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Medi-Cal Rates Information

Medi-Cal Rates as of 02/15/2020 (Codes 67108 thru 72141)

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
O 67108 REPAIR OF RETINAL DETACH; W/ VITRECTOMY 5.65 $210.35 --- $265.27 004 1 0 0.00 $0.00 Y
K 67108 REPAIR OF RETINAL DETACH; W/ VITRECTOMY 28.26 $1052.12 --- $1326.81 004 1 0 0.00 $0.00 Y
K 67110 RETINAL DETACH, GAS INJ 25.00 $930.75 --- $1173.75 004 1 0 0.00 $0.00 Y
O 67110 RETINAL DETACH, GAS INJ 5.00 $186.15 --- $234.75 004 1 0 0.00 $0.00 Y
O 67113 REPAIR RETINAL DETACH CPLX 6.31 $234.92 --- $296.25 004 1 0 0.00 $0.00 Y
K 67113 REPAIR RETINAL DETACH CPLX 31.55 $1174.61 --- $1481.27 004 1 0 0.00 $0.00 Y
K 67115 RELEASE ENCIRCLING MATERIAL 9.75 $362.99 --- $457.76 004 1 0 0.00 $0.00 Y
O 67115 RELEASE ENCIRCLING MATERIAL 1.95 $72.60 --- $91.55 004 1 0 0.00 $0.00 Y
O 67120 REMOVE EYE IMPLANT MATERIAL 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 67120 REMOVE EYE IMPLANT MATERIAL 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 67121 REMOVE EYE IMPLANT MATERIAL 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 67121 REMOVE EYE IMPLANT MATERIAL 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 67141 TREATMENT OF RETINA 2.19 $81.53 --- $102.82 004 1 0 0.00 $0.00 Y
K 67141 TREATMENT OF RETINA 10.94 $407.30 --- $513.63 004 1 0 0.00 $0.00 Y
K 67145 TREATMENT OF RETINA 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
O 67145 TREATMENT OF RETINA 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
O 67208 TREATMENT OF RETINAL LESION 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 67208 TREATMENT OF RETINAL LESION 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 67210 TREATMENT OF RETINAL LESION 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 67210 TREATMENT OF RETINAL LESION 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 67218 TREATMENT OF RETINAL LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67218 TREATMENT OF RETINAL LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67220 TREATMENT OF CHOROID LESION 16.95 $631.05 --- $795.80 004 1 0 0.00 $0.00 Y
O 67220 TREATMENT OF CHOROID LESION 3.39 $126.21 --- $159.16 004 1 0 0.00 $0.00 Y
O 67221 OCULAR PHOTODYNAMIC THER 1.56 $58.08 --- $73.24 004 1 0 0.00 $0.00 Y
K 67221 OCULAR PHOTODYNAMIC THER 7.82 $291.14 --- $367.15 004 1 0 0.00 $0.00 Y
K 67225 EYE PHOTODYNAMIC THER ADD-ON 17.93 $667.53 --- $841.81 004 1 0 0.00 $0.00 Y
O 67225 EYE PHOTODYNAMIC THER ADD-ON 3.59 $133.66 --- $168.55 004 1 0 0.00 $0.00 Y
O 67227 DSTRJ EXTENSIVE RETINOPATHY 1.37 $51.01 --- $64.32 004 1 0 0.00 $0.00 Y
K 67227 DSTRJ EXTENSIVE RETINOPATHY 6.88 $256.14 --- $323.02 004 1 0 0.00 $0.00 Y
K 67228 TREATMENT X10SV RETINOPATHY 8.06 $300.07 --- $378.42 004 1 0 0.00 $0.00 Y
O 67228 TREATMENT X10SV RETINOPATHY 1.61 $59.94 --- $75.59 004 1 0 0.00 $0.00 Y
O 67229 TR RETINAL LES PRETERM INF 5.49 $204.39 --- $257.76 004 1 0 0.00 $0.00 Y
K 67229 TR RETINAL LES PRETERM INF 27.47 $1022.71 --- $1289.72 004 1 0 0.00 $0.00 Y
K 67250 REINFORCE EYE WALL 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 67250 REINFORCE EYE WALL 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 67255 REINFORCE/GRAFT EYE WALL 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 67255 REINFORCE/GRAFT EYE WALL 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
K 67299 EYE SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67299 EYE SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67311 REVISE EYE MUSCLE 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
K 67311 REVISE EYE MUSCLE 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
K 67312 STRABISMUS, RECESS OR RESEC; TWO HORIZ 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
O 67312 STRABISMUS, RECESS OR RESEC; TWO HORIZ 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
O 67314 STRABISMUS, ONE MUSCLE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67314 STRABISMUS, ONE MUSCLE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67316 STRABISMUS, 2+ MUSCLES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67316 STRABISMUS, 2+ MUSCLES 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67318 REVISE EYE MUSCLE(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67318 REVISE EYE MUSCLE(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67320 REVISE EYE MUSCLE(S) ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67320 REVISE EYE MUSCLE(S) ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67331 EYE SURGERY FOLLOW-UP ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67331 EYE SURGERY FOLLOW-UP ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67332 REREVISE EYE MUSCLES ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67332 REREVISE EYE MUSCLES ADD-ON 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67334 REVISE EYE MUSCLE W/SUTURE 1.87 $69.62 --- $87.80 004 1 0 0.00 $0.00 Y
K 67334 REVISE EYE MUSCLE W/SUTURE 9.36 $348.47 --- $439.45 004 1 0 0.00 $0.00 Y
