ 578.70\n3629\n46288\n46288\nClosure of anal fistula with rectal advancement flap\n$ 1,596.60\n3630\n46320\n46320\nExcision of thrombosed hemorrhoid, external\n$ 252.07\n3631\n46500\n46500\nInjection of sclerosing solution, hemorrhoids\n$ 104.40\n3632\n46505\n46505\nChemodenervation of internal anal sphincter\n$ 620.82\n3633\n46600\n46600\nAnoscopy; diagnostic, with or without collection of specimen(s) by\nbrushing or washing (separate procedure)\n$ 70.85\n3634\n46604\n46604\nAnoscopy; with dilation (eg, balloon, guide wire, bougie)\n$ 197.10\n3635\n46606\n46606\nAnoscopy; with biopsy, single or multiple\n$ 156.60\n3636\n46608\n46608\nAnoscopy; with removal of foreign body\n$ 236.70\n3637\n46610\n46610\nAnoscopy; with removal of single tumor, polyp, or other lesion by\nhot biopsy forceps or bipolar cautery\n$ 277.20\n3638\n46611\n46611\nAnoscopy; with removal of single tumor, polyp, or other lesion by\nsnare technique\n$ 283.50\n3639\n46612\n46612\nAnoscopy; with removal of multiple tumors, polyps, or other lesions\nby hot biopsy forceps, bipolar cautery or snare technique\n$ 343.80\n3640\n46614\n46614\nAnoscopy; with control of bleeding (eg, injection, bipolar cautery,\nunipolar cautery, laser, heater probe, stapler, plasma coagulator)\n$ 407.70\n3641\n46615\n46615\nAnoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not\namenable to removal by hot biopsy forceps, bipolar cautery or\nsnare technique\n$ 414.00\n3642\n46700\n46700\nAnoplasty, plastic operation for stricture; adult\n$ 1,498.68\n3643\n46705\n46705\nAnoplasty, plastic operation for stricture; infant\n$ 1,416.60\n3644\n46706\n46706\nRepair of anal fistula with fibrin glue\n$ 389.22\n3645\n46707\n46707\nRepair of anorectal fistula with plug (eg, porcine small intestine\nsubmucosa [SIS])\n$ 1,162.37\n3646\n46710\n46710\nRepair of ileoanal pouch fistula\/sinus (eg, perineal or vaginal),\npouch advancement; transperineal approach\n$ 2,534.97\n3647\n46712\n46712\nRepair of ileoanal pouch fistula\/sinus (eg, perineal or vaginal),\npouch advancement; combined transperineal and transabdominal\napproach\n$ 4,490.29\n3648\n46715\n46715\nRepair of low imperforate anus; with anoperineal fistula (cut-back\nprocedure)\n$ 1,563.30\n3649\n46716\n46716\nRepair of low imperforate anus; with transposition of anoperineal\nor anovestibular fistula\n$ 1,954.80\n3650\n46730\n46730\nRepair of high imperforate anus without fistula; perineal or\nsacroperineal approach\n$ 3,294.00\n3651\n46735\n46735\nRepair of high imperforate anus without fistula; combined\ntransabdominal and sacroperineal approaches\n$ 3,994.20\n3652\n46740\n46740\nRepair of high imperforate anus with rectourethral or rectovaginal\nfistula; perineal or sacroperineal approach\n$ 4,257.00\n3653\n46742\n46742\nRepair of high imperforate anus with rectourethral or rectovaginal\nfistula; combined transabdominal and sacroperineal approaches\n$ 5,047.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3654\n46744\n46744\nRepair of cloacal anomaly by anorectovaginoplasty and\nurethroplasty, sacroperineal approach\n$ 5,304.60\n3655\n46746\n46746\nRepair of cloacal anomaly by anorectovaginoplasty and\nurethroplasty, combined abdominal and sacroperineal approach;\n$ 6,437.70\n3656\n46748\n46748\nRepair of cloacal anomaly by anorectovaginoplasty and\nurethroplasty, combined abdominal and sacroperineal approach;\nwith vaginal lengthening by intestinal graft or pedicle flaps\n$ 7,020.00\n3657\n46750\n46750\nSphincteroplasty, anal, for incontinence or prolapse; adult\n$ 1,944.72\n3658\n46751\n46751\nSphincteroplasty, anal, for incontinence or prolapse; child\n$ 1,653.30\n3659\n46753\n46753\nGraft (Thiersch operation) for rectal incontinence and\/or prolapse\n$ 1,352.70\n3660\n46754\n46754\nRemoval of Thiersch wire or suture, anal canal\n$ 287.10\n3661\n46760\n46760\nSphincteroplasty, anal, for incontinence, adult; muscle transplant\n$ 1,932.30\n3662\n46761\n46761\nSphincteroplasty, anal, for incontinence, adult; levator muscle\nimbrication (Park posterior anal repair)\n$ 2,142.41\n3663\n46762\n46762\nSphincteroplasty, anal, for incontinence, adult; implantation\nartificial sphincter\n$ 2,033.00\n3664\n46900\n46900\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\ncontagiosum, herpetic vesicle), simple; chemical\n$ 190.80\n3665\n46910\n46910\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\ncontagiosum, herpetic vesicle), simple; electrodesiccation\n$ 325.80\n3666\n46916\n46916\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\ncontagiosum, herpetic vesicle), simple; cryosurgery\n$ 330.30\n3667\n46917\n46917\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\ncontagiosum, herpetic vesicle), simple; laser surgery\n$ 570.60\n3668\n46922\n46922\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\ncontagiosum, herpetic vesicle), simple; surgical excision\n$ 441.90\n3669\n46924\n46924\nDestruction of lesion(s), anus (eg, condyloma, papilloma, molluscum\ncontagiosum, herpetic vesicle), extensive (eg, laser surgery,\nelectrosurgery, cryosurgery, chemosurgery)\n$ 861.30\n3670\n46930\n46930\nDestruction of internal hemorrhoid(s) by thermal energy (eg,\ninfrared coagulation, cautery, radiofrequency)\n$ 309.16\n3671\n46940\n46940\nCurettage or cautery of anal fissure, including dilation of anal\nsphincter (separate procedure); initial\n$ 342.90\n3672\n46942\n46942\nCurettage or cautery of anal fissure, including dilation of anal\nsphincter (separate procedure); subsequent\n$ 241.20\n3673\n46945\n46945\nHemorrhoidectomy, internal, by ligation other than rubber band;\nsingle hemorrhoid column\/group\n$ 319.50\n3674\n46946\n46946\nHemorrhoidectomy, internal, by ligation other than rubber band; 2\nor more hemorrhoid columns\/groups\n$ 372.60\n3675\n46947\n46947\nHemorrhoidopexy (eg, for prolapsing internal hemorrhoids) by\nstapling\n$ 578.58\n3676\n46999\n46999\nUnlisted procedure, anus\n$ 472.86\n3677\n47000\n47000\nBiopsy of liver, needle; percutaneous\n$ 378.90\n3678\n47001\n47001\nBiopsy of liver, needle; when done for indicated purpose at time of\nother major procedure (List separately in addition to code for\nprimary procedure)\n$ 362.70\n3679\n47010\n47010\nHepatotomy, for open drainage of abscess or cyst, 1 or 2 stages\n$ 2,399.40\n3680\n47015\n47015\nLaparotomy, with aspiration and\/or injection of hepatic parasitic\n(eg, amoebic or echinococcal) cyst(s) or abscess(es)\n$ 1,859.40\n3681\n47120\n47120\nHepatectomy, resection of liver; partial lobectomy\n$ 4,094.10\n3682\n47122\n47122\nHepatectomy, resection of liver; trisegmentectomy\n$ 5,055.30\n3683\n47125\n47125\nHepatectomy, resection of liver; total left lobectomy\n$ 5,123.70\n3684\n47130\n47130\nHepatectomy, resection of liver; total right lobectomy\n$ 5,660.10\n3685\n47133\n47133\nDonor hepatectomy (including cold preservation), from cadaver\ndonor\n$ -\n3686\n47135\n47135\nLiver allotransplantation; orthotopic, partial or whole, from cadaver\nor living donor, any age\n$ 11,907.94\n3687\n47136\n47136\nLiver allotransplantation; heterotopic, partial or whole, from\ncadaver or living donor, any age\n$ 10,222.38\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3688\n47140\n47140\nDonor hepatectomy (including cold preservation), from living donor;\nleft lateral segment only (segments II and III)\n$ 8,705.32\n3689\n47141\n47141\nDonor hepatectomy (including cold preservation), from living donor;\ntotal left lobectomy (segments II, III and IV)\n$ 9,173.83\n3690\n47142\n47142\nDonor hepatectomy (including cold preservation), from living donor;\ntotal right lobectomy (segments V, VI, VII and VIII)\n$ 11,446.63\n3691\n47143\n47143\nBackbench standard preparation of cadaver donor whole liver graft\nprior to allotransplantation, including cholecystectomy, if necessary,\nand dissection and removal of surrounding soft tissues to prepare\nthe vena cava, portal vein, hepatic artery, and comm\n$ -\n3692\n47144\n47144\nBackbench standard preparation of cadaver donor whole liver graft\nprior to allotransplantation, including cholecystectomy, if necessary,\nand dissection and removal of surrounding soft tissues to prepare\nthe vena cava, portal vein, hepatic artery, and comm\n$ -\n3693\n47145\n47145\nBackbench standard preparation of cadaver donor whole liver graft\nprior to allotransplantation, including cholecystectomy, if necessary,\nand dissection and removal of surrounding soft tissues to prepare\nthe vena cava, portal vein, hepatic artery, and comm\n$ -\n3694\n47146\n47146\nBackbench reconstruction of cadaver or living donor liver graft prior\nto allotransplantation; venous anastomosis, each\n$ 795.89\n3695\n47147\n47147\nBackbench reconstruction of cadaver or living donor liver graft prior\nto allotransplantation; arterial anastomosis, each\n$ 928.21\n3696\n47300\n47300\nMarsupialization of cyst or abscess of liver\n$ 2,345.40\n3697\n47350\n47350\nManagement of liver hemorrhage; simple suture of liver wound or\ninjury\n$ 2,863.80\n3698\n47360\n47360\nManagement of liver hemorrhage; complex suture of liver wound or\ninjury, with or without hepatic artery ligation\n$ 3,404.70\n3699\n47361\n47361\nManagement of liver hemorrhage; exploration of hepatic wound,\nextensive debridement, coagulation and\/or suture, with or without\npacking of liver\n$ 5,294.70\n3700\n47362\n47362\nManagement of liver hemorrhage; re-exploration of hepatic wound\nfor removal of packing\n$ 2,229.30\n3701\n47370\n47370\nLaparoscopy, surgical, ablation of 1 or more liver tumor(s);\nradiofrequency\n$ 3,013.06\n3702\n47371\n47371\nLaparoscopy, surgical, ablation of 1 or more liver tumor(s);\ncryosurgical\n$ 3,066.51\n3703\n47379\n47379\nUnlisted laparoscopic procedure, liver\nCost\n3704\n47380\n47380\nAblation, open, of 1 or more liver tumor(s); radiofrequency\n$ 3,485.82\n3705\n47381\n47381\nAblation, open, of 1 or more liver tumor(s); cryosurgical\n$ 3,608.38\n3706\n47382\n47382\nAblation, 1 or more liver tumor(s), percutaneous, radiofrequency\n$ 12,779.28\n3707\n47399\n47399\nUnlisted procedure, liver\nCost\n3708\n47400\n47400\nHepaticotomy or hepaticostomy with exploration, drainage, or\nremoval of calculus\n$ 2,941.20\n3709\n47420\n47420\nCholedochotomy or choledochostomy with exploration, drainage,\nor removal of calculus, with or without cholecystotomy; without\ntransduodenal sphincterotomy or sphincteroplasty\n$ 2,731.50\n3710\n47425\n47425\nCholedochotomy or choledochostomy with exploration, drainage,\nor removal of calculus, with or without cholecystotomy; with\ntransduodenal sphincterotomy or sphincteroplasty\n$ 3,064.50\n3711\n47460\n47460\nTransduodenal sphincterotomy or sphincteroplasty, with or without\ntransduodenal extraction of calculus (separate procedure)\n$ 3,170.70\n3712\n47480\n47480\nCholecystotomy or cholecystostomy, open, with exploration,\ndrainage, or removal of calculus (separate procedure)\n$ 1,964.70\n3713\n47490\n47490\nCholecystostomy, percutaneous, complete procedure, including\nimaging guidance, catheter placement, cholecystogram when\nperformed, and radiological supervision and interpretation\n$ 947.70\n3714\n47500\n47500\nInjection procedure for percutaneous transhepatic cholangiography\n$ 501.30\n3715\n47505\n47505\nInjection procedure for cholangiography through an existing\ncatheter (eg, percutaneous transhepatic or T-tube)\n$ 239.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3716\n47510\n47510\nIntroduction of percutaneous transhepatic catheter for biliary\ndrainage\n$ 825.30\n3717\n47511\n47511\nIntroduction of percutaneous transhepatic stent for internal and\nexternal biliary drainage\n$ 932.40\n3718\n47525\n47525\nChange of percutaneous biliary drainage catheter\n$ 473.40\n3719\n47530\n47530\nRevision and\/or reinsertion of transhepatic tube\n$ 613.80\n3720\n47550\n47550\nBiliary endoscopy, intraoperative (choledochoscopy) (List separately\nin addition to code for primary procedure)\n$ 785.70\n3721\n47552\n47552\nBiliary endoscopy, percutaneous via T-tube or other tract;\ndiagnostic, with collection of specimen(s) by brushing and\/or\nwashing, when performed (separate procedure)\n$ 1,030.50\n3722\n47553\n47553\nBiliary endoscopy, percutaneous via T-tube or other tract; with\nbiopsy, single or multiple\n$ 978.30\n3723\n47554\n47554\nBiliary endoscopy, percutaneous via T-tube or other tract; with\nremoval of calculus\/calculi\n$ 1,421.10\n3724\n47555\n47555\nBiliary endoscopy, percutaneous via T-tube or other tract; with\ndilation of biliary duct stricture(s) without stent\n$ 1,138.50\n3725\n47556\n47556\nBiliary endoscopy, percutaneous via T-tube or other tract; with\ndilation of biliary duct stricture(s) with stent\n$ 1,133.10\n3726\n47560\n47560\nLaparoscopy, surgical; with guided transhepatic cholangiography,\nwithout biopsy\n$ 1,510.58\n3727\n47561\n47561\nLaparoscopy, surgical; with guided transhepatic cholangiography\nwith biopsy\n$ 1,159.20\n3728\n47562\n47562\nLaparoscopy, surgical; cholecystectomy\n$ 2,884.50\n3729\n47563\n47563\nLaparoscopy, surgical; cholecystectomy with cholangiography\n$ 2,978.08\n3730\n47564\n47564\nLaparoscopy, surgical; cholecystectomy with exploration of common\nduct\n$ 3,501.90\n3731\n47570\n47570\nLaparoscopy, surgical; cholecystoenterostomy\n$ 2,934.90\n3732\n47579\n47579\nUnlisted laparoscopy procedure, biliary tract\nCost\n3733\n47600\n47600\nCholecystectomy;\n$ 2,425.73\n3734\n47605\n47605\nCholecystectomy; with cholangiography\n$ 2,408.40\n3735\n47610\n47610\nCholecystectomy with exploration of common duct;\n$ 3,090.60\n3736\n47612\n47612\nCholecystectomy with exploration of common duct; with\ncholedochoenterostomy\n$ 3,743.10\n3737\n47620\n47620\nCholecystectomy with exploration of common duct; with\ntransduodenal sphincterotomy or sphincteroplasty, with or without\ncholangiography\n$ 3,605.40\n3738\n47630\n47630\nBiliary duct stone extraction, percutaneous via T-tube tract, basket,\nor snare (eg, Burhenne technique)\n$ 1,591.20\n3739\n47700\n47700\nExploration for congenital atresia of bile ducts, without repair, with\nor without liver biopsy, with or without cholangiography\n$ 2,565.00\n3740\n47701\n47701\nPortoenterostomy (eg, Kasai procedure)\n$ 3,919.50\n3741\n47711\n47711\nExcision of bile duct tumor, with or without primary repair of bile\nduct; extrahepatic\n$ 3,893.40\n3742\n47712\n47712\nExcision of bile duct tumor, with or without primary repair of bile\nduct; intrahepatic\n$ 4,233.60\n3743\n47715\n47715\nExcision of choledochal cyst\n$ 2,894.40\n3744\n47720\n47720\nCholecystoenterostomy; direct\n$ 2,518.20\n3745\n47721\n47721\nCholecystoenterostomy; with gastroenterostomy\n$ 3,141.90\n3746\n47740\n47740\nCholecystoenterostomy; Roux-en-Y\n$ 3,231.00\n3747\n47741\n47741\nCholecystoenterostomy; Roux-en-Y with gastroenterostomy\n$ 3,558.60\n3748\n47760\n47760\nAnastomosis, of extrahepatic biliary ducts and gastrointestinal tract\n$ 3,577.50\n3749\n47765\n47765\nAnastomosis, of intrahepatic ducts and gastrointestinal tract\n$ 3,862.80\n3750\n47780\n47780\nAnastomosis, Roux-en-Y, of extrahepatic biliary ducts and\ngastrointestinal tract\n$ 4,051.80\n3751\n47785\n47785\nAnastomosis, Roux-en-Y, of intrahepatic biliary ducts and\ngastrointestinal tract\n$ 4,861.80\n3752\n47800\n47800\nReconstruction, plastic, of extrahepatic biliary ducts with end-to-\nend anastomosis\n$ 3,579.30\n3753\n47801\n47801\nPlacement of choledochal stent\n$ 2,097.00\n3754\n47802\n47802\nU-tube hepaticoenterostomy\n$ 3,399.30\n3755\n47900\n47900\nSuture of extrahepatic biliary duct for pre-existing injury (separate\nprocedure)\n$ 3,095.10\n3756\n47999\n47999\nUnlisted procedure, biliary tract\nCost\n3757\n48000\n48000\nPlacement of drains, peripancreatic, for acute pancreatitis;\n$ 2,626.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3758\n48001\n48001\nPlacement of drains, peripancreatic, for acute pancreatitis; with\ncholecystostomy, gastrostomy, and jejunostomy\n$ 2,832.30\n3759\n48020\n48020\nRemoval of pancreatic calculus\n$ 2,904.30\n3760\n48100\n48100\nBiopsy of pancreas, open (eg, fine needle aspiration, needle core\nbiopsy, wedge biopsy)\n$ 2,138.40\n3761\n48102\n48102\nBiopsy of pancreas, percutaneous needle\n$ 634.50\n3762\n48105\n48105\nResection or debridement of pancreas and peripancreatic tissue for\nacute necrotizing pancreatitis\n$ 5,451.85\n3763\n48120\n48120\nExcision of lesion of pancreas (eg, cyst, adenoma)\n$ 2,574.90\n3764\n48140\n48140\nPancreatectomy, distal subtotal, with or without splenectomy;\nwithout pancreaticojejunostomy\n$ 3,533.40\n3765\n48145\n48145\nPancreatectomy, distal subtotal, with or without splenectomy; with\npancreaticojejunostomy\n$ 3,700.80\n3766\n48146\n48146\nPancreatectomy, distal, near-total with preservation of duodenum\n(Child-type procedure)\n$ 3,965.40\n3767\n48148\n48148\nExcision of ampulla of Vater\n$ 3,132.00\n3768\n48150\n48150\nPancreatectomy, proximal subtotal with total duodenectomy,\npartial gastrectomy, choledochoenterostomy and\ngastrojejunostomy (Whipple-type procedure); with\npancreatojejunostomy\n$ 6,010.20\n3769\n48152\n48152\nPancreatectomy, proximal subtotal with total duodenectomy,\npartial gastrectomy, choledochoenterostomy and\ngastrojejunostomy (Whipple-type procedure); without\npancreatojejunostomy\n$ 5,525.10\n3770\n48153\n48153\nPancreatectomy, proximal subtotal with near-total duodenectomy,\ncholedochoenterostomy and duodenojejunostomy (pylorus-sparing,\nWhipple-type procedure); with pancreatojejunostomy\n$ 6,282.90\n3771\n48154\n48154\nPancreatectomy, proximal subtotal with near-total duodenectomy,\ncholedochoenterostomy and duodenojejunostomy (pylorus-sparing,\nWhipple-type procedure); without pancreatojejunostomy\n$ 5,545.84\n3772\n48155\n48155\nPancreatectomy, total\n$ 5,987.70\n3773\n48160\n48160\nPancreatectomy, total or subtotal, with autologous transplantation\nof pancreas or pancreatic islet cells\n$ -\n3774\n48400\n48400\nInjection procedure for intraoperative pancreatography (List\nseparately in addition to code for primary procedure)\n$ 278.10\n3775\n48500\n48500\nMarsupialization of pancreatic cyst\n$ 2,574.90\n3776\n48510\n48510\nExternal drainage, pseudocyst of pancreas, open\n$ 3,393.00\n3777\n48520\n48520\nInternal anastomosis of pancreatic cyst to gastrointestinal tract;\ndirect\n$ 3,391.20\n3778\n48540\n48540\nInternal anastomosis of pancreatic cyst to gastrointestinal tract;\nRoux-en-Y\n$ 3,727.80\n3779\n48545\n48545\nPancreatorrhaphy for injury\n$ 2,807.10\n3780\n48547\n48547\nDuodenal exclusion with gastrojejunostomy for pancreatic injury\n$ 4,583.70\n3781\n48548\n48548\nPancreaticojejunostomy, side-to-side anastomosis (Puestow-type\noperation)\n$ 3,894.97\n3782\n48550\n48550\nDonor pancreatectomy (including cold preservation), with or\nwithout duodenal segment for transplantation\n$ -\n3783\n48551\n48551\nBackbench standard preparation of cadaver donor pancreas\nallograft prior to transplantation, including dissection of allograft\nfrom surrounding soft tissues, splenectomy, duodenotomy, ligation\nof bile duct, ligation of mesenteric vessels, and Y-graft arte\n$ -\n3784\n48552\n48552\nBackbench reconstruction of cadaver donor pancreas allograft prior\nto transplantation, venous anastomosis, each\n$ 568.43\n3785\n48554\n48554\nTransplantation of pancreatic allograft\n$ 5,886.90\n3786\n48556\n48556\nRemoval of transplanted pancreatic allograft\n$ 2,919.60\n3787\n48999\n48999\nUnlisted procedure, pancreas\nCost\n3788\n49000\n49000\nExploratory laparotomy, exploratory celiotomy with or without\nbiopsy(s) (separate procedure)\n$ 2,088.85\n3789\n49002\n49002\nReopening of recent laparotomy\n$ 1,898.10\n3790\n49010\n49010\nExploration, retroperitoneal area with or without biopsy(s)\n(separate procedure)\n$ 2,083.50\n3791\n49020\n49020\nDrainage of peritoneal abscess or localized peritonitis, exclusive of\nappendiceal abscess, open\n$ 1,682.10\n3792\n49040\n49040\nDrainage of subdiaphragmatic or subphrenic abscess, open\n$ 1,975.50\n3793\n49060\n49060\nDrainage of retroperitoneal abscess, open\n$ 1,845.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3794\n49062\n49062\nDrainage of extraperitoneal lymphocele to peritoneal cavity, open\n$ 1,874.70\n3795\n49082\n49082\nAbdominal paracentesis (diagnostic or therapeutic); without\nimaging guidance\n$ 439.20\n3796\n49083\n49083\nAbdominal paracentesis (diagnostic or therapeutic); with imaging\nguidance\n$ 793.44\n3797\n49084\n49084\nPeritoneal lavage, including imaging guidance, when performed\n$ 237.37\n3798\n49180\n49180\nBiopsy, abdominal or retroperitoneal mass, percutaneous needle\n$ 811.80\n3799\n49203\n49203\nExcision or destruction, open, intra-abdominal tumors, cysts or\nendometriomas, 1 or more peritoneal, mesenteric, or\nretroperitoneal primary or secondary tumors; largest tumor 5 cm\ndiameter or less\n$ 2,801.62\n3800\n49204\n49204\nExcision or destruction, open, intra-abdominal tumors, cysts or\nendometriomas, 1 or more peritoneal, mesenteric, or\nretroperitoneal primary or secondary tumors; largest tumor 5.1-\n10.0 cm diameter\n$ 3,508.35\n3801\n49205\n49205\nExcision or destruction, open, intra-abdominal tumors, cysts or\nendometriomas, 1 or more peritoneal, mesenteric, or\nretroperitoneal primary or secondary tumors; largest tumor greater\nthan 10.0 cm diameter\n$ 4,192.01\n3802\n49215\n49215\nExcision of presacral or sacrococcygeal tumor\n$ 3,955.50\n3803\n49220\n49220\nStaging laparotomy for Hodgkins disease or lymphoma (includes\nsplenectomy, needle or open biopsies of both liver lobes, possibly\nalso removal of abdominal nodes, abdominal node and\/or bone\nmarrow biopsies, ovarian repositioning)\n$ 3,829.50\n3804\n49250\n49250\nUmbilectomy, omphalectomy, excision of umbilicus (separate\nprocedure)\n$ 1,416.60\n3805\n49255\n49255\nOmentectomy, epiploectomy, resection of omentum (separate\nprocedure)\n$ 1,802.70\n3806\n49320\n49320\nLaparoscopy, abdomen, peritoneum, and omentum, diagnostic,\nwith or without collection of specimen(s) by brushing or washing\n(separate procedure)\n$ 1,557.11\n3807\n49321\n49321\nLaparoscopy, surgical; with biopsy (single or multiple)\n$ 1,716.30\n3808\n49322\n49322\nLaparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian\ncyst) (single or multiple)\n$ 1,802.70\n3809\n49323\n49323\nLaparoscopy, surgical; with drainage of lymphocele to peritoneal\ncavity\n$ 1,908.90\n3810\n49324\n49324\nLaparoscopy, surgical; with insertion of tunneled intraperitoneal\ncatheter\n$ 943.82\n3811\n49325\n49325\nLaparoscopy, surgical; with revision of previously placed\nintraperitoneal cannula or catheter, with removal of intraluminal\nobstructive material if performed\n$ 950.46\n3812\n49326\n49326\nLaparoscopy, surgical; with omentopexy (omental tacking\nprocedure) (List separately in addition to code for primary\nprocedure)\n$ 706.80\n3813\n49329\n49329\nUnlisted laparoscopy procedure, abdomen, peritoneum and\nomentum\nCost\n3814\n49400\n49400\nInjection of air or contrast into peritoneal cavity (separate\nprocedure)\n$ 233.10\n3815\n49402\n49402\nRemoval of peritoneal foreign body from peritoneal cavity\n$ 1,902.20\n3816\n49405\n49405\nImage-guided fluid collection drainage by catheter (eg, abscess,\nhematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver,\nspleen, lung\/mediastinum), percutaneous\n$ 1,223.25\n3817\n49406\n49406\nImage-guided fluid collection drainage by catheter (eg, abscess,\nhematoma, seroma, lymphocele, cyst); peritoneal or\nretroperitoneal, percutaneous\n$ 1,223.25\n3818\n49407\n49407\nImage-guided fluid collection drainage by catheter (eg, abscess,\nhematoma, seroma, lymphocele, cyst); peritoneal or\nretroperitoneal, transvaginal or transrectal\n$ 757.76\n3819\n49411\n49411\nPlacement of interstitial device(s) for radiation therapy guidance\n(eg, fiducial markers, dosimeter), percutaneous, intra-abdominal,\nintra-pelvic (except prostate), and\/or retroperitoneum, single or\nmultiple\n$ 880.63\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3820\n49418\n49418\nInsertion of tunneled intraperitoneal catheter (eg, dialysis,\nintraperitoneal chemotherapy instillation, management of ascites),\ncomplete procedure, including imaging guidance, catheter\nplacement, contrast injection when performed, and radiological\nsuperv\n$ 1,335.02\n3821\n49419\n49419\nInsertion of tunneled intraperitoneal catheter, with subcutaneous\nport (ie, totally implantable)\n$ 985.96\n3822\n49421\n49421\nInsertion of tunneled intraperitoneal catheter for dialysis, open\n$ 1,449.00\n3823\n49422\n49422\nRemoval of tunneled intraperitoneal catheter\n$ 1,191.60\n3824\n49423\n49423\nExchange of previously placed abscess or cyst drainage catheter\nunder radiological guidance (separate procedure)\n$ 277.20\n3825\n49424\n49424\nContrast injection for assessment of abscess or cyst via previously\nplaced drainage catheter or tube (separate procedure)\n$ 144.00\n3826\n49425\n49425\nInsertion of peritoneal-venous shunt\n$ 2,162.70\n3827\n49426\n49426\nRevision of peritoneal-venous shunt\n$ 1,984.50\n3828\n49427\n49427\nInjection procedure (eg, contrast media) for evaluation of previously\nplaced peritoneal-venous shunt\n$ 216.00\n3829\n49428\n49428\nLigation of peritoneal-venous shunt\n$ 953.79\n3830\n49429\n49429\nRemoval of peritoneal-venous shunt\n$ 1,148.24\n3831\n49435\n49435\nInsertion of subcutaneous extension to intraperitoneal cannula or\ncatheter with remote chest exit site (List separately in addition to\ncode for primary procedure)\n$ 343.46\n3832\n49436\n49436\nDelayed creation of exit site from embedded subcutaneous\nsegment of intraperitoneal cannula or catheter\n$ 485.16\n3833\n49440\n49440\nInsertion of gastrostomy tube, percutaneous, under fluoroscopic\nguidance including contrast injection(s), image documentation and\nreport\n$ 2,849.89\n3834\n49441\n49441\nInsertion of duodenostomy or jejunostomy tube, percutaneous,\nunder fluoroscopic guidance including contrast injection(s), image\ndocumentation and report\n$ 3,205.41\n3835\n49442\n49442\nInsertion of cecostomy or other colonic tube, percutaneous, under\nfluoroscopic guidance including contrast injection(s), image\ndocumentation and report\n$ 2,719.49\n3836\n49446\n49446\nConversion of gastrostomy tube to gastro-jejunostomy tube,\npercutaneous, under fluoroscopic guidance including contrast\ninjection(s), image documentation and report\n$ 2,770.54\n3837\n49450\n49450\nReplacement of gastrostomy or cecostomy (or other colonic) tube,\npercutaneous, under fluoroscopic guidance including contrast\ninjection(s), image documentation and report\n$ 2,007.64\n3838\n49451\n49451\nReplacement of duodenostomy or jejunostomy tube, percutaneous,\nunder fluoroscopic guidance including contrast injection(s), image\ndocumentation and report\n$ 2,121.12\n3839\n49452\n49452\nReplacement of gastro-jejunostomy tube, percutaneous, under\nfluoroscopic guidance including contrast injection(s), image\ndocumentation and report\n$ 2,487.98\n3840\n49460\n49460\nMechanical removal of obstructive material from gastrostomy,\nduodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or\nother colonic) tube, any method, under fluoroscopic guidance\nincluding contrast injection(s), if performed, image documentation\nan\n$ 2,124.43\n3841\n49465\n49465\nContrast injection(s) for radiological evaluation of existing\ngastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or\ncecostomy (or other colonic) tube, from a percutaneous approach\nincluding image documentation and report\n$ 492.81\n3842\n49491\n49491\nRepair, initial inguinal hernia, preterm infant (younger than 37\nweeks gestation at birth), performed from birth up to 50 weeks\npostconception age, with or without hydrocelectomy; reducible\n$ 1,510.04\n3843\n49492\n49492\nRepair, initial inguinal hernia, preterm infant (younger than 37\nweeks gestation at birth), performed from birth up to 50 weeks\npostconception age, with or without hydrocelectomy; incarcerated\nor strangulated\n$ 1,735.71\n3844\n49495\n49495\nRepair, initial inguinal hernia, full term infant younger than age 6\nmonths, or preterm infant older than 50 weeks postconception age\nand younger than age 6 months at the time of surgery, with or\nwithout hydrocelectomy; reducible\n$ 1,575.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3845\n49496\n49496\nRepair, initial inguinal hernia, full term infant younger than age 6\nmonths, or preterm infant older than 50 weeks postconception age\nand younger than age 6 months at the time of surgery, with or\nwithout hydrocelectomy; incarcerated or strangulated\n$ 1,755.00\n3846\n49500\n49500\nRepair initial inguinal hernia, age 6 months to younger than 5 years,\nwith or without hydrocelectomy; reducible\n$ 1,390.50\n3847\n49501\n49501\nRepair initial inguinal hernia, age 6 months to younger than 5 years,\nwith or without hydrocelectomy; incarcerated or strangulated\n$ 1,555.20\n3848\n49505\n49505\nRepair initial inguinal hernia, age 5 years or older; reducible\n$ 1,547.55\n3849\n49507\n49507\nRepair initial inguinal hernia, age 5 years or older; incarcerated or\nstrangulated\n$ 1,889.72\n3850\n49520\n49520\nRepair recurrent inguinal hernia, any age; reducible\n$ 2,031.30\n3851\n49521\n49521\nRepair recurrent inguinal hernia, any age; incarcerated or\nstrangulated\n$ 2,214.90\n3852\n49525\n49525\nRepair inguinal hernia, sliding, any age\n$ 1,647.90\n3853\n49540\n49540\nRepair lumbar hernia\n$ 1,574.10\n3854\n49550\n49550\nRepair initial femoral hernia, any age; reducible\n$ 1,616.40\n3855\n49553\n49553\nRepair initial femoral hernia, any age; incarcerated or strangulated\n$ 1,931.40\n3856\n49555\n49555\nRepair recurrent femoral hernia; reducible\n$ 1,916.10\n3857\n49557\n49557\nRepair recurrent femoral hernia; incarcerated or strangulated\n$ 2,497.50\n3858\n49560\n49560\nRepair initial incisional or ventral hernia; reducible\n$ 1,978.57\n3859\n49561\n49561\nRepair initial incisional or ventral hernia; incarcerated or\nstrangulated\n$ 2,116.80\n3860\n49565\n49565\nRepair recurrent incisional or ventral hernia; reducible\n$ 2,480.40\n3861\n49566\n49566\nRepair recurrent incisional or ventral hernia; incarcerated or\nstrangulated\n$ 2,693.70\n3862\n49568\n49568\nImplantation of mesh or other prosthesis for open incisional or\nventral hernia repair or mesh for closure of debridement for\nnecrotizing soft tissue infection (List separately in addition to code\nfor the incisional or ventral hernia repair)\n$ 736.24\n3863\n49570\n49570\nRepair epigastric hernia (eg, preperitoneal fat); reducible (separate\nprocedure)\n$ 1,421.10\n3864\n49572\n49572\nRepair epigastric hernia (eg, preperitoneal fat); incarcerated or\nstrangulated\n$ 1,670.40\n3865\n49580\n49580\nRepair umbilical hernia, younger than age 5 years; reducible\n$ 1,189.80\n3866\n49582\n49582\nRepair umbilical hernia, younger than age 5 years; incarcerated or\nstrangulated\n$ 1,545.30\n3867\n49585\n49585\nRepair umbilical hernia, age 5 years or older; reducible\n$ 1,441.80\n3868\n49587\n49587\nRepair umbilical hernia, age 5 years or older; incarcerated or\nstrangulated\n$ 1,646.00\n3869\n49590\n49590\nRepair spigelian hernia\n$ 1,654.20\n3870\n49600\n49600\nRepair of small omphalocele, with primary closure\n$ 1,622.70\n3871\n49605\n49605\nRepair of large omphalocele or gastroschisis; with or without\nprosthesis\n$ 3,263.40\n3872\n49606\n49606\nRepair of large omphalocele or gastroschisis; with removal of\nprosthesis, final reduction and closure, in operating room\n$ 2,832.30\n3873\n49610\n49610\nRepair of omphalocele (Gross type operation); first stage\n$ 2,008.80\n3874\n49611\n49611\nRepair of omphalocele (Gross type operation); second stage\n$ 1,946.70\n3875\n49650\n49650\nLaparoscopy, surgical; repair initial inguinal hernia\n$ 1,924.20\n3876\n49651\n49651\nLaparoscopy, surgical; repair recurrent inguinal hernia\n$ 2,074.50\n3877\n49652\n49652\nLaparoscopy, surgical, repair, ventral, umbilical, spigelian or\nepigastric hernia (includes mesh insertion, when performed);\nreducible\n$ 2,109.14\n3878\n49653\n49653\nLaparoscopy, surgical, repair, ventral, umbilical, spigelian or\nepigastric hernia (includes mesh insertion, when performed);\nincarcerated or strangulated\n$ 2,603.68\n3879\n49654\n49654\nLaparoscopy, surgical, repair, incisional hernia (includes mesh\ninsertion, when performed); reducible\n$ 2,373.28\n3880\n49655\n49655\nLaparoscopy, surgical, repair, incisional hernia (includes mesh\ninsertion, when performed); incarcerated or strangulated\n$ 2,891.21\n3881\n49656\n49656\nLaparoscopy, surgical, repair, recurrent incisional hernia (includes\nmesh insertion, when performed); reducible\n$ 2,400.68\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3882\n49657\n49657\nLaparoscopy, surgical, repair, recurrent incisional hernia (includes\nmesh insertion, when performed); incarcerated or strangulated\n$ 3,469.04\n3883\n49659\n49659\nUnlisted laparoscopy procedure, hernioplasty, herniorrhaphy,\nherniotomy\nCost\n3884\n49900\n49900\nSuture, secondary, of abdominal wall for evisceration or dehiscence\n$ 1,555.20\n3885\n49904\n49904\nOmental flap, extra-abdominal (eg, for reconstruction of sternal and\nchest wall defects)\n$ 3,010.88\n3886\n49905\n49905\nOmental flap, intra-abdominal (List separately in addition to code\nfor primary procedure)\n$ 1,532.70\n3887\n49906\n49906\nFree omental flap with microvascular anastomosis\n$ -\n3888\n49999\n49999\nUnlisted procedure, abdomen, peritoneum and omentum\nCost\n3889\n50010\n50010\nRenal exploration, not necessitating other specific procedures\n$ 2,369.70\n3890\n50020\n50020\nDrainage of perirenal or renal abscess, open\n$ 2,348.10\n3891\n50040\n50040\nNephrostomy, nephrotomy with drainage\n$ 2,388.60\n3892\n50045\n50045\nNephrotomy, with exploration\n$ 2,695.50\n3893\n50060\n50060\nNephrolithotomy; removal of calculus\n$ 3,464.10\n3894\n50065\n50065\nNephrolithotomy; secondary surgical operation for calculus\n$ 3,301.20\n3895\n50070\n50070\nNephrolithotomy; complicated by congenital kidney abnormality\n$ 3,739.50\n3896\n50075\n50075\nNephrolithotomy; removal of large staghorn calculus filling renal\npelvis and calyces (including anatrophic pyelolithotomy)\n$ 3,556.80\n3897\n50080\n50080\nPercutaneous nephrostolithotomy or pyelostolithotomy, with or\nwithout dilation, endoscopy, lithotripsy, stenting, or basket\nextraction; up to 2 cm\n$ 3,374.10\n3898\n50081\n50081\nPercutaneous nephrostolithotomy or pyelostolithotomy, with or\nwithout dilation, endoscopy, lithotripsy, stenting, or basket\nextraction; over 2 cm\n$ 3,953.70\n3899\n50100\n50100\nTransection or repositioning of aberrant renal vessels (separate\nprocedure)\n$ 2,421.00\n3900\n50120\n50120\nPyelotomy; with exploration\n$ 2,788.20\n3901\n50125\n50125\nPyelotomy; with drainage, pyelostomy\n$ 2,860.20\n3902\n50130\n50130\nPyelotomy; with removal of calculus (pyelolithotomy,\npelviolithotomy, including coagulum pyelolithotomy)\n$ 3,258.00\n3903\n50135\n50135\nPyelotomy; complicated (eg, secondary operation, congenital\nkidney abnormality)\n$ 3,535.20\n3904\n50200\n50200\nRenal biopsy; percutaneous, by trocar or needle\n$ 563.40\n3905\n50205\n50205\nRenal biopsy; by surgical exposure of kidney\n$ 1,523.70\n3906\n50220\n50220\nNephrectomy, including partial ureterectomy, any open approach\nincluding rib resection;\n$ 3,236.40\n3907\n50225\n50225\nNephrectomy, including partial ureterectomy, any open approach\nincluding rib resection; complicated because of previous surgery on\nsame kidney\n$ 3,862.80\n3908\n50230\n50230\nNephrectomy, including partial ureterectomy, any open approach\nincluding rib resection; radical, with regional lymphadenectomy\nand\/or vena caval thrombectomy\n$ 4,735.80\n3909\n50234\n50234\nNephrectomy with total ureterectomy and bladder cuff; through\nsame incision\n$ 4,532.40\n3910\n50236\n50236\nNephrectomy with total ureterectomy and bladder cuff; through\nseparate incision\n$ 4,327.20\n3911\n50240\n50240\nNephrectomy, partial\n$ 3,764.70\n3912\n50250\n50250\nAblation, open, 1 or more renal mass lesion(s), cryosurgical,\nincluding intraoperative ultrasound guidance and monitoring, if\nperformed\n$ 3,098.95\n3913\n50280\n50280\nExcision or unroofing of cyst(s) of kidney\n$ 2,828.70\n3914\n50290\n50290\nExcision of perinephric cyst\n$ 2,653.20\n3915\n50300\n50300\nDonor nephrectomy (including cold preservation); from cadaver\ndonor, unilateral or bilateral\n$ 2,830.50\n3916\n50320\n50320\nDonor nephrectomy (including cold preservation); open, from living\ndonor\n$ 4,686.30\n3917\n50323\n50323\nBackbench standard preparation of cadaver donor renal allograft\nprior to transplantation, including dissection and removal of\nperinephric fat, diaphragmatic and retroperitoneal attachments,\nexcision of adrenal gland, and preparation of ureter(s), renal ve\n$ -\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3918\n50325\n50325\nBackbench standard preparation of living donor renal allograft\n(open or laparoscopic) prior to transplantation, including dissection\nand removal of perinephric fat and preparation of ureter(s), renal\nvein(s), and renal artery(s), ligating branches, as nec\n$ -\n3919\n50327\n50327\nBackbench reconstruction of cadaver or living donor renal allograft\nprior to transplantation; venous anastomosis, each\n$ 518.41\n3920\n50328\n50328\nBackbench reconstruction of cadaver or living donor renal allograft\nprior to transplantation; arterial anastomosis, each\n$ 452.32\n3921\n50329\n50329\nBackbench reconstruction of cadaver or living donor renal allograft\nprior to transplantation; ureteral anastomosis, each\n$ 410.96\n3922\n50340\n50340\nRecipient nephrectomy (separate procedure)\n$ 2,797.20\n3923\n50360\n50360\nRenal allotransplantation, implantation of graft; without recipient\nnephrectomy\n$ 6,304.50\n3924\n50365\n50365\nRenal allotransplantation, implantation of graft; with recipient\nnephrectomy\n$ 7,696.80\n3925\n50370\n50370\nRemoval of transplanted renal allograft\n$ 2,430.90\n3926\n50380\n50380\nRenal autotransplantation, reimplantation of kidney\n$ 4,360.50\n3927\n50382\n50382\nRemoval (via snare\/capture) and replacement of internally dwelling\nureteral stent via percutaneous approach, including radiological\nsupervision and interpretation\n$ 1,292.64\n3928\n50384\n50384\nRemoval (via snare\/capture) of internally dwelling ureteral stent via\npercutaneous approach, including radiological supervision and\ninterpretation\n$ 1,139.86\n3929\n50385\n50385\nRemoval (via snare\/capture) and replacement of internally dwelling\nureteral stent via transurethral approach, without use of\ncystoscopy, including radiological supervision and interpretation\n$ 1,174.03\n3930\n50386\n50386\nRemoval (via snare\/capture) of internally dwelling ureteral stent via\ntransurethral approach, without use of cystoscopy, including\nradiological supervision and interpretation\n$ 916.76\n3931\n50387\n50387\nRemoval and replacement of externally accessible transnephric\nureteral stent (eg, external\/internal stent) requiring fluoroscopic\nguidance, including radiological supervision and interpretation\n$ 540.10\n3932\n50389\n50389\nRemoval of nephrostomy tube, requiring fluoroscopic guidance (eg,\nwith concurrent indwelling ureteral stent)\n$ 344.26\n3933\n50390\n50390\nAspiration and\/or injection of renal cyst or pelvis by needle,\npercutaneous\n$ 465.30\n3934\n50391\n50391\nInstillation(s) of therapeutic agent into renal pelvis and\/or ureter\nthrough established nephrostomy, pyelostomy or ureterostomy\ntube (eg, anticarcinogenic or antifungal agent)\n$ 374.44\n3935\n50392\n50392\nIntroduction of intracatheter or catheter into renal pelvis for\ndrainage and\/or injection, percutaneous\n$ 666.00\n3936\n50393\n50393\nIntroduction of ureteral catheter or stent into ureter through renal\npelvis for drainage and\/or injection, percutaneous\n$ 703.80\n3937\n50394\n50394\nInjection procedure for pyelography (as nephrostogram,\npyelostogram, antegrade pyeloureterograms) through nephrostomy\nor pyelostomy tube, or indwelling ureteral catheter\n$ 221.40\n3938\n50395\n50395\nIntroduction of guide into renal pelvis and\/or ureter with dilation to\nestablish nephrostomy tract, percutaneous\n$ 870.30\n3939\n50396\n50396\nManometric studies through nephrostomy or pyelostomy tube, or\nindwelling ureteral catheter\n$ 164.70\n3940\n50398\n50398\nChange of nephrostomy or pyelostomy tube\n$ 257.40\n3941\n50400\n50400\nPyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis,\nwith or without plastic operation on ureter, nephropexy,\nnephrostomy, pyelostomy, or ureteral splinting; simple\n$ 3,541.50\n3942\n50405\n50405\nPyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis,\nwith or without plastic operation on ureter, nephropexy,\nnephrostomy, pyelostomy, or ureteral splinting; complicated\n(congenital kidney abnormality, secondary pyeloplasty, solitary kidn\n$ 3,802.50\n3943\n50500\n50500\nNephrorrhaphy, suture of kidney wound or injury\n$ 3,298.50\n3944\n50520\n50520\nClosure of nephrocutaneous or pyelocutaneous fistula\n$ 2,853.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3945\n50525\n50525\nClosure of nephrovisceral fistula (eg, renocolic), including visceral\nrepair; abdominal approach\n$ 3,438.00\n3946\n50526\n50526\nClosure of nephrovisceral fistula (eg, renocolic), including visceral\nrepair; thoracic approach\n$ 3,501.90\n3947\n50540\n50540\nSymphysiotomy for horseshoe kidney with or without pyeloplasty\nand\/or other plastic procedure, unilateral or bilateral (1 operation)\n$ 4,071.60\n3948\n50541\n50541\nLaparoscopy, surgical; ablation of renal cysts\n$ 2,673.90\n3949\n50542\n50542\nLaparoscopy, surgical; ablation of renal mass lesion(s), including\nintraoperative ultrasound guidance and monitoring, when\nperformed\n$ 2,662.34\n3950\n50543\n50543\nLaparoscopy, surgical; partial nephrectomy\n$ 3,268.75\n3951\n50544\n50544\nLaparoscopy, surgical; pyeloplasty\n$ 3,692.70\n3952\n50545\n50545\nLaparoscopy, surgical; radical nephrectomy (includes removal of\nGerota's fascia and surrounding fatty tissue, removal of regional\nlymph nodes, and adrenalectomy)\n$ 3,990.60\n3953\n50546\n50546\nLaparoscopy, surgical; nephrectomy, including partial ureterectomy\n$ 3,727.80\n3954\n50547\n50547\nLaparoscopy, surgical; donor nephrectomy (including cold\npreservation), from living donor\n$ 4,762.80\n3955\n50548\n50548\nLaparoscopy, surgical; nephrectomy with total ureterectomy\n$ 5,098.50\n3956\n50549\n50549\nUnlisted laparoscopy procedure, renal\nCost\n3957\n50551\n50551\nRenal endoscopy through established nephrostomy or pyelostomy,\nwith or without irrigation, instillation, or ureteropyelography,\nexclusive of radiologic service;\n$ 777.60\n3958\n50553\n50553\nRenal endoscopy through established nephrostomy or pyelostomy,\nwith or without irrigation, instillation, or ureteropyelography,\nexclusive of radiologic service; with ureteral catheterization, with or\nwithout dilation of ureter\n$ 774.00\n3959\n50555\n50555\nRenal endoscopy through established nephrostomy or pyelostomy,\nwith or without irrigation, instillation, or ureteropyelography,\nexclusive of radiologic service; with biopsy\n$ 995.40\n3960\n50557\n50557\nRenal endoscopy through established nephrostomy or pyelostomy,\nwith or without irrigation, instillation, or ureteropyelography,\nexclusive of radiologic service; with fulguration and\/or incision, with\nor without biopsy\n$ 1,017.90\n3961\n50561\n50561\nRenal endoscopy through established nephrostomy or pyelostomy,\nwith or without irrigation, instillation, or ureteropyelography,\nexclusive of radiologic service; with removal of foreign body or\ncalculus\n$ 1,484.10\n3962\n50562\n50562\nRenal endoscopy through established nephrostomy or pyelostomy,\nwith or without irrigation, instillation, or ureteropyelography,\nexclusive of radiologic service; with resection of tumor\n$ 1,158.89\n3963\n50570\n50570\nRenal endoscopy through nephrotomy or pyelotomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service;\n$ 1,117.80\n3964\n50572\n50572\nRenal endoscopy through nephrotomy or pyelotomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with ureteral catheterization, with or without\ndilation of ureter\n$ 2,024.10\n3965\n50574\n50574\nRenal endoscopy through nephrotomy or pyelotomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with biopsy\n$ 2,061.00\n3966\n50575\n50575\nRenal endoscopy through nephrotomy or pyelotomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with endopyelotomy (includes cystoscopy,\nureteroscopy, dilation of ureter and ureteral pelvic junction, inci\n$ 2,292.30\n3967\n50576\n50576\nRenal endoscopy through nephrotomy or pyelotomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with fulguration and\/or incision, with or without\nbiopsy\n$ 1,647.90\n3968\n50580\n50580\nRenal endoscopy through nephrotomy or pyelotomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with removal of foreign body or calculus\n$ 2,277.00\n3969\n50590\n50590\nLithotripsy, extracorporeal shock wave\n$ 3,424.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n3970\n50592\n50592\nAblation, 1 or more renal tumor(s), percutaneous, unilateral,\nradiofrequency\n$ 2,900.54\n3971\n50593\n50593\nAblation, renal tumor(s), unilateral, percutaneous, cryotherapy\n$ 3,501.52\n3972\n50600\n50600\nUreterotomy with exploration or drainage (separate procedure)\n$ 2,530.80\n3973\n50605\n50605\nUreterotomy for insertion of indwelling stent, all types\n$ 2,730.60\n3974\n50610\n50610\nUreterolithotomy; upper one-third of ureter\n$ 3,156.30\n3975\n50620\n50620\nUreterolithotomy; middle one-third of ureter\n$ 3,373.20\n3976\n50630\n50630\nUreterolithotomy; lower one-third of ureter\n$ 3,577.50\n3977\n50650\n50650\nUreterectomy, with bladder cuff (separate procedure)\n$ 3,143.70\n3978\n50660\n50660\nUreterectomy, total, ectopic ureter, combination abdominal,\nvaginal and\/or perineal approach\n$ 3,429.00\n3979\n50684\n50684\nInjection procedure for ureterography or ureteropyelography\nthrough ureterostomy or indwelling ureteral catheter\n$ 153.90\n3980\n50686\n50686\nManometric studies through ureterostomy or indwelling ureteral\ncatheter\n$ 120.60\n3981\n50688\n50688\nChange of ureterostomy tube or externally accessible ureteral stent\nvia ileal conduit\n$ 162.00\n3982\n50690\n50690\nInjection procedure for visualization of ileal conduit and\/or\nureteropyelography, exclusive of radiologic service\n$ 143.10\n3983\n50700\n50700\nUreteroplasty, plastic operation on ureter (eg, stricture)\n$ 2,943.00\n3984\n50715\n50715\nUreterolysis, with or without repositioning of ureter for\nretroperitoneal fibrosis\n$ 2,781.00\n3985\n50722\n50722\nUreterolysis for ovarian vein syndrome\n$ 2,421.00\n3986\n50725\n50725\nUreterolysis for retrocaval ureter, with reanastomosis of upper\nurinary tract or vena cava\n$ 3,769.20\n3987\n50727\n50727\nRevision of urinary-cutaneous anastomosis (any type urostomy);\n$ 1,869.30\n3988\n50728\n50728\nRevision of urinary-cutaneous anastomosis (any type urostomy);\nwith repair of fascial defect and hernia\n$ 2,663.10\n3989\n50740\n50740\nUreteropyelostomy, anastomosis of ureter and renal pelvis\n$ 3,374.10\n3990\n50750\n50750\nUreterocalycostomy, anastomosis of ureter to renal calyx\n$ 3,605.40\n3991\n50760\n50760\nUreteroureterostomy\n$ 3,244.50\n3992\n50770\n50770\nTransureteroureterostomy, anastomosis of ureter to contralateral\nureter\n$ 3,445.20\n3993\n50780\n50780\nUreteroneocystostomy; anastomosis of single ureter to bladder\n$ 3,356.10\n3994\n50782\n50782\nUreteroneocystostomy; anastomosis of duplicated ureter to bladder $ 3,492.90\n3995\n50783\n50783\nUreteroneocystostomy; with extensive ureteral tailoring\n$ 3,594.60\n3996\n50785\n50785\nUreteroneocystostomy; with vesico-psoas hitch or bladder flap\n$ 3,877.20\n3997\n50800\n50800\nUreteroenterostomy, direct anastomosis of ureter to intestine\n$ 3,301.20\n3998\n50810\n50810\nUreterosigmoidostomy, with creation of sigmoid bladder and\nestablishment of abdominal or perineal colostomy, including\nintestine anastomosis\n$ 4,635.00\n3999\n50815\n50815\nUreterocolon conduit, including intestine anastomosis\n$ 4,789.80\n4000\n50820\n50820\nUreteroileal conduit (ileal bladder), including intestine anastomosis\n(Bricker operation)\n$ 5,985.00\n4001\n50825\n50825\nContinent diversion, including intestine anastomosis using any\nsegment of small and\/or large intestine (Kock pouch or Camey\nenterocystoplasty)\n$ 5,768.10\n4002\n50830\n50830\nUrinary undiversion (eg, taking down of ureteroileal conduit,\nureterosigmoidostomy or ureteroenterostomy with\nureteroureterostomy or ureteroneocystostomy)\n$ 5,469.30\n4003\n50840\n50840\nReplacement of all or part of ureter by intestine segment, including\nintestine anastomosis\n$ 3,718.80\n4004\n50845\n50845\nCutaneous appendico-vesicostomy\n$ 4,222.80\n4005\n50860\n50860\nUreterostomy, transplantation of ureter to skin\n$ 2,807.10\n4006\n50900\n50900\nUreterorrhaphy, suture of ureter (separate procedure)\n$ 2,652.30\n4007\n50920\n50920\nClosure of ureterocutaneous fistula\n$ 2,907.90\n4008\n50930\n50930\nClosure of ureterovisceral fistula (including visceral repair)\n$ 3,404.70\n4009\n50940\n50940\nDeligation of ureter\n$ 2,729.70\n4010\n50945\n50945\nLaparoscopy, surgical; ureterolithotomy\n$ 2,889.90\n4011\n50947\n50947\nLaparoscopy, surgical; ureteroneocystostomy with cystoscopy and\nureteral stent placement\n$ 4,301.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4012\n50948\n50948\nLaparoscopy, surgical; ureteroneocystostomy without cystoscopy\nand ureteral stent placement\n$ 3,933.00\n4013\n50949\n50949\nUnlisted laparoscopy procedure, ureter\nCost\n4014\n50951\n50951\nUreteral endoscopy through established ureterostomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service;\n$ 607.50\n4015\n50953\n50953\nUreteral endoscopy through established ureterostomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with ureteral catheterization, with or without\ndilation of ureter\n$ 669.60\n4016\n50955\n50955\nUreteral endoscopy through established ureterostomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with biopsy\n$ 731.70\n4017\n50957\n50957\nUreteral endoscopy through established ureterostomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with fulguration and\/or incision, with or without\nbiopsy\n$ 751.50\n4018\n50961\n50961\nUreteral endoscopy through established ureterostomy, with or\nwithout irrigation, instillation, or ureteropyelography, exclusive of\nradiologic service; with removal of foreign body or calculus\n$ 978.30\n4019\n50970\n50970\nUreteral endoscopy through ureterotomy, with or without\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\nservice;\n$ 824.40\n4020\n50972\n50972\nUreteral endoscopy through ureterotomy, with or without\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\nservice; with ureteral catheterization, with or without dilation of\nureter\n$ 791.10\n4021\n50974\n50974\nUreteral endoscopy through ureterotomy, with or without\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\nservice; with biopsy\n$ 1,133.10\n4022\n50976\n50976\nUreteral endoscopy through ureterotomy, with or without\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\nservice; with fulguration and\/or incision, with or without biopsy\n$ 1,040.40\n4023\n50980\n50980\nUreteral endoscopy through ureterotomy, with or without\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\nservice; with removal of foreign body or calculus\n$ 936.90\n4024\n51020\n51020\nCystotomy or cystostomy; with fulguration and\/or insertion of\nradioactive material\n$ 1,968.30\n4025\n51030\n51030\nCystotomy or cystostomy; with cryosurgical destruction of\nintravesical lesion\n$ 1,923.30\n4026\n51040\n51040\nCystostomy, cystotomy with drainage\n$ 1,717.20\n4027\n51045\n51045\nCystotomy, with insertion of ureteral catheter or stent (separate\nprocedure)\n$ 1,909.80\n4028\n51050\n51050\nCystolithotomy, cystotomy with removal of calculus, without vesical\nneck resection\n$ 2,162.70\n4029\n51060\n51060\nTransvesical ureterolithotomy\n$ 2,581.20\n4030\n51065\n51065\nCystotomy, with calculus basket extraction and\/or ultrasonic or\nelectrohydraulic fragmentation of ureteral calculus\n$ 2,421.00\n4031\n51080\n51080\nDrainage of perivesical or prevesical space abscess\n$ 1,701.90\n4032\n51100\n51100\nAspiration of bladder; by needle\n$ 178.51\n4033\n51101\n51101\nAspiration of bladder; by trocar or intracatheter\n$ 271.08\n4034\n51102\n51102\nAspiration of bladder; with insertion of suprapubic catheter\n$ 591.70\n4035\n51500\n51500\nExcision of urachal cyst or sinus, with or without umbilical hernia\nrepair\n$ 2,151.00\n4036\n51520\n51520\nCystotomy; for simple excision of vesical neck (separate procedure)\n$ 2,277.00\n4037\n51525\n51525\nCystotomy; for excision of bladder diverticulum, single or multiple\n(separate procedure)\n$ 2,837.70\n4038\n51530\n51530\nCystotomy; for excision of bladder tumor\n$ 2,457.00\n4039\n51535\n51535\nCystotomy for excision, incision, or repair of ureterocele\n$ 2,631.60\n4040\n51550\n51550\nCystectomy, partial; simple\n$ 2,953.80\n4041\n51555\n51555\nCystectomy, partial; complicated (eg, postradiation, previous\nsurgery, difficult location)\n$ 3,749.40\n4042\n51565\n51565\nCystectomy, partial, with reimplantation of ureter(s) into bladder\n(ureteroneocystostomy)\n$ 4,053.60\n4043\n51570\n51570\nCystectomy, complete; (separate procedure)\n$ 5,027.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4044\n51575\n51575\nCystectomy, complete; with bilateral pelvic lymphadenectomy,\nincluding external iliac, hypogastric, and obturator nodes\n$ 6,365.70\n4045\n51580\n51580\nCystectomy, complete, with ureterosigmoidostomy or\nureterocutaneous transplantations;\n$ 5,994.00\n4046\n51585\n51585\nCystectomy, complete, with ureterosigmoidostomy or\nureterocutaneous transplantations; with bilateral pelvic\nlymphadenectomy, including external iliac, hypogastric, and\nobturator nodes\n$ 6,684.30\n4047\n51590\n51590\nCystectomy, complete, with ureteroileal conduit or sigmoid bladder,\nincluding intestine anastomosis;\n$ 7,559.10\n4048\n51595\n51595\nCystectomy, complete, with ureteroileal conduit or sigmoid bladder,\nincluding intestine anastomosis; with bilateral pelvic\nlymphadenectomy, including external iliac, hypogastric, and\nobturator nodes\n$ 8,475.30\n4049\n51596\n51596\nCystectomy, complete, with continent diversion, any open\ntechnique, using any segment of small and\/or large intestine to\nconstruct neobladder\n$ 8,883.90\n4050\n51597\n51597\nPelvic exenteration, complete, for vesical, prostatic or urethral\nmalignancy, with removal of bladder and ureteral transplantations,\nwith or without hysterectomy and\/or abdominoperineal resection\nof rectum and colon and colostomy, or any combination there\n$ 10,661.40\n4051\n51600\n51600\nInjection procedure for cystography or voiding urethrocystography\n$ 147.60\n4052\n51605\n51605\nInjection procedure and placement of chain for contrast and\/or\nchain urethrocystography\n$ 128.70\n4053\n51610\n51610\nInjection procedure for retrograde urethrocystography\n$ 185.40\n4054\n51700\n51700\nBladder irrigation, simple, lavage and\/or instillation\n$ 116.10\n4055\n51701\n51701\nInsertion of non-indwelling bladder catheter (eg, straight\ncatheterization for residual urine)\n$ 119.17\n4056\n51702\n51702\nInsertion of temporary indwelling bladder catheter; simple (eg,\nFoley)\n$ 222.55\n4057\n51705\n51705\nChange of cystostomy tube; simple\n$ 105.30\n4058\n51710\n51710\nChange of cystostomy tube; complicated\n$ 319.50\n4059\n51715\n51715\nEndoscopic injection of implant material into the submucosal\ntissues of the urethra and\/or bladder neck\n$ 925.20\n4060\n51720\n51720\nBladder instillation of anticarcinogenic agent (including retention\ntime)\n$ 173.70\n4061\n51725\n51725\nSimple cystometrogram (CMG) (eg, spinal manometer)\n$ 301.50\n4062\n51725-26 26\n51725\nSimple cystometrogram (CMG) (eg, spinal manometer)\n$ 253.80\n4063\n51725-TC TC\n51725\nSimple cystometrogram (CMG) (eg, spinal manometer)\n$ 187.19\n4064\n51726\n51726\nComplex cystometrogram (ie, calibrated electronic equipment);\n$ 369.00\n4065\n51726-26 26\n51726\nComplex cystometrogram (ie, calibrated electronic equipment);\n$ 369.00\n4066\n51726-TC TC\n51726\nComplex cystometrogram (ie, calibrated electronic equipment);\n$ 369.00\n4067\n51727\n51727\nComplex cystometrogram (ie, calibrated electronic equipment);\nwith urethral pressure profile studies (ie, urethral closure pressure\nprofile), any technique\n$ 686.90\n4068\n51728\n51728\nComplex cystometrogram (ie, calibrated electronic equipment);\nwith voiding pressure studies (ie, bladder voiding pressure), any\ntechnique\n$ 686.02\n4069\n51729\n51729\nComplex cystometrogram (ie, calibrated electronic equipment);\nwith voiding pressure studies (ie, bladder voiding pressure) and\nurethral pressure profile studies (ie, urethral closure pressure\nprofile), any technique\n$ 704.40\n4070\n51736\n51736\nSimple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical\nuroflowmeter)\n$ 157.50\n4071\n51736-26 26\n51736\nSimple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical\nuroflowmeter)\n$ 131.40\n4072\n51736-TC TC\n51736\nSimple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical\nuroflowmeter)\n$ 77.28\n4073\n51741\n51741\nComplex uroflowmetry (eg, calibrated electronic equipment)\n$ 159.30\n4074\n51741-26 26\n51741\nComplex uroflowmetry (eg, calibrated electronic equipment)\n$ 134.10\n4075\n51741-TC TC\n51741\nComplex uroflowmetry (eg, calibrated electronic equipment)\n$ 79.98\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4076\n51784\n51784\nElectromyography studies (EMG) of anal or urethral sphincter, other\nthan needle, any technique\n$ 236.70\n4077\n51784-26 26\n51784\nElectromyography studies (EMG) of anal or urethral sphincter, other\nthan needle, any technique\n$ 201.60\n4078\n51784-TC TC\n51784\nElectromyography studies (EMG) of anal or urethral sphincter, other\nthan needle, any technique\n$ 148.69\n4079\n51785\n51785\nNeedle electromyography studies (EMG) of anal or urethral\nsphincter, any technique\n$ 247.50\n4080\n51785-26 26\n51785\nNeedle electromyography studies (EMG) of anal or urethral\nsphincter, any technique\n$ 207.00\n4081\n51785-TC TC\n51785\nNeedle electromyography studies (EMG) of anal or urethral\nsphincter, any technique\n$ 175.98\n4082\n51792\n51792\nStimulus evoked response (eg, measurement of bulbocavernosus\nreflex latency time)\n$ 239.40\n4083\n51792-26 26\n51792\nStimulus evoked response (eg, measurement of bulbocavernosus\nreflex latency time)\n$ 202.50\n4084\n51792-TC TC\n51792\nStimulus evoked response (eg, measurement of bulbocavernosus\nreflex latency time)\n$ 181.58\n4085\n51797\n51797\nVoiding pressure studies, intra-abdominal (ie, rectal, gastric,\nintraperitoneal) (List separately in addition to code for primary\nprocedure)\n$ 247.50\n4086\n51797-26 26\n51797\nVoiding pressure studies, intra-abdominal (ie, rectal, gastric,\nintraperitoneal) (List separately in addition to code for primary\nprocedure)\n$ 207.00\n4087\n51797-TC TC\n51797\nVoiding pressure studies, intra-abdominal (ie, rectal, gastric,\nintraperitoneal) (List separately in addition to code for primary\nprocedure)\n$ 166.46\n4088\n51798\n51798\nMeasurement of post-voiding residual urine and\/or bladder\ncapacity by ultrasound, non-imaging\n$ 51.15\n4089\n51800\n51800\nCystoplasty or cystourethroplasty, plastic operation on bladder\nand\/or vesical neck (anterior Y-plasty, vesical fundus resection), any\nprocedure, with or without wedge resection of posterior vesical\nneck\n$ 2,849.40\n4090\n51820\n51820\nCystourethroplasty with unilateral or bilateral\nureteroneocystostomy\n$ 3,780.00\n4091\n51840\n51840\nAnterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-\nKrantz, Burch); simple\n$ 2,495.70\n4092\n51841\n51841\nAnterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-\nKrantz, Burch); complicated (eg, secondary repair)\n$ 2,781.00\n4093\n51845\n51845\nAbdomino-vaginal vesical neck suspension, with or without\nendoscopic control (eg, Stamey, Raz, modified Pereyra)\n$ 2,781.00\n4094\n51860\n51860\nCystorrhaphy, suture of bladder wound, injury or rupture; simple\n$ 2,200.50\n4095\n51865\n51865\nCystorrhaphy, suture of bladder wound, injury or rupture;\ncomplicated\n$ 2,982.60\n4096\n51880\n51880\nClosure of cystostomy (separate procedure)\n$ 1,339.20\n4097\n51900\n51900\nClosure of vesicovaginal fistula, abdominal approach\n$ 3,454.20\n4098\n51920\n51920\nClosure of vesicouterine fistula;\n$ 2,559.60\n4099\n51925\n51925\nClosure of vesicouterine fistula; with hysterectomy\n$ 3,301.20\n4100\n51940\n51940\nClosure, exstrophy of bladder\n$ 4,738.50\n4101\n51960\n51960\nEnterocystoplasty, including intestinal anastomosis\n$ 4,652.10\n4102\n51980\n51980\nCutaneous vesicostomy\n$ 2,439.00\n4103\n51990\n51990\nLaparoscopy, surgical; urethral suspension for stress incontinence\n$ 2,447.10\n4104\n51992\n51992\nLaparoscopy, surgical; sling operation for stress incontinence (eg,\nfascia or synthetic)\n$ 2,637.00\n4105\n51999\n51999\nUnlisted laparoscopy procedure, bladder\nCost\n4106\n52000\n52000\nCystourethroscopy (separate procedure)\n$ 405.34\n4107\n52001\n52001\nCystourethroscopy with irrigation and evacuation of multiple\nobstructing clots\n$ 676.66\n4108\n52005\n52005\nCystourethroscopy, with ureteral catheterization, with or without\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\nservice;\n$ 579.60\n4109\n52007\n52007\nCystourethroscopy, with ureteral catheterization, with or without\nirrigation, instillation, or ureteropyelography, exclusive of radiologic\nservice; with brush biopsy of ureter and\/or renal pelvis\n$ 640.