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Medi-Cal Rates Information

Medi-Cal Rates as of 02/15/2020 (Codes 21116 thru 23195)

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


CPT codes, descriptions and other data are copyright 2002 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.


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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 21116 INJECTION JAW JOINT X-RAY 3.68 $137.01 --- $172.78 004 1 0 0.00 $0.00 Y
K 21120 GENIOPLASTY, AUGMENTATION 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 21120 GENIOPLASTY, AUGMENTATION 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 21121 GENIOPLASTY, SLIDING OSTEOTOMY, SINGLE 3.60 $134.03 --- $169.02 004 1 0 0.00 $0.00 Y
K 21121 GENIOPLASTY, SLIDING OSTEOTOMY, SINGLE 18.00 $670.14 --- $845.10 004 1 0 0.00 $0.00 Y
K 21122 GENIOPLASTY, SLIDING OSTEOTOMY, TWO 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 21122 GENIOPLASTY, SLIDING OSTEOTOMY, TWO 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 21123 GENIOPLASTY, SLIDING AUGMENTATION 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 21123 GENIOPLASTY, SLIDING AUGMENTATION 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
K 21127 AUGMENTATION LOWER JAW BONE 25.60 $953.09 --- $1201.92 004 1 0 0.00 $0.00 Y
O 21127 AUGMENTATION LOWER JAW BONE 5.12 $190.62 --- $240.38 004 1 0 0.00 $0.00 Y
O 21137 REDUCTION FOREHEAD, CONTOURING ONLY 3.60 $134.03 --- $169.02 004 1 0 0.00 $0.00 Y
K 21137 REDUCTION FOREHEAD, CONTOURING ONLY 18.00 $670.14 --- $845.10 004 1 0 0.00 $0.00 Y
K 21138 REDUCTION FOREHEAD, CONTOURING & PROSTH. 22.00 $819.06 --- $1032.90 004 1 0 0.00 $0.00 Y
O 21138 REDUCTION FOREHEAD, CONTOURING & PROSTH. 4.40 $163.81 --- $206.58 004 1 0 0.00 $0.00 Y
O 21139 REDUCT, FOREHEAD, CONT & SETBACK 4.40 $163.81 --- $206.58 004 1 0 0.00 $0.00 Y
K 21139 REDUCT FOREHEAD, CONT & SETBACK 22.00 $819.06 --- $1032.90 004 1 0 0.00 $0.00 Y
K 21141 LEFORT I-1 PIECE W/O GRAFT 27.92 $1039.46 --- $1310.84 004 1 0 0.00 $0.00 Y
O 21141 LEFORT I-1 PIECE W/O GRAFT 5.58 $207.74 --- $261.98 004 1 0 0.00 $0.00 Y
O 21142 LEFORT I-2 PIECE W/O GRAFT 5.79 $215.56 --- $271.84 004 1 0 0.00 $0.00 Y
K 21142 LEFORT I-2 PIECE W/O GRAFT 28.95 $1077.81 --- $1359.20 004 1 0 0.00 $0.00 Y
K 21143 LEFORT I-3/> PIECE W/O GRAFT 30.10 $1120.62 --- $1413.20 004 1 0 0.00 $0.00 Y
O 21143 LEFORT I-3/> PIECE W/O GRAFT 6.02 $224.12 --- $282.64 004 1 0 0.00 $0.00 Y
O 21145 LEFORT I-1 PIECE W/ GRAFT 4.98 $185.41 --- $233.81 004 1 0 0.00 $0.00 Y
K 21145 LEFORT I-1 PIECE W/ GRAFT 24.92 $927.77 --- $1169.99 004 1 0 0.00 $0.00 Y
K 21146 LEFORT I-2 PIECE W/ GRAFT 27.31 $1016.75 --- $1282.20 004 1 0 0.00 $0.00 Y
O 21146 LEFORT I-2 PIECE W/ GRAFT 5.46 $203.28 --- $256.35 004 1 0 0.00 $0.00 Y
O 21147 LEFORT I-3/> PIECE W/ GRAFT 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 21147 LEFORT I-3/> PIECE W/ GRAFT 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
K 21150 LEFORT II ANTERIOR INTRUSION 33.06 $1230.82 --- $1552.17 004 1 0 0.00 $0.00 Y
O 21150 LEFORT II ANTERIOR INTRUSION 6.61 $246.09 --- $310.34 004 1 0 0.00 $0.00 Y
O 21151 LEFORT II W/BONE GRAFTS 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
K 21151 LEFORT II W/BONE GRAFTS 27.18 $1011.91 --- $1276.10 004 1 0 0.00 $0.00 Y
K 21154 LEFORT III W/O LEFORT I 29.45 $1096.42 --- $1382.68 004 1 0 0.00 $0.00 Y
O 21154 LEFORT III W/O LEFORT I 5.89 $219.28 --- $276.54 004 1 0 0.00 $0.00 Y
O 21155 LEFORT III W/ LEFORT I 5.89 $219.28 --- $276.54 004 1 0 0.00 $0.00 Y
K 21155 LEFORT III W/ LEFORT I 29.45 $1096.42 --- $1382.68 004 1 0 0.00 $0.00 Y
K 21159 LEFORT III W/FHDW/O LEFORT I 36.24 $1349.22 --- $1701.47 004 1 0 0.00 $0.00 Y
O 21159 LEFORT III W/FHDW/O LEFORT I 7.25 $269.92 --- $340.39 004 1 0 0.00 $0.00 Y
O 21160 LEFORT III W/FHD W/ LEFORT I 7.25 $269.92 --- $340.39 004 1 0 0.00 $0.00 Y
K 21160 LEFORT III W/FHD W/ LEFORT I 36.24 $1349.22 --- $1701.47 004 1 0 0.00 $0.00 Y
K 21172 RECONST ORBITAL RIM 36.24 $1349.22 --- $1701.47 004 1 0 0.00 $0.00 Y
O 21172 RECONST ORBITAL RIM 7.25 $269.92 --- $340.39 004 1 0 0.00 $0.00 Y
O 21175 RECONST. BIFRONTAL 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 21175 RECONST. BIFRONTAL 39.64 $1475.80 --- $1861.10 004 1 0 0.00 $0.00 Y
K 21179 RECONST., FOREHEAD/SUPRAORBITAL RIMS 33.77 $1257.26 --- $1585.50 004 1 0 0.00 $0.00 Y
O 21179 RECONSTR., FOREHEAD/SUPRAORBITAL RIMS 6.75 $251.30 --- $316.91 004 1 0 0.00 $0.00 Y
O 21180 RECONST., FOREHEAD/SUPRAORBITAL W/GRAFT 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 21180 RECONSTR., FOREHEAD/SUPRAORBITAL W/GRAFT 33.98 $1265.08 --- $1595.36 004 1 0 0.00 $0.00 Y
K 21181 REMOVAL TUMOR CRANIAL BONES 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 21181 REMOVAL TUMOR CRANIAL BONES 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 21182 RECONSTRUCT CRANIAL BONE 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 21182 RECONSTRUCT CRANIAL BONE 39.64 $1475.80 --- $1861.10 004 1 0 0.00 $0.00 Y
K 21183 RECONSTRUCT CRANIAL BONE 39.64 $1475.80 --- $1861.10 004 1 0 0.00 $0.00 Y
O 21183 RECONSTRUCT CRANIAL BONE 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
O 21184 RECONSTRUCT CRANIAL BONE 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 21184 RECONSTRUCT CRANIAL BONE 39.64 $1475.80 --- $1861.10 004 1 0 0.00 $0.00 Y
K 21188 RECONST., MIDFACE (OTHER THAN LEFORT) 32.72 $1218.17 --- $1536.20 004 1 0 0.00 $0.00 Y
O 21188 RECONST., MIDFACE (OTHER THAN LEFORT) 6.54 $243.48 --- $307.05 004 1 0 0.00 $0.00 Y
O 21193 RECONST LWR JAW W/O GRAFT 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 21193 RECONST LWR JAW W/O GRAFT 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
K 21194 RECONST LWR JAW W/GRAFT 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 21194 RECONST LWR JAW W/GRAFT 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 21195 RECONST LWR JAW W/O FIXATION 4.98 $185.41 --- $233.81 004 1 0 0.00 $0.00 Y
K 21195 RECONST LWR JAW W/O FIXATION 24.92 $927.77 --- $1169.99 004 1 0 0.00 $0.00 Y
K 21196 RECONST LWR JAW W/FIXATION 28.00 $1042.44 --- $1314.60 004 1 0 0.00 $0.00 Y
