|
Revasc evasc fpvt stent sf 1st
|
$34,498.10 |
$34,498.10 |
$34,498.10 |
$20,474.72
|
|
Revasc evasc imvt angio cplx 1st
|
$34,498.75 |
$34,498.75 |
$34,498.75 |
$19,149.11
|
|
Revasc evasc imvt angio sf 1st
|
$34,498.75 |
$34,498.75 |
$34,498.75 |
$19,814.30
|
|
Revasc evasc ivt stent cplx 1st
|
$34,497.45 |
$34,497.45 |
$34,497.45 |
$20,474.72
|
|
Revasc evasc ivt stent sf 1st
|
$34,497.45 |
$34,497.45 |
$34,497.45 |
$20,474.72
|
|
Revasc evasc tpvt angio cplx 1st
|
$34,497.45 |
$34,497.45 |
$34,497.45 |
$20,474.72
|
|
Revasc evasc tpvt angio sf 1st
|
$34,497.45 |
$34,497.45 |
$34,497.45 |
$16,491.68
|
|
Revasc evasc tpvt athrec cplx 1st
|
$54,779.40 |
$54,779.40 |
$54,779.40 |
$29,940.41
|
|
Revasc evasc tpvt athrec sf 1st
|
$54,779.40 |
$54,779.40 |
$54,779.40 |
$25,720.00
|
|
Revasc intra lithotrip-ather
|
$20,446.85 |
$20,446.85 |
$20,446.85 |
$19,875.58
|
|
Revasc intra lithotrip-stent
|
$20,446.85 |
$20,446.85 |
$20,446.85 |
$20,213.00
|
|
Revasc intravasc lithotripsy
|
$12,614.53 |
$12,614.53 |
$12,614.53 |
$11,278.00
|
|
Revasc lithotrip-stent-ather
|
$36,293.84 |
$36,293.84 |
$36,293.84 |
$21,280.02
|
|
Revise abdomen-venous shunt
|
$1,633.60 |
$1,633.60 |
$1,633.60 |
$4,176.15
|
|
Revise additional leg tendon
|
$259.20 |
$259.20 |
$259.20 |
$3,532.79
|
|
Revise aqueous shunt eye
|
$4,198.40 |
$4,198.40 |
$4,198.40 |
$4,538.03
|
|
Revise arm/leg nerve
|
$1,239.20 |
$1,239.20 |
$1,239.20 |
$3,754.40
|
|
Revise bladder & ureter(s)
|
$3,277.60 |
$3,277.60 |
$3,277.60 |
$3,277.60
|
|
Revise breast reconst 19380
|
$3,846.40 |
$3,846.40 |
$3,846.40 |
$7,127.17
|
|
Revise esophagus & stomach 43325
|
$3,326.40 |
$3,326.40 |
$3,326.40 |
$3,326.40
|
|
Revise eye
|
$3,406.40 |
$3,406.40 |
$3,406.40 |
$4,462.45
|
|
Revise eyelashes
|
$659.20 |
$659.20 |
$659.20 |
$659.20
|
|
Revise eyelashes
|
$2,180.80 |
$2,180.80 |
$2,180.80 |
$3,655.60
|
|
Revise eyelid defect
|
$2,684.80 |
$2,684.80 |
$2,684.80 |
$2,760.73
|
|
Revise eyelid defect
|
$2,784.00 |
$2,784.00 |
$2,784.00 |
$2,784.00
|
|
Revise eyelid lining
|
$3,038.40 |
$3,038.40 |
$3,038.40 |
$2,698.92
|
|
Revise eyelid lining
|
$2,657.60 |
$2,657.60 |
$2,657.60 |
$3,482.06
|
|
Revise eyelid lining
|
$3,251.20 |
$3,251.20 |
$3,251.20 |
$3,269.14
|
|
Revise eye muscle
|
$2,964.80 |
$2,964.80 |
$28,351.95 |
$3,566.44
|
|
Revise eye muscle
|
$3,366.40 |
$3,366.40 |
$3,366.40 |
$3,758.84
|
|
Revise eye muscle add-on
|
$895.20 |
$895.20 |
$895.20 |
$1,934.00
|
|
Revise eye muscle(s)
|
$3,515.20 |
$3,515.20 |
$3,515.20 |
$3,269.14
|
|
Revise eye muscle(s) add-on