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4110\n52010\n52010\nCystourethroscopy, with ejaculatory duct catheterization, with or\nwithout irrigation, instillation, or duct radiography, exclusive of\nradiologic service\n$ 576.00\n4111\n52204\n52204\nCystourethroscopy, with biopsy(s)\n$ 595.75\n4112\n52214\n52214\nCystourethroscopy, with fulguration (including cryosurgery or laser\nsurgery) of trigone, bladder neck, prostatic fossa, urethra, or\nperiurethral glands\n$ 769.50\n4113\n52224\n52224\nCystourethroscopy, with fulguration (including cryosurgery or laser\nsurgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or\nwithout biopsy\n$ 747.00\n4114\n52234\n52234\nCystourethroscopy, with fulguration (including cryosurgery or laser\nsurgery) and\/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0\ncm)\n$ 1,017.90\n4115\n52235\n52235\nCystourethroscopy, with fulguration (including cryosurgery or laser\nsurgery) and\/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0\ncm)\n$ 1,761.30\n4116\n52240\n52240\nCystourethroscopy, with fulguration (including cryosurgery or laser\nsurgery) and\/or resection of; LARGE bladder tumor(s)\n$ 2,543.40\n4117\n52250\n52250\nCystourethroscopy with insertion of radioactive substance, with or\nwithout biopsy or fulguration\n$ 849.60\n4118\n52260\n52260\nCystourethroscopy, with dilation of bladder for interstitial cystitis;\ngeneral or conduction (spinal) anesthesia\n$ 592.18\n4119\n52265\n52265\nCystourethroscopy, with dilation of bladder for interstitial cystitis;\nlocal anesthesia\n$ 540.90\n4120\n52270\n52270\nCystourethroscopy, with internal urethrotomy; female\n$ 819.00\n4121\n52275\n52275\nCystourethroscopy, with internal urethrotomy; male\n$ 882.00\n4122\n52276\n52276\nCystourethroscopy with direct vision internal urethrotomy\n$ 1,261.80\n4123\n52277\n52277\nCystourethroscopy, with resection of external sphincter\n(sphincterotomy)\n$ 1,206.90\n4124\n52281\n52281\nCystourethroscopy, with calibration and\/or dilation of urethral\nstricture or stenosis, with or without meatotomy, with or without\ninjection procedure for cystography, male or female\n$ 580.93\n4125\n52282\n52282\nCystourethroscopy, with insertion of permanent urethral stent\n$ 1,030.50\n4126\n52283\n52283\nCystourethroscopy, with steroid injection into stricture\n$ 563.40\n4127\n52285\n52285\nCystourethroscopy for treatment of the female urethral syndrome\nwith any or all of the following: urethral meatotomy, urethral\ndilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis,\nlateral incisions of the bladder neck, and fulguration\n$ 686.56\n4128\n52290\n52290\nCystourethroscopy; with ureteral meatotomy, unilateral or bilateral\n$ 737.10\n4129\n52300\n52300\nCystourethroscopy; with resection or fulguration of orthotopic\nureterocele(s), unilateral or bilateral\n$ 975.60\n4130\n52301\n52301\nCystourethroscopy; with resection or fulguration of ectopic\nureterocele(s), unilateral or bilateral\n$ 1,035.00\n4131\n52305\n52305\nCystourethroscopy; with incision or resection of orifice of bladder\ndiverticulum, single or multiple\n$ 1,019.70\n4132\n52310\n52310\nCystourethroscopy, with removal of foreign body, calculus, or\nureteral stent from urethra or bladder (separate procedure); simple $ 751.50\n4133\n52315\n52315\nCystourethroscopy, with removal of foreign body, calculus, or\nureteral stent from urethra or bladder (separate procedure);\ncomplicated\n$ 1,328.40\n4134\n52317\n52317\nLitholapaxy: crushing or fragmentation of calculus by any means in\nbladder and removal of fragments; simple or small (less than 2.5\ncm)\n$ 1,377.90\n4135\n52318\n52318\nLitholapaxy: crushing or fragmentation of calculus by any means in\nbladder and removal of fragments; complicated or large (over 2.5\ncm)\n$ 1,948.50\n4136\n52320\n52320\nCystourethroscopy (including ureteral catheterization); with\nremoval of ureteral calculus\n$ 1,344.60\n4137\n52325\n52325\nCystourethroscopy (including ureteral catheterization); with\nfragmentation of ureteral calculus (eg, ultrasonic or electro-\nhydraulic technique)\n$ 1,559.70\n4138\n52327\n52327\nCystourethroscopy (including ureteral catheterization); with\nsubureteric injection of implant material\n$ 1,081.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4139\n52330\n52330\nCystourethroscopy (including ureteral catheterization); with\nmanipulation, without removal of ureteral calculus\n$ 953.10\n4140\n52332\n52332\nCystourethroscopy, with insertion of indwelling ureteral stent (eg,\nGibbons or double-J type)\n$ 924.30\n4141\n52334\n52334\nCystourethroscopy with insertion of ureteral guide wire through\nkidney to establish a percutaneous nephrostomy, retrograde\n$ 875.70\n4142\n52341\n52341\nCystourethroscopy; with treatment of ureteral stricture (eg, balloon\ndilation, laser, electrocautery, and incision)\n$ 1,350.00\n4143\n52342\n52342\nCystourethroscopy; with treatment of ureteropelvic junction\nstricture (eg, balloon dilation, laser, electrocautery, and incision)\n$ 1,461.60\n4144\n52343\n52343\nCystourethroscopy; with treatment of intra-renal stricture (eg,\nballoon dilation, laser, electrocautery, and incision)\n$ 1,619.10\n4145\n52344\n52344\nCystourethroscopy with ureteroscopy; with treatment of ureteral\nstricture (eg, balloon dilation, laser, electrocautery, and incision)\n$ 1,776.60\n4146\n52345\n52345\nCystourethroscopy with ureteroscopy; with treatment of\nureteropelvic junction stricture (eg, balloon dilation, laser,\nelectrocautery, and incision)\n$ 1,845.00\n4147\n52346\n52346\nCystourethroscopy with ureteroscopy; with treatment of intra-renal\nstricture (eg, balloon dilation, laser, electrocautery, and incision)\n$ 2,074.50\n4148\n52351\n52351\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy;\ndiagnostic\n$ 1,377.90\n4149\n52352\n52352\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\nremoval or manipulation of calculus (ureteral catheterization is\nincluded)\n$ 1,629.42\n4150\n52353\n52353\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\nlithotripsy (ureteral catheterization is included)\n$ 2,027.72\n4151\n52354\n52354\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\nbiopsy and\/or fulguration of ureteral or renal pelvic lesion\n$ 1,728.00\n4152\n52355\n52355\nCystourethroscopy, with ureteroscopy and\/or pyeloscopy; with\nresection of ureteral or renal pelvic tumor\n$ 2,030.40\n4153\n52400\n52400\nCystourethroscopy with incision, fulguration, or resection of\ncongenital posterior urethral valves, or congenital obstructive\nhypertrophic mucosal folds\n$ 2,414.70\n4154\n52402\n52402\nCystourethroscopy with transurethral resection or incision of\nejaculatory ducts\n$ 641.48\n4155\n52450\n52450\nTransurethral incision of prostate\n$ 1,562.40\n4156\n52500\n52500\nTransurethral resection of bladder neck (separate procedure)\n$ 1,719.90\n4157\n52601\n52601\nTransurethral electrosurgical resection of prostate, including control\nof postoperative bleeding, complete (vasectomy, meatotomy,\ncystourethroscopy, urethral calibration and\/or dilation, and internal\nurethrotomy are included)\n$ 2,701.80\n4158\n52630\n52630\nTransurethral resection; residual or regrowth of obstructive\nprostate tissue including control of postoperative bleeding,\ncomplete (vasectomy, meatotomy, cystourethroscopy, urethral\ncalibration and\/or dilation, and internal urethrotomy are included)\n$ 2,482.20\n4159\n52640\n52640\nTransurethral resection; of postoperative bladder neck contracture\n$ 2,140.20\n4160\n52647\n52647\nLaser coagulation of prostate, including control of postoperative\nbleeding, complete (vasectomy, meatotomy, cystourethroscopy,\nurethral calibration and\/or dilation, and internal urethrotomy are\nincluded if performed)\n$ 2,169.90\n4161\n52648\n52648\nLaser vaporization of prostate, including control of postoperative\nbleeding, complete (vasectomy, meatotomy, cystourethroscopy,\nurethral calibration and\/or dilation, internal urethrotomy and\ntransurethral resection of prostate are included if performed)\n$ 2,472.30\n4162\n52649\n52649\nLaser enucleation of the prostate with morcellation, including\ncontrol of postoperative bleeding, complete (vasectomy,\nmeatotomy, cystourethroscopy, urethral calibration and\/or dilation,\ninternal urethrotomy and transurethral resection of prostate are inc $ 2,156.95\n4163\n52700\n52700\nTransurethral drainage of prostatic abscess\n$ 1,305.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4164\n53000\n53000\nUrethrotomy or urethrostomy, external (separate procedure);\npendulous urethra\n$ 414.90\n4165\n53010\n53010\nUrethrotomy or urethrostomy, external (separate procedure);\nperineal urethra, external\n$ 914.40\n4166\n53020\n53020\nMeatotomy, cutting of meatus (separate procedure); except infant\n$ 583.86\n4167\n53025\n53025\nMeatotomy, cutting of meatus (separate procedure); infant\n$ 236.70\n4168\n53040\n53040\nDrainage of deep periurethral abscess\n$ 692.10\n4169\n53060\n53060\nDrainage of Skene's gland abscess or cyst\n$ 322.20\n4170\n53080\n53080\nDrainage of perineal urinary extravasation; uncomplicated (separate\nprocedure)\n$ 761.40\n4171\n53085\n53085\nDrainage of perineal urinary extravasation; complicated\n$ 1,825.20\n4172\n53200\n53200\nBiopsy of urethra\n$ 473.40\n4173\n53210\n53210\nUrethrectomy, total, including cystostomy; female\n$ 2,104.20\n4174\n53215\n53215\nUrethrectomy, total, including cystostomy; male\n$ 2,781.00\n4175\n53220\n53220\nExcision or fulguration of carcinoma of urethra\n$ 1,617.30\n4176\n53230\n53230\nExcision of urethral diverticulum (separate procedure); female\n$ 2,214.90\n4177\n53235\n53235\nExcision of urethral diverticulum (separate procedure); male\n$ 2,060.10\n4178\n53240\n53240\nMarsupialization of urethral diverticulum, male or female\n$ 852.30\n4179\n53250\n53250\nExcision of bulbourethral gland (Cowper's gland)\n$ 1,313.10\n4180\n53260\n53260\nExcision or fulguration; urethral polyp(s), distal urethra\n$ 520.20\n4181\n53265\n53265\nExcision or fulguration; urethral caruncle\n$ 530.10\n4182\n53270\n53270\nExcision or fulguration; Skene's glands\n$ 564.30\n4183\n53275\n53275\nExcision or fulguration; urethral prolapse\n$ 622.80\n4184\n53400\n53400\nUrethroplasty; first stage, for fistula, diverticulum, or stricture (eg,\nJohannsen type)\n$ 1,926.90\n4185\n53405\n53405\nUrethroplasty; second stage (formation of urethra), including\nurinary diversion\n$ 2,250.90\n4186\n53410\n53410\nUrethroplasty, 1-stage reconstruction of male anterior urethra\n$ 2,686.50\n4187\n53415\n53415\nUrethroplasty, transpubic or perineal, 1-stage, for reconstruction or\nrepair of prostatic or membranous urethra\n$ 3,239.10\n4188\n53420\n53420\nUrethroplasty, 2-stage reconstruction or repair of prostatic or\nmembranous urethra; first stage\n$ 2,888.10\n4189\n53425\n53425\nUrethroplasty, 2-stage reconstruction or repair of prostatic or\nmembranous urethra; second stage\n$ 2,995.20\n4190\n53430\n53430\nUrethroplasty, reconstruction of female urethra\n$ 2,496.60\n4191\n53431\n53431\nUrethroplasty with tubularization of posterior urethra and\/or lower\nbladder for incontinence (eg, Tenago, Leadbetter procedure)\n$ 2,797.78\n4192\n53440\n53440\nSling operation for correction of male urinary incontinence (eg,\nfascia or synthetic)\n$ 2,991.60\n4193\n53442\n53442\nRemoval or revision of sling for male urinary incontinence (eg, fascia\nor synthetic)\n$ 1,171.80\n4194\n53444\n53444\nInsertion of tandem cuff (dual cuff)\n$ 2,081.89\n4195\n53445\n53445\nInsertion of inflatable urethral\/bladder neck sphincter, including\nplacement of pump, reservoir, and cuff\n$ 5,150.70\n4196\n53446\n53446\nRemoval of inflatable urethral\/bladder neck sphincter, including\npump, reservoir, and cuff\n$ 1,825.77\n4197\n53447\n53447\nRemoval and replacement of inflatable urethral\/bladder neck\nsphincter including pump, reservoir, and cuff at the same operative\nsession\n$ 2,507.40\n4198\n53448\n53448\nRemoval and replacement of inflatable urethral\/bladder neck\nsphincter including pump, reservoir, and cuff through an infected\nfield at the same operative session including irrigation and\ndebridement of infected tissue\n$ 3,364.59\n4199\n53449\n53449\nRepair of inflatable urethral\/bladder neck sphincter, including\npump, reservoir, and cuff\n$ 1,864.80\n4200\n53450\n53450\nUrethromeatoplasty, with mucosal advancement\n$ 720.90\n4201\n53460\n53460\nUrethromeatoplasty, with partial excision of distal urethral segment\n(Richardson type procedure)\n$ 726.30\n4202\n53500\n53500\nUrethrolysis, transvaginal, secondary, open, including\ncystourethroscopy (eg, postsurgical obstruction, scarring)\n$ 1,914.08\n4203\n53502\n53502\nUrethrorrhaphy, suture of urethral wound or injury, female\n$ 1,486.80\n4204\n53505\n53505\nUrethrorrhaphy, suture of urethral wound or injury; penile\n$ 1,532.70\n4205\n53510\n53510\nUrethrorrhaphy, suture of urethral wound or injury; perineal\n$ 1,917.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4206\n53515\n53515\nUrethrorrhaphy, suture of urethral wound or injury;\nprostatomembranous\n$ 2,654.10\n4207\n53520\n53520\nClosure of urethrostomy or urethrocutaneous fistula, male\n(separate procedure)\n$ 1,213.20\n4208\n53600\n53600\nDilation of urethral stricture by passage of sound or urethral dilator,\nmale; initial\n$ 154.80\n4209\n53601\n53601\nDilation of urethral stricture by passage of sound or urethral dilator,\nmale; subsequent\n$ 149.40\n4210\n53605\n53605\nDilation of urethral stricture or vesical neck by passage of sound or\nurethral dilator, male, general or conduction (spinal) anesthesia\n$ 230.40\n4211\n53620\n53620\nDilation of urethral stricture by passage of filiform and follower,\nmale; initial\n$ 218.70\n4212\n53621\n53621\nDilation of urethral stricture by passage of filiform and follower,\nmale; subsequent\n$ 137.70\n4213\n53660\n53660\nDilation of female urethra including suppository and\/or instillation;\ninitial\n$ 114.30\n4214\n53661\n53661\nDilation of female urethra including suppository and\/or instillation;\nsubsequent\n$ 120.60\n4215\n53665\n53665\nDilation of female urethra, general or conduction (spinal) anesthesia $ 215.10\n4216\n53850\n53850\nTransurethral destruction of prostate tissue; by microwave\nthermotherapy\n$ 1,637.10\n4217\n53852\n53852\nTransurethral destruction of prostate tissue; by radiofrequency\nthermotherapy\n$ 1,448.10\n4218\n53855\n53855\nInsertion of a temporary prostatic urethral stent, including urethral\nmeasurement\n$ 1,749.79\n4219\n53899\n53899\nUnlisted procedure, urinary system\nCost\n4220\n54000\n54000\nSlitting of prepuce, dorsal or lateral (separate procedure); newborn\n$ 164.70\n4221\n54001\n54001\nSlitting of prepuce, dorsal or lateral (separate procedure); except\nnewborn\n$ 314.10\n4222\n54015\n54015\nIncision and drainage of penis, deep\n$ 437.40\n4223\n54050\n54050\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\nmolluscum contagiosum, herpetic vesicle), simple; chemical\n$ 134.50\n4224\n54055\n54055\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\nmolluscum contagiosum, herpetic vesicle), simple;\nelectrodesiccation\n$ 271.58\n4225\n54056\n54056\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\nmolluscum contagiosum, herpetic vesicle), simple; cryosurgery\n$ 239.88\n4226\n54057\n54057\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\nmolluscum contagiosum, herpetic vesicle), simple; laser surgery\n$ 601.20\n4227\n54060\n54060\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\nmolluscum contagiosum, herpetic vesicle), simple; surgical excision\n$ 481.62\n4228\n54065\n54065\nDestruction of lesion(s), penis (eg, condyloma, papilloma,\nmolluscum contagiosum, herpetic vesicle), extensive (eg, laser\nsurgery, electrosurgery, cryosurgery, chemosurgery)\n$ 906.65\n4229\n54100\n54100\nBiopsy of penis; (separate procedure)\n$ 266.40\n4230\n54105\n54105\nBiopsy of penis; deep structures\n$ 447.30\n4231\n54110\n54110\nExcision of penile plaque (Peyronie disease);\n$ 1,395.90\n4232\n54111\n54111\nExcision of penile plaque (Peyronie disease); with graft to 5 cm in\nlength\n$ 2,362.50\n4233\n54112\n54112\nExcision of penile plaque (Peyronie disease); with graft greater than\n5 cm in length\n$ 2,682.90\n4234\n54115\n54115\nRemoval foreign body from deep penile tissue (eg, plastic implant)\n$ 1,062.00\n4235\n54120\n54120\nAmputation of penis; partial\n$ 2,043.00\n4236\n54125\n54125\nAmputation of penis; complete\n$ 2,709.00\n4237\n54130\n54130\nAmputation of penis, radical; with bilateral inguinofemoral\nlymphadenectomy\n$ 3,754.80\n4238\n54135\n54135\nAmputation of penis, radical; in continuity with bilateral pelvic\nlymphadenectomy, including external iliac, hypogastric and\nobturator nodes\n$ 4,963.50\n4239\n54150\n54150\nCircumcision, using clamp or other device with regional dorsal\npenile or ring block\n$ 272.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4240\n54160\n54160\nCircumcision, surgical excision other than clamp, device, or dorsal\nslit; neonate (28 days of age or less)\n$ 403.94\n4241\n54161\n54161\nCircumcision, surgical excision other than clamp, device, or dorsal\nslit; older than 28 days of age\n$ 860.79\n4242\n54162\n54162\nLysis or excision of penile post-circumcision adhesions\n$ 426.82\n4243\n54163\n54163\nRepair incomplete circumcision\n$ 415.19\n4244\n54164\n54164\nFrenulotomy of penis\n$ 409.15\n4245\n54200\n54200\nInjection procedure for Peyronie disease;\n$ 129.60\n4246\n54205\n54205\nInjection procedure for Peyronie disease; with surgical exposure of\nplaque\n$ 1,035.00\n4247\n54220\n54220\nIrrigation of corpora cavernosa for priapism\n$ 500.40\n4248\n54230\n54230\nInjection procedure for corpora cavernosography\n$ 298.80\n4249\n54231\n54231\nDynamic cavernosometry, including intracavernosal injection of\nvasoactive drugs (eg, papaverine, phentolamine)\n$ 468.90\n4250\n54235\n54235\nInjection of corpora cavernosa with pharmacologic agent(s) (eg,\npapaverine, phentolamine)\n$ 206.10\n4251\n54240\n54240\nPenile plethysmography\n$ 298.80\n4252\n54240-26 26\n54240\nPenile plethysmography\n$ 250.20\n4253\n54240-TC TC\n54240\nPenile plethysmography\n$ 114.40\n4254\n54250\n54250\nNocturnal penile tumescence and\/or rigidity test\n$ 354.60\n4255\n54250-26 26\n54250\nNocturnal penile tumescence and\/or rigidity test\n$ 300.60\n4256\n54250-TC TC\n54250\nNocturnal penile tumescence and\/or rigidity test\n$ 36.49\n4257\n54300\n54300\nPlastic operation of penis for straightening of chordee (eg,\nhypospadias), with or without mobilization of urethra\n$ 1,865.70\n4258\n54304\n54304\nPlastic operation on penis for correction of chordee or for first stage\nhypospadias repair with or without transplantation of prepuce\nand\/or skin flaps\n$ 2,242.80\n4259\n54308\n54308\nUrethroplasty for second stage hypospadias repair (including\nurinary diversion); less than 3 cm\n$ 2,268.00\n4260\n54312\n54312\nUrethroplasty for second stage hypospadias repair (including\nurinary diversion); greater than 3 cm\n$ 2,523.60\n4261\n54316\n54316\nUrethroplasty for second stage hypospadias repair (including\nurinary diversion) with free skin graft obtained from site other than\ngenitalia\n$ 3,016.80\n4262\n54318\n54318\nUrethroplasty for third stage hypospadias repair to release penis\nfrom scrotum (eg, third stage Cecil repair)\n$ 1,798.20\n4263\n54322\n54322\n1-stage distal hypospadias repair (with or without chordee or\ncircumcision); with simple meatal advancement (eg, Magpi, V-flap)\n$ 2,155.50\n4264\n54324\n54324\n1-stage distal hypospadias repair (with or without chordee or\ncircumcision); with urethroplasty by local skin flaps (eg, flip-flap,\nprepucial flap)\n$ 2,382.30\n4265\n54326\n54326\n1-stage distal hypospadias repair (with or without chordee or\ncircumcision); with urethroplasty by local skin flaps and mobilization\nof urethra\n$ 2,894.40\n4266\n54328\n54328\n1-stage distal hypospadias repair (with or without chordee or\ncircumcision); with extensive dissection to correct chordee and\nurethroplasty with local skin flaps, skin graft patch, and\/or island\nflap\n$ 3,250.80\n4267\n54332\n54332\n1-stage proximal penile or penoscrotal hypospadias repair requiring\nextensive dissection to correct chordee and urethroplasty by use of\nskin graft tube and\/or island flap\n$ 3,355.20\n4268\n54336\n54336\n1-stage perineal hypospadias repair requiring extensive dissection\nto correct chordee and urethroplasty by use of skin graft tube\nand\/or island flap\n$ 3,821.40\n4269\n54340\n54340\nRepair of hypospadias complications (ie, fistula, stricture,\ndiverticula); by closure, incision, or excision, simple\n$ 1,658.70\n4270\n54344\n54344\nRepair of hypospadias complications (ie, fistula, stricture,\ndiverticula); requiring mobilization of skin flaps and urethroplasty\nwith flap or patch graft\n$ 2,642.40\n4271\n54348\n54348\nRepair of hypospadias complications (ie, fistula, stricture,\ndiverticula); requiring extensive dissection and urethroplasty with\nflap, patch or tubed graft (includes urinary diversion)\n$ 2,793.60\n4272\n54352\n54352\nRepair of hypospadias cripple requiring extensive dissection and\nexcision of previously constructed structures including re-release of\nchordee and reconstruction of urethra and penis by use of local skin\nas grafts and island flaps and skin brought in as f\n$ 4,481.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4273\n54360\n54360\nPlastic operation on penis to correct angulation\n$ 2,171.70\n4274\n54380\n54380\nPlastic operation on penis for epispadias distal to external sphincter; $ 1,931.40\n4275\n54385\n54385\nPlastic operation on penis for epispadias distal to external sphincter;\nwith incontinence\n$ 2,791.80\n4276\n54390\n54390\nPlastic operation on penis for epispadias distal to external sphincter;\nwith exstrophy of bladder\n$ 3,728.70\n4277\n54400\n54400\nInsertion of penile prosthesis; non-inflatable (semi-rigid)\n$ 2,731.50\n4278\n54401\n54401\nInsertion of penile prosthesis; inflatable (self-contained)\n$ 3,038.40\n4279\n54405\n54405\nInsertion of multi-component, inflatable penile prosthesis, including\nplacement of pump, cylinders, and reservoir\n$ 4,616.10\n4280\n54406\n54406\nRemoval of all components of a multi-component, inflatable penile\nprosthesis without replacement of prosthesis\n$ 1,880.16\n4281\n54408\n54408\nRepair of component(s) of a multi-component, inflatable penile\nprosthesis\n$ 1,921.58\n4282\n54410\n54410\nRemoval and replacement of all component(s) of a multi-\ncomponent, inflatable penile prosthesis at the same operative\nsession\n$ 2,100.99\n4283\n54411\n54411\nRemoval and replacement of all components of a multi-component\ninflatable penile prosthesis through an infected field at the same\noperative session, including irrigation and debridement of infected\ntissue\n$ 2,627.25\n4284\n54415\n54415\nRemoval of non-inflatable (semi-rigid) or inflatable (self-contained)\npenile prosthesis, without replacement of prosthesis\n$ 1,371.75\n4285\n54416\n54416\nRemoval and replacement of non-inflatable (semi-rigid) or inflatable\n(self-contained) penile prosthesis at the same operative session\n$ 1,604.70\n4286\n54417\n54417\nRemoval and replacement of non-inflatable (semi-rigid) or inflatable\n(self-contained) penile prosthesis through an infected field at the\nsame operative session, including irrigation and debridement of\ninfected tissue\n$ 2,244.96\n4287\n54420\n54420\nCorpora cavernosa-saphenous vein shunt (priapism operation),\nunilateral or bilateral\n$ 2,497.50\n4288\n54430\n54430\nCorpora cavernosa-corpus spongiosum shunt (priapism operation),\nunilateral or bilateral\n$ 2,107.80\n4289\n54435\n54435\nCorpora cavernosa-glans penis fistulization (eg, biopsy needle,\nWinter procedure, rongeur, or punch) for priapism\n$ 1,043.10\n4290\n54440\n54440\nPlastic operation of penis for injury\n$ 2,582.10\n4291\n54450\n54450\nForeskin manipulation including lysis of preputial adhesions and\nstretching\n$ 306.90\n4292\n54500\n54500\nBiopsy of testis, needle (separate procedure)\n$ 216.90\n4293\n54505\n54505\nBiopsy of testis, incisional (separate procedure)\n$ 644.40\n4294\n54512\n54512\nExcision of extraparenchymal lesion of testis\n$ 1,581.30\n4295\n54520\n54520\nOrchiectomy, simple (including subcapsular), with or without\ntesticular prosthesis, scrotal or inguinal approach\n$ 1,175.40\n4296\n54522\n54522\nOrchiectomy, partial\n$ 1,944.00\n4297\n54530\n54530\nOrchiectomy, radical, for tumor; inguinal approach\n$ 1,833.30\n4298\n54535\n54535\nOrchiectomy, radical, for tumor; with abdominal exploration\n$ 2,160.00\n4299\n54550\n54550\nExploration for undescended testis (inguinal or scrotal area)\n$ 1,594.80\n4300\n54560\n54560\nExploration for undescended testis with abdominal exploration\n$ 1,918.80\n4301\n54600\n54600\nReduction of torsion of testis, surgical, with or without fixation of\ncontralateral testis\n$ 1,393.65\n4302\n54620\n54620\nFixation of contralateral testis (separate procedure)\n$ 835.20\n4303\n54640\n54640\nOrchiopexy, inguinal approach, with or without hernia repair\n$ 1,790.10\n4304\n54650\n54650\nOrchiopexy, abdominal approach, for intra-abdominal testis (eg,\nFowler-Stephens)\n$ 2,026.80\n4305\n54660\n54660\nInsertion of testicular prosthesis (separate procedure)\n$ 810.90\n4306\n54670\n54670\nSuture or repair of testicular injury\n$ 1,364.40\n4307\n54680\n54680\nTransplantation of testis(es) to thigh (because of scrotal\ndestruction)\n$ 1,658.70\n4308\n54690\n54690\nLaparoscopy, surgical; orchiectomy\n$ 1,737.90\n4309\n54692\n54692\nLaparoscopy, surgical; orchiopexy for intra-abdominal testis\n$ 1,801.80\n4310\n54699\n54699\nUnlisted laparoscopy procedure, testis\nCost\n4311\n54700\n54700\nIncision and drainage of epididymis, testis and\/or scrotal space (eg,\nabscess or hematoma)\n$ 458.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4312\n54800\n54800\nBiopsy of epididymis, needle\n$ 265.50\n4313\n54830\n54830\nExcision of local lesion of epididymis\n$ 927.90\n4314\n54840\n54840\nExcision of spermatocele, with or without epididymectomy\n$ 1,296.00\n4315\n54860\n54860\nEpididymectomy; unilateral\n$ 1,228.50\n4316\n54861\n54861\nEpididymectomy; bilateral\n$ 1,728.00\n4317\n54865\n54865\nExploration of epididymis, with or without biopsy\n$ 355.87\n4318\n54900\n54900\nEpididymovasostomy, anastomosis of epididymis to vas deferens;\nunilateral\n$ 2,325.60\n4319\n54901\n54901\nEpididymovasostomy, anastomosis of epididymis to vas deferens;\nbilateral\n$ 3,038.40\n4320\n55000\n55000\nPuncture aspiration of hydrocele, tunica vaginalis, with or without\ninjection of medication\n$ 195.30\n4321\n55040\n55040\nExcision of hydrocele; unilateral\n$ 1,405.80\n4322\n55041\n55041\nExcision of hydrocele; bilateral\n$ 2,132.10\n4323\n55060\n55060\nRepair of tunica vaginalis hydrocele (Bottle type)\n$ 1,287.90\n4324\n55100\n55100\nDrainage of scrotal wall abscess\n$ 311.40\n4325\n55110\n55110\nScrotal exploration\n$ 1,147.50\n4326\n55120\n55120\nRemoval of foreign body in scrotum\n$ 633.60\n4327\n55150\n55150\nResection of scrotum\n$ 1,387.80\n4328\n55175\n55175\nScrotoplasty; simple\n$ 1,220.40\n4329\n55180\n55180\nScrotoplasty; complicated\n$ 2,162.70\n4330\n55200\n55200\nVasotomy, cannulization with or without incision of vas, unilateral\nor bilateral (separate procedure)\n$ 648.90\n4331\n55250\n55250\nVasectomy, unilateral or bilateral (separate procedure), including\npostoperative semen examination(s)\n$ 699.30\n4332\n55300\n55300\nVasotomy for vasograms, seminal vesiculograms, or\nepididymograms, unilateral or bilateral\n$ 647.10\n4333\n55400\n55400\nVasovasostomy, vasovasorrhaphy\n$ 2,832.30\n4334\n55450\n55450\nLigation (percutaneous) of vas deferens, unilateral or bilateral\n(separate procedure)\n$ 628.20\n4335\n55500\n55500\nExcision of hydrocele of spermatic cord, unilateral (separate\nprocedure)\n$ 1,228.50\n4336\n55520\n55520\nExcision of lesion of spermatic cord (separate procedure)\n$ 1,085.40\n4337\n55530\n55530\nExcision of varicocele or ligation of spermatic veins for varicocele;\n(separate procedure)\n$ 1,527.30\n4338\n55535\n55535\nExcision of varicocele or ligation of spermatic veins for varicocele;\nabdominal approach\n$ 1,635.30\n4339\n55540\n55540\nExcision of varicocele or ligation of spermatic veins for varicocele;\nwith hernia repair\n$ 1,801.80\n4340\n55550\n55550\nLaparoscopy, surgical, with ligation of spermatic veins for varicocele\n$ 1,717.20\n4341\n55559\n55559\nUnlisted laparoscopy procedure, spermatic cord\nCost\n4342\n55600\n55600\nVesiculotomy;\n$ 1,231.20\n4343\n55605\n55605\nVesiculotomy; complicated\n$ 1,653.30\n4344\n55650\n55650\nVesiculectomy, any approach\n$ 2,868.30\n4345\n55680\n55680\nExcision of Mullerian duct cyst\n$ 2,533.50\n4346\n55700\n55700\nBiopsy, prostate; needle or punch, single or multiple, any approach\n$ 395.58\n4347\n55705\n55705\nBiopsy, prostate; incisional, any approach\n$ 1,171.80\n4348\n55706\n55706\nBiopsies, prostate, needle, transperineal, stereotactic template\nguided saturation sampling, including imaging guidance\n$ 1,380.90\n4349\n55720\n55720\nProstatotomy, external drainage of prostatic abscess, any approach;\nsimple\n$ 1,424.70\n4350\n55725\n55725\nProstatotomy, external drainage of prostatic abscess, any approach;\ncomplicated\n$ 1,768.50\n4351\n55801\n55801\nProstatectomy, perineal, subtotal (including control of\npostoperative bleeding, vasectomy, meatotomy, urethral calibration\nand\/or dilation, and internal urethrotomy)\n$ 2,970.00\n4352\n55810\n55810\nProstatectomy, perineal radical;\n$ 3,842.10\n4353\n55812\n55812\nProstatectomy, perineal radical; with lymph node biopsy(s) (limited\npelvic lymphadenectomy)\n$ 4,482.00\n4354\n55815\n55815\nProstatectomy, perineal radical; with bilateral pelvic\nlymphadenectomy, including external iliac, hypogastric and\nobturator nodes\n$ 6,071.40\n4355\n55821\n55821\nProstatectomy (including control of postoperative bleeding,\nvasectomy, meatotomy, urethral calibration and\/or dilation, and\ninternal urethrotomy); suprapubic, subtotal, 1 or 2 stages\n$ 3,183.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4356\n55831\n55831\nProstatectomy (including control of postoperative bleeding,\nvasectomy, meatotomy, urethral calibration and\/or dilation, and\ninternal urethrotomy); retropubic, subtotal\n$ 3,345.30\n4357\n55840\n55840\nProstatectomy, retropubic radical, with or without nerve sparing;\n$ 3,969.90\n4358\n55842\n55842\nProstatectomy, retropubic radical, with or without nerve sparing;\nwith lymph node biopsy(s) (limited pelvic lymphadenectomy)\n$ 4,228.20\n4359\n55845\n55845\nProstatectomy, retropubic radical, with or without nerve sparing;\nwith bilateral pelvic lymphadenectomy, including external iliac,\nhypogastric, and obturator nodes\n$ 5,271.39\n4360\n55860\n55860\nExposure of prostate, any approach, for insertion of radioactive\nsubstance;\n$ 2,182.50\n4361\n55862\n55862\nExposure of prostate, any approach, for insertion of radioactive\nsubstance; with lymph node biopsy(s) (limited pelvic\nlymphadenectomy)\n$ 3,091.50\n4362\n55865\n55865\nExposure of prostate, any approach, for insertion of radioactive\nsubstance; with bilateral pelvic lymphadenectomy, including\nexternal iliac, hypogastric and obturator nodes\n$ 3,793.50\n4363\n55866\n55866\nLaparoscopy, surgical prostatectomy, retropubic radical, including\nnerve sparing, includes robotic assistance, when performed\n$ 4,611.87\n4364\n55870\n55870\nElectroejaculation\n$ 236.70\n4365\n55873\n55873\nCryosurgical ablation of the prostate (includes ultrasonic guidance\nand monitoring)\n$ 2,685.60\n4366\n55875\n55875\nTransperineal placement of needles or catheters into prostate for\ninterstitial radioelement application, with or without cystoscopy\n$ 1,796.65\n4367\n55876\n55876\nPlacement of interstitial device(s) for radiation therapy guidance\n(eg, fiducial markers, dosimeter), prostate (via needle, any\napproach), single or multiple\n$ 323.66\n4368\n55899\n55899\nUnlisted procedure, male genital system\nCost\n4369\n55920\n55920\nPlacement of needles or catheters into pelvic organs and\/or\ngenitalia (except prostate) for subsequent interstitial radioelement\napplication\n$ 1,072.06\n4370\n55970\n55970\nIntersex surgery; male to female\n$ -\n4371\n55980\n55980\nIntersex surgery; female to male\n$ -\n4372\n56405\n56405\nIncision and drainage of vulva or perineal abscess\n$ 259.20\n4373\n56420\n56420\nIncision and drainage of Bartholin's gland abscess\n$ 243.90\n4374\n56440\n56440\nMarsupialization of Bartholin's gland cyst\n$ 718.20\n4375\n56441\n56441\nLysis of labial adhesions\n$ 456.30\n4376\n56442\n56442\nHymenotomy, simple incision\n$ 126.23\n4377\n56501\n56501\nDestruction of lesion(s), vulva; simple (eg, laser surgery,\nelectrosurgery, cryosurgery, chemosurgery)\n$ 259.47\n4378\n56515\n56515\nDestruction of lesion(s), vulva; extensive (eg, laser surgery,\nelectrosurgery, cryosurgery, chemosurgery)\n$ 850.10\n4379\n56605\n56605\nBiopsy of vulva or perineum (separate procedure); 1 lesion\n$ 199.48\n4380\n56606\n56606\nBiopsy of vulva or perineum (separate procedure); each separate\nadditional lesion (List separately in addition to code for primary\nprocedure)\n$ 102.60\n4381\n56620\n56620\nVulvectomy simple; partial\n$ 2,186.10\n4382\n56625\n56625\nVulvectomy simple; complete\n$ 2,652.30\n4383\n56630\n56630\nVulvectomy, radical, partial;\n$ 3,249.90\n4384\n56631\n56631\nVulvectomy, radical, partial; with unilateral inguinofemoral\nlymphadenectomy\n$ 4,042.80\n4385\n56632\n56632\nVulvectomy, radical, partial; with bilateral inguinofemoral\nlymphadenectomy\n$ 4,846.50\n4386\n56633\n56633\nVulvectomy, radical, complete;\n$ 4,097.70\n4387\n56634\n56634\nVulvectomy, radical, complete; with unilateral inguinofemoral\nlymphadenectomy\n$ 4,748.40\n4388\n56637\n56637\nVulvectomy, radical, complete; with bilateral inguinofemoral\nlymphadenectomy\n$ 5,682.60\n4389\n56640\n56640\nVulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic\nlymphadenectomy\n$ 5,745.60\n4390\n56700\n56700\nPartial hymenectomy or revision of hymenal ring\n$ 637.20\n4391\n56740\n56740\nExcision of Bartholin's gland or cyst\n$ 920.70\n4392\n56800\n56800\nPlastic repair of introitus\n$ 898.20\n4393\n56805\n56805\nClitoroplasty for intersex state\n$ 2,296.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4394\n56810\n56810\nPerineoplasty, repair of perineum, nonobstetrical (separate\nprocedure)\n$ 1,035.90\n4395\n56820\n56820\nColposcopy of the vulva;\n$ 198.44\n4396\n56821\n56821\nColposcopy of the vulva; with biopsy(s)\n$ 293.12\n4397\n57000\n57000\nColpotomy; with exploration\n$ 914.40\n4398\n57010\n57010\nColpotomy; with drainage of pelvic abscess\n$ 1,030.50\n4399\n57020\n57020\nColpocentesis (separate procedure)\n$ 249.30\n4400\n57022\n57022\nIncision and drainage of vaginal hematoma; obstetrical\/postpartum\n$ 398.70\n4401\n57023\n57023\nIncision and drainage of vaginal hematoma; non-obstetrical (eg,\npost-trauma, spontaneous bleeding)\n$ 398.70\n4402\n57061\n57061\nDestruction of vaginal lesion(s); simple (eg, laser surgery,\nelectrosurgery, cryosurgery, chemosurgery)\n$ 442.80\n4403\n57065\n57065\nDestruction of vaginal lesion(s); extensive (eg, laser surgery,\nelectrosurgery, cryosurgery, chemosurgery)\n$ 1,008.47\n4404\n57100\n57100\nBiopsy of vaginal mucosa; simple (separate procedure)\n$ 232.20\n4405\n57105\n57105\nBiopsy of vaginal mucosa; extensive, requiring suture (including\ncysts)\n$ 724.50\n4406\n57106\n57106\nVaginectomy, partial removal of vaginal wall;\n$ 1,195.20\n4407\n57107\n57107\nVaginectomy, partial removal of vaginal wall; with removal of\nparavaginal tissue (radical vaginectomy)\n$ 3,107.70\n4408\n57109\n57109\nVaginectomy, partial removal of vaginal wall; with removal of\nparavaginal tissue (radical vaginectomy) with bilateral total pelvic\nlymphadenectomy and para-aortic lymph node sampling (biopsy)\n$ 3,578.40\n4409\n57110\n57110\nVaginectomy, complete removal of vaginal wall;\n$ 2,316.60\n4410\n57111\n57111\nVaginectomy, complete removal of vaginal wall; with removal of\nparavaginal tissue (radical vaginectomy)\n$ 3,666.60\n4411\n57112\n57112\nVaginectomy, complete removal of vaginal wall; with removal of\nparavaginal tissue (radical vaginectomy) with bilateral total pelvic\nlymphadenectomy and para-aortic lymph node sampling (biopsy)\n$ 3,849.30\n4412\n57120\n57120\nColpocleisis (Le Fort type)\n$ 2,274.30\n4413\n57130\n57130\nExcision of vaginal septum\n$ 940.50\n4414\n57135\n57135\nExcision of vaginal cyst or tumor\n$ 710.87\n4415\n57150\n57150\nIrrigation of vagina and\/or application of medicament for treatment\nof bacterial, parasitic, or fungoid disease\n$ 100.80\n4416\n57155\n57155\nInsertion of uterine tandem and\/or vaginal ovoids for clinical\nbrachytherapy\n$ 1,064.04\n4417\n57160\n57160\nFitting and insertion of pessary or other intravaginal support device\n$ 113.40\n4418\n57170\n57170\nDiaphragm or cervical cap fitting with instructions\n$ 99.00\n4419\n57180\n57180\nIntroduction of any hemostatic agent or pack for spontaneous or\ntraumatic nonobstetrical vaginal hemorrhage (separate procedure)\n$ 322.20\n4420\n57200\n57200\nColporrhaphy, suture of injury of vagina (nonobstetrical)\n$ 978.30\n4421\n57210\n57210\nColpoperineorrhaphy, suture of injury of vagina and\/or perineum\n(nonobstetrical)\n$ 1,352.70\n4422\n57220\n57220\nPlastic operation on urethral sphincter, vaginal approach (eg, Kelly\nurethral plication)\n$ 1,349.10\n4423\n57230\n57230\nPlastic repair of urethrocele\n$ 1,215.90\n4424\n57240\n57240\nAnterior colporrhaphy, repair of cystocele with or without repair of\nurethrocele\n$ 1,586.70\n4425\n57250\n57250\nPosterior colporrhaphy, repair of rectocele with or without\nperineorrhaphy\n$ 1,559.70\n4426\n57260\n57260\nCombined anteroposterior colporrhaphy;\n$ 2,090.70\n4427\n57265\n57265\nCombined anteroposterior colporrhaphy; with enterocele repair\n$ 2,418.62\n4428\n57267\n57267\nInsertion of mesh or other prosthesis for repair of pelvic floor\ndefect, each site (anterior, posterior compartment), vaginal\napproach (List separately in addition to code for primary procedure) $ 693.09\n4429\n57268\n57268\nRepair of enterocele, vaginal approach (separate procedure)\n$ 1,725.30\n4430\n57270\n57270\nRepair of enterocele, abdominal approach (separate procedure)\n$ 2,124.90\n4431\n57280\n57280\nColpopexy, abdominal approach\n$ 2,472.30\n4432\n57282\n57282\nColpopexy, vaginal; extra-peritoneal approach (sacrospinous,\niliococcygeus)\n$ 2,729.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4433\n57283\n57283\nColpopexy, vaginal; intra-peritoneal approach (uterosacral, levator\nmyorrhaphy)\n$ 1,612.15\n4434\n57284\n57284\nParavaginal defect repair (including repair of cystocele, if\nperformed); open abdominal approach\n$ 2,523.60\n4435\n57287\n57287\nRemoval or revision of sling for stress incontinence (eg, fascia or\nsynthetic)\n$ 2,081.70\n4436\n57288\n57288\nSling operation for stress incontinence (eg, fascia or synthetic)\n$ 2,816.10\n4437\n57289\n57289\nPereyra procedure, including anterior colporrhaphy\n$ 2,429.10\n4438\n57291\n57291\nConstruction of artificial vagina; without graft\n$ 3,295.80\n4439\n57292\n57292\nConstruction of artificial vagina; with graft\n$ 3,924.90\n4440\n57295\n57295\nRevision (including removal) of prosthetic vaginal graft; vaginal\napproach\n$ 1,167.58\n4441\n57296\n57296\nRevision (including removal) of prosthetic vaginal graft; open\nabdominal approach\n$ 2,490.17\n4442\n57300\n57300\nClosure of rectovaginal fistula; vaginal or transanal approach\n$ 1,933.20\n4443\n57305\n57305\nClosure of rectovaginal fistula; abdominal approach\n$ 2,477.70\n4444\n57307\n57307\nClosure of rectovaginal fistula; abdominal approach, with\nconcomitant colostomy\n$ 2,581.20\n4445\n57308\n57308\nClosure of rectovaginal fistula; transperineal approach, with\nperineal body reconstruction, with or without levator plication\n$ 2,317.50\n4446\n57310\n57310\nClosure of urethrovaginal fistula;\n$ 2,374.20\n4447\n57311\n57311\nClosure of urethrovaginal fistula; with bulbocavernosus transplant\n$ 2,729.70\n4448\n57320\n57320\nClosure of vesicovaginal fistula; vaginal approach\n$ 2,652.30\n4449\n57330\n57330\nClosure of vesicovaginal fistula; transvesical and vaginal approach\n$ 2,680.20\n4450\n57335\n57335\nVaginoplasty for intersex state\n$ 3,069.90\n4451\n57400\n57400\nDilation of vagina under anesthesia (other than local)\n$ 370.80\n4452\n57410\n57410\nPelvic examination under anesthesia (other than local)\n$ 318.60\n4453\n57415\n57415\nRemoval of impacted vaginal foreign body (separate procedure)\nunder anesthesia (other than local)\n$ 415.80\n4454\n57420\n57420\nColposcopy of the entire vagina, with cervix if present;\n$ 238.08\n4455\n57421\n57421\nColposcopy of the entire vagina, with cervix if present; with\nbiopsy(s) of vagina\/cervix\n$ 339.81\n4456\n57423\n57423\nParavaginal defect repair (including repair of cystocele, if\nperformed), laparoscopic approach\n$ 2,061.99\n4457\n57425\n57425\nLaparoscopy, surgical, colpopexy (suspension of vaginal apex)\n$ 2,099.02\n4458\n57426\n57426\nRevision (including removal) of prosthetic vaginal graft, laparoscopic\napproach\n$ 1,885.00\n4459\n57452\n57452\nColposcopy of the cervix including upper\/adjacent vagina;\n$ 242.93\n4460\n57454\n57454\nColposcopy of the cervix including upper\/adjacent vagina; with\nbiopsy(s) of the cervix and endocervical curettage\n$ 343.46\n4461\n57455\n57455\nColposcopy of the cervix including upper\/adjacent vagina; with\nbiopsy(s) of the cervix\n$ 169.72\n4462\n57456\n57456\nColposcopy of the cervix including upper\/adjacent vagina; with\nendocervical curettage\n$ 187.31\n4463\n57460\n57460\nColposcopy of the cervix including upper\/adjacent vagina; with loop\nelectrode biopsy(s) of the cervix\n$ 953.23\n4464\n57461\n57461\nColposcopy of the cervix including upper\/adjacent vagina; with loop\nelectrode conization of the cervix\n$ 893.18\n4465\n57500\n57500\nBiopsy of cervix, single or multiple, or local excision of lesion, with\nor without fulguration (separate procedure)\n$ 251.05\n4466\n57505\n57505\nEndocervical curettage (not done as part of a dilation and\ncurettage)\n$ 221.40\n4467\n57510\n57510\nCautery of cervix; electro or thermal\n$ 308.03\n4468\n57511\n57511\nCautery of cervix; cryocautery, initial or repeat\n$ 287.10\n4469\n57513\n57513\nCautery of cervix; laser ablation\n$ 1,030.50\n4470\n57520\n57520\nConization of cervix, with or without fulguration, with or without\ndilation and curettage, with or without repair; cold knife or laser\n$ 1,079.10\n4471\n57522\n57522\nConization of cervix, with or without fulguration, with or without\ndilation and curettage, with or without repair; loop electrode\nexcision\n$ 1,080.48\n4472\n57530\n57530\nTrachelectomy (cervicectomy), amputation of cervix (separate\nprocedure)\n$ 979.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4473\n57531\n57531\nRadical trachelectomy, with bilateral total pelvic lymphadenectomy\nand para-aortic lymph node sampling biopsy, with or without\nremoval of tube(s), with or without removal of ovary(s)\n$ 4,499.10\n4474\n57540\n57540\nExcision of cervical stump, abdominal approach;\n$ 2,022.30\n4475\n57545\n57545\nExcision of cervical stump, abdominal approach; with pelvic floor\nrepair\n$ 2,276.10\n4476\n57550\n57550\nExcision of cervical stump, vaginal approach;\n$ 1,606.50\n4477\n57555\n57555\nExcision of cervical stump, vaginal approach; with anterior and\/or\nposterior repair\n$ 2,096.10\n4478\n57556\n57556\nExcision of cervical stump, vaginal approach; with repair of\nenterocele\n$ 2,295.90\n4479\n57558\n57558\nDilation and curettage of cervical stump\n$ 286.85\n4480\n57700\n57700\nCerclage of uterine cervix, nonobstetrical\n$ 1,133.10\n4481\n57720\n57720\nTrachelorrhaphy, plastic repair of uterine cervix, vaginal approach\n$ 1,098.90\n4482\n57800\n57800\nDilation of cervical canal, instrumental (separate procedure)\n$ 262.80\n4483\n58100\n58100\nEndometrial sampling (biopsy) with or without endocervical\nsampling (biopsy), without cervical dilation, any method (separate\nprocedure)\n$ 266.06\n4484\n58110\n58110\nEndometrial sampling (biopsy) performed in conjunction with\ncolposcopy (List separately in addition to code for primary\nprocedure)\n$ 146.06\n4485\n58120\n58120\nDilation and curettage, diagnostic and\/or therapeutic\n(nonobstetrical)\n$ 903.20\n4486\n58140\n58140\nMyomectomy, excision of fibroid tumor(s) of uterus, 1 to 4\nintramural myoma(s) with total weight of 250 g or less and\/or\nremoval of surface myomas; abdominal approach\n$ 2,851.59\n4487\n58145\n58145\nMyomectomy, excision of fibroid tumor(s) of uterus, 1 to 4\nintramural myoma(s) with total weight of 250 g or less and\/or\nremoval of surface myomas; vaginal approach\n$ 2,299.50\n4488\n58146\n58146\nMyomectomy, excision of fibroid tumor(s) of uterus, 5 or more\nintramural myomas and\/or intramural myomas with total weight\ngreater than 250 g, abdominal approach\n$ 2,845.00\n4489\n58150\n58150\nTotal abdominal hysterectomy (corpus and cervix), with or without\nremoval of tube(s), with or without removal of ovary(s);\n$ 3,175.21\n4490\n58152\n58152\nTotal abdominal hysterectomy (corpus and cervix), with or without\nremoval of tube(s), with or without removal of ovary(s); with colpo-\nurethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)\n$ 3,904.20\n4491\n58180\n58180\nSupracervical abdominal hysterectomy (subtotal hysterectomy),\nwith or without removal of tube(s), with or without removal of\novary(s)\n$ 3,280.50\n4492\n58200\n58200\nTotal abdominal hysterectomy, including partial vaginectomy, with\npara-aortic and pelvic lymph node sampling, with or without\nremoval of tube(s), with or without removal of ovary(s)\n$ 3,940.20\n4493\n58210\n58210\nRadical abdominal hysterectomy, with bilateral total pelvic\nlymphadenectomy and para-aortic lymph node sampling (biopsy),\nwith or without removal of tube(s), with or without removal of\novary(s)\n$ 6,048.90\n4494\n58240\n58240\nPelvic exenteration for gynecologic malignancy, with total\nabdominal hysterectomy or cervicectomy, with or without removal\nof tube(s), with or without removal of ovary(s), with removal of\nbladder and ureteral transplantations, and\/or abdominoperineal\nrese\n$ 8,435.70\n4495\n58260\n58260\nVaginal hysterectomy, for uterus 250 g or less;\n$ 3,085.20\n4496\n58262\n58262\nVaginal hysterectomy, for uterus 250 g or less; with removal of\ntube(s), and\/or ovary(s)\n$ 3,554.10\n4497\n58263\n58263\nVaginal hysterectomy, for uterus 250 g or less; with removal of\ntube(s), and\/or ovary(s), with repair of enterocele\n$ 3,879.90\n4498\n58267\n58267\nVaginal hysterectomy, for uterus 250 g or less; with colpo-\nurethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type)\nwith or without endoscopic control\n$ 3,544.20\n4499\n58270\n58270\nVaginal hysterectomy, for uterus 250 g or less; with repair of\nenterocele\n$ 3,762.90\n4500\n58275\n58275\nVaginal hysterectomy, with total or partial vaginectomy;\n$ 3,759.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4501\n58280\n58280\nVaginal hysterectomy, with total or partial vaginectomy; with repair\nof enterocele\n$ 3,493.80\n4502\n58285\n58285\nVaginal hysterectomy, radical (Schauta type operation)\n$ 3,948.30\n4503\n58290\n58290\nVaginal hysterectomy, for uterus greater than 250 g;\n$ 3,249.20\n4504\n58291\n58291\nVaginal hysterectomy, for uterus greater than 250 g; with removal\nof tube(s) and\/or ovary(s)\n$ 3,588.32\n4505\n58292\n58292\nVaginal hysterectomy, for uterus greater than 250 g; with removal\nof tube(s) and\/or ovary(s), with repair of enterocele\n$ 3,867.52\n4506\n58293\n58293\nVaginal hysterectomy, for uterus greater than 250 g; with colpo-\nurethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type)\nwith or without endoscopic control\n$ 4,011.49\n4507\n58294\n58294\nVaginal hysterectomy, for uterus greater than 250 g; with repair of\nenterocele\n$ 3,502.18\n4508\n58300\n58300\nInsertion of intrauterine device (IUD)\n$ 308.70\n4509\n58301\n58301\nRemoval of intrauterine device (IUD)\n$ 124.20\n4510\n58321\n58321\nArtificial insemination; intra-cervical\n$ 183.60\n4511\n58322\n58322\nArtificial insemination; intra-uterine\n$ 226.80\n4512\n58323\n58323\nSperm washing for artificial insemination\n$ 200.70\n4513\n58340\n58340\nCatheterization and introduction of saline or contrast material for\nsaline infusion sonohysterography (SIS) or hysterosalpingography\n$ 279.39\n4514\n58345\n58345\nTranscervical introduction of fallopian tube catheter for diagnosis\nand\/or re-establishing patency (any method), with or without\nhysterosalpingography\n$ 1,163.70\n4515\n58346\n58346\nInsertion of Heyman capsules for clinical brachytherapy\n$ 1,416.42\n4516\n58350\n58350\nChromotubation of oviduct, including materials\n$ 360.90\n4517\n58353\n58353\nEndometrial ablation, thermal, without hysteroscopic guidance\n$ 681.30\n4518\n58356\n58356\nEndometrial cryoablation with ultrasonic guidance, including\nendometrial curettage, when performed\n$ 2,930.73\n4519\n58400\n58400\nUterine suspension, with or without shortening of round ligaments,\nwith or without shortening of sacrouterine ligaments; (separate\nprocedure)\n$ 1,903.50\n4520\n58410\n58410\nUterine suspension, with or without shortening of round ligaments,\nwith or without shortening of sacrouterine ligaments; with\npresacral sympathectomy\n$ 2,566.80\n4521\n58520\n58520\nHysterorrhaphy, repair of ruptured uterus (nonobstetrical)\n$ 1,658.70\n4522\n58540\n58540\nHysteroplasty, repair of uterine anomaly (Strassman type)\n$ 2,497.50\n4523\n58541\n58541\nLaparoscopy, surgical, supracervical hysterectomy, for uterus 250 g\nor less;\n$ 2,275.20\n4524\n58542\n58542\nLaparoscopy, surgical, supracervical hysterectomy, for uterus 250 g\nor less; with removal of tube(s) and\/or ovary(s)\n$ 2,512.31\n4525\n58543\n58543\nLaparoscopy, surgical, supracervical hysterectomy, for uterus\ngreater than 250 g;\n$ 2,546.70\n4526\n58544\n58544\nLaparoscopy, surgical, supracervical hysterectomy, for uterus\ngreater than 250 g; with removal of tube(s) and\/or ovary(s)\n$ 2,839.57\n4527\n58545\n58545\nLaparoscopy, surgical, myomectomy, excision; 1 to 4 intramural\nmyomas with total weight of 250 g or less and\/or removal of\nsurface myomas\n$ 2,496.86\n4528\n58546\n58546\nLaparoscopy, surgical, myomectomy, excision; 5 or more intramural\nmyomas and\/or intramural myomas with total weight greater than\n250 g\n$ 3,009.13\n4529\n58548\n58548\nLaparoscopy, surgical, with radical hysterectomy, with bilateral total\npelvic lymphadenectomy and para-aortic lymph node sampling\n(biopsy), with removal of tube(s) and ovary(s), if performed\n$ 4,382.63\n4530\n58550\n58550\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g\nor less;\n$ 3,277.49\n4531\n58552\n58552\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g\nor less; with removal of tube(s) and\/or ovary(s)\n$ 2,608.28\n4532\n58553\n58553\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus greater\nthan 250 g;\n$ 3,010.69\n4533\n58554\n58554\nLaparoscopy, surgical, with vaginal hysterectomy, for uterus greater\nthan 250 g; with removal of tube(s) and\/or ovary(s)\n$ 3,357.56\n4534\n58555\n58555\nHysteroscopy, diagnostic (separate procedure)\n$ 857.70\n4535\n58558\n58558\nHysteroscopy, surgical; with sampling (biopsy) of endometrium\nand\/or polypectomy, with or without D & C\n$ 1,402.27\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4536\n58559\n58559\nHysteroscopy, surgical; with lysis of intrauterine adhesions (any\nmethod)\n$ 1,555.20\n4537\n58560\n58560\nHysteroscopy, surgical; with division or resection of intrauterine\nseptum (any method)\n$ 1,865.70\n4538\n58561\n58561\nHysteroscopy, surgical; with removal of leiomyomata\n$ 2,065.50\n4539\n58562\n58562\nHysteroscopy, surgical; with removal of impacted foreign body\n$ 1,035.00\n4540\n58563\n58563\nHysteroscopy, surgical; with endometrial ablation (eg, endometrial\nresection, electrosurgical ablation, thermoablation)\n$ 2,528.26\n4541\n58565\n58565\nHysteroscopy, surgical; with bilateral fallopian tube cannulation to\ninduce occlusion by placement of permanent implants\n$ 4,424.15\n4542\n58570\n58570\nLaparoscopy, surgical, with total hysterectomy, for uterus 250 g or\nless;\n$ 2,503.83\n4543\n58571\n58571\nLaparoscopy, surgical, with total hysterectomy, for uterus 250 g or\nless; with removal of tube(s) and\/or ovary(s)\n$ 2,801.61\n4544\n58572\n58572\nLaparoscopy, surgical, with total hysterectomy, for uterus greater\nthan 250 g;\n$ 3,013.79\n4545\n58573\n58573\nLaparoscopy, surgical, with total hysterectomy, for uterus greater\nthan 250 g; with removal of tube(s) and\/or ovary(s)\n$ 3,509.08\n4546\n58578\n58578\nUnlisted laparoscopy procedure, uterus\nCost\n4547\n58579\n58579\nUnlisted hysteroscopy procedure, uterus\nCost\n4548\n58600\n58600\nLigation or transection of fallopian tube(s), abdominal or vaginal\napproach, unilateral or bilateral\n$ 1,508.40\n4549\n58605\n58605\nLigation or transection of fallopian tube(s), abdominal or vaginal\napproach, postpartum, unilateral or bilateral, during same\nhospitalization (separate procedure)\n$ 1,312.20\n4550\n58611\n58611\nLigation or transection of fallopian tube(s) when done at the time of\ncesarean delivery or intra-abdominal surgery (not a separate\nprocedure) (List separately in addition to code for primary\nprocedure)\n$ 861.75\n4551\n58615\n58615\nOcclusion of fallopian tube(s) by device (eg, band, clip, Falope ring)\nvaginal or suprapubic approach\n$ 1,441.80\n4552\n58660\n58660\nLaparoscopy, surgical; with lysis of adhesions (salpingolysis,\novariolysis) (separate procedure)\n$ 2,250.71\n4553\n58661\n58661\nLaparoscopy, surgical; with removal of adnexal structures (partial or\ntotal oophorectomy and\/or salpingectomy)\n$ 2,277.00\n4554\n58662\n58662\nLaparoscopy, surgical; with fulguration or excision of lesions of the\novary, pelvic viscera, or peritoneal surface by any method\n$ 2,523.37\n4555\n58670\n58670\nLaparoscopy, surgical; with fulguration of oviducts (with or without\ntransection)\n$ 1,802.70\n4556\n58671\n58671\nLaparoscopy, surgical; with occlusion of oviducts by device (eg,\nband, clip, or Falope ring)\n$ 1,802.70\n4557\n58672\n58672\nLaparoscopy, surgical; with fimbrioplasty\n$ 2,601.00\n4558\n58673\n58673\nLaparoscopy, surgical; with salpingostomy (salpingoneostomy)\n$ 1,854.00\n4559\n58679\n58679\nUnlisted laparoscopy procedure, oviduct, ovary\nCost\n4560\n58700\n58700\nSalpingectomy, complete or partial, unilateral or bilateral (separate\nprocedure)\n$ 2,060.10\n4561\n58720\n58720\nSalpingo-oophorectomy, complete or partial, unilateral or bilateral\n(separate procedure)\n$ 2,178.51\n4562\n58740\n58740\nLysis of adhesions (salpingolysis, ovariolysis)\n$ 2,415.84\n4563\n58750\n58750\nTubotubal anastomosis\n$ 3,936.60\n4564\n58752\n58752\nTubouterine implantation\n$ 3,450.60\n4565\n58760\n58760\nFimbrioplasty\n$ 3,038.40\n4566\n58770\n58770\nSalpingostomy (salpingoneostomy)\n$ 3,193.20\n4567\n58800\n58800\nDrainage of ovarian cyst(s), unilateral or bilateral (separate\nprocedure); vaginal approach\n$ 1,184.40\n4568\n58805\n58805\nDrainage of ovarian cyst(s), unilateral or bilateral (separate\nprocedure); abdominal approach\n$ 1,800.90\n4569\n58820\n58820\nDrainage of ovarian abscess; vaginal approach, open\n$ 1,287.90\n4570\n58822\n58822\nDrainage of ovarian abscess; abdominal approach\n$ 1,772.10\n4571\n58825\n58825\nTransposition, ovary(s)\n$ 1,837.80\n4572\n58900\n58900\nBiopsy of ovary, unilateral or bilateral (separate procedure)\n$ 1,833.30\n4573\n58920\n58920\nWedge resection or bisection of ovary, unilateral or bilateral\n$ 2,329.20\n4574\n58925\n58925\nOvarian cystectomy, unilateral or bilateral\n$ 2,331.00\n4575\n58940\n58940\nOophorectomy, partial or total, unilateral or bilateral;\n$ 2,069.10\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4576\n58943\n58943\nOophorectomy, partial or total, unilateral or bilateral; for ovarian,\ntubal or primary peritoneal malignancy, with para-aortic and pelvic\nlymph node biopsies, peritoneal washings, peritoneal biopsies,\ndiaphragmatic assessments, with or without salpingecto\n$ 3,457.80\n4577\n58950\n58950\nResection (initial) of ovarian, tubal or primary peritoneal malignancy\nwith bilateral salpingo-oophorectomy and omentectomy;\n$ 3,549.60\n4578\n58951\n58951\nResection (initial) of ovarian, tubal or primary peritoneal malignancy\nwith bilateral salpingo-oophorectomy and omentectomy; with total\nabdominal hysterectomy, pelvic and limited para-aortic\nlymphadenectomy\n$ 4,583.70\n4579\n58952\n58952\nResection (initial) of ovarian, tubal or primary peritoneal malignancy\nwith bilateral salpingo-oophorectomy and omentectomy; with\nradical dissection for debulking (ie, radical excision or destruction,\nintra-abdominal or retroperitoneal tumors)\n$ 5,935.50\n4580\n58953\n58953\nBilateral salpingo-oophorectomy with omentectomy, total\nabdominal hysterectomy and radical dissection for debulking;\n$ 7,745.77\n4581\n58954\n58954\nBilateral salpingo-oophorectomy with omentectomy, total\nabdominal hysterectomy and radical dissection for debulking; with\npelvic lymphadenectomy and limited para-aortic lymphadenectomy\n$ 8,407.75\n4582\n58956\n58956\nBilateral salpingo-oophorectomy with total omentectomy, total\nabdominal hysterectomy for malignancy\n$ 5,467.49\n4583\n58957\n58957\nResection (tumor debulking) of recurrent ovarian, tubal, primary\nperitoneal, uterine malignancy (intra-abdominal, retroperitoneal\ntumors), with omentectomy, if performed;\n$ 5,807.52\n4584\n58958\n58958\nResection (tumor debulking) of recurrent ovarian, tubal, primary\nperitoneal, uterine malignancy (intra-abdominal, retroperitoneal\ntumors), with omentectomy, if performed; with pelvic\nlymphadenectomy and limited para-aortic lymphadenectomy\n$ 6,432.44\n4585\n58960\n58960\nLaparotomy, for staging or restaging of ovarian, tubal, or primary\nperitoneal malignancy (second look), with or without omentectomy,\nperitoneal washing, biopsy of abdominal and pelvic peritoneum,\ndiaphragmatic assessment with pelvic and limited para-aorti\n$ 3,839.96\n4586\n58970\n58970\nFollicle puncture for oocyte retrieval, any method\n$ 1,406.70\n4587\n58974\n58974\nEmbryo transfer, intrauterine\n$ 537.30\n4588\n58976\n58976\nGamete, zygote, or embryo intrafallopian transfer, any method\n$ 1,545.30\n4589\n58999\n58999\nUnlisted procedure, female genital system (nonobstetrical)\nCost\n4590\n59000\n59000\nAmniocentesis; diagnostic\n$ 332.21\n4591\n59001\n59001\nAmniocentesis; therapeutic amniotic fluid reduction (includes\nultrasound guidance)\n$ 440.43\n4592\n59012\n59012\nCordocentesis (intrauterine), any method\n$ 669.60\n4593\n59015\n59015\nChorionic villus sampling, any method\n$ 360.90\n4594\n59020\n59020\nFetal contraction stress test\n$ 178.81\n4595\n59020-26 26\n59020\nFetal contraction stress test\n$ 90.59\n4596\n59020-TC TC\n59020\nFetal contraction stress test\n$ 88.22\n4597\n59025\n59025\nFetal non-stress test\n$ 115.69\n4598\n59025-26 26\n59025\nFetal non-stress test\n$ 69.45\n4599\n59025-TC TC\n59025\nFetal non-stress test\n$ 46.24\n4600\n59030\n59030\nFetal scalp blood sampling\n$ 194.40\n4601\n59050\n59050\nFetal monitoring during labor by consulting physician (ie, non-\nattending physician) with written report; supervision and\ninterpretation\n$ 285.30\n4602\n59051\n59051\nFetal monitoring during labor by consulting physician (ie, non-\nattending physician) with written report; interpretation only\n$ 109.29\n4603\n59070\n59070\nTransabdominal amnioinfusion, including ultrasound guidance\n$ 959.77\n4604\n59072\n59072\nFetal umbilical cord occlusion, including ultrasound guidance\n$ 1,227.78\n4605\n59074\n59074\nFetal fluid drainage (eg, vesicocentesis, thoracocentesis,\nparacentesis), including ultrasound guidance\n$ 935.82\n4606\n59076\n59076\nFetal shunt placement, including ultrasound guidance\n$ 1,204.41\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4607\n59100\n59100\nHysterotomy, abdominal (eg, for hydatidiform mole, abortion)\n$ 1,908.00\n4608\n59120\n59120\nSurgical treatment of ectopic pregnancy; tubal or ovarian, requiring\nsalpingectomy and\/or oophorectomy, abdominal or vaginal\napproach\n$ 2,453.40\n4609\n59121\n59121\nSurgical treatment of ectopic pregnancy; tubal or ovarian, without\nsalpingectomy and\/or oophorectomy\n$ 2,041.20\n4610\n59130\n59130\nSurgical treatment of ectopic pregnancy; abdominal pregnancy\n$ 2,061.90\n4611\n59135\n59135\nSurgical treatment of ectopic pregnancy; interstitial, uterine\npregnancy requiring total hysterectomy\n$ 2,800.80\n4612\n59136\n59136\nSurgical treatment of ectopic pregnancy; interstitial, uterine\npregnancy with partial resection of uterus\n$ 2,285.10\n4613\n59140\n59140\nSurgical treatment of ectopic pregnancy; cervical, with evacuation\n$ 1,562.40\n4614\n59150\n59150\nLaparoscopic treatment of ectopic pregnancy; without\nsalpingectomy and\/or oophorectomy\n$ 2,317.50\n4615\n59151\n59151\nLaparoscopic treatment of ectopic pregnancy; with salpingectomy\nand\/or oophorectomy\n$ 2,414.78\n4616\n59160\n59160\nCurettage, postpartum\n$ 765.00\n4617\n59200\n59200\nInsertion of cervical dilator (eg, laminaria, prostaglandin) (separate\nprocedure)\n$ 276.79\n4618\n59300\n59300\nEpisiotomy or vaginal repair, by other than attending\n$ 566.10\n4619\n59320\n59320\nCerclage of cervix, during pregnancy; vaginal\n$ 1,122.47\n4620\n59325\n59325\nCerclage of cervix, during pregnancy; abdominal\n$ 1,416.60\n4621\n59350\n59350\nHysterorrhaphy of ruptured uterus\n$ 2,176.20\n4622\n59400\n59400\nRoutine obstetric care including antepartum care, vaginal delivery\n(with or without episiotomy, and\/or forceps) and postpartum care\n$ 2,781.00\n4623\n59409\n59409\nVaginal delivery only (with or without episiotomy and\/or forceps);\n$ 1,588.98\n4624\n59410\n59410\nVaginal delivery only (with or without episiotomy and\/or forceps);\nincluding postpartum care\n$ 1,924.97\n4625\n59412\n59412\nExternal cephalic version, with or without tocolysis\n$ 540.90\n4626\n59414\n59414\nDelivery of placenta (separate procedure)\n$ 484.20\n4627\n59425\n59425\nAntepartum care only; 4-6 visits\n$ 747.00\n4628\n59426\n59426\nAntepartum care only; 7 or more visits\n$ 1,168.00\n4629\n59430\n59430\nPostpartum care only (separate procedure)\n$ 240.30\n4630\n59514\n59514\nCesarean delivery only;\n$ 2,233.35\n4631\n59515\n59515\nCesarean delivery only; including postpartum care\n$ 2,676.17\n4632\n59525\n59525\nSubtotal or total hysterectomy after cesarean delivery (List\nseparately in addition to code for primary procedure)\n$ 1,751.40\n4633\n59610\n59610\nRoutine obstetric care including antepartum care, vaginal delivery\n(with or without episiotomy, and\/or forceps) and postpartum care,\nafter previous cesarean delivery\n$ 3,295.80\n4634\n59612\n59612\nVaginal delivery only, after previous cesarean delivery (with or\nwithout episiotomy and\/or forceps);\n$ 2,271.60\n4635\n59614\n59614\nVaginal delivery only, after previous cesarean delivery (with or\nwithout episiotomy and\/or forceps); including postpartum care\n$ 2,339.10\n4636\n59618\n59618\nRoutine obstetric care including antepartum care, cesarean delivery,\nand postpartum care, following attempted vaginal delivery after\nprevious cesarean delivery\n$ 3,965.40\n4637\n59620\n59620\nCesarean delivery only, following attempted vaginal delivery after\nprevious cesarean delivery;\n$ 2,781.00\n4638\n59622\n59622\nCesarean delivery only, following attempted vaginal delivery after\nprevious cesarean delivery; including postpartum care\n$ 2,632.19\n4639\n59812\n59812\nTreatment of incomplete abortion, any trimester, completed\nsurgically\n$ 800.34\n4640\n59820\n59820\nTreatment of missed abortion, completed surgically; first trimester\n$ 815.24\n4641\n59821\n59821\nTreatment of missed abortion, completed surgically; second\ntrimester\n$ 1,081.80\n4642\n59830\n59830\nTreatment of septic abortion, completed surgically\n$ 1,153.80\n4643\n59840\n59840\nInduced abortion, by dilation and curettage\n$ 947.70\n4644\n59841\n59841\nInduced abortion, by dilation and evacuation\n$ 1,118.90\n4645\n59850\n59850\nInduced abortion, by 1 or more intra-amniotic injections\n(amniocentesis-injections), including hospital admission and visits,\ndelivery of fetus and secundines;\n$ 1,398.