O 21196 RECONST LWR JAW W/FIXATION 5.60 $208.49 --- $262.92 004 1 0 0.00 $0.00 Y
O 21198 RECONSTR LWR JAW SEGMENT 2.38 $88.61 --- $111.74 004 1 0 0.00 $0.00 Y
K 21198 RECONSTR LWR JAW SEGMENT 11.90 $443.04 --- $558.71 004 1 0 0.00 $0.00 Y
K 21199 RECONSTR LWR JAW W/ADVANCE 24.01 $893.89 --- $1127.27 004 1 0 0.00 $0.00 Y
O 21199 RECONSTR LWR JAW W/ADVANCE 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
O 21206 OSTEOTOMY, MAXILLA, SIGMENTAL 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 21206 OSTEOTOMY, MAXILLA, SIGMENTAL 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
K 21208 AUGMENTATION OF FACIAL BONES 16.64 $619.51 --- $781.25 004 1 0 0.00 $0.00 Y
O 21208 AUGMENTATION OF FACIAL BONES 3.33 $123.98 --- $156.34 004 1 0 0.00 $0.00 Y
O 21209 REDUCTION OF FACIAL BONES 2.56 $95.31 --- $120.19 004 1 0 0.00 $0.00 Y
K 21209 REDUCTION OF FACIAL BONES 12.82 $477.29 --- $601.90 004 1 0 0.00 $0.00 Y
K 21210 FACE BONE GRAFT 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 21210 FACE BONE GRAFT 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 21215 LOWER JAW BONE GRAFT 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 21215 LOWER JAW BONE GRAFT 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
K 21230 RIB CARTILAGE GRAFT 18.00 $670.14 --- $845.10 004 1 0 0.00 $0.00 Y
O 21230 RIB CARTILAGE GRAFT 3.60 $134.03 --- $169.02 004 1 0 0.00 $0.00 Y
O 21235 GRAFT; EAR CARTILAGE, AUTOGRAFT 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 21235 GRAFT; EAR CARTILAGE, AUTOGRAFT 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 21240 ARTHROPLASTY, JAW JOINT, OBTAINING GRAFT 23.74 $883.84 --- $1114.59 004 1 0 0.00 $0.00 Y
O 21240 ARTHROPLASTY, JAW JOINT, OBTAINING GRAFT 4.75 $176.84 --- $223.01 004 1 0 0.00 $0.00 Y
O 21242 RECONSTRUCTION OF JAW JOINT 4.47 $166.42 --- $209.87 004 1 0 0.00 $0.00 Y
K 21242 RECONSTRUCTION OF JAW JOINT 22.36 $832.46 --- $1049.80 004 1 0 0.00 $0.00 Y
K 21243 RECONSTRUCTION OF JAW JOINT 31.70 $1180.19 --- $1488.32 004 1 0 0.00 $0.00 Y
O 21243 RECONSTRUCTION OF JAW JOINT 6.34 $236.04 --- $297.66 004 1 0 0.00 $0.00 Y
O 21244 RECONSTRUCTION OF LOWER JAW 4.23 $157.48 --- $198.60 004 1 0 0.00 $0.00 Y
K 21244 RECONSTRUCTION OF LOWER JAW 21.13 $786.67 --- $992.05 004 1 0 0.00 $0.00 Y
K 21245 RECONSTRUCTION OF JAW 21.34 $794.49 --- $1001.91 004 1 0 0.00 $0.00 Y
O 21245 RECONSTRUCTION OF JAW 4.27 $158.97 --- $200.48 004 1 0 0.00 $0.00 Y
O 21246 RECONSTRUCTION OF JAW 3.83 $142.59 --- $179.82 004 1 0 0.00 $0.00 Y
K 21246 RECONSTRUCTION OF JAW 19.17 $713.70 --- $900.03 004 1 0 0.00 $0.00 Y
K 21247 RECONSTRUCTION MANDIBLE CONDYLE 33.27 $1238.64 --- $1562.03 004 1 0 0.00 $0.00 Y
O 21247 RECONSTRUCTION MANDIBLE CONDYLE 6.65 $247.58 --- $312.22 004 1 0 0.00 $0.00 Y
O 21248 RECONSTRUCTION OF JAW 3.43 $127.70 --- $161.04 004 1 0 0.00 $0.00 Y
K 21248 RECONSTRUCTION OF JAW 17.13 $637.75 --- $804.25 004 1 0 0.00 $0.00 Y
K 21249 RECONSTRUCTION OF JAW 27.22 $1013.40 --- $1277.98 004 1 0 0.00 $0.00 Y
O 21249 RECONSTRUCTION OF JAW 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
O 21255 RECONST. ZYGOMATIC ARCH/GLENOID FOSSA 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 21255 RECONST. ZYGOMATIC ARCH/GLENOID FOSSA 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
K 21256 RECONST. ORBIT W/OSTEOTOMIES 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 21256 RECONST. ORBIT W/OSTEOTOMIES 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 21260 REVISE EYE SOCKETS 4.25 $158.23 --- $199.54 004 1 0 0.00 $0.00 Y
K 21260 REVISE EYE SOCKETS 21.23 $790.39 --- $996.75 004 1 0 0.00 $0.00 Y
K 21261 REVISE EYE SOCKETS 44.62 $1661.20 --- $2094.91 004 1 0 0.00 $0.00 Y
O 21261 REVISE EYE SOCKETS 8.92 $332.09 --- $418.79 004 1 0 0.00 $0.00 Y
O 21263 REVISE EYE SOCKETS 8.36 $311.24 --- $392.50 004 1 0 0.00 $0.00 Y
K 21263 REVISE EYE SOCKETS 41.79 $1555.84 --- $1962.04 004 1 0 0.00 $0.00 Y
K 21267 REVISE EYE SOCKETS 38.52 $1434.10 --- $1808.51 004 1 0 0.00 $0.00 Y
O 21267 REVISE EYE SOCKETS 7.70 $286.67 --- $361.52 004 1 0 0.00 $0.00 Y
O 21268 REVISE EYE SOCKETS 8.54 $317.94 --- $400.95 004 1 0 0.00 $0.00 Y
K 21268 REVISE EYE SOCKETS 42.71 $1590.09 --- $2005.23 004 1 0 0.00 $0.00 Y
K 21270 AUGMENTATION CHEEK BONE 15.83 $589.35 --- $743.22 004 1 0 0.00 $0.00 Y
O 21270 AUGMENTATION CHEEK BONE 3.17 $118.02 --- $148.83 004 1 0 0.00 $0.00 Y
O 21275 REVISION ORBITOFACIAL BONES 4.79 $178.33 --- $224.89 004 1 0 0.00 $0.00 Y
K 21275 REVISION ORBITOFACIAL BONES 23.96 $892.03 --- $1124.92 004 1 0 0.00 $0.00 Y
K 21280 MEDIAL CANTHOPEXY, SEPARATE PROCEDURE 10.52 $391.66 --- $493.91 004 1 0 0.00 $0.00 Y
O 21280 MEDIAL CANTHOPEXY, SEPARATE PROCEDURE 2.10 $78.18 --- $98.60 004 1 0 0.00 $0.00 Y
O 21282 REVISION OF EYELID 2.07 $77.07 --- $97.19 004 1 0 0.00 $0.00 Y
K 21282 REVISION OF EYELID 10.36 $385.70 --- $486.40 004 1 0 0.00 $0.00 Y
K 21295 REDUCTION OF MASSETER MUSCLE AND BONE 6.21 $231.20 --- $291.56 004 1 0 0.00 $0.00 Y
O 21295 9908CTION OF MASSETER MUSCLE AND BONE 1.24 $46.17 --- $58.22 004 1 0 0.00 $0.00 Y
O 21296 REVISION OF JAW MUSCLE 1.73 $64.41 --- $81.22 004 1 0 0.00 $0.00 Y
K 21296 REVISION OF JAW MUSCLE 8.66 $322.41 --- $406.59 004 1 0 0.00 $0.00 Y
K 21299 UNLISTED CRANIOFACIAL/MAXILLOFACIAL PROC 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 21299 UNLISTED CRANIOFACIAL/MAXILLOFACIAL PROC 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21310 CLOSED TX NOSE FX W/O MANJ 1.38 $51.38 --- $64.79 004 1 0 0.00 $0.00 Y
K 21315 CLOSED TX NOSE FX W/O STABLJ 2.13 $79.30 --- $100.00 004 1 1 0.00 $0.00 Y
K 21320 CLOSED TX NOSE FX W/ STABLJ 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
K 21325 OPEN TX NOSE FX UNCOMPLICATD 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 21325 OPEN TX NOSE FX UNCOMPLICATD 0.90 $33.51 --- $42.26 004 1 0 0.00 $0.00 Y
O 21330 OPEN TX NOSE FX W/SKELE FIXJ 1.90 $70.74 --- $89.21 004 1 0 0.00 $0.00 Y
K 21330 OPEN TX NOSE FX W/SKELE FIXJ 9.50 $353.69 --- $446.03 004 1 0 0.00 $0.00 Y
K 21335 OPEN TX NOSE & SEPTAL FX 17.00 $632.91 --- $798.15 004 1 0 0.00 $0.00 Y