|
$804.80 |
$804.80 |
$804.80 |
$2,199.19
|
|
Revise eye muscle w/suture
|
$1,507.20 |
$1,507.20 |
$1,507.20 |
$1,507.20
|
|
Revise eye socket implant
|
$5,192.00 |
$5,192.00 |
$5,192.00 |
$5,008.35
|
|
Revise eye sockets
|
$3,432.80 |
$3,432.80 |
$3,432.80 |
$6,966.64
|
|
Revise eye sockets
|
$6,089.60 |
$6,089.60 |
$6,089.60 |
$6,966.64
|
|
Revise eye sockets
|
$5,630.40 |
$5,630.40 |
$5,630.40 |
$6,966.64
|
|
Revise eye sockets
|
$8,025.60 |
$8,025.60 |
$8,025.60 |
$7,000.36
|
|
Revise eye with implant
|
$3,371.20 |
$3,371.20 |
$3,371.20 |
$4,173.97
|
|
Revise finger joint each
|
$1,362.40 |
$1,362.40 |
$1,362.40 |
$3,839.54
|
|
Revise finger joint each
|
$1,246.40 |
$1,246.40 |
$17,589.60 |
$2,211.05
|
|
Revise gastric port open 43886
|
$1,230.40 |
$1,230.40 |
$1,230.40 |
$4,055.70
|
|
Revise/graft eyelid lining
|
$3,628.80 |
$3,628.80 |
$3,628.80 |
$3,628.80
|
|
Revise/graft eyelid lining
|
$3,259.20 |
$3,259.20 |
$3,259.20 |
$4,627.00
|
|
Revise/graft eyelid lining
|
$3,196.80 |
$3,196.80 |
$3,196.80 |
$4,462.45
|
|
Revise/graft eyelid lining
|
$3,510.40 |
$3,510.40 |
$3,510.40 |
$3,510.40
|
|
Revise/graft eyelid lining
|
$3,208.00 |
$3,208.00 |
$3,208.00 |
$4,462.45
|
|
Revise graft w/vein
|
$4,513.60 |
$4,513.60 |
$4,513.60 |
$5,110.00
|
|
Revise graft w/vein 35881
|
$4,979.20 |
$4,979.20 |
$4,979.20 |
$5,339.00
|
|
Revise hand/finger tendon
|
$2,084.00 |
$2,084.00 |
$2,084.00 |
$7,807.24
|
|
Revise head/neck of femur
|
$4,809.60 |
$4,809.60 |
$4,809.60 |
$8,453.60
|
|
Revise hernia & sperm veins
|
$2,702.40 |
$2,702.40 |
$2,702.40 |
$4,176.15
|
|
Revise hip joint replacement
|
$6,486.00 |
$6,486.00 |
$9,432.00 |
$8,659.95
|
|
Revise hip joint replacement
|
$7,536.00 |
$7,536.00 |
$7,536.00 |
$7,536.00
|
|
Revise hip joint replacement
|
$7,248.00 |
$7,248.00 |
$7,248.00 |
$6,492.20
|
|
Revise/implant finger joint
|
$1,780.00 |
$1,780.00 |
$1,780.00 |
$5,376.00
|
|
Revise kneecap
|
$3,241.60 |
$3,241.60 |
$3,241.60 |
$7,700.67
|
|
Revise kneecap with implant
|
$4,140.80 |
$4,140.80 |
$4,140.80 |
$10,629.07
|
|
Revise knuckle joint
|
$1,326.40 |
$1,326.40 |
$1,326.40 |
$5,023.20
|
|
Revise knuckle with implant
|
$1,546.40 |
$1,546.40 |
$1,546.40 |
$6,511.82
|
|
Revise low back nerve(s)
|
$3,603.20 |
$3,603.20 |
$3,603.20 |
$3,603.20
|
|
Revise lower leg tendon
|
$3,182.40 |
$3,182.40 |
$61,997.68 |
$4,627.00
|
|
Revise lower leg tendon
|
$3,688.00 |
$3,688.00 |
$3,688.00 |
$5,339.00
|
|
Revise lower leg tendons
|
$2,684.80 |
$2,684.80 |
$2,684.80 |
$3,839.54
|
|
Revise middle ear bone
