R644

PDF page 610 / N30

LeFort I advancement
# R379 - in one segment...................................................................               10         803.80          20
# E961   - in two segments ......................................................... add                            296.60
# E962   - in three segments ...................................................... add                             594.20
    LeFort I intrusion
# R538 - in one segment...................................................................               10        1059.35          20
# E963   - in two segments ......................................................... add                            296.60
# E964   - in three segment ........................................................ add                            594.20
    LeFort I extrusion
# R567 - in one segment* .................................................................               10        1315.70          20
# E965   - in two segments ......................................................... add                            296.60
# E966   - in three segments ...................................................... add                             594.20
    LeFort I cleft palate
# R580 - in one segment* .................................................................               10        1525.30          20
# E967   - in two segments ......................................................... add                            256.40
# E968   - in three segments ...................................................... add                             511.90
# E969   - with SMR.................................................................... add                         204.80
# E970   - with pharyngoplasty ................................................... add                              307.15
# E971   - with closure alveolar fistula with or without bone graft add                                             383.65
# E972   - with closure hard palate fistula with or without bone graft
            ................................................................................... add                  511.90
# R588 Naso-maxillary osteotomy without LeFort I* ...........................                            6          803.80          15
# R389 LeFort II maxillary osteotomy and advancement* ..................                                 10        1443.95          20
# R395 Construction glenoid fossa and zygomatic arch* (Obwegeser
         technique)...........................................................................           10        1402.75          20
# R396 Construction absent condyle and ascending ramus*..............                                    6          803.80          10
# R609 Combined LeFort I and LeFort III osteotomy in hemifacial
           microsomia .........................................................................          10        1586.20          20
# R145 Mandibular condylotomy.........................................................                   6          204.80           7
# R618 Coronoidotomy .......................................................................              6         204.80           7
# R644 Coronoidectomy......................................................................               6         307.15           6
     Note:
     * Includes harvesting and grafting of bone or cartilage grafts.

Master, record 4869. Record Layout PDF, page 1.

R64420260401999999990000307150000000774600000000000000000095760000000957600

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