O 21335 OPEN TX NOSE & SEPTAL FX 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
O 21336 OPEN TX SEPTAL FX W/WO STABJ 1.28 $47.65 --- $60.10 004 1 0 0.00 $0.00 Y
K 21336 OPEN TX SEPTAL FX W/WO STABJ 6.38 $237.53 --- $299.54 004 1 0 0.00 $0.00 Y
K 21337 CLOSED TX SEPTAL&NOSE FX 3.51 $130.68 --- $164.79 004 1 0 0.00 $0.00 Y
K 21338 OPEN NASOETHMOID FX W/O FIXJ 12.95 $482.13 --- $608.00 004 1 0 0.00 $0.00 Y
O 21338 OPEN NASOETHMOID FX W/O FIXJ 2.59 $96.43 --- $121.60 004 1 0 0.00 $0.00 Y
O 21339 OPEN NASOETHMOID FX W/ FIXJ 2.98 $110.95 --- $139.91 004 1 0 0.00 $0.00 Y
K 21339 OPEN NASOETHMOID FX W/ FIXJ 14.90 $554.73 --- $699.56 004 1 0 0.00 $0.00 Y
K 21340 PERQ TX NASOETHMOID FX 19.91 $741.25 --- $934.77 004 1 0 0.00 $0.00 Y
O 21340 PERQ TX NASOETHMOID FX 3.98 $148.18 --- $186.86 004 1 0 0.00 $0.00 Y
O 21343 OPEN TX DPRSD FRONT SINUS FX 4.37 $162.70 --- $205.17 004 1 0 0.00 $0.00 Y
K 21343 OPEN TX DPRSD FRONT SINUS FX 21.84 $813.10 --- $1025.39 004 1 0 0.00 $0.00 Y
K 21344 OPEN TX COMPL FRONT SINUS FX 19.16 $713.33 --- $899.56 004 1 0 0.00 $0.00 Y
O 21344 OPEN TX COMPL FRONT SINUS FX 3.83 $142.59 --- $179.82 004 1 0 0.00 $0.00 Y
O 21345 CLOSED TX NOSE/JAW FX 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 21345 CLOSED TX NOSE/JAW FX 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 21346 OPN TX NASOMAX FX W/FIXJ 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 21346 OPN TX NASOMAX FX W/FIXJ 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 21347 OPN TX NASOMAX FX MULTPLE 5.23 $194.71 --- $245.55 004 1 0 0.00 $0.00 Y
K 21347 OPN TX NASOMAX FX MULTPLE 26.16 $973.94 --- $1228.21 004 1 0 0.00 $0.00 Y
K 21348 OPN TX NASOMAX FX W/GRAFT 12.51 $465.75 --- $587.34 004 1 0 0.00 $0.00 Y
O 21348 OPN TX NASOMAX FX W/GRAFT 2.50 $93.08 --- $117.38 004 1 0 0.00 $0.00 Y
K 21355 PERQ TX MALAR FRACTURE 3.46 $128.82 --- $162.45 004 1 0 0.00 $0.00 Y
K 21356 OPN TX DPRSD ZYGOMATIC ARCH 7.42 $276.25 --- $348.37 004 1 0 0.00 $0.00 Y
O 21356 OPN TX DPRSD ZYGOMATIC ARCH 1.48 $55.10 --- $69.49 004 1 0 0.00 $0.00 Y
O 21360 OPN TX DPRSD MALAR FRACTURE 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 21360 OPN TX DPRSD MALAR FRACTURE 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 21365 OPN TX COMPLX MALAR FX 14.72 $548.03 --- $691.10 004 1 0 0.00 $0.00 Y
O 21365 OPN TX COMPLX MALAR FX 2.94 $109.46 --- $138.03 004 1 0 0.00 $0.00 Y
O 21366 OPN TX COMPLX MALAR W/GRFT 2.98 $110.95 --- $139.91 004 1 0 0.00 $0.00 Y
K 21366 OPN TX COMPLX MALAR W/GRFT 14.91 $555.10 --- $700.02 004 1 0 0.00 $0.00 Y
K 21385 OPN TX ORBIT FX TRANSANTRAL 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 21385 OPN TX ORBIT FX TRANSANTRAL 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 21386 OPN TX ORBIT FX PERIORBITAL 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 21386 OPN TX ORBIT FX PERIORBITAL 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 21387 OPN TX ORBIT FX COMBINED 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 21387 OPN TX ORBIT FX COMBINED 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 21390 OPN TX ORBIT PERIORBTL IMPLT 3.17 $118.02 --- $148.83 004 1 0 0.00 $0.00 Y
K 21390 OPN TX ORBIT PERIORBTL IMPLT 15.86 $590.47 --- $744.63 004 1 0 0.00 $0.00 Y
K 21395 OPN TX ORBIT PERIORBT W/GRFT 19.07 $709.98 --- $895.34 004 1 0 0.00 $0.00 Y
O 21395 OPN TX ORBIT PERIORBT W/GRFT 3.81 $141.85 --- $178.88 004 1 0 0.00 $0.00 Y
O 21400 CLOSED TX ORBIT W/O MANIPULJ 1.09 $40.58 --- $51.18 004 1 0 0.00 $0.00 Y
K 21400 CLOSED TX ORBIT W/O MANIPULJ 5.46 $203.28 --- $256.35 004 1 0 0.00 $0.00 Y
K 21401 CLOSED TX ORBIT W/ MANIPULJ 7.03 $261.73 --- $330.06 004 1 0 0.00 $0.00 Y
O 21401 CLOSED TX ORBIT W/ MANIPULJ 1.41 $52.49 --- $66.20 004 1 0 0.00 $0.00 Y
O 21406 OPN TX ORBIT FX W/O IMPLANT 2.81 $104.62 --- $131.93 004 1 0 0.00 $0.00 Y
K 21406 OPN TX ORBIT FX W/O IMPLANT 14.03 $522.34 --- $658.71 004 1 0 0.00 $0.00 Y
K 21407 OPN TX ORBIT FX W/IMPLANT 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
O 21407 OPN TX ORBIT FX W/IMPLANT 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
O 21408 OPN TX ORBIT FX W/BONE GRFT 2.53 $94.19 --- $118.78 004 1 0 0.00 $0.00 Y
K 21408 OPN TX ORBIT FX W/BONE GRFT 12.64 $470.59 --- $593.45 004 1 0 0.00 $0.00 Y
K 21421 TREAT MOUTH ROOF FRACTURE 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
O 21421 TREAT MOUTH ROOF FRACTURE 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
O 21422 TREAT MOUTH ROOF FRACTURE 2.62 $97.54 --- $123.01 004 1 0 0.00 $0.00 Y
K 21422 TREAT MOUTH ROOF FRACTURE 13.12 $488.46 --- $615.98 004 1 0 0.00 $0.00 Y
K 21423 TREAT MOUTH ROOF FRACTURE 14.17 $527.55 --- $665.28 004 1 0 0.00 $0.00 Y
O 21423 TREAT MOUTH ROOF FRACTURE 2.83 $105.36 --- $132.87 004 1 0 0.00 $0.00 Y
O 21431 TREAT CRANIOFACIAL FRACTURE 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 21431 TREAT CRANIOFACIAL FRACTURE 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 21432 TREAT CRANIOFACIAL FRACTURE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 21432 TREAT CRANIOFACIAL FRACTURE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 21433 TREAT CRANIOFACIAL FRACTURE 7.17 $266.94 --- $336.63 004 1 0 0.00 $0.00 Y
K 21433 TREAT CRANIOFACIAL FRACTURE 35.85 $1334.70 --- $1683.16 004 1 0 0.00 $0.00 Y
K 21435 TREAT CRANIOFACIAL FRACTURE 959.20 $959.20 --- -- 042 0 0 0.00 $0.00 Y
O 21435 TREAT CRANIOFACIAL FRACTURE 191.73 $191.73 --- -- 042 0 0 0.00 $0.00 Y
O 21436 TREAT CRANIOFACIAL FRACTURE 5.78 $215.19 --- $271.37 004 1 0 0.00 $0.00 Y
K 21436 TREAT CRANIOFACIAL FRACTURE 28.86 $1074.46 --- $1354.98 004 1 0 0.00 $0.00 Y
K 21440 TREAT DENTAL RIDGE FRACTURE 3.57 $132.91 --- $167.61 004 1 0 0.00 $0.00 Y
K 21445 TREAT DENTAL RIDGE FRACTURE 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
O 21445 TREAT DENTAL RIDGE FRACTURE 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
O 21450 TREAT LOWER JAW FRACTURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21450 TREAT LOWER JAW FRACTURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21451 TREAT LOWER JAW FRACTURE 10.18 $379.00 --- $477.95 004 1 0 0.00 $0.00 Y
