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Medi-Cal Rates Information

Medi-Cal Rates as of 02/15/2020 (Codes 63285 thru 67107)

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month


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Proc Type Proc Code Procedure Description Unit Value Basic Rate Child Rate ER Rate Conv Ind ER Ind Cut-back Ind Prof % Rental Rate Non-Physn. Med.Prac. Ind
K 63285 BX/EXC IDRL IMED LESN CERVL 52.04 $1937.45 --- $2443.28 004 1 0 0.00 $0.00 Y
O 63285 BX/EXC IDRL IMED LESN CERVL 10.41 $387.56 --- $488.75 004 1 0 0.00 $0.00 Y
O 63286 BX/EXC IDRL IMED LESN THRC 10.98 $408.79 --- $515.51 004 1 0 0.00 $0.00 Y
K 63286 BX/EXC IDRL IMED LESN THRC 54.90 $2043.93 --- $2577.56 004 1 0 0.00 $0.00 Y
K 63287 BX/EXC IDRL IMED LESN THRLMB 53.22 $1981.38 --- $2498.68 004 1 0 0.00 $0.00 Y
O 63287 BX/EXC IDRL IMED LESN THRLMB 10.64 $396.13 --- $499.55 004 1 0 0.00 $0.00 Y
O 63290 BX/EXC XDRL/IDRL LSN ANY LVL 10.76 $400.59 --- $505.18 004 1 0 0.00 $0.00 Y
K 63290 BX/EXC XDRL/IDRL LSN ANY LVL 53.78 $2002.23 --- $2524.97 004 1 0 0.00 $0.00 Y
K 63295 REPAIR LAMINECTOMY DEFECT 5.10 $189.88 --- $239.45 004 1 0 0.00 $0.00 Y
O 63295 REPAIR LAMINECTOMY DEFECT 1.02 $37.98 --- $47.89 004 1 0 0.00 $0.00 Y
O 63300 REMOVE VERT XDRL BODY CRVCL 7.46 $277.74 --- $350.25 004 1 0 0.00 $0.00 Y
K 63300 REMOVE VERT XDRL BODY CRVCL 37.32 $1389.42 --- $1752.17 004 1 0 0.00 $0.00 Y
K 63301 REMOVE VERT XDRL BODY THRC 39.46 $1469.10 --- $1852.65 004 1 0 0.00 $0.00 Y
O 63301 REMOVE VERT XDRL BODY THRC 7.89 $293.74 --- $370.44 004 1 0 0.00 $0.00 Y
O 63302 REMOVE VERT XDRL BODY THRLMB 7.96 $296.35 --- $373.72 004 1 0 0.00 $0.00 Y
K 63302 REMOVE VERT XDRL BODY THRLMB 39.82 $1482.50 --- $1869.55 004 1 0 0.00 $0.00 Y
K 63303 REMOV VERT XDRL BDY LMBR/SAC 46.07 $1715.19 --- $2162.99 004 1 0 0.00 $0.00 Y
O 63303 REMOV VERT XDRL BDY LMBR/SAC 9.21 $342.89 --- $432.41 004 1 0 0.00 $0.00 Y
O 63304 REMOVE VERT IDRL BODY CRVCL 9.12 $339.54 --- $428.18 004 1 0 0.00 $0.00 Y
K 63304 REMOVE VERT IDRL BODY CRVCL 45.61 $1698.06 --- $2141.39 004 1 0 0.00 $0.00 Y
K 63305 REMOVE VERT IDRL BODY THRC 48.47 $1804.54 --- $2275.67 004 1 0 0.00 $0.00 Y
O 63305 REMOVE VERT IDRL BODY THRC 9.69 $360.76 --- $454.95 004 1 0 0.00 $0.00 Y
O 63306 REMOV VERT IDRL BDY THRCLMBR 9.52 $354.43 --- $446.96 004 1 0 0.00 $0.00 Y
K 63306 REMOV VERT IDRL BDY THRCLMBR 47.62 $1772.89 --- $2235.76 004 1 0 0.00 $0.00 Y
K 63307 REMOV VERT IDRL BDY LMBR/SAC 46.20 $1720.03 --- $2169.09 004 1 0 0.00 $0.00 Y
O 63307 REMOV VERT IDRL BDY LMBR/SAC 9.24 $344.01 --- $433.82 004 1 0 0.00 $0.00 Y
O 63308 REMOVE VERTEBRAL BODY ADD-ON 1.58 $58.82 --- $74.18 004 1 0 0.00 $0.00 Y
K 63308 REMOVE VERTEBRAL BODY ADD-ON 7.89 $293.74 --- $370.44 004 1 0 0.00 $0.00 Y
K 63600 REMOVE SPINAL CORD LESION 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
O 63600 REMOVE SPINAL CORD LESION 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
O 63610 STIMULATION OF SPINAL CORD 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 63610 STIMULATION OF SPINAL CORD 6.23 $231.94 --- $292.50 004 1 0 0.00 $0.00 Y
K 63620 SRS SPINAL LESION 14.27 $531.27 --- -- 004 0 0 0.00 $0.00 Y
O 63620 SRS SPINAL LESION 2.85 $106.11 --- -- 004 0 0 0.00 $0.00 Y
O 63621 SRS SPINAL LESION ADDL 0.89 $33.13 --- -- 004 0 0 0.00 $0.00 Y
K 63621 SRS SPINAL LESION ADDL 4.43 $164.93 --- -- 004 0 0 0.00 $0.00 Y
K 63650 IMPLANT NEUROELECTRODES 11.72 $436.34 --- $550.25 004 1 0 0.00 $0.00 Y
O 63650 IMPLANT NEUROELECTRODES 2.34 $87.12 --- $109.86 004 1 0 0.00 $0.00 Y
O 63655 IMPLANT NEUROELECTRODES 4.17 $155.25 --- $195.78 004 1 0 0.00 $0.00 Y
K 63655 IMPLANT NEUROELECTRODES 20.86 $776.62 --- $979.38 004 1 0 0.00 $0.00 Y
K 63661 REMOVE SPINE ELTRD PERQ ARAY 12.89 $479.89 --- -- 004 0 0 0.00 $0.00 Y
O 63661 REMOVE SPINE ELTRD PERQ ARAY 2.58 $96.05 --- -- 004 0 0 0.00 $0.00 Y
O 63662 REMOVE SPINE ELTRD PLATE 3.12 $116.16 --- -- 004 0 0 0.00 $0.00 Y
K 63662 REMOVE SPINE ELTRD PLATE 15.62 $581.53 --- -- 004 0 0 0.00 $0.00 Y
K 63663 REVISE SPINE ELTRD PERQ ARAY 18.76 $698.43 --- -- 004 0 0 0.00 $0.00 Y
O 63663 REVISE SPINE ELTRD PERQ ARAY 3.75 $139.61 --- -- 004 0 0 0.00 $0.00 Y
O 63664 REVISE SPINE ELTRD PLATE 3.25 $121.00 --- -- 004 0 0 0.00 $0.00 Y
K 63664 REVISE SPINE ELTRD PLATE 16.26 $605.36 --- -- 004 0 0 0.00 $0.00 Y
K 63685 INSRT/REDO SPINE N GENERATOR 10.16 $378.26 --- $477.01 004 1 0 0.00 $0.00 Y
O 63685 INSRT/REDO SPINE N GENERATOR 2.03 $75.58 --- $95.31 004 1 0 0.00 $0.00 Y
O 63688 REVISION OR REML OF IMPLANTED RECEIVER 1.63 $60.68 --- $76.53 004 1 0 0.00 $0.00 Y
K 63688 REVISION OR REML OF IMPLANTED RECEIVER 8.13 $302.68 --- $381.70 004 1 0 0.00 $0.00 Y
K 63700 REPAIR OF SPINAL HERNIATION 22.65 $843.26 --- $1063.42 004 1 0 0.00 $0.00 Y
O 63700 REPAIR OF SPINAL HERNIATION 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 63702 REPAIR OF SPINAL HERNIATION 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
K 63702 REPAIR OF SPINAL HERNIATION 22.65 $843.26 --- $1063.42 004 1 0 0.00 $0.00 Y
K 63704 REPAIR OF SPINAL HERNIATION 27.18 $1011.91 --- $1276.10 004 1 0 0.00 $0.00 Y
O 63704 REPAIR OF SPINAL HERNIATION 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
O 63706 REPAIR OF SPINAL HERNIATION 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
K 63706 REPAIR OF SPINAL HERNIATION 27.18 $1011.91 --- $1276.10 004 1 0 0.00 $0.00 Y
K 63707 REPAIR SPINAL FLUID LEAKAGE 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 63707 REPAIR SPINAL FLUID LEAKAGE 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 63709 REPAIR SPINAL FLUID LEAKAGE 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 63709 REPAIR SPINAL FLUID LEAKAGE 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
K 63710 GRAFT REPAIR OF SPINE DEFECT 22.60 $841.40 --- $1061.07 004 1 0 0.00 $0.00 Y
O 63710 GRAFT REPAIR OF SPINE DEFECT 4.52 $168.28 --- $212.21 004 1 0 0.00 $0.00 Y
O 63740 CREATION OF SHUNT, LUMBAR, INCLU LAMINEC 5.20 $193.60 --- $244.14 004 1 0 0.00 $0.00 Y