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4646\n59851\n59851\nInduced abortion, by 1 or more intra-amniotic injections\n(amniocentesis-injections), including hospital admission and visits,\ndelivery of fetus and secundines; with dilation and curettage and\/or\nevacuation\n$ 1,555.20\n4647\n59852\n59852\nInduced abortion, by 1 or more intra-amniotic injections\n(amniocentesis-injections), including hospital admission and visits,\ndelivery of fetus and secundines; with hysterotomy (failed intra-\namniotic injection)\n$ 1,869.30\n4648\n59855\n59855\nInduced abortion, by 1 or more vaginal suppositories (eg,\nprostaglandin) with or without cervical dilation (eg, laminaria),\nincluding hospital admission and visits, delivery of fetus and\nsecundines;\n$ 1,235.70\n4649\n59856\n59856\nInduced abortion, by 1 or more vaginal suppositories (eg,\nprostaglandin) with or without cervical dilation (eg, laminaria),\nincluding hospital admission and visits, delivery of fetus and\nsecundines; with dilation and curettage and\/or evacuation\n$ 1,441.80\n4650\n59857\n59857\nInduced abortion, by 1 or more vaginal suppositories (eg,\nprostaglandin) with or without cervical dilation (eg, laminaria),\nincluding hospital admission and visits, delivery of fetus and\nsecundines; with hysterotomy (failed medical evacuation)\n$ 1,810.80\n4651\n59866\n59866\nMultifetal pregnancy reduction(s) (MPR)\n$ 796.50\n4652\n59870\n59870\nUterine evacuation and curettage for hydatidiform mole\n$ 1,081.80\n4653\n59871\n59871\nRemoval of cerclage suture under anesthesia (other than local)\n$ 444.60\n4654\n59897\n59897\nUnlisted fetal invasive procedure, including ultrasound guidance,\nwhen performed\nCost\n4655\n59898\n59898\nUnlisted laparoscopy procedure, maternity care and delivery\nCost\n4656\n59899\n59899\nUnlisted procedure, maternity care and delivery\nCost\n4657\n60000\n60000\nIncision and drainage of thyroglossal duct cyst, infected\n$ 305.10\n4658\n60100\n60100\nBiopsy thyroid, percutaneous core needle\n$ 279.00\n4659\n60200\n60200\nExcision of cyst or adenoma of thyroid, or transection of isthmus\n$ 1,590.30\n4660\n60210\n60210\nPartial thyroid lobectomy, unilateral; with or without\nisthmusectomy\n$ 2,587.50\n4661\n60212\n60212\nPartial thyroid lobectomy, unilateral; with contralateral subtotal\nlobectomy, including isthmusectomy\n$ 3,165.30\n4662\n60220\n60220\nTotal thyroid lobectomy, unilateral; with or without isthmusectomy\n$ 2,613.60\n4663\n60225\n60225\nTotal thyroid lobectomy, unilateral; with contralateral subtotal\nlobectomy, including isthmusectomy\n$ 3,329.10\n4664\n60240\n60240\nThyroidectomy, total or complete\n$ 3,250.80\n4665\n60252\n60252\nThyroidectomy, total or subtotal for malignancy; with limited neck\ndissection\n$ 3,743.10\n4666\n60254\n60254\nThyroidectomy, total or subtotal for malignancy; with radical neck\ndissection\n$ 5,427.00\n4667\n60260\n60260\nThyroidectomy, removal of all remaining thyroid tissue following\nprevious removal of a portion of thyroid\n$ 2,396.70\n4668\n60270\n60270\nThyroidectomy, including substernal thyroid; sternal split or\ntransthoracic approach\n$ 4,066.20\n4669\n60271\n60271\nThyroidectomy, including substernal thyroid; cervical approach\n$ 3,284.10\n4670\n60280\n60280\nExcision of thyroglossal duct cyst or sinus;\n$ 2,004.30\n4671\n60281\n60281\nExcision of thyroglossal duct cyst or sinus; recurrent\n$ 2,155.50\n4672\n60300\n60001\nAspiration and\/or injection, thyroid cyst\n$ 304.43\n4673\n60500\n60500\nParathyroidectomy or exploration of parathyroid(s);\n$ 3,088.80\n4674\n60502\n60502\nParathyroidectomy or exploration of parathyroid(s); re-exploration\n$ 3,404.70\n4675\n60505\n60505\nParathyroidectomy or exploration of parathyroid(s); with\nmediastinal exploration, sternal split or transthoracic approach\n$ 3,624.30\n4676\n60512\n60512\nParathyroid autotransplantation (List separately in addition to code\nfor primary procedure)\n$ 802.80\n4677\n60520\n60520\nThymectomy, partial or total; transcervical approach (separate\nprocedure)\n$ 3,260.70\n4678\n60521\n60521\nThymectomy, partial or total; sternal split or transthoracic\napproach, without radical mediastinal dissection (separate\nprocedure)\n$ 3,193.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4679\n60522\n60522\nThymectomy, partial or total; sternal split or transthoracic\napproach, with radical mediastinal dissection (separate procedure)\n$ 4,230.00\n4680\n60540\n60540\nAdrenalectomy, partial or complete, or exploration of adrenal gland\nwith or without biopsy, transabdominal, lumbar or dorsal (separate\nprocedure);\n$ 3,249.90\n4681\n60545\n60545\nAdrenalectomy, partial or complete, or exploration of adrenal gland\nwith or without biopsy, transabdominal, lumbar or dorsal (separate\nprocedure); with excision of adjacent retroperitoneal tumor\n$ 3,646.80\n4682\n60600\n60600\nExcision of carotid body tumor; without excision of carotid artery\n$ 3,170.70\n4683\n60605\n60605\nExcision of carotid body tumor; with excision of carotid artery\n$ 3,828.60\n4684\n60650\n60650\nLaparoscopy, surgical, with adrenalectomy, partial or complete, or\nexploration of adrenal gland with or without biopsy,\ntransabdominal, lumbar or dorsal\n$ 2,901.27\n4685\n60659\n60659\nUnlisted laparoscopy procedure, endocrine system\nCost\n4686\n60699\n60699\nUnlisted procedure, endocrine system\nCost\n4687\n61000\n61000\nSubdural tap through fontanelle, or suture, infant, unilateral or\nbilateral; initial\n$ 347.40\n4688\n61001\n61001\nSubdural tap through fontanelle, or suture, infant, unilateral or\nbilateral; subsequent taps\n$ 268.20\n4689\n61020\n61020\nVentricular puncture through previous burr hole, fontanelle, suture,\nor implanted ventricular catheter\/reservoir; without injection\n$ 477.00\n4690\n61026\n61026\nVentricular puncture through previous burr hole, fontanelle, suture,\nor implanted ventricular catheter\/reservoir; with injection of\nmedication or other substance for diagnosis or treatment\n$ 539.10\n4691\n61050\n61050\nCisternal or lateral cervical (C1-C2) puncture; without injection\n(separate procedure)\n$ 422.10\n4692\n61055\n61055\nCisternal or lateral cervical (C1-C2) puncture; with injection of\nmedication or other substance for diagnosis or treatment (eg, C1-\nC2)\n$ 605.70\n4693\n61070\n61070\nPuncture of shunt tubing or reservoir for aspiration or injection\nprocedure\n$ 314.10\n4694\n61105\n61105\nTwist drill hole for subdural or ventricular puncture\n$ 1,647.90\n4695\n61107\n61107\nTwist drill hole(s) for subdural, intracerebral, or ventricular\npuncture; for implanting ventricular catheter, pressure recording\ndevice, or other intracerebral monitoring device\n$ 2,286.90\n4696\n61108\n61108\nTwist drill hole(s) for subdural, intracerebral, or ventricular\npuncture; for evacuation and\/or drainage of subdural hematoma\n$ 3,141.90\n4697\n61120\nBurr hole(s) for ventricular puncture (including injection of gas,\ncontrast media, dye, or radioactive material)\n$ 1,748.70\n4698\n61140\nBurr hole(s) or trephine; with biopsy of brain or intracranial lesion\n$ 3,785.40\n4699\n61150\nBurr hole(s) or trephine; with drainage of brain abscess or cyst\n$ 3,656.70\n4700\n61151\nBurr hole(s) or trephine; with subsequent tapping (aspiration) of\nintracranial abscess or cyst\n$ 1,149.30\n4701\n61154\n61154\nBurr hole(s) with evacuation and\/or drainage of hematoma,\nextradural or subdural\n$ 4,333.50\n4702\n61156\n61156\nBurr hole(s); with aspiration of hematoma or cyst, intracerebral\n$ 3,850.20\n4703\n61210\nBurr hole(s); for implanting ventricular catheter, reservoir, EEG\nelectrode(s), pressure recording device, or other cerebral\nmonitoring device (separate procedure)\n$ 2,266.20\n4704\n61215\nInsertion of subcutaneous reservoir, pump or continuous infusion\nsystem for connection to ventricular catheter\n$ 2,421.00\n4705\n61250\nBurr hole(s) or trephine, supratentorial, exploratory, not followed\nby other surgery\n$ 2,483.10\n4706\n61253\n61253\nBurr hole(s) or trephine, infratentorial, unilateral or bilateral\n$ 3,609.90\n4707\n61304\nCraniectomy or craniotomy, exploratory; supratentorial\n$ 5,562.00\n4708\n61305\nCraniectomy or craniotomy, exploratory; infratentorial (posterior\nfossa)\n$ 5,964.30\n4709\n61312\n61312\nCraniectomy or craniotomy for evacuation of hematoma,\nsupratentorial; extradural or subdural\n$ 6,644.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4710\n61313\nCraniectomy or craniotomy for evacuation of hematoma,\nsupratentorial; intracerebral\n$ 6,731.10\n4711\n61314\nCraniectomy or craniotomy for evacuation of hematoma,\ninfratentorial; extradural or subdural\n$ 6,798.60\n4712\n61315\nCraniectomy or craniotomy for evacuation of hematoma,\ninfratentorial; intracerebellar\n$ 7,305.30\n4713\n61316\n61316\nIncision and subcutaneous placement of cranial bone graft (List\nseparately in addition to code for primary procedure)\n$ 1,146.13\n4714\n61320\nCraniectomy or craniotomy, drainage of intracranial abscess;\nsupratentorial\n$ 6,000.30\n4715\n61321\nCraniectomy or craniotomy, drainage of intracranial abscess;\ninfratentorial\n$ 5,699.70\n4716\n61322\nCraniectomy or craniotomy, decompressive, with or without\nduraplasty, for treatment of intracranial hypertension, without\nevacuation of associated intraparenchymal hematoma; without\nlobectomy\n$ 5,756.79\n4717\n61323\nCraniectomy or craniotomy, decompressive, with or without\nduraplasty, for treatment of intracranial hypertension, without\nevacuation of associated intraparenchymal hematoma; with\nlobectomy\n$ 6,798.55\n4718\n61330\nDecompression of orbit only, transcranial approach\n$ 4,500.90\n4719\n61332\nExploration of orbit (transcranial approach); with biopsy\n$ 5,355.00\n4720\n61333\nExploration of orbit (transcranial approach); with removal of lesion\n$ 5,422.50\n4721\n61334\nExploration of orbit (transcranial approach); with removal of foreign\nbody\n$ 5,355.00\n4722\n61340\nSubtemporal cranial decompression (pseudotumor cerebri, slit\nventricle syndrome)\n$ 4,254.30\n4723\n61343\nCraniectomy, suboccipital with cervical laminectomy for\ndecompression of medulla and spinal cord, with or without dural\ngraft (eg, Arnold-Chiari malformation)\n$ 7,812.00\n4724\n61345\n61345\nOther cranial decompression, posterior fossa\n$ 3,861.00\n4725\n61440\n61440\nCraniotomy for section of tentorium cerebelli (separate procedure)\n$ 3,904.20\n4726\n61450\n61450\nCraniectomy, subtemporal, for section, compression, or\ndecompression of sensory root of gasserian ganglion\n$ 5,769.00\n4727\n61458\n61458\nCraniectomy, suboccipital; for exploration or decompression of\ncranial nerves\n$ 6,541.20\n4728\n61460\n61460\nCraniectomy, suboccipital; for section of 1 or more cranial nerves\n$ 6,573.60\n4729\n61470\n61470\nCraniectomy, suboccipital; for medullary tractotomy\n$ 5,194.80\n4730\n61480\n61480\nCraniectomy, suboccipital; for mesencephalic tractotomy or\npedunculotomy\n$ 4,833.00\n4731\n61490\n61490\nCraniotomy for lobotomy, including cingulotomy\n$ 3,848.40\n4732\n61500\n61500\nCraniectomy; with excision of tumor or other bone lesion of skull\n$ 5,799.60\n4733\n61501\n61501\nCraniectomy; for osteomyelitis\n$ 5,518.80\n4734\n61510\n61510\nCraniectomy, trephination, bone flap craniotomy; for excision of\nbrain tumor, supratentorial, except meningioma\n$ 7,210.80\n4735\n61512\n61512\nCraniectomy, trephination, bone flap craniotomy; for excision of\nmeningioma, supratentorial\n$ 7,498.80\n4736\n61514\n61514\nCraniectomy, trephination, bone flap craniotomy; for excision of\nbrain abscess, supratentorial\n$ 6,441.30\n4737\n61516\n61516\nCraniectomy, trephination, bone flap craniotomy; for excision or\nfenestration of cyst, supratentorial\n$ 6,448.50\n4738\n61517\n61517\nImplantation of brain intracavitary chemotherapy agent (List\nseparately in addition to code for primary procedure)\n$ 317.57\n4739\n61518\n61518\nCraniectomy for excision of brain tumor, infratentorial or posterior\nfossa; except meningioma, cerebellopontine angle tumor, or\nmidline tumor at base of skull\n$ 7,177.50\n4740\n61519\n61519\nCraniectomy for excision of brain tumor, infratentorial or posterior\nfossa; meningioma\n$ 7,713.00\n4741\n61520\n61520\nCraniectomy for excision of brain tumor, infratentorial or posterior\nfossa; cerebellopontine angle tumor\n$ 8,054.10\n4742\n61521\n61521\nCraniectomy for excision of brain tumor, infratentorial or posterior\nfossa; midline tumor at base of skull\n$ 8,868.60\n4743\n61522\n61522\nCraniectomy, infratentorial or posterior fossa; for excision of brain\nabscess\n$ 6,534.00\n4744\n61524\n61524\nCraniectomy, infratentorial or posterior fossa; for excision or\nfenestration of cyst\n$ 6,491.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4745\n61526\n61526\nCraniectomy, bone flap craniotomy, transtemporal (mastoid) for\nexcision of cerebellopontine angle tumor;\n$ 7,533.00\n4746\n61530\n61530\nCraniectomy, bone flap craniotomy, transtemporal (mastoid) for\nexcision of cerebellopontine angle tumor; combined with\nmiddle\/posterior fossa craniotomy\/craniectomy\n$ 7,915.50\n4747\n61531\n61531\nSubdural implantation of strip electrodes through 1 or more burr or\ntrephine hole(s) for long-term seizure monitoring\n$ 4,017.60\n4748\n61533\n61533\nCraniotomy with elevation of bone flap; for subdural implantation\nof an electrode array, for long-term seizure monitoring\n$ 5,459.40\n4749\n61534\n61534\nCraniotomy with elevation of bone flap; for excision of\nepileptogenic focus without electrocorticography during surgery\n$ 5,832.00\n4750\n61535\n61535\nCraniotomy with elevation of bone flap; for removal of epidural or\nsubdural electrode array, without excision of cerebral tissue\n(separate procedure)\n$ 3,613.50\n4751\n61536\n61536\nCraniotomy with elevation of bone flap; for excision of cerebral\nepileptogenic focus, with electrocorticography during surgery\n(includes removal of electrode array)\n$ 6,593.40\n4752\n61537\n61537\nCraniotomy with elevation of bone flap; for lobectomy, temporal\nlobe, without electrocorticography during surgery\n$ 5,691.54\n4753\n61538\n61538\nCraniotomy with elevation of bone flap; for lobectomy, temporal\nlobe, with electrocorticography during surgery\n$ 7,169.40\n4754\n61539\n61539\nCraniotomy with elevation of bone flap; for lobectomy, other than\ntemporal lobe, partial or total, with electrocorticography during\nsurgery\n$ 6,920.10\n4755\n61540\n61540\nCraniotomy with elevation of bone flap; for lobectomy, other than\ntemporal lobe, partial or total, without electrocorticography during\nsurgery\n$ 6,750.11\n4756\n61541\n61541\nCraniotomy with elevation of bone flap; for transection of corpus\ncallosum\n$ 7,540.20\n4757\n61542\n61542\nCraniotomy with elevation of bone flap; for total hemispherectomy\n$ 7,416.00\n4758\n61543\n61543\nCraniotomy with elevation of bone flap; for partial or subtotal\n(functional) hemispherectomy\n$ 6,798.60\n4759\n61544\n61544\nCraniotomy with elevation of bone flap; for excision or coagulation\nof choroid plexus\n$ 5,931.00\n4760\n61545\n61545\nCraniotomy with elevation of bone flap; for excision of\ncraniopharyngioma\n$ 9,750.60\n4761\n61546\n61546\nCraniotomy for hypophysectomy or excision of pituitary tumor,\nintracranial approach\n$ 7,222.50\n4762\n61548\n61548\nHypophysectomy or excision of pituitary tumor, transnasal or\ntransseptal approach, nonstereotactic\n$ 6,168.60\n4763\n61550\n61550\nCraniectomy for craniosynostosis; single cranial suture\n$ 3,863.70\n4764\n61552\n61552\nCraniectomy for craniosynostosis; multiple cranial sutures\n$ 4,626.90\n4765\n61556\n61556\nCraniotomy for craniosynostosis; frontal or parietal bone flap\n$ 4,708.80\n4766\n61557\n61557\nCraniotomy for craniosynostosis; bifrontal bone flap\n$ 5,355.90\n4767\n61558\n61558\nExtensive craniectomy for multiple cranial suture craniosynostosis\n(eg, cloverleaf skull); not requiring bone grafts\n$ 6,180.30\n4768\n61559\n61559\nExtensive craniectomy for multiple cranial suture craniosynostosis\n(eg, cloverleaf skull); recontouring with multiple osteotomies and\nbone autografts (eg, barrel-stave procedure) (includes obtaining\ngrafts)\n$ 7,004.70\n4769\n61563\n61563\nExcision, intra and extracranial, benign tumor of cranial bone (eg,\nfibrous dysplasia); without optic nerve decompression\n$ 5,598.00\n4770\n61564\n61564\nExcision, intra and extracranial, benign tumor of cranial bone (eg,\nfibrous dysplasia); with optic nerve decompression\n$ 7,004.70\n4771\n61566\n61566\nCraniotomy with elevation of bone flap; for selective\namygdalohippocampectomy\n$ 6,648.74\n4772\n61567\n61567\nCraniotomy with elevation of bone flap; for multiple subpial\ntransections, with electrocorticography during surgery\n$ 7,585.18\n4773\n61570\n61570\nCraniectomy or craniotomy; with excision of foreign body from\nbrain\n$ 6,655.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4774\n61571\n61571\nCraniectomy or craniotomy; with treatment of penetrating wound\nof brain\n$ 7,112.70\n4775\n61575\n61575\nTransoral approach to skull base, brain stem or upper spinal cord\nfor biopsy, decompression or excision of lesion;\n$ 5,925.60\n4776\n61576\n61576\nTransoral approach to skull base, brain stem or upper spinal cord\nfor biopsy, decompression or excision of lesion; requiring splitting of\ntongue and\/or mandible (including tracheostomy)\n$ 6,066.00\n4777\n61580\n61580\nCraniofacial approach to anterior cranial fossa; extradural, including\nlateral rhinotomy, ethmoidectomy, sphenoidectomy, without\nmaxillectomy or orbital exenteration\n$ 5,279.40\n4778\n61581\n61581\nCraniofacial approach to anterior cranial fossa; extradural, including\nlateral rhinotomy, orbital exenteration, ethmoidectomy,\nsphenoidectomy and\/or maxillectomy\n$ 6,869.70\n4779\n61582\n61582\nCraniofacial approach to anterior cranial fossa; extradural, including\nunilateral or bifrontal craniotomy, elevation of frontal lobe(s),\nosteotomy of base of anterior cranial fossa\n$ 6,235.20\n4780\n61583\n61583\nCraniofacial approach to anterior cranial fossa; intradural, including\nunilateral or bifrontal craniotomy, elevation or resection of frontal\nlobe, osteotomy of base of anterior cranial fossa\n$ 6,881.40\n4781\n61584\n61584\nOrbitocranial approach to anterior cranial fossa, extradural,\nincluding supraorbital ridge osteotomy and elevation of frontal\nand\/or temporal lobe(s); without orbital exenteration\n$ 6,746.40\n4782\n61585\n61585\nOrbitocranial approach to anterior cranial fossa, extradural,\nincluding supraorbital ridge osteotomy and elevation of frontal\nand\/or temporal lobe(s); with orbital exenteration\n$ 7,112.70\n4783\n61586\n61586\nBicoronal, transzygomatic and\/or LeFort I osteotomy approach to\nanterior cranial fossa with or without internal fixation, without\nbone graft\n$ 4,247.10\n4784\n61590\n61590\nInfratemporal pre-auricular approach to middle cranial fossa\n(parapharyngeal space, infratemporal and midline skull base,\nnasopharynx), with or without disarticulation of the mandible,\nincluding parotidectomy, craniotomy, decompression and\/or\nmobilization\n$ 8,847.90\n4785\n61591\n61591\nInfratemporal post-auricular approach to middle cranial fossa\n(internal auditory meatus, petrous apex, tentorium, cavernous\nsinus, parasellar area, infratemporal fossa) including\nmastoidectomy, resection of sigmoid sinus, with or without\ndecompression and\n$ 9,154.80\n4786\n61592\n61592\nOrbitocranial zygomatic approach to middle cranial fossa\n(cavernous sinus and carotid artery, clivus, basilar artery or petrous\napex) including osteotomy of zygoma, craniotomy, extra- or\nintradural elevation of temporal lobe\n$ 7,725.60\n4787\n61595\n61595\nTranstemporal approach to posterior cranial fossa, jugular foramen\nor midline skull base, including mastoidectomy, decompression of\nsigmoid sinus and\/or facial nerve, with or without mobilization\n$ 6,030.00\n4788\n61596\n61596\nTranscochlear approach to posterior cranial fossa, jugular foramen\nor midline skull base, including labyrinthectomy, decompression,\nwith or without mobilization of facial nerve and\/or petrous carotid\nartery\n$ 6,489.00\n4789\n61597\n61597\nTranscondylar (far lateral) approach to posterior cranial fossa,\njugular foramen or midline skull base, including occipital\ncondylectomy, mastoidectomy, resection of C1-C3 vertebral\nbody(s), decompression of vertebral artery, with or without\nmobilization\n$ 7,729.20\n4790\n61598\n61598\nTranspetrosal approach to posterior cranial fossa, clivus or foramen\nmagnum, including ligation of superior petrosal sinus and\/or\nsigmoid sinus\n$ 6,545.70\n4791\n61600\n61600\nResection or excision of neoplastic, vascular or infectious lesion of\nbase of anterior cranial fossa; extradural\n$ 5,345.10\n4792\n61601\n61601\nResection or excision of neoplastic, vascular or infectious lesion of\nbase of anterior cranial fossa; intradural, including dural repair, with\nor without graft\n$ 6,008.40\n4793\n61605\n61605\nResection or excision of neoplastic, vascular or infectious lesion of\ninfratemporal fossa, parapharyngeal space, petrous apex;\nextradural\n$ 5,562.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4794\n61606\n61606\nResection or excision of neoplastic, vascular or infectious lesion of\ninfratemporal fossa, parapharyngeal space, petrous apex;\nintradural, including dural repair, with or without graft\n$ 7,875.00\n4795\n61607\n61607\nResection or excision of neoplastic, vascular or infectious lesion of\nparasellar area, cavernous sinus, clivus or midline skull base;\nextradural\n$ 7,877.70\n4796\n61608\n61608\nResection or excision of neoplastic, vascular or infectious lesion of\nparasellar area, cavernous sinus, clivus or midline skull base;\nintradural, including dural repair, with or without graft\n$ 8,641.80\n4797\n61609\n61609\nTransection or ligation, carotid artery in cavernous sinus; without\nrepair (List separately in addition to code for primary procedure)\n$ 2,159.10\n4798\n61610\n61610\nTransection or ligation, carotid artery in cavernous sinus; with\nrepair by anastomosis or graft (List separately in addition to code\nfor primary procedure)\n$ 5,758.20\n4799\n61611\n61611\nTransection or ligation, carotid artery in petrous canal; without\nrepair (List separately in addition to code for primary procedure)\n$ 1,481.40\n4800\n61612\n61612\nTransection or ligation, carotid artery in petrous canal; with repair\nby anastomosis or graft (List separately in addition to code for\nprimary procedure)\n$ 5,562.00\n4801\n61613\n61613\nObliteration of carotid aneurysm, arteriovenous malformation, or\ncarotid-cavernous fistula by dissection within cavernous sinus\n$ 8,973.90\n4802\n61615\n61615\nResection or excision of neoplastic, vascular or infectious lesion of\nbase of posterior cranial fossa, jugular foramen, foramen magnum,\nor C1-C3 vertebral bodies; extradural\n$ 6,874.20\n4803\n61616\nResection or excision of neoplastic, vascular or infectious lesion of\nbase of posterior cranial fossa, jugular foramen, foramen magnum,\nor C1-C3 vertebral bodies; intradural, including dural repair, with or\nwithout graft\n$ 8,987.40\n4804\n61618\n61618\nSecondary repair of dura for cerebrospinal fluid leak, anterior,\nmiddle or posterior cranial fossa following surgery of the skull base;\nby free tissue graft (eg, pericranium, fascia, tensor fascia lata,\nadipose tissue, homologous or synthetic grafts)\n$ 3,795.30\n4805\n61619\n61619\nSecondary repair of dura for cerebrospinal fluid leak, anterior,\nmiddle or posterior cranial fossa following surgery of the skull base;\nby local or regionalized vascularized pedicle flap or myocutaneous\nflap (including galea, temporalis, frontalis or occi\n$ 6,327.00\n4806\n61623\n61623\nEndovascular temporary balloon arterial occlusion, head or neck\n(extracranial\/intracranial) including selective catheterization of\nvessel to be occluded, positioning and inflation of occlusion balloon,\nconcomitant neurological monitoring, and radiologic s\n$ 2,587.65\n4807\n61624\n61624\nTranscatheter permanent occlusion or embolization (eg, for tumor\ndestruction, to achieve hemostasis, to occlude a vascular\nmalformation), percutaneous, any method; central nervous system\n(intracranial, spinal cord)\n$ 4,705.20\n4808\n61626\n61626\nTranscatheter permanent occlusion or embolization (eg, for tumor\ndestruction, to achieve hemostasis, to occlude a vascular\nmalformation), percutaneous, any method; non-central nervous\nsystem, head or neck (extracranial, brachiocephalic branch)\n$ 3,346.20\n4809\n61630\n61630\nBalloon angioplasty, intracranial (eg, atherosclerotic stenosis),\npercutaneous\n$ 4,445.59\n4810\n61635\n61635\nTranscatheter placement of intravascular stent(s), intracranial (eg,\natherosclerotic stenosis), including balloon angioplasty, if\nperformed\n$ 5,059.80\n4811\n61640\n61640\nBalloon dilatation of intracranial vasospasm, percutaneous; initial\nvessel\n$ 3,692.54\n4812\n61641\n61641\nBalloon dilatation of intracranial vasospasm, percutaneous; each\nadditional vessel in same vascular family (List separately in addition\nto code for primary procedure)\n$ 1,825.26\n4813\n61642\n61642\nBalloon dilatation of intracranial vasospasm, percutaneous; each\nadditional vessel in different vascular family (List separately in\naddition to code for primary procedure)\n$ 1,874.98\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4814\n61680\n61680\nSurgery of intracranial arteriovenous malformation; supratentorial,\nsimple\n$ 7,841.70\n4815\n61682\n61682\nSurgery of intracranial arteriovenous malformation; supratentorial,\ncomplex\n$ 9,553.50\n4816\n61684\n61684\nSurgery of intracranial arteriovenous malformation; infratentorial,\nsimple\n$ 8,433.00\n4817\n61686\n61686\nSurgery of intracranial arteriovenous malformation; infratentorial,\ncomplex\n$ 10,935.90\n4818\n61690\n61690\nSurgery of intracranial arteriovenous malformation; dural, simple\n$ 7,769.70\n4819\n61692\n61692\nSurgery of intracranial arteriovenous malformation; dural, complex\n$ 8,279.10\n4820\n61697\n61697\nSurgery of complex intracranial aneurysm, intracranial approach;\ncarotid circulation\n$ 8,145.00\n4821\n61698\n61698\nSurgery of complex intracranial aneurysm, intracranial approach;\nvertebrobasilar circulation\n$ 7,839.00\n4822\n61700\n61700\nSurgery of simple intracranial aneurysm, intracranial approach;\ncarotid circulation\n$ 8,034.30\n4823\n61702\n61702\nSurgery of simple intracranial aneurysm, intracranial approach;\nvertebrobasilar circulation\n$ 7,725.60\n4824\n61703\n61703\nSurgery of intracranial aneurysm, cervical approach by application\nof occluding clamp to cervical carotid artery (Selverstone-\nCrutchfield type)\n$ 3,445.20\n4825\n61705\n61705\nSurgery of aneurysm, vascular malformation or carotid-cavernous\nfistula; by intracranial and cervical occlusion of carotid artery\n$ 8,181.00\n4826\n61708\n61708\nSurgery of aneurysm, vascular malformation or carotid-cavernous\nfistula; by intracranial electrothrombosis\n$ 6,218.10\n4827\n61710\n61710\nSurgery of aneurysm, vascular malformation or carotid-cavernous\nfistula; by intra-arterial embolization, injection procedure, or\nballoon catheter\n$ 5,119.20\n4828\n61711\n61711\nAnastomosis, arterial, extracranial-intracranial (eg, middle\ncerebral\/cortical) arteries\n$ 6,508.80\n4829\n61720\n61720\nCreation of lesion by stereotactic method, including burr hole(s) and\nlocalizing and recording techniques, single or multiple stages;\nglobus pallidus or thalamus\n$ 4,897.80\n4830\n61735\n61735\nCreation of lesion by stereotactic method, including burr hole(s) and\nlocalizing and recording techniques, single or multiple stages;\nsubcortical structure(s) other than globus pallidus or thalamus\n$ 5,054.40\n4831\n61750\n61750\nStereotactic biopsy, aspiration, or excision, including burr hole(s),\nfor intracranial lesion;\n$ 5,047.20\n4832\n61751\n61751\nStereotactic biopsy, aspiration, or excision, including burr hole(s),\nfor intracranial lesion; with computed tomography and\/or magnetic\nresonance guidance\n$ 5,544.00\n4833\n61760\n61760\nStereotactic implantation of depth electrodes into the cerebrum for\nlong-term seizure monitoring\n$ 5,960.70\n4834\n61770\n61770\nStereotactic localization, including burr hole(s), with insertion of\ncatheter(s) or probe(s) for placement of radiation source\n$ 5,312.70\n4835\n61790\n61790\nCreation of lesion by stereotactic method, percutaneous, by\nneurolytic agent (eg, alcohol, thermal, electrical, radiofrequency);\ngasserian ganglion\n$ 4,118.40\n4836\n61791\n61791\nCreation of lesion by stereotactic method, percutaneous, by\nneurolytic agent (eg, alcohol, thermal, electrical, radiofrequency);\ntrigeminal medullary tract\n$ 3,960.90\n4837\n61796\n61796\nStereotactic radiosurgery (particle beam, gamma ray, or linear\naccelerator); 1 simple cranial lesion\n$ 4,260.08\n4838\n61797\n61797\nStereotactic radiosurgery (particle beam, gamma ray, or linear\naccelerator); each additional cranial lesion, simple (List separately in\naddition to code for primary procedure)\n$ 1,148.15\n4839\n61798\n61798\nStereotactic radiosurgery (particle beam, gamma ray, or linear\naccelerator); 1 complex cranial lesion\n$ 4,339.38\n4840\n61799\n61799\nStereotactic radiosurgery (particle beam, gamma ray, or linear\naccelerator); each additional cranial lesion, complex (List separately\nin addition to code for primary procedure)\n$ 1,612.19\n4841\n61800\n61800\nApplication of stereotactic headframe for stereotactic radiosurgery\n(List separately in addition to code for primary procedure)\n$ 806.16\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4842\n61850\n61850\nTwist drill or burr hole(s) for implantation of neurostimulator\nelectrodes, cortical\n$ 3,304.80\n4843\n61860\n61860\nCraniectomy or craniotomy for implantation of neurostimulator\nelectrodes, cerebral, cortical\n$ 4,075.20\n4844\n61863\n61863\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\nimplantation of neurostimulator electrode array in subcortical site\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\nperiaqueductal gray), without use of intraoperat\n$ 3,473.61\n4845\n61864\n61864\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\nimplantation of neurostimulator electrode array in subcortical site\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\nperiaqueductal gray), without use of intraoperat\n$ 1,609.63\n4846\n61867\n61867\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\nimplantation of neurostimulator electrode array in subcortical site\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\nperiaqueductal gray), with use of intraoperative\n$ 5,176.91\n4847\n61868\n61868\nTwist drill, burr hole, craniotomy, or craniectomy with stereotactic\nimplantation of neurostimulator electrode array in subcortical site\n(eg, thalamus, globus pallidus, subthalamic nucleus, periventricular,\nperiaqueductal gray), with use of intraoperative\n$ 2,433.01\n4848\n61870\n61870\nCraniectomy for implantation of neurostimulator electrodes,\ncerebellar; cortical\n$ 3,723.30\n4849\n61875\n61875\nCraniectomy for implantation of neurostimulator electrodes,\ncerebellar; subcortical\n$ 3,501.90\n4850\n61880\n61880\nRevision or removal of intracranial neurostimulator electrodes\n$ 2,471.40\n4851\n61885\n61885\nInsertion or replacement of cranial neurostimulator pulse generator\nor receiver, direct or inductive coupling; with connection to a single\nelectrode array\n$ 943.20\n4852\n61886\n61886\nInsertion or replacement of cranial neurostimulator pulse generator\nor receiver, direct or inductive coupling; with connection to 2 or\nmore electrode arrays\n$ 1,390.50\n4853\n61888\n61888\nRevision or removal of cranial neurostimulator pulse generator or\nreceiver\n$ 1,009.80\n4854\n62000\n62000\nElevation of depressed skull fracture; simple, extradural\n$ 3,420.00\n4855\n62005\nElevation of depressed skull fracture; compound or comminuted,\nextradural\n$ 4,185.00\n4856\n62010\n62010\nElevation of depressed skull fracture; with repair of dura and\/or\ndebridement of brain\n$ 5,310.00\n4857\n62100\n62100\nCraniotomy for repair of dural\/cerebrospinal fluid leak, including\nsurgery for rhinorrhea\/otorrhea\n$ 5,804.10\n4858\n62115\n62115\nReduction of craniomegalic skull (eg, treated hydrocephalus); not\nrequiring bone grafts or cranioplasty\n$ 2,946.76\n4859\n62116\n62116\nReduction of craniomegalic skull (eg, treated hydrocephalus); with\nsimple cranioplasty\n$ 4,497.88\n4860\n62117\n62117\nReduction of craniomegalic skull (eg, treated hydrocephalus);\nrequiring craniotomy and reconstruction with or without bone graft\n(includes obtaining grafts)\n$ 4,892.40\n4861\n62120\n62120\nRepair of encephalocele, skull vault, including cranioplasty\n$ 4,874.40\n4862\n62121\n62121\nCraniotomy for repair of encephalocele, skull base\n$ 4,878.00\n4863\n62140\n62140\nCranioplasty for skull defect; up to 5 cm diameter\n$ 4,598.10\n4864\n62141\n62141\nCranioplasty for skull defect; larger than 5 cm diameter\n$ 4,816.80\n4865\n62142\n62142\nRemoval of bone flap or prosthetic plate of skull\n$ 3,197.70\n4866\n62143\n62143\nReplacement of bone flap or prosthetic plate of skull\n$ 3,862.80\n4867\n62145\n62145\nCranioplasty for skull defect with reparative brain surgery\n$ 4,948.20\n4868\n62146\n62146\nCranioplasty with autograft (includes obtaining bone grafts); up to 5\ncm diameter\n$ 4,377.60\n4869\n62147\n62147\nCranioplasty with autograft (includes obtaining bone grafts); larger\nthan 5 cm diameter\n$ 4,841.10\n4870\n62148\n62148\nIncision and retrieval of subcutaneous cranial bone graft for\ncranioplasty (List separately in addition to code for primary\nprocedure)\n$ 445.59\n4871\n62160\nNeuroendoscopy, intracranial, for placement or replacement of\nventricular catheter and attachment to shunt system or external\ndrainage (List separately in addition to code for primary procedure)\n$ 479.08\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4872\n62161\nNeuroendoscopy, intracranial; with dissection of adhesions,\nfenestration of septum pellucidum or intraventricular cysts\n(including placement, replacement, or removal of ventricular\ncatheter)\n$ 5,992.94\n4873\n62162\nNeuroendoscopy, intracranial; with fenestration or excision of\ncolloid cyst, including placement of external ventricular catheter for\ndrainage\n$ 6,085.95\n4874\n62163\nNeuroendoscopy, intracranial; with retrieval of foreign body\n$ 6,926.90\n4875\n62164\nNeuroendoscopy, intracranial; with excision of brain tumor,\nincluding placement of external ventricular catheter for drainage\n$ 7,165.41\n4876\n62165\nNeuroendoscopy, intracranial; with excision of pituitary tumor,\ntransnasal or trans-sphenoidal approach\n$ 6,442.36\n4877\n62180\nVentriculocisternostomy (Torkildsen type operation)\n$ 4,006.80\n4878\n62190\nCreation of shunt; subarachnoid\/subdural-atrial, -jugular, -auricular\n$ 3,469.50\n4879\n62192\nCreation of shunt; subarachnoid\/subdural-peritoneal, -pleural,\nother terminus\n$ 3,523.50\n4880\n62194\nReplacement or irrigation, subarachnoid\/subdural catheter\n$ 1,296.90\n4881\n62200\nVentriculocisternostomy, third ventricle;\n$ 4,726.80\n4882\n62201\nVentriculocisternostomy, third ventricle; stereotactic,\nneuroendoscopic method\n$ 4,996.62\n4883\n62220\nCreation of shunt; ventriculo-atrial, -jugular, -auricular\n$ 4,307.40\n4884\n62223\nCreation of shunt; ventriculo-peritoneal, -pleural, other terminus\n$ 4,331.70\n4885\n62225\nReplacement or irrigation, ventricular catheter\n$ 1,852.20\n4886\n62230\nReplacement or revision of cerebrospinal fluid shunt, obstructed\nvalve, or distal catheter in shunt system\n$ 3,162.60\n4887\n62252\n62252\nReprogramming of programmable cerebrospinal shunt\n$ 236.70\n4888\n62252-26 26\n62252\nReprogramming of programmable cerebrospinal shunt\n$ 122.96\n4889\n62252-TC TC\n62252\nReprogramming of programmable cerebrospinal shunt\n$ 113.74\n4890\n62256\nRemoval of complete cerebrospinal fluid shunt system; without\nreplacement\n$ 1,863.00\n4891\n62258\nRemoval of complete cerebrospinal fluid shunt system; with\nreplacement by similar or other shunt at same operation\n$ 4,531.50\n4892\n62263\n62263\nPercutaneous lysis of epidural adhesions using solution injection\n(eg, hypertonic saline, enzyme) or mechanical means (eg, catheter)\nincluding radiologic localization (includes contrast when\nadministered), multiple adhesiolysis sessions; 2 or more days\n$ 1,090.80\n4893\n62264\n62264\nPercutaneous lysis of epidural adhesions using solution injection\n(eg, hypertonic saline, enzyme) or mechanical means (eg, catheter)\nincluding radiologic localization (includes contrast when\nadministered), multiple adhesiolysis sessions; 1 day\n$ 1,042.86\n4894\n62267\nPercutaneous aspiration within the nucleus pulposus, intervertebral\ndisc, or paravertebral tissue for diagnostic purposes\n$ 816.24\n4895\n62268\nPercutaneous aspiration, spinal cord cyst or syrinx\n$ 1,906.20\n4896\n62269\nBiopsy of spinal cord, percutaneous needle\n$ 1,579.50\n4897\n62270\n62270\nSpinal puncture, lumbar, diagnostic\n$ 215.10\n4898\n62272\n62272\nSpinal puncture, therapeutic, for drainage of cerebrospinal fluid (by\nneedle or catheter)\n$ 283.50\n4899\n62273\n62273\nInjection, epidural, of blood or clot patch\n$ 512.10\n4900\n62280\nInjection\/infusion of neurolytic substance (eg, alcohol, phenol, iced\nsaline solutions), with or without other therapeutic substance;\nsubarachnoid\n$ 483.30\n4901\n62281\nInjection\/infusion of neurolytic substance (eg, alcohol, phenol, iced\nsaline solutions), with or without other therapeutic substance;\nepidural, cervical or thoracic\n$ 566.10\n4902\n62282\nInjection\/infusion of neurolytic substance (eg, alcohol, phenol, iced\nsaline solutions), with or without other therapeutic substance;\nepidural, lumbar, sacral (caudal)\n$ 636.30\n4903\n62284\n62284\nInjection procedure for myelography and\/or computed\ntomography, spinal (other than C1-C2 and posterior fossa)\n$ 522.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4904\n62287\nDecompression procedure, percutaneous, of nucleus pulposus of\nintervertebral disc, any method utilizing needle based technique to\nremove disc material under fluoroscopic imaging or other form of\nindirect visualization, with the use of an endoscope, with d\n$ 3,543.30\n4905\n62290\n62290\nInjection procedure for discography, each level; lumbar\n$ 551.70\n4906\n62291\n62291\nInjection procedure for discography, each level; cervical or thoracic\n$ 524.70\n4907\n62292\n62292\nInjection procedure for chemonucleolysis, including discography,\nintervertebral disc, single or multiple levels, lumbar\n$ 2,452.50\n4908\n62294\n62294\nInjection procedure, arterial, for occlusion of arteriovenous\nmalformation, spinal\n$ 1,232.10\n4909\n62310\n62310\nInjection(s), of diagnostic or therapeutic substance(s) (including\nanesthetic, antispasmodic, opioid, steroid, other solution), not\nincluding neurolytic substances, including needle or catheter\nplacement, includes contrast for localization when performed,\n$ 875.70\n4910\n62311\nInjection(s), of diagnostic or therapeutic substance(s) (including\nanesthetic, antispasmodic, opioid, steroid, other solution), not\nincluding neurolytic substances, including needle or catheter\nplacement, includes contrast for localization when performed,\n$ 933.30\n4911\n62318\n62318\nInjection(s), including indwelling catheter placement, continuous\ninfusion or intermittent bolus, of diagnostic or therapeutic\nsubstance(s) (including anesthetic, antispasmodic, opioid, steroid,\nother solution), not including neurolytic substances, includ\n$ 968.40\n4912\n62319\n62319\nInjection(s), including indwelling catheter placement, continuous\ninfusion or intermittent bolus, of diagnostic or therapeutic\nsubstance(s) (including anesthetic, antispasmodic, opioid, steroid,\nother solution), not including neurolytic substances, includ\n$ 942.30\n4913\n62350\n62350\nImplantation, revision or repositioning of tunneled intrathecal or\nepidural catheter, for long-term medication administration via an\nexternal pump or implantable reservoir\/infusion pump; without\nlaminectomy\n$ 1,545.30\n4914\n62351\n62351\nImplantation, revision or repositioning of tunneled intrathecal or\nepidural catheter, for long-term medication administration via an\nexternal pump or implantable reservoir\/infusion pump; with\nlaminectomy\n$ 2,763.90\n4915\n62355\n62355\nRemoval of previously implanted intrathecal or epidural catheter\n$ 1,368.00\n4916\n62360\n62360\nImplantation or replacement of device for intrathecal or epidural\ndrug infusion; subcutaneous reservoir\n$ 566.10\n4917\n62361\nImplantation or replacement of device for intrathecal or epidural\ndrug infusion; nonprogrammable pump\n$ 1,849.28\n4918\n62362\n62362\nImplantation or replacement of device for intrathecal or epidural\ndrug infusion; programmable pump, including preparation of pump,\nwith or without programming\n$ 1,653.30\n4919\n62365\n62365\nRemoval of subcutaneous reservoir or pump, previously implanted\nfor intrathecal or epidural infusion\n$ 1,313.10\n4920\n62367\n62367\nElectronic analysis of programmable, implanted pump for\nintrathecal or epidural drug infusion (includes evaluation of\nreservoir status, alarm status, drug prescription status); without\nreprogramming or refill\n$ 103.05\n4921\n62368\n62368\nElectronic analysis of programmable, implanted pump for\nintrathecal or epidural drug infusion (includes evaluation of\nreservoir status, alarm status, drug prescription status); with\nreprogramming\n$ 136.97\n4922\n63001\n63001\nLaminectomy with exploration and\/or decompression of spinal cord\nand\/or cauda equina, without facetectomy, foraminotomy or\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical\n$ 4,944.60\n4923\n63003\n63003\nLaminectomy with exploration and\/or decompression of spinal cord\nand\/or cauda equina, without facetectomy, foraminotomy or\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic\n$ 5,364.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4924\n63005\n63005\nLaminectomy with exploration and\/or decompression of spinal cord\nand\/or cauda equina, without facetectomy, foraminotomy or\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar,\nexcept for spondylolisthesis\n$ 4,862.70\n4925\n63011\n63011\nLaminectomy with exploration and\/or decompression of spinal cord\nand\/or cauda equina, without facetectomy, foraminotomy or\ndiscectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral\n$ 4,583.70\n4926\n63012\n63012\nLaminectomy with removal of abnormal facets and\/or pars inter-\narticularis with decompression of cauda equina and nerve roots for\nspondylolisthesis, lumbar (Gill type procedure)\n$ 4,892.40\n4927\n63015\n63015\nLaminectomy with exploration and\/or decompression of spinal cord\nand\/or cauda equina, without facetectomy, foraminotomy or\ndiscectomy (eg, spinal stenosis), more than 2 vertebral segments;\ncervical\n$ 6,095.70\n4928\n63016\n63016\nLaminectomy with exploration and\/or decompression of spinal cord\nand\/or cauda equina, without facetectomy, foraminotomy or\ndiscectomy (eg, spinal stenosis), more than 2 vertebral segments;\nthoracic\n$ 5,768.10\n4929\n63017\n63017\nLaminectomy with exploration and\/or decompression of spinal cord\nand\/or cauda equina, without facetectomy, foraminotomy or\ndiscectomy (eg, spinal stenosis), more than 2 vertebral segments;\nlumbar\n$ 5,402.70\n4930\n63020\n63020\nLaminotomy (hemilaminectomy), with decompression of nerve\nroot(s), including partial facetectomy, foraminotomy and\/or\nexcision of herniated intervertebral disc; 1 interspace, cervical\n$ 4,932.00\n4931\n63030\n63030\nLaminotomy (hemilaminectomy), with decompression of nerve\nroot(s), including partial facetectomy, foraminotomy and\/or\nexcision of herniated intervertebral disc; 1 interspace, lumbar\n$ 5,275.80\n4932\n63035\n63035\nLaminotomy (hemilaminectomy), with decompression of nerve\nroot(s), including partial facetectomy, foraminotomy and\/or\nexcision of herniated intervertebral disc; each additional interspace,\ncervical or lumbar (List separately in addition to code for primar\n$ 1,433.70\n4933\n63040\n63040\nLaminotomy (hemilaminectomy), with decompression of nerve\nroot(s), including partial facetectomy, foraminotomy and\/or\nexcision of herniated intervertebral disc, reexploration, single\ninterspace; cervical\n$ 5,602.50\n4934\n63042\n63042\nLaminotomy (hemilaminectomy), with decompression of nerve\nroot(s), including partial facetectomy, foraminotomy and\/or\nexcision of herniated intervertebral disc, reexploration, single\ninterspace; lumbar\n$ 6,077.70\n4935\n63043\nLaminotomy (hemilaminectomy), with decompression of nerve\nroot(s), including partial facetectomy, foraminotomy and\/or\nexcision of herniated intervertebral disc, reexploration, single\ninterspace; each additional cervical interspace (List separately in\naddi\n$ 304.43\n4936\n63044\n63044\nLaminotomy (hemilaminectomy), with decompression of nerve\nroot(s), including partial facetectomy, foraminotomy and\/or\nexcision of herniated intervertebral disc, reexploration, single\ninterspace; each additional lumbar interspace (List separately in\nadditi\n$ -\n4937\n63045\n63045\nLaminectomy, facetectomy and foraminotomy (unilateral or\nbilateral with decompression of spinal cord, cauda equina and\/or\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\nsegment; cervical\n$ 5,896.80\n4938\n63046\n63046\nLaminectomy, facetectomy and foraminotomy (unilateral or\nbilateral with decompression of spinal cord, cauda equina and\/or\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\nsegment; thoracic\n$ 5,850.90\n4939\n63047\n63047\nLaminectomy, facetectomy and foraminotomy (unilateral or\nbilateral with decompression of spinal cord, cauda equina and\/or\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\nsegment; lumbar\n$ 6,197.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4940\n63048\n63048\nLaminectomy, facetectomy and foraminotomy (unilateral or\nbilateral with decompression of spinal cord, cauda equina and\/or\nnerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral\nsegment; each additional segment, cervical, thoracic, or lu\n$ 2,574.90\n4941\n63050\nLaminoplasty, cervical, with decompression of the spinal cord, 2 or\nmore vertebral segments;\n$ 5,247.21\n4942\n63051\nLaminoplasty, cervical, with decompression of the spinal cord, 2 or\nmore vertebral segments; with reconstruction of the posterior bony\nelements (including the application of bridging bone graft and non-\nsegmental fixation devices [eg, wire, suture, mini-pl\n$ 5,950.77\n4943\n63055\n63055\nTranspedicular approach with decompression of spinal cord, equina\nand\/or nerve root(s) (eg, herniated intervertebral disc), single\nsegment; thoracic\n$ 6,694.20\n4944\n63056\n63056\nTranspedicular approach with decompression of spinal cord, equina\nand\/or nerve root(s) (eg, herniated intervertebral disc), single\nsegment; lumbar (including transfacet, or lateral extraforaminal\napproach) (eg, far lateral herniated intervertebral disc)\n$ 5,550.30\n4945\n63057\n63057\nTranspedicular approach with decompression of spinal cord, equina\nand\/or nerve root(s) (eg, herniated intervertebral disc), single\nsegment; each additional segment, thoracic or lumbar (List\nseparately in addition to code for primary procedure)\n$ 1,699.20\n4946\n63064\n63064\nCostovertebral approach with decompression of spinal cord or\nnerve root(s) (eg, herniated intervertebral disc), thoracic; single\nsegment\n$ 5,833.80\n4947\n63066\n63066\nCostovertebral approach with decompression of spinal cord or\nnerve root(s) (eg, herniated intervertebral disc), thoracic; each\nadditional segment (List separately in addition to code for primary\nprocedure)\n$ 1,287.90\n4948\n63075\n63075\nDiscectomy, anterior, with decompression of spinal cord and\/or\nnerve root(s), including osteophytectomy; cervical, single interspace $ 5,081.40\n4949\n63076\n63076\nDiscectomy, anterior, with decompression of spinal cord and\/or\nnerve root(s), including osteophytectomy; cervical, each additional\ninterspace (List separately in addition to code for primary\nprocedure)\n$ 1,952.10\n4950\n63077\n63077\nDiscectomy, anterior, with decompression of spinal cord and\/or\nnerve root(s), including osteophytectomy; thoracic, single\ninterspace\n$ 4,871.70\n4951\n63078\n63078\nDiscectomy, anterior, with decompression of spinal cord and\/or\nnerve root(s), including osteophytectomy; thoracic, each additional\ninterspace (List separately in addition to code for primary\nprocedure)\n$ 1,342.80\n4952\n63081\n63081\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, anterior approach with decompression of spinal cord\nand\/or nerve root(s); cervical, single segment\n$ 6,626.70\n4953\n63082\n63082\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, anterior approach with decompression of spinal cord\nand\/or nerve root(s); cervical, each additional segment (List\nseparately in addition to code for primary procedure)\n$ 1,591.20\n4954\n63085\n63085\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, transthoracic approach with decompression of spinal\ncord and\/or nerve root(s); thoracic, single segment\n$ 7,022.70\n4955\n63086\n63086\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, transthoracic approach with decompression of spinal\ncord and\/or nerve root(s); thoracic, each additional segment (List\nseparately in addition to code for primary procedure)\n$ 1,986.30\n4956\n63087\n63087\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, combined thoracolumbar approach with decompression\nof spinal cord, cauda equina or nerve root(s), lower thoracic or\nlumbar; single segment\n$ 6,282.90\n4957\n63088\n63088\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, combined thoracolumbar approach with decompression\nof spinal cord, cauda equina or nerve root(s), lower thoracic or\nlumbar; each additional segment (List separately in addition to code\n$ 1,699.