O 21451 TREAT LOWER JAW FRACTURE 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
O 21452 TREAT LOWER JAW FRACTURE 1.79 $66.64 --- $84.04 004 1 0 0.00 $0.00 Y
K 21452 TREAT LOWER JAW FRACTURE 8.94 $332.84 --- $419.73 004 1 0 0.00 $0.00 Y
K 21453 TREAT LOWER JAW FRACTURE 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 21453 TREAT LOWER JAW FRACTURE 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 21454 TREAT LOWER JAW FRACTURE 1.99 $74.09 --- $93.43 004 1 0 0.00 $0.00 Y
K 21454 TREAT LOWER JAW FRACTURE 9.93 $369.69 --- $466.21 004 1 0 0.00 $0.00 Y
K 21461 TREAT LOWER JAW FRACTURE 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
O 21461 TREAT LOWER JAW FRACTURE 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
O 21462 TREAT LOWER JAW FRACTURE 3.25 $121.00 --- $152.59 004 1 0 0.00 $0.00 Y
K 21462 TREAT LOWER JAW FRACTURE 16.23 $604.24 --- $762.00 004 1 0 0.00 $0.00 Y
K 21465 TREAT LOWER JAW FRACTURE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 21465 TREAT LOWER JAW FRACTURE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 21470 TREAT LOWER JAW FRACTURE 190.00 $190.00 --- -- 042 0 0 0.00 $0.00 Y
K 21470 TREAT LOWER JAW FRACTURE 950.00 $950.00 --- -- 042 0 0 0.00 $0.00 Y
K 21480 RESET DISLOCATED JAW 1.90 $70.74 --- $89.21 004 1 1 0.00 $0.00 Y
O 21480 RESET DISLOCATED JAW 0.38 $14.15 --- $17.84 004 1 0 0.00 $0.00 Y
O 21485 RESET DISLOCATED JAW 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21485 RESET DISLOCATED JAW 6.58 $244.97 --- $308.93 004 1 0 0.00 $0.00 Y
K 21490 REPAIR DISLOCATED JAW 18.28 $680.56 --- $858.25 004 1 0 0.00 $0.00 Y
O 21490 REPAIR DISLOCATED JAW 3.66 $136.26 --- $171.84 004 1 0 0.00 $0.00 Y
O 21497 INTERDENTAL WIRING 1.43 $53.24 --- $67.14 004 1 0 0.00 $0.00 Y
K 21497 INTERDENTAL WIRING 7.16 $266.57 --- $336.16 004 1 1 0.00 $0.00 Y
K 21499 HEAD SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 21499 HEAD SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 21501 DRAIN NECK/CHEST LESION 1.37 $51.01 --- $64.32 004 1 0 0.00 $0.00 Y
K 21501 DRAIN NECK/CHEST LESION 6.86 $255.40 --- $322.08 004 1 0 0.00 $0.00 Y
K 21502 DRAIN CHEST LESION 6.94 $258.38 --- $325.83 004 1 0 0.00 $0.00 Y
O 21502 DRAIN CHEST LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 21510 DRAINAGE OF BONE LESION 2.35 $87.49 --- $110.33 004 1 0 0.00 $0.00 Y
K 21510 DRAINAGE OF BONE LESION 11.73 $436.71 --- $550.72 004 1 0 0.00 $0.00 Y
K 21550 BIOPSY OF NECK/CHEST 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
K 21552 EXC NECK LES SC 3 CM/> 9.94 $370.07 --- -- 004 0 0 0.00 $0.00 Y
O 21552 EXC NECK LES SC 3 CM/> 1.99 $74.09 --- -- 004 0 0 0.00 $0.00 Y
O 21554 EXC NECK TUM DEEP 5 CM/> 3.25 $121.00 --- -- 004 0 0 0.00 $0.00 Y
K 21554 EXC NECK TUM DEEP 5 CM/> 16.26 $605.36 --- -- 004 0 0 0.00 $0.00 Y
K 21555 EXC NECK LES SC < 3 CM 8.89 $330.97 --- $417.39 004 1 0 0.00 $0.00 Y
O 21555 EXC NECK LES SC < 3 CM 1.78 $66.27 --- $83.57 004 1 0 0.00 $0.00 Y
O 21556 EXC NECK TUM DEEP < 5 CM 2.14 $79.67 --- $100.47 004 1 0 0.00 $0.00 Y
K 21556 EXC NECK TUM DEEP < 5 CM 10.72 $399.11 --- $503.30 004 1 0 0.00 $0.00 Y
K 21557 RESECT NECK TUM < 5 CM 17.97 $669.02 --- $843.69 004 1 0 0.00 $0.00 Y
O 21557 RESECT NECK TUM < 5 CM 3.59 $133.66 --- $168.55 004 1 0 0.00 $0.00 Y
O 21558 RESECT NECK TUM 5 CM/> 6.08 $226.36 --- -- 004 0 0 0.00 $0.00 Y
K 21558 RESECT NECK TUM 5 CM/> 30.41 $1132.16 --- -- 004 0 0 0.00 $0.00 Y
K 21600 PARTIAL REMOVAL OF RIB 7.31 $272.15 --- $343.20 004 1 0 0.00 $0.00 Y
O 21600 PARTIAL REMOVAL OF RIB 1.46 $54.36 --- $68.55 004 1 0 0.00 $0.00 Y
O 21601 EXC CHEST WALL TUMOR W/RIBS 5.49 $204.43 --- -- 004 0 0 0.00 $0.00 Y
K 21601 EXC CHEST WALL TUMOR W/RIBS 27.45 $1022.16 --- -- 004 0 0 0.00 $0.00 Y
K 21602 EXC CH WAL TUM W/O LYMPHADEC 37.18 $1384.23 --- -- 004 0 0 0.00 $0.00 Y
O 21602 EXC CH WAL TUM W/O LYMPHADEC 7.43 $276.85 --- -- 004 0 0 0.00 $0.00 Y
O 21603 EXC CH WAL TUM W/LYMPHADEC 8.19 $305.20 --- -- 004 0 0 0.00 $0.00 Y
K 21603 EXC CH WAL TUM W/LYMPHADEC 40.98 $1526.02 --- -- 004 0 0 0.00 $0.00 Y
K 21610 PARTIAL REMOVAL OF RIB 11.99 $446.39 --- $562.93 004 1 0 0.00 $0.00 Y
O 21610 PARTIAL REMOVAL OF RIB 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
O 21615 EXCISION FIRST AND/OR CERVICAL RIB 3.46 $128.82 --- $162.45 004 1 0 0.00 $0.00 Y
K 21615 EXCISION FIRST AND/OR CERVICAL RIB; 17.11 $637.01 --- $803.31 004 1 0 0.00 $0.00 Y
K 21616 REMOVAL OF RIB AND NERVES 18.46 $687.27 --- $866.70 004 1 0 0.00 $0.00 Y
O 21616 REMOVAL OF RIB AND NERVES 3.74 $139.24 --- $175.59 004 1 0 0.00 $0.00 Y
O 21620 PARTIAL REMOVAL OF STERNUM 3.01 $112.06 --- $141.32 004 1 0 0.00 $0.00 Y
K 21620 PARTIAL REMOVAL OF STERNUM 15.04 $559.94 --- $706.13 004 1 0 0.00 $0.00 Y
K 21627 STERNAL DEBRIDEMENT 19.67 $732.31 --- $923.51 004 1 0 0.00 $0.00 Y
O 21627 STERNAL DEBRIDEMENT 3.93 $146.31 --- $184.51 004 1 0 0.00 $0.00 Y
O 21630 RADICAL RESECTION OF STERUM 6.51 $242.37 --- $305.64 004 1 0 0.00 $0.00 Y
K 21630 RADICAL RESECTION OF STERNUM 32.54 $1211.46 --- $1527.75 004 1 0 0.00 $0.00 Y
K 21632 EXTENSIVE STERNUM SURGERY 29.94 $1114.67 --- $1405.68 004 1 0 0.00 $0.00 Y
O 21632 EXTENSIVE STERNUM SURGERY 5.99 $223.01 --- $281.23 004 1 0 0.00 $0.00 Y
K 21685 HYOID MYOTOMY & SUSPENSION 11.38 $423.54 --- $534.29 004 1 0 0.00 $0.00 Y
K 21700 REVISION OF NECK MUSCLE 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 21700 REVISION OF NECK MUSCLE 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 21705 REVISION OF NECK MUSCLE/RIB 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 21705 REVISION OF NECK MUSCLE/RIB 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 21720 REVISION OF NECK MUSCLE 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 21720 REVISION OF NECK MUSCLE 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 21725 REVISION OF NECK MUSCLE 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
K 21725 REVISION OF NECK MUSCLE 10.19 $379.37 --- $478.42 004 1 0 0.00 $0.00 Y
K 21740 RECONSTRUCTION OF STERNUM 28.96 $1078.18 --- $1359.67 004 1 0 0.00 $0.00 Y
O 21740 RECONSTRUCTION OF STERNUM 5.79 $215.56 --- $271.84 004 1 0 0.00 $0.00 Y