K 63740 CREATION OF SHUNT, LUMBAR, INCLU LAMINEC 26.00 $967.98 --- $1220.70 004 1 0 0.00 $0.00 Y
K 63741 SHUNT, LUMBAR, PERCUT 20.80 $774.38 --- $976.56 004 1 0 0.00 $0.00 Y
O 63741 SHUNT,LUMBAR,PERCUT 4.16 $154.88 --- $195.31 004 1 0 0.00 $0.00 Y
O 63744 REVISION OF SPINAL SHUNT 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 63744 REVISION OF SPINAL SHUNT 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 63746 REMOVAL OF SPINAL SHUNT 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
O 63746 REMOVAL OF SPINAL SHUNT 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
K 64400 NJX AA&/STRD TRIGEMINAL NRV 1.52 $56.59 --- $71.36 004 1 1 0.00 $0.00 Y
K 64405 NJX AA&/STRD GR OCPL NRV 1.69 $62.92 --- $79.35 004 1 1 0.00 $0.00 Y
K 64408 NJX AA&/STRD VAGUS NRV 1.78 $66.27 --- $83.57 004 1 1 0.00 $0.00 Y
K 64415 NJX AA&/STRD BRACH PLEXUS 1.94 $72.23 --- $91.08 004 1 0 0.00 $0.00 Y
K 64416 NJX AA&/STRD BRACH PLEX NFS 2.87 $106.85 --- $134.75 004 1 0 0.00 $0.00 Y
K 64417 NJX AA&/STRD AXILLARY NRV 1.75 $65.15 --- $82.16 004 1 0 0.00 $0.00 Y
K 64418 NJX AA&/STRD SPRSCAP NRV 1.63 $60.68 --- $76.53 004 1 0 0.00 $0.00 Y
K 64420 NJX AA&/STRD NTRCOST NRV 1 1.60 $59.57 --- $75.12 004 1 1 0.00 $0.00 Y
K 64421 NJX AA&/STRD NTRCOST NRV EA 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 64425 NJX AA&/STRD II IH NERVES 1.85 $68.88 --- $86.86 004 1 0 0.00 $0.00 Y
K 64430 NJX AA&/STRD PUDENDAL NERVE 1.88 $69.99 --- $88.27 004 1 0 0.00 $0.00 Y
K 64435 NJX AA&/STRD PARACRV NRV 1.96 $72.97 --- $92.02 004 1 0 0.00 $0.00 Y
K 64445 NJX AA&/STRD SCIATIC NERVE 2.11 $78.56 --- $99.06 004 1 1 0.00 $0.00 Y
K 64446 NJX AA&/STRD SCIATIC NRV NFS 2.67 $99.40 --- $125.36 004 1 0 0.00 $0.00 Y
K 64447 NJX AA&/STRD FEMORAL NERVE 1.32 $49.14 --- $61.97 004 1 0 0.00 $0.00 Y
K 64448 NJX AA&/STRD FEM NERVE NFS 2.46 $91.73 --- $115.50 004 1 0 0.00 $0.00 Y
K 64449 NJX AA&/STRD LMBR PLEX NFS 2.46 $91.62 --- $115.50 004 1 0 0.00 $0.00 Y
K 64450 NJX AA&/STRD OTHER PN/BRANCH 1.32 $49.14 --- $61.97 004 1 1 0.00 $0.00 Y
P 64450 NJX AA&/STRD OTHER PN/BRANCH 1.32 $49.14 --- -- 015 0 1 0.00 $0.00 Y
K 64451 NJX AA&/STRD NRV NRVTG SI JT 5.18 $193.01 --- -- 004 0 0 0.00 $0.00 Y
K 64454 NJX AA&/STRD GNCLR NRV BRNCH 5.23 $195.02 --- -- 004 0 0 0.00 $0.00 Y
K 64455 N BLOCK INJ PLANTAR DIGIT 0.76 $28.29 --- -- 004 0 1 0.00 $0.00 Y
P 64455 N BLOCK INJ PLANTAR DIGIT 0.76 $28.29 --- -- 015 0 1 0.00 $0.00 Y
K 64461 PVB THORACIC SINGLE INJ SITE 3.53 $131.42 --- -- 004 0 0 0.00 $0.00 Y
K 64462 PVB THORACIC 2ND+ INJ SITE 1.99 $74.09 --- -- 004 0 0 0.00 $0.00 Y
K 64463 PVB THORACIC CONT INFUSION 3.86 $143.71 --- -- 004 0 0 0.00 $0.00 Y
K 64479 INJ FORAMEN EPIDURAL C/T 4.15 $154.50 --- $194.84 004 1 0 0.00 $0.00 Y
K 64480 INJ FORAMEN EPIDURAL ADD-ON 3.77 $140.36 --- $177.00 004 1 0 0.00 $0.00 Y
K 64483 INJ FORAMEN EPIDURAL L/S 3.85 $143.34 --- $180.76 004 1 0 0.00 $0.00 Y
K 64484 INJ FORAMEN EPIDURAL ADD-ON 3.58 $133.28 --- $168.08 004 1 0 0.00 $0.00 Y
K 64486 TAP BLOCK UNIL BY INJECTION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64487 TAP BLOCK UNI BY INFUSION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64488 TAP BLOCK BI INJECTION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64489 TAP BLOCK BI BY INFUSION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64490 INJ PARAVERT F JNT C/T 1 LEV 4.32 $160.83 --- $202.82 004 1 0 0.00 $0.00 Y
K 64491 INJ PARAVERT F JNT C/T 2 LEV 2.14 $79.67 --- $100.47 004 1 0 0.00 $0.00 Y
K 64492 INJ PARAVERT F JNT C/T 3 LEV 2.17 $80.79 --- $101.88 004 1 0 0.00 $0.00 Y
K 64493 INJ PARAVERT F JNT L/S 1 LEV 3.88 $144.45 --- $182.17 004 1 0 0.00 $0.00 Y
K 64494 INJ PARAVERT F JNT L/S 2 LEV 1.96 $72.97 --- $92.02 004 1 0 0.00 $0.00 Y
K 64495 INJ PARAVERT F JNT L/S 3 LEV 1.99 $74.09 --- $93.43 004 1 0 0.00 $0.00 Y
K 64505 N BLOCK SPENOPALATINE GANGL 1.63 $60.68 --- $76.53 004 1 0 0.00 $0.00 Y
K 64510 N BLOCK STELLATE GANGLION 1.63 $60.68 --- $76.53 004 1 0 0.00 $0.00 Y
K 64517 N BLOCK INJ HYPOGAS PLXS 4.25 $158.18 --- $199.54 004 1 0 0.00 $0.00 Y
K 64520 N BLOCK LUMBAR/THORACIC 2.25 $83.77 --- $105.64 004 1 0 0.00 $0.00 Y
K 64530 N BLOCK INJ CELIAC PELUS 3.77 $140.36 --- $177.00 004 1 0 0.00 $0.00 Y
K 64553 IMPLANT NEUROELECTRODES 3.82 $142.22 --- $179.35 004 1 0 0.00 $0.00 Y
O 64553 IMPLANT NEUROELECTRODES 0.74 $27.55 --- $34.74 004 1 0 0.00 $0.00 Y
K 64566 NEUROELTRD STIM POST TIBIAL 3.16 $117.65 --- -- 004 0 1 0.00 $0.00 Y
K 64568 INC FOR VAGUS N ELECT IMPL 14.77 $549.90 --- -- 004 0 0 0.00 $0.00 Y
O 64568 INC FOR VAGUS N ELECT IMPL 2.95 $109.98 --- -- 004 0 0 0.00 $0.00 Y
O 64569 REVISE/REPL VAGUS N ELTRD 2.72 $101.09 --- -- 004 0 0 0.00 $0.00 Y
K 64569 REVISE/REPL VAGUS N ELTRD 13.58 $505.46 --- -- 004 0 0 0.00 $0.00 Y
K 64570 REMOVE VAGUS N ELTRD 11.82 $439.94 --- -- 004 0 0 0.00 $0.00 Y
O 64570 REMOVE VAGUS N ELTRD 2.36 $87.99 --- -- 004 0 0 0.00 $0.00 Y
K 64575 IMPLANT NEUROELECTRODES 7.33 $272.90 --- $344.14 004 1 0 0.00 $0.00 Y
K 64585 REVISE/REMOVE NEUROELECTRODE 3.32 $123.60 --- $155.87 004 1 0 0.00 $0.00 Y
K 64590 INSRT/REDO PN/GASTR STIMUL 3.63 $135.14 --- -- 004 0 0 0.00 $0.00 Y
K 64595 REVISE/RMV PN/GASTR STIMUL 2.91 $108.34 --- -- 004 0 0 0.00 $0.00 Y
K 64600 INJECTION TREATMENT OF NERVE 3.05 $113.55 --- $143.20 004 1 0 0.00 $0.00 Y
K 64605 INJECTION TREATMENT OF NERVE 4.27 $158.97 --- $200.48 004 1 0 0.00 $0.00 Y
K 64610 INJECTION TREATMENT OF NERVE 5.51 $205.14 --- $258.69 004 1 0 0.00 $0.00 Y
K 64611 CHEMODENERV SALIV GLANDS 2.31 $85.92 --- -- 004 0 1 0.00 $0.00 Y
K 64612 DESTROY NERVE FACE MUSCLE 2.24 $83.40 --- $105.17 004 1 0 0.00 $0.00 Y
K 64615 CHEMODENERV MUSC MIGRAINE 2.79 $103.87 --- $130.99 004 1 0 0.00 $0.00 Y
K 64616 CHEMODENERV MUSC NECK DYSTON 2.43 $90.47 --- -- 004 0 0 0.00 $0.00 Y
K 64617 CHEMODENER MUSCLE LARYNX EMG 2.64 $98.29 --- -- 004 0 0 0.00 $0.00 Y
K 64620 INJECTION TREATMENT OF NERVE 2.67 $99.40 --- $125.36 004 1 0 0.00 $0.00 Y
K 64624 DSTRJ NULYT AGT GNCLR NRV 10.07 $375.00 --- -- 004 0 0 0.00 $0.00 Y
K 64625 RF ABLTJ NRV NRVTG SI JT 12.26 $456.79 --- -- 004 0 0 0.00 $0.00 Y