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4958\n63090\n63090\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, transperitoneal or retroperitoneal approach with\ndecompression of spinal cord, cauda equina or nerve root(s), lower\nthoracic, lumbar, or sacral; single segment\n$ 6,551.10\n4959\n63091\n63091\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, transperitoneal or retroperitoneal approach with\ndecompression of spinal cord, cauda equina or nerve root(s), lower\nthoracic, lumbar, or sacral; each additional segment (List separately\n$ 1,787.40\n4960\n63101\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, lateral extracavitary approach with decompression of\nspinal cord and\/or nerve root(s) (eg, for tumor or retropulsed bone\nfragments); thoracic, single segment\n$ 6,101.26\n4961\n63102\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, lateral extracavitary approach with decompression of\nspinal cord and\/or nerve root(s) (eg, for tumor or retropulsed bone\nfragments); lumbar, single segment\n$ 6,074.85\n4962\n63103\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, lateral extracavitary approach with decompression of\nspinal cord and\/or nerve root(s) (eg, for tumor or retropulsed bone\nfragments); thoracic or lumbar, each additional segment (List se\n$ 1,901.26\n4963\n63170\n63170\nLaminectomy with myelotomy (eg, Bischof or DREZ type), cervical,\nthoracic, or thoracolumbar\n$ 5,840.10\n4964\n63172\n63172\nLaminectomy with drainage of intramedullary cyst\/syrinx; to\nsubarachnoid space\n$ 5,694.30\n4965\n63173\n63173\nLaminectomy with drainage of intramedullary cyst\/syrinx; to\nperitoneal or pleural space\n$ 5,922.90\n4966\n63180\n63180\nLaminectomy and section of dentate ligaments, with or without\ndural graft, cervical; 1 or 2 segments\n$ 5,348.70\n4967\n63182\n63182\nLaminectomy and section of dentate ligaments, with or without\ndural graft, cervical; more than 2 segments\n$ 5,603.40\n4968\n63185\n63185\nLaminectomy with rhizotomy; 1 or 2 segments\n$ 4,599.00\n4969\n63190\n63190\nLaminectomy with rhizotomy; more than 2 segments\n$ 5,452.20\n4970\n63191\n63191\nLaminectomy with section of spinal accessory nerve\n$ 3,994.20\n4971\n63194\n63194\nLaminectomy with cordotomy, with section of 1 spinothalamic tract,\n1 stage; cervical\n$ 4,356.90\n4972\n63195\n63195\nLaminectomy with cordotomy, with section of 1 spinothalamic tract,\n1 stage; thoracic\n$ 4,849.20\n4973\n63196\n63196\nLaminectomy with cordotomy, with section of both spinothalamic\ntracts, 1 stage; cervical\n$ 4,980.60\n4974\n63197\n63197\nLaminectomy with cordotomy, with section of both spinothalamic\ntracts, 1 stage; thoracic\n$ 5,346.00\n4975\n63198\n63198\nLaminectomy with cordotomy with section of both spinothalamic\ntracts, 2 stages within 14 days; cervical\n$ 5,892.30\n4976\n63199\n63199\nLaminectomy with cordotomy with section of both spinothalamic\ntracts, 2 stages within 14 days; thoracic\n$ 5,892.30\n4977\n63200\n63200\nLaminectomy, with release of tethered spinal cord, lumbar\n$ 4,874.40\n4978\n63250\n63250\nLaminectomy for excision or occlusion of arteriovenous\nmalformation of spinal cord; cervical\n$ 6,437.70\n4979\n63251\n63251\nLaminectomy for excision or occlusion of arteriovenous\nmalformation of spinal cord; thoracic\n$ 6,669.90\n4980\n63252\n63252\nLaminectomy for excision or occlusion of arteriovenous\nmalformation of spinal cord; thoracolumbar\n$ 7,471.80\n4981\n63265\n63265\nLaminectomy for excision or evacuation of intraspinal lesion other\nthan neoplasm, extradural; cervical\n$ 5,824.80\n4982\n63266\n63266\nLaminectomy for excision or evacuation of intraspinal lesion other\nthan neoplasm, extradural; thoracic\n$ 6,412.50\n4983\n63267\n63267\nLaminectomy for excision or evacuation of intraspinal lesion other\nthan neoplasm, extradural; lumbar\n$ 5,632.20\n4984\n63268\n63268\nLaminectomy for excision or evacuation of intraspinal lesion other\nthan neoplasm, extradural; sacral\n$ 4,805.10\n4985\n63270\n63270\nLaminectomy for excision of intraspinal lesion other than neoplasm,\nintradural; cervical\n$ 5,739.30\n4986\n63271\n63271\nLaminectomy for excision of intraspinal lesion other than neoplasm,\nintradural; thoracic\n$ 5,804.10\n4987\n63272\n63272\nLaminectomy for excision of intraspinal lesion other than neoplasm,\nintradural; lumbar\n$ 5,796.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n4988\n63273\n63273\nLaminectomy for excision of intraspinal lesion other than neoplasm,\nintradural; sacral\n$ 5,023.80\n4989\n63275\n63275\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nextradural, cervical\n$ 6,346.80\n4990\n63276\n63276\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nextradural, thoracic\n$ 6,246.90\n4991\n63277\n63277\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nextradural, lumbar\n$ 5,616.90\n4992\n63278\n63278\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nextradural, sacral\n$ 5,306.40\n4993\n63280\n63280\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nintradural, extramedullary, cervical\n$ 6,412.50\n4994\n63281\n63281\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nintradural, extramedullary, thoracic\n$ 6,556.50\n4995\n63282\n63282\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nintradural, extramedullary, lumbar\n$ 6,702.30\n4996\n63283\n63283\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nintradural, sacral\n$ 5,282.10\n4997\n63285\n63285\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nintradural, intramedullary, cervical\n$ 6,808.50\n4998\n63286\n63286\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nintradural, intramedullary, thoracic\n$ 7,128.00\n4999\n63287\n63287\nLaminectomy for biopsy\/excision of intraspinal neoplasm;\nintradural, intramedullary, thoracolumbar\n$ 7,533.00\n5000\n63290\n63290\nLaminectomy for biopsy\/excision of intraspinal neoplasm; combined\nextradural-intradural lesion, any level\n$ 7,120.80\n5001\n63295\nOsteoplastic reconstruction of dorsal spinal elements, following\nprimary intraspinal procedure (List separately in addition to code\nfor primary procedure)\n$ 876.68\n5002\n63300\n63300\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nextradural, cervical\n$ 6,033.60\n5003\n63301\n63301\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nextradural, thoracic by transthoracic approach\n$ 6,150.60\n5004\n63302\n63302\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nextradural, thoracic by thoracolumbar approach\n$ 6,551.10\n5005\n63303\n63303\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nextradural, lumbar or sacral by transperitoneal or retroperitoneal\napproach\n$ 6,489.00\n5006\n63304\n63304\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nintradural, cervical\n$ 6,502.50\n5007\n63305\n63305\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nintradural, thoracic by transthoracic approach\n$ 6,653.70\n5008\n63306\n63306\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nintradural, thoracic by thoracolumbar approach\n$ 6,643.80\n5009\n63307\n63307\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment;\nintradural, lumbar or sacral by transperitoneal or retroperitoneal\napproach\n$ 7,065.90\n5010\n63308\n63308\nVertebral corpectomy (vertebral body resection), partial or\ncomplete, for excision of intraspinal lesion, single segment; each\nadditional segment (List separately in addition to codes for single\nsegment)\n$ 1,661.40\n5011\n63600\n63600\nCreation of lesion of spinal cord by stereotactic method,\npercutaneous, any modality (including stimulation and\/or\nrecording)\n$ 3,244.50\n5012\n63610\n63610\nStereotactic stimulation of spinal cord, percutaneous, separate\nprocedure not followed by other surgery\n$ 2,502.90\n5013\n63615\n63615\nStereotactic biopsy, aspiration, or excision of lesion, spinal cord\n$ 3,785.40\n5014\n63620\n63620\nStereotactic radiosurgery (particle beam, gamma ray, or linear\naccelerator); 1 spinal lesion\n$ 1,894.72\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5015\n63621\n63621\nStereotactic radiosurgery (particle beam, gamma ray, or linear\naccelerator); each additional spinal lesion (List separately in\naddition to code for primary procedure)\n$ 590.80\n5016\n63650\n63650\nPercutaneous implantation of neurostimulator electrode array,\nepidural\n$ 3,397.50\n5017\n63655\n63655\nLaminectomy for implantation of neurostimulator electrodes,\nplate\/paddle, epidural\n$ 4,462.20\n5018\n63661\nRemoval of spinal neurostimulator electrode percutaneous array(s),\nincluding fluoroscopy, when performed\n$ 1,863.09\n5019\n63662\nRemoval of spinal neurostimulator electrode plate\/paddle(s) placed\nvia laminotomy or laminectomy, including fluoroscopy, when\nperformed\n$ 3,176.79\n5020\n63663\nRevision including replacement, when performed, of spinal\nneurostimulator electrode percutaneous array(s), including\nfluoroscopy, when performed\n$ 2,705.03\n5021\n63664\nRevision including replacement, when performed, of spinal\nneurostimulator electrode plate\/paddle(s) placed via laminotomy or\nlaminectomy, including fluoroscopy, when performed\n$ 3,472.26\n5022\n63685\n63685\nInsertion or replacement of spinal neurostimulator pulse generator\nor receiver, direct or inductive coupling\n$ 2,304.90\n5023\n63688\nRevision or removal of implanted spinal neurostimulator pulse\ngenerator or receiver\n$ 1,452.60\n5024\n63700\n63700\nRepair of meningocele; less than 5 cm diameter\n$ 3,715.20\n5025\n63702\n63702\nRepair of meningocele; larger than 5 cm diameter\n$ 3,716.10\n5026\n63704\n63704\nRepair of myelomeningocele; less than 5 cm diameter\n$ 4,053.60\n5027\n63706\n63706\nRepair of myelomeningocele; larger than 5 cm diameter\n$ 4,401.00\n5028\n63707\n63707\nRepair of dural\/cerebrospinal fluid leak, not requiring laminectomy\n$ 4,411.80\n5029\n63709\n63709\nRepair of dural\/cerebrospinal fluid leak or pseudomeningocele, with\nlaminectomy\n$ 5,055.30\n5030\n63710\n63710\nDural graft, spinal\n$ 4,424.40\n5031\n63740\n63740\nCreation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or\nother; including laminectomy\n$ 4,424.40\n5032\n63741\n63741\nCreation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or\nother; percutaneous, not requiring laminectomy\n$ 2,841.30\n5033\n63744\n63744\nReplacement, irrigation or revision of lumbosubarachnoid shunt\n$ 2,214.90\n5034\n63746\n63746\nRemoval of entire lumbosubarachnoid shunt system without\nreplacement\n$ 1,661.40\n5035\n64400\nInjection, anesthetic agent; trigeminal nerve, any division or branch\n$ 369.00\n5036\n64402\n64402\nInjection, anesthetic agent; facial nerve\n$ 243.90\n5037\n64405\n64405\nInjection, anesthetic agent; greater occipital nerve\n$ 242.10\n5038\n64408\n64408\nInjection, anesthetic agent; vagus nerve\n$ 284.40\n5039\n64410\n64410\nInjection, anesthetic agent; phrenic nerve\n$ 250.20\n5040\n64412\n64412\nInjection, anesthetic agent; spinal accessory nerve\n$ 242.10\n5041\n64413\n64413\nInjection, anesthetic agent; cervical plexus\n$ 299.70\n5042\n64415\n64415\nInjection, anesthetic agent; brachial plexus, single\n$ 268.20\n5043\n64416\n64416\nInjection, anesthetic agent; brachial plexus, continuous infusion by\ncatheter (including catheter placement)\n$ 305.64\n5044\n64417\n64417\nInjection, anesthetic agent; axillary nerve\n$ 250.20\n5045\n64418\n64418\nInjection, anesthetic agent; suprascapular nerve\n$ 274.07\n5046\n64420\n64420\nInjection, anesthetic agent; intercostal nerve, single\n$ 261.90\n5047\n64421\n64421\nInjection, anesthetic agent; intercostal nerves, multiple, regional\nblock\n$ 486.90\n5048\n64425\n64425\nInjection, anesthetic agent; ilioinguinal, iliohypogastric nerves\n$ 257.40\n5049\n64430\n64430\nInjection, anesthetic agent; pudendal nerve\n$ 261.00\n5050\n64435\n64435\nInjection, anesthetic agent; paracervical (uterine) nerve\n$ 234.90\n5051\n64445\n64445\nInjection, anesthetic agent; sciatic nerve, single\n$ 326.70\n5052\n64446\n64446\nInjection, anesthetic agent; sciatic nerve, continuous infusion by\ncatheter (including catheter placement)\n$ 305.97\n5053\n64447\n64447\nInjection, anesthetic agent; femoral nerve, single\n$ 228.81\n5054\n64448\n64448\nInjection, anesthetic agent; femoral nerve, continuous infusion by\ncatheter (including catheter placement)\n$ 275.13\n5055\n64449\n64449\nInjection, anesthetic agent; lumbar plexus, posterior approach,\ncontinuous infusion by catheter (including catheter placement)\n$ 306.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5056\n64450\n64450\nInjection, anesthetic agent; other peripheral nerve or branch\n$ 185.40\n5057\n64455\n64455\nInjection(s), anesthetic agent and\/or steroid, plantar common\ndigital nerve(s) (eg, Morton's neuroma)\n$ 157.67\n5058\n64479\n64479\nInjection(s), anesthetic agent and\/or steroid, transforaminal\nepidural, with imaging guidance (fluoroscopy or CT); cervical or\nthoracic, single level\n$ 485.10\n5059\n64480\n64480\nInjection(s), anesthetic agent and\/or steroid, transforaminal\nepidural, with imaging guidance (fluoroscopy or CT); cervical or\nthoracic, each additional level (List separately in addition to code for\nprimary procedure)\n$ 436.50\n5060\n64483\n64483\nInjection(s), anesthetic agent and\/or steroid, transforaminal\nepidural, with imaging guidance (fluoroscopy or CT); lumbar or\nsacral, single level\n$ 398.11\n5061\n64484\n64484\nInjection(s), anesthetic agent and\/or steroid, transforaminal\nepidural, with imaging guidance (fluoroscopy or CT); lumbar or\nsacral, each additional level (List separately in addition to code for\nprimary procedure)\n$ 447.30\n5062\n64490\n64490\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\n(zygapophyseal) joint (or nerves innervating that joint) with image\nguidance (fluoroscopy or CT), cervical or thoracic; single level\n$ 404.72\n5063\n64491\n64491\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\n(zygapophyseal) joint (or nerves innervating that joint) with image\nguidance (fluoroscopy or CT), cervical or thoracic; second level (List\nseparately in addition to code for primary proced\n$ 287.25\n5064\n64492\n64492\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\n(zygapophyseal) joint (or nerves innervating that joint) with image\nguidance (fluoroscopy or CT), cervical or thoracic; third and any\nadditional level(s) (List separately in addition to co\n$ 287.36\n5065\n64493\n64493\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\n(zygapophyseal) joint (or nerves innervating that joint) with image\nguidance (fluoroscopy or CT), lumbar or sacral; single level\n$ 398.98\n5066\n64494\n64494\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\n(zygapophyseal) joint (or nerves innervating that joint) with image\nguidance (fluoroscopy or CT), lumbar or sacral; second level (List\nseparately in addition to code for primary procedure)\n$ 227.39\n5067\n64495\n64495\nInjection(s), diagnostic or therapeutic agent, paravertebral facet\n(zygapophyseal) joint (or nerves innervating that joint) with image\nguidance (fluoroscopy or CT), lumbar or sacral; third and any\nadditional level(s) (List separately in addition to code f\n$ 227.49\n5068\n64505\n64505\nInjection, anesthetic agent; sphenopalatine ganglion\n$ 244.80\n5069\n64508\n64508\nInjection, anesthetic agent; carotid sinus (separate procedure)\n$ 262.80\n5070\n64510\n64510\nInjection, anesthetic agent; stellate ganglion (cervical sympathetic)\n$ 295.20\n5071\n64517\n64517\nInjection, anesthetic agent; superior hypogastric plexus\n$ 385.18\n5072\n64520\n64520\nInjection, anesthetic agent; lumbar or thoracic (paravertebral\nsympathetic)\n$ 490.41\n5073\n64530\n64530\nInjection, anesthetic agent; celiac plexus, with or without radiologic\nmonitoring\n$ 540.90\n5074\n64550\n64550\nApplication of surface (transcutaneous) neurostimulator\n$ 123.54\n5075\n64553\n64553\nPercutaneous implantation of neurostimulator electrode array;\ncranial nerve\n$ 360.90\n5076\n64555\n64555\nPercutaneous implantation of neurostimulator electrode array;\nperipheral nerve (excludes sacral nerve)\n$ 309.60\n5077\n64561\n64561\nPercutaneous implantation of neurostimulator electrode array;\nsacral nerve (transforaminal placement) including image guidance,\nif performed\n$ 1,611.28\n5078\n64565\n64565\nPercutaneous implantation of neurostimulator electrode array;\nneuromuscular\n$ 293.40\n5079\n64566\n64566\nPosterior tibial neurostimulation, percutaneous needle electrode,\nsingle treatment, includes programming\n$ 266.83\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5080\n64568\n64568\nIncision for implantation of cranial nerve (eg, vagus nerve)\nneurostimulator electrode array and pulse generator\n$ 1,127.59\n5081\n64569\n64569\nRevision or replacement of cranial nerve (eg, vagus nerve)\nneurostimulator electrode array, including connection to existing\npulse generator\n$ 1,130.12\n5082\n64570\n64570\nRemoval of cranial nerve (eg, vagus nerve) neurostimulator\nelectrode array and pulse generator\n$ 999.18\n5083\n64575\n64575\nIncision for implantation of neurostimulator electrode array;\nperipheral nerve (excludes sacral nerve)\n$ 963.90\n5084\n64580\n64580\nIncision for implantation of neurostimulator electrode array;\nneuromuscular\n$ 793.80\n5085\n64581\n64581\nIncision for implantation of neurostimulator electrode array; sacral\nnerve (transforaminal placement)\n$ 1,141.09\n5086\n64585\n64585\nRevision or removal of peripheral neurostimulator electrode array\n$ 678.60\n5087\n64590\n64590\nInsertion or replacement of peripheral or gastric neurostimulator\npulse generator or receiver, direct or inductive coupling\n$ 738.90\n5088\n64595\n64595\nRevision or removal of peripheral or gastric neurostimulator pulse\ngenerator or receiver\n$ 530.10\n5089\n64600\n64600\nDestruction by neurolytic agent, trigeminal nerve; supraorbital,\ninfraorbital, mental, or inferior alveolar branch\n$ 540.90\n5090\n64605\n64605\nDestruction by neurolytic agent, trigeminal nerve; second and third\ndivision branches at foramen ovale\n$ 669.60\n5091\n64610\n64610\nDestruction by neurolytic agent, trigeminal nerve; second and third\ndivision branches at foramen ovale under radiologic monitoring\n$ 1,837.80\n5092\n64612\n64612\nChemodenervation of muscle(s); muscle(s) innervated by facial\nnerve, unilateral (eg, for blepharospasm, hemifacial spasm)\n$ 377.10\n5093\n64616\n64616\nChemodenervation of muscle(s); neck muscle(s), excluding muscles\nof the larynx, unilateral (eg, for cervical dystonia, spasmodic\ntorticollis)\n$ 202.21\n5094\n64617\n64617\nChemodenervation of muscle(s); larynx, unilateral, percutaneous\n(eg, for spasmodic dysphonia), includes guidance by needle\nelectromyography, when performed\n$ 353.99\n5095\n64620\n64620\nDestruction by neurolytic agent, intercostal nerve\n$ 417.60\n5096\n64630\n64630\nDestruction by neurolytic agent; pudendal nerve\n$ 391.50\n5097\n64632\n64632\nDestruction by neurolytic agent; plantar common digital nerve\n$ 278.02\n5098\n64633\n64633\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\nwith imaging guidance (fluoroscopy or CT); cervical or thoracic,\nsingle facet joint\n$ 1,004.45\n5099\n64634\n64634\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\nwith imaging guidance (fluoroscopy or CT); cervical or thoracic, each\nadditional facet joint (List separately in addition to code for primary\nprocedure)\n$ 457.76\n5100\n64635\n64635\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\nwith imaging guidance (fluoroscopy or CT); lumbar or sacral, single\nfacet joint\n$ 986.15\n5101\n64636\n64636\nDestruction by neurolytic agent, paravertebral facet joint nerve(s),\nwith imaging guidance (fluoroscopy or CT); lumbar or sacral, each\nadditional facet joint (List separately in addition to code for primary\nprocedure)\n$ 412.31\n5102\n64640\n64640\nDestruction by neurolytic agent; other peripheral nerve or branch\n$ 394.20\n5103\n64642\n64642\nChemodenervation of one extremity; 1-4 muscle(s)\n$ 353.99\n5104\n64643\n64643\nChemodenervation of one extremity; each additional extremity, 1-4\nmuscle(s) (List separately in addition to code for primary procedure) $ 73.55\n5105\n64644\n64644\nChemodenervation of one extremity; 5 or more muscle(s)\n$ 353.99\n5106\n64645\n64645\nChemodenervation of one extremity; each additional extremity, 5\nor more muscle(s) (List separately in addition to code for primary\nprocedure)\n$ 84.31\n5107\n64646\n64646\nChemodenervation of trunk muscle(s); 1-5 muscle(s)\n$ 353.99\n5108\n64647\n64647\nChemodenervation of trunk muscle(s); 6 or more muscle(s)\n$ 353.99\n5109\n64650\n64650\nChemodenervation of eccrine glands; both axillae\n$ 106.28\n5110\n64653\n64653\nChemodenervation of eccrine glands; other area(s) (eg, scalp, face,\nneck), per day\n$ 139.04\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5111\n64680\n64680\nDestruction by neurolytic agent, with or without radiologic\nmonitoring; celiac plexus\n$ 685.80\n5112\n64681\n64681\nDestruction by neurolytic agent, with or without radiologic\nmonitoring; superior hypogastric plexus\n$ 734.56\n5113\n64702\n64702\nNeuroplasty; digital, 1 or both, same digit\n$ 1,325.70\n5114\n64704\n64704\nNeuroplasty; nerve of hand or foot\n$ 1,467.90\n5115\n64708\n64708\nNeuroplasty, major peripheral nerve, arm or leg, open; other than\nspecified\n$ 1,944.90\n5116\n64712\n64712\nNeuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve\n$ 2,121.30\n5117\n64713\n64713\nNeuroplasty, major peripheral nerve, arm or leg, open; brachial\nplexus\n$ 2,725.20\n5118\n64714\n64714\nNeuroplasty, major peripheral nerve, arm or leg, open; lumbar\nplexus\n$ 2,422.80\n5119\n64716\n64716\nNeuroplasty and\/or transposition; cranial nerve (specify)\n$ 2,464.20\n5120\n64718\n64718\nNeuroplasty and\/or transposition; ulnar nerve at elbow\n$ 2,523.60\n5121\n64719\n64719\nNeuroplasty and\/or transposition; ulnar nerve at wrist\n$ 1,989.90\n5122\n64721\n64721\nNeuroplasty and\/or transposition; median nerve at carpal tunnel\n$ 1,854.00\n5123\n64722\n64722\nDecompression; unspecified nerve(s) (specify)\n$ 2,050.20\n5124\n64726\n64726\nDecompression; plantar digital nerve\n$ 751.50\n5125\n64727\n64727\nInternal neurolysis, requiring use of operating microscope (List\nseparately in addition to code for neuroplasty) (Neuroplasty\nincludes external neurolysis)\n$ 2,111.40\n5126\n64732\n64732\nTransection or avulsion of; supraorbital nerve\n$ 1,287.90\n5127\n64734\n64734\nTransection or avulsion of; infraorbital nerve\n$ 1,476.00\n5128\n64736\n64736\nTransection or avulsion of; mental nerve\n$ 1,255.50\n5129\n64738\n64738\nTransection or avulsion of; inferior alveolar nerve by osteotomy\n$ 1,447.20\n5130\n64740\n64740\nTransection or avulsion of; lingual nerve\n$ 1,586.70\n5131\n64742\n64742\nTransection or avulsion of; facial nerve, differential or complete\n$ 1,668.60\n5132\n64744\n64744\nTransection or avulsion of; greater occipital nerve\n$ 1,597.50\n5133\n64746\n64746\nTransection or avulsion of; phrenic nerve\n$ 803.70\n5134\n64752\n64752\nTransection or avulsion of; vagus nerve (vagotomy), transthoracic\n$ 2,326.50\n5135\n64755\n64755\nTransection or avulsion of; vagus nerves limited to proximal\nstomach (selective proximal vagotomy, proximal gastric vagotomy,\nparietal cell vagotomy, supra- or highly selective vagotomy)\n$ 3,316.50\n5136\n64760\n64760\nTransection or avulsion of; vagus nerve (vagotomy), abdominal\n$ 1,964.70\n5137\n64761\n64761\nTransection or avulsion of; pudendal nerve\n$ 855.00\n5138\n64763\n64763\nTransection or avulsion of obturator nerve, extrapelvic, with or\nwithout adductor tenotomy\n$ 1,021.50\n5139\n64766\n64766\nTransection or avulsion of obturator nerve, intrapelvic, with or\nwithout adductor tenotomy\n$ 1,606.50\n5140\n64771\n64771\nTransection or avulsion of other cranial nerve, extradural\n$ 1,647.90\n5141\n64772\n64772\nTransection or avulsion of other spinal nerve, extradural\n$ 2,052.90\n5142\n64774\n64774\nExcision of neuroma; cutaneous nerve, surgically identifiable\n$ 922.50\n5143\n64776\n64776\nExcision of neuroma; digital nerve, 1 or both, same digit\n$ 1,074.60\n5144\n64778\n64778\nExcision of neuroma; digital nerve, each additional digit (List\nseparately in addition to code for primary procedure)\n$ 461.70\n5145\n64782\n64782\nExcision of neuroma; hand or foot, except digital nerve\n$ 1,261.80\n5146\n64783\n64783\nExcision of neuroma; hand or foot, each additional nerve, except\nsame digit (List separately in addition to code for primary\nprocedure)\n$ 669.60\n5147\n64784\n64784\nExcision of neuroma; major peripheral nerve, except sciatic\n$ 1,841.40\n5148\n64786\n64786\nExcision of neuroma; sciatic nerve\n$ 2,403.00\n5149\n64787\n64787\nImplantation of nerve end into bone or muscle (List separately in\naddition to neuroma excision)\n$ 1,390.50\n5150\n64788\n64788\nExcision of neurofibroma or neurolemmoma; cutaneous nerve\n$ 1,159.20\n5151\n64790\n64790\nExcision of neurofibroma or neurolemmoma; major peripheral\nnerve\n$ 2,151.90\n5152\n64792\n64792\nExcision of neurofibroma or neurolemmoma; extensive (including\nmalignant type)\n$ 2,224.80\n5153\n64795\n64795\nBiopsy of nerve\n$ 914.40\n5154\n64802\n64802\nSympathectomy, cervical\n$ 2,657.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5155\n64804\n64804\nSympathectomy, cervicothoracic\n$ 3,587.40\n5156\n64809\n64809\nSympathectomy, thoracolumbar\n$ 2,945.70\n5157\n64818\n64818\nSympathectomy, lumbar\n$ 2,699.10\n5158\n64820\n64820\nSympathectomy; digital arteries, each digit\n$ 1,219.55\n5159\n64821\n64821\nSympathectomy; radial artery\n$ 1,203.16\n5160\n64822\n64822\nSympathectomy; ulnar artery\n$ 1,201.92\n5161\n64823\n64823\nSympathectomy; superficial palmar arch\n$ 1,223.47\n5162\n64831\n64831\nSuture of digital nerve, hand or foot; 1 nerve\n$ 1,704.60\n5163\n64832\n64832\nSuture of digital nerve, hand or foot; each additional digital nerve\n(List separately in addition to code for primary procedure)\n$ 927.90\n5164\n64834\n64834\nSuture of 1 nerve; hand or foot, common sensory nerve\n$ 1,899.00\n5165\n64835\n64835\nSuture of 1 nerve; median motor thenar\n$ 1,967.40\n5166\n64836\n64836\nSuture of 1 nerve; ulnar motor\n$ 2,360.70\n5167\n64837\n64837\nSuture of each additional nerve, hand or foot (List separately in\naddition to code for primary procedure)\n$ 1,134.90\n5168\n64840\n64840\nSuture of posterior tibial nerve\n$ 2,778.30\n5169\n64856\n64856\nSuture of major peripheral nerve, arm or leg, except sciatic;\nincluding transposition\n$ 2,831.40\n5170\n64857\n64857\nSuture of major peripheral nerve, arm or leg, except sciatic; without\ntransposition\n$ 2,518.20\n5171\n64858\n64858\nSuture of sciatic nerve\n$ 2,503.80\n5172\n64859\n64859\nSuture of each additional major peripheral nerve (List separately in\naddition to code for primary procedure)\n$ 1,147.50\n5173\n64861\n64861\nSuture of; brachial plexus\n$ 2,703.60\n5174\n64862\n64862\nSuture of; lumbar plexus\n$ 3,292.20\n5175\n64864\n64864\nSuture of facial nerve; extracranial\n$ 2,355.30\n5176\n64865\n64865\nSuture of facial nerve; infratemporal, with or without grafting\n$ 3,441.60\n5177\n64866\n64866\nAnastomosis; facial-spinal accessory\n$ 3,690.90\n5178\n64868\n64868\nAnastomosis; facial-hypoglossal\n$ 4,108.50\n5179\n64870\n64870\nAnastomosis; facial-phrenic\n$ 3,644.10\n5180\n64872\n64872\nSuture of nerve; requiring secondary or delayed suture (List\nseparately in addition to code for primary neurorrhaphy)\n$ 1,768.50\n5181\n64874\n64874\nSuture of nerve; requiring extensive mobilization, or transposition\nof nerve (List separately in addition to code for nerve suture)\n$ 2,524.50\n5182\n64876\n64876\nSuture of nerve; requiring shortening of bone of extremity (List\nseparately in addition to code for nerve suture)\n$ 441.19\n5183\n64885\nNerve graft (includes obtaining graft), head or neck; up to 4 cm in\nlength\n$ 3,759.30\n5184\n64886\nNerve graft (includes obtaining graft), head or neck; more than 4 cm\nlength\n$ 3,234.60\n5185\n64890\nNerve graft (includes obtaining graft), single strand, hand or foot;\nup to 4 cm length\n$ 3,495.60\n5186\n64891\nNerve graft (includes obtaining graft), single strand, hand or foot;\nmore than 4 cm length\n$ 2,845.80\n5187\n64892\nNerve graft (includes obtaining graft), single strand, arm or leg; up\nto 4 cm length\n$ 2,796.30\n5188\n64893\nNerve graft (includes obtaining graft), single strand, arm or leg;\nmore than 4 cm length\n$ 3,074.40\n5189\n64895\nNerve graft (includes obtaining graft), multiple strands (cable), hand\nor foot; up to 4 cm length\n$ 3,388.50\n5190\n64896\nNerve graft (includes obtaining graft), multiple strands (cable), hand\nor foot; more than 4 cm length\n$ 3,841.20\n5191\n64897\nNerve graft (includes obtaining graft), multiple strands (cable), arm\nor leg; up to 4 cm length\n$ 3,540.60\n5192\n64898\nNerve graft (includes obtaining graft), multiple strands (cable), arm\nor leg; more than 4 cm length\n$ 3,940.20\n5193\n64901\nNerve graft, each additional nerve; single strand (List separately in\naddition to code for primary procedure)\n$ 2,362.50\n5194\n64902\n64902\nNerve graft, each additional nerve; multiple strands (cable) (List\nseparately in addition to code for primary procedure)\n$ 2,455.20\n5195\n64905\nNerve pedicle transfer; first stage\n$ 2,021.40\n5196\n64907\nNerve pedicle transfer; second stage\n$ 2,226.60\n5197\n64910\nNerve repair; with synthetic conduit or vein allograft (eg, nerve\ntube), each nerve\n$ 1,599.15\n5198\n64911\nNerve repair; with autogenous vein graft (includes harvest of vein\ngraft), each nerve\n$ 1,901.18\n5199\n64999\n64999\nUnlisted procedure, nervous system\n$ 468.58\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5200\n65091\n65091\nEvisceration of ocular contents; without implant\n$ 1,363.50\n5201\n65093\n65093\nEvisceration of ocular contents; with implant\n$ 1,705.50\n5202\n65101\n65101\nEnucleation of eye; without implant\n$ 2,083.44\n5203\n65103\n65103\nEnucleation of eye; with implant, muscles not attached to implant\n$ 1,895.40\n5204\n65105\n65105\nEnucleation of eye; with implant, muscles attached to implant\n$ 2,379.60\n5205\n65110\n65110\nExenteration of orbit (does not include skin graft), removal of\norbital contents; only\n$ 3,046.50\n5206\n65112\n65112\nExenteration of orbit (does not include skin graft), removal of\norbital contents; with therapeutic removal of bone\n$ 3,127.50\n5207\n65114\n65114\nExenteration of orbit (does not include skin graft), removal of\norbital contents; with muscle or myocutaneous flap\n$ 3,379.50\n5208\n65125\n65125\nModification of ocular implant with placement or replacement of\npegs (eg, drilling receptacle for prosthesis appendage) (separate\nprocedure)\n$ 772.20\n5209\n65130\n65130\nInsertion of ocular implant secondary; after evisceration, in scleral\nshell\n$ 1,467.90\n5210\n65135\n65135\nInsertion of ocular implant secondary; after enucleation, muscles\nnot attached to implant\n$ 1,566.00\n5211\n65140\n65140\nInsertion of ocular implant secondary; after enucleation, muscles\nattached to implant\n$ 2,068.20\n5212\n65150\n65150\nReinsertion of ocular implant; with or without conjunctival graft\n$ 1,441.80\n5213\n65155\n65155\nReinsertion of ocular implant; with use of foreign material for\nreinforcement and\/or attachment of muscles to implant\n$ 1,653.30\n5214\n65175\n65175\nRemoval of ocular implant\n$ 1,166.40\n5215\n65205\n65205\nRemoval of foreign body, external eye; conjunctival superficial\n$ 116.74\n5216\n65210\n65210\nRemoval of foreign body, external eye; conjunctival embedded\n(includes concretions), subconjunctival, or scleral nonperforating\n$ 131.60\n5217\n65220\n65220\nRemoval of foreign body, external eye; corneal, without slit lamp\n$ 112.50\n5218\n65222\n65222\nRemoval of foreign body, external eye; corneal, with slit lamp\n$ 163.91\n5219\n65235\n65235\nRemoval of foreign body, intraocular; from anterior chamber of eye\nor lens\n$ 1,715.40\n5220\n65260\n65260\nRemoval of foreign body, intraocular; from posterior segment,\nmagnetic extraction, anterior or posterior route\n$ 1,864.80\n5221\n65265\n65265\nRemoval of foreign body, intraocular; from posterior segment,\nnonmagnetic extraction\n$ 2,199.60\n5222\n65270\n65270\nRepair of laceration; conjunctiva, with or without nonperforating\nlaceration sclera, direct closure\n$ 275.02\n5223\n65272\n65272\nRepair of laceration; conjunctiva, by mobilization and\nrearrangement, without hospitalization\n$ 494.10\n5224\n65273\n65273\nRepair of laceration; conjunctiva, by mobilization and\nrearrangement, with hospitalization\n$ 726.30\n5225\n65275\n65275\nRepair of laceration; cornea, nonperforating, with or without\nremoval foreign body\n$ 821.70\n5226\n65280\n65280\nRepair of laceration; cornea and\/or sclera, perforating, not involving\nuveal tissue\n$ 2,082.60\n5227\n65285\n65285\nRepair of laceration; cornea and\/or sclera, perforating, with\nreposition or resection of uveal tissue\n$ 3,026.69\n5228\n65286\n65286\nRepair of laceration; application of tissue glue, wounds of cornea\nand\/or sclera\n$ 927.00\n5229\n65290\n65290\nRepair of wound, extraocular muscle, tendon and\/or Tenon's\ncapsule\n$ 1,153.80\n5230\n65400\n65400\nExcision of lesion, cornea (keratectomy, lamellar, partial), except\npterygium\n$ 1,133.10\n5231\n65410\n65410\nBiopsy of cornea\n$ 466.20\n5232\n65420\n65420\nExcision or transposition of pterygium; without graft\n$ 944.78\n5233\n65426\n65426\nExcision or transposition of pterygium; with graft\n$ 1,369.33\n5234\n65430\n65430\nScraping of cornea, diagnostic, for smear and\/or culture\n$ 122.40\n5235\n65435\n65435\nRemoval of corneal epithelium; with or without chemocauterization\n(abrasion, curettage)\n$ 157.50\n5236\n65436\n65436\nRemoval of corneal epithelium; with application of chelating agent\n(eg, EDTA)\n$ 463.50\n5237\n65450\n65450\nDestruction of lesion of cornea by cryotherapy, photocoagulation or\nthermocauterization\n$ 483.30\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5238\n65600\n65600\nMultiple punctures of anterior cornea (eg, for corneal erosion,\ntattoo)\n$ 817.20\n5239\n65710\n65710\nKeratoplasty (corneal transplant); anterior lamellar\n$ 3,068.10\n5240\n65730\n65730\nKeratoplasty (corneal transplant); penetrating (except in aphakia or\npseudophakia)\n$ 3,759.30\n5241\n65750\n65750\nKeratoplasty (corneal transplant); penetrating (in aphakia)\n$ 3,811.50\n5242\n65755\n65755\nKeratoplasty (corneal transplant); penetrating (in pseudophakia)\n$ 3,698.10\n5243\n65756\n65756\nKeratoplasty (corneal transplant); endothelial\n$ 2,478.45\n5244\n65757\n65757\nBackbench preparation of corneal endothelial allograft prior to\ntransplantation (List separately in addition to code for primary\nprocedure)\n$ -\n5245\n65760\n65760\nKeratomileusis\n$ 3,709.80\n5246\n65765\n65765\nKeratophakia\n$ 3,844.80\n5247\n65767\n65767\nEpikeratoplasty\n$ 3,079.80\n5248\n65770\n65770\nKeratoprosthesis\n$ 3,605.40\n5249\n65771\n65771\nRadial keratotomy\n$ 1,617.30\n5250\n65772\n65772\nCorneal relaxing incision for correction of surgically induced\nastigmatism\n$ 1,199.70\n5251\n65775\n65775\nCorneal wedge resection for correction of surgically induced\nastigmatism\n$ 1,380.60\n5252\n65780\n65780\nOcular surface reconstruction; amniotic membrane transplantation,\nmultiple layers\n$ 1,555.66\n5253\n65781\n65781\nOcular surface reconstruction; limbal stem cell allograft (eg,\ncadaveric or living donor)\n$ 2,458.31\n5254\n65782\n65782\nOcular surface reconstruction; limbal conjunctival autograft\n(includes obtaining graft)\n$ 1,989.88\n5255\n65800\n65800\nParacentesis of anterior chamber of eye (separate procedure); with\nremoval of aqueous\n$ 360.90\n5256\n65810\n65810\nParacentesis of anterior chamber of eye (separate procedure); with\nremoval of vitreous and\/or discission of anterior hyaloid membrane,\nwith or without air injection\n$ 1,247.40\n5257\n65815\n65815\nParacentesis of anterior chamber of eye (separate procedure); with\nremoval of blood, with or without irrigation and\/or air injection\n$ 1,110.60\n5258\n65820\n65820\nGoniotomy\n$ 1,758.60\n5259\n65850\n65850\nTrabeculotomy ab externo\n$ 2,154.60\n5260\n65855\n65855\nTrabeculoplasty by laser surgery, 1 or more sessions (defined\ntreatment series)\n$ 1,647.90\n5261\n65860\n65860\nSevering adhesions of anterior segment, laser technique (separate\nprocedure)\n$ 1,277.10\n5262\n65865\n65865\nSevering adhesions of anterior segment of eye, incisional technique\n(with or without injection of air or liquid) (separate procedure);\ngoniosynechiae\n$ 1,256.40\n5263\n65870\n65870\nSevering adhesions of anterior segment of eye, incisional technique\n(with or without injection of air or liquid) (separate procedure);\nanterior synechiae, except goniosynechiae\n$ 1,376.10\n5264\n65875\n65875\nSevering adhesions of anterior segment of eye, incisional technique\n(with or without injection of air or liquid) (separate procedure);\nposterior synechiae\n$ 1,417.50\n5265\n65880\n65880\nSevering adhesions of anterior segment of eye, incisional technique\n(with or without injection of air or liquid) (separate procedure);\ncorneovitreal adhesions\n$ 1,403.10\n5266\n65900\n65900\nRemoval of epithelial downgrowth, anterior chamber of eye\n$ 1,668.60\n5267\n65920\n65920\nRemoval of implanted material, anterior segment of eye\n$ 1,873.17\n5268\n65930\n65930\nRemoval of blood clot, anterior segment of eye\n$ 1,298.70\n5269\n66020\n66020\nInjection, anterior chamber of eye (separate procedure); air or\nliquid\n$ 360.90\n5270\n66030\n66030\nInjection, anterior chamber of eye (separate procedure); medication $ 232.20\n5271\n66130\n66130\nExcision of lesion, sclera\n$ 1,153.80\n5272\n66150\n66150\nFistulization of sclera for glaucoma; trephination with iridectomy\n$ 1,913.40\n5273\n66155\n66155\nFistulization of sclera for glaucoma; thermocauterization with\niridectomy\n$ 1,854.00\n5274\n66160\n66160\nFistulization of sclera for glaucoma; sclerectomy with punch or\nscissors, with iridectomy\n$ 1,874.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5275\n66165\n66165\nFistulization of sclera for glaucoma; iridencleisis or iridotasis\n$ 1,788.30\n5276\n66170\n66170\nFistulization of sclera for glaucoma; trabeculectomy ab externo in\nabsence of previous surgery\n$ 2,064.60\n5277\n66172\n66172\nFistulization of sclera for glaucoma; trabeculectomy ab externo with\nscarring from previous ocular surgery or trauma (includes injection\nof antifibrotic agents)\n$ 2,304.00\n5278\n66180\n66180\nAqueous shunt to extraocular reservoir (eg, Molteno, Schocket,\nDenver-Krupin)\n$ 2,621.70\n5279\n66185\n66185\nRevision of aqueous shunt to extraocular reservoir\n$ 1,754.10\n5280\n66220\n66220\nRepair of scleral staphyloma; without graft\n$ 2,317.50\n5281\n66225\n66225\nRepair of scleral staphyloma; with graft\n$ 3,115.80\n5282\n66250\n66250\nRevision or repair of operative wound of anterior segment, any\ntype, early or late, major or minor procedure\n$ 1,555.20\n5283\n66500\n66500\nIridotomy by stab incision (separate procedure); except transfixion\n$ 891.00\n5284\n66505\n66505\nIridotomy by stab incision (separate procedure); with transfixion as\nfor iris bombe\n$ 844.20\n5285\n66600\n66600\nIridectomy, with corneoscleral or corneal section; for removal of\nlesion\n$ 1,434.60\n5286\n66605\n66605\nIridectomy, with corneoscleral or corneal section; with cyclectomy\n$ 2,086.20\n5287\n66625\n66625\nIridectomy, with corneoscleral or corneal section; peripheral for\nglaucoma (separate procedure)\n$ 1,401.30\n5288\n66630\n66630\nIridectomy, with corneoscleral or corneal section; sector for\nglaucoma (separate procedure)\n$ 1,356.30\n5289\n66635\n66635\nIridectomy, with corneoscleral or corneal section; optical (separate\nprocedure)\n$ 1,356.30\n5290\n66680\n66680\nRepair of iris, ciliary body (as for iridodialysis)\n$ 1,522.80\n5291\n66682\n66682\nSuture of iris, ciliary body (separate procedure) with retrieval of\nsuture through small incision (eg, McCannel suture)\n$ 1,645.20\n5292\n66700\n66700\nCiliary body destruction; diathermy\n$ 1,231.20\n5293\n66710\n66710\nCiliary body destruction; cyclophotocoagulation, transscleral\n$ 1,313.10\n5294\n66711\n66711\nCiliary body destruction; cyclophotocoagulation, endoscopic\n$ 1,283.69\n5295\n66720\n66720\nCiliary body destruction; cryotherapy\n$ 1,313.10\n5296\n66740\n66740\nCiliary body destruction; cyclodialysis\n$ 1,275.30\n5297\n66761\n66761\nIridotomy\/iridectomy by laser surgery (eg, for glaucoma) (per\nsession)\n$ 1,380.60\n5298\n66762\n66762\nIridoplasty by photocoagulation (1 or more sessions) (eg, for\nimprovement of vision, for widening of anterior chamber angle)\n$ 1,241.10\n5299\n66770\n66770\nDestruction of cyst or lesion iris or ciliary body (nonexcisional\nprocedure)\n$ 1,347.30\n5300\n66820\n66820\nDiscission of secondary membranous cataract (opacified posterior\nlens capsule and\/or anterior hyaloid); stab incision technique\n(Ziegler or Wheeler knife)\n$ 1,007.10\n5301\n66821\n66821\nDiscission of secondary membranous cataract (opacified posterior\nlens capsule and\/or anterior hyaloid); laser surgery (eg, YAG laser)\n(1 or more stages)\n$ 1,117.54\n5302\n66825\n66825\nRepositioning of intraocular lens prosthesis, requiring an incision\n(separate procedure)\n$ 1,701.90\n5303\n66830\n66830\nRemoval of secondary membranous cataract (opacified posterior\nlens capsule and\/or anterior hyaloid) with corneo-scleral section,\nwith or without iridectomy (iridocapsulotomy, iridocapsulectomy)\n$ 1,787.40\n5304\n66840\n66840\nRemoval of lens material; aspiration technique, 1 or more stages\n$ 2,086.20\n5305\n66850\n66850\nRemoval of lens material; phacofragmentation technique\n(mechanical or ultrasonic) (eg, phacoemulsification), with aspiration\n$ 2,266.20\n5306\n66852\n66852\nRemoval of lens material; pars plana approach, with or without\nvitrectomy\n$ 2,191.50\n5307\n66920\n66920\nRemoval of lens material; intracapsular\n$ 2,442.60\n5308\n66930\n66930\nRemoval of lens material; intracapsular, for dislocated lens\n$ 2,337.30\n5309\n66940\n66940\nRemoval of lens material; extracapsular (other than 66840, 66850,\n66852)\n$ 2,358.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5310\n66982\n66982\nExtracapsular cataract removal with insertion of intraocular lens\nprosthesis (1-stage procedure), manual or mechanical technique\n(eg, irrigation and aspiration or phacoemulsification), complex,\nrequiring devices or techniques not generally used in routine\n$ 2,692.80\n5311\n66983\n66983\nIntracapsular cataract extraction with insertion of intraocular lens\nprosthesis (1 stage procedure)\n$ 2,913.30\n5312\n66984\n66984\nExtracapsular cataract removal with insertion of intraocular lens\nprosthesis (1 stage procedure), manual or mechanical technique\n(eg, irrigation and aspiration or phacoemulsification)\n$ 2,961.00\n5313\n66985\n66985\nInsertion of intraocular lens prosthesis (secondary implant), not\nassociated with concurrent cataract removal\n$ 2,276.10\n5314\n66986\n66986\nExchange of intraocular lens\n$ 2,513.70\n5315\n66990\n66990\nUse of ophthalmic endoscope (List separately in addition to code for\nprimary procedure)\n$ 208.58\n5316\n66999\n66999\nUnlisted procedure, anterior segment of eye\nCost\n5317\n67005\n67005\nRemoval of vitreous, anterior approach (open sky technique or\nlimbal incision); partial removal\n$ 2,368.80\n5318\n67010\n67010\nRemoval of vitreous, anterior approach (open sky technique or\nlimbal incision); subtotal removal with mechanical vitrectomy\n$ 3,078.00\n5319\n67015\n67015\nAspiration or release of vitreous, subretinal or choroidal fluid, pars\nplana approach (posterior sclerotomy)\n$ 1,328.40\n5320\n67025\n67025\nInjection of vitreous substitute, pars plana or limbal approach (fluid-\ngas exchange), with or without aspiration (separate procedure)\n$ 1,447.20\n5321\n67027\n67027\nImplantation of intravitreal drug delivery system (eg, ganciclovir\nimplant), includes concomitant removal of vitreous\n$ 2,884.50\n5322\n67028\n67028\nIntravitreal injection of a pharmacologic agent (separate procedure) $ 677.70\n5323\n67030\n67030\nDiscission of vitreous strands (without removal), pars plana\napproach\n$ 1,555.20\n5324\n67031\n67031\nSevering of vitreous strands, vitreous face adhesions, sheets,\nmembranes or opacities, laser surgery (1 or more stages)\n$ 1,725.30\n5325\n67036\n67036\nVitrectomy, mechanical, pars plana approach;\n$ 3,816.00\n5326\n67039\n67039\nVitrectomy, mechanical, pars plana approach; with focal endolaser\nphotocoagulation\n$ 4,336.20\n5327\n67040\n67040\nVitrectomy, mechanical, pars plana approach; with endolaser\npanretinal photocoagulation\n$ 4,686.30\n5328\n67041\n67041\nVitrectomy, mechanical, pars plana approach; with removal of\npreretinal cellular membrane (eg, macular pucker)\n$ 3,643.85\n5329\n67042\n67042\nVitrectomy, mechanical, pars plana approach; with removal of\ninternal limiting membrane of retina (eg, for repair of macular hole,\ndiabetic macular edema), includes, if performed, intraocular\ntamponade (ie, air, gas or silicone oil)\n$ 4,430.03\n5330\n67043\n67043\nVitrectomy, mechanical, pars plana approach; with removal of\nsubretinal membrane (eg, choroidal neovascularization), includes, if\nperformed, intraocular tamponade (ie, air, gas or silicone oil) and\nlaser photocoagulation\n$ 4,581.88\n5331\n67101\n67101\nRepair of retinal detachment, 1 or more sessions; cryotherapy or\ndiathermy, with or without drainage of subretinal fluid\n$ 2,293.20\n5332\n67105\n67105\nRepair of retinal detachment, 1 or more sessions; photocoagulation,\nwith or without drainage of subretinal fluid\n$ 2,421.00\n5333\n67107\n67107\nRepair of retinal detachment; scleral buckling (such as lamellar\nscleral dissection, imbrication or encircling procedure), with or\nwithout implant, with or without cryotherapy, photocoagulation,\nand drainage of subretinal fluid\n$ 3,351.60\n5334\n67108\n67108\nRepair of retinal detachment; with vitrectomy, any method, with or\nwithout air or gas tamponade, focal endolaser photocoagulation,\ncryotherapy, drainage of subretinal fluid, scleral buckling, and\/or\nremoval of lens by same technique\n$ 4,954.50\n5335\n67110\n67110\nRepair of retinal detachment; by injection of air or other gas (eg,\npneumatic retinopexy)\n$ 2,899.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5336\n67112\n67112\nRepair of retinal detachment; by scleral buckling or vitrectomy, on\npatient having previous ipsilateral retinal detachment repair(s)\nusing scleral buckling or vitrectomy techniques\n$ 3,100.50\n5337\n67113\n67113\nRepair of complex retinal detachment (eg, proliferative\nvitreoretinopathy, stage C-1 or greater, diabetic traction retinal\ndetachment, retinopathy of prematurity, retinal tear of greater than\n90 degrees), with vitrectomy and membrane peeling, may include\n$ 4,729.72\n5338\n67115\n67115\nRelease of encircling material (posterior segment)\n$ 1,184.40\n5339\n67120\n67120\nRemoval of implanted material, posterior segment; extraocular\n$ 1,269.90\n5340\n67121\n67121\nRemoval of implanted material, posterior segment; intraocular\n$ 1,663.20\n5341\n67141\n67141\nProphylaxis of retinal detachment (eg, retinal break, lattice\ndegeneration) without drainage, 1 or more sessions; cryotherapy,\ndiathermy\n$ 1,359.90\n5342\n67145\n67145\nProphylaxis of retinal detachment (eg, retinal break, lattice\ndegeneration) without drainage, 1 or more sessions;\nphotocoagulation (laser or xenon arc)\n$ 1,518.03\n5343\n67208\n67208\nDestruction of localized lesion of retina (eg, macular edema,\ntumors), 1 or more sessions; cryotherapy, diathermy\n$ 1,661.40\n5344\n67210\n67210\nDestruction of localized lesion of retina (eg, macular edema,\ntumors), 1 or more sessions; photocoagulation\n$ 1,524.43\n5345\n67218\n67218\nDestruction of localized lesion of retina (eg, macular edema,\ntumors), 1 or more sessions; radiation by implantation of source\n(includes removal of source)\n$ 2,276.10\n5346\n67220\n67220\nDestruction of localized lesion of choroid (eg, choroidal\nneovascularization); photocoagulation (eg, laser), 1 or more\nsessions\n$ 1,760.40\n5347\n67221\n67221\nDestruction of localized lesion of choroid (eg, choroidal\nneovascularization); photodynamic therapy (includes intravenous\ninfusion)\n$ 1,009.80\n5348\n67225\n67225\nDestruction of localized lesion of choroid (eg, choroidal\nneovascularization); photodynamic therapy, second eye, at single\nsession (List separately in addition to code for primary eye\ntreatment)\n$ 424.48\n5349\n67227\n67227\nDestruction of extensive or progressive retinopathy (eg, diabetic\nretinopathy), 1 or more sessions, cryotherapy, diathermy\n$ 1,713.60\n5350\n67228\n67228\nTreatment of extensive or progressive retinopathy, 1 or more\nsessions; (eg, diabetic retinopathy), photocoagulation\n$ 1,702.39\n5351\n67229\n67229\nTreatment of extensive or progressive retinopathy, 1 or more\nsessions; preterm infant (less than 37 weeks gestation at birth),\nperformed from birth up to 1 year of age (eg, retinopathy of\nprematurity), photocoagulation or cryotherapy\n$ 1,631.69\n5352\n67250\n67250\nScleral reinforcement (separate procedure); without graft\n$ 1,955.70\n5353\n67255\n67255\nScleral reinforcement (separate procedure); with graft\n$ 2,400.30\n5354\n67299\n67299\nUnlisted procedure, posterior segment\nCost\n5355\n67311\n67311\nStrabismus surgery, recession or resection procedure; 1 horizontal\nmuscle\n$ 1,532.70\n5356\n67312\n67312\nStrabismus surgery, recession or resection procedure; 2 horizontal\nmuscles\n$ 2,008.80\n5357\n67314\n67314\nStrabismus surgery, recession or resection procedure; 1 vertical\nmuscle (excluding superior oblique)\n$ 1,854.00\n5358\n67316\n67316\nStrabismus surgery, recession or resection procedure; 2 or more\nvertical muscles (excluding superior oblique)\n$ 2,276.10\n5359\n67318\n67318\nStrabismus surgery, any procedure, superior oblique muscle\n$ 2,106.90\n5360\n67320\n67320\nTransposition procedure (eg, for paretic extraocular muscle), any\nextraocular muscle (specify) (List separately in addition to code for\nprimary procedure)\n$ 2,286.90\n5361\n67331\n67331\nStrabismus surgery on patient with previous eye surgery or injury\nthat did not involve the extraocular muscles (List separately in\naddition to code for primary procedure)\n$ 1,467.90\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5362\n67332\n67332\nStrabismus surgery on patient with scarring of extraocular muscles\n(eg, prior ocular injury, strabismus or retinal detachment surgery)\nor restrictive myopathy (eg, dysthyroid ophthalmopathy) (List\nseparately in addition to code for primary procedure)\n$ 2,152.80\n5363\n67334\n67334\nStrabismus surgery by posterior fixation suture technique, with or\nwithout muscle recession (List separately in addition to code for\nprimary procedure)\n$ 1,441.80\n5364\n67335\n67335\nPlacement of adjustable suture(s) during strabismus surgery,\nincluding postoperative adjustment(s) of suture(s) (List separately in\naddition to code for specific strabismus surgery)\n$ 720.90\n5365\n67340\n67340\nStrabismus surgery involving exploration and\/or repair of detached\nextraocular muscle(s) (List separately in addition to code for\nprimary procedure)\n$ 1,802.70\n5366\n67343\n67343\nRelease of extensive scar tissue without detaching extraocular\nmuscle (separate procedure)\n$ 1,390.50\n5367\n67345\n67345\nChemodenervation of extraocular muscle\n$ 539.10\n5368\n67346\n67346\nBiopsy of extraocular muscle\n$ 544.18\n5369\n67399\n67399\nUnlisted procedure, ocular muscle\nCost\n5370\n67400\n67400\nOrbitotomy without bone flap (frontal or transconjunctival\napproach); for exploration, with or without biopsy\n$ 2,160.00\n5371\n67405\n67405\nOrbitotomy without bone flap (frontal or transconjunctival\napproach); with drainage only\n$ 1,980.90\n5372\n67412\n67412\nOrbitotomy without bone flap (frontal or transconjunctival\napproach); with removal of lesion\n$ 2,352.60\n5373\n67413\n67413\nOrbitotomy without bone flap (frontal or transconjunctival\napproach); with removal of foreign body\n$ 2,716.20\n5374\n67414\n67414\nOrbitotomy without bone flap (frontal or transconjunctival\napproach); with removal of bone for decompression\n$ 2,228.40\n5375\n67415\n67415\nFine needle aspiration of orbital contents\n$ 437.40\n5376\n67420\n67420\nOrbitotomy with bone flap or window, lateral approach (eg,\nKroenlein); with removal of lesion\n$ 3,352.50\n5377\n67430\n67430\nOrbitotomy with bone flap or window, lateral approach (eg,\nKroenlein); with removal of foreign body\n$ 2,887.20\n5378\n67440\n67440\nOrbitotomy with bone flap or window, lateral approach (eg,\nKroenlein); with drainage\n$ 3,031.20\n5379\n67445\n67445\nOrbitotomy with bone flap or window, lateral approach (eg,\nKroenlein); with removal of bone for decompression\n$ 2,722.50\n5380\n67450\n67450\nOrbitotomy with bone flap or window, lateral approach (eg,\nKroenlein); for exploration, with or without biopsy\n$ 2,966.40\n5381\n67500\n67500\nRetrobulbar injection; medication (separate procedure, does not\ninclude supply of medication)\n$ 175.50\n5382\n67505\n67505\nRetrobulbar injection; alcohol\n$ 280.80\n5383\n67515\n67515\nInjection of medication or other substance into Tenon's capsule\n$ 139.50\n5384\n67550\n67550\nOrbital implant (implant outside muscle cone); insertion\n$ 1,802.70\n5385\n67560\n67560\nOrbital implant (implant outside muscle cone); removal or revision\n$ 1,784.70\n5386\n67570\n67570\nOptic nerve decompression (eg, incision or fenestration of optic\nnerve sheath)\n$ 2,440.80\n5387\n67599\n67599\nUnlisted procedure, orbit\nCost\n5388\n67700\n67700\nBlepharotomy, drainage of abscess, eyelid\n$ 184.47\n5389\n67710\n67710\nSevering of tarsorrhaphy\n$ 311.40\n5390\n67715\n67715\nCanthotomy (separate procedure)\n$ 366.30\n5391\n67800\n67800\nExcision of chalazion; single\n$ 218.88\n5392\n67801\n67801\nExcision of chalazion; multiple, same lid\n$ 304.59\n5393\n67805\n67805\nExcision of chalazion; multiple, different lids\n$ 356.44\n5394\n67808\n67808\nExcision of chalazion; under general anesthesia and\/or requiring\nhospitalization, single or multiple\n$ 565.20\n5395\n67810\n67810\nIncisional biopsy of eyelid skin including lid margin\n$ 250.20\n5396\n67820\n67820\nCorrection of trichiasis; epilation, by forceps only\n$ 94.99\n5397\n67825\n67825\nCorrection of trichiasis; epilation by other than forceps (eg, by\nelectrosurgery, cryotherapy, laser surgery)\n$ 178.20\n5398\n67830\n67830\nCorrection of trichiasis; incision of lid margin\n$ 503.10\n5399\n67835\n67835\nCorrection of trichiasis; incision of lid margin, with free mucous\nmembrane graft\n$ 1,691.10\n5400\n67840\n67840\nExcision of lesion of eyelid (except chalazion) without closure or\nwith simple direct closure\n$ 353.47\n5401\n67850\n67850\nDestruction of lesion of lid margin (up to 1 cm)\n$ 252.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5402\n67875\n67875\nTemporary closure of eyelids by suture (eg, Frost suture)\n$ 442.80\n5403\n67880\n67880\nConstruction of intermarginal adhesions, median tarsorrhaphy, or\ncanthorrhaphy;\n$ 864.00\n5404\n67882\n67882\nConstruction of intermarginal adhesions, median tarsorrhaphy, or\ncanthorrhaphy; with transposition of tarsal plate\n$ 1,364.40\n5405\n67900\n67900\nRepair of brow ptosis (supraciliary, mid-forehead or coronal\napproach)\n$ 1,399.50\n5406\n67901\n67901\nRepair of blepharoptosis; frontalis muscle technique with suture or\nother material (eg, banked fascia)\n$ 2,169.00\n5407\n67902\n67902\nRepair of blepharoptosis; frontalis muscle technique with\nautologous fascial sling (includes obtaining fascia)\n$ 2,372.40\n5408\n67903\n67903\nRepair of blepharoptosis; (tarso) levator resection or advancement,\ninternal approach\n$ 2,374.20\n5409\n67904\n67904\nRepair of blepharoptosis; (tarso) levator resection or advancement,\nexternal approach\n$ 2,879.10\n5410\n67906\n67906\nRepair of blepharoptosis; superior rectus technique with fascial sling\n(includes obtaining fascia)\n$ 2,122.20\n5411\n67908\n67908\nRepair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator\nresection (eg, Fasanella-Servat type)\n$ 1,909.80\n5412\n67909\n67909\nReduction of overcorrection of ptosis\n$ 1,689.30\n5413\n67911\n67911\nCorrection of lid retraction\n$ 2,162.70\n5414\n67912\n67912\nCorrection of lagophthalmos, with implantation of upper eyelid lid\nload (eg, gold weight)\n$ 2,145.90\n5415\n67914\n67914\nRepair of ectropion; suture\n$ 977.40\n5416\n67915\n67915\nRepair of ectropion; thermocauterization\n$ 483.30\n5417\n67916\n67916\nRepair of ectropion; excision tarsal wedge\n$ 1,341.90\n5418\n67917\n67917\nRepair of ectropion; extensive (eg, tarsal strip operations)\n$ 1,854.00\n5419\n67921\n67921\nRepair of entropion; suture\n$ 769.50\n5420\n67922\n67922\nRepair of entropion; thermocauterization\n$ 378.90\n5421\n67923\n67923\nRepair of entropion; excision tarsal wedge\n$ 1,467.90\n5422\n67924\n67924\nRepair of entropion; extensive (eg, tarsal strip or capsulopalpebral\nfascia repairs operation)\n$ 1,857.60\n5423\n67930\n67930\nSuture of recent wound, eyelid, involving lid margin, tarsus, and\/or\npalpebral conjunctiva direct closure; partial thickness\n$ 949.50\n5424\n67935\n67935\nSuture of recent wound, eyelid, involving lid margin, tarsus, and\/or\npalpebral conjunctiva direct closure; full thickness\n$ 1,545.30\n5425\n67938\n67938\nRemoval of embedded foreign body, eyelid\n$ 222.30\n5426\n67950\n67950\nCanthoplasty (reconstruction of canthus)\n$ 1,822.50\n5427\n67961\n67961\nExcision and repair of eyelid, involving lid margin, tarsus,\nconjunctiva, canthus, or full thickness, may include preparation for\nskin graft or pedicle flap with adjacent tissue transfer or\nrearrangement; up to one-fourth of lid margin\n$ 2,062.80\n5428\n67966\n67966\nExcision and repair of eyelid, involving lid margin, tarsus,\nconjunctiva, canthus, or full thickness, may include preparation for\nskin graft or pedicle flap with adjacent tissue transfer or\nrearrangement; over one-fourth of lid margin\n$ 2,368.80\n5429\n67971\n67971\nReconstruction of eyelid, full thickness by transfer of\ntarsoconjunctival flap from opposing eyelid; up to two-thirds of\neyelid, 1 stage or first stage\n$ 2,272.50\n5430\n67973\n67973\nReconstruction of eyelid, full thickness by transfer of\ntarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1\nstage or first stage\n$ 3,181.50\n5431\n67974\n67974\nReconstruction of eyelid, full thickness by transfer of\ntarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1\nstage or first stage\n$ 3,420.90\n5432\n67975\n67975\nReconstruction of eyelid, full thickness by transfer of\ntarsoconjunctival flap from opposing eyelid; second stage\n$ 1,535.40\n5433\n67999\n67999\nUnlisted procedure, eyelids\nCost\n5434\n68020\n68020\nIncision of conjunctiva, drainage of cyst\n$ 166.30\n5435\n68040\n68040\nExpression of conjunctival follicles (eg, for trachoma)\n$ 128.70\n5436\n68100\n68100\nBiopsy of conjunctiva\n$ 187.20\n5437\n68110\n68110\nExcision of lesion, conjunctiva; up to 1 cm\n$ 365.72\n5438\n68115\n68115\nExcision of lesion, conjunctiva; over 1 cm\n$ 454.50\n5439\n68130\n68130\nExcision of lesion, conjunctiva; with adjacent sclera\n$ 813.60\n5440\n68135\n68135\nDestruction of lesion, conjunctiva\n$ 247.50\n5441\n68200\n68200\nSubconjunctival injection\n$ 178.