O 21742 REPAIR STERN/NUSS W/O SCOPE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21742 REPAIR STERN/NUSS W/O SCOPE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21743 REPAIR STERNUM/NUSS W/SCOPE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 21743 REPAIR STERNUM/NUSS W/SCOPE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 21750 REPAIR OF STERNUM SEPARATION 4.36 $162.32 --- $204.70 004 1 0 0.00 $0.00 Y
K 21750 REPAIR OF STERNUM SEPARATION 21.79 $811.24 --- $1023.04 004 1 0 0.00 $0.00 Y
K 21811 OPTX OF RIB FX W/FIXJ SCOPE 13.83 $514.89 --- $649.32 004 1 0 0.00 $0.00 Y
O 21811 OPTX OF RIB FX W/FIXJ SCOPE 2.76 $102.75 --- $129.58 004 1 0 0.00 $0.00 Y
O 21812 TREATMENT OF RIB FRACTURE 3.31 $123.23 --- $155.40 004 1 0 0.00 $0.00 Y
K 21812 TREATMENT OF RIB FRACTURE 16.57 $616.90 --- $777.96 004 1 0 0.00 $0.00 Y
K 21813 TREATMENT OF RIB FRACTURE 22.57 $840.28 --- $1059.66 004 1 0 0.00 $0.00 Y
O 21813 TREATMENT OF RIB FRACTURE 4.51 $167.91 --- $211.74 004 1 0 0.00 $0.00 Y
O 21820 TREAT STERNUM FRACTURE 0.62 $23.08 --- $29.11 004 1 0 0.00 $0.00 Y
K 21820 TREAT STERNUM FRACTURE 3.11 $115.79 --- $146.01 004 1 1 0.00 $0.00 Y
K 21825 TREAT STERNUM FRACTURE 16.93 $630.30 --- $794.86 004 1 0 0.00 $0.00 Y
O 21825 TREAT STERNUM FRACTURE 3.39 $126.21 --- $159.16 004 1 0 0.00 $0.00 Y
O 21899 NECK/CHEST SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21899 NECK/CHEST SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 21920 BIOPSY SOFT TISSUE OF BACK 2.06 $76.69 --- $96.72 004 1 0 0.00 $0.00 Y
O 21920 BIOPSY SOFT TISSUE OF BACK 0.41 $15.26 --- $19.25 004 1 0 0.00 $0.00 Y
O 21925 BIOPSY SOFT TISSUE OF BACK 1.45 $53.98 --- $68.08 004 1 0 0.00 $0.00 Y
K 21925 BIOPSY SOFT TISSUE OF BACK 7.23 $269.17 --- $339.45 004 1 0 0.00 $0.00 Y
K 21930 EXC BACK LES SC < 3 CM 9.97 $371.18 --- $468.09 004 1 0 0.00 $0.00 Y
O 21930 EXC BACK LES SC < 3 CM 1.99 $74.09 --- $93.43 004 1 0 0.00 $0.00 Y
O 21931 EXC BACK LES SC 3 CM/> 2.07 $77.07 --- -- 004 0 0 0.00 $0.00 Y
K 21931 EXC BACK LES SC 3 CM/> 10.37 $386.08 --- -- 004 0 0 0.00 $0.00 Y
K 21932 EXC BACK TUM DEEP < 5 CM 14.89 $554.35 --- $699.09 004 1 0 0.00 $0.00 Y
O 21932 EXC BACK TUM DEEP < 5 CM 2.98 $110.95 --- $139.91 004 1 0 0.00 $0.00 Y
O 21933 EXC BACK TUM DEEP 5 CM/> 3.27 $121.74 --- -- 004 0 0 0.00 $0.00 Y
K 21933 EXC BACK TUM DEEP 5 CM/> 16.36 $609.08 --- -- 004 0 0 0.00 $0.00 Y
K 21935 RESECT BACK TUM < 5 CM 22.44 $835.44 --- $1053.56 004 1 0 0.00 $0.00 Y
O 21935 RESECT BACK TUM < 5 CM 4.49 $167.16 --- $210.81 004 1 0 0.00 $0.00 Y
O 21936 RESECT BACK TUM 5 CM/> 6.31 $234.92 --- -- 004 0 0 0.00 $0.00 Y
K 21936 RESECT BACK TUM 5 CM/> 31.56 $1174.98 --- -- 004 0 0 0.00 $0.00 Y
K 22010 I&D P-SPINE C/T/CERV-THOR 17.83 $663.81 --- $837.12 004 1 0 0.00 $0.00 Y
O 22010 I&D P-SPINE C/T/CERV-THOR 3.57 $132.91 --- $167.61 004 1 0 0.00 $0.00 Y
O 22015 I&D ABSCESS P-SPINE L/S/LS 3.54 $131.79 --- $166.20 004 1 0 0.00 $0.00 Y
K 22015 I&D ABSCESS P-SPINE L/S/LS 17.68 $658.23 --- $830.08 004 1 0 0.00 $0.00 Y
K 22100 PARTIAL EXCISION OF POST VERT,CERVICAL 12.90 $480.27 --- $605.66 004 1 0 0.00 $0.00 Y
O 22100 PARTIAL EXCISION OF POST VERT,CERVICAL 2.58 $96.05 --- $121.13 004 1 0 0.00 $0.00 Y
O 22101 REMOVE PART THORAX VERTEBRA 2.67 $99.40 --- $125.36 004 1 0 0.00 $0.00 Y
K 22101 REMOVE PART THORAX VERTEBRA 13.35 $497.02 --- $626.78 004 1 0 0.00 $0.00 Y
K 22102 REMOVE PART LUMBAR VERTEBRA 10.28 $382.72 --- $482.65 004 1 0 0.00 $0.00 Y
O 22102 REMOVE PART LUMBAR VERTEBRA 2.06 $76.69 --- $96.72 004 1 0 0.00 $0.00 Y
O 22103 PARTIAL EXCISION OF POSTERIOR VERTEBRAL 0.63 $23.45 --- $29.58 004 1 0 0.00 $0.00 Y
K 22103 PARTIAL EXCISION OF POSTERIOR VERTEBRAL 3.19 $118.76 --- $149.77 004 1 0 0.00 $0.00 Y
K 22110 PARTIAL EXCISION VERT BODY,CERVICAL 16.66 $620.25 --- $782.19 004 1 0 0.00 $0.00 Y
O 22110 PARTIAL EXCISION VERT BODY,CERVICAL 3.33 $123.98 --- $156.34 004 1 0 0.00 $0.00 Y
O 22112 REMOVE PART THORAX VERTEBRA 3.35 $124.72 --- $157.28 004 1 0 0.00 $0.00 Y
K 22112 REMOVE PART THORAX VERTEBRA 16.79 $625.09 --- $788.29 004 1 0 0.00 $0.00 Y
K 22114 REMOVE PART LUMBAR VERTEBRA 14.52 $540.58 --- $681.71 004 1 0 0.00 $0.00 Y
O 22114 REMOVE PART LUMBAR VERTEBRA 2.90 $107.97 --- $136.16 004 1 0 0.00 $0.00 Y
O 22116 PARTIAL EXCISION OF VERTEBRAL BODY EACH 0.63 $23.45 --- $29.58 004 1 0 0.00 $0.00 Y
K 22116 PARTIAL EXCISION OF VERTEBRAL BODY EACH 3.14 $116.90 --- $147.42 004 1 0 0.00 $0.00 Y
K 22206 INCIS SPINE 3 COLUMN THORAC 46.29 $1723.38 --- -- 004 0 0 0.00 $0.00 Y
O 22206 INCIS SPINE 3 COLUMN THORAC 9.26 $344.75 --- -- 004 0 0 0.00 $0.00 Y
O 22207 INCIS SPINE 3 COLUMN LUMBAR 9.13 $340.28 --- -- 004 0 0 0.00 $0.00 Y
K 22207 INCIS SPINE 3 COLUMN LUMBAR 45.72 $1702.16 --- -- 004 0 0 0.00 $0.00 Y
K 22208 INCIS SPINE 3 COLUMN ADL SEG 11.55 $430.01 --- -- 004 0 0 0.00 $0.00 Y
O 22208 INCIS SPINE 3 COLUMN ADL SEG 2.31 $86.00 --- -- 004 0 0 0.00 $0.00 Y
O 22210 INCIS 1 VERTEBRAL SEG CERV 5.63 $209.60 --- $264.33 004 1 0 0.00 $0.00 Y
K 22210 INCIS 1 VERTEBRAL SEG CERV 28.15 $1048.02 --- $1321.64 004 1 0 0.00 $0.00 Y
K 22212 INCIS 1 VERTEBRAL SEG THORAC 27.77 $1033.88 --- $1303.80 004 1 0 0.00 $0.00 Y
O 22212 INCIS 1 VERTEBRAL SEG THORAC 5.55 $206.63 --- $260.57 004 1 0 0.00 $0.00 Y
O 22214 INCIS 1 VERTEBRAL SEG LUMBAR 5.22 $194.34 --- $245.08 004 1 0 0.00 $0.00 Y
K 22214 INCIS 1 VERTEBRAL SEG LUMBAR 26.08 $970.96 --- $1224.46 004 1 0 0.00 $0.00 Y
K 22216 INCIS ADDL SPINE SEGMENT 8.24 $306.78 --- $386.87 004 1 0 0.00 $0.00 Y
O 22216 INCIS ADDL SPINE SEGMENT 1.65 $61.43 --- $77.47 004 1 0 0.00 $0.00 Y
O 22220 INCIS W/DISCECTOMY CERVICAL 5.72 $212.96 --- $268.55 004 1 0 0.00 $0.00 Y
K 22220 INCIS W/DISCECTOMY CERVICAL 28.61 $1065.15 --- $1343.24 004 1 0 0.00 $0.00 Y
K 22222 INCIS W/DISCECTOMY THORACIC 25.65 $954.95 --- $1204.27 004 1 0 0.00 $0.00 Y
O 22222 INCIS W/DISCECTOMY THORACIC 5.13 $190.99 --- $240.85 004 1 0 0.00 $0.00 Y
O 22224 INCIS W/DISCECTOMY LUMBAR 5.45 $202.90 --- $255.88 004 1 0 0.00 $0.00 Y
K 22224 INCIS W/DISCECTOMY LUMBAR 27.22 $1013.40 --- $1277.98 004 1 0 0.00 $0.00 Y
K 22226 REVISE EXTRA SPINE SEGMENT 8.18 $304.54 --- $384.05 004 1 0 0.00 $0.00 Y
