|
Revision of amputation
|
$14,481.60 |
$14,481.60 |
$14,481.60 |
$8,412.89
|
|
Revision of ankle joint
|
$9,716.00 |
$9,716.00 |
$9,716.00 |
$7,913.97
|
|
Revision of aqueous shunt
|
$4,720.80 |
$4,720.80 |
$4,720.80 |
$3,173.34
|
|
Revision of arm nerve(s)
|
$7,106.40 |
$7,106.40 |
$7,106.40 |
$3,833.60
|
|
Revision of big toe
|
$6,736.80 |
$6,736.80 |
$6,736.80 |
$5,855.00
|
|
Revision of bladder neck
|
$10,516.80 |
$10,516.80 |
$10,516.80 |
$4,526.00
|
|
Revision of calf tendon
|
$10,712.80 |
$10,712.80 |
$10,712.80 |
$3,839.54
|
|
Revision of cervix
|
$2,452.80 |
$2,452.80 |
$2,452.80 |
$3,721.00
|
|
Revision of cervix
|
$9,794.40 |
$9,794.40 |
$9,794.40 |
$3,854.76
|
|
Revision of collar bone
|
$12,045.60 |
$12,045.60 |
$12,045.60 |
$5,886.74
|
|
Revision of collar bone
|
$24,768.80 |
$24,768.80 |
$24,768.80 |
$12,147.50
|
|
Revision of colostomy
|
$11,300.80 |
$11,300.80 |
$11,300.80 |
$4,332.25
|
|
Revision of cornea
|
$6,871.20 |
$6,871.20 |
$6,871.20 |
$2,760.73
|
|
Revision of cranial nerve
|
$7,252.00 |
$7,252.00 |
$7,252.00 |
$2,310.83
|
|
Revision of eyelid
|
$3,595.20 |
$3,595.20 |
$3,595.20 |
$2,760.73
|
|
Revision of eyelid
|
$2,654.40 |
$2,654.40 |
$2,654.40 |
$2,654.40
|
|
Revision of eyelid
|
$6,893.60 |
$6,893.60 |
$6,893.60 |
$2,860.80
|
|
Revision of eyelid
|
$5,068.00 |
$5,068.00 |
$5,068.00 |
$2,760.73
|
|
Revision of eyelid
|
$3,684.80 |
$3,684.80 |
$3,684.80 |
$3,417.95
|
|
Revision of foot
|
$7,593.60 |
$7,593.60 |
$7,593.60 |
$3,839.54
|
|
Revision of foot and ankle
|
$10,505.60 |
$10,505.60 |
$10,505.60 |
$6,915.20
|
|
Revision of foot bones
|
$16,884.00 |
$16,884.00 |
$16,884.00 |
$6,411.60
|
|
Revision of foot fascia 28250
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,839.54
|
|
Revision of foot tendon
|
$12,348.00 |
$12,348.00 |
$12,348.00 |
$5,886.74
|
|
Revision of foot tendon
|
$3,388.00 |
$3,388.00 |
$3,388.00 |
$3,388.00
|
|
Revision of hip tendon
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,839.54
|
|
Revision of ileostomy; simple 44312
|
$11,300.80 |
$11,300.80 |
$11,300.80 |
$4,332.25
|
|
Revision of infusion pump
|
$11,037.60 |
$11,037.60 |
$11,037.60 |
$4,306.60
|
|
Revision of iris
|
$2,268.00 |
$2,268.00 |
$2,268.00 |
$1,388.40
|
|
Revision of iris
|
$2,951.20 |
$2,951.20 |
$2,951.20 |
$1,335.24
|
|
Revision of jaw muscle/bone
|
$3,914.40 |
$3,914.40 |
$3,914.40 |
$1,752.89
|
|
Revision of jaw muscle/bone
|
$7,352.80 |
$7,352.80 |
$7,352.80 |
$3,837.72
|
|
Revision of knee joint
|
$15,069.60 |
$15,069.60 |
$15,069.60 |
$15,069.60
|
|
Revision of knee joint
|
$12,555.20 |
$12,555.20 |
$12,555.20 |