K 67335 EYE SUTURE DURING SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67335 EYE SUTURE DURING SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67340 REVISE EYE MUSCLE ADD-ON 2.34 $87.12 --- $109.86 004 1 0 0.00 $0.00 Y
K 67340 REVISE EYE MUSCLE ADD-ON 11.71 $435.96 --- $549.78 004 1 0 0.00 $0.00 Y
K 67343 RELEASE, SCAR TISSUE 14.06 $523.45 --- $660.12 004 1 0 0.00 $0.00 Y
O 67343 RELEASE, SCAR TISSUE 2.81 $104.62 --- $131.93 004 1 0 0.00 $0.00 Y
K 67345 DESTROY NERVE EYE MUSCLE 4.08 $151.90 --- $191.56 004 1 0 0.00 $0.00 Y
K 67346 BIOPSY EYE MUSCLE 4.11 $153.09 --- -- 004 0 0 0.00 $0.00 Y
O 67346 BIOPSY EYE MUSCLE 0.82 $30.62 --- -- 004 0 0 0.00 $0.00 Y
O 67399 EYE MUSCLE SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67399 EYE MUSCLE SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67400 ORBITOTOMY W/OUT BNE FLP(FRONTAL/TRANSCO 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 67400 ORBITOTOMY W/OUT BNE FLP(FRONT/TRANSCONJ 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 67405 EXPLORE/DRAIN EYE SOCKET 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 67405 EXPLORE/DRAIN EYE SOCKET 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 67412 EXPLORE/TREAT EYE SOCKET 14.25 $530.53 --- $669.04 004 1 0 0.00 $0.00 Y
O 67412 EXPLORE/TREAT EYE SOCKET 2.85 $106.11 --- $133.81 004 1 0 0.00 $0.00 Y
O 67413 EXPLORE/TREAT EYE SOCKET 2.41 $89.72 --- $113.15 004 1 0 0.00 $0.00 Y
K 67413 EXPLORE/TREAT EYE SOCKET 12.08 $449.74 --- $567.16 004 1 0 0.00 $0.00 Y
K 67414 EXPLR/DECOMPRESS EYE SOCKET 12.38 $460.91 --- $581.24 004 1 0 0.00 $0.00 Y
O 67414 EXPLR/DECOMPRESS EYE SOCKET 2.48 $92.33 --- $116.44 004 1 0 0.00 $0.00 Y
K 67415 ASPIRATION ORBITAL CONTENTS 2.25 $83.77 --- $105.64 004 1 0 0.00 $0.00 Y
K 67420 EXPLORE/TREAT EYE SOCKET 24.92 $927.77 --- $1169.99 004 1 0 0.00 $0.00 Y
O 67420 EXPLORE/TREAT EYE SOCKET 4.98 $185.41 --- $233.81 004 1 0 0.00 $0.00 Y
O 67430 EXPLORE/TREAT EYE SOCKET 4.98 $185.41 --- $233.81 004 1 0 0.00 $0.00 Y
K 67430 EXPLORE/TREAT EYE SOCKET 24.92 $927.77 --- $1169.99 004 1 0 0.00 $0.00 Y
K 67440 EXPLORE/DRAIN EYE SOCKET 22.65 $843.26 --- $1063.42 004 1 0 0.00 $0.00 Y
O 67440 EXPLORE/DRAIN EYE SOCKET 4.53 $168.65 --- $212.68 004 1 0 0.00 $0.00 Y
O 67445 EXPLR/DECOMPRESS EYE SOCKET 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 67445 EXPLR/DECOMPRESS EYE SOCKET 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
K 67450 EXPLORE/BIOPSY EYE SOCKET 24.46 $910.65 --- $1148.40 004 1 0 0.00 $0.00 Y
O 67450 EXPLORE/BIOPSY EYE SOCKET 4.89 $182.05 --- $229.59 004 1 0 0.00 $0.00 Y
K 67500 INJECT/TREAT EYE SOCKET 4.01 $149.29 --- $188.27 004 1 1 0.00 $0.00 Y
K 67505 INJECT/TREAT EYE SOCKET 3.24 $120.63 --- $152.12 004 1 0 0.00 $0.00 Y
K 67515 INJECT/TREAT EYE SOCKET 3.07 $114.30 --- $144.14 004 1 0 0.00 $0.00 Y
K 67550 INSERT EYE SOCKET IMPLANT 14.72 $548.03 --- $691.10 004 1 0 0.00 $0.00 Y
O 67550 INSERT EYE SOCKET IMPLANT 2.94 $109.46 --- $138.03 004 1 0 0.00 $0.00 Y
O 67560 REVISE EYE SOCKET IMPLANT 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 67560 REVISE EYE SOCKET IMPLANT 19.99 $744.23 --- $938.53 004 1 0 0.00 $0.00 Y
K 67570 REVISE EYE SOCKET IMPLANT 13.49 $502.23 --- $633.36 004 1 0 0.00 $0.00 Y
O 67570 REVISE EYE SOCKET IMPLANT 2.70 $100.52 --- $126.77 004 1 0 0.00 $0.00 Y
O 67599 ORBIT SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67599 ORBIT SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67700 DRAINAGE OF EYELID ABSCESS 3.35 $124.72 --- $157.28 004 1 1 0.00 $0.00 Y
K 67710 INCISION OF EYELID 3.29 $122.49 --- $154.47 004 1 0 0.00 $0.00 Y
K 67715 INCISION OF EYELID FOLD 0.85 $31.65 --- $39.91 004 1 0 0.00 $0.00 Y
K 67800 REMOVE EYELID LESION 3.46 $128.82 --- $162.45 004 1 1 0.00 $0.00 Y
K 67801 REMOVE EYELID LESIONS 3.83 $142.59 --- $179.82 004 1 1 0.00 $0.00 Y
K 67805 REMOVE EYELID LESIONS 4.08 $151.90 --- $191.56 004 1 1 0.00 $0.00 Y
K 67808 REMOVE EYELID LESION(S) 3.53 $131.42 --- $165.73 004 1 0 0.00 $0.00 Y
O 67808 REMOVE EYELID LESION(S) 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67810 BIOPSY EYELID & LID MARGIN 2.91 $108.34 --- $136.62 004 1 1 0.00 $0.00 Y
K 67820 REVISE EYELASHES 1.14 $42.44 --- $53.52 004 1 1 0.00 $0.00 Y
1 67820 REVISE EYELASHES 13.48 $13.48 --- $13.48 009 1 1 0.00 $0.00 Y
K 67825 CORRECT OF TRICHIASIS;OTHER THAN FORCEPS 4.20 $156.37 --- $197.19 004 1 1 0.00 $0.00 Y
K 67830 REVISE EYELASHES 8.23 $306.40 --- $386.40 004 1 1 0.00 $0.00 Y
O 67830 REVISE EYELASHES 1.64 $61.06 --- $77.00 004 1 0 0.00 $0.00 Y
O 67835 REVISE EYELASHES 1.98 $73.72 --- $92.96 004 1 0 0.00 $0.00 Y
K 67835 REVISE EYELASHES 9.91 $368.95 --- $465.27 004 1 0 0.00 $0.00 Y
K 67840 REMOVE EYELID LESION 3.91 $145.57 --- $183.57 004 1 0 0.00 $0.00 Y
K 67850 TREAT EYELID LESION 4.15 $154.50 --- $194.84 004 1 0 0.00 $0.00 Y
K 67875 CLOSURE, LIDS, TEMP 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
O 67875 CLOSURE, LIDS, TEMP 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
O 67880 REVISION OF EYELID 2.39 $88.98 --- $112.21 004 1 0 0.00 $0.00 Y
K 67880 REVISION OF EYELID 11.94 $444.53 --- $560.58 004 1 0 0.00 $0.00 Y
K 67882 REVISION OF EYELID 15.39 $572.97 --- $722.56 004 1 0 0.00 $0.00 Y