O 22226 REVISE EXTRA SPINE SEGMENT 1.64 $61.06 --- $77.00 004 1 0 0.00 $0.00 Y
O 22310 CLOSED TX VERT FX W/O MANJ 0.74 $27.55 --- $34.74 004 1 0 0.00 $0.00 Y
K 22310 CLOSED TX VERT FX W/O MANJ 3.68 $137.01 --- $172.78 004 1 0 0.00 $0.00 Y
K 22315 CLOSED TX VERT FX W/MANJ 10.69 $397.99 --- $501.90 004 1 0 0.00 $0.00 Y
O 22315 CLOSED TX VERT FX W/MANJ 2.14 $79.67 --- $100.47 004 1 0 0.00 $0.00 Y
O 22318 TREAT ODONTOID FX W/O GRAFT 5.25 $195.46 --- $246.49 004 1 0 0.00 $0.00 Y
K 22318 TREAT ODONTOID FX W/O GRAFT 26.23 $976.54 --- $1231.50 004 1 0 0.00 $0.00 Y
K 22319 TREAT ODONTOID FX W/GRAFT 29.66 $1104.24 --- $1392.54 004 1 0 0.00 $0.00 Y
O 22319 TREAT ODONTOID FX W/GRAFT 5.93 $220.77 --- $278.41 004 1 0 0.00 $0.00 Y
O 22325 TREAT SPINE FRACTURE 3.90 $145.20 --- $183.11 004 1 0 0.00 $0.00 Y
K 22325 TREAT SPINE FRACTURE 19.49 $725.61 --- $915.06 004 1 0 0.00 $0.00 Y
K 22326 TREAT NECK SPINE FRACTURE 27.18 $1011.91 --- $1276.10 004 1 0 0.00 $0.00 Y
O 22326 TREAT NECK SPINE FRACTURE 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
O 22327 TREAT THORAX SPINE FRACTURE 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
K 22327 TREAT THORAX SPINE FRACTURE 27.18 $1011.91 --- $1276.10 004 1 0 0.00 $0.00 Y
K 22328 TREAT EACH ADD SPINE FX 6.31 $234.92 --- $296.25 004 1 0 0.00 $0.00 Y
O 22328 TREAT EACH ADD SPINE FX 1.26 $46.91 --- $59.16 004 1 0 0.00 $0.00 Y
K 22505 MANIPULATION OF SPINE 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
K 22510 PERQ CERVICOTHORACIC INJECT 10.58 $393.89 --- -- 004 0 0 0.00 $0.00 Y
K 22511 PERQ LUMBOSACRAL INJECTION 9.94 $370.07 --- -- 004 0 0 0.00 $0.00 Y
K 22512 VERTEBROPLASTY ADDL INJECT 4.88 $181.68 --- -- 004 0 0 0.00 $0.00 Y
K 22513 PERQ VERTEBRAL AUGMENTATION 12.54 $466.86 --- -- 004 0 0 0.00 $0.00 Y
O 22513 PERQ VERTEBRAL AUGMENTATION 2.50 $93.43 --- -- 004 0 0 0.00 $0.00 Y
O 22514 PERQ VERTEBRAL AUGMENTATION 2.34 $87.12 --- -- 004 0 0 0.00 $0.00 Y
K 22514 PERQ VERTEBRAL AUGMENTATION 11.70 $435.62 --- -- 004 0 0 0.00 $0.00 Y
K 22515 PERQ VERTEBRAL AUGMENTATION 5.24 $195.09 --- -- 004 0 0 0.00 $0.00 Y
O 22515 PERQ VERTEBRAL AUGMENTATION 1.04 $39.02 --- -- 004 0 0 0.00 $0.00 Y
O 22532 LAT THORAX SPINE FUSION 4.42 $164.74 --- $207.52 004 1 0 0.00 $0.00 Y
K 22532 LAT THORAX SPINE FUSION 22.12 $823.71 --- $1038.53 004 1 0 0.00 $0.00 Y
K 22533 LAT LUMBAR SPINE FUSION 20.96 $780.26 --- $984.07 004 1 0 0.00 $0.00 Y
O 22533 LAT LUMBAR SPINE FUSION 4.19 $156.05 --- $196.72 004 1 0 0.00 $0.00 Y
O 22534 LAT THOR/LUMB ADDL SEG 1.11 $41.40 --- $52.11 004 1 0 0.00 $0.00 Y
K 22534 LAT THOR/LUMB ADDL SEG 5.56 $207.00 --- $261.04 004 1 0 0.00 $0.00 Y
K 22548 ARTHRODESIS,ANT TRANSORAL OR EXTRAORAL T 36.75 $1368.20 --- $1725.41 004 1 0 0.00 $0.00 Y
O 22548 ARTHRODESIS,ANT TRANSORAL OR EXTRAORAL T 7.35 $273.64 --- $345.08 004 1 0 0.00 $0.00 Y
O 22551 NECK SPINE FUSE&REMOV BEL C2 7.64 $284.58 --- -- 004 0 0 0.00 $0.00 Y
K 22551 NECK SPINE FUSE&REMOV BEL C2 38.22 $1422.88 --- -- 004 0 0 0.00 $0.00 Y
K 22552 *11ADDL NECK SPINE FUSION 8.83 $328.77 --- -- 004 0 0 0.00 $0.00 Y
O 22552 *11ADDL NECK SPINE FUSION 1.77 $65.75 --- -- 004 0 0 0.00 $0.00 Y
O 22554 ARTHRODESIS, ANT INTERBODY TECH,CERVICAL 5.82 $216.68 --- $273.25 004 1 0 0.00 $0.00 Y
K 22554 ARTHRODESIS, ANT INTERBODY TECH,CERVICAL 29.10 $1083.39 --- $1366.25 004 1 0 0.00 $0.00 Y
K 22556 ARTHRODESIS, ANT INTERBODY TECH,THORACIC 34.50 $1284.44 --- $1619.78 004 1 0 0.00 $0.00 Y
O 22556 ARTHRODESIS, ANT INTERBODY TECH,THORACIC 6.90 $256.89 --- $323.96 004 1 0 0.00 $0.00 Y
O 22558 ARTHRODESIS, ANT INTERBODY TECH,LUMBAR 6.50 $242.00 --- $305.18 004 1 0 0.00 $0.00 Y
K 22558 ARTHRODESIS, ANT INTERBODY TECH,LUMBAR 32.49 $1209.60 --- $1525.41 004 1 0 0.00 $0.00 Y
K 22585 ARTHRODESIS, EACH ADDITIONAL SPACE 7.60 $282.95 --- $356.82 004 1 0 0.00 $0.00 Y
O 22585 ARTHRODESIS, EACH ADDITIONAL SPACE 1.52 $56.59 --- $71.36 004 1 0 0.00 $0.00 Y
O 22586 PRESCRL FUSE W/ INSTR L5-S1 6.57 $244.60 --- -- 004 0 0 0.00 $0.00 Y
K 22586 PRESCRL FUSE W/ INSTR L5-S1 32.88 $1224.12 --- -- 004 0 0 0.00 $0.00 Y
K 22590 ARTHRODESIS, POST TECH, CRANIOCERVICAL 32.07 $1193.97 --- $1505.69 004 1 0 0.00 $0.00 Y
O 22590 ARTHRODESIS, POST TECH, CRANIOCERVICAL 6.42 $239.02 --- $301.42 004 1 0 0.00 $0.00 Y
O 22595 ARTHRODESIS, POST TECH, ATLAS-AXIS 6.05 $225.24 --- $284.05 004 1 0 0.00 $0.00 Y
K 22595 ARTHRODESIS, POST TECH, ATLAS-AXIS 30.22 $1125.09 --- $1418.83 004 1 0 0.00 $0.00 Y
K 22600 ARTHRODESIS, POST TECH, CERVICAL 25.68 $956.07 --- $1205.68 004 1 0 0.00 $0.00 Y
O 22600 ARTHRODESIS, POST TECH, CERVICAL 5.14 $191.36 --- $241.32 004 1 0 0.00 $0.00 Y
O 22610 THORAX SPINE FUSION 5.07 $188.76 --- -- 004 0 0 0.00 $0.00 N
K 22610 THORAX SPINE FUSION 25.35 $943.78 --- -- 004 0 0 0.00 $0.00 N
K 22612 LUMBAR SPINE FUSION 32.03 $1192.48 --- -- 004 0 0 0.00 $0.00 N
O 22612 LUMBAR SPINE FUSION 6.41 $238.64 --- -- 004 0 0 0.00 $0.00 N
O 22614 SPINE FUSION EXTRA SEGMENT 1.76 $65.52 --- $82.63 004 1 0 0.00 $0.00 Y
K 22614 SPINE FUSION EXTRA SEGMENT 8.80 $327.62 --- $413.16 004 1 0 0.00 $0.00 Y
K 22630 LUMBAR SPINE FUSION 30.21 $1124.72 --- $1418.36 004 1 0 0.00 $0.00 Y
O 22630 LUMBAR SPINE FUSION 6.04 $224.87 --- $283.58 004 1 0 0.00 $0.00 Y
O 22632 SPINE FUSION EXTRA SEGMENT 1.43 $53.24 --- $67.14 004 1 0 0.00 $0.00 Y
K 22632 SPINE FUSION EXTRA SEGMENT 7.15 $266.19 --- $335.69 004 1 0 0.00 $0.00 Y
K 22633 LUMBAR SPINE FUSION COMBINED 40.69 $1514.84 --- -- 004 0 0 0.00 $0.00 Y
O 22633 LUMBAR SPINE FUSION COMBINED 8.14 $302.97 --- -- 004 0 0 0.00 $0.00 Y
O 22634 SPINE FUSION EXTRA SEGMENT 2.16 $80.51 --- -- 004 0 0 0.00 $0.00 Y
K 22634 SPINE FUSION EXTRA SEGMENT 10.81 $402.53 --- -- 004 0 0 0.00 $0.00 Y
K 22800 POST FUSION 27.79 $1034.62 --- $1304.74 004 1 0 0.00 $0.00 Y
O 22800 POST FUSION 5.55 $206.63 --- $260.57 004 1 0 0.00 $0.00 Y
O 22802 POST FUSION 7-12 VERT SEG 9.08 $338.05 --- $426.31 004 1 0 0.00 $0.00 Y
K 22802 POST FUSION 7-12 VERT SEG 45.39 $1689.87 --- $2131.06 004 1 0 0.00 $0.00 Y
K 22804 POST FUSION 13/> VERT SEG 49.30 $1835.44 --- $2314.64 004 1 0 0.00 $0.00 Y
