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COMMONWEALTH OF PENNSYLVANIA

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PA Bulletin, Doc. No. 06-2478c

[36 Pa.B. 7698]
[Saturday, December 16, 2006]

[Continued from previous Web Page]

Procedure Codes with Fees Exceeding 100% Medicare
Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier)
63088 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED THORACOLUMBAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA OR NERVE ROOT(S), LOWER THORACIC OR LUMBAR; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $52.66 N/A N/A $263.28
63091 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, TRANSPERITONEAL OR RETROPERITONEAL APPROACH WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA OR NERVE ROOT(S), LOWER THORACIC, LUMBAR OR SACRAL; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $35.88 N/A N/A $179.40
63308 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR EXCISION OF INTRASPINAL LESION, SINGLE SEGMENT; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODES FOR SINGLE SEGMENT) $65.44 N/A N/A $327.21
63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL $139.93 N/A N/A $699.64
63707 REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, NOT REQUIRING LAMINECTOMY $153.31 N/A N/A $766.53
63709 REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK OR PSEUDOMENINGOCELE, WITH LAMINECTOMY $191.67 N/A N/A $958.33
63710 DURAL GRAFT, SPINAL $189.20 N/A N/A $946.02
63740 CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; INCLUDING LAMINECTOMY $154.17 N/A N/A $770.85
63741 CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; PERCUTANEOUS, NOT REQUIRING LAMINECTOMY $105.14 N/A N/A $525.69
63744 REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT $108.89 N/A N/A $544.47
63746 REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT N/A N/A N/A $419.25
64472 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $62.95
64476 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $47.48
64480 INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $77.48
64555 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE) N/A N/A N/A $132.51
64575 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE) N/A N/A N/A $274.72
64714 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS $114.20 N/A N/A $570.98
64722 DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY) $59.33 N/A N/A $296.66
64726 DECOMPRESSION; PLANTAR DIGITAL NERVE N/A N/A N/A $270.24
64727 INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS) N/A N/A N/A $183.42
64740 TRANSECTION OR AVULSION OF; LINGUAL NERVE $81.58 N/A N/A $407.91
64742 TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE $83.73 N/A N/A $418.65
64752 TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), TRANSTHORACIC $88.45 N/A N/A $442.23
64760 TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), ABDOMINAL $81.28 N/A N/A $406.40
64761 TRANSECTION OR AVULSION OF; PUDENDAL NERVE N/A N/A N/A $379.40
64771 TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL $101.23 N/A N/A $506.14
64772 TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL $96.83 N/A N/A $484.15
64778 EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A$183.19
64787 IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION) $50.62 N/A N/A $253.11
64795 BIOPSY OF NERVE N/A N/A N/A $183.28
64832 SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $340.58
64859 SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $51.35 N/A N/A $256.73
64868 ANASTOMOSIS; FACIAL-HYPOGLOSSAL $193.35 N/A N/A $966.75
64870 ANASTOMOSIS; FACIAL-PHRENIC $188.81 N/A N/A $944.04
64872 SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY NEURORRHAPHY) $24.24 N/A N/A $121.19
64874 SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE SUTURE) $35.61 N/A N/A $178.06
64876 SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE SUTURE) $40.38 N/A N/A $201.89
65125 MODIFICATION OF OCULAR IMPLANT WITH PLACEMENT OR REPLACEMENT OF PEGS (EG, DRILLING RECEPTACLE FOR PROSTHESIS APPENDAGE) (SEPARATE PROCEDURE) N/A N/A N/A $247.45
65150 REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT N/A N/A N/A $519.45
65280 REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE N/A N/A N/A $515.17
65710 KERATOPLASTY (CORNEAL TRANSPLANT); LAMELLAR N/A N/A N/A $869.79
65730 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA) N/A N/A N/A $972.57
65755 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA) N/A N/A N/A $993.30
65772 CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM N/A N/A N/A $310.14
65775 CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM N/A N/A N/A $431.68
65855 TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT SERIES) N/A N/A N/A $257.64
65860 SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE) $45.09 N/A N/A $225.46
65900 REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER OF EYE N/A N/A N/A $781.36
66155 FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY N/A N/A N/A $646.96
66220 REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT N/A N/A N/A $549.69
66225 REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT N/A N/A N/A $734.26
66625 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE) N/A N/A N/A $364.01
66682 SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE THROUGH SMALL INCISION (EG, MCCANNEL SUTURE) N/A N/A N/A $471.07
66700 CILIARY BODY DESTRUCTION; DIATHERMY N/A N/A N/A $322.79
66740 CILIARY BODY DESTRUCTION; CYCLODIALYSIS N/A N/A N/A $323.85
66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID); LASER SURGERY (EG, YAG LASER) (ONE OR MORE STAGES) N/A N/A N/A $216.51
66830 REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID) WITH CORNEO-SCLERAL SECTION, WITH OR WITHOUT IRIDECTOMY (IRIDOCAPSULOTOMY, IRIDOCAPSULECTOMY) N/A N/A N/A $559.64