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5442\n68320\n68320\nConjunctivoplasty; with conjunctival graft or extensive\nrearrangement\n$ 1,654.20\n5443\n68325\n68325\nConjunctivoplasty; with buccal mucous membrane graft (includes\nobtaining graft)\n$ 2,090.70\n5444\n68326\n68326\nConjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft\nor extensive rearrangement\n$ 2,130.30\n5445\n68328\n68328\nConjunctivoplasty, reconstruction cul-de-sac; with buccal mucous\nmembrane graft (includes obtaining graft)\n$ 2,104.20\n5446\n68330\n68330\nRepair of symblepharon; conjunctivoplasty, without graft\n$ 1,292.40\n5447\n68335\n68335\nRepair of symblepharon; with free graft conjunctiva or buccal\nmucous membrane (includes obtaining graft)\n$ 1,466.10\n5448\n68340\n68340\nRepair of symblepharon; division of symblepharon, with or without\ninsertion of conformer or contact lens\n$ 1,123.20\n5449\n68360\n68360\nConjunctival flap; bridge or partial (separate procedure)\n$ 978.30\n5450\n68362\n68362\nConjunctival flap; total (such as Gunderson thin flap or purse string\nflap)\n$ 1,544.40\n5451\n68371\n68371\nHarvesting conjunctival allograft, living donor\n$ 817.41\n5452\n68399\n68399\nUnlisted procedure, conjunctiva\nCost\n5453\n68400\n68400\nIncision, drainage of lacrimal gland\n$ 301.50\n5454\n68420\n68420\nIncision, drainage of lacrimal sac (dacryocystotomy or\ndacryocystostomy)\n$ 362.70\n5455\n68440\n68440\nSnip incision of lacrimal punctum\n$ 276.30\n5456\n68500\n68500\nExcision of lacrimal gland (dacryoadenectomy), except for tumor;\ntotal\n$ 1,859.40\n5457\n68505\n68505\nExcision of lacrimal gland (dacryoadenectomy), except for tumor;\npartial\n$ 1,574.10\n5458\n68510\n68510\nBiopsy of lacrimal gland\n$ 674.10\n5459\n68520\n68520\nExcision of lacrimal sac (dacryocystectomy)\n$ 1,632.60\n5460\n68525\n68525\nBiopsy of lacrimal sac\n$ 518.40\n5461\n68530\n68530\nRemoval of foreign body or dacryolith, lacrimal passages\n$ 947.70\n5462\n68540\n68540\nExcision of lacrimal gland tumor; frontal approach\n$ 2,062.80\n5463\n68550\n68550\nExcision of lacrimal gland tumor; involving osteotomy\n$ 2,482.20\n5464\n68700\n68700\nPlastic repair of canaliculi\n$ 1,694.70\n5465\n68705\n68705\nCorrection of everted punctum, cautery\n$ 265.50\n5466\n68720\n68720\nDacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)\n$ 2,123.10\n5467\n68745\n68745\nConjunctivorhinostomy (fistulization of conjunctiva to nasal cavity);\nwithout tube\n$ 2,060.10\n5468\n68750\n68750\nConjunctivorhinostomy (fistulization of conjunctiva to nasal cavity);\nwith insertion of tube or stent\n$ 2,332.80\n5469\n68760\n68760\nClosure of the lacrimal punctum; by thermocauterization, ligation,\nor laser surgery\n$ 283.50\n5470\n68761\n68761\nClosure of the lacrimal punctum; by plug, each\n$ 256.50\n5471\n68770\n68770\nClosure of lacrimal fistula (separate procedure)\n$ 925.20\n5472\n68801\n68801\nDilation of lacrimal punctum, with or without irrigation\n$ 136.80\n5473\n68810\n68810\nProbing of nasolacrimal duct, with or without irrigation;\n$ 195.30\n5474\n68811\n68811\nProbing of nasolacrimal duct, with or without irrigation; requiring\ngeneral anesthesia\n$ 422.10\n5475\n68815\n68815\nProbing of nasolacrimal duct, with or without irrigation; with\ninsertion of tube or stent\n$ 532.80\n5476\n68816\n68816\nProbing of nasolacrimal duct, with or without irrigation; with\ntransluminal balloon catheter dilation\n$ 1,322.33\n5477\n68840\n68840\nProbing of lacrimal canaliculi, with or without irrigation\n$ 178.20\n5478\n68850\n68850\nInjection of contrast medium for dacryocystography\n$ 170.10\n5479\n68899\n68899\nUnlisted procedure, lacrimal system\nCost\n5480\n69000\n69000\nDrainage external ear, abscess or hematoma; simple\n$ 190.80\n5481\n69005\n69005\nDrainage external ear, abscess or hematoma; complicated\n$ 526.50\n5482\n69020\n69020\nDrainage external auditory canal, abscess\n$ 200.70\n5483\n69090\n69090\nEar piercing\n$ 105.30\n5484\n69100\n69100\nBiopsy external ear\n$ 164.70\n5485\n69105\n69105\nBiopsy external auditory canal\n$ 234.90\n5486\n69110\n69110\nExcision external ear; partial, simple repair\n$ 848.70\n5487\n69120\n69120\nExcision external ear; complete amputation\n$ 1,729.80\n5488\n69140\n69140\nExcision exostosis(es), external auditory canal\n$ 1,996.20\n5489\n69145\n69145\nExcision soft tissue lesion, external auditory canal\n$ 643.50\n5490\n69150\n69150\nRadical excision external auditory canal lesion; without neck\ndissection\n$ 2,611.80\n5491\n69155\n69155\nRadical excision external auditory canal lesion; with neck dissection\n$ 4,492.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5492\n69200\n69200\nRemoval foreign body from external auditory canal; without general\nanesthesia\n$ 128.70\n5493\n69205\n69205\nRemoval foreign body from external auditory canal; with general\nanesthesia\n$ 525.89\n5494\n69210\n69210\nRemoval impacted cerumen requiring instrumentation, unilateral\n$ 64.34\n5495\n69220\n69220\nDebridement, mastoidectomy cavity, simple (eg, routine cleaning)\n$ 104.73\n5496\n69222\n69222\nDebridement, mastoidectomy cavity, complex (eg, with anesthesia\nor more than routine cleaning)\n$ 315.90\n5497\n69300\n69300\nOtoplasty, protruding ear, with or without size reduction\n$ 2,126.70\n5498\n69310\n69310\nReconstruction of external auditory canal (meatoplasty) (eg, for\nstenosis due to injury, infection) (separate procedure)\n$ 3,252.60\n5499\n69320\n69320\nReconstruction external auditory canal for congenital atresia, single\nstage\n$ 3,473.10\n5500\n69399\n69399\nUnlisted procedure, external ear\nCost\n5501\n69400\n69400\nEustachian tube inflation, transnasal; with catheterization\n$ 144.90\n5502\n69401\n69401\nEustachian tube inflation, transnasal; without catheterization\n$ 108.90\n5503\n69405\n69405\nEustachian tube catheterization, transtympanic\n$ 154.80\n5504\n69420\n69420\nMyringotomy including aspiration and\/or eustachian tube inflation\n$ 268.20\n5505\n69421\n69421\nMyringotomy including aspiration and\/or eustachian tube inflation\nrequiring general anesthesia\n$ 380.70\n5506\n69424\n69424\nVentilating tube removal requiring general anesthesia\n$ 226.80\n5507\n69433\n69433\nTympanostomy (requiring insertion of ventilating tube), local or\ntopical anesthesia\n$ 426.42\n5508\n69436\n69436\nTympanostomy (requiring insertion of ventilating tube), general\nanesthesia\n$ 621.90\n5509\n69440\n69440\nMiddle ear exploration through postauricular or ear canal incision\n$ 2,028.60\n5510\n69450\n69450\nTympanolysis, transcanal\n$ 2,083.50\n5511\n69501\n69501\nTransmastoid antrotomy (simple mastoidectomy)\n$ 2,442.60\n5512\n69502\n69502\nMastoidectomy; complete\n$ 3,323.70\n5513\n69505\n69505\nMastoidectomy; modified radical\n$ 3,462.30\n5514\n69511\n69511\nMastoidectomy; radical\n$ 3,429.00\n5515\n69530\n69530\nPetrous apicectomy including radical mastoidectomy\n$ 4,139.10\n5516\n69535\n69535\nResection temporal bone, external approach\n$ 6,341.40\n5517\n69540\n69540\nExcision aural polyp\n$ 322.20\n5518\n69550\n69550\nExcision aural glomus tumor; transcanal\n$ 3,636.90\n5519\n69552\n69552\nExcision aural glomus tumor; transmastoid\n$ 4,195.80\n5520\n69554\n69554\nExcision aural glomus tumor; extended (extratemporal)\n$ 5,842.80\n5521\n69601\n69601\nRevision mastoidectomy; resulting in complete mastoidectomy\n$ 3,073.50\n5522\n69602\n69602\nRevision mastoidectomy; resulting in modified radical\nmastoidectomy\n$ 3,607.20\n5523\n69603\n69603\nRevision mastoidectomy; resulting in radical mastoidectomy\n$ 3,481.20\n5524\n69604\n69604\nRevision mastoidectomy; resulting in tympanoplasty\n$ 3,876.30\n5525\n69605\n69605\nRevision mastoidectomy; with apicectomy\n$ 3,746.70\n5526\n69610\n69610\nTympanic membrane repair, with or without site preparation of\nperforation for closure, with or without patch\n$ 432.90\n5527\n69620\n69620\nMyringoplasty (surgery confined to drumhead and donor area)\n$ 2,461.50\n5528\n69631\n69631\nTympanoplasty without mastoidectomy (including canalplasty,\natticotomy and\/or middle ear surgery), initial or revision; without\nossicular chain reconstruction\n$ 3,134.70\n5529\n69632\n69632\nTympanoplasty without mastoidectomy (including canalplasty,\natticotomy and\/or middle ear surgery), initial or revision; with\nossicular chain reconstruction (eg, postfenestration)\n$ 3,681.00\n5530\n69633\n69633\nTympanoplasty without mastoidectomy (including canalplasty,\natticotomy and\/or middle ear surgery), initial or revision; with\nossicular chain reconstruction and synthetic prosthesis (eg, partial\nossicular replacement prosthesis [PORP], total ossicular repl\n$ 3,594.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5531\n69635\n69635\nTympanoplasty with antrotomy or mastoidotomy (including\ncanalplasty, atticotomy, middle ear surgery, and\/or tympanic\nmembrane repair); without ossicular chain reconstruction\n$ 3,904.20\n5532\n69636\n69636\nTympanoplasty with antrotomy or mastoidotomy (including\ncanalplasty, atticotomy, middle ear surgery, and\/or tympanic\nmembrane repair); with ossicular chain reconstruction\n$ 4,133.70\n5533\n69637\n69637\nTympanoplasty with antrotomy or mastoidotomy (including\ncanalplasty, atticotomy, middle ear surgery, and\/or tympanic\nmembrane repair); with ossicular chain reconstruction and synthetic\nprosthesis (eg, partial ossicular replacement prosthesis [PORP], total $ 4,131.90\n5534\n69641\n69641\nTympanoplasty with mastoidectomy (including canalplasty, middle\near surgery, tympanic membrane repair); without ossicular chain\nreconstruction\n$ 3,818.70\n5535\n69642\n69642\nTympanoplasty with mastoidectomy (including canalplasty, middle\near surgery, tympanic membrane repair); with ossicular chain\nreconstruction\n$ 4,161.60\n5536\n69643\n69643\nTympanoplasty with mastoidectomy (including canalplasty, middle\near surgery, tympanic membrane repair); with intact or\nreconstructed wall, without ossicular chain reconstruction\n$ 4,333.50\n5537\n69644\n69644\nTympanoplasty with mastoidectomy (including canalplasty, middle\near surgery, tympanic membrane repair); with intact or\nreconstructed canal wall, with ossicular chain reconstruction\n$ 4,814.10\n5538\n69645\n69645\nTympanoplasty with mastoidectomy (including canalplasty, middle\near surgery, tympanic membrane repair); radical or complete,\nwithout ossicular chain reconstruction\n$ 4,619.70\n5539\n69646\n69646\nTympanoplasty with mastoidectomy (including canalplasty, middle\near surgery, tympanic membrane repair); radical or complete, with\nossicular chain reconstruction\n$ 5,045.40\n5540\n69650\n69650\nStapes mobilization\n$ 2,429.10\n5541\n69660\n69660\nStapedectomy or stapedotomy with reestablishment of ossicular\ncontinuity, with or without use of foreign material;\n$ 3,344.40\n5542\n69661\n69661\nStapedectomy or stapedotomy with reestablishment of ossicular\ncontinuity, with or without use of foreign material; with footplate\ndrill out\n$ 3,737.70\n5543\n69662\n69662\nRevision of stapedectomy or stapedotomy\n$ 4,239.90\n5544\n69666\n69666\nRepair oval window fistula\n$ 3,217.50\n5545\n69667\n69667\nRepair round window fistula\n$ 3,156.30\n5546\n69670\n69670\nMastoid obliteration (separate procedure)\n$ 3,295.80\n5547\n69676\n69676\nTympanic neurectomy\n$ 2,268.90\n5548\n69700\n69700\nClosure postauricular fistula, mastoid (separate procedure)\n$ 1,625.40\n5549\n69710\n69710\nImplantation or replacement of electromagnetic bone conduction\nhearing device in temporal bone\n$ 1,761.30\n5550\n69711\n69711\nRemoval or repair of electromagnetic bone conduction hearing\ndevice in temporal bone\n$ 1,287.90\n5551\n69714\n69714\nImplantation, osseointegrated implant, temporal bone, with\npercutaneous attachment to external speech processor\/cochlear\nstimulator; without mastoidectomy\n$ 2,985.05\n5552\n69715\n69715\nImplantation, osseointegrated implant, temporal bone, with\npercutaneous attachment to external speech processor\/cochlear\nstimulator; with mastoidectomy\n$ 3,580.56\n5553\n69717\n69717\nReplacement (including removal of existing device), osseointegrated\nimplant, temporal bone, with percutaneous attachment to external\nspeech processor\/cochlear stimulator; without mastoidectomy\n$ 3,079.84\n5554\n69718\n69718\nReplacement (including removal of existing device), osseointegrated\nimplant, temporal bone, with percutaneous attachment to external\nspeech processor\/cochlear stimulator; with mastoidectomy\n$ 3,691.07\n5555\n69720\n69720\nDecompression facial nerve, intratemporal; lateral to geniculate\nganglion\n$ 3,883.50\n5556\n69725\n69725\nDecompression facial nerve, intratemporal; including medial to\ngeniculate ganglion\n$ 5,624.10\n5557\n69740\n69740\nSuture facial nerve, intratemporal, with or without graft or\ndecompression; lateral to geniculate ganglion\n$ 4,449.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5558\n69745\n69745\nSuture facial nerve, intratemporal, with or without graft or\ndecompression; including medial to geniculate ganglion\n$ 5,244.30\n5559\n69799\n69799\nUnlisted procedure, middle ear\nCost\n5560\n69801\n69801\nLabyrinthotomy, with perfusion of vestibuloactive drug(s);\ntranscanal\n$ 3,175.20\n5561\n69805\n69805\nEndolymphatic sac operation; without shunt\n$ 3,862.80\n5562\n69806\n69806\nEndolymphatic sac operation; with shunt\n$ 4,377.60\n5563\n69820\n69820\nFenestration semicircular canal\n$ 3,438.00\n5564\n69840\n69840\nRevision fenestration operation\n$ 2,353.50\n5565\n69905\n69905\nLabyrinthectomy; transcanal\n$ 3,857.40\n5566\n69910\n69910\nLabyrinthectomy; with mastoidectomy\n$ 4,439.70\n5567\n69915\n69915\nVestibular nerve section, translabyrinthine approach\n$ 5,052.60\n5568\n69930\n69930\nCochlear device implantation, with or without mastoidectomy\n$ 5,318.10\n5569\n69949\n69949\nUnlisted procedure, inner ear\nCost\n5570\n69950\n69950\nVestibular nerve section, transcranial approach\n$ 5,448.60\n5571\n69955\n69955\nTotal facial nerve decompression and\/or repair (may include graft)\n$ 5,846.40\n5572\n69960\n69960\nDecompression internal auditory canal\n$ 5,529.60\n5573\n69970\n69970\nRemoval of tumor, temporal bone\n$ 6,309.00\n5574\n69979\n69979\nUnlisted procedure, temporal bone, middle fossa approach\nCost\n5575\n69990\n69990\nMicrosurgical techniques, requiring use of operating microscope\n(List separately in addition to code for primary procedure)\n$ 834.30\n5576\n90291\n90291\nCytomegalovirus immune globulin (CMV-IgIV), human, for\nintravenous use\n$ 72.90\n5577\n90296\n90296\nDiphtheria antitoxin, equine, any route\n$ 77.40\n5578\n90474\n90474\nImmunization administration by intranasal or oral route; each\nadditional vaccine (single or combination vaccine\/toxoid) (List\nseparately in addition to code for primary procedure)\n$ 17.03\n5579\n90703\n90703\nTetanus toxoid adsorbed, for intramuscular use\n$ 19.30\n5580\n90785\n90785\nInteractive complexity (List separately in addition to the code for\nprimary procedure)\n$ 8.74\n5581\n90791\n90791\nPsychiatric diagnostic evaluation\n$ 276.51\n5582\n90792\n90792\nPsychiatric diagnostic evaluation with medical services\n$ 222.74\n5583\n90832\n90832\nPsychotherapy, 30 minutes with patient and\/or family member\n$ 114.22\n5584\n90833\n90833\nPsychotherapy, 30 minutes with patient and\/or family member\nwhen performed with an evaluation and management service (List\nseparately in addition to the code for primary procedure)\n$ 74.62\n5585\n90834\n90834\nPsychotherapy, 45 minutes with patient and\/or family member\n$ 144.87\n5586\n90836\n90836\nPsychotherapy, 45 minutes with patient and\/or family member\nwhen performed with an evaluation and management service (List\nseparately in addition to the code for primary procedure)\n$ 120.89\n5587\n90837\n90837\nPsychotherapy, 60 minutes with patient and\/or family member\n$ 211.77\n5588\n90838\n90838\nPsychotherapy, 60 minutes with patient and\/or family member\nwhen performed with an evaluation and management service (List\nseparately in addition to the code for primary procedure)\n$ 195.68\n5589\n90845\n90845\nPsychoanalysis\n$ 166.50\n5590\n90846\n90846\nFamily psychotherapy (without the patient present)\n$ 159.30\n5591\n90847\n90847\nFamily psychotherapy (conjoint psychotherapy) (with patient\npresent)\n$ 151.62\n5592\n90849\n90849\nMultiple-family group psychotherapy\n$ 129.60\n5593\n90853\n90853\nGroup psychotherapy (other than of a multiple-family group)\n$ 87.30\n5594\n90863\n90863\nPharmacologic management, including prescription and review of\nmedication, when performed with psychotherapy services (List\nseparately in addition to the code for primary procedure)\n$ 93.77\n5595\n90865\n90865\nNarcosynthesis for psychiatric diagnostic and therapeutic purposes\n(eg, sodium amobarbital (Amytal) interview)\n$ 271.80\n5596\n90870\n90870\nElectroconvulsive therapy (includes necessary monitoring)\n$ 209.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5597\n90875\n90875\nIndividual psychophysiological therapy incorporating biofeedback\ntraining by any modality (face-to-face with the patient), with\npsychotherapy (eg, insight oriented, behavior modifying or\nsupportive psychotherapy); 30 minutes\n$ 117.06\n5598\n90876\n90876\nIndividual psychophysiological therapy incorporating biofeedback\ntraining by any modality (face-to-face with the patient), with\npsychotherapy (eg, insight oriented, behavior modifying or\nsupportive psychotherapy); 45 minutes\n$ 226.80\n5599\n90880\n90880\nHypnotherapy\n$ 183.60\n5600\n90882\n90882\nEnvironmental intervention for medical management purposes on a\npsychiatric patient's behalf with agencies, employers, or institutions $ 118.80\n5601\n90885\n90885\nPsychiatric evaluation of hospital records, other psychiatric reports,\npsychometric and\/or projective tests, and other accumulated data\nfor medical diagnostic purposes\n$ 120.97\n5602\n90887\n90887\nInterpretation or explanation of results of psychiatric, other medical\nexaminations and procedures, or other accumulated data to family\nor other responsible persons, or advising them how to assist patient $ 159.30\n5603\n90889\n90889\nPreparation of report of patient's psychiatric status, history,\ntreatment, or progress (other than for legal or consultative\npurposes) for other individuals, agencies, or insurance carriers\n$ 171.00\n5604\n90899\n90899\nUnlisted psychiatric service or procedure\nCost\n5605\n90901\n90901\nBiofeedback training by any modality\n$ 123.30\n5606\n90911\n90911\nBiofeedback training, perineal muscles, anorectal or urethral\nsphincter, including EMG and\/or manometry\n$ 180.00\n5607\n90935\n90935\nHemodialysis procedure with single evaluation by a physician or\nother qualified health care professional\n$ 249.80\n5608\n90937\n90937\nHemodialysis procedure requiring repeated evaluation(s) with or\nwithout substantial revision of dialysis prescription\n$ 566.10\n5609\n90940\n90940\nHemodialysis access flow study to determine blood flow in grafts\nand arteriovenous fistulae by an indicator method\n$ -\n5610\n90945\n90945\nDialysis procedure other than hemodialysis (eg, peritoneal dialysis,\nhemofiltration, or other continuous renal replacement therapies),\nwith single evaluation by a physician or other qualified health care\nprofessional\n$ 300.60\n5611\n90947\n90947\nDialysis procedure other than hemodialysis (eg, peritoneal dialysis,\nhemofiltration, or other continuous renal replacement therapies)\nrequiring repeated evaluations by a physician or other qualified\nhealth care professional, with or without substantial re\n$ 482.40\n5612\n90951\n90951\nEnd-stage renal disease (ESRD) related services monthly, for\npatients younger than 2 years of age to include monitoring for the\nadequacy of nutrition, assessment of growth and development, and\ncounseling of parents; with 4 or more face-to-face visits by a\n$ 1,568.42\n5613\n90952\n90952\nEnd-stage renal disease (ESRD) related services monthly, for\npatients younger than 2 years of age to include monitoring for the\nadequacy of nutrition, assessment of growth and development, and\ncounseling of parents; with 2-3 face-to-face visits by a physi\n$ -\n5614\n90953\n90953\nEnd-stage renal disease (ESRD) related services monthly, for\npatients younger than 2 years of age to include monitoring for the\nadequacy of nutrition, assessment of growth and development, and\ncounseling of parents; with 1 face-to-face visit by a physicia\n$ -\n5615\n90954\n90954\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 2-11 years of age to include monitoring for the adequacy of\nnutrition, assessment of growth and development, and counseling\nof parents; with 4 or more face-to-face visits by a physician\n$ 1,325.75\n5616\n90955\n90955\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 2-11 years of age to include monitoring for the adequacy of\nnutrition, assessment of growth and development, and counseling\nof parents; with 2-3 face-to-face visits by a physician or ot\n$ 742.53\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5617\n90956\n90956\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 2-11 years of age to include monitoring for the adequacy of\nnutrition, assessment of growth and development, and counseling\nof parents; with 1 face-to-face visit by a physician or other\n$ 521.08\n5618\n90957\n90957\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 12-19 years of age to include monitoring for the adequacy\nof nutrition, assessment of growth and development, and\ncounseling of parents; with 4 or more face-to-face visits by a\nphysicia\n$ 1,046.60\n5619\n90958\n90958\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 12-19 years of age to include monitoring for the adequacy\nof nutrition, assessment of growth and development, and\ncounseling of parents; with 2-3 face-to-face visits by a physician or o $ 702.47\n5620\n90959\n90959\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 12-19 years of age to include monitoring for the adequacy\nof nutrition, assessment of growth and development, and\ncounseling of parents; with 1 face-to-face visit by a physician or\nothe\n$ 462.30\n5621\n90960\n90960\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 20 years of age and older; with 4 or more face-to-face visits\nby a physician or other qualified health care professional per month $ 515.18\n5622\n90961\n90961\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 20 years of age and older; with 2-3 face-to-face visits by a\nphysician or other qualified health care professional per month\n$ 413.70\n5623\n90962\n90962\nEnd-stage renal disease (ESRD) related services monthly, for\npatients 20 years of age and older; with 1 face-to-face visit by a\nphysician or other qualified health care professional per month\n$ 301.29\n5624\n90963\n90963\nEnd-stage renal disease (ESRD) related services for home dialysis per\nfull month, for patients younger than 2 years of age to include\nmonitoring for the adequacy of nutrition, assessment of growth and\ndevelopment, and counseling of parents\n$ 898.85\n5625\n90964\n90964\nEnd-stage renal disease (ESRD) related services for home dialysis\nper full month, for patients 2-11 years of age to include monitoring\nfor the adequacy of nutrition, assessment of growth and\ndevelopment, and counseling of parents\n$ 750.40\n5626\n90965\n90965\nEnd-stage renal disease (ESRD) related services for home dialysis\nper full month, for patients 12-19 years of age to include\nmonitoring for the adequacy of nutrition, assessment of growth and\ndevelopment, and counseling of parents\n$ 704.13\n5627\n90966\n90966\nEnd-stage renal disease (ESRD) related services for home dialysis\nper full month, for patients 20 years of age and older\n$ 368.71\n5628\n90967\n90967\nEnd-stage renal disease (ESRD) related services for dialysis less than\na full month of service, per day; for patients younger than 2 years of\nage\n$ 33.03\n5629\n90968\n90968\nEnd-stage renal disease (ESRD) related services for dialysis less than\na full month of service, per day; for patients 2-11 years of age\n$ 26.85\n5630\n90969\n90969\nEnd-stage renal disease (ESRD) related services for dialysis less than\na full month of service, per day; for patients 12-19 years of age\n$ 19.63\n5631\n90970\n90970\nEnd-stage renal disease (ESRD) related services for dialysis less than\na full month of service, per day; for patients 20 years of age and\nolder\n$ 13.50\n5632\n90989\n90989\nDialysis training, patient, including helper where applicable, any\nmode, completed course\n$ 653.40\n5633\n90993\n90993\nDialysis training, patient, including helper where applicable, any\nmode, course not completed, per training session\n$ 135.90\n5634\n90997\n90997\nHemoperfusion (eg, with activated charcoal or resin)\n$ 597.60\n5635\n90999\n90999\nUnlisted dialysis procedure, inpatient or outpatient\nCost\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5636\n91010\n91010\nEsophageal motility (manometric study of the esophagus and\/or\ngastroesophageal junction) study with interpretation and report;\n$ 101.54\n5637\n91013\nEsophageal motility (manometric study of the esophagus and\/or\ngastroesophageal junction) study with interpretation and report;\nwith stimulation or perfusion (eg, stimulant, acid or alkali perfusion)\n(List separately in addition to code for primary procedu\n$ 68.42\n5638\n91013-26 26\nEsophageal motility (manometric study of the esophagus and\/or\ngastroesophageal junction) study with interpretation and report;\nwith stimulation or perfusion (eg, stimulant, acid or alkali perfusion)\n(List separately in addition to code for primary procedu\n$ 29.29\n5639\n91013-TC TC\n$ 39.13\n5640\n91020\n91020\nGastric motility (manometric) studies\n$ 255.60\n5641\n91020-26 26\n91020\nGastric motility (manometric) studies\n$ 74.00\n5642\n91020-TC TC\n91020\nGastric motility (manometric) studies\n$ 181.60\n5643\n91022\n91022\nDuodenal motility (manometric) study\n$ 213.12\n5644\n91030\n91030\nEsophagus, acid perfusion (Bernstein) test for esophagitis\n$ 158.40\n5645\n91030-26 26\n91030\nEsophagus, acid perfusion (Bernstein) test for esophagitis\n$ 49.29\n5646\n91030-TC TC\n91030\nEsophagus, acid perfusion (Bernstein) test for esophagitis\n$ 109.11\n5647\n91034\n91034\nEsophagus, gastroesophageal reflux test; with nasal catheter pH\nelectrode(s) placement, recording, analysis and interpretation\n$ 170.59\n5648\n91035\n91035\nEsophagus, gastroesophageal reflux test; with mucosal attached\ntelemetry pH electrode placement, recording, analysis and\ninterpretation\n$ 236.07\n5649\n91037\n91037\nEsophageal function test, gastroesophageal reflux test with nasal\ncatheter intraluminal impedance electrode(s) placement, recording,\nanalysis and interpretation;\n$ 148.35\n5650\n91038\n91038\nEsophageal function test, gastroesophageal reflux test with nasal\ncatheter intraluminal impedance electrode(s) placement, recording,\nanalysis and interpretation; prolonged (greater than 1 hour, up to\n24 hours)\n$ 163.99\n5651\n91040\n91040\nEsophageal balloon distension provocation study\n$ 142.29\n5652\n91065\n91065\nBreath hydrogen or methane test (eg, for detection of lactase\ndeficiency, fructose intolerance, bacterial overgrowth, or oro-cecal\ngastrointestinal transit)\n$ 16.38\n5653\n91110\n91110\nGastrointestinal tract imaging, intraluminal (eg, capsule endoscopy),\nesophagus through ileum, with interpretation and report\n$ 522.07\n5654\n91111\n91111\nGastrointestinal tract imaging, intraluminal (eg, capsule endoscopy),\nesophagus with interpretation and report\n$ 122.66\n5655\n91120\n91120\nRectal sensation, tone, and compliance test (ie, response to graded\nballoon distention)\n$ 129.65\n5656\n91122\n91122\nAnorectal manometry\n$ 357.30\n5657\n91122-26 26\n91122\nAnorectal manometry\n$ 131.95\n5658\n91122-TC TC\n91122\nAnorectal manometry\n$ 225.35\n5659\n91132\n91132\nElectrogastrography, diagnostic, transcutaneous;\n$ 74.61\n5660\n91133\n91133\nElectrogastrography, diagnostic, transcutaneous; with provocative\ntesting\n$ 110.50\n5661\n91299\n91299\nUnlisted diagnostic gastroenterology procedure\nCost\n5662\n92002\n92002\nOphthalmological services: medical examination and evaluation\nwith initiation of diagnostic and treatment program; intermediate,\nnew patient\n$ 87.67\n5663\n92004\n92004\nOphthalmological services: medical examination and evaluation\nwith initiation of diagnostic and treatment program;\ncomprehensive, new patient, 1 or more visits\n$ 103.19\n5664\n92012\n92012\nOphthalmological services: medical examination and evaluation,\nwith initiation or continuation of diagnostic and treatment\nprogram; intermediate, established patient\n$ 62.82\n5665\n92014\n92014\nOphthalmological services: medical examination and evaluation,\nwith initiation or continuation of diagnostic and treatment\nprogram; comprehensive, established patient, 1 or more visits\n$ 87.18\n5666\n92015\n92015\nDetermination of refractive state\n$ 28.58\n5667\n92018\n92018\nOphthalmological examination and evaluation, under general\nanesthesia, with or without manipulation of globe for passive range\nof motion or other manipulation to facilitate diagnostic\nexamination; complete\n$ 246.60\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5668\n92019\n92019\nOphthalmological examination and evaluation, under general\nanesthesia, with or without manipulation of globe for passive range\nof motion or other manipulation to facilitate diagnostic\nexamination; limited\n$ 153.90\n5669\n92020\n92020\nGonioscopy (separate procedure)\n$ 53.27\n5670\n92025\n92025\nComputerized corneal topography, unilateral or bilateral, with\ninterpretation and report\n$ 28.67\n5671\n92060\n92060\nSensorimotor examination with multiple measurements of ocular\ndeviation (eg, restrictive or paretic muscle with diplopia) with\ninterpretation and report (separate procedure)\n$ 66.59\n5672\n92060-26 26\n92060\nSensorimotor examination with multiple measurements of ocular\ndeviation (eg, restrictive or paretic muscle with diplopia) with\ninterpretation and report (separate procedure)\n$ 37.17\n5673\n92060-TC TC\n92060\nSensorimotor examination with multiple measurements of ocular\ndeviation (eg, restrictive or paretic muscle with diplopia) with\ninterpretation and report (separate procedure)\n$ 29.42\n5674\n92065\n92065\nOrthoptic and\/or pleoptic training, with continuing medical\ndirection and evaluation\n$ 56.70\n5675\n92065-26 26\n92065\nOrthoptic and\/or pleoptic training, with continuing medical\ndirection and evaluation\n$ 16.99\n5676\n92065-TC TC\n92065\nOrthoptic and\/or pleoptic training, with continuing medical\ndirection and evaluation\n$ 39.71\n5677\n92071\n92071\nFitting of contact lens for treatment of ocular surface disease\n$ 62.75\n5678\n92072\n92072\nFitting of contact lens for management of keratoconus, initial fitting $ 238.67\n5679\n92081\n92081\nVisual field examination, unilateral or bilateral, with interpretation\nand report; limited examination (eg, tangent screen, Autoplot, arc\nperimeter, or single stimulus level automated test, such as Octopus\n3 or 7 equivalent)\n$ 46.80\n5680\n92081-26 26\n92081\nVisual field examination, unilateral or bilateral, with interpretation\nand report; limited examination (eg, tangent screen, Autoplot, arc\nperimeter, or single stimulus level automated test, such as Octopus\n3 or 7 equivalent)\n$ 21.54\n5681\n92081-TC TC\n92081\nVisual field examination, unilateral or bilateral, with interpretation\nand report; limited examination (eg, tangent screen, Autoplot, arc\nperimeter, or single stimulus level automated test, such as Octopus\n3 or 7 equivalent)\n$ 25.26\n5682\n92082\n92082\nVisual field examination, unilateral or bilateral, with interpretation\nand report; intermediate examination (eg, at least 2 isopters on\nGoldmann perimeter, or semiquantitative, automated\nsuprathreshold screening program, Humphrey suprathreshold\nautomatic\n$ 81.78\n5683\n92082-26 26\n92082\nVisual field examination, unilateral or bilateral, with interpretation\nand report; intermediate examination (eg, at least 2 isopters on\nGoldmann perimeter, or semiquantitative, automated\nsuprathreshold screening program, Humphrey suprathreshold\nautomatic\n$ 35.28\n5684\n92082-TC TC\n92082\nVisual field examination, unilateral or bilateral, with interpretation\nand report; intermediate examination (eg, at least 2 isopters on\nGoldmann perimeter, or semiquantitative, automated\nsuprathreshold screening program, Humphrey suprathreshold\nautomatic\n$ 46.50\n5685\n92083\n92083\nVisual field examination, unilateral or bilateral, with interpretation\nand report; extended examination (eg, Goldmann visual fields with\nat least 3 isopters plotted and static determination within the\ncentral 30 , or quantitative, automated threshold peri\n$ 125.94\n5686\n92083-26 26\n92083\nVisual field examination, unilateral or bilateral, with interpretation\nand report; extended examination (eg, Goldmann visual fields with\nat least 3 isopters plotted and static determination within the\ncentral 30 , or quantitative, automated threshold peri\n$ 51.26\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5687\n92083-TC TC\n92083\nVisual field examination, unilateral or bilateral, with interpretation\nand report; extended examination (eg, Goldmann visual fields with\nat least 3 isopters plotted and static determination within the\ncentral 30 , or quantitative, automated threshold peri\n$ 74.68\n5688\n92100\n92100\nSerial tonometry (separate procedure) with multiple measurements\nof intraocular pressure over an extended time period with\ninterpretation and report, same day (eg, diurnal curve or medical\ntreatment of acute elevation of intraocular pressure)\n$ 52.70\n5689\n92136\n92136\nOphthalmic biometry by partial coherence interferometry with\nintraocular lens power calculation\n$ 123.93\n5690\n92136-26 26\n92136\nOphthalmic biometry by partial coherence interferometry with\nintraocular lens power calculation\n$ 44.16\n5691\n92136-TC TC\n92136\nOphthalmic biometry by partial coherence interferometry with\nintraocular lens power calculation\n$ 79.77\n5692\n92140\n92140\nProvocative tests for glaucoma, with interpretation and report,\nwithout tonography\n$ 57.90\n5693\n92225\n92225\nOphthalmoscopy, extended, with retinal drawing (eg, for retinal\ndetachment, melanoma), with interpretation and report; initial\n$ 79.44\n5694\n92226\n92226\nOphthalmoscopy, extended, with retinal drawing (eg, for retinal\ndetachment, melanoma), with interpretation and report;\nsubsequent\n$ 70.28\n5695\n92230\n92230\nFluorescein angioscopy with interpretation and report\n$ 126.90\n5696\n92235\n92235\nFluorescein angiography (includes multiframe imaging) with\ninterpretation and report\n$ 247.50\n5697\n92235-26 26\n92235\nFluorescein angiography (includes multiframe imaging) with\ninterpretation and report\n$ 98.35\n5698\n92235-TC TC\n92235\nFluorescein angiography (includes multiframe imaging) with\ninterpretation and report\n$ 149.15\n5699\n92240\n92240\nIndocyanine-green angiography (includes multiframe imaging) with\ninterpretation and report\n$ 225.00\n5700\n92240-26 26\n92240\nIndocyanine-green angiography (includes multiframe imaging) with\ninterpretation and report\n$ 50.91\n5701\n92240-TC TC\n92240\nIndocyanine-green angiography (includes multiframe imaging) with\ninterpretation and report\n$ 174.09\n5702\n92250\n92250\nFundus photography with interpretation and report\n$ 79.20\n5703\n92250-26 26\n92250\nFundus photography with interpretation and report\n$ 21.57\n5704\n92250-TC TC\n92250\nFundus photography with interpretation and report\n$ 57.63\n5705\n92260\n92260\nOphthalmodynamometry\n$ 66.60\n5706\n92265\n92265\nNeedle oculoelectromyography, 1 or more extraocular muscles, 1 or\nboth eyes, with interpretation and report\n$ 128.70\n5707\n92265-26 26\n92265\nNeedle oculoelectromyography, 1 or more extraocular muscles, 1 or\nboth eyes, with interpretation and report\n$ 64.52\n5708\n92265-TC TC\n92265\nNeedle oculoelectromyography, 1 or more extraocular muscles, 1 or\nboth eyes, with interpretation and report\n$ 64.18\n5709\n92270\n92270\nElectro-oculography with interpretation and report\n$ 128.70\n5710\n92270-26 26\n92270\nElectro-oculography with interpretation and report\n$ 53.38\n5711\n92270-TC TC\n92270\nElectro-oculography with interpretation and report\n$ 75.32\n5712\n92275\n92275\nElectroretinography with interpretation and report\n$ 162.90\n5713\n92275-26 26\n92275\nElectroretinography with interpretation and report\n$ 55.10\n5714\n92275-TC TC\n92275\nElectroretinography with interpretation and report\n$ 107.80\n5715\n92283\n92283\nColor vision examination, extended, eg, anomaloscope or\nequivalent\n$ 56.70\n5716\n92283-26 26\n92283\nColor vision examination, extended, eg, anomaloscope or\nequivalent\n$ 8.54\n5717\n92283-TC TC\n92283\nColor vision examination, extended, eg, anomaloscope or\nequivalent\n$ 48.16\n5718\n92284\n92284\nDark adaptation examination with interpretation and report\n$ 113.40\n5719\n92284-26 26\n92284\nDark adaptation examination with interpretation and report\n$ 20.35\n5720\n92284-TC TC\n92284\nDark adaptation examination with interpretation and report\n$ 93.05\n5721\n92285\n92285\nExternal ocular photography with interpretation and report for\ndocumentation of medical progress (eg, close-up photography, slit\nlamp photography, goniophotography, stereo-photography)\n$ 59.40\n5722\n92285-26 26\n92285\nExternal ocular photography with interpretation and report for\ndocumentation of medical progress (eg, close-up photography, slit\nlamp photography, goniophotography, stereo-photography)\n$ 8.25\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5723\n92285-TC TC\n92285\nExternal ocular photography with interpretation and report for\ndocumentation of medical progress (eg, close-up photography, slit\nlamp photography, goniophotography, stereo-photography)\n$ 51.15\n5724\n92286\n92286\nAnterior segment imaging with interpretation and report; with\nspecular microscopy and endothelial cell analysis\n$ 235.92\n5725\n92286-26 26\n92286\nAnterior segment imaging with interpretation and report; with\nspecular microscopy and endothelial cell analysis\n$ 127.49\n5726\n92286-TC TC\n92286\nAnterior segment imaging with interpretation and report; with\nspecular microscopy and endothelial cell analysis\n$ 108.43\n5727\n92287\n92287\nAnterior segment imaging with interpretation and report; with\nfluorescein angiography\n$ 180.00\n5728\n92287-26 26\n92287\nAnterior segment imaging with interpretation and report; with\nfluorescein angiography\n$ 56.26\n5729\n92287-TC TC\n92287\nAnterior segment imaging with interpretation and report; with\nfluorescein angiography\n$ 123.74\n5730\n92310\n92310\nPrescription of optical and physical characteristics of and fitting of\ncontact lens, with medical supervision of adaptation; corneal lens,\nboth eyes, except for aphakia\n$ 268.20\n5731\n92311\n92311\nPrescription of optical and physical characteristics of and fitting of\ncontact lens, with medical supervision of adaptation; corneal lens\nfor aphakia, 1 eye\n$ 180.90\n5732\n92312\n92312\nPrescription of optical and physical characteristics of and fitting of\ncontact lens, with medical supervision of adaptation; corneal lens\nfor aphakia, both eyes\n$ 247.50\n5733\n92313\n92313\nPrescription of optical and physical characteristics of and fitting of\ncontact lens, with medical supervision of adaptation; corneoscleral\nlens\n$ 91.51\n5734\n92314\n92314\nPrescription of optical and physical characteristics of contact lens,\nwith medical supervision of adaptation and direction of fitting by\nindependent technician; corneal lens, both eyes except for aphakia\n$ 67.48\n5735\n92315\n92315\nPrescription of optical and physical characteristics of contact lens,\nwith medical supervision of adaptation and direction of fitting by\nindependent technician; corneal lens for aphakia, 1 eye\n$ 63.02\n5736\n92316\n92316\nPrescription of optical and physical characteristics of contact lens,\nwith medical supervision of adaptation and direction of fitting by\nindependent technician; corneal lens for aphakia, both eyes\n$ 98.58\n5737\n92317\n92317\nPrescription of optical and physical characteristics of contact lens,\nwith medical supervision of adaptation and direction of fitting by\nindependent technician; corneoscleral lens\n$ 66.07\n5738\n92325\n92325\nModification of contact lens (separate procedure), with medical\nsupervision of adaptation\n$ 43.20\n5739\n92326\n92326\nReplacement of contact lens\n$ 118.80\n5740\n92340\n92340\nFitting of spectacles, except for aphakia; monofocal\n$ 56.70\n5741\n92341\n92341\nFitting of spectacles, except for aphakia; bifocal\n$ 40.23\n5742\n92342\n92342\nFitting of spectacles, except for aphakia; multifocal, other than\nbifocal\n$ 52.41\n5743\n92352\n92352\nFitting of spectacle prosthesis for aphakia; monofocal\n$ 22.45\n5744\n92353\n92353\nFitting of spectacle prosthesis for aphakia; multifocal\n$ 51.30\n5745\n92354\n92354\nFitting of spectacle mounted low vision aid; single element system\n$ 28.49\n5746\n92355\n92355\nFitting of spectacle mounted low vision aid; telescopic or other\ncompound lens system\n$ 43.94\n5747\n92358\n92358\nProsthesis service for aphakia, temporary (disposable or loan,\nincluding materials)\n$ 23.79\n5748\n92370\n92370\nRepair and refitting spectacles; except for aphakia\n$ 48.20\n5749\n92371\n92371\nRepair and refitting spectacles; spectacle prosthesis for aphakia\n$ 70.29\n5750\n92499\n92499\nUnlisted ophthalmological service or procedure\n$ -\n5751\n92502\n92502\nOtolaryngologic examination under general anesthesia\n$ 297.00\n5752\n92504\n92504\nBinocular microscopy (separate diagnostic procedure)\n$ 61.25\n5753\n92511\n92511\nNasopharyngoscopy with endoscope (separate procedure)\n$ 229.50\n5754\n92512\n92512\nNasal function studies (eg, rhinomanometry)\n$ 144.00\n5755\n92516\n92516\nFacial nerve function studies (eg, electroneuronography)\n$ 123.30\n5756\n92520\n92520\nLaryngeal function studies (ie, aerodynamic testing and acoustic\ntesting)\n$ 257.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5757\n92521\n92521\nEvaluation of speech fluency (eg, stuttering, cluttering)\n$ 114.48\n5758\n92521\n92521\nSpeech therapy, in the home, per diem\n$ 114.48\n5759\n92522\n92522\nEvaluation of speech sound production (eg, articulation,\nphonological process, apraxia, dysarthria);\n$ 92.94\n5760\n92523\n92523\nEvaluation of speech sound production (eg, articulation,\nphonological process, apraxia, dysarthria); with evaluation of\nlanguage comprehension and expression (eg, receptive and\nexpressive language)\n$ 193.07\n5761\n92524\n92524\nBehavioral and qualitative analysis of voice and resonance\n$ 96.89\n5762\n92526\n92526\nTreatment of swallowing dysfunction and\/or oral function for\nfeeding\n$ 123.30\n5763\n92531\n92531\nSpontaneous nystagmus, including gaze\n$ 54.00\n5764\n92532\n92532\nPositional nystagmus test\n$ 62.10\n5765\n92533\n92533\nCaloric vestibular test, each irrigation (binaural, bithermal\nstimulation constitutes 4 tests)\n$ 76.50\n5766\n92534\n92534\nOptokinetic nystagmus test\n$ 63.00\n5767\n92540\n92540\nBasic vestibular evaluation, includes spontaneous nystagmus test\nwith eccentric gaze fixation nystagmus, with recording, positional\nnystagmus test, minimum of 4 positions, with recording, optokinetic\nnystagmus test, bidirectional foveal and peripheral sti\n$ 124.58\n5768\n92541\n92541\nSpontaneous nystagmus test, including gaze and fixation\nnystagmus, with recording\n$ 121.50\n5769\n92541-26 26\n92541\nSpontaneous nystagmus test, including gaze and fixation\nnystagmus, with recording\n$ 79.30\n5770\n92541-TC TC\n92541\nSpontaneous nystagmus test, including gaze and fixation\nnystagmus, with recording\n$ 42.20\n5771\n92542\n92542\nPositional nystagmus test, minimum of 4 positions, with recording\n$ 114.30\n5772\n92542-26 26\n92542\nPositional nystagmus test, minimum of 4 positions, with recording\n$ 69.82\n5773\n92542-TC TC\n92542\nPositional nystagmus test, minimum of 4 positions, with recording\n$ 44.48\n5774\n92543\n92543\nCaloric vestibular test, each irrigation (binaural, bithermal\nstimulation constitutes 4 tests), with recording\n$ 128.70\n5775\n92543-26 26\n92543\nCaloric vestibular test, each irrigation (binaural, bithermal\nstimulation constitutes 4 tests), with recording\n$ 40.96\n5776\n92543-TC TC\n92543\nCaloric vestibular test, each irrigation (binaural, bithermal\nstimulation constitutes 4 tests), with recording\n$ 87.74\n5777\n92544\n92544\nOptokinetic nystagmus test, bidirectional, foveal or peripheral\nstimulation, with recording\n$ 77.40\n5778\n92544-26 26\n92544\nOptokinetic nystagmus test, bidirectional, foveal or peripheral\nstimulation, with recording\n$ 43.16\n5779\n92544-TC TC\n92544\nOptokinetic nystagmus test, bidirectional, foveal or peripheral\nstimulation, with recording\n$ 34.24\n5780\n92545\n92545\nOscillating tracking test, with recording\n$ 77.40\n5781\n92545-26 26\n92545\nOscillating tracking test, with recording\n$ 41.96\n5782\n92545-TC TC\n92545\nOscillating tracking test, with recording\n$ 35.44\n5783\n92546\n92546\nSinusoidal vertical axis rotational testing\n$ 101.70\n5784\n92546-26 26\n92546\nSinusoidal vertical axis rotational testing\n$ 12.98\n5785\n92546-TC TC\n92546\nSinusoidal vertical axis rotational testing\n$ 88.72\n5786\n92547\n92547\nUse of vertical electrodes (List separately in addition to code for\nprimary procedure)\n$ 72.00\n5787\n92548\n92548\nComputerized dynamic posturography\n$ 216.00\n5788\n92548-26 26\n92548\nComputerized dynamic posturography\n$ 47.62\n5789\n92548-TC TC\n92548\nComputerized dynamic posturography\n$ 168.38\n5790\n92550\n92550\nTympanometry and reflex threshold measurements\n$ 38.60\n5791\n92551\n92551\nScreening test, pure tone, air only\n$ 34.20\n5792\n92552\n92552\nPure tone audiometry (threshold); air only\n$ 40.77\n5793\n92553\n92553\nPure tone audiometry (threshold); air and bone\n$ 61.69\n5794\n92555\n92555\nSpeech audiometry threshold;\n$ 36.90\n5795\n92556\n92556\nSpeech audiometry threshold; with speech recognition\n$ 54.76\n5796\n92557\n92557\nComprehensive audiometry threshold evaluation and speech\nrecognition (92553 and 92556 combined)\n$ 92.70\n5797\n92559\n92559\nAudiometric testing of groups\n$ 41.40\n5798\n92560\n92560\nBekesy audiometry; screening\n$ 66.60\n5799\n92561\n92561\nBekesy audiometry; diagnostic\n$ 83.70\n5800\n92562\n92562\nLoudness balance test, alternate binaural or monaural\n$ 40.50\n5801\n92563\n92563\nTone decay test\n$ 45.00\n5802\n92564\n92564\nShort increment sensitivity index (SISI)\n$ 41.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5803\n92565\n92565\nStenger test, pure tone\n$ 50.40\n5804\n92567\n92567\nTympanometry (impedance testing)\n$ 43.18\n5805\n92568\n92568\nAcoustic reflex testing, threshold\n$ 41.40\n5806\n92570\n92570\nAcoustic immittance testing, includes tympanometry (impedance\ntesting), acoustic reflex threshold testing, and acoustic reflex decay\ntesting\n$ 58.15\n5807\n92571\n92571\nFiltered speech test\n$ 38.70\n5808\n92572\n92572\nStaggered spondaic word test\n$ 42.30\n5809\n92575\n92575\nSensorineural acuity level test\n$ 36.00\n5810\n92576\n92576\nSynthetic sentence identification test\n$ 38.70\n5811\n92577\n92577\nStenger test, speech\n$ 51.30\n5812\n92579\n92579\nVisual reinforcement audiometry (VRA)\n$ 102.60\n5813\n92582\n92582\nConditioning play audiometry\n$ 65.70\n5814\n92583\n92583\nSelect picture audiometry\n$ 72.00\n5815\n92584\n92584\nElectrocochleography\n$ 252.00\n5816\n92585\n92585\nAuditory evoked potentials for evoked response audiometry and\/or\ntesting of the central nervous system; comprehensive\n$ 353.70\n5817\n92585-26 26\n92585\nAuditory evoked potentials for evoked response audiometry and\/or\ntesting of the central nervous system; comprehensive\n$ 65.25\n5818\n92585-TC TC\n92585\nAuditory evoked potentials for evoked response audiometry and\/or\ntesting of the central nervous system; comprehensive\n$ 288.45\n5819\n92586\n92586\nAuditory evoked potentials for evoked response audiometry and\/or\ntesting of the central nervous system; limited\n$ 151.11\n5820\n92587\n92587\nDistortion product evoked otoacoustic emissions; limited evaluation\n(to confirm the presence or absence of hearing disorder, 3-6\nfrequencies) or transient otoacoustic emissions, with interpretation\nand report\n$ 124.20\n5821\n92587-26 26\n92587\nDistortion product evoked otoacoustic emissions; limited evaluation\n(to confirm the presence or absence of hearing disorder, 3-6\nfrequencies) or transient otoacoustic emissions, with interpretation\nand report\n$ 105.08\n5822\n92587-TC TC\n92587\nDistortion product evoked otoacoustic emissions; limited evaluation\n(to confirm the presence or absence of hearing disorder, 3-6\nfrequencies) or transient otoacoustic emissions, with interpretation\nand report\n$ 19.12\n5823\n92588\n92588\nDistortion product evoked otoacoustic emissions; comprehensive\ndiagnostic evaluation (quantitative analysis of outer hair cell\nfunction by cochlear mapping, minimum of 12 frequencies), with\ninterpretation and report\n$ 141.30\n5824\n92588-26 26\n92588\nDistortion product evoked otoacoustic emissions; comprehensive\ndiagnostic evaluation (quantitative analysis of outer hair cell\nfunction by cochlear mapping, minimum of 12 frequencies), with\ninterpretation and report\n$ 122.06\n5825\n92588-TC TC\n92588\nDistortion product evoked otoacoustic emissions; comprehensive\ndiagnostic evaluation (quantitative analysis of outer hair cell\nfunction by cochlear mapping, minimum of 12 frequencies), with\ninterpretation and report\n$ 19.24\n5826\n92590\n92590\nHearing aid examination and selection; monaural\n$ 113.40\n5827\n92591\n92591\nHearing aid examination and selection; binaural\n$ 146.70\n5828\n92592\n92592\nHearing aid check; monaural\n$ 40.50\n5829\n92593\n92593\nHearing aid check; binaural\n$ 57.60\n5830\n92594\n92594\nElectroacoustic evaluation for hearing aid; monaural\n$ 36.00\n5831\n92595\n92595\nElectroacoustic evaluation for hearing aid; binaural\n$ 38.70\n5832\n92596\n92596\nEar protector attenuation measurements\n$ 51.30\n5833\n92597\n92597\nEvaluation for use and\/or fitting of voice prosthetic device to\nsupplement oral speech\n$ 188.10\n5834\n92601\n92601\nDiagnostic analysis of cochlear implant, patient younger than 7\nyears of age; with programming\n$ 279.88\n5835\n92602\n92602\nDiagnostic analysis of cochlear implant, patient younger than 7\nyears of age; subsequent reprogramming\n$ 200.79\n5836\n92603\n92603\nDiagnostic analysis of cochlear implant, age 7 years or older; with\nprogramming\n$ 187.38\n5837\n92604\n92604\nDiagnostic analysis of cochlear implant, age 7 years or older;\nsubsequent reprogramming\n$ 124.41\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5838\n92605\n92605\nEvaluation for prescription of non-speech-generating augmentative\nand alternative communication device, face-to-face with the\npatient; first hour\n$ 166.79\n5839\n92606\n92606\nTherapeutic service(s) for the use of non-speech-generating device,\nincluding programming and modification\n$ 151.11\n5840\n92607\n92607\nEvaluation for prescription for speech-generating augmentative and\nalternative communication device, face-to-face with the patient;\nfirst hour\n$ 259.20\n5841\n92608\n92608\nEvaluation for prescription for speech-generating augmentative and\nalternative communication device, face-to-face with the patient;\neach additional 30 minutes (List separately in addition to code for\nprimary procedure)\n$ 57.16\n5842\n92609\n92609\nTherapeutic services for the use of speech-generating device,\nincluding programming and modification\n$ 139.99\n5843\n92610\n92610\nEvaluation of oral and pharyngeal swallowing function\n$ 270.34\n5844\n92611\n92611\nMotion fluoroscopic evaluation of swallowing function by cine or\nvideo recording\n$ 264.89\n5845\n92612\n92612\nFlexible fiberoptic endoscopic evaluation of swallowing by cine or\nvideo recording;\n$ 336.75\n5846\n92613\n92613\nFlexible fiberoptic endoscopic evaluation of swallowing by cine or\nvideo recording; interpretation and report only\n$ 86.41\n5847\n92614\n92614\nFlexible fiberoptic endoscopic evaluation, laryngeal sensory testing\nby cine or video recording;\n$ 296.87\n5848\n92615\n92615\nFlexible fiberoptic endoscopic evaluation, laryngeal sensory testing\nby cine or video recording; interpretation and report only\n$ 78.45\n5849\n92616\n92616\nFlexible fiberoptic endoscopic evaluation of swallowing and\nlaryngeal sensory testing by cine or video recording;\n$ 438.23\n5850\n92617\n92617\nFlexible fiberoptic endoscopic evaluation of swallowing and\nlaryngeal sensory testing by cine or video recording; interpretation\nand report only\n$ 103.33\n5851\n92620\n92620\nEvaluation of central auditory function, with report; initial 60\nminutes\n$ 99.31\n5852\n92621\n92621\nEvaluation of central auditory function, with report; each additional\n15 minutes (List separately in addition to code for primary\nprocedure)\n$ 25.94\n5853\n92625\n92625\nAssessment of tinnitus (includes pitch, loudness matching, and\nmasking)\n$ 93.11\n5854\n92626\n92626\nEvaluation of auditory rehabilitation status; first hour\n$ 174.65\n5855\n92627\n92627\nEvaluation of auditory rehabilitation status; each additional 15\nminutes (List separately in addition to code for primary procedure)\n$ 43.12\n5856\n92630\n92630\nAuditory rehabilitation; prelingual hearing loss\n$ -\n5857\n92633\n92633\nAuditory rehabilitation; postlingual hearing loss\n$ -\n5858\n92640\n92640\nDiagnostic analysis with programming of auditory brainstem\nimplant, per hour\n$ 122.67\n5859\n92700\n92700\nUnlisted otorhinolaryngological service or procedure\n$ 32.92\n5860\n92920\n92920\nPercutaneous transluminal coronary angioplasty; single major\ncoronary artery or branch\n$ 1,048.78\n5861\n92921\n92921\nPercutaneous transluminal coronary angioplasty; each additional\nbranch of a major coronary artery (List separately in addition to\ncode for primary procedure)\n$ 4,410.41\n5862\n92924\n92924\nPercutaneous transluminal coronary atherectomy, with coronary\nangioplasty when performed; single major coronary artery or\nbranch\n$ 1,247.20\n5863\n92925\n92925\nPercutaneous transluminal coronary atherectomy, with coronary\nangioplasty when performed; each additional branch of a major\ncoronary artery (List separately in addition to code for primary\nprocedure)\n$ 8,842.66\n5864\n92928\n92928\nPercutaneous transcatheter placement of intracoronary stent(s),\nwith coronary angioplasty when performed; single major coronary\nartery or branch\n$ 1,165.44\n5865\n92929\n92929\nPercutaneous transcatheter placement of intracoronary stent(s),\nwith coronary angioplasty when performed; each additional branch\nof a major coronary artery (List separately in addition to code for\nprimary procedure)\n$ 6,363.75\n5866\n92933\n92933\nPercutaneous transluminal coronary atherectomy, with\nintracoronary stent, with coronary angioplasty when performed;\nsingle major coronary artery or branch\n$ 1,303.22\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5867\n92934\n92934\nPercutaneous transluminal coronary atherectomy, with\nintracoronary stent, with coronary angioplasty when performed;\neach additional branch of a major coronary artery (List separately in\naddition to code for primary procedure)\n$ 6,363.75\n5868\n92937\n92937\nPercutaneous transluminal revascularization of or through coronary\nartery bypass graft (internal mammary, free arterial, venous), any\ncombination of intracoronary stent, atherectomy and angioplasty,\nincluding distal protection when performed; single vesse\n$ 1,164.19\n5869\n92938\n92938\nPercutaneous transluminal revascularization of or through coronary\nartery bypass graft (internal mammary, free arterial, venous), any\ncombination of intracoronary stent, atherectomy and angioplasty,\nincluding distal protection when performed; each additio\n$ 6,363.75\n5870\n92941\n92941\nPercutaneous transluminal revascularization of acute total\/subtotal\nocclusion during acute myocardial infarction, coronary artery or\ncoronary artery bypass graft, any combination of intracoronary\nstent, atherectomy and angioplasty, including aspiration th\n$ 1,306.01\n5871\n92943\n92943\nPercutaneous transluminal revascularization of chronic total\nocclusion, coronary artery, coronary artery branch, or coronary\nartery bypass graft, any combination of intracoronary stent,\natherectomy and angioplasty; single vessel\n$ 1,306.01\n5872\n92944\n92944\nPercutaneous transluminal revascularization of chronic total\nocclusion, coronary artery, coronary artery branch, or coronary\nartery bypass graft, any combination of intracoronary stent,\natherectomy and angioplasty; each additional coronary artery,\ncoronar\n$ 6,363.75\n5873\n92950\n92950\nCardiopulmonary resuscitation (eg, in cardiac arrest)\n$ 482.59\n5874\n92953\n92953\nTemporary transcutaneous pacing\n$ 329.40\n5875\n92960\n92960\nCardioversion, elective, electrical conversion of arrhythmia; external $ 425.70\n5876\n92961\n92961\nCardioversion, elective, electrical conversion of arrhythmia; internal\n(separate procedure)\n$ 945.23\n5877\n92970\n92970\nCardioassist-method of circulatory assist; internal\n$ 684.90\n5878\n92971\n92971\nCardioassist-method of circulatory assist; external\n$ 275.40\n5879\n92973\n92973\nPercutaneous transluminal coronary thrombectomy mechanical\n(List separately in addition to code for primary procedure)\n$ 1,041.07\n5880\n92974\n92974\nTranscatheter placement of radiation delivery device for\nsubsequent coronary intravascular brachytherapy (List separately in\naddition to code for primary procedure)\n$ 801.14\n5881\n92975\n92975\nThrombolysis, coronary; by intracoronary infusion, including\nselective coronary angiography\n$ 1,488.60\n5882\n92977\n92977\nThrombolysis, coronary; by intravenous infusion\n$ 753.30\n5883\n92978\n92978\nIntravascular ultrasound (coronary vessel or graft) during diagnostic\nevaluation and\/or therapeutic intervention including imaging\nsupervision, interpretation and report; initial vessel (List separately\nin addition to code for primary procedure)\n$ 333.84\n5884\n92979\n92979\nIntravascular ultrasound (coronary vessel or graft) during diagnostic\nevaluation and\/or therapeutic intervention including imaging\nsupervision, interpretation and report; each additional vessel (List\nseparately in addition to code for primary procedure)\n$ 236.88\n5885\n92986\n92986\nPercutaneous balloon valvuloplasty; aortic valve\n$ 3,656.70\n5886\n92987\n92987\nPercutaneous balloon valvuloplasty; mitral valve\n$ 3,403.45\n5887\n92990\n92990\nPercutaneous balloon valvuloplasty; pulmonary valve\n$ 2,477.70\n5888\n92992\n92992\nAtrial septectomy or septostomy; transvenous method, balloon (eg,\nRashkind type) (includes cardiac catheterization)\n$ -\n5889\n92993\n92993\nAtrial septectomy or septostomy; blade method (Park septostomy)\n(includes cardiac catheterization)\n$ 4,408.20\n5890\n92997\n92997\nPercutaneous transluminal pulmonary artery balloon angioplasty;\nsingle vessel\n$ 2,449.80\n5891\n92998\n92998\nPercutaneous transluminal pulmonary artery balloon angioplasty;\neach additional vessel (List separately in addition to code for\nprimary procedure)\n$ 949.50\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5892\n93000\n93000\nElectrocardiogram, routine ECG with at least 12 leads; with\ninterpretation and report\n$ 71.00\n5893\n93005\n93005\nElectrocardiogram, routine ECG with at least 12 leads; tracing only,\nwithout interpretation and report\n$ 56.70\n5894\n93010\n93010\nElectrocardiogram, routine ECG with at least 12 leads;\ninterpretation and report only\n$ 51.30\n5895\n93015\n93015\nCardiovascular stress test using maximal or submaximal treadmill or\nbicycle exercise, continuous electrocardiographic monitoring,\nand\/or pharmacological stress; with supervision, interpretation and\nreport\n$ 338.10\n5896\n93016\n93016\nCardiovascular stress test using maximal or submaximal treadmill or\nbicycle exercise, continuous electrocardiographic monitoring,\nand\/or pharmacological stress; supervision only, without\ninterpretation and report\n$ 100.80\n5897\n93017\n93017\nCardiovascular stress test using maximal or submaximal treadmill or\nbicycle exercise, continuous electrocardiographic monitoring,\nand\/or pharmacological stress; tracing only, without interpretation\nand report\n$ 164.70\n5898\n93018\n93018\nCardiovascular stress test using maximal or submaximal treadmill or\nbicycle exercise, continuous electrocardiographic monitoring,\nand\/or pharmacological stress; interpretation and report only\n$ 170.10\n5899\n93024\n93024\nErgonovine provocation test\n$ 380.70\n5900\n93024-26 26\n93024\nErgonovine provocation test\n$ 180.32\n5901\n93024-TC TC\n93024\nErgonovine provocation test\n$ 200.38\n5902\n93025\n93025\nMicrovolt T-wave alternans for assessment of ventricular\narrhythmias\n$ 119.07\n5903\n93040\n93040\nRhythm ECG, 1-3 leads; with interpretation and report\n$ 49.49\n5904\n93041\n93041\nRhythm ECG, 1-3 leads; tracing only without interpretation and\nreport\n$ 44.10\n5905\n93042\n93042\nRhythm ECG, 1-3 leads; interpretation and report only\n$ 36.00\n5906\n93224\n93224\nExternal electrocardiographic recording up to 48 hours by\ncontinuous rhythm recording and storage; includes recording,\nscanning analysis with report, review and interpretation by a\nphysician or other qualified health care professional\n$ 481.75\n5907\n93225\n93225\nExternal electrocardiographic recording up to 48 hours by\ncontinuous rhythm recording and storage; recording (includes\nconnection, recording, and disconnection)\n$ 162.00\n5908\n93226\n93226\nExternal electrocardiographic recording up to 48 hours by\ncontinuous rhythm recording and storage; scanning analysis with\nreport\n$ 175.50\n5909\n93227\n93227\nExternal electrocardiographic recording up to 48 hours by\ncontinuous rhythm recording and storage; review and\ninterpretation by a physician or other qualified health care\nprofessional\n$ 173.70\n5910\n93228\n93228\nExternal mobile cardiovascular telemetry with electrocardiographic\nrecording, concurrent computerized real time data analysis and\ngreater than 24 hours of accessible ECG data storage (retrievable\nwith query) with ECG triggered and patient selected events\n$ 71.24\n5911\n93229\n93229\nExternal mobile cardiovascular telemetry with electrocardiographic\nrecording, concurrent computerized real time data analysis and\ngreater than 24 hours of accessible ECG data storage (retrievable\nwith query) with ECG triggered and patient selected events\n$ 1,453.15\n5912\n93268\n93268\nExternal patient and, when performed, auto activated\nelectrocardiographic rhythm derived event recording with symptom-\nrelated memory loop with remote download capability up to 30\ndays, 24-hour attended monitoring; includes transmission, review\nand interpr\n$ 382.17\n5913\n93270\n93270\nExternal patient and, when performed, auto activated\nelectrocardiographic rhythm derived event recording with symptom-\nrelated memory loop with remote download capability up to 30\ndays, 24-hour attended monitoring; recording (includes connection,\nrecording\n$ 136.