K 64630 INJECTION TREATMENT OF NERVE 2.64 $98.29 --- $123.95 004 1 0 0.00 $0.00 Y
K 64632 N BLOCK INJ COMMON DIGIT 1.37 $51.01 --- -- 004 0 1 0.00 $0.00 Y
P 64632 N BLOCK INJ COMMON DIGIT 1.37 $51.01 --- -- 015 0 1 0.00 $0.00 Y
K 64633 DESTROY CERV/THOR FACET JNT 5.36 $199.38 --- $251.65 004 1 0 0.00 $0.00 Y
K 64634 DESTROY C/TH FACET JNT ADDL 1.58 $58.95 --- $74.18 004 1 0 0.00 $0.00 Y
K 64635 DESTROY LUMB/SAC FACET JNT 5.25 $195.34 --- $246.49 004 1 0 0.00 $0.00 Y
K 64636 DESTROY L/S FACET JNT ADDL 1.38 $51.31 --- $64.79 004 1 0 0.00 $0.00 Y
K 64640 INJECTION TREATMENT OF NERVE 3.37 $125.47 --- $158.22 004 1 1 0.00 $0.00 Y
K 64642 CHEMODENERV 1 EXTREMITY 1-4 2.45 $91.21 --- -- 004 0 0 0.00 $0.00 Y
K 64643 CHEMODENERV 1 EXTREM 1-4 EA 1.63 $60.68 --- -- 004 0 0 0.00 $0.00 Y
K 64644 CHEMODENERV 1 EXTREM 5/> MUS 1.63 $60.68 --- -- 004 0 0 0.00 $0.00 Y
K 64645 CHEMODENERV 1 EXTREM 5/> EA 1.86 $69.25 --- -- 004 0 0 0.00 $0.00 Y
K 64646 CHEMODENERV TRUNK MUSC 1-5 2.65 $98.66 --- -- 004 0 0 0.00 $0.00 Y
K 64647 CHEMODENERV TRUNK MUSC 6/> 3.06 $113.92 --- -- 004 0 0 0.00 $0.00 Y
K 64650 CHEMODENERV ECCRINE GLANDS 1.37 $51.01 --- $64.32 004 1 0 0.00 $0.00 Y
K 64653 CHEMODENERV ECCRINE GLANDS 1.57 $58.45 --- $73.71 004 1 0 0.00 $0.00 Y
K 64680 INJECTION TREATMENT OF NERVE 3.17 $118.02 --- $148.83 004 1 0 0.00 $0.00 Y
K 64681 INJECTION TREATMENT OF NERVE 10.63 $395.66 --- $499.08 004 1 0 0.00 $0.00 Y
K 64702 REVISE FINGER/TOE NERVE 5.44 $202.53 --- $255.41 004 1 1 0.00 $0.00 Y
P 64702 REVISE FINGER/TOE NERVE 5.44 $202.53 --- -- 015 0 1 0.00 $0.00 Y
O 64702 REVISE FINGER/TOE NERVE 1.09 $40.58 --- $51.18 004 1 0 0.00 $0.00 Y
O 64704 REVISE HAND/FOOT NERVE 1.60 $59.57 --- $75.12 004 1 0 0.00 $0.00 Y
P 64704 REVISE HAND/FOOT NERVE 8.00 $297.84 --- -- 015 0 0 0.00 $0.00 Y
K 64704 REVISE HAND/FOOT NERVE 8.00 $297.84 --- $375.60 004 1 0 0.00 $0.00 Y
K 64708 REVISE ARM/LEG NERVE 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
O 64708 REVISE ARM/LEG NERVE 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
O 64712 REVISION OF SCIATIC NERVE 2.38 $88.61 --- $111.74 004 1 0 0.00 $0.00 Y
K 64712 REVISION OF SCIATIC NERVE 11.92 $443.78 --- $559.64 004 1 0 0.00 $0.00 Y
K 64713 REVISION OF ARM NERVE(S) 16.97 $631.76 --- $796.74 004 1 0 0.00 $0.00 Y
O 64713 REVISION OF ARM NERVE(S) 3.39 $126.35 --- $159.16 004 1 0 0.00 $0.00 Y
O 64714 REVISE LOW BACK NERVE(S) 2.71 $100.89 --- $127.23 004 1 0 0.00 $0.00 Y
K 64714 REVISE LOW BACK NERVE(S) 13.56 $504.84 --- $636.64 004 1 0 0.00 $0.00 Y
K 64716 REVISION OF CRANIAL NERVE 10.71 $398.73 --- $502.83 004 1 0 0.00 $0.00 Y
O 64716 REVISION OF CRANIAL NERVE 2.14 $79.67 --- $100.47 004 1 0 0.00 $0.00 Y
O 64718 REVISE ULNAR NERVE AT ELBOW 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
K 64718 REVISE ULNAR NERVE AT ELBOW 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
K 64719 REVISE ULNAR NERVE AT WRIST 7.96 $296.35 --- $373.72 004 1 0 0.00 $0.00 Y
O 64719 REVISE ULNAR NERVE AT WRIST 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
O 64721 REVISE MEDIAN NERVE AT WRIST 1.70 $63.29 --- $79.82 004 1 0 0.00 $0.00 Y
K 64721 REVISE MEDIAN NERVE AT WRIST 8.51 $316.83 --- $399.54 004 1 0 0.00 $0.00 Y
K 64722 RELIEVE PRESSURE ON NERVE(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 64722 RELIEVE PRESSURE ON NERVE(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 64726 RELEASE FOOT/TOE NERVE 1.09 $40.58 --- $51.18 004 1 0 0.00 $0.00 Y
P 64726 RELEASE FOOT/TOE NERVE 5.44 $202.53 --- -- 015 0 0 0.00 $0.00 Y
K 64726 RELEASE FOOT/TOE NERVE 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
K 64727 INTERNAL NERVE REVISION 4.73 $176.10 --- $222.07 004 1 0 0.00 $0.00 Y
O 64727 INTERNAL NERVE REVISION 0.95 $35.37 --- $44.60 004 1 0 0.00 $0.00 Y
O 64732 INCISION OF BROW NERVE 1.42 $52.87 --- $66.67 004 1 0 0.00 $0.00 Y
K 64732 INCISION OF BROW NERVE 7.08 $263.59 --- $332.41 004 1 0 0.00 $0.00 Y
K 64734 INCISION OF CHEEK NERVE 7.43 $276.62 --- $348.84 004 1 0 0.00 $0.00 Y
O 64734 INCISION OF CHEEK NERVE 1.49 $55.47 --- $69.96 004 1 0 0.00 $0.00 Y
O 64736 INCISION OF CHIN NERVE 1.40 $52.12 --- $65.73 004 1 0 0.00 $0.00 Y
K 64736 INCISION OF CHIN NERVE 7.00 $260.61 --- $328.65 004 1 0 0.00 $0.00 Y
K 64738 INCISION OF JAW NERVE 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
O 64738 INCISION OF JAW NERVE 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
O 64740 INCISION OF TONGUE NERVE 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
K 64740 INCISION OF TONGUE NERVE 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
K 64742 INCISION OF FACIAL NERVE 10.20 $379.75 --- $478.89 004 1 0 0.00 $0.00 Y
O 64742 INCISION OF FACIAL NERVE 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
O 64744 INCISE NERVE BACK OF HEAD 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 64744 INCISE NERVE BACK OF HEAD 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 64746 INCISE DIAPHRAGM NERVE 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
O 64746 INCISE DIAPHRAGM NERVE 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
O 64755 INCISION OF STOMACH NERVES 3.17 $118.02 --- $148.83 004 1 0 0.00 $0.00 Y
K 64755 INCISION OF STOMACH NERVES 15.86 $590.47 --- $744.63 004 1 0 0.00 $0.00 Y
K 64760 INCISION OF VAGUS NERVE 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
O 64760 INCISION OF VAGUS NERVE 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
O 64763 INCISE HIP/THIGH NERVE 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 64763 INCISE HIP/THIGH NERVE 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 64766 INCISE HIP/THIGH NERVE 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 64766 INCISE HIP/THIGH NERVE 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 64771 SEVER CRANIAL NERVE 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 64771 SEVER CRANIAL NERVE 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 64772 INCISION OF SPINAL NERVE 10.89 $405.43 --- $511.29 004 1 0 0.00 $0.00 Y