66850 REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION N/A N/A N/A $620.46
66920 REMOVAL OF LENS MATERIAL; INTRACAPSULAR N/A N/A N/A $599.06
66940 REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852) N/A N/A N/A $611.66
66983 INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE) N/A N/A N/A $554.14
66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION) N/A N/A N/A $653.17
66985 INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL N/A N/A N/A $583.93
67005 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL N/A N/A N/A $390.66
67010 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL REMOVAL WITH MECHANICAL VITRECTOMY N/A N/A N/A $455.98
67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE) N/A N/A N/A $149.08
67031 SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR OPACITIES, LASER SURGERY (ONE OR MORE STAGES) N/A N/A N/A $268.97
67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $156.07 N/A N/A $780.34
67107 REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL DISSECTION, IMBRICATION OR ENCIRCLING PROCEDURE), WITH OR WITHOUT IMPLANT, WITH OR WITHOUT CRYOTHERAPY, PHOTOCOAGULATION, AND DRAINAGE OF SUBRETINAL FLUID $194.25 N/A N/A $971.24
67115 RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT) N/A N/A N/A $370.36
67227 DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY N/A N/A N/A $448.44
67250 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT N/A N/A N/A $656.66
67255 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT N/A N/A N/A $689.45
67311 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONE HORIZONTAL MUSCLE N/A N/A N/A $469.41
67320 TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIFY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $237.44
67331 STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT INVOLVE THE EXTRAOCULAR MUSCLES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $222.80
67332 STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULAR MUSCLES (EG, PRIOR OCULAR INJURY, STRABISMUS OR RETINAL DETACHMENT SURGERY) OR RESTRICTIVE MYOPATHY (EG, DYSTHYROID OPHTHALMOPATHY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $246.20
67334 STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT MUSCLE RECESSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $218.09
67335 PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING POSTOPERATIVE ADJUSTMENT(S) OF SUTURE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR SPECIFIC STRABISMUS SURGERY) N/A N/A N/A $136.62
67340STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR MUSCLE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $269.64
67415FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS N/A N/A N/A $95.43
67500RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION) N/A N/A N/A $41.38
67505RETROBULBAR INJECTION; ALCOHOL N/A N/A N/A $43.20
67515 INJECTION OF MEDICATION OR OTHER SUBSTANCE INTO TENONOS CAPSULE N/A N/A N/A $37.02
67825 CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY ELECTROSURGERY, CRYOTHERAPY, LASER SURGERY) N/A N/A N/A $102.64
67830 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN N/A N/A N/A $118.14
67835 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE GRAFT N/A N/A N/A $377.15
67901 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERIAL (EG, BANKED FASCIA) N/A N/A N/A $481.83
67903 REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, INTERNAL APPROACH N/A N/A N/A $444.42
67904 REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH N/A N/A N/A $428.85
67908 REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLEROS MUSCLE-LEVATOR RESECTION (EG, FASANELLA-SERVAT TYPE) N/A N/A N/A $385.81
67921 REPAIR OF ENTROPION; SUTURE N/A N/A N/A $232.80
67924 REPAIR OF ENTROPION; EXTENSIVE (EG, TARSAL STRIP OR CAPSULOPALPEBRAL FASCIA REPAIRS OPERATION) N/A N/A N/A $388.53
68325 CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT) N/A N/A N/A $516.23
68326 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT N/A N/A N/A $501.08
68330 REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT N/A N/A N/A $351.69
68335 REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE (INCLUDES OBTAINING GRAFT) N/A N/A N/A $501.88
68340 REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OR CONTACT LENS N/A N/A N/A $304.56
68700 PLASTIC REPAIR OF CANALICULI N/A N/A N/A $464.62
68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY) $124.40 N/A N/A $621.99
69005 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED N/A N/A N/A $148.05
69105 BIOPSY EXTERNAL AUDITORY CANAL N/A N/A N/A $60.67
69120 EXCISION EXTERNAL EAR; COMPLETE AMPUTATION N/A N/A N/A $376.65
69300 OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION N/A N/A N/A $407.24
69450 TYMPANOLYSIS, TRANSCANAL N/A N/A N/A $465.45
69501 TRANSMASTOID ANTROTOMY (SIMPLE MASTOIDECTOMY) N/A N/A N/A $674.33
69550 EXCISION AURAL GLOMUS TUMOR; TRANSCANAL N/A N/A N/A $952.26
69801 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE PROCEDURES OR PERFUSION OF VESTIBULOACTIVE DRUGS (SINGLE OR MULTIPLE PERFUSIONS); TRANSCANAL N/A N/A N/A $669.50
69806 ENDOLYMPHATIC SAC OPERATION; WITH SHUNT N/A N/A N/A $876.23
69990 MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $219.84
70015 CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $60.87 $48.59 $109.46
70030 RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY N/A $8.80 $14.97 $23.77
70100 RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS N/A $9.18 No Change $25.68
70120 RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE N/A $9.18 No Change $25.68
70130 RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE N/A $17.26 No Change $44.76