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5914\n93271\n93271\nExternal patient and, when performed, auto activated\nelectrocardiographic rhythm derived event recording with symptom-\nrelated memory loop with remote download capability up to 30\ndays, 24-hour attended monitoring; transmission and analysis\n$ 215.10\n5915\n93272\n93272\nExternal patient and, when performed, auto activated\nelectrocardiographic rhythm derived event recording with symptom-\nrelated memory loop with remote download capability up to 30\ndays, 24-hour attended monitoring; review and interpretation by a\nphysician\n$ 91.80\n5916\n93278\n93278\nSignal-averaged electrocardiography (SAECG), with or without ECG\n$ 211.50\n5917\n93278-26 26\n93278\nSignal-averaged electrocardiography (SAECG), with or without ECG\n$ 79.25\n5918\n93278-TC TC\n93278\nSignal-averaged electrocardiography (SAECG), with or without ECG\n$ 132.25\n5919\n93279\n93279\nProgramming device evaluation (in person) with iterative\nadjustment of the implantable device to test the function of the\ndevice and select optimal permanent programmed values with\nanalysis, review and report by a physician or other qualified health\ncare\n$ 82.45\n5920\n93280\n93280\nProgramming device evaluation (in person) with iterative\nadjustment of the implantable device to test the function of the\ndevice and select optimal permanent programmed values with\nanalysis, review and report by a physician or other qualified health\ncare\n$ 98.60\n5921\n93281\n93281\nProgramming device evaluation (in person) with iterative\nadjustment of the implantable device to test the function of the\ndevice and select optimal permanent programmed values with\nanalysis, review and report by a physician or other qualified health\ncare\n$ 114.49\n5922\n93282\n93282\nProgramming device evaluation (in person) with iterative\nadjustment of the implantable device to test the function of the\ndevice and select optimal permanent programmed values with\nanalysis, review and report by a physician or other qualified health\ncare\n$ 107.41\n5923\n93283\n93283\nProgramming device evaluation (in person) with iterative\nadjustment of the implantable device to test the function of the\ndevice and select optimal permanent programmed values with\nanalysis, review and report by a physician or other qualified health\ncare\n$ 135.22\n5924\n93284\n93284\nProgramming device evaluation (in person) with iterative\nadjustment of the implantable device to test the function of the\ndevice and select optimal permanent programmed values with\nanalysis, review and report by a physician or other qualified health\ncare\n$ 171.39\n5925\n93285\n93285\nProgramming device evaluation (in person) with iterative\nadjustment of the implantable device to test the function of the\ndevice and select optimal permanent programmed values with\nanalysis, review and report by a physician or other qualified health\ncare\n$ 67.31\n5926\n93286\n93286\nPeri-procedural device evaluation (in person) and programming of\ndevice system parameters before or after a surgery, procedure, or\ntest with analysis, review and report by a physician or other\nqualified health care professional; single, dual, or multiple\n$ 31.89\n5927\n93287\n93287\nPeri-procedural device evaluation (in person) and programming of\ndevice system parameters before or after a surgery, procedure, or\ntest with analysis, review and report by a physician or other\nqualified health care professional; single, dual, or multiple\n$ 56.46\n5928\n93288\n93288\nInterrogation device evaluation (in person) with analysis, review and\nreport by a physician or other qualified health care professional,\nincludes connection, recording and disconnection per patient\nencounter; single, dual, or multiple lead pacemaker syste\n$ 55.14\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5929\n93289\n93289\nInterrogation device evaluation (in person) with analysis, review and\nreport by a physician or other qualified health care professional,\nincludes connection, recording and disconnection per patient\nencounter; single, dual, or multiple lead implantable car\n$ 100.80\n5930\n93290\n93290\nInterrogation device evaluation (in person) with analysis, review and\nreport by a physician or other qualified health care professional,\nincludes connection, recording and disconnection per patient\nencounter; implantable cardiovascular monitor system, inc\n$ 52.49\n5931\n93291\n93291\nInterrogation device evaluation (in person) with analysis, review and\nreport by a physician or other qualified health care professional,\nincludes connection, recording and disconnection per patient\nencounter; implantable loop recorder system, including he\n$ 55.68\n5932\n93293\n93293\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\nor multiple lead pacemaker system, includes recording with and\nwithout magnet application with analysis, review and report(s) by a\nphysician or other qualified health care professional, up\n$ 38.13\n5933\n93294\n93294\nInterrogation device evaluation(s) (remote), up to 90 days; single,\ndual, or multiple lead pacemaker system with interim analysis,\nreview(s) and report(s) by a physician or other qualified health care\nprofessional\n$ 94.89\n5934\n93295\n93295\nInterrogation device evaluation(s) (remote), up to 90 days; single,\ndual, or multiple lead implantable cardioverter-defibrillator system\nwith interim analysis, review(s) and report(s) by a physician or other\nqualified health care professional\n$ 152.27\n5935\n93296\n93296\nInterrogation device evaluation(s) (remote), up to 90 days; single,\ndual, or multiple lead pacemaker system or implantable\ncardioverter-defibrillator system, remote data acquisition(s), receipt\nof transmissions and technician review, technical support and\n$ 93.78\n5936\n93297\n93297\nInterrogation device evaluation(s), (remote) up to 30 days;\nimplantable cardiovascular monitor system, including analysis of 1\nor more recorded physiologic cardiovascular data elements from all\ninternal and external sensors, analysis, review(s) and report\n$ 56.66\n5937\n93298\n93298\nInterrogation device evaluation(s), (remote) up to 30 days;\nimplantable loop recorder system, including analysis of recorded\nheart rhythm data, analysis, review(s) and report(s) by a physician\nor other qualified health care professional\n$ 75.22\n5938\n93299\n93299\nInterrogation device evaluation(s), (remote) up to 30 days;\nimplantable cardiovascular monitor system or implantable loop\nrecorder system, remote data acquisition(s), receipt of\ntransmissions and technician review, technical support and\ndistribution of re\n$ -\n5939\n93303\n93303\nTransthoracic echocardiography for congenital cardiac anomalies;\ncomplete\n$ 513.90\n5940\n93303-26 26\n93303\nTransthoracic echocardiography for congenital cardiac anomalies;\ncomplete\n$ 152.41\n5941\n93303-TC TC\n93303\nTransthoracic echocardiography for congenital cardiac anomalies;\ncomplete\n$ 361.49\n5942\n93304\n93304\nTransthoracic echocardiography for congenital cardiac anomalies;\nfollow-up or limited study\n$ 280.80\n5943\n93304-26 26\n93304\nTransthoracic echocardiography for congenital cardiac anomalies;\nfollow-up or limited study\n$ 72.52\n5944\n93304-TC TC\n93304\nTransthoracic echocardiography for congenital cardiac anomalies;\nfollow-up or limited study\n$ 208.28\n5945\n93306\n93306\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\ncomplete, with spectral Doppler echocardiography, and with color\nflow Doppler echocardiography\n$ 230.29\n5946\n93307\n93307\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\ncomplete, without spectral or color Doppler echocardiography\n$ 499.03\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5947\n93307-26 26\n93307\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\ncomplete, without spectral or color Doppler echocardiography\n$ 182.92\n5948\n93307-TC TC\n93307\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\ncomplete, without spectral or color Doppler echocardiography\n$ 316.11\n5949\n93308\n93308\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\nfollow-up or limited study\n$ 58.08\n5950\n93312\n93312\nEchocardiography, transesophageal, real-time with image\ndocumentation (2D) (with or without M-mode recording); including\nprobe placement, image acquisition, interpretation and report\n$ 665.35\n5951\n93312-26 26\n93312\nEchocardiography, transesophageal, real-time with image\ndocumentation (2D) (with or without M-mode recording); including\nprobe placement, image acquisition, interpretation and report\n$ 208.89\n5952\n93312-TC TC\n93312\nEchocardiography, transesophageal, real-time with image\ndocumentation (2D) (with or without M-mode recording); including\nprobe placement, image acquisition, interpretation and report\n$ 456.47\n5953\n93313\n93313\nEchocardiography, transesophageal, real-time with image\ndocumentation (2D) (with or without M-mode recording);\nplacement of transesophageal probe only\n$ 257.40\n5954\n93314\n93314\nEchocardiography, transesophageal, real-time with image\ndocumentation (2D) (with or without M-mode recording); image\nacquisition, interpretation and report only\n$ 424.80\n5955\n93314-26 26\n93314\nEchocardiography, transesophageal, real-time with image\ndocumentation (2D) (with or without M-mode recording); image\nacquisition, interpretation and report only\n$ 81.18\n5956\n93314-TC TC\n93314\nEchocardiography, transesophageal, real-time with image\ndocumentation (2D) (with or without M-mode recording); image\nacquisition, interpretation and report only\n$ 343.62\n5957\n93315\n93315\nTransesophageal echocardiography for congenital cardiac\nanomalies; including probe placement, image acquisition,\ninterpretation and report\n$ 663.30\n5958\n93315-26 26\n93315\nTransesophageal echocardiography for congenital cardiac\nanomalies; including probe placement, image acquisition,\ninterpretation and report\n$ 463.40\n5959\n93316\n93316\nTransesophageal echocardiography for congenital cardiac\nanomalies; placement of transesophageal probe only\n$ 135.90\n5960\n93317\n93317\nTransesophageal echocardiography for congenital cardiac\nanomalies; image acquisition, interpretation and report only\n$ 526.50\n5961\n93317-26 26\n93317\nTransesophageal echocardiography for congenital cardiac\nanomalies; image acquisition, interpretation and report only\n$ 300.16\n5962\n93318\n93318\nEchocardiography, transesophageal (TEE) for monitoring purposes,\nincluding probe placement, real time 2-dimensional image\nacquisition and interpretation leading to ongoing (continuous)\nassessment of (dynamically changing) cardiac pumping function and\nto t\n$ 847.00\n5963\n93320\n93320\nDoppler echocardiography, pulsed wave and\/or continuous wave\nwith spectral display (List separately in addition to codes for\nechocardiographic imaging); complete\n$ 307.08\n5964\n93320-26 26\n93320\nDoppler echocardiography, pulsed wave and\/or continuous wave\nwith spectral display (List separately in addition to codes for\nechocardiographic imaging); complete\n$ 116.49\n5965\n93320-TC TC\n93320\nDoppler echocardiography, pulsed wave and\/or continuous wave\nwith spectral display (List separately in addition to codes for\nechocardiographic imaging); complete\n$ 190.59\n5966\n93321\n93321\nDoppler echocardiography, pulsed wave and\/or continuous wave\nwith spectral display (List separately in addition to codes for\nechocardiographic imaging); follow-up or limited study (List\nseparately in addition to codes for echocardiographic imaging)\n$ 187.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5967\n93321-26 26\n93321\nDoppler echocardiography, pulsed wave and\/or continuous wave\nwith spectral display (List separately in addition to codes for\nechocardiographic imaging); follow-up or limited study (List\nseparately in addition to codes for echocardiographic imaging)\n$ 52.95\n5968\n93321-TC TC\n93321\nDoppler echocardiography, pulsed wave and\/or continuous wave\nwith spectral display (List separately in addition to codes for\nechocardiographic imaging); follow-up or limited study (List\nseparately in addition to codes for echocardiographic imaging)\n$ 134.25\n5969\n93325\n93325\nDoppler echocardiography color flow velocity mapping (List\nseparately in addition to codes for echocardiography)\n$ 247.27\n5970\n93325-26 26\n93325\nDoppler echocardiography color flow velocity mapping (List\nseparately in addition to codes for echocardiography)\n$ 44.14\n5971\n93325-TC TC\n93325\nDoppler echocardiography color flow velocity mapping (List\nseparately in addition to codes for echocardiography)\n$ 203.13\n5972\n93350\n93350\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\nduring rest and cardiovascular stress test using treadmill, bicycle\nexercise and\/or pharmacologically induced stress, with\ninterpretation\n$ 853.56\n5973\n93350-26 26\n93350\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\nduring rest and cardiovascular stress test using treadmill, bicycle\nexercise and\/or pharmacologically induced stress, with\ninterpretation\n$ 280.69\n5974\n93350-TC TC\n93350\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\nduring rest and cardiovascular stress test using treadmill, bicycle\nexercise and\/or pharmacologically induced stress, with\ninterpretation\n$ 572.87\n5975\n93351\n93351\nEchocardiography, transthoracic, real-time with image\ndocumentation (2D), includes M-mode recording, when performed,\nduring rest and cardiovascular stress test using treadmill, bicycle\nexercise and\/or pharmacologically induced stress, with\ninterpretation\n$ 274.13\n5976\n93352\n93352\nUse of echocardiographic contrast agent during stress\nechocardiography (List separately in addition to code for primary\nprocedure)\n$ 113.06\n5977\n93462\n93462\nLeft heart catheterization by transseptal puncture through intact\nseptum or by transapical puncture (List separately in addition to\ncode for primary procedure)\n$ 756.48\n5978\n93503\n93503\nInsertion and placement of flow directed catheter (eg, Swan-Ganz)\nfor monitoring purposes\n$ 725.40\n5979\n93505\n93505\nEndomyocardial biopsy\n$ 1,007.10\n5980\n93505-26 26\n93505\nEndomyocardial biopsy\n$ 290.16\n5981\n93505-TC TC\n93505\nEndomyocardial biopsy\n$ 716.94\n5982\n93530\n93530\nRight heart catheterization, for congenital cardiac anomalies\n$ -\n5983\n93531\n93531\nCombined right heart catheterization and retrograde left heart\ncatheterization, for congenital cardiac anomalies\n$ -\n5984\n93532\n93532\nCombined right heart catheterization and transseptal left heart\ncatheterization through intact septum with or without retrograde\nleft heart catheterization, for congenital cardiac anomalies\n$ -\n5985\n93533\n93533\nCombined right heart catheterization and transseptal left heart\ncatheterization through existing septal opening, with or without\nretrograde left heart catheterization, for congenital cardiac\nanomalies\n$ -\n5986\n93561\n93561\nIndicator dilution studies such as dye or thermodilution, including\narterial and\/or venous catheterization; with cardiac output\nmeasurement (separate procedure)\n$ -\n5987\n93562\n93562\nIndicator dilution studies such as dye or thermodilution, including\narterial and\/or venous catheterization; subsequent measurement of\ncardiac output\n$ -\n5988\n93563\n93563\nInjection procedure during cardiac catheterization including imaging\nsupervision, interpretation, and report; for selective coronary\nangiography during congenital heart catheterization (List separately\nin addition to code for primary procedure)\n$ 206.77\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n5989\n93564\n93564\nInjection procedure during cardiac catheterization including imaging\nsupervision, interpretation, and report; for selective opacification of\naortocoronary venous or arterial bypass graft(s) (eg, aortocoronary\nsaphenous vein, free radial artery, or free ma\n$ 207.05\n5990\n93565\n93565\nInjection procedure during cardiac catheterization including imaging\nsupervision, interpretation, and report; for selective left ventricular\nor left atrial angiography (List separately in addition to code for\nprimary procedure)\n$ 160.18\n5991\n93566\n93566\nInjection procedure during cardiac catheterization including imaging\nsupervision, interpretation, and report; for selective right\nventricular or right atrial angiography (List separately in addition to\ncode for primary procedure)\n$ 642.05\n5992\n93567\n93567\nInjection procedure during cardiac catheterization including imaging\nsupervision, interpretation, and report; for supravalvular\naortography (List separately in addition to code for primary\nprocedure)\n$ 525.96\n5993\n93568\n93568\nInjection procedure during cardiac catheterization including imaging\nsupervision, interpretation, and report; for pulmonary angiography\n(List separately in addition to code for primary procedure)\n$ 578.40\n5994\n93571\n93571\nIntravascular Doppler velocity and\/or pressure derived coronary\nflow reserve measurement (coronary vessel or graft) during\ncoronary angiography including pharmacologically induced stress;\ninitial vessel (List separately in addition to code for primary pro\n$ 693.90\n5995\n93571-26 26\n93571\nIntravascular Doppler velocity and\/or pressure derived coronary\nflow reserve measurement (coronary vessel or graft) during\ncoronary angiography including pharmacologically induced stress;\ninitial vessel (List separately in addition to code for primary pro\n$ 352.53\n5996\n93572\n93572\nIntravascular Doppler velocity and\/or pressure derived coronary\nflow reserve measurement (coronary vessel or graft) during\ncoronary angiography including pharmacologically induced stress;\neach additional vessel (List separately in addition to code for pri\n$ 637.20\n5997\n93572-26 26\n93572\nIntravascular Doppler velocity and\/or pressure derived coronary\nflow reserve measurement (coronary vessel or graft) during\ncoronary angiography including pharmacologically induced stress;\neach additional vessel (List separately in addition to code for pri\n$ 290.14\n5998\n93580\n93580\nPercutaneous transcatheter closure of congenital interatrial\ncommunication (ie, Fontan fenestration, atrial septal defect) with\nimplant\n$ 10,167.89\n5999\n93600\n93600\nBundle of His recording\n$ 772.20\n6000\n93600-26 26\n93600\nBundle of His recording\n$ 310.59\n6001\n93602\n93602\nIntra-atrial recording\n$ 510.30\n6002\n93602-26 26\n93602\nIntra-atrial recording\n$ 254.62\n6003\n93603\n93603\nRight ventricular recording\n$ 605.70\n6004\n93603-26 26\n93603\nRight ventricular recording\n$ 221.61\n6005\n93609\n93609\nIntraventricular and\/or intra-atrial mapping of tachycardia site(s)\nwith catheter manipulation to record from multiple sites to identify\norigin of tachycardia (List separately in addition to code for primary\nprocedure)\n$ 1,494.00\n6006\n93609-26 26\n93609\nIntraventricular and\/or intra-atrial mapping of tachycardia site(s)\nwith catheter manipulation to record from multiple sites to identify\norigin of tachycardia (List separately in addition to code for primary\nprocedure)\n$ 825.96\n6007\n93610\n93610\nIntra-atrial pacing\n$ 592.20\n6008\n93610-26 26\n93610\nIntra-atrial pacing\n$ 416.14\n6009\n93612\n93612\nIntraventricular pacing\n$ 568.80\n6010\n93612-26 26\n93612\nIntraventricular pacing\n$ 327.81\n6011\n93613\n93613\nIntracardiac electrophysiologic 3-dimensional mapping (List\nseparately in addition to code for primary procedure)\n$ 1,153.65\n6012\n93615\n93615\nEsophageal recording of atrial electrogram with or without\nventricular electrogram(s);\n$ 134.10\n6013\n93615-26 26\n93615\nEsophageal recording of atrial electrogram with or without\nventricular electrogram(s);\n$ 103.31\n6014\n93616\n93616\nEsophageal recording of atrial electrogram with or without\nventricular electrogram(s); with pacing\n$ 358.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6015\n93616-26 26\n93616\nEsophageal recording of atrial electrogram with or without\nventricular electrogram(s); with pacing\n$ 165.00\n6016\n93618\n93618\nInduction of arrhythmia by electrical pacing\n$ 1,287.90\n6017\n93618-26 26\n93618\nInduction of arrhythmia by electrical pacing\n$ 730.18\n6018\n93619\n93619\nComprehensive electrophysiologic evaluation with right atrial\npacing and recording, right ventricular pacing and recording, His\nbundle recording, including insertion and repositioning of multiple\nelectrode catheters, without induction or attempted inducti\n$ 2,567.70\n6019\n93619-26 26\n93619\nComprehensive electrophysiologic evaluation with right atrial\npacing and recording, right ventricular pacing and recording, His\nbundle recording, including insertion and repositioning of multiple\nelectrode catheters, without induction or attempted inducti\n$ 1,141.78\n6020\n93620\n93620\nComprehensive electrophysiologic evaluation including insertion\nand repositioning of multiple electrode catheters with induction or\nattempted induction of arrhythmia; with right atrial pacing and\nrecording, right ventricular pacing and recording, His bund\n$ 3,511.80\n6021\n93620-26 26\n93620\nComprehensive electrophysiologic evaluation including insertion\nand repositioning of multiple electrode catheters with induction or\nattempted induction of arrhythmia; with right atrial pacing and\nrecording, right ventricular pacing and recording, His bund\n$ 1,780.00\n6022\n93621\n93621\nComprehensive electrophysiologic evaluation including insertion\nand repositioning of multiple electrode catheters with induction or\nattempted induction of arrhythmia; with left atrial pacing and\nrecording from coronary sinus or left atrium (List separatel\n$ 3,800.70\n6023\n93621-26 26\n93621\nComprehensive electrophysiologic evaluation including insertion\nand repositioning of multiple electrode catheters with induction or\nattempted induction of arrhythmia; with left atrial pacing and\nrecording from coronary sinus or left atrium (List separatel\n$ 425.44\n6024\n93622\n93622\nComprehensive electrophysiologic evaluation including insertion\nand repositioning of multiple electrode catheters with induction or\nattempted induction of arrhythmia; with left ventricular pacing and\nrecording (List separately in addition to code for prim\n$ -\n6025\n93623\n93623\nProgrammed stimulation and pacing after intravenous drug infusion\n(List separately in addition to code for primary procedure)\n$ 625.50\n6026\n93623-26 26\n93623\nProgrammed stimulation and pacing after intravenous drug infusion\n(List separately in addition to code for primary procedure)\n$ 377.16\n6027\n93624\n93624\nElectrophysiologic follow-up study with pacing and recording to test\neffectiveness of therapy, including induction or attempted induction\nof arrhythmia\n$ 1,545.30\n6028\n93624-26 26\n93624\nElectrophysiologic follow-up study with pacing and recording to test\neffectiveness of therapy, including induction or attempted induction\nof arrhythmia\n$ 841.51\n6029\n93631\n93631\nIntraoperative epicardial and endocardial pacing and mapping to\nlocalize the site of tachycardia or zone of slow conduction for\nsurgical correction\n$ 1,283.52\n6030\n93640\n93640\nElectrophysiologic evaluation of single or dual chamber pacing\ncardioverter-defibrillator leads including defibrillation threshold\nevaluation (induction of arrhythmia, evaluation of sensing and\npacing for arrhythmia termination) at time of initial implant\n$ 578.16\n6031\n93641\n93641\nElectrophysiologic evaluation of single or dual chamber pacing\ncardioverter-defibrillator leads including defibrillation threshold\nevaluation (induction of arrhythmia, evaluation of sensing and\npacing for arrhythmia termination) at time of initial implant\n$ 1,702.80\n6032\n93641-26 26\n93641\nElectrophysiologic evaluation of single or dual chamber pacing\ncardioverter-defibrillator leads including defibrillation threshold\nevaluation (induction of arrhythmia, evaluation of sensing and\npacing for arrhythmia termination) at time of initial implant\n$ 890.84\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6033\n93642\n93642\nElectrophysiologic evaluation of single or dual chamber pacing\ncardioverter-defibrillator (includes defibrillation threshold\nevaluation, induction of arrhythmia, evaluation of sensing and\npacing for arrhythmia termination, and programming or\nreprogramming\n$ 841.38\n6034\n93650\n93650\nIntracardiac catheter ablation of atrioventricular node function,\natrioventricular conduction for creation of complete heart block,\nwith or without temporary pacemaker placement\n$ 3,193.20\n6035\n93653\n93653\nComprehensive electrophysiologic evaluation including insertion\nand repositioning of multiple electrode catheters with induction or\nattempted induction of an arrhythmia with right atrial pacing and\nrecording, right ventricular pacing and recording (when n\n$ 1,587.14\n6036\n93654\n93654\nComprehensive electrophysiologic evaluation including insertion\nand repositioning of multiple electrode catheters with induction or\nattempted induction of an arrhythmia with right atrial pacing and\nrecording, right ventricular pacing and recording (when n\n$ 2,118.20\n6037\n93655\n93655\nIntracardiac catheter ablation of a discrete mechanism of\narrhythmia which is distinct from the primary ablated mechanism,\nincluding repeat diagnostic maneuvers, to treat a spontaneous or\ninduced arrhythmia (List separately in addition to code for primary\n$ 793.43\n6038\n93656\n93656\nComprehensive electrophysiologic evaluation including transseptal\ncatheterizations, insertion and repositioning of multiple electrode\ncatheters with induction or attempted induction of an arrhythmia\nincluding left or right atrial pacing\/recording when nec\n$ 2,118.70\n6039\n93657\n93657\nAdditional linear or focal intracardiac catheter ablation of the left or\nright atrium for treatment of atrial fibrillation remaining after\ncompletion of pulmonary vein isolation (List separately in addition\nto code for primary procedure)\n$ 794.38\n6040\n93660\n93660\nEvaluation of cardiovascular function with tilt table evaluation, with\ncontinuous ECG monitoring and intermittent blood pressure\nmonitoring, with or without pharmacological intervention\n$ 639.00\n6041\n93660-26 26\n93660\nEvaluation of cardiovascular function with tilt table evaluation, with\ncontinuous ECG monitoring and intermittent blood pressure\nmonitoring, with or without pharmacological intervention\n$ 361.25\n6042\n93660-TC TC\n93660\nEvaluation of cardiovascular function with tilt table evaluation, with\ncontinuous ECG monitoring and intermittent blood pressure\nmonitoring, with or without pharmacological intervention\n$ 277.75\n6043\n93662\n93662\nIntracardiac echocardiography during therapeutic\/diagnostic\nintervention, including imaging supervision and interpretation (List\nseparately in addition to code for primary procedure)\n$ -\n6044\n93668\n93668\nPeripheral arterial disease (PAD) rehabilitation, per session\n$ 142.65\n6045\n93701\n93701\nBioimpedance-derived physiologic cardiovascular analysis\n$ 86.57\n6046\n93721-26 26\n93721\nPlethysmography for determination of lung volumes and, when\nperformed, airway resistance\n$ 23.56\n6047\n93721-TC TC\n93721\nPlethysmography for determination of lung volumes and, when\nperformed, airway resistance\n$ 95.27\n6048\n93722-26 26\n93722\nPlethysmography for determination of lung volumes and, when\nperformed, airway resistance\n$ 23.56\n6049\n93722-TC TC\n93722\nPlethysmography for determination of lung volumes and, when\nperformed, airway resistance\n$ 95.27\n6050\n93724\n93724\nElectronic analysis of antitachycardia pacemaker system (includes\nelectrocardiographic recording, programming of device, induction\nand termination of tachycardia via implanted pacemaker, and\ninterpretation of recordings)\n$ 575.15\n6051\n93733-26 26\n93733\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\nor multiple lead pacemaker system, includes recording with and\nwithout magnet application with analysis, review and report(s) by a\nphysician or other qualified health care professional, up\n$ 38.13\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6052\n93733-TC TC\n93733\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\nor multiple lead pacemaker system, includes recording with and\nwithout magnet application with analysis, review and report(s) by a\nphysician or other qualified health care professional, up\n$ 98.63\n6053\n93736-26 26\n93736\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\nor multiple lead pacemaker system, includes recording with and\nwithout magnet application with analysis, review and report(s) by a\nphysician or other qualified health care professional, up\n$ 38.13\n6054\n93736-TC TC\n93736\nTranstelephonic rhythm strip pacemaker evaluation(s) single, dual,\nor multiple lead pacemaker system, includes recording with and\nwithout magnet application with analysis, review and report(s) by a\nphysician or other qualified health care professional, up\n$ 98.63\n6055\n93740\n93740\nTemperature gradient studies\n$ 108.00\n6056\n93745\n93745\nInitial set-up and programming by a physician or other qualified\nhealth care professional of wearable cardioverter-defibrillator\nincludes initial programming of system, establishing baseline\nelectronic ECG, transmission of data to data repository, patient\n$ -\n6057\n93750\n93750\nInterrogation of ventricular assist device (VAD), in person, with\nphysician or other qualified health care professional analysis of\ndevice parameters (eg, drivelines, alarms, power surges), review of\ndevice function (eg, flow and volume status, septum sta\n$ 107.14\n6058\n93770\n93770\nDetermination of venous pressure\n$ 30.60\n6059\n93784\n93784\nAmbulatory blood pressure monitoring, utilizing a system such as\nmagnetic tape and\/or computer disk, for 24 hours or longer;\nincluding recording, scanning analysis, interpretation and report\n$ 369.90\n6060\n93786\n93786\nAmbulatory blood pressure monitoring, utilizing a system such as\nmagnetic tape and\/or computer disk, for 24 hours or longer;\nrecording only\n$ 65.66\n6061\n93788\n93788\nAmbulatory blood pressure monitoring, utilizing a system such as\nmagnetic tape and\/or computer disk, for 24 hours or longer;\nscanning analysis with report\n$ 137.83\n6062\n93790\n93790\nAmbulatory blood pressure monitoring, utilizing a system such as\nmagnetic tape and\/or computer disk, for 24 hours or longer; review\nwith interpretation and report\n$ 65.76\n6063\n93797\n93797\nPhysician or other qualified health care professional services for\noutpatient cardiac rehabilitation; without continuous ECG\nmonitoring (per session)\n$ 46.80\n6064\n93798\n93798\nPhysician or other qualified health care professional services for\noutpatient cardiac rehabilitation; with continuous ECG monitoring\n(per session)\n$ 68.76\n6065\n93799\n93799\nUnlisted cardiovascular service or procedure\nCost\n6066\n93875-26 26\n93875\nDuplex scan of extracranial arteries; complete bilateral study\n$ 47.85\n6067\n93875-TC TC\n93875\nDuplex scan of extracranial arteries; complete bilateral study\n$ 383.73\n6068\n93880\n93880\nDuplex scan of extracranial arteries; complete bilateral study\n$ 431.58\n6069\n93880-26 26\n93880\nDuplex scan of extracranial arteries; complete bilateral study\n$ 47.85\n6070\n93880-TC TC\n93880\nDuplex scan of extracranial arteries; complete bilateral study\n$ 383.73\n6071\n93882\n93882\nDuplex scan of extracranial arteries; unilateral or limited study\n$ 43.57\n6072\n93886\n93886\nTranscranial Doppler study of the intracranial arteries; complete\nstudy\n$ 53.54\n6073\n93888\n93888\nTranscranial Doppler study of the intracranial arteries; limited study $ 44.63\n6074\n93890\n93890\nTranscranial Doppler study of the intracranial arteries;\nvasoreactivity study\n$ 121.20\n6075\n93892\n93892\nTranscranial Doppler study of the intracranial arteries; emboli\ndetection without intravenous microbubble injection\n$ 138.59\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6076\n93922\n93922\nLimited bilateral noninvasive physiologic studies of upper or lower\nextremity arteries, (eg, for lower extremity: ankle\/brachial indices\nat distal posterior tibial and anterior tibial\/dorsalis pedis arteries\nplus bidirectional, Doppler waveform recording\n$ 26.81\n6077\n93923\n93923\nComplete bilateral noninvasive physiologic studies of upper or\nlower extremity arteries, 3 or more levels (eg, for lower extremity:\nankle\/brachial indices at distal posterior tibial and anterior\ntibial\/dorsalis pedis arteries plus segmental blood pressure\n$ 364.50\n6078\n93923-26 26\n93923\nComplete bilateral noninvasive physiologic studies of upper or\nlower extremity arteries, 3 or more levels (eg, for lower extremity:\nankle\/brachial indices at distal posterior tibial and anterior\ntibial\/dorsalis pedis arteries plus segmental blood pressure\n$ 51.22\n6079\n93923-TC TC\n93923\nComplete bilateral noninvasive physiologic studies of upper or\nlower extremity arteries, 3 or more levels (eg, for lower extremity:\nankle\/brachial indices at distal posterior tibial and anterior\ntibial\/dorsalis pedis arteries plus segmental blood pressure\n$ 313.28\n6080\n93924\n93924\nNoninvasive physiologic studies of lower extremity arteries, at rest\nand following treadmill stress testing, (ie, bidirectional Doppler\nwaveform or volume plethysmography recording and analysis at\nrest with ankle\/brachial indices immediately after and at\n$ 369.00\n6081\n93924-26 26\n93924\nNoninvasive physiologic studies of lower extremity arteries, at rest\nand following treadmill stress testing, (ie, bidirectional Doppler\nwaveform or volume plethysmography recording and analysis at\nrest with ankle\/brachial indices immediately after and at\n$ 45.73\n6082\n93924-TC TC\n93924\nNoninvasive physiologic studies of lower extremity arteries, at rest\nand following treadmill stress testing, (ie, bidirectional Doppler\nwaveform or volume plethysmography recording and analysis at\nrest with ankle\/brachial indices immediately after and at\n$ 323.27\n6083\n93925\n93925\nDuplex scan of lower extremity arteries or arterial bypass grafts;\ncomplete bilateral study\n$ 398.17\n6084\n93925-26 26\n93925\nDuplex scan of lower extremity arteries or arterial bypass grafts;\ncomplete bilateral study\n$ 56.52\n6085\n93925-TC TC\n93925\nDuplex scan of lower extremity arteries or arterial bypass grafts;\ncomplete bilateral study\n$ 341.65\n6086\n93926\n93926\nDuplex scan of lower extremity arteries or arterial bypass grafts;\nunilateral or limited study\n$ 245.96\n6087\n93926-26 26\n93926\nDuplex scan of lower extremity arteries or arterial bypass grafts;\nunilateral or limited study\n$ 38.91\n6088\n93926-TC TC\n93926\nDuplex scan of lower extremity arteries or arterial bypass grafts;\nunilateral or limited study\n$ 207.05\n6089\n93930\n93930\nDuplex scan of upper extremity arteries or arterial bypass grafts;\ncomplete bilateral study\n$ 432.90\n6090\n93930-26 26\n93930\nDuplex scan of upper extremity arteries or arterial bypass grafts;\ncomplete bilateral study\n$ 37.29\n6091\n93930-TC TC\n93930\nDuplex scan of upper extremity arteries or arterial bypass grafts;\ncomplete bilateral study\n$ 395.61\n6092\n93931\n93931\nDuplex scan of upper extremity arteries or arterial bypass grafts;\nunilateral or limited study\n$ 270.90\n6093\n93931-26 26\n93931\nDuplex scan of upper extremity arteries or arterial bypass grafts;\nunilateral or limited study\n$ 23.26\n6094\n93931-TC TC\n93931\nDuplex scan of upper extremity arteries or arterial bypass grafts;\nunilateral or limited study\n$ 247.64\n6095\n93965\n93965\nNoninvasive physiologic studies of extremity veins, complete\nbilateral study (eg, Doppler waveform analysis with responses to\ncompression and other maneuvers, phleborheography, impedance\nplethysmography)\n$ 243.31\n6096\n93965-26 26\n93965\nNoninvasive physiologic studies of extremity veins, complete\nbilateral study (eg, Doppler waveform analysis with responses to\ncompression and other maneuvers, phleborheography, impedance\nplethysmography)\n$ 30.99\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6097\n93965-TC TC\n93965\nNoninvasive physiologic studies of extremity veins, complete\nbilateral study (eg, Doppler waveform analysis with responses to\ncompression and other maneuvers, phleborheography, impedance\nplethysmography)\n$ 212.32\n6098\n93970\n93970\nDuplex scan of extremity veins including responses to compression\nand other maneuvers; complete bilateral study\n$ 382.93\n6099\n93970-26 26\n93970\nDuplex scan of extremity veins including responses to compression\nand other maneuvers; complete bilateral study\n$ 64.54\n6100\n93970-TC TC\n93970\nDuplex scan of extremity veins including responses to compression\nand other maneuvers; complete bilateral study\n$ 318.39\n6101\n93971\n93971\nDuplex scan of extremity veins including responses to compression\nand other maneuvers; unilateral or limited study\n$ 237.86\n6102\n93971-26 26\n93971\nDuplex scan of extremity veins including responses to compression\nand other maneuvers; unilateral or limited study\n$ 41.87\n6103\n93971-TC TC\n93971\nDuplex scan of extremity veins including responses to compression\nand other maneuvers; unilateral or limited study\n$ 195.99\n6104\n93975\n93975\nDuplex scan of arterial inflow and venous outflow of abdominal,\npelvic, scrotal contents and\/or retroperitoneal organs; complete\nstudy\n$ 387.90\n6105\n93975-26 26\n93975\nDuplex scan of arterial inflow and venous outflow of abdominal,\npelvic, scrotal contents and\/or retroperitoneal organs; complete\nstudy\n$ 86.92\n6106\n93975-TC TC\n93975\nDuplex scan of arterial inflow and venous outflow of abdominal,\npelvic, scrotal contents and\/or retroperitoneal organs; complete\nstudy\n$ 300.98\n6107\n93976\n93976\nDuplex scan of arterial inflow and venous outflow of abdominal,\npelvic, scrotal contents and\/or retroperitoneal organs; limited study $ 109.12\n6108\n93978\n93978\nDuplex scan of aorta, inferior vena cava, iliac vasculature, or bypass\ngrafts; complete study\n$ 46.67\n6109\n93979\n93979\nDuplex scan of aorta, inferior vena cava, iliac vasculature, or bypass\ngrafts; unilateral or limited study\n$ 32.53\n6110\n93980\n93980\nDuplex scan of arterial inflow and venous outflow of penile vessels;\ncomplete study\n$ 179.39\n6111\n93981\n93981\nDuplex scan of arterial inflow and venous outflow of penile vessels;\nfollow-up or limited study\n$ 63.58\n6112\n93982\n93982\nNoninvasive physiologic study of implanted wireless pressure sensor\nin aneurysmal sac following endovascular repair, complete study\nincluding recording, analysis of pressure and waveform tracings,\ninterpretation and report\n$ 101.76\n6113\n93990\n93990\nDuplex scan of hemodialysis access (including arterial inflow, body\nof access and venous outflow)\n$ 16.62\n6114\n94002\n94002\nVentilation assist and management, initiation of pressure or volume\npreset ventilators for assisted or controlled breathing; hospital\ninpatient\/observation, initial day\n$ 218.34\n6115\n94003\n94003\nVentilation assist and management, initiation of pressure or volume\npreset ventilators for assisted or controlled breathing; hospital\ninpatient\/observation, each subsequent day\n$ 157.25\n6116\n94004\n94004\nVentilation assist and management, initiation of pressure or volume\npreset ventilators for assisted or controlled breathing; nursing\nfacility, per day\n$ 114.51\n6117\n94005\n94005\nHome ventilator management care plan oversight of a patient\n(patient not present) in home, domiciliary or rest home (eg, assisted\nliving) requiring review of status, review of laboratories and other\nstudies and revision of orders and respiratory care plan\n$ 203.72\n6118\n94010\n94010\nSpirometry, including graphic record, total and timed vital capacity,\nexpiratory flow rate measurement(s), with or without maximal\nvoluntary ventilation\n$ 92.70\n6119\n94010-26 26\n94010\nSpirometry, including graphic record, total and timed vital capacity,\nexpiratory flow rate measurement(s), with or without maximal\nvoluntary ventilation\n$ 18.97\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6120\n94010-TC TC\n94010\nSpirometry, including graphic record, total and timed vital capacity,\nexpiratory flow rate measurement(s), with or without maximal\nvoluntary ventilation\n$ 73.73\n6121\n94011\n94011\nMeasurement of spirometric forced expiratory flows in an infant or\nchild through 2 years of age\n$ 216.23\n6122\n94012\n94012\nMeasurement of spirometric forced expiratory flows, before and\nafter bronchodilator, in an infant or child through 2 years of age\n$ 352.90\n6123\n94013\n94013\nMeasurement of lung volumes (ie, functional residual capacity\n[FRC], forced vital capacity [FVC], and expiratory reserve volume\n[ERV]) in an infant or child through 2 years of age\n$ 76.21\n6124\n94014\n94014\nPatient-initiated spirometric recording per 30-day period of time;\nincludes reinforced education, transmission of spirometric tracing,\ndata capture, analysis of transmitted data, periodic recalibration\nand review and interpretation by a physician or other\n$ 91.80\n6125\n94015\n94015\nPatient-initiated spirometric recording per 30-day period of time;\nrecording (includes hook-up, reinforced education, data\ntransmission, data capture, trend analysis, and periodic\nrecalibration)\n$ 54.46\n6126\n94016\n94016\nPatient-initiated spirometric recording per 30-day period of time;\nreview and interpretation only by a physician or other qualified\nhealth care professional\n$ 58.50\n6127\n94060\n94060\nBronchodilation responsiveness, spirometry as in 94010, pre- and\npost-bronchodilator administration\n$ 128.70\n6128\n94060-26 26\n94060\nBronchodilation responsiveness, spirometry as in 94010, pre- and\npost-bronchodilator administration\n$ 24.14\n6129\n94060-TC TC\n94060\nBronchodilation responsiveness, spirometry as in 94010, pre- and\npost-bronchodilator administration\n$ 104.56\n6130\n94150\n94150\nVital capacity, total (separate procedure)\n$ 5.54\n6131\n94200\n94200\nMaximum breathing capacity, maximal voluntary ventilation\n$ 11.13\n6132\n94250\n94250\nExpired gas collection, quantitative, single procedure (separate\nprocedure)\n$ 33.30\n6133\n94250-26 26\n94250\nExpired gas collection, quantitative, single procedure (separate\nprocedure)\n$ 6.45\n6134\n94250-TC TC\n94250\nExpired gas collection, quantitative, single procedure (separate\nprocedure)\n$ 26.85\n6135\n94375\n94375\nRespiratory flow volume loop\n$ 99.00\n6136\n94375-26 26\n94375\nRespiratory flow volume loop\n$ 33.70\n6137\n94375-TC TC\n94375\nRespiratory flow volume loop\n$ 65.30\n6138\n94450\n94450\nBreathing response to hypoxia (hypoxia response curve)\n$ 24.61\n6139\n94452\n94452\nHigh altitude simulation test (HAST), with interpretation and report\nby a physician or other qualified health care professional;\n$ 37.46\n6140\n94453\n94453\nHigh altitude simulation test (HAST), with interpretation and report\nby a physician or other qualified health care professional; with\nsupplemental oxygen titration\n$ 48.67\n6141\n94610\n94610\nIntrapulmonary surfactant administration by a physician or other\nqualified health care professional through endotracheal tube\n$ 157.18\n6142\n94620\n94620\nPulmonary stress testing; simple (eg, 6-minute walk test, prolonged\nexercise test for bronchospasm with pre- and post-spirometry and\noximetry)\n$ 254.70\n6143\n94620-26 26\n94620\nPulmonary stress testing; simple (eg, 6-minute walk test, prolonged\nexercise test for bronchospasm with pre- and post-spirometry and\noximetry)\n$ 129.42\n6144\n94620-TC TC\n94620\nPulmonary stress testing; simple (eg, 6-minute walk test, prolonged\nexercise test for bronchospasm with pre- and post-spirometry and\noximetry)\n$ 125.28\n6145\n94621\n94621\nPulmonary stress testing; complex (including measurements of CO2\nproduction, O2 uptake, and electrocardiographic recordings)\n$ 81.55\n6146\n94640\n94640\nPressurized or nonpressurized inhalation treatment for acute\nairway obstruction or for sputum induction for diagnostic purposes\n(eg, with an aerosol generator, nebulizer, metered dose inhaler or\nintermittent positive pressure breathing [IPPB] device)\n$ 41.40\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6147\n94645\n94645\nContinuous inhalation treatment with aerosol medication for acute\nairway obstruction; each additional hour (List separately in addition\nto code for primary procedure)\n$ 32.68\n6148\n94660\n94660\nContinuous positive airway pressure ventilation (CPAP), initiation\nand management\n$ 180.90\n6149\n94664\n94664\nDemonstration and\/or evaluation of patient utilization of an aerosol\ngenerator, nebulizer, metered dose inhaler or IPPB device\n$ 49.61\n6150\n94667\n94667\nManipulation chest wall, such as cupping, percussing, and vibration\nto facilitate lung function; initial demonstration and\/or evaluation\n$ 63.00\n6151\n94668\n94668\nManipulation chest wall, such as cupping, percussing, and vibration\nto facilitate lung function; subsequent\n$ 54.90\n6152\n94680\n94680\nOxygen uptake, expired gas analysis; rest and exercise, direct,\nsimple\n$ 26.96\n6153\n94681\n94681\nOxygen uptake, expired gas analysis; including CO2 output,\npercentage oxygen extracted\n$ 169.20\n6154\n94681-26 26\n94681\nOxygen uptake, expired gas analysis; including CO2 output,\npercentage oxygen extracted\n$ 28.35\n6155\n94681-TC TC\n94681\nOxygen uptake, expired gas analysis; including CO2 output,\npercentage oxygen extracted\n$ 140.85\n6156\n94750\n94750\nPulmonary compliance study (eg, plethysmography, volume and\npressure measurements)\n$ 98.10\n6157\n94750-26 26\n94750\nPulmonary compliance study (eg, plethysmography, volume and\npressure measurements)\n$ 11.39\n6158\n94750-TC TC\n94750\nPulmonary compliance study (eg, plethysmography, volume and\npressure measurements)\n$ 86.71\n6159\n94760\n94760\nNoninvasive ear or pulse oximetry for oxygen saturation; single\ndetermination\n$ 34.98\n6160\n94761\n94761\nNoninvasive ear or pulse oximetry for oxygen saturation; multiple\ndeterminations (eg, during exercise)\n$ 72.00\n6161\n94774\n94774\nPediatric home apnea monitoring event recording including\nrespiratory rate, pattern and heart rate per 30-day period of time;\nincludes monitor attachment, download of data, review,\ninterpretation, and preparation of a report by a physician or other\nqualif\n$ -\n6162\n94775\n94775\nPediatric home apnea monitoring event recording including\nrespiratory rate, pattern and heart rate per 30-day period of time;\nmonitor attachment only (includes hook-up, initiation of recording\nand disconnection)\n$ -\n6163\n94776\n94776\nPediatric home apnea monitoring event recording including\nrespiratory rate, pattern and heart rate per 30-day period of time;\nmonitoring, download of information, receipt of transmission(s) and\nanalyses by computer only\n$ -\n6164\n94777\n94777\nPediatric home apnea monitoring event recording including\nrespiratory rate, pattern and heart rate per 30-day period of time;\nreview, interpretation and preparation of report only by a physician\nor other qualified health care professional\n$ -\n6165\n94799\n94799\nUnlisted pulmonary service or procedure\n$ 27.50\n6166\n95004\n95004\nPercutaneous tests (scratch, puncture, prick) with allergenic\nextracts, immediate type reaction, including test interpretation and\nreport, specify number of tests\n$ 7.55\n6167\n95012\n95012\nNitric oxide expired gas determination\n$ 56.16\n6168\n95017\n95017\nAllergy testing, any combination of percutaneous (scratch,\npuncture, prick) and intracutaneous (intradermal), sequential and\nincremental, with venoms, immediate type reaction, including test\ninterpretation and report, specify number of tests\n$ 17.14\n6169\n95018\n95018\nAllergy testing, any combination of percutaneous (scratch,\npuncture, prick) and intracutaneous (intradermal), sequential and\nincremental, with drugs or biologicals, immediate type reaction,\nincluding test interpretation and report, specify number of tests\n$ 42.06\n6170\n95024\n95024\nIntracutaneous (intradermal) tests with allergenic extracts,\nimmediate type reaction, including test interpretation and report,\nspecify number of tests\n$ 14.40\n6171\n95027\n95027\nIntracutaneous (intradermal) tests, sequential and incremental,\nwith allergenic extracts for airborne allergens, immediate type\nreaction, including test interpretation and report, specify number of\ntests\n$ 12.83\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6172\n95028\n95028\nIntracutaneous (intradermal) tests with allergenic extracts, delayed\ntype reaction, including reading, specify number of tests\n$ 20.70\n6173\n95044\n95044\nPatch or application test(s) (specify number of tests)\n$ 19.08\n6174\n95052\n95052\nPhoto patch test(s) (specify number of tests)\n$ 13.50\n6175\n95056\n95056\nPhoto tests\n$ 12.60\n6176\n95060\n95060\nOphthalmic mucous membrane tests\n$ 23.40\n6177\n95065\n95065\nDirect nasal mucous membrane test\n$ 20.70\n6178\n95070\n95070\nInhalation bronchial challenge testing (not including necessary\npulmonary function tests); with histamine, methacholine, or similar\ncompounds\n$ 175.50\n6179\n95071\n95071\nInhalation bronchial challenge testing (not including necessary\npulmonary function tests); with antigens or gases, specify\n$ 204.30\n6180\n95076\n95076\nIngestion challenge test (sequential and incremental ingestion of\ntest items, eg, food, drug or other substance); initial 120 minutes of\ntesting\n$ 219.54\n6181\n95079\n95079\nIngestion challenge test (sequential and incremental ingestion of\ntest items, eg, food, drug or other substance); each additional 60\nminutes of testing (List separately in addition to code for primary\nprocedure)\n$ 152.06\n6182\n95115\n95115\nProfessional services for allergen immunotherapy not including\nprovision of allergenic extracts; single injection\n$ 17.96\n6183\n95117\n95117\nProfessional services for allergen immunotherapy not including\nprovision of allergenic extracts; 2 or more injections\n$ 23.11\n6184\n95120\n95120\nProfessional services for allergen immunotherapy in the office or\ninstitution of the prescribing physician or other qualified health care\nprofessional, including provision of allergenic extract; single\ninjection\n$ 26.10\n6185\n95125\n95125\nProfessional services for allergen immunotherapy in the office or\ninstitution of the prescribing physician or other qualified health care\nprofessional, including provision of allergenic extract; 2 or more\ninjections\n$ 28.80\n6186\n95130\n95130\nProfessional services for allergen immunotherapy in the office or\ninstitution of the prescribing physician or other qualified health care\nprofessional, including provision of allergenic extract; single stinging\ninsect venom\n$ 34.20\n6187\n95131\n95131\nProfessional services for allergen immunotherapy in the office or\ninstitution of the prescribing physician or other qualified health care\nprofessional, including provision of allergenic extract; 2 stinging\ninsect venoms\n$ 47.70\n6188\n95132\n95132\nProfessional services for allergen immunotherapy in the office or\ninstitution of the prescribing physician or other qualified health care\nprofessional, including provision of allergenic extract; 3 stinging\ninsect venoms\n$ 62.10\n6189\n95133\n95133\nProfessional services for allergen immunotherapy in the office or\ninstitution of the prescribing physician or other qualified health care\nprofessional, including provision of allergenic extract; 4 stinging\ninsect venoms\n$ 63.90\n6190\n95134\n95134\nProfessional services for allergen immunotherapy in the office or\ninstitution of the prescribing physician or other qualified health care\nprofessional, including provision of allergenic extract; 5 stinging\ninsect venoms\n$ 65.70\n6191\n95144\n95144\nProfessional services for the supervision of preparation and\nprovision of antigens for allergen immunotherapy, single dose\nvial(s) (specify number of vials)\n$ 33.49\n6192\n95145\n95145\nProfessional services for the supervision of preparation and\nprovision of antigens for allergen immunotherapy (specify number\nof doses); single stinging insect venom\n$ 36.00\n6193\n95146\n95146\nProfessional services for the supervision of preparation and\nprovision of antigens for allergen immunotherapy (specify number\nof doses); 2 single stinging insect venoms\n$ 46.80\n6194\n95147\n95147\nProfessional services for the supervision of preparation and\nprovision of antigens for allergen immunotherapy (specify number\nof doses); 3 single stinging insect venoms\n$ 64.80\n6195\n95148\n95148\nProfessional services for the supervision of preparation and\nprovision of antigens for allergen immunotherapy (specify number\nof doses); 4 single stinging insect venoms\n$ 65.