$12,555.20
|
|
Revision of knee joint
|
$17,208.80 |
$17,208.80 |
$17,208.80 |
$8,885.39
|
|
Revision of knee joint
|
$12,555.20 |
$12,555.20 |
$12,555.20 |
$12,555.20
|
|
Revision of knee joint
|
$20,092.80 |
$20,092.80 |
$20,092.80 |
$14,241.77
|
|
Revision of larynx
|
$14,319.20 |
$14,319.20 |
$14,319.20 |
$7,000.36
|
|
Revision of leg vein 37780
|
$7,028.00 |
$7,028.00 |
$7,028.00 |
$3,724.63
|
|
Revision of neck muscle
|
$7,285.60 |
$7,285.60 |
$7,285.60 |
$5,419.00
|
|
Revision of neck muscle
|
$7,285.60 |
$7,285.60 |
$7,285.60 |
$3,839.54
|
|
Revision of neck muscle
|
$1,965.60 |
$1,965.60 |
$1,965.60 |
$1,328.80
|
|
Revision of nose
|
$3,740.80 |
$3,740.80 |
$3,740.80 |
$3,819.23
|
|
Revision of nose
|
$5,773.60 |
$5,773.60 |
$5,773.60 |
$5,773.60
|
|
Revision of nose
|
$4,082.40 |
$4,082.40 |
$4,082.40 |
$4,082.40
|
|
Revision of nose
|
$14,319.20 |
$14,319.20 |
$14,319.20 |
$7,000.36
|
|
Revision of nose
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$6,759.31
|
|
Revision of nose
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$6,759.31
|
|
Revision of penis
|
$11,261.60 |
$11,261.60 |
$11,261.60 |
$4,846.99
|
|
Revision of penis
|
$6,115.20 |
$6,115.20 |
$6,115.20 |
$4,081.37
|
|
Revision of penis
|
$2,301.60 |
$2,301.60 |
$2,301.60 |
$4,040.25
|
|
Revision of penis
|
$7,336.00 |
$7,336.00 |
$7,336.00 |
$4,350.00
|
|
Revision of pharyngeal walls
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$6,553.49
|
|
Revision of radius
|
$16,990.40 |
$16,990.40 |
$16,990.40 |
$6,871.42
|
|
Revision of radius
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$4,499.12
|
|
Revision of sciatic nerve
|
$7,106.40 |
$7,106.40 |
$7,106.40 |
$2,888.00
|
|
Revision of scrotum
|
$4,368.00 |
$4,368.00 |
$4,368.00 |
$4,081.37
|
|
Revision of scrotum
|
$10,920.00 |
$10,920.00 |
$10,920.00 |
$5,631.74
|
|
Revision of spinal shunt
|
$14,308.00 |
$14,308.00 |
$14,308.00 |
$7,088.41
|
|
Revision of testis
|
$11,138.40 |
$11,138.40 |
$11,138.40 |
$5,631.74
|
|
Revision of thigh muscles
|
$13,490.40 |
$13,490.40 |
$13,490.40 |
$5,886.74
|
|
Revision of toe
|
$3,108.00 |
$3,108.00 |
$3,108.00 |
$3,108.00
|
|
Revision of ulna
|
$5,376.00 |
$5,376.00 |
$5,376.00 |
$5,376.00
|
|
Revision of unstable kneecap
|
$11,284.00 |
$11,284.00 |
$11,284.00 |
$5,886.74
|
|
Revision of unstable kneecap
|
$7,576.80 |
$7,576.80 |
$7,576.80 |
$6,973.47
|
|
Revision of urethra
|
$7,134.40 |
$7,134.40 |
$7,134.40 |
$4,081.37
|
|
Revision of urethra
|
$10,343.20 |
$10,343.20 |
$10,343.20 |
$4,081.37
|
|
Revision of urethra
|
$10,018.40 |
$10,018.40 |
$10,018.40 |
$5,741.00
|