O 67882 REVISION OF EYELID 3.08 $114.67 --- $144.61 004 1 0 0.00 $0.00 Y
O 67900 REPAIR BROW DEFECT 1.77 $65.90 --- $83.10 004 1 0 0.00 $0.00 Y
K 67900 REPAIR BROW DEFECT 8.86 $329.86 --- $415.98 004 1 0 0.00 $0.00 Y
K 67901 REPAIR EYELID DEFECT 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
O 67901 REPAIR EYELID DEFECT 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
O 67902 REPAIR EYELID DEFECT 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
K 67902 REPAIR EYELID DEFECT 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
K 67903 REPAIR BLEPHAROPTOSIS; RESECT/ADVAN INTE 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
O 67903 REPAIR BLEPHAROPTOSIS; RESECT/ADVAN INTE 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
O 67904 REPAIR BLEPHAROPTOSIS; RESECT/ADVAN, EXT 3.23 $120.25 --- $151.65 004 1 0 0.00 $0.00 Y
K 67904 REPAIR BLEPHAROPTOSIS; RESECT/ADVAN, EXT 16.16 $601.64 --- $758.71 004 1 0 0.00 $0.00 Y
K 67906 REPAIR EYELID DEFECT 16.00 $595.68 --- $751.20 004 1 0 0.00 $0.00 Y
O 67906 REPAIR EYELID DEFECT 3.20 $119.14 --- $150.24 004 1 0 0.00 $0.00 Y
O 67908 REPAIR EYELID DEFECT 2.31 $86.00 --- $108.45 004 1 0 0.00 $0.00 Y
K 67908 REPAIR EYELID DEFECT 11.64 $433.36 --- $546.50 004 1 0 0.00 $0.00 Y
K 67909 REVISE EYELID DEFECT 12.60 $469.10 --- $591.57 004 1 0 0.00 $0.00 Y
O 67909 REVISE EYELID DEFECT 2.52 $93.82 --- $118.31 004 1 0 0.00 $0.00 Y
O 67911 REVISE EYELID DEFECT 2.20 $81.91 --- $103.29 004 1 0 0.00 $0.00 Y
K 67911 REVISE EYELID DEFECT 11.10 $413.25 --- $521.15 004 1 0 0.00 $0.00 Y
K 67912 CORRECTION EYELID W/IMPLANT 22.66 $843.49 --- $1063.89 004 1 0 0.00 $0.00 Y
O 67912 CORRECTION EYELID W/IMPLANT 4.53 $168.70 --- $212.68 004 1 0 0.00 $0.00 Y
K 67914 REPAIR EYELID DEFECT 6.50 $242.00 --- $305.18 004 1 0 0.00 $0.00 Y
K 67915 REPAIR EYELID DEFECT 5.72 $212.96 --- $268.55 004 1 0 0.00 $0.00 Y
K 67916 REPAIR EYELID DEFECT 9.06 $337.30 --- $425.37 004 1 0 0.00 $0.00 Y
O 67916 REPAIR EYELID DEFECT 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 67917 REPAIR EYELID DEFECT 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 67917 REPAIR EYELID DEFECT 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 67921 REPAIR EYELID DEFECT 6.31 $234.92 --- $296.25 004 1 0 0.00 $0.00 Y
K 67922 REPAIR EYELID DEFECT 5.63 $209.60 --- $264.33 004 1 0 0.00 $0.00 Y
K 67923 REPAIR EYELID DEFECT 9.07 $337.68 --- $425.84 004 1 0 0.00 $0.00 Y
O 67923 REPAIR EYELID DEFECT 1.81 $67.39 --- $84.98 004 1 0 0.00 $0.00 Y
O 67924 REPAIR EYELID DEFECT 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
K 67924 REPAIR EYELID DEFECT 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
K 67930 REPAIR EYELID WOUND 6.55 $243.86 --- $307.52 004 1 0 0.00 $0.00 Y
K 67935 REPAIR EYELID WOUND 9.36 $348.47 --- $439.45 004 1 0 0.00 $0.00 Y
O 67935 REPAIR EYELID WOUND 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67938 REMOVE EYELID FOREIGN BODY 1.47 $54.73 --- $69.02 004 1 0 0.00 $0.00 Y
1 67938 REMOVE EYELID FOREIGN BODY 273.27 $273.27 --- $273.27 009 1 0 0.00 $0.00 Y
K 67938 REMOVE EYELID FOREIGN BODY 7.34 $273.27 --- $344.61 004 1 1 0.00 $0.00 Y
K 67950 REVISION OF EYELID 11.51 $428.52 --- $540.39 004 1 0 0.00 $0.00 Y
O 67950 REVISION OF EYELID 2.30 $85.63 --- $107.99 004 1 0 0.00 $0.00 Y
O 67961 REVISION OF EYELID 2.25 $83.77 --- $105.64 004 1 0 0.00 $0.00 Y
K 67961 REVISION OF EYELID 11.27 $419.58 --- $529.13 004 1 0 0.00 $0.00 Y
K 67966 REVISION OF EYELID 12.41 $462.02 --- $582.65 004 1 0 0.00 $0.00 Y
O 67966 REVISION OF EYELID 2.48 $92.33 --- $116.44 004 1 0 0.00 $0.00 Y
O 67971 RECONSTRUCTION OF EYELID 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 67971 RECONSTRUCTION OF EYELID 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 67973 RECONSTRUCTION OF EYELID 16.99 $632.54 --- $797.68 004 1 0 0.00 $0.00 Y
O 67973 RECONSTRUCTION OF EYELID 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
O 67974 RECONSTRUCTION OF EYELID 3.89 $144.82 --- $182.64 004 1 0 0.00 $0.00 Y
K 67974 RECONSTRUCTION OF EYELID 19.44 $723.75 --- $912.71 004 1 0 0.00 $0.00 Y
K 67975 RECONSTRUCTION OF EYELID 7.69 $286.30 --- $361.05 004 1 0 0.00 $0.00 Y
O 67975 RECONSTRUCTION OF EYELID 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 67999 EYELID SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 67999 EYELID SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 68020 INCISE/DRAIN EYELID LINING 3.41 $126.95 --- $160.10 004 1 1 0.00 $0.00 Y
K 68040 TREATMENT OF EYELID LESIONS 5.74 $213.70 --- $269.49 004 1 1 0.00 $0.00 Y
K 68100 BIOPSY OF EYELID LINING 3.49 $129.93 --- $163.86 004 1 1 0.00 $0.00 Y
K 68110 REMOVE EYELID LINING LESION 4.03 $150.04 --- $189.21 004 1 0 0.00 $0.00 Y
K 68115 REMOVE EYELID LINING LESION 4.18 $155.62 --- $196.25 004 1 0 0.00 $0.00 Y
O 68115 REMOVE EYELID LINING LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 68130 REMOVE EYELID LINING LESION 1.27 $47.28 --- $59.63 004 1 0 0.00 $0.00 Y
K 68130 REMOVE EYELID LINING LESION 6.36 $236.78 --- $298.60 004 1 0 0.00 $0.00 Y
K 68135 REMOVE EYELID LINING LESION 3.80 $141.47 --- $178.41 004 1 0 0.00 $0.00 Y
