CPT code 45333: Flexible sigmoidoscopy, hot biopsy forceps removal2026 Medicare rate & RVUs in North Dakota
Reports flexible sigmoidoscopy with removal of a colorectal lesion using hot biopsy forceps, such as treatment of a polyp found in the examined segment.
In North Dakota, Medicare pays $363.71 for 45333 in the office and $82.14 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 45333 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 45333 covers
A flexible sigmoidoscope is advanced through the rectum to examine the lower colon. During the examination, the endoscopist uses hot biopsy forceps to grasp and remove a lesion, commonly a small polyp. Gastroenterologists and other physicians trained in gastrointestinal endoscopy perform this service in settings such as an endoscopy center or hospital outpatient department.
Select this code when the documented removal technique is hot biopsy forceps, rather than tissue sampling alone or removal by snare. The report should identify the examined segment, lesion, and removal method. When related endoscopies are performed in the same session, CMS applies endoscopy-family pricing rather than pricing each service independently. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment is barred, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How North Dakota compares for 45333
Across 109 of 109 payment localities, the office rate for 45333 runs from $320.76 in Arkansas to $507.37 in San Benito County, CA. North Dakota pays $363.71. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$363.71
- Los Angeles, CA · California$424.46+$60.75
- Washington, DC area · District of Columbia$426.86+$63.15
- Miami, FL · Florida$392.04+$28.33
- Chicago, IL · Illinois$379.50+$15.79
- Manhattan, NY · New York$425.88+$62.17
- Alaska · Alaska$410.17+$46.46
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $326.10 | $79.73 |
| ArkansasArkansas | $320.76 | $78.89 |
| ArizonaArizona | $357.40 | $84.56 |
| Bakersfield, CACalifornia | $395.95 | $87.35 |
| Chico, CACalifornia | $395.31 | $86.71 |
| El Centro, CACalifornia | $395.35 | $86.75 |
| Fresno, CACalifornia | $395.31 | $86.71 |
| Hanford, CACalifornia | $395.31 | $86.71 |
| Madera, CACalifornia | $395.31 | $86.71 |
| Merced, CACalifornia | $395.31 | $86.71 |
| Modesto, CACalifornia | $395.31 | $86.71 |
| Napa, CACalifornia | $466.31 | $95.20 |
| Oxnard, CACalifornia | $423.19 | $90.38 |
| Redding, CACalifornia | $395.31 | $86.71 |
| Rest of CaliforniaCalifornia | $395.31 | $86.71 |
| Riverside, CACalifornia | $397.69 | $89.09 |
| Sacramento, CACalifornia | $417.06 | $89.60 |
| Salinas, CACalifornia | $415.57 | $89.23 |
| San Diego, CACalifornia | $427.04 | $90.29 |
| Marin County, CACalifornia | $496.11 | $99.10 |
| San Francisco, CACalifornia | $495.86 | $98.85 |
| San Benito County, CACalifornia | $507.37 | $101.34 |
| Santa Clara County, CACalifornia | $506.34 | $100.32 |
| San Luis Obispo, CACalifornia | $408.66 | $87.95 |
| Santa Cruz, CACalifornia | $432.44 | $90.33 |
| Santa Maria, CACalifornia | $417.59 | $89.28 |
| Santa Rosa, CACalifornia | $436.93 | $91.16 |
| Stockton, CACalifornia | $395.31 | $86.71 |
| Vallejo, CACalifornia | $465.95 | $94.84 |
| Visalia, CACalifornia | $395.31 | $86.71 |
| Yuba City, CACalifornia | $395.31 | $86.71 |
| ColoradoColorado | $386.93 | $87.34 |
| ConnecticutConnecticut | $394.52 | $91.27 |
| DelawareDelaware | $363.86 | $85.67 |
| Fort Lauderdale, FLFlorida | $378.05 | $92.82 |
| Rest of FloridaFlorida | $358.12 | $88.94 |
| Atlanta, GAGeorgia | $374.67 | $88.60 |
| Rest of GeorgiaGeorgia | $335.98 | $84.82 |
| Hawaii, Guam, HIHawaii | $407.49 | $87.35 |
| IowaIowa | $337.27 | $79.64 |
| IdahoIdaho | $339.38 | $80.34 |
| East St. Louis, ILIllinois | $350.71 | $91.66 |
| Rest of IllinoisIllinois | $345.22 | $88.15 |
| Suburban Chicago, ILIllinois | $382.48 | $93.31 |
| IndianaIndiana | $341.65 | $80.63 |
| KansasKansas | $334.64 | $80.11 |
| KentuckyKentucky | $333.01 | $82.70 |