O 64772 INCISION OF SPINAL NERVE 2.18 $81.16 --- $102.35 004 1 0 0.00 $0.00 Y
O 64774 REMOVE SKIN NERVE LESION 0.82 $30.53 --- $38.50 004 1 0 0.00 $0.00 Y
K 64774 REMOVE SKIN NERVE LESION 4.10 $152.64 --- $192.50 004 1 1 0.00 $0.00 Y
K 64776 REMOVE DIGIT NERVE LESION 4.11 $153.02 --- $192.96 004 1 1 0.00 $0.00 Y
O 64776 REMOVE DIGIT NERVE LESION 0.82 $30.53 --- $38.50 004 1 0 0.00 $0.00 Y
O 64778 DIGIT NERVE SURGERY ADDON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64778 DIGIT NERVE SURGERY ADDON 2.16 $80.42 --- $101.41 004 1 1 0.00 $0.00 Y
K 64782 REMOVE LIMB NERVE LESION 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 64782 REMOVE LIMB NERVE LESION 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
P 64782 REMOVE LIMB NERVE LESION 6.80 $253.16 --- -- 015 0 0 0.00 $0.00 Y
P 64783 LIMB NERVE SURGERY ADDON 0.00 $0.00 --- -- 015 0 0 0.00 $0.00 Y
O 64783 LIMB NERVE SURGERY ADDON 1.12 $41.70 --- $52.58 004 1 0 0.00 $0.00 Y
K 64783 LIMB NERVE SURGERY ADDON 5.61 $208.86 --- $263.39 004 1 0 0.00 $0.00 Y
K 64784 REMOVE NERVE LESION 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 64784 REMOVE NERVE LESION 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 64786 REMOVE SCIATIC NERVE LESION 4.84 $180.19 --- $227.24 004 1 0 0.00 $0.00 Y
K 64786 REMOVE SCIATIC NERVE LESION 24.18 $900.22 --- $1135.25 004 1 0 0.00 $0.00 Y
K 64787 IMPLANT NERVE END 6.19 $230.45 --- $290.62 004 1 0 0.00 $0.00 Y
O 64787 IMPLANT NERVE END 1.24 $46.17 --- $58.22 004 1 0 0.00 $0.00 Y
O 64788 REMOVE SKIN NERVE LESION 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 64788 REMOVE SKIN NERVE LESION 6.80 $253.16 --- $319.26 004 1 1 0.00 $0.00 Y
K 64790 REMOVAL OF NERVE LESION 16.22 $603.87 --- $761.53 004 1 0 0.00 $0.00 Y
O 64790 REMOVAL OF NERVE LESION 3.24 $120.63 --- $152.12 004 1 0 0.00 $0.00 Y
O 64792 REMOVAL OF NERVE LESION 4.20 $156.37 --- $197.19 004 1 0 0.00 $0.00 Y
K 64792 REMOVAL OF NERVE LESION 21.02 $782.57 --- $986.89 004 1 0 0.00 $0.00 Y
K 64795 BIOPSY OF NERVE 4.28 $159.34 --- $200.95 004 1 0 0.00 $0.00 Y
O 64795 BIOPSY OF NERVE 0.86 $32.02 --- $40.38 004 1 0 0.00 $0.00 Y
O 64802 SYMPATHECTOMY CERVICAL 2.90 $107.97 --- $136.16 004 1 0 0.00 $0.00 Y
K 64802 SYMPATHECTOMY CERVICAL 14.50 $539.84 --- $680.78 004 1 0 0.00 $0.00 Y
K 64804 REMOVE SYMPATHETIC NERVES 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 64804 REMOVE SYMPATHETIC NERVES 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 64809 REMOVE SYMPATHETIC NERVES 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 64809 REMOVE SYMPATHETIC NERVES 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
K 64818 REMOVE SYMPATHETIC NERVES 15.00 $558.45 --- $704.25 004 1 0 0.00 $0.00 Y
O 64818 REMOVE SYMPATHETIC NERVES 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
O 64820 SYMPATHECTOMY DIGITAL ARTERY 2.13 $79.30 --- $100.00 004 1 0 0.00 $0.00 Y
K 64820 SYMPATHECTOMY DIGITAL ARTERY 10.67 $397.24 --- $500.96 004 1 0 0.00 $0.00 Y
K 64821 REMOVE SYMPATHETIC NERVES 13.85 $515.64 --- -- 004 0 0 0.00 $0.00 Y
O 64821 REMOVE SYMPATHETIC NERVES 2.77 $103.13 --- -- 004 0 0 0.00 $0.00 Y
O 64822 REMOVE SYMPATHETIC NERVES 2.77 $103.13 --- -- 004 0 0 0.00 $0.00 Y
K 64822 REMOVE SYMPATHETIC NERVES 13.85 $515.64 --- -- 004 0 0 0.00 $0.00 Y
K 64823 SYMPATHECTOMY SUPFC PALMAR 15.97 $594.56 --- -- 004 0 0 0.00 $0.00 Y
O 64823 SYMPATHECTOMY SUPFC PALMAR 3.19 $118.76 --- -- 004 0 0 0.00 $0.00 Y
O 64831 REPAIR OF DIGIT NERVE 1.52 $56.59 --- $71.36 004 1 0 0.00 $0.00 Y
P 64831 REPAIR OF DIGIT NERVE 7.59 $282.58 --- -- 015 0 0 0.00 $0.00 Y
K 64831 REPAIR OF DIGIT NERVE 7.59 $282.58 --- $356.35 004 1 0 0.00 $0.00 Y
K 64832 REPAIR NERVE ADDON 4.11 $153.02 --- $192.96 004 1 0 0.00 $0.00 Y
P 64832 REPAIR NERVE ADDON 4.11 $153.02 --- -- 015 0 0 0.00 $0.00 Y
O 64832 REPAIR NERVE ADDON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 64834 REPAIR OF HAND OR FOOT NERVE 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
P 64834 REPAIR OF HAND OR FOOT NERVE 9.06 $337.30 --- -- 015 0 0 0.00 $0.00 Y
K 64834 REPAIR OF HAND OR FOOT NERVE 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
K 64835 REPAIR OF HAND OR FOOT NERVE 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 64835 REPAIR OF HAND OR FOOT NERVE 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 64836 REPAIR OF HAND OR FOOT NERVE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 64836 REPAIR OF HAND OR FOOT NERVE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 64837 REPAIR NERVE ADDON 9.41 $350.33 --- $441.80 004 1 0 0.00 $0.00 Y
O 64837 REPAIR NERVE ADDON 1.88 $69.99 --- $88.27 004 1 0 0.00 $0.00 Y
P 64837 REPAIR NERVE ADDON 0.00 $0.00 --- -- 015 0 0 0.00 $0.00 Y
O 64840 REPAIR OF LEG NERVE 3.80 $141.47 --- $178.41 004 1 0 0.00 $0.00 Y
K 64840 REPAIR OF LEG NERVE 19.02 $708.11 --- $892.99 004 1 0 0.00 $0.00 Y
K 64856 REPAIR/TRANSPOSE NERVE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 64856 REPAIR/TRANSPOSE NERVE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 64857 REPAIR ARM/LEG NERVE 4.20 $156.37 --- $197.19 004 1 0 0.00 $0.00 Y
K 64857 REPAIR ARM/LEG NERVE 20.99 $781.46 --- $985.48 004 1 0 0.00 $0.00 Y
K 64858 REPAIR SCIATIC NERVE 25.75 $958.67 --- $1208.96 004 1 0 0.00 $0.00 Y
O 64858 REPAIR SCIATIC NERVE 5.15 $191.73 --- $241.79 004 1 0 0.00 $0.00 Y
O 64859 NERVE SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64859 NERVE SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64861 REPAIR OF ARM NERVES 29.46 $1096.80 --- $1383.15 004 1 0 0.00 $0.00 Y
O 64861 REPAIR OF ARM NERVES 5.89 $219.28 --- $276.54 004 1 0 0.00 $0.00 Y
O 64862 REPAIR OF LOW BACK NERVES 5.92 $220.40 --- $277.94 004 1 0 0.00 $0.00 Y
K 64862 REPAIR OF LOW BACK NERVES 29.60 $1102.01 --- $1389.72 004 1 0 0.00 $0.00 Y
K 64864 REPAIR OF FACIAL NERVE 18.21 $677.96 --- $854.96 004 1 0 0.00 $0.00 Y
O 64864 REPAIR OF FACIAL NERVE 3.64 $135.52 --- $170.90 004 1 0 0.00 $0.00 Y
O 64865 REPAIR OF FACIAL NERVE 4.47 $166.42 --- $209.87 004 1 0 0.00 $0.00 Y
