| Code |
Description |
Old Price |
New Price |
Allowable |
| 20005 |
I&D Soft Tissue Abscess |
$843.00 |
|
$516.33 |
| 20680 |
Removal of Implant; Deep |
$1,200.00 |
|
$1,010.80 |
| 20912 |
Cartilage Graft Nasal Septum |
$1,428.00 |
|
$1,342.90 |
| 21026 |
Excision of Facial Bone |
$2,300.00 |
|
$2,037.71 |
| 21029 |
Removal Benign Tumor Face Bone |
$1,174.00 |
|
$905.62 |
| 21138 |
Forhead Appl of Prosth bone |
$2,235.00 |
|
$2,037.71 |
| 21208 |
Osteoplasty Facial Bones |
$2,250.00 |
|
$2,037.71 |
| 21210 |
Graft Bone; Nasal/Maxilla/Mal |
$2,563.00 |
|
$2,037.71 |
| 21280 |
MEDIAL CANTHOPEXY SEPARATE PROCEDURE |
$1,100.00 |
|
$905.62 |
| 21282 |
LATERAL CANTHOPEXY |
$987.00 |
|
$905.62 |
| 21320 |
Closed Txmt Nasal Frac/Stabliz |
$987.00 |
|
$905.62 |
| 21337 |
Closed Txmt of Nasal Fracture |
$987.00 |
|
$905.62 |
| 21340 |
Canthal Ligament Nasolacrimal |
$2,250.00 |
|
$905.62 |
| 21356 |
Open Treatment of Zygomatic |
$2,300.00 |
|
$2,037.71 |
| 21360 |
Open Treatment Depressed Malar |
$2,250.00 |
|
$2,037.71 |
| 21390 |
OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC |
$2,194.00 |
|
$2,037.71 |
| 21555 |
Exc Tumor Soft Tissue of Neck |
$843.00 |
|
$516.33 |
| 21556 |
Exc Deep Sunfascial Instramuscu |
$1,097.00 |
|
$1,010.80 |
| 25111 |
Excision Ganglion Wrist |
$1,035.00 |
|
$701.51 |
| 26115 |
Excise Tumor/Vasc Hand/Finger |
$724.00 |
|
$516.33 |
| 26160 |
Excision Gaglion Cyst |
$790.00 |
|
$701.51 |