K 68200 TREAT EYELID BY INJECTION 2.97 $110.57 --- $139.44 004 1 1 0.00 $0.00 Y
K 68320 REVISE/GRAFT EYELID LINING 12.00 $446.76 --- $563.40 004 1 0 0.00 $0.00 Y
O 68320 REVISE/GRAFT EYELID LINING 2.40 $89.35 --- $112.68 004 1 0 0.00 $0.00 Y
O 68325 REVISE/GRAFT EYELID LINING 2.80 $104.24 --- $131.46 004 1 0 0.00 $0.00 Y
K 68325 REVISE/GRAFT EYELID LINING 14.00 $521.22 --- $657.30 004 1 0 0.00 $0.00 Y
K 68326 REVISE/GRAFT EYELID LINING 13.03 $485.11 --- $611.76 004 1 0 0.00 $0.00 Y
O 68326 REVISE/GRAFT EYELID LINING 2.61 $97.17 --- $122.54 004 1 0 0.00 $0.00 Y
O 68328 REVISE/GRAFT EYELID LINING 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 68328 REVISE/GRAFT EYELID LINING 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 68330 REVISE EYELID LINING 10.47 $389.80 --- $491.57 004 1 0 0.00 $0.00 Y
O 68330 REVISE EYELID LINING 2.09 $77.81 --- $98.13 004 1 0 0.00 $0.00 Y
O 68335 REVISE/GRAFT EYELID LINING 2.36 $87.86 --- $110.80 004 1 0 0.00 $0.00 Y
K 68335 REVISE/GRAFT EYELID LINING 11.81 $439.69 --- $554.48 004 1 0 0.00 $0.00 Y
K 68340 SEPARATE EYELID ADHESIONS 14.44 $537.60 --- $677.96 004 1 0 0.00 $0.00 Y
O 68340 SEPARATE EYELID ADHESIONS 2.89 $107.59 --- $135.69 004 1 0 0.00 $0.00 Y
O 68360 REVISE EYELID LINING 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
K 68360 REVISE EYELID LINING 5.66 $210.72 --- $265.74 004 1 0 0.00 $0.00 Y
K 68362 REVISE EYELID LINING 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 68362 REVISE EYELID LINING 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 68371 HARVEST EYE TISSUE ALOGRAFT 0.81 $30.12 --- $38.03 004 1 0 0.00 $0.00 Y
K 68371 HARVEST EYE TISSUE ALOGRAFT 4.05 $150.61 --- $190.15 004 1 0 0.00 $0.00 Y
K 68399 EYELID LINING SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 68399 EYELID LINING SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 68400 INCISE/DRAIN TEAR GLAND 0.98 $36.49 --- $46.01 004 1 0 0.00 $0.00 Y
K 68400 INCISE/DRAIN TEAR GLAND 4.90 $182.43 --- $230.06 004 1 0 0.00 $0.00 Y
K 68420 INCISE/DRAIN TEAR SAC 5.37 $199.93 --- $252.12 004 1 0 0.00 $0.00 Y
O 68420 INCISE/DRAIN TEAR SAC 1.07 $39.84 --- $50.24 004 1 0 0.00 $0.00 Y
K 68440 INCISE TEAR DUCT OPENING 3.20 $119.14 --- $150.24 004 1 1 0.00 $0.00 Y
K 68500 REMOVAL OF TEAR GLAND 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 68500 REMOVAL OF TEAR GLAND 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 68505 PARTIAL REMOVAL TEAR GLAND 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 68505 PARTIAL REMOVAL TEAR GLAND 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 68510 BIOPSY OF TEAR GLAND 12.79 $476.17 --- $600.49 004 1 0 0.00 $0.00 Y
O 68510 BIOPSY OF TEAR GLAND 2.56 $95.31 --- $120.19 004 1 0 0.00 $0.00 Y
O 68520 REMOVAL OF TEAR SAC 2.44 $90.84 --- $114.56 004 1 0 0.00 $0.00 Y
K 68520 REMOVAL OF TEAR SAC 12.20 $454.21 --- $572.79 004 1 0 0.00 $0.00 Y
K 68525 BIOPSY OF TEAR SAC 6.89 $256.51 --- $323.49 004 1 0 0.00 $0.00 Y
O 68525 BIOPSY OF TEAR SAC 1.38 $51.38 --- $64.79 004 1 0 0.00 $0.00 Y
O 68530 CLEARANCE OF TEAR DUCT 2.65 $98.66 --- $124.42 004 1 0 0.00 $0.00 Y
K 68530 CLEARANCE OF TEAR DUCT 13.27 $494.04 --- $623.03 004 1 0 0.00 $0.00 Y
K 68540 REMOVE TEAR GLAND LESION 16.52 $615.04 --- $775.61 004 1 0 0.00 $0.00 Y
O 68540 REMOVE TEAR GLAND LESION 3.30 $122.86 --- $154.94 004 1 0 0.00 $0.00 Y
O 68550 REMOVE TEAR GLAND LESION 4.46 $166.05 --- $209.40 004 1 0 0.00 $0.00 Y
K 68550 REMOVE TEAR GLAND LESION 22.29 $829.86 --- $1046.52 004 1 0 0.00 $0.00 Y
K 68700 REPAIR TEAR DUCTS 22.29 $829.86 --- $1046.52 004 1 0 0.00 $0.00 Y
O 68700 REPAIR TEAR DUCTS 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 68705 REVISE TEAR DUCT OPENING 4.02 $149.66 --- $188.74 004 1 0 0.00 $0.00 Y
K 68720 CREATE TEAR SAC DRAIN 14.06 $523.45 --- $660.12 004 1 0 0.00 $0.00 Y
O 68720 CREATE TEAR SAC DRAIN 2.81 $104.62 --- $131.93 004 1 0 0.00 $0.00 Y
O 68745 CREATE TEAR DUCT DRAIN 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
K 68745 CREATE TEAR DUCT DRAIN 15.00 $558.45 --- $704.25 004 1 0 0.00 $0.00 Y
K 68750 CREATE TEAR DUCT DRAIN 15.00 $558.45 --- $704.25 004 1 0 0.00 $0.00 Y
O 68750 CREATE TEAR DUCT DRAIN 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
K 68760 CLOSE TEAR DUCT OPENING 3.69 $137.38 --- $173.25 004 1 1 0.00 $0.00 Y
K 68761 CLOSURE OF LACRIMAL PUNCTUM 3.37 $125.47 --- $158.22 004 1 0 0.00 $0.00 Y
1 68761 CLOSURE OF LACRIMAL PUNCTUM 125.47 $125.47 --- $125.47 009 1 0 0.00 $0.00 Y
O 68770 CLOSE TEAR SYSTEM FISTULA 1.92 $71.48 --- $90.14 004 1 0 0.00 $0.00 Y
K 68770 CLOSE TEAR SYSTEM FISTULA 9.63 $358.52 --- $452.13 004 1 0 0.00 $0.00 Y
K 68801 DILATION OF LACRIMAL PUNCTUM 3.67 $136.63 --- $172.31 004 1 1 0.00 $0.00 Y
1 68801 DILATION OF LACRIMAL PUNCTUM 136.63 $136.63 --- $136.63 009 1 0 0.00 $0.00 Y
K 68810 PROBE NASOLACRIMAL DUCT 4.99 $185.78 --- $234.28 004 1 1 0.00 $0.00 Y
K 68811 PROBE NASOLACRIMAL DUCT 3.01 $112.06 --- $141.32 004 1 0 0.00 $0.00 Y
O 68811 PROBE NASOLACRIMAL DUCT 0.60 $22.34 --- $28.17 004 1 0 0.00 $0.00 Y
O 68815 PROBE NASOLACRIMAL DUCT 1.19 $44.30 --- $55.87 004 1 0 0.00 $0.00 Y
K 68815 PROBE NASOLACRIMAL DUCT 5.94 $221.15 --- $278.88 004 1 0 0.00 $0.00 Y