K 64865 REPAIR OF FACIAL NERVE 22.36 $832.46 --- $1049.80 004 1 0 0.00 $0.00 Y
K 64866 FUSION OF FACIAL/OTHER NERVE 26.00 $967.98 --- $1220.70 004 1 0 0.00 $0.00 Y
O 64866 FUSION OF FACIAL/OTHER NERVE 5.20 $193.60 --- $244.14 004 1 0 0.00 $0.00 Y
O 64868 FUSION OF FACIAL/OTHER NERVE 5.20 $193.60 --- $244.14 004 1 0 0.00 $0.00 Y
K 64868 FUSION OF FACIAL/OTHER NERVE 26.00 $967.98 --- $1220.70 004 1 0 0.00 $0.00 Y
K 64872 SUBSEQUENT REPAIR OF NERVE 3.05 $113.55 --- $143.20 004 1 0 0.00 $0.00 Y
O 64872 SUBSEQUENT REPAIR OF NERVE 0.61 $22.71 --- $28.64 004 1 0 0.00 $0.00 Y
O 64874 REPAIR & REVISE NERVE ADD-ON 0.89 $33.13 --- $41.79 004 1 0 0.00 $0.00 Y
K 64874 REPAIR & REVISE NERVE ADD-ON 4.47 $166.42 --- $209.87 004 1 0 0.00 $0.00 Y
K 64876 REPAIR NERVE/SHORTEN BONE 4.68 $174.24 --- $219.73 004 1 0 0.00 $0.00 Y
O 64876 REPAIR NERVE/SHORTEN BONE 0.94 $35.00 --- $44.13 004 1 0 0.00 $0.00 Y
O 64885 NERVE GRAFT HEAD/NECK 3.74 $139.24 --- $175.59 004 1 0 0.00 $0.00 Y
K 64885 NERVE GRAFT HEAD/NECK 18.71 $696.57 --- $878.43 004 1 0 0.00 $0.00 Y
K 64886 NERVE GRAFT HEAD/NECK >4 CM 22.31 $830.60 --- $1047.45 004 1 0 0.00 $0.00 Y
O 64886 NERVE GRAFT HEAD/NECK >4 CM 4.46 $166.05 --- $209.40 004 1 0 0.00 $0.00 Y
O 64890 NERVE GRAFT HAND/FOOT 3.48 $129.56 --- $163.39 004 1 0 0.00 $0.00 Y
K 64890 NERVE GRAFT HAND/FOOT 17.40 $647.80 --- $816.93 004 1 0 0.00 $0.00 Y
K 64891 NERVE GRAFT HAND/FOOT >4 CM 16.57 $616.90 --- $777.96 004 1 0 0.00 $0.00 Y
O 64891 NERVE GRAFT HAND/FOOT >4 CM 0.22 $8.19 --- $10.33 004 1 0 0.00 $0.00 Y
O 64892 NERVE GRAFT ARM/LEG <4 CM 3.21 $119.51 --- $150.71 004 1 0 0.00 $0.00 Y
K 64892 NERVE GRAFT ARM/LEG <4 CM 16.09 $599.03 --- $755.43 004 1 0 0.00 $0.00 Y
K 64893 NERVE GRAFT ARM/LEG >4 CM 18.65 $694.34 --- $875.62 004 1 0 0.00 $0.00 Y
O 64893 NERVE GRAFT ARM/LEG >4 CM 3.73 $138.87 --- $175.12 004 1 0 0.00 $0.00 Y
O 64895 NERVE GRAFT HAND/FOOT 4.12 $153.39 --- $193.43 004 1 0 0.00 $0.00 Y
K 64895 NERVE GRAFT HAND/FOOT 20.65 $768.80 --- $969.52 004 1 0 0.00 $0.00 Y
K 64896 NERVE GRAFT HAND/FOOT >4 CM 23.51 $875.28 --- $1103.79 004 1 0 0.00 $0.00 Y
O 64896 NERVE GRAFT HAND/FOOT >4 CM 4.70 $174.98 --- $220.67 004 1 0 0.00 $0.00 Y
O 64897 NERVE GRAFT ARM/LEG 3.93 $146.31 --- $184.51 004 1 0 0.00 $0.00 Y
K 64897 NERVE GRAFT ARM/LEG 19.66 $731.94 --- $923.04 004 1 0 0.00 $0.00 Y
K 64898 NERVE GRAFT ARM/LEG >4 CM 21.27 $791.88 --- $998.63 004 1 0 0.00 $0.00 Y
O 64898 NERVE GRAFT ARM/LEG >4 CM 4.25 $158.23 --- $199.54 004 1 0 0.00 $0.00 Y
O 64901 NERVE GRAFT ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64901 NERVE GRAFT ADD-ON 12.88 $479.52 --- $604.72 004 1 0 0.00 $0.00 Y
K 64902 NERVE GRAFT ADD-ON 14.98 $557.71 --- $703.31 004 1 0 0.00 $0.00 Y
O 64902 NERVE GRAFT ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 64905 NERVE PEDICLE TRANSFER 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64905 NERVE PEDICLE TRANSFER 14.13 $526.06 --- $663.40 004 1 0 0.00 $0.00 Y
K 64907 NERVE PEDICLE TRANSFER 18.53 $689.87 --- $869.98 004 1 0 0.00 $0.00 Y
O 64907 NERVE PEDICLE TRANSFER 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 64910 NERVE REPAIR W/ALLOGRAFT 3.09 $114.97 --- -- 004 0 0 0.00 $0.00 Y
K 64910 NERVE REPAIR W/ALLOGRAFT 15.44 $574.84 --- -- 004 0 0 0.00 $0.00 Y
K 64911 NEURORRAPHY W/VEIN AUTOGRAFT 18.78 $699.20 --- -- 004 0 0 0.00 $0.00 Y
O 64911 NEURORRAPHY W/VEIN AUTOGRAFT 3.76 $139.84 --- -- 004 0 0 0.00 $0.00 Y
O 64912 NRV RPR W/NRV ALGRFT 1ST 3.63 $135.15 --- -- 004 0 0 0.00 $0.00 Y
K 64912 NRV RPR W/NRV ALGRFT 1ST 18.15 $675.73 --- -- 004 0 0 0.00 $0.00 Y
K 64913 NRV RPR W/NRV ALGRFT EA ADDL 3.58 $133.56 --- -- 004 0 0 0.00 $0.00 Y
O 64913 NRV RPR W/NRV ALGRFT EA ADDL 0.71 $26.71 --- -- 004 0 0 0.00 $0.00 Y
O 64999 NERVOUS SYSTEM SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 64999 NERVOUS SYSTEM SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 65091 REVISE EYE 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 65091 REVISE EYE 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 65093 REVISE EYE WITH IMPLANT 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 65093 REVISE EYE WITH IMPLANT 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 65101 REMOVAL OF EYE 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 65101 REMOVAL OF EYE 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 65103 REMOVE EYE/INSERT IMPLANT 2.38 $88.61 --- $111.74 004 1 0 0.00 $0.00 Y
K 65103 REMOVE EYE/INSERT IMPLANT 12.23 $455.32 --- $574.20 004 1 0 0.00 $0.00 Y
K 65105 REMOVE EYE/ATTACH IMPLANT 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 65105 REMOVE EYE/ATTACH IMPLANT 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 65110 REMOVAL OF EYE 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
K 65110 REMOVAL OF EYE 22.65 $843.26 --- $1063.42 004 1 0 0.00 $0.00 Y
K 65112 REMOVE EYE/REVISE SOCKET 30.71 $1143.33 --- $1441.83 004 1 0 0.00 $0.00 Y
O 65112 REMOVE EYE/REVISE SOCKET 6.14 $228.59 --- $288.27 004 1 0 0.00 $0.00 Y
O 65114 REMOVE EYE/REVISE SOCKET 5.10 $189.87 --- $239.45 004 1 0 0.00 $0.00 Y
K 65114 REMOVE EYE/REVISE SOCKET 25.37 $944.53 --- $1191.12 004 1 0 0.00 $0.00 Y
K 65125 MODIF OF OCULAR IMP W/PLACE OR REPLACE 7.02 $261.35 --- $329.59 004 1 0 0.00 $0.00 Y
K 65130 INSERT OCULAR IMPLANT 10.53 $392.03 --- $494.38 004 1 0 0.00 $0.00 Y
O 65130 INSERT OCULAR IMPLANT 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
O 65135 INSERT OCULAR IMPLANT 2.49 $92.70 --- $116.91 004 1 0 0.00 $0.00 Y
K 65135 INSERT OCULAR IMPLANT 12.57 $467.98 --- $590.16 004 1 0 0.00 $0.00 Y
K 65140 ATTACH OCULAR IMPLANT 15.75 $586.37 --- $739.46 004 1 0 0.00 $0.00 Y
O 65140 ATTACH OCULAR IMPLANT 3.15 $117.27 --- $147.89 004 1 0 0.00 $0.00 Y
O 65150 REVISE OCULAR IMPLANT 2.85 $106.11 --- $133.81 004 1 0 0.00 $0.00 Y
K 65150 REVISE OCULAR IMPLANT 14.23 $529.78 --- $668.10 004 1 0 0.00 $0.00 Y
K 65155 REINSERT OCULAR IMPLANT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 65155 REINSERT OCULAR IMPLANT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 65175 REMOVAL OF OCULAR IMPLANT 2.69 $100.15 --- $126.30 004 1 0 0.00 $0.00 Y