O 22804 POST FUSION 13/> VERT SEG 9.86 $367.09 --- $462.93 004 1 0 0.00 $0.00 Y
O 22808 ANT FUSION 2-3 VERT SEG 6.76 $251.67 --- $317.38 004 1 0 0.00 $0.00 Y
K 22808 ANT FUSION 2-3 VERT SEG 33.80 $1258.37 --- $1586.91 004 1 0 0.00 $0.00 Y
K 22810 ANT FUSION 4-7 VERT SEG 36.70 $1366.34 --- $1723.07 004 1 0 0.00 $0.00 Y
O 22810 ANT FUSION 4-7 VERT SEG 7.34 $273.27 --- $344.61 004 1 0 0.00 $0.00 Y
O 22812 ANT FUSION 8/> VERT SEG 8.88 $330.60 --- $416.92 004 1 0 0.00 $0.00 Y
K 22812 ANT FUSION 8/> VERT SEG 44.40 $1653.01 --- $2084.58 004 1 0 0.00 $0.00 Y
K 22818 KYPHECTOMY 1-2 SEGMENTS 46.20 $1720.03 --- $2169.09 004 1 0 0.00 $0.00 Y
O 22818 KYPHECTOMY 1-2 SEGMENTS 9.24 $344.01 --- $433.82 004 1 0 0.00 $0.00 Y
O 22819 KYPHECTOMY 3 OR MORE 10.36 $385.70 --- $486.40 004 1 0 0.00 $0.00 Y
K 22819 KYPHECTOMY 3 OR MORE 51.81 $1928.89 --- $2432.48 004 1 0 0.00 $0.00 Y
K 22830 EXPLORATION OF SPINAL FUSION 17.96 $668.65 --- $843.22 004 1 0 0.00 $0.00 Y
O 22830 EXPLORATION OF SPINAL FUSION 3.59 $133.66 --- $168.55 004 1 0 0.00 $0.00 Y
O 22840 INSERT SPINE FIXATION DEVICE 1.98 $73.72 --- $92.96 004 1 0 0.00 $0.00 Y
K 22840 INSERT SPINE FIXATION DEVICE 9.88 $367.83 --- $463.87 004 1 0 0.00 $0.00 Y
K 22841 INSERT SPINE FIXATION DEVICE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 22841 INSERT SPINE FIXATION DEVICE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 22842 INSERT SPINE FIXATION DEVICE 2.20 $81.91 --- $103.29 004 1 0 0.00 $0.00 Y
K 22842 INSERT SPINE FIXATION DEVICE 11.01 $409.90 --- $516.92 004 1 0 0.00 $0.00 Y
K 22843 INSERT SPINE FIXATION DEVICE 13.74 $511.54 --- $645.09 004 1 0 0.00 $0.00 Y
O 22843 INSERT SPINE FIXATION DEVICE 2.75 $102.38 --- $129.11 004 1 0 0.00 $0.00 Y
O 22844 INSERT SPINE FIXATION DEVICE 3.35 $124.72 --- $157.28 004 1 0 0.00 $0.00 Y
K 22844 INSERT SPINE FIXATION DEVICE 16.79 $625.09 --- $788.29 004 1 0 0.00 $0.00 Y
K 22845 INSERT SPINE FIXATION DEVICE 9.61 $357.78 --- $451.19 004 1 0 0.00 $0.00 Y
O 22845 INSERT SPINE FIXATION DEVICE 1.93 $71.85 --- $90.61 004 1 0 0.00 $0.00 Y
O 22846 INSERT SPINE FIXATION DEVICE 2.54 $94.56 --- $119.25 004 1 0 0.00 $0.00 Y
K 22846 INSERT SPINE FIXATION DEVICE 12.69 $472.45 --- $595.80 004 1 0 0.00 $0.00 Y
K 22847 INSERT SPINE FIXATION DEVICE 14.09 $524.57 --- $661.53 004 1 0 0.00 $0.00 Y
O 22847 INSERT SPINE FIXATION DEVICE 2.82 $104.99 --- $132.40 004 1 0 0.00 $0.00 Y
O 22848 INSERT PELV FIXATION DEVICE 1.83 $68.13 --- $85.92 004 1 0 0.00 $0.00 Y
K 22848 INSERT PELV FIXATION DEVICE 9.19 $342.14 --- $431.47 004 1 0 0.00 $0.00 Y
K 22849 REINSERTION OF SPINAL FIXATION DEVICE 19.30 $718.54 --- $906.14 004 1 0 0.00 $0.00 Y
O 22849 REINSERTION OF SPINAL FIXATION DEVICE 3.86 $143.71 --- $181.23 004 1 0 0.00 $0.00 Y
O 22850 REMOVAL POST NONSEG INSTRUMENTATION 2.85 $106.11 --- $133.81 004 1 0 0.00 $0.00 Y
K 22850 REMOVAL POST NONSEG INSTRUMENTATION 14.26 $530.90 --- $669.51 004 1 0 0.00 $0.00 Y
K 22852 REMOVAL POST SEGMENTAL INSTRUMENTATION 14.35 $534.25 --- $673.73 004 1 0 0.00 $0.00 Y
O 22852 REMOVAL POST SEGMENTAL INSTRUMENTATION 2.87 $106.85 --- $134.75 004 1 0 0.00 $0.00 Y
O 22853 INSJ BIOMECHANICAL DEVICE 1.18 $43.93 --- -- 004 0 0 0.00 $0.00 Y
K 22853 INSJ BIOMECHANICAL DEVICE 5.90 $219.66 --- -- 004 0 0 0.00 $0.00 Y
K 22854 INSJ BIOMECHANICAL DEVICE 7.63 $284.06 --- -- 004 0 0 0.00 $0.00 Y
O 22854 INSJ BIOMECHANICAL DEVICE 1.52 $56.59 --- -- 004 0 0 0.00 $0.00 Y
O 22855 REMOVAL OF ANTERIOR INSTRUMENTATION 2.58 $96.05 --- $121.13 004 1 0 0.00 $0.00 Y
K 22855 REMOVAL OF ANTERIOR INSTRUMENTATION 12.92 $481.01 --- $606.59 004 1 0 0.00 $0.00 Y
K 22856 CERV ARTIFIC DISKECTOMY 33.07 $1231.20 --- -- 004 0 0 0.00 $0.00 Y
O 22856 CERV ARTIFIC DISKECTOMY 6.61 $246.09 --- -- 004 0 0 0.00 $0.00 Y
O 22857 LUMBAR ARTIF DISKECTOMY 4.98 $185.39 --- -- 004 0 0 0.00 $0.00 Y
K 22857 LUMBAR ARTIF DISKECTOMY 24.91 $927.39 --- -- 004 0 0 0.00 $0.00 Y
K 22858 SECOND LEVEL CER DISKECTOMY 11.35 $422.80 --- -- 004 0 0 0.00 $0.00 Y
O 22858 SECOND LEVEL CER DISKECTOMY 2.27 $84.56 --- -- 004 0 0 0.00 $0.00 Y
O 22859 INSJ BIOMECHANICAL DEVICE 1.52 $56.59 --- -- 004 0 0 0.00 $0.00 Y
K 22859 INSJ BIOMECHANICAL DEVICE 7.63 $284.06 --- -- 004 0 0 0.00 $0.00 Y
K 22861 REVISE CERV ARTIFIC DISC 40.09 $1492.55 --- -- 004 0 0 0.00 $0.00 Y
O 22861 REVISE CERV ARTIFIC DISC 8.02 $298.58 --- -- 004 0 0 0.00 $0.00 Y
O 22862 REVISE LUMBAR ARTIF DISC 6.14 $228.63 --- -- 004 0 0 0.00 $0.00 Y
K 22862 REVISE LUMBAR ARTIF DISC 30.71 $1143.15 --- -- 004 0 0 0.00 $0.00 Y
K 22864 REMOVE CERV ARTIF DISC 36.70 $1366.34 --- -- 004 0 0 0.00 $0.00 Y
O 22864 REMOVE CERV ARTIF DISC 7.34 $273.27 --- -- 004 0 0 0.00 $0.00 Y
O 22865 REMOVE LUMB ARTIF DISC 5.97 $222.26 --- -- 004 0 0 0.00 $0.00 Y
K 22865 REMOVE LUMB ARTIF DISC 29.85 $1111.28 --- -- 004 0 0 0.00 $0.00 Y
K 22867 INSJ STABLJ DEV W/DCMPRN 22.55 $839.54 --- -- 004 0 0 0.00 $0.00 Y
K 22868 INSJ STABLJ DEV W/DCMPRN 5.53 $205.88 --- -- 004 0 0 0.00 $0.00 Y
O 22868 INSJ STABLJ DEV W/DCMPRN 1.10 $40.95 --- -- 004 0 0 0.00 $0.00 Y
K 22869 INSJ STABLJ DEV W/O DCMPRN 12.58 $468.35 --- -- 004 0 0 0.00 $0.00 Y
K 22870 INSJ STABLJ DEV W/O DCMPRN 3.23 $120.25 --- -- 004 0 0 0.00 $0.00 Y
O 22870 INSJ STABLJ DEV W/O DCMPRN 0.64 $23.83 --- -- 004 0 0 0.00 $0.00 Y
O 22899 SPINE SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 22899 SPINE SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 22900 EXC ABDL TUM DEEP < 5 CM 10.85 $403.95 --- -- 004 0 0 0.00 $0.00 Y
O 22900 EXC ABDL TUM DEEP < 5 CM 2.17 $80.79 --- -- 004 0 0 0.00 $0.00 Y
O 22901 EXC ABDL TUM DEEP 5 CM/> 2.92 $108.71 --- -- 004 0 0 0.00 $0.00 Y
K 22901 EXC ABDL TUM DEEP 5 CM/> 14.59 $543.19 --- -- 004 0 0 0.00 $0.00 Y
K 22902 EXC ABD LES SC < 3 CM 9.60 $357.41 --- $450.72 004 1 0 0.00 $0.00 Y
O 22902 EXC ABD LES SC < 3 CM 1.92 $71.48 --- $90.14 004 1 0 0.00 $0.00 Y
O 22903 EXC ABD LES SC 3 CM/> 1.95 $72.60 --- $91.55 004 1 0 0.00 $0.00 Y
K 22903 EXC ABD LES SC 3 CM/> 9.73 $362.25 --- $456.82 004 1 0 0.00 $0.00 Y
K 22904 RESECT ABD TUM < 5 CM 22.67 $844.00 --- $1064.36 004 1 0 0.00 $0.00 Y
O 22904 RESECT ABD TUM < 5 CM 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 22905 RESECT ABD TUM 5 CM/> 5.88 $218.91 --- -- 004 0 0 0.00 $0.00 Y