|
Revision open av fistula without thromb
|
$12,947.20 |
$12,947.20 |
$12,947.20 |
$8,037.35
|
|
Revision orbitofacial bones
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$6,547.81
|
|
Revision/removal of kneecap
|
$10,035.20 |
$10,035.20 |
$10,035.20 |
$6,839.00
|
|
Revision tips
|
$18,586.40 |
$18,586.40 |
$18,586.40 |
$9,879.50
|
|
Revis reconst shoulder joint
|
$18,558.40 |
$18,558.40 |
$18,558.40 |
$10,029.25
|
|
Revis reconst shoulder joint
|
$10,152.80 |
$10,152.80 |
$10,152.80 |
$7,074.60
|
|
Revj fem anast autog vn grf
|
$11,620.00 |
$11,620.00 |
$11,620.00 |
$6,035.20
|
|
Revj fem anast nonautog grf
|
$11,620.00 |
$11,620.00 |
$11,620.00 |
$6,396.89
|
|
Revj mstdc rsltg compl mstdc
|
$14,319.20 |
$14,319.20 |
$14,319.20 |
$6,966.64
|
|
Revj mstdc rsltg tympanplsty
|
$14,319.20 |
$14,319.20 |
$14,319.20 |
$6,547.81
|
|
Revj prior hypspad repair
|
$12,387.20 |
$12,387.20 |
$12,387.20 |
$6,015.75
|
|
Revj/rmvl nea pn w/int nstim
|
$6,014.40 |
$6,014.40 |
$6,014.40 |
$5,682.40
|
|
Rev mastoidectomy rsltg modf rad mstdc 69602
|
$11,933.60 |
$11,933.60 |
$11,933.60 |
$7,000.36
|
|
Rev-rem impl neurostim gen-rec
|
$11,737.60 |
$11,737.60 |
$11,737.60 |
$4,534.00
|
|
Rev/rmv perph nstim eltrd ra
|
$5,398.40 |
$5,398.40 |
$5,398.40 |
$4,121.65
|
|
Rev/rmv prph sac/gstr npg/r
|
$9,548.00 |
$9,548.00 |
$9,548.00 |
$4,807.27
|
|
Rev/rplcmt sk-mnt crnl nstm
|
$38,656.80 |
$38,656.80 |
$38,656.80 |
$23,756.52
|
|
Rev rplc/rmv thrc vrt tethrg
|
$414.40 |
$414.40 |
$414.40 |
$5,033.60
|
|
Rev/rplct hpglsl nstm ary pg
|
$25,345.60 |
$25,345.60 |
$25,345.60 |
$14,685.79
|
|
Rezafungin 200 mg intravenous solution
|
$3,653.82 |
$3,653.82 |
$3,653.82 |
$4,987.55
|
|
Rf abltj nrv nrvtg si jt
|
$5,924.80 |
$5,924.80 |
$5,924.80 |
$3,138.15
|
|
Rheumatoid factor qualitative
|
$67.76 |
$67.76 |
$67.76 |
$57.20
|
|
Rheumatoid factor quantitative
|
$45.36 |
$45.36 |
$45.36 |
$57.00
|
|
Rh ig IV
|
$175.28 |
$175.28 |
$175.28 |
$175.28
|
|
Rh ig minidose im
|
$100.24 |
$100.24 |
$100.24 |
$100.24
|
|
Rhinp prim lat&alr crtlge&/elvtn nsl tip
|
$4,256.00 |
$4,256.00 |
$4,256.00 |
$4,256.00
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$300.09 |
$300.09 |
$300.09 |
$243.11
|
|
Rho d immune globulin 50 mcg
|
$114.31 |
$114.31 |
$114.31 |
$106.14
|
|
Rho(d) immune globulin h, sd
|
$9,493.43 |
$9,493.43 |
$9,493.43 |
$3,709.00
|
|
Rho d immune globulin inj
|
$217.71 |
$217.71 |
$217.71 |
$217.71
|
|
Rho(d) immune globulin (rhig) human full dose im
|
$238.56 |
$238.56 |
$238.56 |
$172.80
|
|
R hrt cath chd abnl nt cnj
|
$6,104.00 |
$6,104.00 |
$6,104.00 |
$6,095.95
|