K 65175 REMOVAL OF OCULAR IMPLANT 13.47 $501.49 --- $632.42 004 1 0 0.00 $0.00 Y
K 65205 REMOVE FOREIGN BODY FROM EYE 2.99 $111.32 --- $140.38 004 1 1 0.00 $0.00 Y
1 65205 REMOVE FOREIGN BODY FROM EYE 6.74 $6.74 --- $6.74 009 1 1 0.00 $0.00 Y
1 65210 REMOVE FOREIGN BODY FROM EYE 117.27 $117.27 --- $117.27 009 1 0 0.00 $0.00 Y
K 65210 REMOVE FOREIGN BODY FROM EYE 3.15 $117.27 --- $147.89 004 1 1 0.00 $0.00 Y
K 65220 REMOVE FOREIGN BODY FROM EYE 3.87 $144.08 --- $181.70 004 1 1 0.00 $0.00 Y
1 65220 REMOVE FOREIGN BODY FROM EYE 13.48 $13.48 --- $13.48 009 1 1 0.00 $0.00 Y
1 65222 REMOVE FOREIGN BODY FROM EYE 20.21 $20.21 --- $20.21 009 1 1 0.00 $0.00 Y
K 65222 REMOVE FOREIGN BODY FROM EYE 3.16 $117.65 --- $148.36 004 1 1 0.00 $0.00 Y
K 65235 REMOVE FOREIGN BODY FROM EYE 12.27 $456.81 --- $576.08 004 1 0 0.00 $0.00 Y
O 65235 REMOVE FOREIGN BODY FROM EYE 2.45 $91.21 --- $115.03 004 1 0 0.00 $0.00 Y
O 65260 REMOVE FOREIGN BODY FROM EYE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 65260 REMOVE FOREIGN BODY FROM EYE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 65265 REMOVE FOREIGN BODY FROM EYE 18.12 $674.61 --- $850.73 004 1 0 0.00 $0.00 Y
O 65265 REMOVE FOREIGN BODY FROM EYE 3.62 $134.77 --- $169.96 004 1 0 0.00 $0.00 Y
O 65270 REPAIR OF EYE WOUND 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 65270 REPAIR OF EYE WOUND 2.49 $92.70 --- $116.91 004 1 0 0.00 $0.00 Y
K 65272 REPAIR OF EYE WOUND 4.15 $154.50 --- $194.84 004 1 0 0.00 $0.00 Y
O 65272 REPAIR OF EYE WOUND 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 65273 REPAIR OF EYE WOUND 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 65273 REPAIR OF EYE WOUND 4.14 $154.13 --- $194.37 004 1 0 0.00 $0.00 Y
K 65275 REPAIR OF EYE WOUND 8.91 $331.72 --- $418.32 004 1 0 0.00 $0.00 Y
O 65275 REPAIR OF EYE WOUND 1.78 $66.27 --- $83.57 004 1 0 0.00 $0.00 Y
O 65280 REPAIR OF EYE WOUND 2.58 $96.05 --- $121.13 004 1 0 0.00 $0.00 Y
K 65280 REPAIR OF EYE WOUND 12.89 $479.89 --- $605.19 004 1 0 0.00 $0.00 Y
K 65285 REPAIR OF EYE WOUND 22.75 $846.98 --- $1068.11 004 1 0 0.00 $0.00 Y
O 65285 REPAIR OF EYE WOUND 4.55 $169.40 --- $213.62 004 1 0 0.00 $0.00 Y
O 65286 REPAIR OF EYE WOUND 2.33 $86.75 --- $109.39 004 1 0 0.00 $0.00 Y
K 65286 REPAIR OF EYE WOUND 11.63 $432.98 --- $546.03 004 1 0 0.00 $0.00 Y
K 65290 REPAIR OF EYE SOCKET WOUND 5.25 $195.46 --- $246.49 004 1 0 0.00 $0.00 Y
O 65290 REPAIR OF EYE SOCKET WOUND 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 65400 REMOVAL OF EYE LESION 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
K 65410 BIOPSY OF CORNEA 1.45 $53.98 --- $68.08 004 1 0 0.00 $0.00 Y
K 65420 REMOVAL OF EYE LESION 6.80 $253.16 --- $319.26 004 1 1 0.00 $0.00 Y
K 65426 REMOVAL OF EYE LESION 10.73 $399.48 --- $503.77 004 1 0 0.00 $0.00 Y
O 65426 REMOVAL OF EYE LESION 2.15 $80.04 --- $100.94 004 1 0 0.00 $0.00 Y
1 65430 CORNEAL SMEAR 3.70 $137.75 --- $173.72 004 1 1 0.00 $0.00 Y
K 65430 CORNEAL SMEAR 3.70 $137.75 --- $173.72 004 1 1 0.00 $0.00 Y
K 65435 CURETTE/TREAT CORNEA 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
1 65435 CURETTE/TREAT CORNEA 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
1 65436 CURETTE/TREAT CORNEA 4.39 $163.44 --- $206.11 004 1 0 0.00 $0.00 Y
K 65436 CURETTE/TREAT CORNEA 4.39 $163.44 --- $206.11 004 1 0 0.00 $0.00 Y
K 65450 TREATMENT OF CORNEAL LESION 4.71 $175.35 --- $221.13 004 1 0 0.00 $0.00 Y
K 65600 REVISION OF CORNEA 8.00 $297.84 --- $375.60 004 1 0 0.00 $0.00 Y
O 65600 REVISION OF CORNEA 1.60 $59.57 --- $75.12 004 1 0 0.00 $0.00 Y
O 65710 CORNEAL TRANSPLANT 4.80 $178.70 --- -- 004 0 0 0.00 $0.00 Y
K 65710 CORNEAL TRANSPLANT 24.00 $893.52 --- -- 004 0 0 0.00 $0.00 Y
K 65730 CORNEAL TRANSPLANT 30.00 $1116.90 --- -- 004 0 0 0.00 $0.00 Y
O 65730 CORNEAL TRANSPLANT 6.00 $223.38 --- -- 004 0 0 0.00 $0.00 Y
O 65750 KERATOPLASTY, PENETRATING (IN APHAKIA) 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 65750 KERATOPLASTY, PENETRATING (IN APHAKIA) 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
K 65755 KERATOPLASTY,PENETRATING 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 65755 KERATOPLASTY,PENETRATING 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 65756 CORNEAL TRNSPL ENDOTHELIAL 4.01 $149.29 --- -- 004 0 0 0.00 $0.00 Y
K 65756 CORNEAL TRNSPL ENDOTHELIAL 20.07 $747.21 --- -- 004 0 0 0.00 $0.00 Y
K 65757 PREP CORNEAL ENDO ALLOGRAFT 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 65757 PREP CORNEAL ENDO ALLOGRAFT 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 65770 REVISE CORNEA WITH IMPLANT 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 65770 REVISE CORNEA WITH IMPLANT 29.90 $1113.18 --- $1403.81 004 1 0 0.00 $0.00 Y
K 65778 COVER EYE W/MEMBRANE 1.70 $63.29 --- -- 004 0 0 0.00 $0.00 Y
O 65778 COVER EYE W/MEMBRANE 0.34 $12.66 --- -- 004 0 0 0.00 $0.00 Y
O 65779 COVER EYE W/MEMBRANE SUTURE 1.34 $49.89 --- -- 004 0 0 0.00 $0.00 Y
K 65779 COVER EYE W/MEMBRANE SUTURE 6.70 $249.44 --- -- 004 0 0 0.00 $0.00 Y
K 65780 OCULAR RECONST TRANSPLANT 8.42 $313.48 --- $395.32 004 1 0 0.00 $0.00 Y
O 65780 OCULAR RECONST TRANSPLANT 1.68 $62.70 --- $78.88 004 1 0 0.00 $0.00 Y
O 65781 OCULAR RECONST TRANSPLANT 2.87 $106.88 --- $134.75 004 1 0 0.00 $0.00 Y
K 65781 OCULAR RECONST TRANSPLANT 14.35 $534.39 --- $673.73 004 1 0 0.00 $0.00 Y
K 65782 OCULAR RECONST TRANSPLANT 12.22 $454.77 --- $573.73 004 1 0 0.00 $0.00 Y
O 65782 OCULAR RECONST TRANSPLANT 2.44 $90.84 --- $114.56 004 1 0 0.00 $0.00 Y
K 65785 IMPLTJ NTRSTRML CRNL RNG SEG 52.28 $1946.38 --- -- 004 0 0 0.00 $0.00 Y
K 65800 DRAINAGE OF EYE 2.11 $78.56 --- $99.06 004 1 0 0.00 $0.00 Y
K 65810 DRAINAGE OF EYE 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
K 65815 DRAINAGE OF EYE 6.12 $227.85 --- $287.33 004 1 0 0.00 $0.00 Y
O 65815 DRAINAGE OF EYE 1.22 $45.42 --- $57.28 004 1 0 0.00 $0.00 Y