| New Orleans, LALouisiana | $350.77 | $85.81 |
| Rest of LouisianaLouisiana | $332.09 | $82.90 |
| Metropolitan Boston, MAMassachusetts | $429.53 | $93.34 |
| Rest of MassachusettsMassachusetts | $383.84 | $87.35 |
| Baltimore area, MDMaryland | $393.28 | $91.15 |
| Rest of MarylandMaryland | $371.70 | $86.75 |
| Rest of MaineMaine | $340.48 | $81.43 |
| Southern Maine, MEMaine | $362.57 | $83.54 |
| Detroit, MIMichigan | $362.26 | $90.54 |
| Rest of MichiganMichigan | $342.03 | $84.96 |
| MinnesotaMinnesota | $371.90 | $82.17 |
| Metropolitan Kansas City, MOMissouri | $348.98 | $84.59 |
| Metropolitan St. Louis, MOMissouri | $353.20 | $85.14 |
| Rest of MissouriMissouri | $325.07 | $82.35 |
| MississippiMississippi | $323.03 | $80.60 |
| MontanaMontana | $368.06 | $86.49 |
| North CarolinaNorth Carolina | $344.64 | $81.93 |
| NebraskaNebraska | $339.61 | $79.73 |
| New HampshireNew Hampshire | $379.88 | $86.77 |
| Northern New JerseyNew Jersey | $421.40 | $94.78 |
| Rest of New JerseyNew Jersey | $399.36 | $91.88 |
| New MexicoNew Mexico | $343.80 | $85.60 |
| NevadaNevada | $367.16 | $85.31 |
| NYC suburbs and Long Island, NYNew York | $436.25 | $101.46 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $401.37 | $93.05 |
| Queens, NYNew York | $431.03 | $98.21 |
| Rest of New YorkNew York | $350.38 | $82.89 |
| OhioOhio | $341.14 | $84.07 |
| OklahomaOklahoma | $333.24 | $81.80 |
| Portland, OROregon | $401.45 | $88.62 |
| Rest of OregonOregon | $364.65 | $84.21 |
| Metropolitan Philadelphia, PAPennsylvania | $383.13 | $90.01 |
| Rest of PennsylvaniaPennsylvania | $342.23 | $83.75 |
| Puerto RicoPuerto Rico | $371.38 | $86.71 |
| Rhode IslandRhode Island | $378.48 | $87.62 |
| South CarolinaSouth Carolina | $343.39 | $83.22 |
| South DakotaSouth Dakota | $363.20 | $81.63 |
| TennesseeTennessee | $336.44 | $80.49 |
| Austin, TXTexas | $385.34 | $87.44 |
| Beaumont, TXTexas | $339.63 | $83.40 |
| Brazoria, TXTexas | $364.07 | $85.04 |
| Dallas, TXTexas | $366.25 | $85.80 |
| Fort Worth, TXTexas | $363.24 | $85.61 |
| Galveston, TXTexas | $365.05 | $85.45 |
| Houston, TXTexas | $369.07 | $89.47 |
| Rest of TexasTexas | $351.54 | $84.33 |
| UtahUtah | $348.71 | $84.04 |
| VirginiaVirginia | $360.64 | $83.86 |
| Virgin Islands, VIUnited States Virgin Islands | $371.38 | $86.71 |
| VermontVermont | $361.34 | $82.59 |
| Rest of WashingtonWashington | $383.42 | $86.93 |
| King County, WAWashington | $439.69 | $94.21 |
| WisconsinWisconsin | $349.96 | $80.22 |
| West VirginiaWest Virginia | $330.60 | $85.91 |
| WyomingWyoming | $366.17 | $84.60 |
45333 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$320.76
$451.34
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $410.17 | 1 |
| AL | $326.10 | 1 |
| AR | $320.76 | 1 |
| AZ | $357.40 | 1 |
| CA | $395.31–$507.37 | 29 |
| CO | $386.93 | 1 |
| CT | $394.52 | 1 |
| DC | $426.86 | 1 |
| DE | $363.86 | 1 |
| FL | $358.12–$392.04 | 3 |
| GA | $335.98–$374.67 | 2 |
| GU | $407.49 | 1 |
| HI | $407.49 | 1 |
| IA | $337.27 | 1 |
| ID | $339.38 | 1 |
| IL | $345.22–$382.48 | 4 |
| IN | $341.65 | 1 |
| KS | $334.64 | 1 |
| KY | $333.01 | 1 |
| LA | $332.09–$350.77 | 2 |
| MA | $383.84–$429.53 | 2 |
| MD | $371.70–$426.86 | 3 |
| ME | $340.48–$362.57 | 2 |
| MI | $342.03–$362.26 | 2 |
| MN | $371.90 | 1 |
| MO | $325.07–$353.20 | 3 |
| MS | $323.03 | 1 |
| MT | $368.06 | 1 |
| NC | $344.64 | 1 |
| ND | $363.71 | 1 |
| NE | $339.61 | 1 |
| NH | $379.88 | 1 |
| NJ | $399.36–$421.40 | 2 |
| NM | $343.80 | 1 |
| NV | $367.16 | 1 |
| NY | $350.38–$436.25 | 5 |
| OH | $341.14 | 1 |
| OK | $333.24 | 1 |
| OR | $364.65–$401.45 | 2 |
| PA | $342.23–$383.13 | 2 |
| PR | $371.38 | 1 |
| RI | $378.48 | 1 |
| SC | $343.39 | 1 |
| SD | $363.20 | 1 |
| TN | $336.44 | 1 |
| TX | $339.63–$385.34 | 8 |
| UT | $348.71 | 1 |
| VA | $360.64–$426.86 | 2 |
| VI | $371.38 | 1 |
| VT | $361.34 | 1 |
| WA | $383.42–$439.69 | 2 |
| WI | $349.96 | 1 |