K 68816 PROBE NL DUCT W/BALLOON 12.32 $458.67 --- $578.42 004 1 0 0.00 $0.00 Y
O 68816 PROBE NL DUCT W/BALLOON 2.46 $91.59 --- $115.50 004 1 0 0.00 $0.00 Y
K 68840 EXPLORE/IRRIGATE TEAR DUCTS 4.17 $155.25 --- $195.78 004 1 1 0.00 $0.00 Y
K 68850 INJECTION FOR TEAR SAC X-RAY 6.53 $243.11 --- $306.58 004 1 0 0.00 $0.00 Y
K 68899 TEAR DUCT SYSTEM SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 68899 TEAR DUCT SYSTEM SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69000 DRAIN EXTERNAL EAR LESION 1.52 $56.59 --- $71.36 004 1 1 0.00 $0.00 Y
K 69005 DRAIN EXTERNAL EAR LESION 91.84 $91.84 --- -- 042 0 0 0.00 $0.00 Y
O 69005 DRAIN EXTERNAL EAR LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69020 DRAIN OUTER EAR CANAL LESION 1.58 $58.82 --- $74.18 004 1 1 0.00 $0.00 Y
K 69100 BIOPSY OF EXTERNAL EAR 1.08 $40.21 --- $50.71 004 1 1 0.00 $0.00 Y
K 69105 BIOPSY OF EXTERNAL EAR CANAL 0.99 $36.86 --- $46.48 004 1 1 0.00 $0.00 Y
K 69110 REMOVE EXTERNAL EAR PARTIAL 3.40 $126.58 --- $159.63 004 1 1 0.00 $0.00 Y
K 69120 REMOVAL OF EXTERNAL EAR 8.00 $297.84 --- $375.60 004 1 0 0.00 $0.00 Y
O 69120 REMOVAL OF EXTERNAL EAR 1.60 $59.57 --- $75.12 004 1 0 0.00 $0.00 Y
O 69140 REMOVE EAR CANAL LESION(S) 2.63 $97.91 --- $123.48 004 1 0 0.00 $0.00 Y
K 69140 REMOVE EAR CANAL LESION(S) 13.17 $490.32 --- $618.33 004 1 0 0.00 $0.00 Y
K 69145 REMOVE EAR CANAL LESION(S) 4.85 $180.57 --- $227.71 004 1 1 0.00 $0.00 Y
O 69145 REMOVE EAR CANAL LESION(S) 0.97 $36.11 --- $45.54 004 1 0 0.00 $0.00 Y
O 69150 EXTENSIVE EAR CANAL SURGERY 4.14 $154.13 --- $194.37 004 1 0 0.00 $0.00 Y
K 69150 EXTENSIVE EAR CANAL SURGERY 20.70 $770.66 --- $971.87 004 1 0 0.00 $0.00 Y
K 69155 EXTENSIVE EAR/NECK SURGERY 33.73 $1255.77 --- $1583.62 004 1 0 0.00 $0.00 Y
O 69155 EXTENSIVE EAR/NECK SURGERY 6.75 $251.30 --- $316.91 004 1 0 0.00 $0.00 Y
K 69200 CLEAR OUTER EAR CANAL 0.93 $34.62 --- $43.66 004 1 1 0.00 $0.00 Y
K 69205 CLEAR OUTER EAR CANAL 2.16 $80.42 --- $101.41 004 1 0 0.00 $0.00 Y
K 69209 REMOVE IMPACTED EAR WAX UNI 0.31 $11.54 --- $14.55 004 1 1 0.00 $0.00 Y
K 69210 REMOVE IMPACTED EAR WAX 0.82 $30.53 --- $38.50 004 1 1 0.00 $0.00 Y
K 69220 CLEAN OUT MASTOID CAVITY 1.13 $42.07 --- $53.05 004 1 0 0.00 $0.00 Y
K 69222 CLEAN OUT MASTOID CAVITY 3.00 $111.69 --- $140.85 004 1 0 0.00 $0.00 Y
K 69300 REVISE EXTERNAL EAR 10.00 $372.30 --- $469.50 004 1 0 0.00 $0.00 Y
O 69300 REVISE EXTERNAL EAR 2.00 $74.46 --- $93.90 004 1 0 0.00 $0.00 Y
O 69310 REBUILD OUTER EAR CANAL 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
K 69310 REBUILD OUTER EAR CANAL 16.99 $632.54 --- $797.68 004 1 0 0.00 $0.00 Y
K 69320 REBUILD OUTER EAR CANAL 18.12 $674.61 --- $850.73 004 1 0 0.00 $0.00 Y
O 69320 REBUILD OUTER EAR CANAL 3.62 $134.77 --- $169.96 004 1 0 0.00 $0.00 Y
O 69399 OUTER EAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69399 OUTER EAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69420 INCISION OF EARDRUM 1.50 $55.85 --- $70.43 004 1 1 0.00 $0.00 Y
K 69424 REMOVE VENTILATING TUBE 1.70 $63.29 --- $79.82 004 1 0 0.00 $0.00 Y
K 69433 CREATE EARDRUM OPENING 1.61 $59.94 --- $75.59 004 1 0 0.00 $0.00 Y
K 69436 CREATE EARDRUM OPENING 3.24 $120.63 --- $152.12 004 1 0 0.00 $0.00 Y
K 69440 EXPLORATION OF MIDDLE EAR 11.33 $421.82 --- $531.94 004 1 0 0.00 $0.00 Y
O 69440 EXPLORATION OF MIDDLE EAR 2.27 $84.51 --- $106.58 004 1 0 0.00 $0.00 Y
O 69450 EARDRUM REVISION 1.02 $37.97 --- $47.89 004 1 0 0.00 $0.00 Y
K 69450 EARDRUM REVISION 5.10 $189.87 --- $239.45 004 1 0 0.00 $0.00 Y
K 69501 MASTOIDECTOMY 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 69501 MASTOIDECTOMY 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 69502 MASTOIDECTOMY 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 69502 MASTOIDECTOMY 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 69505 REMOVE MASTOID STRUCTURES 20.14 $749.81 --- $945.57 004 1 0 0.00 $0.00 Y
O 69505 REMOVE MASTOID STRUCTURES 4.03 $150.04 --- $189.21 004 1 0 0.00 $0.00 Y
O 69511 EXTENSIVE MASTOID SURGERY 4.17 $155.25 --- $195.78 004 1 0 0.00 $0.00 Y
K 69511 EXTENSIVE MASTOID SURGERY 20.85 $776.25 --- $978.91 004 1 0 0.00 $0.00 Y
K 69530 EXTENSIVE MASTOID SURGERY 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 69530 EXTENSIVE MASTOID SURGERY 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 69535 REMOVE PART OF TEMPORAL BONE 11.36 $422.93 --- $533.35 004 1 0 0.00 $0.00 Y
K 69535 REMOVE PART OF TEMPORAL BONE 56.82 $2115.41 --- $2667.70 004 1 0 0.00 $0.00 Y
K 69540 REMOVE EAR LESION 1.40 $52.12 --- $65.73 004 1 0 0.00 $0.00 Y
O 69540 REMOVE EAR LESION 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 69550 REMOVE EAR LESION 4.10 $152.64 --- $192.50 004 1 0 0.00 $0.00 Y
K 69550 REMOVE EAR LESION 20.51 $763.59 --- $962.94 004 1 0 0.00 $0.00 Y
K 69552 REMOVE EAR LESION 31.76 $1182.42 --- $1491.13 004 1 0 0.00 $0.00 Y
O 69552 REMOVE EAR LESION 6.35 $236.41 --- $298.13 004 1 0 0.00 $0.00 Y
O 69554 REMOVE EAR LESION 10.23 $380.86 --- $480.30 004 1 0 0.00 $0.00 Y
K 69554 REMOVE EAR LESION 51.15 $1904.31 --- $2401.49 004 1 0 0.00 $0.00 Y