O 65820 GONIOTOMY 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 65820 GONIOTOMY 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 65850 INCISION OF EYE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 65850 INCISION OF EYE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 65855 TRABECULOPLASTY LASER SURG 1.15 $42.81 --- $53.99 004 1 0 0.00 $0.00 Y
K 65855 TRABECULOPLASTY LASER SURG 5.79 $215.56 --- $271.84 004 1 0 0.00 $0.00 Y
K 65860 INCISE INNER EYE ADHESIONS 8.47 $315.34 --- $397.67 004 1 0 0.00 $0.00 Y
O 65860 INCISE INNER EYE ADHESIONS 1.69 $62.92 --- $79.35 004 1 0 0.00 $0.00 Y
O 65865 INCISE INNER EYE ADHESIONS 2.20 $81.91 --- $103.29 004 1 0 0.00 $0.00 Y
K 65865 INCISE INNER EYE ADHESIONS 11.10 $413.25 --- $521.15 004 1 0 0.00 $0.00 Y
K 65870 INCISE INNER EYE ADHESIONS 10.53 $392.03 --- $494.38 004 1 0 0.00 $0.00 Y
O 65870 INCISE INNER EYE ADHESIONS 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
O 65875 INCISE INNER EYE ADHESIONS 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
K 65875 INCISE INNER EYE ADHESIONS 10.53 $392.03 --- $494.38 004 1 0 0.00 $0.00 Y
K 65880 INCISE INNER EYE ADHESIONS 10.53 $392.03 --- $494.38 004 1 0 0.00 $0.00 Y
O 65880 INCISE INNER EYE ADHESIONS 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
O 65900 REMOVE EYE LESION 4.43 $164.93 --- $207.99 004 1 0 0.00 $0.00 Y
K 65900 REMOVE EYE LESION 22.14 $824.27 --- $1039.47 004 1 0 0.00 $0.00 Y
K 65920 REMOVE IMPLANT OF EYE 13.85 $515.64 --- $650.26 004 1 0 0.00 $0.00 Y
O 65920 REMOVE IMPLANT OF EYE 2.77 $103.13 --- $130.05 004 1 0 0.00 $0.00 Y
O 65930 REMOVE BLOOD CLOT FROM EYE 2.98 $110.95 --- $139.91 004 1 0 0.00 $0.00 Y
K 65930 REMOVE BLOOD CLOT FROM EYE 14.91 $555.10 --- $700.02 004 1 0 0.00 $0.00 Y
K 66020 INJECTION TREATMENT OF EYE 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 66030 INJECTION TREATMENT OF EYE 1.54 $57.33 --- $72.30 004 1 0 0.00 $0.00 Y
K 66130 REMOVE EYE LESION 12.64 $470.59 --- $593.45 004 1 0 0.00 $0.00 Y
O 66130 REMOVE EYE LESION 2.53 $94.19 --- $118.78 004 1 0 0.00 $0.00 Y
O 66150 INCISION OF EYE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 66150 INCISION OF EYE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 66155 INCISION OF EYE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 66155 INCISION OF EYE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 66160 INCISION OF EYE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 66160 INCISION OF EYE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 66170 INCISION OF EYE 18.12 $674.61 --- $850.73 004 1 0 0.00 $0.00 Y
O 66170 INCISION OF EYE 3.62 $134.77 --- $169.96 004 1 0 0.00 $0.00 Y
O 66172 FISULIZATION OF SCLERA FOR GLAUCOMA; 4.70 $174.98 --- $220.67 004 1 0 0.00 $0.00 Y
K 66172 FISTULIZATION OF SCLERA FOR GLAUCOMA; 23.48 $874.16 --- $1102.39 004 1 0 0.00 $0.00 Y
K 66179 AQUEOUS SHUNT EYE W/O GRAFT 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 66179 AQUEOUS SHUNT EYE W/O GRAFT 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 66180 AQUEOUS SHUNT 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 66180 AQUEOUS SHUNT 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
K 66184 REVISION OF AQUEOUS SHUNT 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 66184 REVISION OF AQUEOUS SHUNT 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 66185 REVISION, AQUEOUS SHUNT 1.53 $56.96 --- $71.83 004 1 0 0.00 $0.00 Y
K 66185 REVISION, AQUEOUS SHUNT 7.67 $285.55 --- $360.11 004 1 0 0.00 $0.00 Y
K 66225 REPAIR/GRAFT EYE LESION 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
O 66225 REPAIR/GRAFT EYE LESION 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
O 66250 FOLLOW-UP SURGERY OF EYE 2.39 $88.98 --- $112.21 004 1 0 0.00 $0.00 Y
K 66250 FOLLOW-UP SURGERY OF EYE 11.97 $445.64 --- $561.99 004 1 0 0.00 $0.00 Y
K 66500 INCISION OF IRIS 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
O 66500 INCISION OF IRIS 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 66505 INCISION OF IRIS 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 66505 INCISION OF IRIS 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
K 66600 REMOVE IRIS AND LESION 15.58 $580.04 --- $731.48 004 1 0 0.00 $0.00 Y
O 66600 REMOVE IRIS AND LESION 3.12 $116.16 --- $146.48 004 1 0 0.00 $0.00 Y
O 66605 REMOVAL OF IRIS 4.31 $160.46 --- $202.35 004 1 0 0.00 $0.00 Y
K 66605 REMOVAL OF IRIS 21.55 $802.31 --- $1011.77 004 1 0 0.00 $0.00 Y
K 66625 REMOVAL OF IRIS 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 66625 REMOVAL OF IRIS 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 66630 REMOVAL OF IRIS 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 66630 REMOVAL OF IRIS 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 66635 REMOVAL OF IRIS 11.12 $414.00 --- $522.08 004 1 0 0.00 $0.00 Y
O 66635 REMOVAL OF IRIS 2.22 $82.65 --- $104.23 004 1 0 0.00 $0.00 Y
O 66680 REPAIR IRIS & CILIARY BODY 2.01 $74.83 --- $94.37 004 1 0 0.00 $0.00 Y
K 66680 REPAIR IRIS & CILIARY BODY 10.03 $373.42 --- $470.91 004 1 0 0.00 $0.00 Y
K 66682 REPAIR IRIS & CILIARY BODY 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 66682 REPAIR IRIS & CILIARY BODY 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 66700 DESTRUCTION CILIARY BODY 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
K 66700 DESTRUCTION CILIARY BODY 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
K 66710 CILIARY TRANSSLERAL THERAPY 6.68 $248.70 --- $313.63 004 1 0 0.00 $0.00 Y
O 66710 CILIARY TRANSSLERAL THERAPY 1.34 $49.89 --- $62.91 004 1 0 0.00 $0.00 Y
O 66711 ECP CILIARY BODY DESTRUCTION 1.15 $42.77 --- $53.99 004 1 0 0.00 $0.00 Y
K 66711 ECP CILIARY BODY DESTRUCTION 5.74 $213.87 --- $269.49 004 1 0 0.00 $0.00 Y
K 66720 DESTRUCTION CILIARY BODY 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 66740 DESTRUCTION CILIARY BODY 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
O 66740 DESTRUCTION CILIARY BODY 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
K 66761 REVISION OF IRIS 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