K 22905 RESECT ABD TUM 5 CM/> 29.41 $1094.93 --- -- 004 0 0 0.00 $0.00 Y
K 22999 ABDOMEN SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 22999 ABDOMEN SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 23000 REMOVAL OF CALCIUM DEPOSITS 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 23000 REMOVAL OF CALCIUM DEPOSITS 6.80 $253.16 --- $319.26 004 1 0 0.00 $0.00 Y
K 23020 RELEASE SHOULDER JOINT 12.46 $463.89 --- $585.00 004 1 0 0.00 $0.00 Y
O 23020 RELEASE SHOULDER JOINT 2.49 $92.70 --- $116.91 004 1 0 0.00 $0.00 Y
O 23030 DRAIN SHOULDER LESION 1.51 $56.22 --- $70.89 004 1 0 0.00 $0.00 Y
K 23030 DRAIN SHOULDER LESION 7.54 $280.71 --- $354.00 004 1 0 0.00 $0.00 Y
K 23031 DRAIN SHOULDER BURSA 3.72 $138.50 --- $174.65 004 1 0 0.00 $0.00 Y
K 23035 DRAIN SHOULDER BONE LESION 20.48 $762.47 --- $961.54 004 1 0 0.00 $0.00 Y
O 23035 DRAIN SHOULDER BONE LESION 4.10 $152.64 --- $192.50 004 1 0 0.00 $0.00 Y
O 23040 EXPLORATORY SHOULDER SURGERY 2.49 $92.70 --- $116.91 004 1 0 0.00 $0.00 Y
K 23040 EXPLORATORY SHOULDER SURGERY 12.46 $463.89 --- $585.00 004 1 0 0.00 $0.00 Y
K 23044 EXPLORATORY SHOULDER SURGERY 12.46 $463.89 --- $585.00 004 1 0 0.00 $0.00 Y
O 23044 EXPLORATORY SHOULDER SURGERY 2.49 $92.70 --- $116.91 004 1 0 0.00 $0.00 Y
K 23065 BIOPSY SHOULDER TISSUES 2.26 $84.14 --- $106.11 004 1 0 0.00 $0.00 Y
K 23066 BIOPSY SHOULDER TISSUES 5.01 $186.52 --- $235.22 004 1 0 0.00 $0.00 Y
O 23066 BIOPSY SHOULDER TISSUES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 23071 EXC SHOULDER LES SC 3 CM/> 1.85 $68.88 --- $86.86 004 1 0 0.00 $0.00 Y
K 23071 EXC SHOULDER LES SC 3 CM/> 9.25 $344.38 --- $434.29 004 1 0 0.00 $0.00 Y
K 23073 EXC SHOULDER TUM DEEP 5 CM/> 15.27 $568.50 --- -- 004 0 0 0.00 $0.00 Y
O 23073 EXC SHOULDER TUM DEEP 5 CM/> 3.05 $113.55 --- -- 004 0 0 0.00 $0.00 Y
O 23075 EXC SHOULDER LES SC < 3 CM 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 23075 EXC SHOULDER LES SC < 3 CM 3.25 $121.00 --- $152.59 004 1 0 0.00 $0.00 Y
K 23076 EXC SHOULDER TUM DEEP < 5 CM 13.13 $488.83 --- $616.45 004 1 0 0.00 $0.00 Y
O 23076 EXC SHOULDER TUM DEEP < 5 CM 2.63 $97.91 --- $123.48 004 1 0 0.00 $0.00 Y
O 23077 RESECT SHOULDER TUM < 5 CM 5.03 $187.27 --- $236.16 004 1 0 0.00 $0.00 Y
K 23077 RESECT SHOULDER TUM < 5 CM 25.16 $936.71 --- $1181.26 004 1 0 0.00 $0.00 Y
K 23078 RESECT SHOULDER TUM 5 CM/> 30.59 $1138.87 --- -- 004 0 0 0.00 $0.00 Y
O 23078 RESECT SHOULDER TUM 5 CM/> 6.12 $227.85 --- -- 004 0 0 0.00 $0.00 Y
O 23100 BIOPSY OF SHOULDER JOINT 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
K 23100 BIOPSY OF SHOULDER JOINT 11.99 $446.39 --- $562.93 004 1 0 0.00 $0.00 Y
K 23101 SHOULDER JOINT SURGERY 11.60 $431.87 --- $544.62 004 1 0 0.00 $0.00 Y
O 23101 SHOULDER JOINT SURGERY 2.32 $86.37 --- $108.92 004 1 0 0.00 $0.00 Y
O 23105 REMOVE SHOULDER JOINT LINING 3.30 $122.86 --- $154.94 004 1 0 0.00 $0.00 Y
K 23105 REMOVE SHOULDER JOINT LINING 16.60 $618.02 --- $779.37 004 1 0 0.00 $0.00 Y
K 23106 INCISION OF COLLARBONE JOINT 16.60 $618.02 --- $779.37 004 1 0 0.00 $0.00 Y
O 23106 INCISION OF COLLARBONE JOINT 3.32 $123.60 --- $155.87 004 1 0 0.00 $0.00 Y
O 23107 EXPLORE TREAT SHOULDER JOINT 2.49 $92.70 --- $116.91 004 1 0 0.00 $0.00 Y
K 23107 EXPLORE TREAT SHOULDER JOINT 12.46 $463.89 --- $585.00 004 1 0 0.00 $0.00 Y
K 23120 PARTIAL REMOVAL COLLAR BONE 9.63 $358.52 --- $452.13 004 1 0 0.00 $0.00 Y
O 23120 PARTIAL REMOVAL COLLAR BONE 1.93 $71.85 --- $90.61 004 1 0 0.00 $0.00 Y
O 23125 REMOVAL OF COLLAR BONE 3.32 $123.60 --- $155.87 004 1 0 0.00 $0.00 Y
K 23125 REMOVAL OF COLLAR BONE 16.62 $618.76 --- $780.31 004 1 0 0.00 $0.00 Y
K 23130 REMOVE SHOULDER BONE PART 9.63 $358.52 --- $452.13 004 1 0 0.00 $0.00 Y
O 23130 REMOVE SHOULDER BONE PART 1.93 $71.85 --- $90.61 004 1 0 0.00 $0.00 Y
O 23140 REMOVAL OF BONE LESION 1.36 $50.63 --- $63.85 004 1 0 0.00 $0.00 Y
K 23140 REMOVAL OF BONE LESION 6.82 $253.91 --- $320.20 004 1 0 0.00 $0.00 Y
K 23145 REMOVAL OF BONE LESION 10.19 $379.37 --- $478.42 004 1 0 0.00 $0.00 Y
O 23145 REMOVAL OF BONE LESION 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
O 23146 REMOVAL OF BONE LESION 2.04 $75.95 --- $95.78 004 1 0 0.00 $0.00 Y
K 23146 REMOVAL OF BONE LESION 10.19 $379.37 --- $478.42 004 1 0 0.00 $0.00 Y
K 23150 REMOVAL OF HUMERUS LESION 10.76 $400.59 --- $505.18 004 1 0 0.00 $0.00 Y
O 23150 REMOVAL OF HUMERUS LESION 2.15 $80.04 --- $100.94 004 1 0 0.00 $0.00 Y
O 23155 REMOVAL OF HUMERUS LESION 2.83 $105.36 --- $132.87 004 1 0 0.00 $0.00 Y
K 23155 REMOVAL OF HUMERUS LESION 14.16 $527.18 --- $664.81 004 1 0 0.00 $0.00 Y
K 23156 REMOVAL OF HUMERUS LESION 14.16 $527.18 --- $664.81 004 1 0 0.00 $0.00 Y
O 23156 REMOVAL OF HUMERUS LESION 2.83 $105.36 --- $132.87 004 1 0 0.00 $0.00 Y
O 23170 REMOVE COLLAR BONE LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 23170 REMOVE COLLAR BONE LESION 7.53 $280.34 --- $353.53 004 1 0 0.00 $0.00 Y
K 23172 REMOVE SHOULDER BLADE LESION 7.18 $267.31 --- $337.10 004 1 0 0.00 $0.00 Y
O 23172 REMOVE SHOULDER BLADE LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 23174 REMOVE HUMERUS LESION 3.28 $122.11 --- $154.00 004 1 0 0.00 $0.00 Y
K 23174 REMOVE HUMERUS LESION 16.31 $607.22 --- $765.75 004 1 0 0.00 $0.00 Y
K 23180 REMOVE COLLAR BONE LESION 10.43 $388.31 --- $489.69 004 1 0 0.00 $0.00 Y
O 23180 REMOVE COLLAR BONE LESION 2.09 $77.81 --- $98.13 004 1 0 0.00 $0.00 Y
O 23182 REMOVE SHOULDER BLADE LESION 2.22 $82.65 --- $104.23 004 1 0 0.00 $0.00 Y
K 23182 REMOVE SHOULDER BLADE LESION 11.09 $412.88 --- $520.68 004 1 0 0.00 $0.00 Y
K 23184 REMOVE HUMERUS LESION 10.89 $405.43 --- $511.29 004 1 0 0.00 $0.00 Y
O 23184 REMOVE HUMERUS LESION 2.18 $81.16 --- $102.35 004 1 0 0.00 $0.00 Y
O 23190 PARTIAL REMOVAL OF SCAPULA 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 23190 PARTIAL REMOVAL OF SCAPULA 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 23195 REMOVAL OF HEAD OF HUMERUS 17.21 $640.73 --- $808.01 004 1 0 0.00 $0.00 Y
O 23195 REMOVAL OF HEAD OF HUMERUS 3.44 $128.07 --- $161.51 004 1 0 0.00 $0.00 Y