K 69601 MASTOID SURGERY REVISION 16.99 $632.54 --- $797.68 004 1 0 0.00 $0.00 Y
O 69601 MASTOID SURGERY REVISION 3.40 $126.58 --- $159.63 004 1 0 0.00 $0.00 Y
O 69602 MASTOID SURGERY REVISION 4.18 $155.62 --- $196.25 004 1 0 0.00 $0.00 Y
K 69602 MASTOID SURGERY REVISION 20.92 $778.85 --- $982.19 004 1 0 0.00 $0.00 Y
K 69603 MASTOID SURGERY REVISION 21.56 $802.68 --- $1012.24 004 1 0 0.00 $0.00 Y
O 69603 MASTOID SURGERY REVISION 4.31 $160.46 --- $202.35 004 1 0 0.00 $0.00 Y
O 69604 MASTOID SURGERY REVISION 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 69604 MASTOID SURGERY REVISION 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
K 69605 MASTOID SURGERY REVISION 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 69605 MASTOID SURGERY REVISION 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
K 69610 REPAIR OF EARDRUM 3.83 $142.59 --- $179.82 004 1 1 0.00 $0.00 Y
K 69620 REPAIR OF EARDRUM 13.00 $483.99 --- $610.35 004 1 0 0.00 $0.00 Y
O 69620 REPAIR OF EARDRUM 2.60 $96.80 --- $122.07 004 1 0 0.00 $0.00 Y
O 69631 REPAIR EARDRUM STRUCTURES 4.40 $163.81 --- $206.58 004 1 0 0.00 $0.00 Y
K 69631 REPAIR EARDRUM STRUCTURES 22.00 $819.06 --- $1032.90 004 1 0 0.00 $0.00 Y
K 69632 REBUILD EARDRUM STRUCTURES 22.00 $819.06 --- $1032.90 004 1 0 0.00 $0.00 Y
O 69632 REBUILD EARDRUM STRUCTURES 4.40 $163.81 --- $206.58 004 1 0 0.00 $0.00 Y
O 69633 REBUILD EARDRUM STRUCTURES 4.40 $163.81 --- $206.58 004 1 0 0.00 $0.00 Y
K 69633 REBUILD EARDRUM STRUCTURES 22.00 $819.06 --- $1032.90 004 1 0 0.00 $0.00 Y
K 69635 REPAIR EARDRUM STRUCTURES 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
O 69635 REPAIR EARDRUM STRUCTURES 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
O 69636 REBUILD EARDRUM STRUCTURES 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 69636 REBUILD EARDRUM STRUCTURES 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
K 69637 REBUILD EARDRUM STRUCTURES 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 69637 REBUILD EARDRUM STRUCTURES 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 69641 REVISE MIDDLE EAR & MASTOID 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 69641 REVISE MIDDLE EAR & MASTOID 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
K 69642 REVISE MIDDLE EAR & MASTOID 25.95 $966.12 --- $1218.35 004 1 0 0.00 $0.00 Y
O 69642 REVISE MIDDLE EAR & MASTOID 5.19 $193.22 --- $243.67 004 1 0 0.00 $0.00 Y
O 69643 REVISE MIDDLE EAR & MASTOID 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 69643 REVISE MIDDLE EAR & MASTOID 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
K 69644 REVISE MIDDLE EAR & MASTOID 26.08 $970.96 --- $1224.46 004 1 0 0.00 $0.00 Y
O 69644 REVISE MIDDLE EAR & MASTOID 5.22 $194.34 --- $245.08 004 1 0 0.00 $0.00 Y
O 69645 REVISE MIDDLE EAR & MASTOID 5.06 $188.38 --- $237.57 004 1 0 0.00 $0.00 Y
K 69645 REVISE MIDDLE EAR & MASTOID 25.28 $941.17 --- $1186.90 004 1 0 0.00 $0.00 Y
K 69646 REVISE MIDDLE EAR & MASTOID 27.18 $1011.91 --- $1276.10 004 1 0 0.00 $0.00 Y
O 69646 REVISE MIDDLE EAR & MASTOID 5.44 $202.53 --- $255.41 004 1 0 0.00 $0.00 Y
O 69650 RELEASE MIDDLE EAR BONE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
K 69650 RELEASE MIDDLE EAR BONE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
K 69660 REVISE MIDDLE EAR BONE 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
O 69660 REVISE MIDDLE EAR BONE 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
O 69661 REVISE MIDDLE EAR BONE 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
K 69661 REVISE MIDDLE EAR BONE 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
K 69662 REVISION MIDDLE EAR BONE 13.59 $505.96 --- $638.05 004 1 0 0.00 $0.00 Y
O 69662 REVISION MIDDLE EAR BONE 2.72 $101.27 --- $127.70 004 1 0 0.00 $0.00 Y
O 69666 REPAIR MIDDLE EAR STRUCTURES 4.30 $160.09 --- $201.89 004 1 0 0.00 $0.00 Y
K 69666 REPAIR MIDDLE EAR STRUCTURES 21.60 $804.17 --- $1014.12 004 1 0 0.00 $0.00 Y
K 69667 REPAIR MIDDLE EAR STRUCTURES 21.60 $804.17 --- $1014.12 004 1 0 0.00 $0.00 Y
O 69667 REPAIR MIDDLE EAR STRUCTURES 4.30 $160.09 --- $201.89 004 1 0 0.00 $0.00 Y
O 69670 REMOVE MASTOID AIR CELLS 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69670 REMOVE MASTOID AIR CELLS 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69676 REMOVE MIDDLE EAR NERVE 15.31 $569.99 --- $718.80 004 1 0 0.00 $0.00 Y
O 69676 REMOVE MIDDLE EAR NERVE 3.06 $113.92 --- $143.67 004 1 0 0.00 $0.00 Y
O 69700 CLOSE MASTOID FISTULA 1.59 $59.20 --- $74.65 004 1 0 0.00 $0.00 Y
K 69700 CLOSE MASTOID FISTULA 7.93 $295.23 --- $372.31 004 1 0 0.00 $0.00 Y
K 69720 RELEASE FACIAL NERVE 24.00 $893.52 --- $1126.80 004 1 0 0.00 $0.00 Y
O 69720 RELEASE FACIAL NERVE 4.80 $178.70 --- $225.36 004 1 0 0.00 $0.00 Y
O 69725 RELEASE FACIAL NERVE 5.89 $219.28 --- $276.54 004 1 0 0.00 $0.00 Y
K 69725 RELEASE FACIAL NERVE 29.45 $1096.42 --- $1382.68 004 1 0 0.00 $0.00 Y
K 69740 REPAIR FACIAL NERVE 30.00 $1116.90 --- $1408.50 004 1 0 0.00 $0.00 Y
O 69740 REPAIR FACIAL NERVE 6.00 $223.38 --- $281.70 004 1 0 0.00 $0.00 Y
O 69745 REPAIR FACIAL NERVE 6.40 $238.27 --- $300.48 004 1 0 0.00 $0.00 Y