K 66762 IRIDOPLASTY BY PHOTOCOAGULATION 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
K 66770 REMOVAL OF INNER EYE LESION 8.49 $316.08 --- $398.61 004 1 0 0.00 $0.00 Y
O 66770 REMOVAL OF INNER EYE LESION 1.70 $63.29 --- $79.82 004 1 0 0.00 $0.00 Y
O 66820 INCISION SECONDARY CATARACT 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
K 66820 INCISION SECONDARY CATARACT 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
K 66821 LASERING, SECONDARY CATARACT 5.00 $186.15 --- $234.75 004 1 0 0.00 $0.00 Y
O 66821 LASERING, SECONDARY CATARACT 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 66825 REPOSITION INTRAOCULAR LENS 2.73 $101.64 --- $128.17 004 1 0 0.00 $0.00 Y
K 66825 REPOSITION INTRAOCULAR LENS 13.67 $508.93 --- $641.81 004 1 0 0.00 $0.00 Y
K 66830 REML OF SECONDARY CATARACT 13.00 $483.99 --- $610.35 004 1 0 0.00 $0.00 Y
O 66830 REML OF SECONDARY CATARACT 2.60 $96.80 --- $122.07 004 1 0 0.00 $0.00 Y
O 66840 REML,LENS MATERIAL,ASPIRATION,1>STAGES 2.44 $90.84 --- $114.56 004 1 0 0.00 $0.00 Y
K 66840 REML,LENS MATERIAL,ASPIRATION,1>STAGES 12.19 $453.83 --- $572.32 004 1 0 0.00 $0.00 Y
K 66850 REML,LENS MATERIAL,PHACOFRAGMENT.TECH.AS 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 66850 REML,LENS MATERIAL,PHACOFRAGMENT.TECH.AS 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 66852 RML. LENS, PARS PLANA 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 66852 RML.LENS, PARS PLANA 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 66920 REML OF LENS MAT'L, INTRACAPSULAR 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 66920 REML OF LENS MAT'L, INTRACAPSULAR 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 66930 INTRACAP.DISLOCAT.LENS EXTRACTION 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 66930 INTRACAP.DISLOCAT.LENS EXTRACTION 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
K 66940 REML OF LENS MAT'L, EXTRACAPSULAR 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 66940 REML OF LENS MAT'L, EXTRACAPSULAR 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 66982 XCAPSL CTRC RMVL CPLX WO ECP 5.40 $201.04 --- $253.53 004 1 0 0.00 $0.00 Y
K 66982 XCAPSL CTRC RMVL CPLX WO ECP 27.10 $1008.93 --- $1272.35 004 1 0 0.00 $0.00 Y
K 66983 CATARACT SURG W/IOL 1 STAGE 27.00 $1005.21 --- $1267.65 004 1 0 0.00 $0.00 Y
O 66983 CATARACT SURG W/IOL 1 STAGE 5.40 $201.04 --- $253.53 004 1 0 0.00 $0.00 Y
O 66984 XCAPSL CTRC RMVL W/O ECP 5.40 $201.04 --- $253.53 004 1 0 0.00 $0.00 Y
K 66984 XCAPSL CTRC RMVL W/O ECP 27.00 $1005.21 --- $1267.65 004 1 0 0.00 $0.00 Y
K 66985 INSERT LENS PROSTHESIS 12.69 $472.45 --- $595.80 004 1 0 0.00 $0.00 Y
O 66985 INSERT LENS PROTHESIS 2.54 $94.56 --- $119.25 004 1 0 0.00 $0.00 Y
O 66986 EXCHANGE LENS PROTHESIS 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 66986 EXCHANGE LENS PROTHESIS 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 66987 XCAPSL CTRC RMVL CPLX W/ECP 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 66987 XCAPSL CTRC RMVL CPLX W/ECP 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
O 66988 XCAPSL CTRC RMVL W/ECP 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 66988 XCAPSL CTRC RMVL W/ECP 0.00 $0.00 --- -- 004 0 0 0.00 $0.00 Y
K 66990 OPHTHALMIC ENDOSCOPE ADDON 1.25 $46.65 --- -- 004 0 0 0.00 $0.00 Y
K 66999 UNLISTED PROCEDURE,ANTERIOR SEGMENT,EYE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 66999 UNLISTED PROCEDURE,ANTERIOR SEGMENT,EYE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67005 REML,VITREOUS,PARTIAL ANT.APPROACH 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
K 67005 REML,VITREOUS,PARTIAL ANT.APPROACH 15.00 $558.45 --- $704.25 004 1 0 0.00 $0.00 Y
K 67010 PARTIAL REMOVAL OF EYE FLUID 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 67010 PARTIAL REMOVAL OF EYE FLUID 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 67015 RELEASE OF EYE FLUID 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
K 67015 RELEASE OF EYE FLUID 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
K 67025 INJ OF VITREOUS SUBSTITUTE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 67025 INJ OF VITREOUS SUBSTITUTE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 67027 IMPLANT EYE DRUG SYSTEM 3.16 $117.65 --- $148.36 004 1 0 0.00 $0.00 Y
K 67027 IMPLANT EYE DRUG SYSTEM 15.80 $588.23 --- $741.81 004 1 0 0.00 $0.00 Y
K 67028 INTRAVITREAL INJ 9.78 $364.11 --- $459.17 004 1 0 0.00 $0.00 Y
O 67028 INTRAVITREAL INJ 1.96 $72.97 --- $92.02 004 1 0 0.00 $0.00 Y
K 67030 INCISE INNER EYE STRANDS 10.38 $386.45 --- $487.34 004 1 0 0.00 $0.00 Y
K 67031 LASER SURGERY EYE STRANDS 6.52 $242.74 --- $306.11 004 1 0 0.00 $0.00 Y
O 67031 LASER SURGERY EYE STRANDS 1.30 $48.40 --- $61.04 004 1 0 0.00 $0.00 Y
O 67036 REMOVAL OF INNER EYE FLUID 6.40 $238.27 --- $300.48 004 1 0 0.00 $0.00 Y
K 67036 REMOVAL OF INNER EYE FLUID 31.00 $1154.13 --- $1455.45 004 1 0 0.00 $0.00 Y
K 67039 VITRECTOMY, FOCAL LASER COAG 34.00 $1265.82 --- $1596.30 004 1 0 0.00 $0.00 Y
O 67039 VITRECTOMY,FOCAL LASER COAG 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
O 67040 LASER TREATMENT OF RETINA 4.65 $173.12 --- $218.32 004 1 0 0.00 $0.00 Y
K 67040 LASER TREATMENT OF RETINA 24.69 $919.21 --- $1159.20 004 1 0 0.00 $0.00 Y
K 67041 VIT FOR MACULAR PUCKER 22.11 $823.16 --- $1038.06 004 1 0 0.00 $0.00 Y
O 67041 VIT FOR MACULAR PUCKER 4.42 $164.56 --- $207.52 004 1 0 0.00 $0.00 Y
O 67042 VIT FOR MACULAR HOLE 5.06 $188.38 --- $237.57 004 1 0 0.00 $0.00 Y
K 67042 VIT FOR MACULAR HOLE 25.28 $941.17 --- $1186.90 004 1 0 0.00 $0.00 Y
K 67043 VIT FOR MEMBRANE DISSECT 26.56 $988.83 --- $1246.99 004 1 0 0.00 $0.00 Y
O 67043 VIT FOR MEMBRANE DISSECT 5.31 $197.69 --- $249.30 004 1 0 0.00 $0.00 Y
K 67101 REPAIR DETACHED RETINA 7.83 $291.51 --- $367.62 004 1 0 0.00 $0.00 Y
K 67105 REPAIR DETACHED RETINA 7.06 $262.84 --- $331.47 004 1 0 0.00 $0.00 Y
K 67107 REPAIR OF RETINAL DETACH; SCLERAL BUCK 26.67 $992.92 --- $1252.16 004 1 0 0.00 $0.00 Y
O 67107 REPAIR OF RETINAL DETACH; SCLERAL BUCK 5.33 $198.44 --- $250.24 004 1 0 0.00 $0.00 Y