| WV | $330.60 | 1 |
| WY | $366.17 | 1 |
How the 45333 rate is calculated
Each of 45333’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45333
RVUs × geographic indexes × conversion factor
Work1.51
1.51 RVUs× 1.000 GPCI
Practice expense9.29
9.29 RVUs× 1.000 GPCI
Malpractice0.22
0.22 RVUs× 1.000 GPCI
Adjusted RVUs
11.0200
Conversion factor
$33.4009
Medicare rate
$368.08
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,501
- Code
- 45333
- Physician work
- 1.51
- Practice expense
- 9.29
- Malpractice
- 0.22
GPCI2026.csv
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.51 | × 1.000 | 1.5100 |
| Practice expense | 9.29 | × 1.000 | 9.2900 |
| Malpractice | 0.22 | × 0.406 | 0.0893 |
| Total RVUs | 10.8893 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$363.71
Office: (1.51 × 1 + 9.29 × 1 + 0.22 × 0.406) × $33.4009 = $363.71
Facility: (1.51 × 1 + 0.86 × 1 + 0.22 × 0.406) × $33.4009 = $82.14
Payment rules and modifiers for 45333
The CMS indicators that decide how 45333 is paid alongside other services.
CMS payment indicators · 45333
Flexible sigmoidoscopy, hot biopsy forceps removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45333 without 51 · national office
$368.08
Flexible sigmoidoscopy, hot biopsy forceps removal
45333-51 · Second procedure: 50%
$184.04
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 45333 has changed in North Dakota
45333 · Office / nonfacility
$363.71
Effective 2026-10-01
The base rate is $56.45 higher than on 2025-10-01, moving from $307.26 to $363.71 (18.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$307.26changed to$363.71
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.55 changed to 1.51
- Practice expense RVU 7.83 changed to 9.29
- Malpractice RVU 0.23 changed to 0.22
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$323.36changed to$307.26
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 8.04 changed to 7.83
- Malpractice RVU 0.24 changed to 0.23
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$318.08changed to$323.36
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$332.40changed to$318.08
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 8.15 changed to 8.04
- Malpractice RVU 0.23 changed to 0.24
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$347.61changed to$332.40
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 8.40 changed to 8.15
- Malpractice RVU 0.22 changed to 0.23
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$347.55changed to$347.61
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 8.32 changed to 8.40
- Malpractice RVU 0.21 changed to 0.22
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$317.83changed to$347.55
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 7.15 changed to 8.32
- Malpractice RVU 0.22 changed to 0.21
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$308.48changed to$317.83
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 6.88 changed to 7.15
- Malpractice RVU 0.24 changed to 0.22
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$298.42changed to$308.48
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 6.61 changed to 6.88
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$295.05changed to$298.42
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 6.54 changed to 6.61
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$350.47changed to$295.05
- Conversion factor 35.8043 changed to 35.8887
- Work RVU 1.65 changed to 1.55
- Practice expense RVU 8.00 changed to 6.54
- Malpractice RVU 0.25 changed to 0.24
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$299.35changed to$350.47
- Conversion factor 35.9335 changed to 35.8043
- Work RVU 1.79 changed to 1.65
- Practice expense RVU 6.38 changed to 8.00
- Malpractice RVU 0.29 changed to 0.25
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$297.86changed to$299.35
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$296.62changed to$297.86