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6196\n95149\n95149\nProfessional services for the supervision of preparation and\nprovision of antigens for allergen immunotherapy (specify number\nof doses); 5 single stinging insect venoms\n$ 81.00\n6197\n95165\n95165\nProfessional services for the supervision of preparation and\nprovision of antigens for allergen immunotherapy; single or multiple\nantigens (specify number of doses)\n$ 15.30\n6198\n95170\n95170\nProfessional services for the supervision of preparation and provision\nof antigens for allergen immunotherapy; whole body extract of\nbiting insect or other arthropod (specify number of doses)\n$ 33.30\n6199\n95180\n95180\nRapid desensitization procedure, each hour (eg, insulin, penicillin,\nequine serum)\n$ 207.00\n6200\n95199\n95199\nUnlisted allergy\/clinical immunologic service or procedure\nCost\n6201\n95250\n95250\nAmbulatory continuous glucose monitoring of interstitial tissue fluid\nvia a subcutaneous sensor for a minimum of 72 hours; sensor\nplacement, hook-up, calibration of monitor, patient training,\nremoval of sensor, and printout of recording\n$ 265.16\n6202\n95251\n95251\nAmbulatory continuous glucose monitoring of interstitial tissue fluid\nvia a subcutaneous sensor for a minimum of 72 hours;\ninterpretation and report\n$ 62.92\n6203\n95803\n95803\nActigraphy testing, recording, analysis, interpretation, and report\n(minimum of 72 hours to 14 consecutive days of recording)\n$ 80.02\n6204\n95805\n95805\nMultiple sleep latency or maintenance of wakefulness testing,\nrecording, analysis and interpretation of physiological\nmeasurements of sleep during multiple trials to assess sleepiness\n$ 566.10\n6205\n95805-26 26\n95805\nMultiple sleep latency or maintenance of wakefulness testing,\nrecording, analysis and interpretation of physiological\nmeasurements of sleep during multiple trials to assess sleepiness\n$ 70.32\n6206\n95805-TC TC\n95805\nMultiple sleep latency or maintenance of wakefulness testing,\nrecording, analysis and interpretation of physiological\nmeasurements of sleep during multiple trials to assess sleepiness\n$ 495.78\n6207\n95806\n95806\nSleep study, unattended, simultaneous recording of, heart rate,\noxygen saturation, respiratory airflow, and respiratory effort (eg,\nthoracoabdominal movement)\n$ 66.94\n6208\n95807\n95807\nSleep study, simultaneous recording of ventilation, respiratory\neffort, ECG or heart rate, and oxygen saturation, attended by a\ntechnologist\n$ 713.70\n6209\n95807-26 26\n95807\nSleep study, simultaneous recording of ventilation, respiratory\neffort, ECG or heart rate, and oxygen saturation, attended by a\ntechnologist\n$ 80.56\n6210\n95807-TC TC\n95807\nSleep study, simultaneous recording of ventilation, respiratory\neffort, ECG or heart rate, and oxygen saturation, attended by a\ntechnologist\n$ 633.14\n6211\n95808\n95808\nPolysomnography; any age, sleep staging with 1-3 additional\nparameters of sleep, attended by a technologist\n$ 756.90\n6212\n95808-26 26\n95808\nPolysomnography; any age, sleep staging with 1-3 additional\nparameters of sleep, attended by a technologist\n$ 91.44\n6213\n95808-TC TC\n95808\nPolysomnography; any age, sleep staging with 1-3 additional\nparameters of sleep, attended by a technologist\n$ 665.46\n6214\n95810\n95810\nPolysomnography; age 6 years or older, sleep staging with 4 or\nmore additional parameters of sleep, attended by a technologist\n$ 747.00\n6215\n95810-26 26\n95810\nPolysomnography; age 6 years or older, sleep staging with 4 or\nmore additional parameters of sleep, attended by a technologist\n$ 129.14\n6216\n95810-TC TC\n95810\nPolysomnography; age 6 years or older, sleep staging with 4 or\nmore additional parameters of sleep, attended by a technologist\n$ 617.86\n6217\n95811\n95811\nPolysomnography; age 6 years or older, sleep staging with 4 or\nmore additional parameters of sleep, with initiation of continuous\npositive airway pressure therapy or bilevel ventilation, attended by\na technologist\n$ 455.02\n6218\n95812\n95812\nElectroencephalogram (EEG) extended monitoring; 41-60 minutes\n$ 174.48\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6219\n95813\n95813\nElectroencephalogram (EEG) extended monitoring; greater than 1\nhour\n$ 221.97\n6220\n95816\n95816\nElectroencephalogram (EEG); including recording awake and drowsy $ 266.90\n6221\n95816-26 26\n95816\nElectroencephalogram (EEG); including recording awake and drowsy $ 33.98\n6222\n95816-TC TC\n95816\nElectroencephalogram (EEG); including recording awake and drowsy $ 232.92\n6223\n95819\n95819\nElectroencephalogram (EEG); including recording awake and asleep\n$ 215.10\n6224\n95819-26 26\n95819\nElectroencephalogram (EEG); including recording awake and asleep\n$ 23.60\n6225\n95819-TC TC\n95819\nElectroencephalogram (EEG); including recording awake and asleep\n$ 191.50\n6226\n95822\n95822\nElectroencephalogram (EEG); recording in coma or sleep only\n$ 270.90\n6227\n95822-26 26\n95822\nElectroencephalogram (EEG); recording in coma or sleep only\n$ 33.28\n6228\n95822-TC TC\n95822\nElectroencephalogram (EEG); recording in coma or sleep only\n$ 237.62\n6229\n95824\n95824\nElectroencephalogram (EEG); cerebral death evaluation only\n$ 177.30\n6230\n95827\n95827\nElectroencephalogram (EEG); all night recording\n$ 343.80\n6231\n95827-26 26\n95827\nElectroencephalogram (EEG); all night recording\n$ 22.14\n6232\n95827-TC TC\n95827\nElectroencephalogram (EEG); all night recording\n$ 321.66\n6233\n95829\n95829\nElectrocorticogram at surgery (separate procedure)\n$ 533.70\n6234\n95829-26 26\n95829\nElectrocorticogram at surgery (separate procedure)\n$ 80.52\n6235\n95829-TC TC\n95829\nElectrocorticogram at surgery (separate procedure)\n$ 453.18\n6236\n95830\n95830\nInsertion by physician or other qualified health care professional of\nsphenoidal electrodes for electroencephalographic (EEG) recording\n$ 241.20\n6237\n95831\n95831\nMuscle testing, manual (separate procedure) with report; extremity\n(excluding hand) or trunk\n$ 105.30\n6238\n95832\n95832\nMuscle testing, manual (separate procedure) with report; hand,\nwith or without comparison with normal side\n$ 72.90\n6239\n95833\n95833\nMuscle testing, manual (separate procedure) with report; total\nevaluation of body, excluding hands\n$ 113.40\n6240\n95834\n95834\nMuscle testing, manual (separate procedure) with report; total\nevaluation of body, including hands\n$ 139.50\n6241\n95851\n95851\nRange of motion measurements and report (separate procedure);\neach extremity (excluding hand) or each trunk section (spine)\n$ 87.30\n6242\n95852\n95852\nRange of motion measurements and report (separate procedure);\nhand, with or without comparison with normal side\n$ 72.00\n6243\n95857\n95857\nCholinesterase inhibitor challenge test for myasthenia gravis\n$ 122.40\n6244\n95860\n95860\nNeedle electromyography; 1 extremity with or without related\nparaspinal areas\n$ 216.72\n6245\n95860-26 26\n95860\nNeedle electromyography; 1 extremity with or without related\nparaspinal areas\n$ 82.27\n6246\n95860-TC TC\n95860\nNeedle electromyography; 1 extremity with or without related\nparaspinal areas\n$ 134.45\n6247\n95861\n95861\nNeedle electromyography; 2 extremities with or without related\nparaspinal areas\n$ 282.23\n6248\n95861-26 26\n95861\nNeedle electromyography; 2 extremities with or without related\nparaspinal areas\n$ 125.43\n6249\n95861-TC TC\n95861\nNeedle electromyography; 2 extremities with or without related\nparaspinal areas\n$ 156.80\n6250\n95863\n95863\nNeedle electromyography; 3 extremities with or without related\nparaspinal areas\n$ 473.40\n6251\n95863-26 26\n95863\nNeedle electromyography; 3 extremities with or without related\nparaspinal areas\n$ 207.62\n6252\n95863-TC TC\n95863\nNeedle electromyography; 3 extremities with or without related\nparaspinal areas\n$ 265.78\n6253\n95864\n95864\nNeedle electromyography; 4 extremities with or without related\nparaspinal areas\n$ 618.30\n6254\n95864-26 26\n95864\nNeedle electromyography; 4 extremities with or without related\nparaspinal areas\n$ 251.46\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6255\n95864-TC TC\n95864\nNeedle electromyography; 4 extremities with or without related\nparaspinal areas\n$ 366.84\n6256\n95865\n95865\nNeedle electromyography; larynx\n$ 201.02\n6257\n95866\n95866\nNeedle electromyography; hemidiaphragm\n$ 154.18\n6258\n95867\n95867\nNeedle electromyography; cranial nerve supplied muscle(s),\nunilateral\n$ 211.50\n6259\n95867-26 26\n95867\nNeedle electromyography; cranial nerve supplied muscle(s),\nunilateral\n$ 71.74\n6260\n95867-TC TC\n95867\nNeedle electromyography; cranial nerve supplied muscle(s),\nunilateral\n$ 139.76\n6261\n95868\n95868\nNeedle electromyography; cranial nerve supplied muscles, bilateral\n$ 257.40\n6262\n95868-26 26\n95868\nNeedle electromyography; cranial nerve supplied muscles, bilateral\n$ 104.05\n6263\n95868-TC TC\n95868\nNeedle electromyography; cranial nerve supplied muscles, bilateral\n$ 153.35\n6264\n95869\n95869\nNeedle electromyography; thoracic paraspinal muscles (excluding\nT1 or T12)\n$ 162.34\n6265\n95869-26 26\n95869\nNeedle electromyography; thoracic paraspinal muscles (excluding\nT1 or T12)\n$ 33.27\n6266\n95869-TC TC\n95869\nNeedle electromyography; thoracic paraspinal muscles (excluding\nT1 or T12)\n$ 129.07\n6267\n95870\n95870\nNeedle electromyography; limited study of muscles in 1 extremity\nor non-limb (axial) muscles (unilateral or bilateral), other than\nthoracic paraspinal, cranial nerve supplied muscles, or sphincters\n$ 99.09\n6268\n95870-26 26\n95870\nNeedle electromyography; limited study of muscles in 1 extremity\nor non-limb (axial) muscles (unilateral or bilateral), other than\nthoracic paraspinal, cranial nerve supplied muscles, or sphincters\n$ 64.59\n6269\n95870-TC TC\n95870\nNeedle electromyography; limited study of muscles in 1 extremity\nor non-limb (axial) muscles (unilateral or bilateral), other than\nthoracic paraspinal, cranial nerve supplied muscles, or sphincters\n$ 34.50\n6270\n95872\n95872\nNeedle electromyography using single fiber electrode, with\nquantitative measurement of jitter, blocking and\/or fiber density,\nany\/all sites of each muscle studied\n$ 257.40\n6271\n95872-26 26\n95872\nNeedle electromyography using single fiber electrode, with\nquantitative measurement of jitter, blocking and\/or fiber density,\nany\/all sites of each muscle studied\n$ 186.60\n6272\n95872-TC TC\n95872\nNeedle electromyography using single fiber electrode, with\nquantitative measurement of jitter, blocking and\/or fiber density,\nany\/all sites of each muscle studied\n$ 70.80\n6273\n95873\n95873\nElectrical stimulation for guidance in conjunction with\nchemodenervation (List separately in addition to code for primary\nprocedure)\n$ 55.40\n6274\n95874\n95874\nNeedle electromyography for guidance in conjunction with\nchemodenervation (List separately in addition to code for primary\nprocedure)\n$ 56.80\n6275\n95875\n95875\nIschemic limb exercise test with serial specimen(s) acquisition for\nmuscle(s) metabolite(s)\n$ 144.00\n6276\n95875-26 26\n95875\nIschemic limb exercise test with serial specimen(s) acquisition for\nmuscle(s) metabolite(s)\n$ 61.86\n6277\n95875-TC TC\n95875\nIschemic limb exercise test with serial specimen(s) acquisition for\nmuscle(s) metabolite(s)\n$ 82.14\n6278\n95905\n95905\nMotor and\/or sensory nerve conduction, using preconfigured\nelectrode array(s), amplitude and latency\/velocity study, each limb,\nincludes F-wave study when performed, with interpretation and\nreport\n$ 7.78\n6279\n95921\n95921\nTesting of autonomic nervous system function; cardiovagal\ninnervation (parasympathetic function), including 2 or more of the\nfollowing: heart rate response to deep breathing with recorded R-R\ninterval, Valsalva ratio, and 30:15 ratio\n$ 104.40\n6280\n95921-26 26\n95921\nTesting of autonomic nervous system function; cardiovagal\ninnervation (parasympathetic function), including 2 or more of the\nfollowing: heart rate response to deep breathing with recorded R-R\ninterval, Valsalva ratio, and 30:15 ratio\n$ 49.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6281\n95921-TC TC\n95921\nTesting of autonomic nervous system function; cardiovagal\ninnervation (parasympathetic function), including 2 or more of the\nfollowing: heart rate response to deep breathing with recorded R-R\ninterval, Valsalva ratio, and 30:15 ratio\n$ 54.70\n6282\n95922\n95922\nTesting of autonomic nervous system function; vasomotor\nadrenergic innervation (sympathetic adrenergic function), including\nbeat-to-beat blood pressure and R-R interval changes during\nValsalva maneuver and at least 5 minutes of passive tilt\n$ 108.90\n6283\n95922-26 26\n95922\nTesting of autonomic nervous system function; vasomotor\nadrenergic innervation (sympathetic adrenergic function), including\nbeat-to-beat blood pressure and R-R interval changes during\nValsalva maneuver and at least 5 minutes of passive tilt\n$ 46.18\n6284\n95922-TC TC\n95922\nTesting of autonomic nervous system function; vasomotor\nadrenergic innervation (sympathetic adrenergic function), including\nbeat-to-beat blood pressure and R-R interval changes during\nValsalva maneuver and at least 5 minutes of passive tilt\n$ 62.72\n6285\n95923\n95923\nTesting of autonomic nervous system function; sudomotor,\nincluding 1 or more of the following: quantitative sudomotor axon\nreflex test (QSART), silastic sweat imprint, thermoregulatory sweat\ntest, and changes in sympathetic skin potential\n$ 100.80\n6286\n95923-26 26\n95923\nTesting of autonomic nervous system function; sudomotor,\nincluding 1 or more of the following: quantitative sudomotor axon\nreflex test (QSART), silastic sweat imprint, thermoregulatory sweat\ntest, and changes in sympathetic skin potential\n$ 16.78\n6287\n95923-TC TC\n95923\nTesting of autonomic nervous system function; sudomotor,\nincluding 1 or more of the following: quantitative sudomotor axon\nreflex test (QSART), silastic sweat imprint, thermoregulatory sweat\ntest, and changes in sympathetic skin potential\n$ 84.02\n6288\n95925\n95925\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in upper limbs\n$ 369.00\n6289\n95925-26 26\n95925\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in upper limbs\n$ 47.98\n6290\n95925-TC TC\n95925\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in upper limbs\n$ 321.02\n6291\n95926\n95926\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in lower limbs\n$ 298.80\n6292\n95926-26 26\n95926\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in lower limbs\n$ 41.65\n6293\n95926-TC TC\n95926\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in lower limbs\n$ 257.15\n6294\n95927\n95927\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in the trunk or head\n$ 298.80\n6295\n95927-26 26\n95927\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in the trunk or head\n$ 43.75\n6296\n95927-TC TC\n95927\nShort-latency somatosensory evoked potential study, stimulation of\nany\/all peripheral nerves or skin sites, recording from the central\nnervous system; in the trunk or head\n$ 255.05\n6297\n95929\n95929\nCentral motor evoked potential study (transcranial motor\nstimulation); lower limbs\n$ 280.97\n6298\n95930\n95930\nVisual evoked potential (VEP) testing central nervous system,\ncheckerboard or flash\n$ 339.30\n6299\n95930-26 26\n95930\nVisual evoked potential (VEP) testing central nervous system,\ncheckerboard or flash\n$ 34.63\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6300\n95930-TC TC\n95930\nVisual evoked potential (VEP) testing central nervous system,\ncheckerboard or flash\n$ 304.67\n6301\n95933\n95933\nOrbicularis oculi (blink) reflex, by electrodiagnostic testing\n$ 175.50\n6302\n95933-26 26\n95933\nOrbicularis oculi (blink) reflex, by electrodiagnostic testing\n$ 56.06\n6303\n95933-TC TC\n95933\nOrbicularis oculi (blink) reflex, by electrodiagnostic testing\n$ 119.44\n6304\n95937\n95937\nNeuromuscular junction testing (repetitive stimulation, paired\nstimuli), each nerve, any 1 method\n$ 180.00\n6305\n95937-26 26\n95937\nNeuromuscular junction testing (repetitive stimulation, paired\nstimuli), each nerve, any 1 method\n$ 73.30\n6306\n95937-TC TC\n95937\nNeuromuscular junction testing (repetitive stimulation, paired\nstimuli), each nerve, any 1 method\n$ 106.70\n6307\n95940\n95940\nContinuous intraoperative neurophysiology monitoring in the\noperating room, one on one monitoring requiring personal\nattendance, each 15 minutes (List separately in addition to code for\nprimary procedure)\n$ 58.81\n6308\n95941\n95941\nContinuous intraoperative neurophysiology monitoring, from\noutside the operating room (remote or nearby) or for monitoring of\nmore than one case while in the operating room, per hour (List\nseparately in addition to code for primary procedure)\n$ 414.90\n6309\n95950\n95950\nMonitoring for identification and lateralization of cerebral seizure\nfocus, electroencephalographic (eg, 8 channel EEG) recording and\ninterpretation, each 24 hours\n$ 655.20\n6310\n95950-26 26\n95950\nMonitoring for identification and lateralization of cerebral seizure\nfocus, electroencephalographic (eg, 8 channel EEG) recording and\ninterpretation, each 24 hours\n$ 138.80\n6311\n95950-TC TC\n95950\nMonitoring for identification and lateralization of cerebral seizure\nfocus, electroencephalographic (eg, 8 channel EEG) recording and\ninterpretation, each 24 hours\n$ 516.40\n6312\n95951\n95951\nMonitoring for localization of cerebral seizure focus by cable or\nradio, 16 or more channel telemetry, combined\nelectroencephalographic (EEG) and video recording and\ninterpretation (eg, for presurgical localization), each 24 hours\n$ 906.30\n6313\n95951-26 26\n95951\nMonitoring for localization of cerebral seizure focus by cable or\nradio, 16 or more channel telemetry, combined\nelectroencephalographic (EEG) and video recording and\ninterpretation (eg, for presurgical localization), each 24 hours\n$ 514.81\n6314\n95953\n95953\nMonitoring for localization of cerebral seizure focus by\ncomputerized portable 16 or more channel EEG,\nelectroencephalographic (EEG) recording and interpretation, each\n24 hours, unattended\n$ 763.20\n6315\n95953-26 26\n95953\nMonitoring for localization of cerebral seizure focus by\ncomputerized portable 16 or more channel EEG,\nelectroencephalographic (EEG) recording and interpretation, each\n24 hours, unattended\n$ 262.86\n6316\n95953-TC TC\n95953\nMonitoring for localization of cerebral seizure focus by\ncomputerized portable 16 or more channel EEG,\nelectroencephalographic (EEG) recording and interpretation, each\n24 hours, unattended\n$ 500.34\n6317\n95954\n95954\nPharmacological or physical activation requiring physician or other\nqualified health care professional attendance during EEG recording\nof activation phase (eg, thiopental activation test)\n$ 355.50\n6318\n95954-26 26\n95954\nPharmacological or physical activation requiring physician or other\nqualified health care professional attendance during EEG recording\nof activation phase (eg, thiopental activation test)\n$ 84.88\n6319\n95954-TC TC\n95954\nPharmacological or physical activation requiring physician or other\nqualified health care professional attendance during EEG recording\nof activation phase (eg, thiopental activation test)\n$ 270.62\n6320\n95955\n95955\nElectroencephalogram (EEG) during nonintracranial surgery (eg,\ncarotid surgery)\n$ 340.20\n6321\n95955-26 26\n95955\nElectroencephalogram (EEG) during nonintracranial surgery (eg,\ncarotid surgery)\n$ 70.64\n6322\n95955-TC TC\n95955\nElectroencephalogram (EEG) during nonintracranial surgery (eg,\ncarotid surgery)\n$ 269.56\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6323\n95956\n95956\nMonitoring for localization of cerebral seizure focus by cable or\nradio, 16 or more channel telemetry, electroencephalographic (EEG)\nrecording and interpretation, each 24 hours, attended by a\ntechnologist or nurse\n$ 779.40\n6324\n95956-26 26\n95956\nMonitoring for localization of cerebral seizure focus by cable or\nradio, 16 or more channel telemetry, electroencephalographic (EEG)\nrecording and interpretation, each 24 hours, attended by a\ntechnologist or nurse\n$ 78.24\n6325\n95956-TC TC\n95956\nMonitoring for localization of cerebral seizure focus by cable or\nradio, 16 or more channel telemetry, electroencephalographic (EEG)\nrecording and interpretation, each 24 hours, attended by a\ntechnologist or nurse\n$ 701.16\n6326\n95957\n95957\nDigital analysis of electroencephalogram (EEG) (eg, for epileptic\nspike analysis)\n$ 166.54\n6327\n95958\n95958\nWada activation test for hemispheric function, including\nelectroencephalographic (EEG) monitoring\n$ 654.30\n6328\n95958-26 26\n95958\nWada activation test for hemispheric function, including\nelectroencephalographic (EEG) monitoring\n$ 232.62\n6329\n95958-TC TC\n95958\nWada activation test for hemispheric function, including\nelectroencephalographic (EEG) monitoring\n$ 421.68\n6330\n95961\n95961\nFunctional cortical and subcortical mapping by stimulation and\/or\nrecording of electrodes on brain surface, or of depth electrodes, to\nprovoke seizures or identify vital brain structures; initial hour of\nattendance by a physician or other qualified health\n$ 429.30\n6331\n95961-26 26\n95961\nFunctional cortical and subcortical mapping by stimulation and\/or\nrecording of electrodes on brain surface, or of depth electrodes, to\nprovoke seizures or identify vital brain structures; initial hour of\nattendance by a physician or other qualified health\n$ 222.66\n6332\n95961-TC TC\n95961\nFunctional cortical and subcortical mapping by stimulation and\/or\nrecording of electrodes on brain surface, or of depth electrodes, to\nprovoke seizures or identify vital brain structures; initial hour of\nattendance by a physician or other qualified health\n$ 206.64\n6333\n95962\n95962\nFunctional cortical and subcortical mapping by stimulation and\/or\nrecording of electrodes on brain surface, or of depth electrodes, to\nprovoke seizures or identify vital brain structures; each additional\nhour of attendance by a physician or other qualifie\n$ 448.20\n6334\n95962-26 26\n95962\nFunctional cortical and subcortical mapping by stimulation and\/or\nrecording of electrodes on brain surface, or of depth electrodes, to\nprovoke seizures or identify vital brain structures; each additional\nhour of attendance by a physician or other qualifie\n$ 291.69\n6335\n95962-TC TC\n95962\nFunctional cortical and subcortical mapping by stimulation and\/or\nrecording of electrodes on brain surface, or of depth electrodes, to\nprovoke seizures or identify vital brain structures; each additional\nhour of attendance by a physician or other qualifie\n$ 156.51\n6336\n95965\n95965\nMagnetoencephalography (MEG), recording and analysis; for\nspontaneous brain magnetic activity (eg, epileptic cerebral cortex\nlocalization)\n$ -\n6337\n95966\n95966\nMagnetoencephalography (MEG), recording and analysis; for\nevoked magnetic fields, single modality (eg, sensory, motor,\nlanguage, or visual cortex localization)\n$ -\n6338\n95967\n95967\nMagnetoencephalography (MEG), recording and analysis; for\nevoked magnetic fields, each additional modality (eg, sensory,\nmotor, language, or visual cortex localization) (List separately in\naddition to code for primary procedure)\n$ -\n6339\n95970\n95970\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient compliance measureme $ 47.70\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6340\n95971\n95971\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient compliance measureme $ 78.30\n6341\n95972\n95972\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient compliance measureme $ 143.10\n6342\n95973\n95973\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient compliance measureme $ 90.90\n6343\n95974\n95974\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient compliance measureme $ 292.50\n6344\n95975\n95975\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude, pulse duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient compliance measureme $ 173.70\n6345\n95978\n95978\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude and duration, battery status,\nelectrode selectability and polarity, impedance and patient\ncompliance measurements), complex deep brain neurostimulator\npulse\n$ 527.16\n6346\n95979\n95979\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude and duration, battery status,\nelectrode selectability and polarity, impedance and patient\ncompliance measurements), complex deep brain neurostimulator\npulse\n$ 253.83\n6347\n95980\n95980\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude and duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient measurements) gastric\nn\n$ 114.21\n6348\n95981\n95981\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude and duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient measurements) gastric\nn\n$ 82.55\n6349\n95982\n95982\nElectronic analysis of implanted neurostimulator pulse generator\nsystem (eg, rate, pulse amplitude and duration, configuration of\nwave form, battery status, electrode selectability, output\nmodulation, cycling, impedance and patient measurements) gastric\nn\n$ 118.30\n6350\n95990\n95990\nRefilling and maintenance of implantable pump or reservoir for\ndrug delivery, spinal (intrathecal, epidural) or brain\n(intraventricular), includes electronic analysis of pump, when\nperformed;\n$ 122.42\n6351\n95992\n95992\nCanalith repositioning procedure(s) (eg, Epley maneuver, Semont\nmaneuver), per day\n$ 115.18\n6352\n95999\n95999\nUnlisted neurological or neuromuscular diagnostic procedure\nCost\n6353\n96000\n96000\nComprehensive computer-based motion analysis by video-taping\nand 3D kinematics;\n$ 180.36\n6354\n96001\n96001\nComprehensive computer-based motion analysis by video-taping\nand 3D kinematics; with dynamic plantar pressure measurements\nduring walking\n$ 174.93\n6355\n96002\n96002\nDynamic surface electromyography, during walking or other\nfunctional activities, 1-12 muscles\n$ 39.63\n6356\n96003\n96003\nDynamic fine wire electromyography, during walking or other\nfunctional activities, 1 muscle\n$ 30.57\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6357\n96004\n96004\nReview and interpretation by physician or other qualified health\ncare professional of comprehensive computer-based motion\nanalysis, dynamic plantar pressure measurements, dynamic surface\nelectromyography during walking or other functional activities, and\n$ 206.48\n6358\n96020\n96020\nNeurofunctional testing selection and administration during\nnoninvasive imaging functional brain mapping, with test\nadministered entirely by a physician or other qualified health care\nprofessional (ie, psychologist), with review of test results and report $ -\n6359\n96040\n96040\nMedical genetics and genetic counseling services, each 30 minutes\nface-to-face with patient\/family\n$ 98.24\n6360\n96101\n96101\nPsychological testing (includes psychodiagnostic assessment of\nemotionality, intellectual abilities, personality and psychopathology,\neg, MMPI, Rorschach, WAIS), per hour of the psychologist's or\nphysician's time, both face-to-face time administering test\n$ 191.25\n6361\n96102\n96102\nPsychological testing (includes psychodiagnostic assessment of\nemotionality, intellectual abilities, personality and psychopathology,\neg, MMPI and WAIS), with qualified health care professional\ninterpretation and report, administered by technician, per ho\n$ 93.33\n6362\n96103\n96103\nPsychological testing (includes psychodiagnostic assessment of\nemotionality, intellectual abilities, personality and psychopathology,\neg, MMPI), administered by a computer, with qualified health care\nprofessional interpretation and report\n$ 87.96\n6363\n96105\n96105\nAssessment of aphasia (includes assessment of expressive and\nreceptive speech and language function, language comprehension,\nspeech production ability, reading, spelling, writing, eg, by Boston\nDiagnostic Aphasia Examination) with interpretation and repor\n$ 170.98\n6364\n96110\n96110\nDevelopmental screening, with interpretation and report, per\nstandardized instrument form\n$ 41.77\n6365\n96111\n96111\nDevelopmental testing, (includes assessment of motor, language,\nsocial, adaptive, and\/or cognitive functioning by standardized\ndevelopmental instruments) with interpretation and report\n$ 175.28\n6366\n96116\n96116\nNeurobehavioral status exam (clinical assessment of thinking,\nreasoning and judgment, eg, acquired knowledge, attention,\nlanguage, memory, planning and problem solving, and visual spatial\nabilities), per hour of the psychologist's or physician's time, bot\n$ 226.49\n6367\n96118\n96118\nNeuropsychological testing (eg, Halstead-Reitan Neuropsychological\nBattery, Wechsler Memory Scales and Wisconsin Card Sorting Test),\nper hour of the psychologist's or physician's time, both face-to-face\ntime administering tests to the patient and time int\n$ 234.56\n6368\n96119\n96119\nNeuropsychological testing (eg, Halstead-Reitan Neuropsychological\nBattery, Wechsler Memory Scales and Wisconsin Card Sorting Test),\nwith qualified health care professional interpretation and report,\nadministered by technician, per hour of technician time\n$ 156.24\n6369\n96120\n96120\nNeuropsychological testing (eg, Wisconsin Card Sorting Test),\nadministered by a computer, with qualified health care professional\ninterpretation and report\n$ 115.84\n6370\n96125\n96125\nStandardized cognitive performance testing (eg, Ross Information\nProcessing Assessment) per hour of a qualified health care\nprofessional's time, both face-to-face time administering tests to\nthe patient and time interpreting these test results and prepari\n$ 208.77\n6371\n96150\n96150\nHealth and behavior assessment (eg, health-focused clinical\ninterview, behavioral observations, psychophysiological monitoring,\nhealth-oriented questionnaires), each 15 minutes face-to-face with\nthe patient; initial assessment\n$ 51.14\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6372\n96151\n96151\nHealth and behavior assessment (eg, health-focused clinical\ninterview, behavioral observations, psychophysiological monitoring,\nhealth-oriented questionnaires), each 15 minutes face-to-face with\nthe patient; re-assessment\n$ 27.87\n6373\n96152\n96152\nHealth and behavior intervention, each 15 minutes, face-to-face;\nindividual\n$ 27.63\n6374\n96153\n96153\nHealth and behavior intervention, each 15 minutes, face-to-face;\ngroup (2 or more patients)\n$ 34.17\n6375\n96154\n96154\nHealth and behavior intervention, each 15 minutes, face-to-face;\nfamily (with the patient present)\n$ 37.46\n6376\n96155\n96155\nHealth and behavior intervention, each 15 minutes, face-to-face;\nfamily (without the patient present)\n$ 38.51\n6377\n96360\n96360\nIntravenous infusion, hydration; initial, 31 minutes to 1 hour\n$ 115.16\n6378\n96361\n96361\nIntravenous infusion, hydration; each additional hour (List\nseparately in addition to code for primary procedure)\n$ 46.20\n6379\n96365\n96365\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\nsubstance or drug); initial, up to 1 hour\n$ 132.82\n6380\n96366\n96366\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\nsubstance or drug); each additional hour (List separately in addition\nto code for primary procedure)\n$ 58.35\n6381\n96367\n96367\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\nsubstance or drug); additional sequential infusion of a new\ndrug\/substance, up to 1 hour (List separately in addition to code for\nprimary procedure)\n$ 84.16\n6382\n96368\n96368\nIntravenous infusion, for therapy, prophylaxis, or diagnosis (specify\nsubstance or drug); concurrent infusion (List separately in addition\nto code for primary procedure)\n$ 48.93\n6383\n96369\n96369\nSubcutaneous infusion for therapy or prophylaxis (specify substance\nor drug); initial, up to 1 hour, including pump set-up and\nestablishment of subcutaneous infusion site(s)\n$ 299.67\n6384\n96370\n96370\nSubcutaneous infusion for therapy or prophylaxis (specify substance\nor drug); each additional hour (List separately in addition to code\nfor primary procedure)\n$ 33.76\n6385\n96371\n96371\nSubcutaneous infusion for therapy or prophylaxis (specify substance\nor drug); additional pump set-up with establishment of new\nsubcutaneous infusion site(s) (List separately in addition to code for\nprimary procedure)\n$ 126.53\n6386\n96372\n90772\nTherapeutic, prophylactic, or diagnostic injection (specify substance\nor drug); subcutaneous or intramuscular\n$ 34.73\n6387\n96373\n96373\nTherapeutic, prophylactic, or diagnostic injection (specify substance\nor drug); intra-arterial\n$ 31.87\n6388\n96374\n90774\nTherapeutic, prophylactic, or diagnostic injection (specify substance\nor drug); intravenous push, single or initial substance\/drug\n$ 97.45\n6389\n96375\n96375\nTherapeutic, prophylactic, or diagnostic injection (specify substance\nor drug); each additional sequential intravenous push of a new\nsubstance\/drug (List separately in addition to code for primary\nprocedure)\n$ 56.42\n6390\n96376\n96376\nTherapeutic, prophylactic, or diagnostic injection (specify substance\nor drug); each additional sequential intravenous push of the same\nsubstance\/drug provided in a facility (List separately in addition to\ncode for primary procedure)\n$ -\n6391\n96379\n96379\nUnlisted therapeutic, prophylactic, or diagnostic intravenous or\nintra-arterial injection or infusion\nCost\n6392\n96401\n96401\nChemotherapy administration, subcutaneous or intramuscular; non-\nhormonal anti-neoplastic\n$ 153.81\n6393\n96402\n96402\nChemotherapy administration, subcutaneous or intramuscular;\nhormonal anti-neoplastic\n$ 82.57\n6394\n96405\n96405\nChemotherapy administration; intralesional, up to and including 7\nlesions\n$ 93.60\n6395\n96406\n96406\nChemotherapy administration; intralesional, more than 7 lesions\n$ 126.00\n6396\n96409\n96409\nChemotherapy administration; intravenous, push technique, single\nor initial substance\/drug\n$ 278.82\n6397\n96411\n96411\nChemotherapy administration; intravenous, push technique, each\nadditional substance\/drug (List separately in addition to code for\nprimary procedure)\n$ 159.52\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6398\n96413\n96413\nChemotherapy administration, intravenous infusion technique; up\nto 1 hour, single or initial substance\/drug\n$ 398.03\n6399\n96415\n96415\nChemotherapy administration, intravenous infusion technique; each\nadditional hour (List separately in addition to code for primary\nprocedure)\n$ 89.79\n6400\n96416\n96416\nChemotherapy administration, intravenous infusion technique;\ninitiation of prolonged chemotherapy infusion (more than 8 hours),\nrequiring use of a portable or implantable pump\n$ 426.61\n6401\n96417\n96417\nChemotherapy administration, intravenous infusion technique; each\nadditional sequential infusion (different substance\/drug), up to 1\nhour (List separately in addition to code for primary procedure)\n$ 190.54\n6402\n96420\n96420\nChemotherapy administration, intra-arterial; push technique\n$ 146.70\n6403\n96422\n96422\nChemotherapy administration, intra-arterial; infusion technique, up\nto 1 hour\n$ 159.30\n6404\n96423\n96423\nChemotherapy administration, intra-arterial; infusion technique,\neach additional hour (List separately in addition to code for primary\nprocedure)\n$ 63.90\n6405\n96425\n96425\nChemotherapy administration, intra-arterial; infusion technique,\ninitiation of prolonged infusion (more than 8 hours), requiring the\nuse of a portable or implantable pump\n$ 108.00\n6406\n96440\n96440\nChemotherapy administration into pleural cavity, requiring and\nincluding thoracentesis\n$ 268.20\n6407\n96450\n96450\nChemotherapy administration, into CNS (eg, intrathecal), requiring\nand including spinal puncture\n$ 228.60\n6408\n96521\n96521\nRefilling and maintenance of portable pump\n$ 338.81\n6409\n96522\n96522\nRefilling and maintenance of implantable pump or reservoir for\ndrug delivery, systemic (eg, intravenous, intra-arterial)\n$ 255.97\n6410\n96523\n96523\nIrrigation of implanted venous access device for drug delivery\nsystems\n$ 79.65\n6411\n96542\n96542\nChemotherapy injection, subarachnoid or intraventricular via\nsubcutaneous reservoir, single or multiple agents\n$ 195.30\n6412\n96549\n96549\nUnlisted chemotherapy procedure\nCost\n6413\n96567\n96567\nPhotodynamic therapy by external application of light to destroy\npremalignant and\/or malignant lesions of the skin and adjacent\nmucosa (eg, lip) by activation of photosensitive drug(s), each\nphototherapy exposure session\n$ 663.01\n6414\n96570\n96570\nPhotodynamic therapy by endoscopic application of light to ablate\nabnormal tissue via activation of photosensitive drug(s); first 30\nminutes (List separately in addition to code for endoscopy or\nbronchoscopy procedures of lung and gastrointestinal tract)\n$ 329.38\n6415\n96571\n96571\nPhotodynamic therapy by endoscopic application of light to ablate\nabnormal tissue via activation of photosensitive drug(s); each\nadditional 15 minutes (List separately in addition to code for\nendoscopy or bronchoscopy procedures of lung and gastrointestin\n$ 163.85\n6416\n96900\n96900\nActinotherapy (ultraviolet light)\n$ 34.20\n6417\n96902\n96902\nMicroscopic examination of hairs plucked or clipped by the\nexaminer (excluding hair collected by the patient) to determine\ntelogen and anagen counts, or structural hair shaft abnormality\n$ 55.80\n6418\n96904\n96904\nWhole body integumentary photography, for monitoring of high\nrisk patients with dysplastic nevus syndrome or a history of\ndysplastic nevi, or patients with a personal or familial history of\nmelanoma\n$ 200.24\n6419\n96910\n96910\nPhotochemotherapy; tar and ultraviolet B (Goeckerman treatment)\nor petrolatum and ultraviolet B\n$ 45.00\n6420\n96912\n96912\nPhotochemotherapy; psoralens and ultraviolet A (PUVA)\n$ 51.30\n6421\n96913\n96913\nPhotochemotherapy (Goeckerman and\/or PUVA) for severe\nphotoresponsive dermatoses requiring at least 4-8 hours of care\nunder direct supervision of the physician (includes application of\nmedication and dressings)\n$ 195.30\n6422\n96920\n96920\nLaser treatment for inflammatory skin disease (psoriasis); total area\nless than 250 sq cm\n$ 398.75\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6423\n96921\n96921\nLaser treatment for inflammatory skin disease (psoriasis); 250 sq cm\nto 500 sq cm\n$ 408.97\n6424\n96922\n96922\nLaser treatment for inflammatory skin disease (psoriasis); over 500\nsq cm\n$ 620.53\n6425\n96999\n96999\nUnlisted special dermatological service or procedure\nCost\n6426\n97001\n97001\nPhysical therapy evaluation\n$ 88.97\n6427\n97002\n97002\nPhysical therapy re-evaluation\n$ 43.47\n6428\n97003\n97003\nOccupational therapy evaluation\n$ 73.80\n6429\n97004\n97004\nOccupational therapy re-evaluation\n$ 36.00\n6430\n97005\n97005\nAthletic training evaluation\n$ 63.80\n6431\n97006\n97006\nAthletic training re-evaluation\n$ 36.00\n6432\n97010\n97010\nApplication of a modality to 1 or more areas; hot or cold packs\n$ 32.94\n6433\n97012\n97012\nApplication of a modality to 1 or more areas; traction, mechanical\n$ 39.16\n6434\n97014\n97014\nApplication of a modality to 1 or more areas; electrical stimulation\n(unattended)\n$ 35.31\n6435\n97016\n97016\nApplication of a modality to 1 or more areas; vasopneumatic\ndevices\n$ 58.50\n6436\n97018\n97018\nApplication of a modality to 1 or more areas; paraffin bath\n$ 43.20\n6437\n97022\n97022\nApplication of a modality to 1 or more areas; whirlpool\n$ 41.40\n6438\n97024\n97024\nApplication of a modality to 1 or more areas; diathermy (eg,\nmicrowave)\n$ 37.81\n6439\n97032\n97032\nApplication of a modality to 1 or more areas; electrical stimulation\n(manual), each 15 minutes\n$ 44.42\n6440\n97033\n97033\nApplication of a modality to 1 or more areas; iontophoresis, each 15\nminutes\n$ 54.90\n6441\n97035\n97035\nApplication of a modality to 1 or more areas; ultrasound, each 15\nminutes\n$ 37.77\n6442\n97039\n97039\nUnlisted modality (specify type and time if constant attendance)\n$ 10.00\n6443\n97110\n97110\nTherapeutic procedure, 1 or more areas, each 15 minutes;\ntherapeutic exercises to develop strength and endurance, range of\nmotion and flexibility\n$ 46.60\n6444\n97112\n97112\nTherapeutic procedure, 1 or more areas, each 15 minutes;\nneuromuscular reeducation of movement, balance, coordination,\nkinesthetic sense, posture, and\/or proprioception for sitting and\/or\nstanding activities\n$ 43.21\n6445\n97113\n97113\nTherapeutic procedure, 1 or more areas, each 15 minutes; aquatic\ntherapy with therapeutic exercises\n$ 52.59\n6446\n97116\n97116\nTherapeutic procedure, 1 or more areas, each 15 minutes; gait\ntraining (includes stair climbing)\n$ 43.91\n6447\n97124\n97124\nTherapeutic procedure, 1 or more areas, each 15 minutes; massage,\nincluding effleurage, petrissage and\/or tapotement (stroking,\ncompression, percussion)\n$ 41.79\n6448\n97140\n97140\nManual therapy techniques (eg, mobilization\/ manipulation, manual\nlymphatic drainage, manual traction), 1 or more regions, each 15\nminutes\n$ 48.65\n6449\n97150\n97150\nTherapeutic procedure(s), group (2 or more individuals)\n$ 27.21\n6450\n97530\n97530\nTherapeutic activities, direct (one-on-one) patient contact (use of\ndynamic activities to improve functional performance), each 15\nminutes\n$ 56.70\n6451\n97532\n97532\nDevelopment of cognitive skills to improve attention, memory,\nproblem solving (includes compensatory training), direct (one-on-\none) patient contact, each 15 minutes\n$ 36.03\n6452\n97535\n97535\nSelf-care\/home management training (eg, activities of daily living\n(ADL) and compensatory training, meal preparation, safety\nprocedures, and instructions in use of assistive technology\ndevices\/adaptive equipment) direct one-on-one contact, each 15\nminutes\n$ 56.70\n6453\n97537\n97537\nCommunity\/work reintegration training (eg, shopping,\ntransportation, money management, avocational activities and\/or\nwork environment\/modification analysis, work task analysis, use of\nassistive technology device\/adaptive equipment), direct one-on-one\ncont\n$ 39.24\n6454\n97542\n97542\nWheelchair management (eg, assessment, fitting, training), each 15\nminutes\n$ 29.60\n6455\n97545\n97545\nWork hardening\/conditioning; initial 2 hours\n$ 190.80\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6456\n97546\n97546\nWork hardening\/conditioning; each additional hour (List separately\nin addition to code for primary procedure)\n$ 99.90\n6457\n97597\n97597\nDebridement (eg, high pressure waterjet with\/without suction,\nsharp selective debridement with scissors, scalpel and forceps),\nopen wound, (eg, fibrin, devitalized epidermis and\/or dermis,\nexudate, debris, biofilm), including topical application(s), wound\n$ 104.34\n6458\n97598\n97598\nDebridement (eg, high pressure waterjet with\/without suction,\nsharp selective debridement with scissors, scalpel and forceps),\nopen wound, (eg, fibrin, devitalized epidermis and\/or dermis,\nexudate, debris, biofilm), including topical application(s), wound\n$ 114.89\n6459\n97602\n97602\nRemoval of devitalized tissue from wound(s), non-selective\ndebridement, without anesthesia (eg, wet-to-moist dressings,\nenzymatic, abrasion), including topical application(s), wound\nassessment, and instruction(s) for ongoing care, per session\n$ 126.66\n6460\n97760\n97760\nOrthotic(s) management and training (including assessment and\nfitting when not otherwise reported), upper extremity(s), lower\nextremity(s) and\/or trunk, each 15 minutes\n$ 63.04\n6461\n97761\n97761\nProsthetic training, upper and\/or lower extremity(s), each 15\nminutes\n$ 57.46\n6462\n97762\n97762\nCheckout for orthotic\/prosthetic use, established patient, each 15\nminutes\n$ 57.79\n6463\n97802\n97802\nMedical nutrition therapy; initial assessment and intervention,\nindividual, face-to-face with the patient, each 15 minutes\n$ 32.69\n6464\n97803\n97803\nMedical nutrition therapy; re-assessment and intervention,\nindividual, face-to-face with the patient, each 15 minutes\n$ 31.73\n6465\n97804\n97804\nMedical nutrition therapy; group (2 or more individuals), each 30\nminutes\n$ 12.42\n6466\n97810\n97810\nAcupuncture, 1 or more needles; without electrical stimulation,\ninitial 15 minutes of personal one-on-one contact with the patient\n$ 60.96\n6467\n97811\n97811\nAcupuncture, 1 or more needles; without electrical stimulation,\neach additional 15 minutes of personal one-on-one contact with the\npatient, with re-insertion of needle(s) (List separately in addition to\ncode for primary procedure)\n$ 51.38\n6468\n97813\n97813\nAcupuncture, 1 or more needles; with electrical stimulation, initial\n15 minutes of personal one-on-one contact with the patient\n$ 66.59\n6469\n97814\n97814\nAcupuncture, 1 or more needles; with electrical stimulation, each\nadditional 15 minutes of personal one-on-one contact with the\npatient, with re-insertion of needle(s) (List separately in addition to\ncode for primary procedure)\n$ 57.30\n6470\n98925\n98925\nOsteopathic manipulative treatment (OMT); 1-2 body regions\ninvolved\n$ 53.46\n6471\n98926\n98926\nOsteopathic manipulative treatment (OMT); 3-4 body regions\ninvolved\n$ 83.70\n6472\n98927\n98927\nOsteopathic manipulative treatment (OMT); 5-6 body regions\ninvolved\n$ 100.80\n6473\n98928\n98928\nOsteopathic manipulative treatment (OMT); 7-8 body regions\ninvolved\n$ 115.20\n6474\n98929\n98929\nOsteopathic manipulative treatment (OMT); 9-10 body regions\ninvolved\n$ 135.00\n6475\n98940\n98940\nChiropractic manipulative treatment (CMT); spinal, 1-2 regions\n$ 48.32\n6476\n98941\n98941\nChiropractic manipulative treatment (CMT); spinal, 3-4 regions\n$ 63.55\n6477\n98942\n98942\nChiropractic manipulative treatment (CMT); spinal, 5 regions\n$ 91.80\n6478\n98943\n98943\nChiropractic manipulative treatment (CMT); extraspinal, 1 or more\nregions\n$ 49.50\n6479\n98960\n98960\nEducation and training for patient self-management by a qualified,\nnonphysician health care professional using a standardized\ncurriculum, face-to-face with the patient (could include\ncaregiver\/family) each 30 minutes; individual patient\n$ 63.65\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6480\n98961\n98961\nEducation and training for patient self-management by a qualified,\nnonphysician health care professional using a standardized\ncurriculum, face-to-face with the patient (could include\ncaregiver\/family) each 30 minutes; 2-4 patients\n$ 49.81\n6481\n98962\n98962\nEducation and training for patient self-management by a qualified,\nnonphysician health care professional using a standardized\ncurriculum, face-to-face with the patient (could include\ncaregiver\/family) each 30 minutes; 5-8 patients\n$ 36.96\n6482\n98966\n98966\nTelephone assessment and management service provided by a\nqualified nonphysician health care professional to an established\npatient, parent, or guardian not originating from a related\nassessment and management service provided within the previous\n7 days n\n$ 40.02\n6483\n98967\n98967\nTelephone assessment and management service provided by a\nqualified nonphysician health care professional to an established\npatient, parent, or guardian not originating from a related\nassessment and management service provided within the previous\n7 days n\n$ 78.06\n6484\n98968\n98968\nTelephone assessment and management service provided by a\nqualified nonphysician health care professional to an established\npatient, parent, or guardian not originating from a related\nassessment and management service provided within the previous\n7 days n\n$ 111.03\n6485\n98969\n98969\nOnline assessment and management service provided by a qualified\nnonphysician health care professional to an established patient or\nguardian, not originating from a related assessment and\nmanagement service provided within the previous 7 days, using the\nI\n$ -\n6486\n99000\n99000\nHandling and\/or conveyance of specimen for transfer from the\noffice to a laboratory\n$ 23.40\n6487\n99001\n99001\nHandling and\/or conveyance of specimen for transfer from the\npatient in other than an office to a laboratory (distance may be\nindicated)\n$ 26.10\n6488\n99002\n99002\nHandling, conveyance, and\/or any other service in connection with\nthe implementation of an order involving devices (eg, designing,\nfitting, packaging, handling, delivery or mailing) when devices such\nas orthotics, protectives, prosthetics are fabricated b\n$ 27.00\n6489\n99024\n99024\nPostoperative follow-up visit, normally included in the surgical\npackage, to indicate that an evaluation and management service\nwas performed during a postoperative period for a reason(s)\nrelated to the original procedure\n$ -\n6490\n99050\n99050\nServices provided in the office at times other than regularly\nscheduled office hours, or days when the office is normally closed\n(eg, holidays, Saturday or Sunday), in addition to basic service\n$ 81.00\n6491\n99051\n99051\nService(s) provided in the office during regularly scheduled evening,\nweekend, or holiday office hours, in addition to basic service\n$ -\n6492\n99053\n99053\nService(s) provided between 10:00 PM and 8:00 AM at 24-hour\nfacility, in addition to basic service\n$ -\n6493\n99056\n99056\nService(s) typically provided in the office, provided out of the office\nat request of patient, in addition to basic service\n$ 101.70\n6494\n99058\n99058\nService(s) provided on an emergency basis in the office, which\ndisrupts other scheduled office services, in addition to basic service\n$ 96.58\n6495\n99075\n99075\nMedical testimony\n$ 627.30\n6496\n99078\n99078\nPhysician or other qualified health care professional qualified by\neducation, training, licensure\/regulation (when applicable)\neducational services rendered to patients in a group setting (eg,\nprenatal, obesity, or diabetic instructions)\n$ 72.00\n6497\n99080\n99080\nSpecial reports such as insurance forms, more than the information\nconveyed in the usual medical communications or standard\nreporting form\n$ 102.60\n6498\n99082\n99082\nUnusual travel (eg, transportation and escort of patient)\n$ 369.00\n6499\n99090\n99090\nAnalysis of clinical data stored in computers (eg, ECGs, blood\npressures, hematologic data)\n$ 232.20\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6500\n99091\n99091\nCollection and interpretation of physiologic data (eg, ECG, blood\npressure, glucose monitoring) digitally stored and\/or transmitted by\nthe patient and\/or caregiver to the physician or other qualified\nhealth care professional, qualified by education, train\n$ 101.30\n6501\n99100\n99100\nAnesthesia for patient of extreme age, younger than 1 year or older\nthan 70 (List separately in addition to code for primary anesthesia\nprocedure)\n$ 88.00\n6502\n99116\n99116\nAnesthesia complicated by utilization of total body hypothermia\n(List separately in addition to code for primary anesthesia\nprocedure)\n$ -\n6503\n99135\n99135\nAnesthesia complicated by utilization of controlled hypotension (List\nseparately in addition to code for primary anesthesia procedure)\n$ -\n6504\n99140\n99140\nAnesthesia complicated by emergency conditions (specify) (List\nseparately in addition to code for primary anesthesia procedure)\n$ 192.50\n6505\n99143\n99143\nModerate sedation services (other than those services described by\ncodes 00100-01999) provided by the same physician or other\nqualified health care professional performing the diagnostic or\ntherapeutic service that the sedation supports, requiring the pre\n$ 192.50\n6506\n99144\n99144\nModerate sedation services (other than those services described by\ncodes 00100-01999) provided by the same physician or other\nqualified health care professional performing the diagnostic or\ntherapeutic service that the sedation supports, requiring the pre\n$ 192.50\n6507\n99145\n99145\nModerate sedation services (other than those services described by\ncodes 00100-01999) provided by the same physician or other\nqualified health care professional performing the diagnostic or\ntherapeutic service that the sedation supports, requiring the pre\n$ -\n6508\n99148\n99148\nModerate sedation services (other than those services described by\ncodes 00100-01999), provided by a physician or other qualified\nhealth care professional other than the health care professional\nperforming the diagnostic or therapeutic service that the se\n$ 143.00\n6509\n99149\n99149\nModerate sedation services (other than those services described by\ncodes 00100-01999), provided by a physician or other qualified\nhealth care professional other than the health care professional\nperforming the diagnostic or therapeutic service that the se\n$ -\n6510\n99150\n99150\nModerate sedation services (other than those services described by\ncodes 00100-01999), provided by a physician or other qualified\nhealth care professional other than the health care professional\nperforming the diagnostic or therapeutic service that the se\n$ -\n6511\n99170\n99170\nAnogenital examination, magnified, in childhood for suspected\ntrauma, including image recording when performed\n$ 363.95\n6512\n99173\n99173\nScreening test of visual acuity, quantitative, bilateral\n$ 29.89\n6513\n99174\n99174\nInstrument-based ocular screening (eg, photoscreening, automated-\nrefraction), bilateral\n$ 39.61\n6514\n99175\n99175\nIpecac or similar administration for individual emesis and continued\nobservation until stomach adequately emptied of poison\n$ 106.20\n6515\n99183\n99183\nPhysician or other qualified health care professional attendance and\nsupervision of hyperbaric oxygen therapy, per session\n$ 271.80\n6516\n99190\n99190\nAssembly and operation of pump with oxygenator or heat\nexchanger (with or without ECG and\/or pressure monitoring); each\nhour\n$ -\n6517\n99191\n99191\nAssembly and operation of pump with oxygenator or heat\nexchanger (with or without ECG and\/or pressure monitoring); 45\nminutes\n$ -\n6518\n99192\n99192\nAssembly and operation of pump with oxygenator or heat\nexchanger (with or without ECG and\/or pressure monitoring); 30\nminutes\n$ -\n6519\n99195\n99195\nPhlebotomy, therapeutic (separate procedure)\n$ 69.30\n6520\n99199\n99199\nUnlisted special service, procedure or report\nCost\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6521\n99201\n99201\nOffice or other outpatient visit for the evaluation and management\nof a new patient, which requires these 3 key components: A\nproblem focused history; A problem focused examination;\nStraightforward medical decision making. Counseling and\/or\ncoordination o\n$ 75.03\n6522\n99202\n99202\nOffice or other outpatient visit for the evaluation and management\nof a new patient, which requires these 3 key components: An\nexpanded problem focused history; An expanded problem focused\nexamination; Straightforward medical decision making. Counseling\na\n$ 86.93\n6523\n99203\n99203\nOffice or other outpatient visit for the evaluation and management\nof a new patient, which requires these 3 key components: A\ndetailed history; A detailed examination; Medical decision making\nof low complexity. Counseling and\/or coordination of care with\n$ 119.33\n6524\n99204\n99204\nOffice or other outpatient visit for the evaluation and management\nof a new patient, which requires these 3 key components: A\ncomprehensive history; A comprehensive examination; Medical\ndecision making of moderate complexity. Counseling and\/or\ncoordinatio\n$ 157.94\n6525\n99205\n99205\nOffice or other outpatient visit for the evaluation and management\nof a new patient, which requires these 3 key components: A\ncomprehensive history; A comprehensive examination; Medical\ndecision making of high complexity. Counseling and\/or coordination\nof\n$ 207.38\n6526\n99211\n99211\nOffice or other outpatient visit for the evaluation and management\nof an established patient, that may not require the presence of a\nphysician or other qualified health care professional. Usually, the\npresenting problem(s) are minimal. Typically, 5 minute\n$ 36.97\n6527\n99212\n99212\nOffice or other outpatient visit for the evaluation and management\nof an established patient, which requires at least 2 of these 3 key\ncomponents: A problem focused history; A problem focused\nexamination; Straightforward medical decision making. Counselin\n$ 56.87\n6528\n99213\n99213\nOffice or other outpatient visit for the evaluation and management\nof an established patient, which requires at least 2 of these 3 key\ncomponents: An expanded problem focused history; An expanded\nproblem focused examination; Medical decision making of low\n$ 74.01\n6529\n99214\n99214\nOffice or other outpatient visit for the evaluation and management\nof an established patient, which requires at least 2 of these 3 key\ncomponents: A detailed history; A detailed examination; Medical\ndecision making of moderate complexity. Counseling and\/o\n$ 101.53\n6530\n99215\n99215\nOffice or other outpatient visit for the evaluation and management\nof an established patient, which requires at least 2 of these 3 key\ncomponents: A comprehensive history; A comprehensive\nexamination; Medical decision making of high complexity.\nCounseling\n$ 156.37\n6531\n99218\n99218\nInitial observation care, per day, for the evaluation and\nmanagement of a patient which requires these 3 key components: A\ndetailed or comprehensive history; A detailed or comprehensive\nexamination; and Medical decision making that is straightforward\nor o\n$ 134.10\n6532\n99219\n99219\nInitial observation care, per day, for the evaluation and\nmanagement of a patient, which requires these 3 key components:\nA comprehensive history; A comprehensive examination; and\nMedical decision making of moderate complexity. Counseling\nand\/or coordinat\n$ 185.40\n6533\n99221\n99221\nInitial hospital care, per day, for the evaluation and management of\na patient, which requires these 3 key components: A detailed or\ncomprehensive history; A detailed or comprehensive examination;\nand Medical decision making that is straightforward or of\n$ 146.86\n6534\n99222\n99222\nInitial hospital care, per day, for the evaluation and management of\na patient, which requires these 3 key components: A comprehensive\nhistory; A comprehensive examination; and Medical decision\nmaking of moderate complexity. Counseling and\/or coordination\n$ 215.43\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6535\n99223\n99223\nInitial hospital care, per day, for the evaluation and management of\na patient, which requires these 3 key components: A comprehensive\nhistory; A comprehensive examination; and Medical decision\nmaking of high complexity. Counseling and\/or coordination of\n$ 242.77\n6536\n99231\n99231\nSubsequent hospital care, per day, for the evaluation and\nmanagement of a patient, which requires at least 2 of these 3 key\ncomponents: A problem focused interval history; A problem focused\nexamination; Medical decision making that is straightforward or o\n$ 76.73\n6537\n99232\n99232\nSubsequent hospital care, per day, for the evaluation and\nmanagement of a patient, which requires at least 2 of these 3 key\ncomponents: An expanded problem focused interval history; An\nexpanded problem focused examination; Medical decision making\nof moder\n$ 99.73\n6538\n99233\n99233\nSubsequent hospital care, per day, for the evaluation and\nmanagement of a patient, which requires at least 2 of these 3 key\ncomponents: A detailed interval history; A detailed examination;\nMedical decision making of high complexity. Counseling and\/or coor $ 152.75\n6539\n99234\n99234\nObservation or inpatient hospital care, for the evaluation and\nmanagement of a patient including admission and discharge on the\nsame date, which requires these 3 key components: A detailed or\ncomprehensive history; A detailed or comprehensive examination;\n$ 174.35\n6540\n99235\n99235\nObservation or inpatient hospital care, for the evaluation and\nmanagement of a patient including admission and discharge on the\nsame date, which requires these 3 key components: A\ncomprehensive history; A comprehensive examination; and Medical\ndecision ma\n$ 238.54\n6541\n99236\n99236\nObservation or inpatient hospital care, for the evaluation and\nmanagement of a patient including admission and discharge on the\nsame date, which requires these 3 key components: A\ncomprehensive history; A comprehensive examination; and Medical\ndecision ma\n$ 384.38\n6542\n99238\n99238\nHospital discharge day management; 30 minutes or less\n$ 133.05\n6543\n99239\n99239\nHospital discharge day management; more than 30 minutes\n$ 172.27\n6544\n99241\n99241\nOffice consultation for a new or established patient, which requires\nthese 3 key components: A problem focused history; A problem\nfocused examination; and Straightforward medical decision making.