70134 RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE N/A $17.26 No Change $39.76
70140 RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS N/A $9.56 No Change $29.56
70150 RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS N/A $12.89 No Change $35.39
70170 DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $15.09 No Change $41.59
70190 RADIOLOGIC EXAMINATION; OPTIC FORAMINA N/A $10.66 No Change $31.66
70200 RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS N/A $13.99 No Change $34.99
70210 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS N/A $8.80 No Change $25.30
70220 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS N/A $12.51 No Change $35.01
70250 RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS N/A $12.14 No Change $33.14
70260 RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS N/A $17.26 No Change $44.76
70328 RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; UNILATERAL N/A $9.18 No Change $25.68
70380 RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS N/A $8.80 No Change $29.80
70470 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $164.32
70480 COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE OR INNER EAR; WITHOUT CONTRAST MATERIAL N/A $64.70 No Change $178.70
70481 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE OR INNER EAR; WITH CONTRAST MATERIAL(S) N/A $69.51 No Change $198.51
70482 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE OR INNER EAR; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $73.19 No Change $225.19
70496 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $88.25 No Change $288.45
70498 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $88.25 No Change $288.45
70540 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE AND NECK; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $337.04
70542 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE AND NECK; WITHOUT CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40
70543 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE AND NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $108.80 No Change $662.69
70545 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S) N/A $60.34 No Change $327.75
70546 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $90.83 No Change $596.30
70547 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S) N/A $60.34 No Change $327.75
70548 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S) N/A $60.34 No Change $327.75
70549 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $90.83 No Change $596.30
71021 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL LORDOTIC PROCEDURE N/A $13.61 No Change $28.61
71035 RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY STUDIES) N/A $9.18 $18.39 $27.56
71551 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITH CONTRAST MATERIAL(S) N/A $87.49 No Change $399.59
71552 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $114.00 No Change $667.72
72010 RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL N/A $22.79 $36.70 $59.49
72020 RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL N/A $7.70 $14.97 $22.67
72050 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS N/A $15.47 No Change $41.97
72052 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR EXTENSION STUDIES N/A $18.36 No Change $50.86
72069 RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS) N/A $11.38 $17.36 $28.74
72070 RADIOLOGIC EXAMINATION, SPINE; THORACIC, TWO VIEWS N/A $11.04 No Change $32.04
72072 RADIOLOGIC EXAMINATION, SPINE; THORACIC, THREE VIEWS N/A $11.04 No Change $32.54
72074 RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF FOUR VIEWS N/A $11.04 No Change $32.54
72090 RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT STUDIES N/A $13.99 No Change $34.99
72100 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; TWO OR THREE VIEWS N/A $11.04 No Change $33.54
72120 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR VIEWS N/A $11.04 No Change $32.04
72126 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL N/A $61.44 No Change $155.44
72127 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $200.32
72128 COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL N/A $58.48 No Change $145.98
72130 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $200.32
72132 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL N/A $61.44 No Change $155.44
72133 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $200.32
72190 RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS N/A $10.66 No Change $31.66
72191 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, PELVIS, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $91.55 No Change $301.35
72194 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $61.44 No Change $163.94
72195 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S) N/A $73.57 No Change $334.69
72196 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S) N/A $87.49 No Change $290.89
72197 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $114.00 No Change $673.01
72200 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS N/A $8.80 No Change $25.30
72202 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS N/A $9.56 No Change $26.06
72220 RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS N/A $8.80 No Change $25.30
73020 RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW N/A $7.70 No Change $24.20
73030 RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS N/A $9.18 No Change $25.68
73050 RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT WEIGHTED DISTRACTION N/A $10.28 No Change $29.28
73202 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $61.44 No Change $153.94

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