DRG/CPT	Medicare
Ancillary procedure
MRI lumbar spine w/o contrast	72148	$224.52
MRI lumbar spine w/wo contrast	72158	$378.41
CT lumbar spine w/ contrast	72132	$231.01
CT lumbar spine w/o contrast	72131	$182.36
CT lumbar spine w/wo contrast	72133	$272.46
Epidural steroid injection	62322	$88.66
Physical therapy	97110	$31.35
Office visit	99213	$51.90
Index operation
Facility fee (TLIF)	DRG 460	$24 459
Facility fee (TOPS™)	DRG460+TOPS	$28 459
Laminectomy	63047	$1152
Posterior instrumentation	22840	$800
Insertion of biomechanical device	22853	$272
Allograft	20931	117
Fluoroscopy	77003	$100
Revision, fixation, or reoperation
Facility fee (TLIF or TOPS™)	DRG 459	$40 822
Removal of device	22850	$758
Posterior instrumentation	22840	$800
Insertion of biomechanical device	22853	$272
Allograft	20931	117
Fluoroscopy	77003	$100