|
Outpatient Facility Fees
|
|
65103
|
Enucleation w/Implant muscle not attached to implant
|
1,585.73
|
|
|
|
65105
|
Enucleation of eye w/implant, muscle
Attached to eye
|
1,585.73
|
|
|
|
65420
|
Cornea, Excision or transposition of Pterygium; without graft
|
822.23
|
|
|
|
65710
|
Keratoplasty (Cornea Transplant Lamellar)
|
2,936.54
|
|
|
|
65730
|
Keratoplasty; Penetrating (non-aphakia)
|
2,936.54
|
|
|
|
65755
|
Keratoplasty; Penetrating (in pseudoaphakia)
|
2,936.54
|
|
|
|
65850
|
Trabeculectomy
|
1,339.05
|
|
|
|
65855
|
Trabeculoplasty Laser (one or more sessions)
|
822.23
|
|
|
|
66170
|
Trabeculectomy ab externo in absence of previous surgery
|
1.339.05
|
|
|
|
66172
|
Trabeculectomy ab externo w/scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)
|
1,339.05
|
|
|
|
66174
|
Transluminal dilation of aqueous outflow canal; without retention of device or stent
|
1,339.05
|
|
|
|
66175
|
Transluminal dilation of aqueous outflow canal; with retention of device or stent
|
1,339.05
|
|
|
|
|
Outpatient Facility Fees
|
|
|
|
|
66180
|
Aqueous Shunt to extra ocular reservoir
|
1,585.73
|
|
|
|
66630
|
Iridectomy; sector for Glaucoma
|
1,585.73
|
|
|
|
66821
|
Yag Laser – one or more sessions
|
1,339.05
|
|
|
|
66982
|
Extra capsular cataract removal
|
975.00
|
|
|
|
66984
|
Cataract Extraction with Primary
Insertion of Intraocular Lens
|
975.00
|
|
|
|
66985
|
Insertion of I.O.L., Subsequent of Extraction
|
975.00
|
|
|
|
67036
|
Vitrectomy, mechanical, pars plana approach
|
1,339.05
|
|
|
|
67039
|
Vitrectomy, W/ focal endolaser, PRP
|
1,339.05
|
|
|
|
67040
|
Vitrectomy, with endolaser panretinal
photocoagulation
|
1,339.05
|
|
|
|
67041
|
Vitrectomy, with removal of pre-retinal cellular membrane
|
1,339.05
|
|
|
|
67042
|
Vitrectomy, with removal of internal limiting membrane
|
1,339.05
|
|
|
|
67043
|
Vitrectomy, with removal of sub-retinal membrane
|
1,339.05
|
|
|
|
67107
|
Repair of retinal detachment – sclera bucking w/without implant
|
1,339.05
|
|
|
|
|
|
|
|
Outpatient Facility Fees
|
|
67108
|
Repair retinal detachment with vitrectomy – any method
|
1,339.05
|
|
|
|
67110
|
Repair of retinal detachment by injection of air or other gas
|
1,339.05
|
|
|
|
67112
|
Repair of retinal detachment by sclera buckling or vitrectomy
|
1,339.05
|
|
|
|
67113
|
Repair of complex retinal detachment
|
1,339.05
|
|
|
|
|
|
|
67228
|
“For Use of Laser Machine “
Only use when a PRP laser is done in a hospital or outpatient facility NOT when it is done in the doctor’s office
|
125.00
|