K 69745 REPAIR FACIAL NERVE 32.00 $1191.36 --- $1502.40 004 1 0 0.00 $0.00 Y
K 69799 MIDDLE EAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 69799 MIDDLE EAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 69801 INCISE INNER EAR 0.92 $34.25 --- $43.19 004 1 0 0.00 $0.00 Y
K 69801 INCISE INNER EAR 4.64 $172.75 --- $217.85 004 1 0 0.00 $0.00 Y
K 69805 EXPLORE INNER EAR 20.87 $776.99 --- $979.85 004 1 0 0.00 $0.00 Y
O 69805 EXPLORE INNER EAR 4.17 $155.25 --- $195.78 004 1 0 0.00 $0.00 Y
O 69806 EXPLORE INNER EAR 4.00 $148.92 --- $187.80 004 1 0 0.00 $0.00 Y
K 69806 EXPLORE INNER EAR 20.00 $744.60 --- $939.00 004 1 0 0.00 $0.00 Y
K 69905 REMOVE INNER EAR 20.68 $769.92 --- $970.93 004 1 0 0.00 $0.00 Y
O 69905 REMOVE INNER EAR 4.14 $154.13 --- $194.37 004 1 0 0.00 $0.00 Y
O 69910 REMOVE INNER EAR & MASTOID 4.18 $155.62 --- $196.25 004 1 0 0.00 $0.00 Y
K 69910 REMOVE INNER EAR & MASTOID 20.91 $778.48 --- $981.72 004 1 0 0.00 $0.00 Y
K 69915 INCISE INNER EAR NERVE 35.40 $1317.94 --- $1662.03 004 1 0 0.00 $0.00 Y
O 69915 INCISE INNER EAR NERVE 7.08 $263.59 --- $332.41 004 1 0 0.00 $0.00 Y
O 69930 IMPLANT COCHLEAR DEVICE 6.06 $225.61 --- $284.52 004 1 0 0.00 $0.00 Y
K 69930 IMPLANT COCHLEAR DEVICE 30.28 $1127.32 --- $1421.65 004 1 0 0.00 $0.00 Y
K 69949 INNER EAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 69949 INNER EAR SURGERY PROCEDURE 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
O 69950 INCISE INNER EAR NERVE 8.14 $303.05 --- $382.17 004 1 0 0.00 $0.00 Y
K 69950 INCISE INNER EAR NERVE 40.71 $1515.63 --- $1911.33 004 1 0 0.00 $0.00 Y
K 69955 RELEASE FACIAL NERVE 42.76 $1591.95 --- $2007.58 004 1 0 0.00 $0.00 Y
O 69955 RELEASE FACIAL NERVE 8.55 $318.32 --- $401.42 004 1 0 0.00 $0.00 Y
O 69960 RELEASE INNER EAR CANAL 8.53 $317.57 --- $400.48 004 1 0 0.00 $0.00 Y
K 69960 RELEASE INNER EAR CANAL 42.65 $1587.86 --- $2002.42 004 1 0 0.00 $0.00 Y
K 69970 REMOVE INNER EAR LESION 47.48 $1767.68 --- $2229.19 004 1 0 0.00 $0.00 Y
O 69970 REMOVE INNER EAR LESION 9.50 $353.69 --- $446.03 004 1 0 0.00 $0.00 Y
O 69979 TEMPORAL BONE SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69979 TEMPORAL BONE SURGERY 0.00 $0.00 --- -- 004 1 0 0.00 $0.00 Y
K 69990 MICROSURGERY ADDON 4.93 $183.54 --- $231.46 004 1 0 0.00 $0.00 Y
O 69990 MICROSURGERY ADDON 0.99 $36.86 --- $46.48 004 1 0 0.00 $0.00 Y
L 70010 CONTRAST XRAY OF BRAIN 45.41 $173.47 --- -- 005 0 0 0.39 $0.00 Y
L 70015 CONTRAST XRAY OF BRAIN 23.30 $89.01 --- -- 005 0 0 0.38 $0.00 Y
L 70030 XRAY EYE FOR FOREIGN BODY 6.46 $24.68 --- -- 005 0 0 0.29 $0.00 Y
L 70100 X-RAY EXAM OF JAW <4VIEWS 6.57 $25.10 --- -- 005 0 0 0.26 $0.00 Y
L 70110 X-RAY EXAM OF JAW 4/> VIEWS 8.91 $34.04 --- -- 005 0 0 0.32 $0.00 Y
L 70120 X-RAY EXAM OF MASTOIDS 6.80 $25.98 --- -- 005 0 0 0.26 $0.00 Y
L 70130 X-RAY EXAM OF MASTOIDS 12.00 $45.84 --- -- 005 0 0 0.30 $0.00 Y
L 70134 X-RAY EXAM OF MIDDLE EAR 12.00 $45.84 --- -- 005 0 0 0.33 $0.00 Y
L 70140 X-RAY EXAM OF FACIAL BONES 6.80 $25.98 --- -- 005 0 0 0.34 $0.00 Y
L 70150 X-RAY EXAM OF FACIAL BONES 9.76 $37.28 --- -- 005 0 0 0.31 $0.00 Y
L 70160 X-RAY EXAM OF NASAL BONES 6.49 $24.79 --- -- 005 0 0 0.26 $0.00 Y
L 70170 X-RAY EXAM OF TEAR DUCT 11.33 $43.28 --- -- 005 0 0 0.31 $0.00 Y
L 70190 X-RAY EXAM OF EYE SOCKETS 6.80 $25.98 --- -- 005 0 0 0.30 $0.00 Y
L 70200 X-RAY EXAM OF EYE SOCKETS 9.92 $37.89 --- -- 005 0 0 0.32 $0.00 Y
L 70210 X-RAY EXAM OF SINUSES 5.66 $21.62 --- -- 005 0 0 0.28 $0.00 Y
L 70220 X-RAY EXAM OF SINUSES 8.73 $33.35 --- -- 005 0 0 0.32 $0.00 Y
L 70240 X-RAY EXAM PITUITARY SADDLE 5.66 $21.62 --- -- 005 0 0 0.31 $0.00 Y
L 70250 XRAY EXAM OF SKULL 6.80 $25.98 --- -- 005 0 0 0.34 $0.00 Y
L 70260 XRAY EXAM OF SKULL 10.56 $40.34 --- -- 005 0 0 0.37 $0.00 Y
L 70300 XRAY EXAM OF TEETH 2.26 $8.63 --- -- 005 0 0 0.39 $0.00 Y
L 70310 XRAY EXAM OF TEETH 4.53 $17.30 --- -- 005 0 0 0.21 $0.00 Y
L 70320 FULL MOUTH XRAY OF TEETH 9.06 $34.61 --- -- 005 0 0 0.22 $0.00 Y
L 70328 XRAY EXAM OF JAW JOINT 6.40 $24.45 --- -- 005 0 0 0.29 $0.00 Y
L 70330 XRAY EXAM OF JAW JOINTS 9.97 $38.09 --- -- 005 0 0 0.25 $0.00 Y
L 70332 X-RAY EXAM OF JAW JOINT 17.80 $68.00 --- -- 005 0 0 0.37 $0.00 Y
L 70350 X-RAY HEAD FOR ORTHODONTIA 4.53 $17.30 --- -- 005 0 0 0.50 $0.00 Y
L 70355 PANORAMIC X-RAY OF JAWS 4.68 $17.88 --- -- 005 0 0 0.52 $0.00 N
L 70360 X-RAY EXAM OF NECK 4.53 $17.30 --- -- 005 0 0 0.29 $0.00 Y
L 70370 THROAT X-RAY & FLUOROSCOPY 9.97 $38.09 --- -- 005 0 0 0.20 $0.00 Y
L 70380 X-RAY EXAM OF SALIVARY GLAND 7.25 $27.70 --- -- 005 0 0 0.24 $0.00 Y
L 70390 X-RAY EXAM OF SALIVARY DUCT 10.82 $41.33 --- -- 005 0 0 0.19 $0.00 Y
L 70450 CT HEAD/BRAIN W/O DYE 27.27 $104.17 --- -- 005 0 0 0.35 $0.00 Y
L 70460 CT HEAD/BRAIN W/DYE 38.15 $145.73 --- -- 005 0 0 0.33 $0.00 Y
L 70470 CT HEAD/BRAIN W/O & W/DYE 45.21 $172.70 --- -- 005 0 0 0.32 $0.00 Y
L 70480 CT ORBIT/EAR/FOSSA W/O DYE 55.24 $211.02 --- -- 005 0 0 0.26 $0.00 Y
L 70481 CT ORBIT/EAR/FOSSA W/DYE 60.25 $230.16 --- -- 005 0 0 0.24 $0.00 Y
L 70482 CT ORBIT/EAR/FOSSA W/O&W/DYE 60.25 $230.16 --- -- 005 0 0 0.23 $0.00 Y
L 70486 CT MAXILLOFACIAL W/O DYE 33.03 $126.17 --- -- 005 0 0 0.29 $0.00 Y