\nCounseling and\/or coordination of care with other physician\n$ 105.67\n6545\n99242\n99242\nOffice consultation for a new or established patient, which requires\nthese 3 key components: An expanded problem focused history; An\nexpanded problem focused examination; and Straightforward\nmedical decision making. Counseling and\/or coordination of care\n$ 143.19\n6546\n99243\n99243\nOffice consultation for a new or established patient, which requires\nthese 3 key components: A detailed history; A detailed examination;\nand Medical decision making of low complexity. Counseling and\/or\ncoordination of care with other physicians, other qua\n$ 182.41\n6547\n99244\n99244\nOffice consultation for a new or established patient, which requires\nthese 3 key components: A comprehensive history; A\ncomprehensive examination; and Medical decision making of\nmoderate complexity. Counseling and\/or coordination of care with\nother physic\n$ 234.86\n6548\n99245\n99245\nOffice consultation for a new or established patient, which requires\nthese 3 key components: A comprehensive history; A\ncomprehensive examination; and Medical decision making of high\ncomplexity. Counseling and\/or coordination of care with other\nphysicians\n$ 298.54\n6549\n99251\n99251\nInpatient consultation for a new or established patient, which\nrequires these 3 key components: A problem focused history; A\nproblem focused examination; and Straightforward medical\ndecision making. Counseling and\/or coordination of care with other\nphysic\n$ 122.67\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6550\n99252\n99252\nInpatient consultation for a new or established patient, which\nrequires these 3 key components: An expanded problem focused\nhistory; An expanded problem focused examination; and\nStraightforward medical decision making. Counseling and\/or\ncoordination of ca\n$ 160.52\n6551\n99253\n99253\nInpatient consultation for a new or established patient, which\nrequires these 3 key components: A detailed history; A detailed\nexamination; and Medical decision making of low complexity.\nCounseling and\/or coordination of care with other physicians, other\n$ 198.36\n6552\n99254\n99254\nInpatient consultation for a new or established patient, which\nrequires these 3 key components: A comprehensive history; A\ncomprehensive examination; and Medical decision making of\nmoderate complexity. Counseling and\/or coordination of care with\nother phy\n$ 242.77\n6553\n99255\n99255\nInpatient consultation for a new or established patient, which\nrequires these 3 key components: A comprehensive history; A\ncomprehensive examination; and Medical decision making of high\ncomplexity. Counseling and\/or coordination of care with other\nphysici\n$ 314.79\n6554\n99281\n99281\nEmergency department visit for the evaluation and management of\na patient, which requires these 3 key components: A problem\nfocused history; A problem focused examination; and\nStraightforward medical decision making. Counseling and\/or\ncoordination of care\n$ 91.71\n6555\n99282\n99282\nEmergency department visit for the evaluation and management of\na patient, which requires these 3 key components: An expanded\nproblem focused history; An expanded problem focused\nexamination; and Medical decision making of low complexity.\nCounseling and\/o\n$ 120.82\n6556\n99283\n99283\nEmergency department visit for the evaluation and management of\na patient, which requires these 3 key components: An expanded\nproblem focused history; An expanded problem focused\nexamination; and Medical decision making of moderate complexity.\nCounseling\n$ 183.70\n6557\n99284\n99284\nEmergency department visit for the evaluation and management of\na patient, which requires these 3 key components: A detailed\nhistory; A detailed examination; and Medical decision making of\nmoderate complexity. Counseling and\/or coordination of care with\no\n$ 260.67\n6558\n99285\n99285\nEmergency department visit for the evaluation and management of\na patient, which requires these 3 key components within the\nconstraints imposed by the urgency of the patient's clinical\ncondition and\/or mental status: A comprehensive history; A\ncomprehensi\n$ 355.91\n6559\n99288\n99288\nPhysician or other qualified health care professional direction of\nemergency medical systems (EMS) emergency care, advanced life\nsupport\n$ 125.00\n6560\n99291\n99291\nCritical care, evaluation and management of the critically ill or\ncritically injured patient; first 30-74 minutes\n$ 370.17\n6561\n99292\n99292\nCritical care, evaluation and management of the critically ill or\ncritically injured patient; each additional 30 minutes (List separately\nin addition to code for primary service)\n$ 187.78\n6562\n99304\n99304\nInitial nursing facility care, per day, for the evaluation and\nmanagement of a patient, which requires these 3 key components:\nA detailed or comprehensive history; A detailed or comprehensive\nexamination; and Medical decision making that is straightforwar\n$ 91.71\n6563\n99305\n99305\nInitial nursing facility care, per day, for the evaluation and\nmanagement of a patient, which requires these 3 key components:\nA comprehensive history; A comprehensive examination; and\nMedical decision making of moderate complexity. Counseling\nand\/or coor\n$ 128.46\n6564\n99306\n99306\nInitial nursing facility care, per day, for the evaluation and\nmanagement of a patient, which requires these 3 key components:\nA comprehensive history; A comprehensive examination; and\nMedical decision making of high complexity. Counseling and\/or\ncoordina\n$ 157.46\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6565\n99341\n99341\nHome visit for the evaluation and management of a new patient,\nwhich requires these 3 key components: A problem focused history;\nA problem focused examination; and Straightforward medical\ndecision making. Counseling and\/or coordination of care with other\n$ 88.12\n6566\n99342\n99342\nHome visit for the evaluation and management of a new patient,\nwhich requires these 3 key components: An expanded problem\nfocused history; An expanded problem focused examination; and\nMedical decision making of low complexity. Counseling and\/or\ncoordinati\n$ 99.69\n6567\n99343\n99343\nHome visit for the evaluation and management of a new patient,\nwhich requires these 3 key components: A detailed history; A\ndetailed examination; and Medical decision making of moderate\ncomplexity. Counseling and\/or coordination of care with other\nphysici\n$ 135.42\n6568\n99344\n99344\nHome visit for the evaluation and management of a new patient,\nwhich requires these 3 key components: A comprehensive history; A\ncomprehensive examination; and Medical decision making of\nmoderate complexity. Counseling and\/or coordination of care with\noth\n$ 189.85\n6569\n99345\n99345\nHome visit for the evaluation and management of a new patient,\nwhich requires these 3 key components: A comprehensive history; A\ncomprehensive examination; and Medical decision making of high\ncomplexity. Counseling and\/or coordination of care with other p\n$ 250.72\n6570\n99347\n99347\nHome visit for the evaluation and management of an established\npatient, which requires at least 2 of these 3 key components: A\nproblem focused interval history; A problem focused examination;\nStraightforward medical decision making. Counseling and\/or coor\n$ 63.21\n6571\n99354\n99354\nProlonged service in the office or other outpatient setting requiring\ndirect patient contact beyond the usual service; first hour (List\nseparately in addition to code for office or other outpatient\nEvaluation and Management service)\n$ 186.25\n6572\n99356\n99356\nProlonged service in the inpatient or observation setting, requiring\nunit\/floor time beyond the usual service; first hour (List separately\nin addition to code for inpatient Evaluation and Management\nservice)\n$ 224.06\n6573\n99358\n99358\nProlonged evaluation and management service before and\/or after\ndirect patient care; first hour\n$ 202.71\n6574\n99360\n99360\nStandby service, requiring prolonged attendance, each 30 minutes\n(eg, operative standby, standby for frozen section, for\ncesarean\/high risk delivery, for monitoring EEG)\n$ 186.05\n6575\n99367\n99367\nMedical team conference with interdisciplinary team of health care\nprofessionals, patient and\/or family not present, 30 minutes or\nmore; participation by physician\n$ 64.15\n6576\n99368\n99368\nMedical team conference with interdisciplinary team of health care\nprofessionals, patient and\/or family not present, 30 minutes or\nmore; participation by nonphysician qualified health care\nprofessional\n$ 41.06\n6577\n99385\n99385\nInitial comprehensive preventive medicine evaluation and\nmanagement of an individual including an age and gender\nappropriate history, examination, counseling\/anticipatory\nguidance\/risk factor reduction interventions, and the ordering of\nlaboratory\/diagnos\n$ 142.18\n6578\n99391\n99391\nPeriodic comprehensive preventive medicine reevaluation and\nmanagement of an individual including an age and gender\nappropriate history, examination, counseling\/anticipatory\nguidance\/risk factor reduction interventions, and the ordering of\nlaboratory\/diag\n$ 82.75\n6579\n99392\n99392\nPeriodic comprehensive preventive medicine reevaluation and\nmanagement of an individual including an age and gender\nappropriate history, examination, counseling\/anticipatory\nguidance\/risk factor reduction interventions, and the ordering of\nlaboratory\/diag\n$ 86.88\n6580\n99393\n99393\nPeriodic comprehensive preventive medicine reevaluation and\nmanagement of an individual including an age and gender\nappropriate history, examination, counseling\/anticipatory\nguidance\/risk factor reduction interventions, and the ordering of\nlaboratory\/diag\n$ 89.13\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6581\n99394\n99394\nPeriodic comprehensive preventive medicine reevaluation and\nmanagement of an individual including an age and gender\nappropriate history, examination, counseling\/anticipatory\nguidance\/risk factor reduction interventions, and the ordering of\nlaboratory\/diag\n$ 105.22\n6582\n99395\n99395\nPeriodic comprehensive preventive medicine reevaluation and\nmanagement of an individual including an age and gender\nappropriate history, examination, counseling\/anticipatory\nguidance\/risk factor reduction interventions, and the ordering of\nlaboratory\/diag\n$ 115.76\n6583\n99396\n99396\nPeriodic comprehensive preventive medicine reevaluation and\nmanagement of an individual including an age and gender\nappropriate history, examination, counseling\/anticipatory\nguidance\/risk factor reduction interventions, and the ordering of\nlaboratory\/diag\n$ 135.29\n6584\n99401\n99401\nPreventive medicine counseling and\/or risk factor reduction\nintervention(s) provided to an individual (separate procedure);\napproximately 15 minutes\n$ 48.03\n6585\n99460\n99460\nInitial hospital or birthing center care, per day, for evaluation and\nmanagement of normal newborn infant\n$ 144.33\n6586\n99461\n99461\nInitial care, per day, for evaluation and management of normal\nnewborn infant seen in other than hospital or birthing center\n$ 98.43\n6587\n99462\n99462\nSubsequent hospital care, per day, for evaluation and management\nof normal newborn\n$ 68.89\n6588\n99463\n99463\nInitial hospital or birthing center care, per day, for evaluation and\nmanagement of normal newborn infant admitted and discharged on\nthe same date\n$ 157.01\n6589\n99464\n99464\nAttendance at delivery (when requested by the delivering physician\nor other qualified health care professional) and initial stabilization\nof newborn\n$ 155.16\n6590\n99465\n99465\nDelivery\/birthing room resuscitation, provision of positive pressure\nventilation and\/or chest compressions in the presence of acute\ninadequate ventilation and\/or cardiac output\n$ 278.60\n6591\n99466\n99466\nCritical care face-to-face services, during an interfacility transport of\ncritically ill or critically injured pediatric patient, 24 months of age\nor younger; first 30-74 minutes of hands-on care during transport\n$ 410.44\n6592\n99467\n99467\nCritical care face-to-face services, during an interfacility transport of\ncritically ill or critically injured pediatric patient, 24 months of age\nor younger; each additional 30 minutes (List separately in addition\nto code for primary service)\n$ 231.30\n6593\n99468\n99468\nInitial inpatient neonatal critical care, per day, for the evaluation\nand management of a critically ill neonate, 28 days of age or\nyounger\n$ 1,541.18\n6594\n99469\n99469\nSubsequent inpatient neonatal critical care, per day, for the\nevaluation and management of a critically ill neonate, 28 days of\nage or younger\n$ 961.49\n6595\n99471\n99471\nInitial inpatient pediatric critical care, per day, for the evaluation\nand management of a critically ill infant or young child, 29 days\nthrough 24 months of age\n$ 1,358.69\n6596\n99472\n99472\nSubsequent inpatient pediatric critical care, per day, for the\nevaluation and management of a critically ill infant or young child,\n29 days through 24 months of age\n$ 920.42\n6597\n99475\n99475\nInitial inpatient pediatric critical care, per day, for the evaluation\nand management of a critically ill infant or young child, 2 through 5\nyears of age\n$ 1,108.22\n6598\n99476\n99476\nSubsequent inpatient pediatric critical care, per day, for the\nevaluation and management of a critically ill infant or young child, 2\nthrough 5 years of age\n$ 815.58\n6599\n99478\n99478\nSubsequent intensive care, per day, for the evaluation and\nmanagement of the recovering very low birth weight infant (present\nbody weight less than 1500 grams)\n$ 398.22\n6600\n99479\n99479\nSubsequent intensive care, per day, for the evaluation and\nmanagement of the recovering low birth weight infant (present\nbody weight of 1500-2500 grams)\n$ 373.08\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6601\n99480\n99480\nSubsequent intensive care, per day, for the evaluation and\nmanagement of the recovering infant (present body weight of 2501-\n5000 grams)\n$ 350.97\n6602\n99499\n99499\nUnlisted evaluation and management service\n$ 38.50\n6603\n99500\n99500\nHome visit for prenatal monitoring and assessment to include fetal\nheart rate, non-stress test, uterine monitoring, and gestational\ndiabetes monitoring\n$ -\n6604\n99502\n99502\nHome visit for newborn care and assessment\n$ 38.50\n6605\n99503\n99503\nHome visit for respiratory therapy care (eg, bronchodilator, oxygen\ntherapy, respiratory assessment, apnea evaluation)\n$ -\n6606\n99504\n99504\nHome visit for mechanical ventilation care\n$ -\n6607\n99505\n99505\nHome visit for stoma care and maintenance including colostomy\nand cystostomy\n$ -\n6608\n99506\n99506\nHome visit for intramuscular injections\n$ -\n6609\n99507\n99507\nHome visit for care and maintenance of catheter(s) (eg, urinary,\ndrainage, and enteral)\n$ 27.50\n6610\n99509\n99509\nHome visit for assistance with activities of daily living and personal\ncare\n$ 33.00\n6611\n99510\n99510\nHome visit for individual, family, or marriage counseling\n$ -\n6612\n99511\n99511\nHome visit for fecal impaction management and enema\nadministration\n$ -\n6613\n99512\n99512\nHome visit for hemodialysis\n$ -\n6614\n99600\n99600\nUnlisted home visit service or procedure\nCost\n6615\n99601\n99601\nHome infusion\/specialty drug administration, per visit (up to 2\nhours);\n$ -\n6616\n99602\n99602\nHome infusion\/specialty drug administration, per visit (up to 2\nhours); each additional hour (List separately in addition to code for\nprimary procedure)\n$ -\n6617\n99605\n99605\nMedication therapy management service(s) provided by a\npharmacist, individual, face-to-face with patient, with assessment\nand intervention if provided; initial 15 minutes, new patient\n$ -\n6618\n99606\n99606\nMedication therapy management service(s) provided by a\npharmacist, individual, face-to-face with patient, with assessment\nand intervention if provided; initial 15 minutes, established patient\n$ -\n6619\n99607\n99607\nMedication therapy management service(s) provided by a\npharmacist, individual, face-to-face with patient, with assessment\nand intervention if provided; each additional 15 minutes (List\nseparately in addition to code for primary service)\n$ -\n6620\nA0380\nA0380\nBLS mileage (per mile)\n$ 8.25\n6621\nA0427\nA0427\nAmbulance service, advanced life support, emergency transport,\nlevel 1 (ALS1- emergency)\n$ 187.00\n6622\nA0428\nA0428\nAmbulance service, basic life support, non-emergency transport,\n(BLS)\n$ 137.50\n6623\nA0430\nA0430\nAmbulance service, conventional air services, transport, one way\n(fixed wing)\n$ 220.00\n6624\nA0998\nA0998\nAmbulance response and treatment, no transport\n$ 137.50\n6625\nD0120\nD0120\nPeriodic oral evaluation - established patient\n$ 30.00\n6626\nD0140\nD0140\nLimited oral evaluation - problem focused\n$ 30.00\n6627\nD0150\nD0150\nComprehensive oral evaluation - new or established patient\n$ 60.00\n6628\nD0160\nD0160\nDetailed and extensive oral evaluation - problem focused, by report\n$ 71.50\n6629\nD0170\nD0170\nRe-evaluation - limited, problem focused (established patient; not\npost-operative visit)\n$ 39.00\n6630\nD0210\nD0210\nIntraoral - complete series of radiographic images\n$ 85.00\n6631\nD0220\nD0220\nIntraoral - periapical first radiographic image\n$ 18.00\n6632\nD0230\nD0230\nIntraoral - periapical each additional radiographic image\n$ 8.00\n6633\nD0240\nD0240\nIntraoral - occlusal radiographic image\n$ 27.50\n6634\nD0250\nD0250\nExtraoral - first radiographic image\n$ 38.00\n6635\nD0260\nD0260\nExtraoral - each additional radiographic image\n$ 32.00\n6636\nD0270\nD0270\nBitewing - single radiographic image\n$ 18.00\n6637\nD0272\nD0272\nBitewings - two radiographic images\n$ 35.50\n6638\nD0274\nD0274\nBitewings - four radiographic images\n$ 41.00\n6639\nD0277\nD0277\nVertical bitewings - 7 to 8 radiographic images\n$ 57.00\n6640\nD0290\nD0290\nPosterior-anterior or lateral skull and facial bone survey\nradiographic image\n$ 81.00\n6641\nD0310\nD0310\nSialography\n$ 155.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6642\nD0320\nD0320\nTemporomandibular joint arthrogram, including injection\n$ 369.00\n6643\nD0321\nD0321\nOther temporomandibular joint radiographic images, by report\n$ 148.00\n6644\nD0322\nD0322\nTomographic survey\n$ 265.00\n6645\nD0330\nD0330\nPanoramic radiographic image\n$ 60.00\n6646\nD0340\nD0340\nCephalometric radiographic image\n$ 55.00\n6647\nD0350\nD0350\nOral\/facial photographic images\n$ 43.00\n6648\nD0415\nD0415\nCollection of microorganisms for culture and sensitivity\n$ 95.00\n6649\nD0425\nD0425\nCaries susceptibility tests\n$ 61.00\n6650\nD0460\nD0460\nPulp vitality tests\n$ 36.00\n6651\nD0470\nD0470\nDiagnostic casts\n$ 69.00\n6652\nD0472\nD0472\nAccession of tissue, gross examination, preparation and\ntransmission of written report\n$ 55.00\n6653\nD0501\nD0501\nHISTOPATHOLOGIC EXAMINATIONS Refers to gross and microscopic\nevaluations of presumptively abnormal tissue(s) that have been\npreviously excised. Includes preparation and transmission of written\nreport.\n$ 127.00\n6654\nD0502\nD0502\nOther oral pathology procedures, by report\n$ 114.00\n6655\nD0999\nD0999\nUnspecified diagnostic procedure, by report\nIndividual Report\n6656\nD1110\nD1110\nProphylaxis - adult\n$ 88.00\n6657\nD1120\nD1120\nProphylaxis - child\n$ 44.00\n6658\nD1206\nD1206\nTopical application of fluoride varnish\n$ 60.00\n6659\nD1208\nD1208\nTopical application of fluoride\n$ 60.00\n6660\nD1310\nD1310\nNutritional counseling for control of dental disease\n$ 47.00\n6661\nD1320\nD1320\nTobacco counseling for the control and prevention of oral disease\n$ 51.00\n6662\nD1330\nD1330\nOral hygiene instructions\n$ 70.00\n6663\nD1351\nD1351\nSealant - per tooth\n$ 55.00\n6664\nD1510\nD1510\nSpace maintainer - fixed - unilateral\n$ 221.00\n6665\nD1515\nD1515\nSpace maintainer - fixed - bilateral\n$ 311.00\n6666\nD1520\nD1520\nSpace maintainer - removable - unilateral\n$ 266.00\n6667\nD1525\nD1525\nSpace maintainer - removable - bilateral\n$ 346.00\n6668\nD1550\nD1550\nRe-cementation of space maintainer\n$ 53.00\n6669\nD2140\nD2140\nAmalgam - one surface, primary or permanent\n$ 75.00\n6670\nD2150\nD2150\nAmalgam - two surfaces, primary or permanent\n$ 108.00\n6671\nD2160\nD2160\nAmalgam - three surfaces, primary or permanent\n$ 119.00\n6672\nD2161\nD2161\nAmalgam - four or more surfaces, primary or permanent\n$ 130.00\n6673\nD2330\nD2330\nResin-based composite - one surface, anterior\n$ 132.00\n6674\nD2331\nD2331\nResin-based composite - two surfaces, anterior\n$ 198.00\n6675\nD2332\nD2332\nResin-based composite - three surfaces, anterior\n$ 220.00\n6676\nD2335\nD2335\nResin-based composite - four or more surfaces or involving incisal\nangle (anterior)\n$ 242.00\n6677\nD2390\nD2390\nResin-based composite crown, anterior\n$ 250.00\n6678\nD2391\nD2391\nResin-based composite - one surface, posterior\n$ 66.00\n6679\nD2392\nD2392\nResin-based composite - two surfaces, posterior\n$ 99.00\n6680\nD2393\nD2393\nResin-based composite - three surfaces, posterior\n$ 110.00\n6681\nD2394\nD2394\nResin-based composite - four or more surfaces, posterior\n$ 121.00\n6682\nD2410\nD2410\nGold foil - one surface\n$ 360.00\n6683\nD2420\nD2420\nGold foil - two surfaces\n$ 443.00\n6684\nD2430\nD2430\nGold foil - three surfaces\n$ 525.00\n6685\nD2510\nD2510\nInlay - metallic - one surface\n$ 522.00\n6686\nD2520\nD2520\nInlay - metallic - two surfaces\n$ 580.00\n6687\nD2530\nD2530\nInlay - metallic - three or more surfaces\n$ 625.00\n6688\nD2542\nD2542\nOnlay - metallic-two surfaces\n$ 650.00\n6689\nD2543\nD2543\nOnlay - metallic-three surfaces\n$ 691.00\n6690\nD2544\nD2544\nOnlay - metallic-four or more surfaces\n$ 720.00\n6691\nD2610\nD2610\nInlay - porcelain\/ceramic - one surface\n$ 583.00\n6692\nD2620\nD2620\nInlay - porcelain\/ceramic - two surfaces\n$ 630.00\n6693\nD2630\nD2630\nInlay - porcelain\/ceramic - three or more surfaces\n$ 671.00\n6694\nD2642\nD2642\nOnlay - porcelain\/ceramic - two surfaces\n$ 688.00\n6695\nD2643\nD2643\nOnlay - porcelain\/ceramic - three surfaces\n$ 717.00\n6696\nD2644\nD2644\nOnlay - porcelain\/ceramic - four or more surfaces\n$ 744.00\n6697\nD2650\nD2650\nInlay - resin-based composite - one surface\n$ 526.00\n6698\nD2651\nD2651\nInlay - resin-based composite - two surfaces\n$ 569.00\n6699\nD2652\nD2652\nInlay - resin-based composite - three or more surfaces\n$ 613.00\n6700\nD2662\nD2662\nOnlay - resin-based composite - two surfaces\n$ 650.00\n6701\nD2663\nD2663\nOnlay - resin-based composite - three surfaces\n$ 669.00\n6702\nD2664\nD2664\nOnlay - resin-based composite - four or more surfaces\n$ 695.00\n6703\nD2710\nD2710\nCrown - resin-based composite (indirect)\n$ 385.00\n6704\nD2720\nD2720\nCrown - resin with high noble metal\n$ 733.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6705\nD2721\nD2721\nCrown - resin with predominantly base metal\n$ 661.00\n6706\nD2722\nD2722\nCrown - resin with noble metal\n$ 703.00\n6707\nD2740\nD2740\nCrown - porcelain\/ceramic substrate\n$ 751.00\n6708\nD2750\nD2750\nCrown - porcelain fused to high noble metal\n$ 744.00\n6709\nD2751\nD2751\nCrown - porcelain fused to predominantly base metal\n$ 540.00\n6710\nD2752\nD2752\nCrown - porcelain fused to noble metal\n$ 795.00\n6711\nD2780\nD2780\nCrown - 3\/4 cast high noble metal\n$ 738.00\n6712\nD2781\nD2781\nCrown - 3\/4 cast predominantly base metal\n$ 697.00\n6713\nD2782\nD2782\nCrown - 3\/4 cast noble metal\n$ 715.00\n6714\nD2783\nD2783\nCrown - 3\/4 porcelain\/ceramic\n$ 750.00\n6715\nD2790\nD2790\nCrown - full cast high noble metal\n$ 728.00\n6716\nD2791\nD2791\nCrown - full cast predominantly base metal\n$ 675.00\n6717\nD2792\nD2792\nCrown - full cast noble metal\n$ 700.00\n6718\nD2799\nD2799\nProvisional crown - further treatment or completion of diagnosis\nnecessary prior to final impression\n$ 215.00\n6719\nD2910\nD2910\nRecement inlay, onlay, or partial coverage restoration\n$ 77.00\n6720\nD2915\nD2915\nRecement cast or prefabricated post and core\n$ 218.00\n6721\nD2920\nD2920\nRecement crown\n$ 99.00\n6722\nD2930\nD2930\nPrefabricated stainless steel crown - primary tooth\n$ 150.00\n6723\nD2931\nD2931\nPrefabricated stainless steel crown - permanent tooth\n$ 150.00\n6724\nD2932\nD2932\nPrefabricated resin crown\n$ 200.00\n6725\nD2933\nD2933\nPrefabricated stainless steel crown with resin window\n$ 239.00\n6726\nD2940\nD2940\nProtective restoration\n$ 71.50\n6727\nD2950\nD2950\nCore buildup, including any pins\n$ 150.00\n6728\nD2951\nD2951\nPin retention - per tooth, in addition to restoration\n$ 77.00\n6729\nD2952\nD2952\nPost and core in addition to crown, indirectly fabricated\n$ 303.50\n6730\nD2953\nD2953\nEach additional indirectly fabricated post - same tooth\n$ 188.00\n6731\nD2954\nD2954\nPrefabricated post and core in addition to crown\n$ 765.00\n6732\nD2955\nD2955\nPost removal\n$ 187.00\n6733\nD2957\nD2957\nEach additional prefabricated post - same tooth\n$ 66.00\n6734\nD2960\nD2960\nLabial veneer (resin laminate) - chairside\n$ 375.00\n6735\nD2961\nD2961\nLabial veneer (resin laminate) - laboratory\n$ 450.00\n6736\nD2962\nD2962\nLabial veneer (porcelain laminate) - laboratory\n$ 495.00\n6737\nD2970\nD2970\nTemporary crown (fractured tooth)\n$ 137.50\n6738\nD2980\nD2980\nCrown repair necessitated by restorative material failure\n$ 180.00\n6739\nD2999\nD2999\nUnspecified restorative procedure, by report\nIndividual Report\n6740\nD3110\nD3110\nPulp cap - direct (excluding final restoration)\n$ 55.00\n6741\nD3120\nD3120\nPulp cap - indirect (excluding final restoration)\n$ 33.00\n6742\nD3220\nD3220\nTherapeutic pulpotomy (excluding final restoration) - removal of\npulp coronal to the dentinocemental junction and application of\nmedicament\n$ 77.00\n6743\nD3221\nD3221\nPulpal debridement, primary and permanent teeth\n$ 88.00\n6744\nD3230\nD3230\nPulpal therapy (resorbable filling) - anterior, primary tooth\n(excluding final restoration)\n$ 175.00\n6745\nD3240\nD3240\nPulpal therapy (resorbable filling) - posterior, primary tooth\n(excluding final restoration)\n$ 196.00\n6746\nD3310\nD3310\nEndodontic therapy, anterior tooth (excluding final restoration)\n$ 247.50\n6747\nD3320\nD3320\nEndodontic therapy, bicuspid tooth (excluding final restoration)\n$ 605.00\n6748\nD3330\nD3330\nEndodontic therapy, molar (excluding final restoration)\n$ 852.50\n6749\nD3331\nD3331\nTreatment of root canal obstruction; non-surgical access\n$ 210.00\n6750\nD3332\nD3332\nIncomplete endodontic therapy; inoperable, unrestorable or\nfractured tooth\n$ 233.00\n6751\nD3333\nD3333\nInternal root repair of perforation defects\n$ 133.00\n6752\nD3346\nD3346\nRetreatment of previous root canal therapy - anterior\n$ 360.00\n6753\nD3347\nD3347\nRetreatment of previous root canal therapy - bicuspid\n$ 360.00\n6754\nD3348\nD3348\nRetreatment of previous root canal therapy - molar\n$ 360.00\n6755\nD3351\nD3351\nApexification\/recalcification\/pulpal regeneration - initial visit (apical\nclosure\/calcific repair of perforations, root resorption, pulp space\ndisinfection, etc.)\n$ 110.00\n6756\nD3352\nD3352\nApexification\/recalcification\/pulpal regeneration - interim\nmedication replacement (apical closure\/calcific repair of\nperforations, root resorption, pulp space disinfection, etc.)\n$ 110.00\n6757\nD3353\nD3353\nApexification\/recalcification - final visit (includes completed root\ncanal therapy - apical closure\/calcific repair of perforations, root\nresorption, etc.)\n$ 110.00\n6758\nD3410\nD3410\nApicoectomy\/periradicular surgery - anterior\n$ 330.00\n6759\nD3421\nD3421\nApicoectomy\/periradicular surgery - bicuspid (first root)\n$ 330.00\n6760\nD3425\nD3425\nApicoectomy\/periradicular surgery - molar (first root)\n$ 330.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6761\nD3426\nD3426\nApicoectomy\/periradicular surgery (each additional root)\n$ 210.00\n6762\nD3430\nD3430\nRetrograde filling - per root\n$ 170.00\n6763\nD3450\nD3450\nRoot amputation - per root\n$ 300.00\n6764\nD3460\nD3460\nEndodontic endosseous implant\n$ 759.00\n6765\nD3470\nD3470\nIntentional reimplantation (including necessary splinting)\n$ 539.00\n6766\nD3910\nD3910\nSurgical procedure for isolation of tooth with rubber dam\n$ 125.00\n6767\nD3920\nD3920\nHemisection (including any root removal), not including root canal\ntherapy\n$ 299.00\n6768\nD3950\nD3950\nCanal preparation and fitting of preformed dowel or post\n$ 160.00\n6769\nD3999\nD3999\nUnspecified endodontic procedure, by report\nIndividual Report\n6770\nD4210\nD4210\nGingivectomy or gingivoplasty - four or more contiguous teeth or\ntooth bounded spaces per quadrant\n$ 420.00\n6771\nD4211\nD4211\nGingivectomy or gingivoplasty - one to three contiguous teeth or\ntooth bounded spaces per quadrant\n$ 148.00\n6772\nD4240\nD4240\nGingival flap procedure, including root planing - four or more\ncontiguous teeth or tooth bounded spaces per quadrant\n$ 493.00\n6773\nD4241\nD4241\nGingival flap procedure, including root planing - one to three\ncontiguous teeth or tooth bounded spaces per quadrant\n$ 207.00\n6774\nD4245\nD4245\nApically positioned flap\n$ 554.00\n6775\nD4249\nD4249\nClinical crown lengthening - hard tissue\n$ 478.00\n6776\nD4260\nD4260\nOsseous surgery (including flap entry and closure) - four or more\ncontiguous teeth or tooth bounded spaces per quadrant\n$ 724.00\n6777\nD4263\nD4263\nBone replacement graft - first site in quadrant\n$ 456.00\n6778\nD4264\nD4264\nBone replacement graft - each additional site in quadrant\n$ 335.00\n6779\nD4266\nD4266\nGuided tissue regeneration - resorbable barrier, per site\n$ 603.00\n6780\nD4267\nD4267\nGuided tissue regeneration - nonresorbable barrier, per site\n(includes membrane removal)\n$ 688.00\n6781\nD4268\nD4268\nSurgical revision procedure, per tooth\n$ 534.00\n6782\nD4270\nD4270\nPedicle soft tissue graft procedure\n$ 536.00\n6783\nD4273\nD4273\nSubepithelial connective tissue graft procedures, per tooth\n$ 735.00\n6784\nD4277\nD4277\nFree soft tissue graft procedure (including donor site surgery), first\ntooth or edentulous tooth position in graft\n$ 595.00\n6785\nD4278\nD4278\nFree soft tissue graft procedure (including donor site surgery), each\nadditional contiguous tooth or edentulous tooth position in same\ngraft site\n$ 595.00\n6786\nD4320\nD4320\nProvisional splinting - intracoronal\n$ 332.00\n6787\nD4321\nD4321\nProvisional splinting - extracoronal\n$ 300.00\n6788\nD4341\nD4341\nPeriodontal scaling and root planing - four or more teeth per\nquadrant\n$ 132.00\n6789\nD4355\nD4355\nFull mouth debridement to enable comprehensive evaluation and\ndiagnosis\n$ 264.00\n6790\nD4360\nD4360\nTrismus appliance (not for TMD treatment)\n$ 220.00\n6791\nD4910\nD4910\nPeriodontal maintenance\n$ 88.00\n6792\nD4920\nD4920\nUnscheduled dressing change (by someone other than treating\ndentist)\n$ 71.00\n6793\nD4921\nD4921\nGingival irrigation per quad\n$ 207.00\n6794\nD4999\nD4999\nUnspecified periodontal procedure, by report\nIndividual Report\n6795\nD5110\nD5110\nComplete denture - maxillary\n$ 600.00\n6796\nD5120\nD5120\nComplete denture - mandibular\n$ 600.00\n6797\nD5130\nD5130\nImmediate denture - maxillary\n$ 700.00\n6798\nD5140\nD5140\nImmediate denture - mandibular\n$ 700.00\n6799\nD5211\nD5211\nMaxillary partial denture - resin base (including any conventional\nclasps, rests and teeth)\n$ 250.00\n6800\nD5212\nD5212\nMandibular partial denture - resin base (including any conventional\nclasps, rests and teeth)\n$ 250.00\n6801\nD5213\nD5213\nMaxillary partial denture - cast metal framework with resin denture\nbases (including any conventional clasps, rests and teeth)\n$ 650.00\n6802\nD5214\nD5214\nMandibular partial denture - cast metal framework with resin\ndenture bases (including any conventional clasps, rests and teeth)\n$ 650.00\n6803\nD5226\nD5226\nMandibular partial denture - flexible base (including any clasps,\nrests and teeth)\n$ 605.00\n6804\nD5231\nD5231\nMandibular partial denture - cast metal framework with resin\ndenture bases (including any conventional clasps, rests and teeth)\n$ 605.00\n6805\nD5251\nD5251\nComplete denture - maxillary\n$ 605.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6806\nD5281\nD5281\nRemovable unilateral partial denture - one piece cast metal\n(including clasps and teeth\n$ 625.00\n6807\nD5310\nD5310\nRepair or replace broken clasp\n$ 27.50\n6808\nD5320\nD5320\nAdd tooth to existing partial denture\n$ 27.50\n6809\nD5410\nD5410\nAdjust complete denture - maxillary\n$ 30.00\n6810\nD5411\nD5411\nAdjust complete denture - mandibular\n$ 30.00\n6811\nD5421\nD5421\nAdjust partial denture - maxillary\n$ 25.00\n6812\nD5422\nD5422\nAdjust partial denture - mandibular\n$ 25.00\n6813\nD5510\nD5510\nRepair broken complete denture base\n$ 55.00\n6814\nD5520\nD5520\nReplace missing or broken teeth - complete denture (each tooth)\n$ 55.00\n6815\nD5610\nD5610\nRepair resin denture base\n$ 50.00\n6816\nD5620\nD5620\nRepair cast framework\n$ 55.00\n6817\nD5630\nD5630\nRepair or replace broken clasp\n$ 55.00\n6818\nD5640\nD5640\nReplace broken teeth - per tooth\n$ 55.00\n6819\nD5650\nD5650\nAdd tooth to existing partial denture\n$ 55.00\n6820\nD5660\nD5660\nAdd clasp to existing partial denture\n$ 50.00\n6821\nD5710\nD5710\nRebase complete maxillary denture\n$ 379.00\n6822\nD5711\nD5711\nRebase complete mandibular denture\n$ 380.00\n6823\nD5720\nD5720\nRebase maxillary partial denture\n$ 367.00\n6824\nD5721\nD5721\nRebase mandibular partial denture\n$ 366.00\n6825\nD5730\nD5730\nReline complete maxillary denture (chairside)\n$ 248.00\n6826\nD5731\nD5731\nReline complete mandibular denture (chairside)\n$ 249.00\n6827\nD5740\nD5740\nReline maxillary partial denture (chairside)\n$ 245.00\n6828\nD5741\nD5741\nReline mandibular partial denture (chairside)\n$ 244.00\n6829\nD5750\nD5750\nReline complete maxillary denture (laboratory)\n$ 110.00\n6830\nD5751\nD5751\nReline complete mandibular denture (laboratory)\n$ 110.00\n6831\nD5760\nD5760\nReline maxillary partial denture (laboratory)\n$ 110.00\n6832\nD5761\nD5761\nReline mandibular partial denture (laboratory)\n$ 110.00\n6833\nD5810\nD5810\nInterim complete denture (maxillary)\n$ 517.00\n6834\nD5811\nD5811\nInterim complete denture (mandibular)\n$ 524.00\n6835\nD5820\nD5820\nInterim partial denture (maxillary)\n$ 442.00\n6836\nD5821\nD5821\nInterim partial denture (mandibular)\n$ 442.00\n6837\nD5850\nD5850\nTissue conditioning, maxillary\n$ 125.00\n6838\nD5851\nD5851\nTissue conditioning, mandibular\n$ 125.00\n6839\nD5860\nD5860\nOverdenture - complete, by report\n$ 660.00\n6840\nD5861\nD5861\nOverdenture - partial, by report\n$ 660.00\n6841\nD5862\nD5862\nPrecision attachment, by report\n$ 435.00\n6842\nD5875\nD5875\nModification of removable prosthesis following implant surgery\n$ 236.00\n6843\nD5899\nD5899\nUnspecified removable prosthodontic procedure, by report\nIndividual Report\n6844\nD5911\nD5911\nFacial moulage (sectional)\nIndividual Report\n6845\nD5912\nD5912\nFacial moulage (complete)\nIndividual Report\n6846\nD5913\nD5913\nNasal prosthesis\nIndividual Report\n6847\nD5914\nD5914\nAuricular prosthesis\nIndividual Report\n6848\nD5915\nD5915\nOrbital prosthesis\nIndividual Report\n6849\nD5916\nD5916\nOcular prosthesis\nIndividual Report\n6850\nD5919\nD5919\nFacial prosthesis\nIndividual Report\n6851\nD5922\nD5922\nNasal septal prosthesis\nIndividual Report\n6852\nD5923\nD5923\nOcular prosthesis, interim\nIndividual Report\n6853\nD5924\nD5924\nCranial prosthesis\nIndividual Report\n6854\nD5925\nD5925\nFacial augmentation implant prosthesis\nIndividual Report\n6855\nD5926\nD5926\nNasal prosthesis, replacement\nIndividual Report\n6856\nD5927\nD5927\nAuricular prosthesis, replacement\nIndividual Report\n6857\nD5928\nD5928\nOrbital prosthesis, replacement\nIndividual Report\n6858\nD5929\nD5929\nFacial prosthesis, replacement\nIndividual Report\n6859\nD5931\nD5931\nObturator prosthesis, surgical\nIndividual Report\n6860\nD5932\nD5932\nObturator prosthesis, definitive\nIndividual Report\n6861\nD5933\nD5933\nObturator prosthesis, modification\nIndividual Report\n6862\nD5934\nD5934\nMandibular resection prosthesis with guide flange\nIndividual Report\n6863\nD5935\nD5935\nMandibular resection prosthesis without guide flange\nIndividual Report\n6864\nD5936\nD5936\nObturator prosthesis, interim\nIndividual Report\n6865\nD5937\nD5937\nTrismus appliance (not for TMD treatment)\nIndividual Report\n6866\nD5951\nD5951\nFeeding aid\nIndividual Report\n6867\nD5952\nD5952\nSpeech aid prosthesis, pediatric\nIndividual Report\n6868\nD5953\nD5953\nSpeech aid prosthesis, adult\nIndividual Report\n6869\nD5954\nD5954\nPalatal augmentation prosthesis\nIndividual Report\n6870\nD5955\nD5955\nPalatal lift prosthesis, definitive\nIndividual Report\n6871\nD5958\nD5958\nPalatal lift prosthesis, interim\nIndividual Report\n6872\nD5959\nD5959\nPalatal lift prosthesis, modification\nIndividual Report\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6873\nD5960\nD5960\nSpeech aid prosthesis, modification\nIndividual Report\n6874\nD5982\nD5982\nSurgical stent\n$ 273.00\n6875\nD5983\nD5983\nRadiation carrier\nIndividual Report\n6876\nD5984\nD5984\nRadiation shield\nIndividual Report\n6877\nD5985\nD5985\nRadiation cone locator\nIndividual Report\n6878\nD5986\nD5986\nFluoride gel carrier\n$ 115.00\n6879\nD5987\nD5987\nCommissure splint\nIndividual Report\n6880\nD5988\nD5988\nSurgical splint\n$ 549.00\n6881\nD5992\nD5992\nAdjust maxillofacial prosthetic appliance, by report\n$ 220.00\n6882\nD5999\nD5999\nUnspecified maxillofacial prosthesis, by report\nIndividual Report\n6883\nD6010\nD6010\nSurgical placement of implant body: endosteal implant\n$ 1,425.00\n6884\nD6012\nD6012\nSurgical placement of interim implant body for transitional\nprosthesis: endosteal implant\n$ 650.00\n6885\nD6040\nD6040\nSurgical placement: eposteal implant\n$ 6,023.00\n6886\nD6050\nD6050\nSurgical placement: transosteal implant\n$ 4,153.00\n6887\nD6055\nD6055\nConnecting bar - implant supported or abutment supported\n$ 1,667.00\n6888\nD6056\nD6056\nPrefabricated abutment - includes modification and placement\n$ 429.00\n6889\nD6057\nD6057\nCustom fabricated abutment - includes placement\n$ 600.00\n6890\nD6058\nD6058\nAbutment supported porcelain\/ceramic crown\n$ 850.00\n6891\nD6059\nD6059\nAbutment supported porcelain fused to metal crown (high noble\nmetal)\n$ 861.00\n6892\nD6060\nD6060\nAbutment supported porcelain fused to metal crown\n(predominantly base metal)\n$ 730.00\n6893\nD6061\nD6061\nAbutment supported porcelain fused to metal crown (noble metal)\n$ 800.00\n6894\nD6062\nD6062\nAbutment supported cast metal crown (high noble metal)\n$ 844.00\n6895\nD6063\nD6063\nAbutment supported cast metal crown (predominantly base metal)\n$ 755.00\n6896\nD6064\nD6064\nAbutment supported cast metal crown (noble metal)\n$ 800.00\n6897\nD6065\nD6065\nImplant supported porcelain\/ceramic crown\n$ 960.00\n6898\nD6066\nD6066\nImplant supported porcelain fused to metal crown (titanium,\ntitanium alloy, high noble metal)\n$ 981.00\n6899\nD6067\nD6067\nImplant supported metal crown (titanium, titanium alloy, high noble\nmetal)\n$ 950.00\n6900\nD6068\nD6068\nABUTMENT SUPPORTED RETAINER FOR PORCELAIN\/CERAMIC FPD\n$ 844.00\n6901\nD6069\nD6069\nAbutment supported retainer for porcelain fused to metal FPD (high\nnoble metal)\n$ 836.00\n6902\nD6070\nD6070\nAbutment supported retainer for porcelain fused to metal FPD\n(predominantly base metal)\n$ 703.00\n6903\nD6071\nD6071\nAbutment supported retainer for porcelain fused to metal FPD\n(noble metal)\n$ 792.00\n6904\nD6072\nD6072\nAbutment supported retainer for cast metal FPD (high noble metal)\n$ 810.00\n6905\nD6073\nD6073\nAbutment supported retainer for cast metal FPD (predominantly\nbase metal)\n$ 760.00\n6906\nD6074\nD6074\nAbutment supported retainer for cast metal FPD (noble metal)\n$ 775.00\n6907\nD6075\nD6075\nImplant supported retainer for ceramic FPD\n$ 906.00\n6908\nD6077\nD6077\nImplant supported retainer for cast metal FPD (titanium, titanium\nalloy, or high noble metal)\n$ 935.00\n6909\nD6078\nD6078\nImplant\/abutment supported fixed denture for completely\nedentulous arch\n$ 2,500.00\n6910\nD6079\nD6079\nImplant\/abutment supported fixed denture for partially edentulous\narch\n$ 1,650.00\n6911\nD6090\nD6090\nRepair implant supported prosthesis, by report\n$ 493.00\n6912\nD6095\nD6095\nREPAIR IMPLANT ABUTMENT, BY REPORT\n$ 500.00\n6913\nD6100\nD6100\nImplant removal, by report\n$ 526.00\n6914\nD6199\nD6199\nUnspecified implant procedure, by report\nIndividual Report\n6915\nD6210\nD6210\nPontic - cast high noble metal\n$ 725.00\n6916\nD6211\nD6211\nPontic - cast predominantly base metal\n$ 675.00\n6917\nD6212\nD6212\nPontic - cast noble metal\n$ 778.00\n6918\nD6240\nD6240\nPontic - porcelain fused to high noble metal\n$ 735.00\n6919\nD6241\nD6241\nPontic - porcelain fused to predominantly base metal\n$ 680.00\n6920\nD6242\nD6242\nPontic - porcelain fused to noble metal\n$ 745.00\n6921\nD6245\nD6245\nPontic - porcelain\/ceramic\n$ 749.00\n6922\nD6250\nD6250\nPontic - resin with high noble metal\n$ 727.00\n6923\nD6251\nD6251\nPontic - resin with predominantly base metal\n$ 680.00\n6924\nD6252\nD6252\nPontic - resin with noble metal\n$ 722.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6925\nD6545\nD6545\nRetainer - cast metal for resin bonded fixed prosthesis\n$ 452.00\n6926\nD6548\nD6548\nRetainer - porcelain\/ceramic for resin bonded fixed prosthesis\n$ 603.00\n6927\nD6600\nD6600\nInlay - porcelain\/ceramic, two surfaces\n$ 750.00\n6928\nD6601\nD6601\nInlay - porcelain\/ceramic, three or more surfaces\n$ 750.00\n6929\nD6608\nD6608\nOnlay -porcelain\/ceramic, two surfaces\n$ 750.00\n6930\nD6609\nD6609\nOnlay - porcelain\/ceramic, three or more surfaces\n$ 750.00\n6931\nD6710\nD6710\nCrown - indirect resin based composite\n$ 250.00\n6932\nD6720\nD6720\nCrown - resin with high noble metal\n$ 750.00\n6933\nD6721\nD6721\nCrown - resin with predominantly base metal\n$ 700.00\n6934\nD6722\nD6722\nCrown - resin with noble metal\n$ 727.00\n6935\nD6740\nD6740\nCrown - porcelain\/ceramic\n$ 768.00\n6936\nD6750\nD6750\nCrown - porcelain fused to high noble metal\n$ 745.00\n6937\nD6751\nD6751\nCrown - porcelain fused to predominantly base metal\n$ 685.00\n6938\nD6752\nD6752\nCrown - porcelain fused to noble metal\n$ 745.00\n6939\nD6780\nD6780\nCrown - 3\/4 cast high noble metal\n$ 727.00\n6940\nD6781\nD6781\nCrown - 3\/4 cast predominantly base metal\n$ 718.00\n6941\nD6782\nD6782\nCrown - 3\/4 cast noble metal\n$ 748.00\n6942\nD6783\nD6783\nCrown - 3\/4 porcelain\/ceramic\n$ 773.00\n6943\nD6790\nD6790\nCrown - full cast high noble metal\n$ 778.00\n6944\nD6791\nD6791\nCrown - full cast predominantly base metal\n$ 675.00\n6945\nD6792\nD6792\nCrown - full cast noble metal\n$ 709.00\n6946\nD6920\nD6920\nConnector bar\n$ 647.00\n6947\nD6930\nD6930\nRecement fixed partial denture\n$ 95.00\n6948\nD6940\nD6940\nStress breaker\n$ 272.00\n6949\nD6950\nD6950\nPrecision attachment\n$ 427.00\n6950\nD6975\nD6975\nCoping\n$ 471.00\n6951\nD6980\nD6980\nFixed partial denture repair necessitated by restorative material\nfailure\n$ 250.00\n6952\nD6999\nD6999\nUnspecified fixed prosthodontic procedure, by report\nIndividual Report\n6953\nD7111\nD7111\nExtraction, coronal remnants - deciduous tooth\n$ 77.00\n6954\nD7140\nD7140\nExtraction, erupted tooth or exposed root (elevation and\/or forceps\nremoval)\n$ 77.00\n6955\nD7210\nD7210\nSurgical removal of erupted tooth requiring removal of bone and\/or\nsectioning of tooth, and including elevation of mucoperiosteal flap if\nindicated\n$ 300.00\n6956\nD7220\nD7220\nRemoval of impacted tooth - soft tissue\n$ 330.00\n6957\nD7230\nD7230\nRemoval of impacted tooth - partially bony\n$ 270.00\n6958\nD7240\nD7240\nRemoval of impacted tooth - completely bony\n$ 300.00\n6959\nD7241\nD7241\nRemoval of impacted tooth - completely bony, with unusual surgical\ncomplications\n$ 395.00\n6960\nD7250\nD7250\nSurgical removal of residual tooth roots (cutting procedure)\n$ 193.00\n6961\nD7260\nD7260\nOroantral fistula closure\n$ 445.00\n6962\nD7270\nD7270\nTooth reimplantation and\/or stabilization of accidentally evulsed or\ndisplaced tooth\n$ 334.00\n6963\nD7272\nD7272\nTooth transplantation (includes reimplantation from one site to\nanother and splinting and\/or stabilization)\n$ 444.00\n6964\nD7280\nD7280\nSurgical access of an unerupted tooth\n$ 310.00\n6965\nD7282\nD7282\nMobilization of erupted or malpositioned tooth to aid eruption\n$ 250.00\n6966\nD7283\nD7283\nPlacement of device to facilitate eruption of impacted tooth\n$ 250.00\n6967\nD7285\nD7285\nBiopsy of oral tissue - hard (bone, tooth)\n$ 165.00\n6968\nD7286\nD7286\nBiopsy of oral tissue - soft\n$ 165.00\n6969\nD7290\nD7290\nSurgical repositioning of teeth\n$ 280.00\n6970\nD7291\nD7291\nTransseptal fiberotomy\/supra crestal fiberotomy, by report\n$ 190.00\n6971\nD7310\nD7310\nAlveoloplasty in conjunction with extractions - four or more teeth or\ntooth spaces, per quadrant\n$ 165.00\n6972\nD7320\nD7320\nAlveoloplasty not in conjunction with extractions -four or more\nteeth or tooth spaces, per quadrant\n$ 277.00\n6973\nD7340\nD7340\nVestibuloplasty - ridge extension (secondary epithelialization)\n$ 602.00\n6974\nD7410\nD7410\nExcision of benign lesion up to 1.25 cm\n$ 262.00\n6975\nD7440\nD7440\nExcision of malignant tumor - lesion diameter up to 1.25 cm\n$ 364.00\n6976\nD7441\nD7441\nExcision of malignant tumor - lesion diameter greater than 1.25 cm\n$ 707.00\n6977\nD7450\nD7450\nRemoval of benign odontogenic cyst or tumor - lesion diameter up\nto 1.25 cm\n$ 323.00\n6978\nD7451\nD7451\nRemoval of benign odontogenic cyst or tumor - lesion diameter\ngreater than 1.25 cm\n$ 448.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n6979\nD7460\nD7460\nRemoval of benign nonodontogenic cyst or tumor - lesion diameter\nup to 1.25 cm\n$ 315.00\n6980\nD7461\nD7461\nRemoval of benign nonodontogenic cyst or tumor - lesion diameter\ngreater than 1.25 cm\n$ 453.00\n6981\nD7465\nD7465\nDestruction of lesion(s) by physical or chemical method, by report\n$ 229.00\n6982\nD7471\nD7471\nRemoval of lateral exostosis (maxilla or mandible)\n$ 373.00\n6983\nD7490\nD7490\nRadical resection of maxilla or mandible\n$ 6,125.00\n6984\nD7510\nD7510\nIncision and drainage of abscess - intraoral soft tissue\n$ 145.00\n6985\nD7520\nD7520\nIncision and drainage of abscess - extraoral soft tissue\n$ 232.00\n6986\nD7530\nD7530\nRemoval of foreign body from mucosa, skin, or subcutaneous\nalveolar tissue\n$ 223.00\n6987\nD7540\nD7540\nRemoval of reaction producing foreign bodies, musculoskeletal\nsystem\n$ 359.00\n6988\nD7550\nD7550\nPartial ostectomy\/sequestrectomy for removal of non-vital bone\n$ 313.00\n6989\nD7560\nD7560\nMaxillary sinusotomy for removal of tooth fragment or foreign body $ 679.00\n6990\nD7610\nD7610\nMaxilla - open reduction (teeth immobilized, if present)\n$ 2,989.00\n6991\nD7620\nD7620\nMaxilla - closed reduction (teeth immobilized, if present)\n$ 2,295.00\n6992\nD7630\nD7630\nMandible - open reduction (teeth immobilized, if present)\n$ 2,959.00\n6993\nD7640\nD7640\nMandible - closed reduction (teeth immobilized, if present)\n$ 2,174.00\n6994\nD7650\nD7650\nMalar and\/or zygomatic arch - open reduction\n$ 2,720.00\n6995\nD7660\nD7660\nMalar and\/or zygomatic arch - closed reduction\n$ 2,227.00\n6996\nD7670\nD7670\nAlveolus closed reduction may include stabilization of teeth\n$ 862.00\n6997\nD7680\nD7680\nFacial bones - complicated reduction with fixation and multiple\nsurgical approaches\n$ 4,768.00\n6998\nD7710\nD7710\nMaxilla open reduction\n$ 3,259.00\n6999\nD7720\nD7720\nMaxilla - closed reduction\n$ 2,161.00\n7000\nD7730\nD7730\nMandible - open reduction\n$ 3,294.00\n7001\nD7740\nD7740\nMandible - closed reduction\n$ 2,435.00\n7002\nD7750\nD7750\nMalar and\/or zygomatic arch - open reduction\n$ 2,875.00\n7003\nD7760\nD7760\nMalar and\/or zygomatic arch - closed reduction\n$ 2,669.00\n7004\nD7770\nD7770\nAlveolus - open reduction stabilization of teeth\n$ 1,675.00\n7005\nD7780\nD7780\nFacial bones - complicated reduction with fixation and multiple\nsurgical approaches\n$ 5,886.00\n7006\nD7810\nD7810\nOpen reduction of dislocation\n$ 2,980.00\n7007\nD7820\nD7820\nClosed reduction of dislocation\n$ 305.00\n7008\nD7830\nD7830\nManipulation under anesthesia\n$ 397.00\n7009\nD7840\nD7840\nCondylectomy\n$ 3,974.00\n7010\nD7850\nD7850\nSurgical discectomy, with\/without implant\n$ 3,935.00\n7011\nD7852\nD7852\nDisc repair\n$ 4,188.00\n7012\nD7854\nD7854\nSynovectomy\n$ 4,157.00\n7013\nD7856\nD7856\nMyotomy\nIndividual Report\n7014\nD7858\nD7858\nJoint reconstruction\nIndividual Report\n7015\nD7860\nD7860\nArthrotomy\nIndividual Report\n7016\nD7865\nD7865\nArthroplasty\nIndividual Report\n7017\nD7870\nD7870\nArthrocentesis\nIndividual Report\n7018\nD7871\nD7871\nNon-arthroscopic lysis and lavage\nIndividual Report\n7019\nD7872\nD7872\nArthroscopy - diagnosis, with or without biopsy\nIndividual Report\n7020\nD7873\nD7873\nArthroscopy - surgical: lavage and lysis of adhesions\nIndividual Report\n7021\nD7874\nD7874\nArthroscopy - surgical: disc repositioning and stabilization\nIndividual Report\n7022\nD7875\nD7875\nArthroscopy - surgical: synovectomy\nIndividual Report\n7023\nD7876\nD7876\nArthroscopy - surgical: discectomy\nIndividual Report\n7024\nD7877\nD7877\nArthroscopy - surgical: debridement\nIndividual Report\n7025\nD7880\nD7880\nOcclusal orthotic device, by report\n$ 598.00\n7026\nD7899\nD7899\nUnspecified TMD therapy, by report\nIndividual Report\n7027\nD7910\nD7910\nSuture of recent small wounds up to 5 cm\n$ 190.00\n7028\nD7911\nD7911\nComplicated suture - up to 5 cm\n$ 294.00\n7029\nD7912\nD7912\nComplicated suture - greater than 5 cm\n$ 415.00\n7030\nD7920\nD7920\nSkin graft (identify defect covered, location and type of graft)\n$ 1,611.00\n7031\nD7940\nD7940\nOsteoplasty - for orthognathic deformities\n$ 2,476.00\n7032\nD7941\nD7941\nOsteotomy - mandibular rami\n$ 6,322.00\n7033\nD7943\nD7943\nOsteotomy - mandibular rami with bone graft; includes obtaining\nthe graft\n$ 5,948.00\n7034\nD7944\nD7944\nOsteotomy - segmented or subapical\n$ 4,735.00\n7035\nD7945\nD7945\nOsteotomy - body of mandible\n$ 4,895.00\n7036\nD7946\nD7946\nLeFort I (maxilla - total)\n$ 5,962.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n7037\nD7947\nD7947\nLeFort I (maxilla - segmented)\n$ 6,104.00\n7038\nD7949\nD7949\nLeFort II or LeFort III - with bone graft\n$ 8,333.00\n7039\nD7955\nD7955\nRepair of maxillofacial soft and\/or hard tissue defect\n$ 1,898.00\n7040\nD7960\nD7960\nFrenulectomy - also known as frenectomy or frenotomy - separate\nprocedure not incidental to another procedure\n$ 275.00\n7041\nD7970\nD7970\nExcision of hyperplastic tissue - per arch\n$ 320.00\n7042\nD7971\nD7971\nExcision of pericoronal gingiva\n$ 150.00\n7043\nD7980\nD7980\nSialolithotomy\n$ 399.00\n7044\nD7981\nD7981\nExcision of salivary gland, by report\n$ 2,389.00\n7045\nD7982\nD7982\nSialodochoplasty\n$ 1,150.00\n7046\nD7983\nD7983\nClosure of salivary fistula\n$ 610.00\n7047\nD7990\nD7990\nEmergency tracheotomy\n$ 870.00\n7048\nD7991\nD7991\nCoronoidectomy\n$ 2,775.00\n7049\nD7995\nD7995\nSynthetic graft - mandible or facial bones, by report\nIndividual Report\n7050\nD7996\nD7996\nImplant-mandible for augmentation purposes (excluding alveolar\nridge), by report\nIndividual Report\n7051\nD7997\nD7997\nAppliance removal (not by dentist who placed appliance), includes\nremoval of archbar\nIndividual Report\n7052\nD7999\nD7999\nUnspecified oral surgery procedure, by report\nIndividual Report\n7053\nD8010\nD8010\nLimited orthodontic treatment of the primary dentition\n$ 1,200.00\n7054\nD8020\nD8020\nLimited orthodontic treatment of the transitional dentition\n$ 1,485.00\n7055\nD8030\nD8030\nLimited orthodontic treatment of the adolescent dentition\n$ 1,616.00\n7056\nD8040\nD8040\nLimited orthodontic treatment of the adult dentition\n$ 1,562.00\n7057\nD8050\nD8050\nInterceptive orthodontic treatment of the primary dentition\n$ 1,545.00\n7058\nD8060\nD8060\nInterceptive orthodontic treatment of the transitional dentition\n$ 1,775.00\n7059\nD8070\nD8070\nComprehensive orthodontic treatment of the transitional dentition\n$ 3,968.00\n7060\nD8080\nD8080\nComprehensive orthodontic treatment of the adolescent dentition\n$ 3,998.00\n7061\nD8090\nD8090\nComprehensive orthodontic treatment of the adult dentition\n$ 4,125.00\n7062\nD8210\nD8210\nRemovable appliance therapy\n$ 231.00\n7063\nD8220\nD8220\nFixed appliance therapy\n$ 231.00\n7064\nD8660\nD8660\nPre-orthodontic treatment visit\n$ 170.00\n7065\nD8670\nD8670\nPeriodic orthodontic treatment visit (as part of contract)\n$ 129.00\n7066\nD8680\nD8680\nOrthodontic retention (removal of appliances, construction and\nplacement of retainer(s))\n$ 275.00\n7067\nD8690\nD8690\nOrthodontic treatment (alternative billing to a contract fee)\n$ 160.00\n7068\nD8691\nD8691\nRepair of orthodontic appliance\n$ 134.00\n7069\nD8692\nD8692\nReplacement of lost or broken retainer\n$ 232.00\n7070\nD8999\nD8999\nUnspecified orthodontic procedure, by report\nIndividual Report\n7071\nD9110\nD9110\nPalliative (emergency) treatment of dental pain - minor procedure\n$ 79.00\n7072\nD9210\nD9210\nLocal anesthesia not in conjunction with operative or surgical\nprocedures\n$ 45.00\n7073\nD9211\nD9211\nRegional block anesthesia\n$ 64.00\n7074\nD9212\nD9212\nTrigeminal division block anesthesia\n$ 168.00\n7075\nD9215\nD9215\nLocal anesthesia in conjunction with operative or surgical\nprocedures\n$ 39.00\n7076\nD9220\nD9220\nDeep sedation\/general anesthesia - first 30 minutes\n$ 250.00\n7077\nD9221\nD9221\nDeep sedation\/general anesthesia - each additional 15 minutes\n$ 105.00\n7078\nD9230\nD9230\nInhalation of nitrous oxide \/ anxiolysis, analgesia\n$ 45.00\n7079\nD9241\nD9241\nIntravenous conscious sedation\/analgesia - first 30 minutes\n$ 250.00\n7080\nD9242\nD9242\nIntravenous conscious sedation\/analgesia - each additional 15\nminutes\n$ 95.00\n7081\nD9248\nD9248\nNon-intravenous conscious sedation\n$ 194.00\n7082\nD9410\nD9410\nHouse\/extended care facility call\n$ 129.00\n7083\nD9420\nD9420\nHospital or ambulatory surgical center call\n$ 150.00\n7084\nD9430\nD9430\nOffice visit for observation (during regularly scheduled hours) - no\nother services performed\n$ 47.00\n7085\nD9440\nD9440\nOffice visit - after regularly scheduled hours\n$ 95.00\n7086\nD9610\nD9610\nTherapeutic parenteral drug, single administration\n$ 60.00\n7087\nD9630\nD9630\nOther drugs and\/or medicaments, by report\n$ 30.00\n7088\nD9910\nD9910\nApplication of desensitizing medicament\n$ 40.00\n7089\nD9911\nD9911\nApplication of desensitizing resin for cervical and\/or root surface,\nper tooth\n$ 46.00\n7090\nD9920\nD9920\nBehavior management, by report\n$ 85.00\n\nCayman Islands Health Services Authority Charge Master\n\nRow #\nBill Code\nModifer\nCPT-4\nHCPCS\nCPT\/HCPCS Long Description\nPrice\n7091\nD9930\nD9930\nTreatment of complications (post-surgical) - unusual circumstances,\nby report\n$ 91.00\n7092\nD9940\nD9940\nOcclusal guard, by report\n$ 250.00\n7093\nD9941\nD9941\nFabrication of athletic mouthguard\n$ 80.00\n7094\nD9950\nD9950\nOcclusion analysis - mounted case\n$ 210.00\n7095\nD9951\nD9951\nOcclusal adjustment - limited\n$ 110.00\n7096\nD9952\nD9952\nOcclusal adjustment - complete\n$ 220.00\n7097\nD9970\nD9970\nEnamel microabrasion\n$ 142.00\n7098\nD9971\nD9971\nOdontoplasty 1 - 2 teeth; includes removal of enamel projections\n$ 85.00\n7099\nD9972\nD9972\nExternal bleaching - per arch - performed in office\n$ 211.00\n7100\nD9973\nD9973\nExternal bleaching - per tooth\n$ 160.00\n7101\nD9974\nD9974\nInternal bleaching - per tooth\n$ 189.00\n7102\nD9999\nD9999\nUnspecified adjunctive procedure, by report\nIndividual Report\n7103\nHS0002\nROOM\/BED: Critical Care\n$ 1,507.00\n7104\nHS0003\nROOM\/BED: High Dependancy\n$ 440.00\n7105\nHS0009\nROOM\/BED: Neonatal\n$ -\n7106\nHS0040\nROOM\/BED: Isolation\n$ 330.00\n7107\nHS0042\nROOM\/BED: Semi Private\n$ 330.00\n7108\nHS0043\nROOM\/BED: Maternal Care\n$ 495.00\n7109\nHS0045\nROOM\/BED: Neonatal - High Dependency\n$ 440.00\n7110\nHS0046\nROOM\/BED: Neonatal - Special Care\n$ 330.00\n7111\nHS0048\nROOM\/BED: Neonatal - Intensive\n$ 1,507.00\n7112\nHS0050\nROOM\/BED: Psychiatry\n$ 330.00\n7113\nHS0060\nROOM\/BED: Private\n$ 467.50\n7114\nHS0070\nDay Treatment\n$ 220.00\n7115\nHS0070\nROOM\/BED: Day Treatment\n$ 220.00\n7116\nHS0080\nROOM\/BED: Sub Acute\n$ 220.00\n7117\nHS0106\nOperating Room Facility Fee 1st Hour\n$ 660.00\n7118\nHS0108\nOperating Room Facility Fee Add. Hours\n$ 192.50\n7119\nHS1013\nLabour & Delivery Room\n$ 825.00\n7120\nHS1015\nOR Facility Fee Dental <1 Hr\n$ 286.00\n7121\nHS1017\nOR Facility Fee Dental >1 Hr\n$ 517.00\n7122\nS9460\nS9460\nDiabetic management program, nurse visit\n$ 36.97\n7123\nS9981\nS9981\nMedical records copying fee, administrative\n$ 5.50\n7124\nS9982\nS9982\nMedical records copying fee, per page\n$ 0.55\n7125\nV5014\nV5014\nRepair\/modification of a hearing aid ( In- House)\n$ 25.00\n7126\nV5030\nV5030\nHearing aid, monaural, body worn, air conduction\nCost","akn_extracted_at":"2026-06-22 15:38:42.425033+00","cms_id":"2014-0074","law_type":"subordinate","year":"2014","number":"74","title":"Health Services Authority Charge Master","status":"in_force"},"provenance":{"files":[{"file_id":"5083","expr_id":"234","kind":"akn_xml","filename":"2014-0074_SL 74 of 2014.akn.xml","source_url":null,"storage_path":"\/Users\/q\/kyleg-data\/working\/SUBORDINATE\/2014\/2014-0074\/2014-0074_SL 74 of 2014.akn.xml","content_md5":"a61044c17376e03289c1e25c79e47f28","byte_size":"1048580","http_last_modified":null,"fetched_at":"2026-06-22 15:38:46.262065+00"},{"file_id":"467","expr_id":"234","kind":"pristine_pdf","filename":"2014-0074_SL 74 of 2014.pdf","source_url":"\/cms\/images\/LEGISLATION\/SUBORDINATE\/2014\/2014-0074\/2014-0074_SL 74 of 2014.pdf","storage_path":"\/Users\/q\/kyleg-data\/pristine\/SUBORDINATE\/2014\/2014-0074\/2014-0074_SL 74 of 2014.pdf","content_md5":"2e387344445560178677cfa90a9ec655","byte_size":"10521844","http_last_modified":null,"fetched_at":"2026-06-21 23:09:35.445579+00"},{"file_id":"468","expr_id":"234","kind":"working_pdf","filename":"2014-0074_SL 74 of 2014.pdf","source_url":"\/cms\/images\/LEGISLATION\/SUBORDINATE\/2014\/2014-0074\/2014-0074_SL 74 of 2014.pdf","storage_path":"\/Users\/q\/kyleg-data\/working\/SUBORDINATE\/2014\/2014-0074\/2014-0074_SL 74 of 2014.pdf","content_md5":"2e387344445560178677cfa90a9ec655","byte_size":"10521844","http_last_modified":null,"fetched_at":"2026-06-21 23:09:35.445579+00"}],"paragraph_count":222,"latest_history":null},"quality":{"expr_id":"234","doc_id":"234","quality_state":"needs_review","quality_score":"76","needs_human_review":"t","deterministic_categories":"{duplicate_text,page_header_footer_noise}","llm_categories":"{truncated_text,other}","repair_actions":"{collapse_duplicate_text,manual_review,reextract_full_text,strip_page_furniture}","finding_severity_counts":"{\"low\": 1, \"medium\": 1}","finding_summary":"Sample shows likely truncation at end and a possible duplicate row header; review full document for completeness.","assessed_at":"2026-06-22 15:29:45.675671+00","updated_at":"2026-06-22 15:29:45.675671+00"}}