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 6.34 changed to 6.38
- Malpractice RVU 0.28 changed to 0.29
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$313.01changed to$296.62
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 7.26 changed to 6.34
- Malpractice RVU 0.29 changed to 0.28
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $313.01
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $363.71 | $82.14 | RVU26D |
| 2026-07-01 | $363.71 | $82.14 | RVU26C |
| 2026-04-01 | $363.71 | $82.14 | RVU26B |
| 2026-01-01 | $363.71 | $82.14 | RVU26A |
| 2025-10-01 | $307.26 | $87.30 | RVU25D |
| 2025-07-01 | $307.26 | $87.30 | RVU25C |
| 2025-04-01 | $307.26 | $87.30 | RVU25B |
| 2025-01-01 | $307.26 | $87.30 | RVU25A |
| 2024-10-01 | $323.36 | $89.35 | RVU24D |
| 2024-07-01 | $323.36 | $89.35 | RVU24C |
| 2024-04-01 | $323.36 | $89.35 | RVU24B |
| 2024-03-09 | $323.36 | $89.35 | RVU24AR |
| 2024-01-01 | $318.08 | $87.89 | RVU24A |
| 2023-10-01 | $332.40 | $89.43 | RVU23D |
| 2023-07-01 | $332.40 | $89.43 | RVU23C |
| 2023-04-01 | $332.40 | $89.43 | RVU23B |
| 2023-01-01 | $332.40 | $89.43 | RVU23A |
| 2022-10-01 | $347.61 | $90.84 | RVU22D |
| 2022-07-01 | $347.61 | $90.84 | RVU22C |
| 2022-04-01 | $347.61 | $90.84 | RVU22B |
| 2022-01-01 | $347.61 | $90.84 | RVU22A |
| 2021-10-01 | $347.55 | $91.09 | RVU21D |
| 2021-07-01 | $347.55 | $91.09 | RVU21C |
| 2021-04-01 | $347.55 | $91.09 | RVU21B |
| 2021-01-01 | $347.55 | $91.09 | RVU21A |
| 2020-10-01 | $317.83 | $93.71 | RVU20D |
| 2020-07-01 | $317.83 | $93.71 | RVU20C |
| 2020-04-01 | $317.83 | $93.71 | RVU20B |
| 2020-01-01 | $317.83 | $93.71 | RVU20A |
| 2019-10-01 | $308.48 | $94.41 | RVU19D |
| 2019-07-01 | $308.48 | $94.41 | RVU19C |
| 2019-04-01 | $308.48 | $94.41 | RVU19B |
| 2019-01-01 | $308.48 | $94.41 | RVU19A |
| 2018-10-01 | $298.42 | $95.02 | RVU18D |
| 2018-07-01 | $298.42 | $95.02 | RVU18C |
| 2018-04-01 | $298.42 | $95.02 | RVU18B |
| 2018-01-01 | $298.42 | $95.02 | RVU18AR1 |
| 2017-10-01 | $295.05 | $95.15 | RVU17D |
| 2017-07-01 | $295.05 | $95.15 | RVU17C |
| 2017-04-01 | $295.05 | $95.15 | RVU17B |
| 2017-01-01 | $295.05 | $95.15 | RVU17A |
| 2016-10-01 | $350.47 | $99.84 | RVU16D |
| 2016-07-01 | $350.47 | $99.84 | RVU16C |
| 2016-04-01 | $350.47 | $99.84 | RVU16B |
| 2016-01-01 | $350.47 | $99.84 | RVU16A |
| 2015-10-01 | $299.35 | $109.26 | RVU15D |
| 2015-07-01 | $299.35 | $109.26 | RVU15C |
| 2015-04-01 | $297.86 | $108.72 | RVU15B |
| 2015-01-01 | $297.86 | $108.72 | RVU15A |
| 2014-10-01 | $296.62 | $108.55 | RVU14D |
| 2014-07-01 | $296.62 | $108.55 | RVU14C |
| 2014-04-01 | $296.62 | $108.55 | RVU14B |
| 2014-01-01 | $296.62 | $108.55 | RVU14A |
| 2013-10-01 | $313.01 | $107.85 | RVU13D |
| 2013-07-01 | $313.01 | $107.85 | RVU13C |
| 2013-04-01 | $313.01 | $107.85 | RVU13B |
| 2013-01-01 | $313.01 | $107.85 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
45333 billing questions
When is this code appropriate instead of a biopsy code?
Use it when the lesion is removed with hot biopsy forceps. A procedure limited to taking tissue for examination is represented by the biopsy service.
How does this differ from snare removal?
This code identifies removal with hot biopsy forceps. Use the snare-removal code when the endoscopist removes the lesion using a snare.
How are related endoscopies in the same session paid?
CMS applies endoscopy-family pricing when related endoscopies are performed together, rather than pricing each as an independent endoscopy.
What documentation supports reporting this service?
Document the flexible sigmoidoscopy, the lesion and its location, and that hot biopsy forceps were used to remove it.
Can modifier 50 or an assistant-at-surgery service be reported?
Modifier 50 is inappropriate for this service. CMS also bars assistant-at-surgery payment and does not permit co-surgeons or team surgery.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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