L 70487 CT MAXILLOFACIAL W/DYE 39.67 $151.54 --- -- 005 0 0 0.32 $0.00 Y
L 70488 CT MAXILLOFACIAL W/O & W/DYE 48.42 $184.96 --- -- 005 0 0 0.30 $0.00 Y
L 70490 CT SOFT TISSUE NECK W/O DYE 45.46 $173.66 --- -- 005 0 0 0.32 $0.00 Y
L 70491 CT SOFT TISSUE NECK W/DYE 55.74 $212.93 --- -- 005 0 0 0.28 $0.00 Y
L 70492 CT SFT TSUE NCK W/O & W/DYE 60.25 $230.16 --- -- 005 0 0 0.25 $0.00 Y
L 70496 CT ANGIOGRAPHY HEAD 69.64 $266.02 --- -- 005 0 0 0.28 $0.00 Y
L 70498 CT ANGIOGRAPHY NECK 69.42 $265.18 --- -- 005 0 0 0.28 $0.00 Y
L 70540 MRI ORBIT/FACE/NECK W/O DYE 72.24 $275.96 --- -- 005 0 0 0.21 $0.00 Y
L 70542 MRI ORBIT/FACE/NECK W/DYE 81.01 $309.46 --- -- 005 0 0 0.23 $0.00 Y
L 70543 MRI ORBT/FAC/NCK W/O &W/DYE 99.30 $379.33 --- -- 005 0 0 0.24 $0.00 Y
L 70544 MR ANGIOGRAPHY HEAD W/O DYE 93.96 $358.93 --- -- 005 0 0 0.14 $0.00 Y
L 70545 MR ANGIOGRAPHY HEAD W/DYE 92.43 $353.08 --- -- 005 0 0 0.14 $0.00 Y
L 70546 MR ANGIOGRAPH HEAD W/O&W/DYE 143.71 $548.97 --- -- 005 0 0 0.14 $0.00 Y
L 70547 MR ANGIOGRAPHY NECK W/O DYE 94.34 $360.38 --- -- 005 0 0 0.14 $0.00 Y
L 70548 MR ANGIOGRAPHY NECK W/DYE 99.06 $378.41 --- -- 005 0 0 0.14 $0.00 Y
L 70549 MR ANGIOGRAPH NECK W/O&W/DYE 144.31 $551.26 --- -- 005 0 0 0.14 $0.00 Y
L 70551 MRI BRAIN STEM W/O DYE 54.27 $207.31 --- -- 005 0 0 0.31 $0.00 Y
L 70552 MRI BRAIN STEM W/DYE 75.80 $289.56 --- -- 005 0 0 0.27 $0.00 Y
L 70553 MRI BRAIN STEM W/O & W/DYE 89.25 $340.94 --- -- 005 0 0 0.29 $0.00 Y
L 70554 FMRI BRAIN BY TECH 107.22 $409.57 --- -- 005 0 0 0.22 $0.00 Y
L 70555 FMRI BRAIN BY PHYS/PSYCH 25.92 $99.01 --- -- 005 0 0 1.00 $0.00 Y
L 70557 MRI BRAIN W/O DYE 44.96 $171.75 --- -- 005 0 0 0.30 $0.00 Y
L 70558 MRI BRAIN W/DYE 46.40 $177.25 --- -- 005 0 0 0.30 $0.00 Y
L 70559 MRI BRAIN W/O & W/DYE 43.66 $166.78 --- -- 005 0 0 0.20 $0.00 Y
L 71045 X-RAY EXAM CHEST 1 VIEW 4.62 $17.67 --- -- 005 0 0 0.45 $0.00 Y
L 71046 X-RAY EXAM CHEST 2 VIEWS 7.19 $27.48 --- -- 005 0 0 0.34 $0.00 Y
L 71047 X-RAY EXAM CHEST 3 VIEWS 9.23 $35.27 --- -- 005 0 0 0.35 $0.00 Y
L 71048 X-RAY EXAM CHEST 4+ VIEWS 9.89 $37.87 --- -- 005 0 0 0.37 $0.00 Y
L 71100 X-RAY EXAM RIBS UNI 2 VIEWS 7.11 $27.16 --- -- 005 0 0 0.33 $0.00 Y
L 71101 X-RAY EXAM UNILAT RIBS/CHEST 8.46 $32.32 --- -- 005 0 0 0.36 $0.00 Y
L 71110 X-RAY EXAM RIBS BIL 3 VIEWS 8.72 $33.31 --- -- 005 0 0 0.35 $0.00 Y
L 71111 X-RAY EXAM RIBS/CHEST4/> VWS 11.10 $42.40 --- -- 005 0 0 0.33 $0.00 Y
L 71120 X-RAY EXAM BREASTBONE 2/>VWS 6.80 $25.98 --- -- 005 0 0 0.33 $0.00 Y
L 71130 X-RAY STRENOCLAVIC JT 3/>VWS 6.80 $25.98 --- -- 005 0 0 0.30 $0.00 Y
L 71250 CT THORAX W/O DYE 42.59 $162.69 --- -- 005 0 0 0.27 $0.00 Y
L 71260 CT THORAX W/DYE 54.32 $207.50 --- -- 005 0 0 0.26 $0.00 Y
L 71270 CT THORAX W/O & W/DYE 65.26 $249.29 --- -- 005 0 0 0.24 $0.00 Y
L 71275 CT ANGIOGRAPHY CHEST 70.92 $270.91 --- -- 005 0 0 0.29 $0.00 Y
L 71550 MRI CHEST W/O DYE 98.99 $378.14 --- -- 005 0 0 0.17 $0.00 Y
L 71551 MRI CHEST W/DYE 109.21 $417.18 --- -- 005 0 0 0.18 $0.00 Y
L 71552 MRI CHEST W/O & W/DYE 138.36 $528.54 --- -- 005 0 0 0.18 $0.00 Y
L 71555 MRI ANGIO CHEST W OR W/O DYE 94.72 $361.83 --- -- 005 0 0 0.21 $0.00 Y
L 72020 X-RAY EXAM OF SPINE 1 VIEW 4.53 $17.30 --- -- 005 0 0 0.34 $0.00 Y
L 72040 X-RAY EXAM NECK SPINE 3/ 6.80 $25.98 --- -- 005 0 0 0.33 $0.00 Y
L 72050 X-RAY EXAM NECK SPINE 4/5VWS 10.47 $40.00 --- -- 005 0 0 0.33 $0.00 Y
L 72052 X-RAY EXAM NECK SPINE 6/>VWS 13.17 $50.31 --- -- 005 0 0 0.31 $0.00 Y
L 72070 X-RAY EXAM THORAC SPINE 2VWS 7.34 $28.04 --- -- 005 0 0 0.32 $0.00 Y
L 72072 X-RAY EXAM THORAC SPINE 3VWS 8.07 $30.83 --- -- 005 0 0 0.30 $0.00 Y
L 72074 X-RAY EXAM THORAC SPINE4/>VW 9.19 $35.11 --- -- 005 0 0 0.27 $0.00 Y
L 72080 X-RAY EXAM THORACOLMB 2/> VW 7.17 $27.39 --- -- 005 0 0 0.34 $0.00 Y
L 72081 X-RAY EXAM ENTIRE SPI 1 VW 9.09 $34.72 --- -- 005 0 0 0.33 $0.00 Y
L 72082 X-RAY EXAM ENTIRE SPI 2/3 VW 14.74 $56.31 --- -- 005 0 0 0.25 $0.00 Y
L 72083 X-RAY EXAM ENTIRE SPI 4/5 VW 16.00 $61.12 --- -- 005 0 0 0.25 $0.00 Y
L 72084 X-RAY EXAM ENTIRE SPI 6/> VW 19.14 $73.11 --- -- 005 0 0 0.24 $0.00 Y
L 72100 X-RAY EXAM L-S SPINE 2/3 VWS 7.93 $30.29 --- -- 005 0 0 0.31 $0.00 Y
L 72110 X-RAY EXAM L-2 SPINE 4/>VWS 11.48 $43.85 --- -- 005 0 0 0.31 $0.00 Y
L 72114 X-RAY EXAM L-S SPINE BENDING 14.74 $56.31 --- -- 005 0 0 0.25 $0.00 Y
L 72120 X-RAY BEND ONLY L-S SPINE 9.06 $34.61 --- -- 005 0 0 0.27 $0.00 Y
L 72125 CT NECK SPINE W/O DYE 43.59 $166.51 --- -- 005 0 0 0.28 $0.00 Y
L 72126 CT NECK SPINE W/DYE 54.31 $207.46 --- -- 005 0 0 0.25 $0.00 Y
L 72127 CT NECK SPINE W/O & W/DYE 64.25 $245.44 --- -- 005 0 0 0.22 $0.00 Y
L 72128 CT CHEST SPINE W/O DYE 42.61 $162.77 --- -- 005 0 0 0.26 $0.00 Y
L 72129 CT CHEST SPINE W/DYE 54.34 $207.58 --- -- 005 0 0 0.25 $0.00 Y
L 72130 CT CHEST SPINE W/O & W/DYE 64.34 $245.78 --- -- 005 0 0 0.22 $0.00 Y
L 72131 CT LUMBAR SPINE W/O DYE 42.35 $161.78 --- -- 005 0 0 0.26 $0.00 Y
L 72132 CT LUMBAR SPINE W/DYE 54.14 $206.81 --- -- 005 0 0 0.25 $0.00 Y
L 72133 CT LUMBAR SPINE W/O & W/DYE 64.31 $245.66 --- -- 005 0 0 0.22 $0.00 Y
L 72141 MRI NECK SPINE W/O DYE 52.63 $201.05 --- -- 005 0 0 0.32 $0.00 Y