|
$4,540.80 |
$4,540.80 |
$4,540.80 |
$6,680.76
|
|
Revise middle ear bone
|
$5,928.00 |
$5,928.00 |
$5,928.00 |
$6,465.11
|
|
Revise middle ear bone
|
$5,659.20 |
$5,659.20 |
$5,659.20 |
$6,373.79
|
|
Revise middle ear & mastoid
|
$5,104.00 |
$5,104.00 |
$5,104.00 |
$6,547.81
|
|
Revise middle ear & mastoid
|
$6,560.00 |
$6,560.00 |
$6,560.00 |
$6,560.00
|
|
Revise middle ear & mastoid
|
$5,993.60 |
$5,993.60 |
$5,993.60 |
$6,547.81
|
|
Revise middle ear & mastoid
|
$7,254.40 |
$7,254.40 |
$7,254.40 |
$7,000.36
|
|
Revise middle ear & mastoid
|
$7,568.00 |
$7,568.00 |
$7,568.00 |
$7,000.36
|
|
Revise middle ear & mastoid 69645
|
$7,132.80 |
$7,132.80 |
$7,132.80 |
$7,000.36
|
|
Revise ocular implant
|
$2,244.80 |
$2,244.80 |
$2,244.80 |
$2,760.73
|
|
Revise ocular implant
|
$3,147.20 |
$3,147.20 |
$3,147.20 |
$4,462.45
|
|
Revise palsy hand tendon(s)
|
$3,787.20 |
$3,787.20 |
$3,787.20 |
$7,907.11
|
|
Revise palsy hand tendon(s)
|
$4,499.20 |
$4,499.20 |
$4,499.20 |
$8,453.60
|
|
Revise penis/urethra
|
$2,369.60 |
$2,369.60 |
$2,369.60 |
$4,478.01
|
|
Revise penis/urethra
|
$2,558.40 |
$2,558.40 |
$2,558.40 |
$4,478.01
|
|
Revise penis/urethra
|
$3,004.80 |
$3,004.80 |
$3,004.80 |
$4,478.01
|
|
Revise prosth vag graft lap
|
$2,150.40 |
$2,150.40 |
$2,150.40 |
$8,185.02
|
|
Revise radius or ulna
|
$4,961.60 |
$4,961.60 |
$4,961.60 |
$4,499.12
|
|
Revise radius & ulna
|
$4,504.00 |
$4,504.00 |
$4,504.00 |
$10,629.07
|
|
Revise radius & ulna
|
$4,692.80 |
$4,692.80 |
$4,692.80 |
$4,692.80
|
|
Revise reconst elbow joint
|
$7,622.40 |
$7,622.40 |
$7,622.40 |
$14,061.89
|
|
Revise reconst elbow joint
|
$8,792.00 |
$8,792.00 |
$8,792.00 |
$14,873.09
|
|
Revise/remove neuroelectrode
|
$2,724.80 |
$2,724.80 |
$2,724.80 |
$4,069.59
|
|
Revise/remove neuroreceiver
|
$1,868.80 |
$1,868.80 |
$1,868.80 |
$9,079.85
|
|
Revise/remove sling repair
|
$1,792.00 |
$1,792.00 |
$1,792.00 |
$3,744.41
|
|
Revise & repair chest wall
|
$4,015.20 |
$4,015.20 |
$4,015.20 |
$4,015.20
|
|
Revise/repair chest wall 32905
|
$3,250.40 |
$3,250.40 |
$3,250.40 |
$3,250.40
|
|
Revise/replace knee joint
|
$4,797.00 |
$4,797.00 |
$6,928.00 |
$5,491.20
|
|
Revise/replace knee joint
|
$8,664.00 |
$8,664.00 |
$8,664.00 |
$7,048.60
|
|
Revise/repl vagus n eltrd
|
$3,632.00 |
$3,632.00 |
$3,632.00 |
$13,628.55
|
|
Revise spermatic cord veins
|
$1,769.60 |
$1,769.60 |
$1,769.60 |
$4,345.52
|
|
Revise spermatic cord veins
|
$2,168.00 |
$2,168.00 |
$2,168.00 |
$7,149.07
|
|
Revise spinal cord vsls crvl
|
$6,965.60 |
$6,965.60 |
$6,965.60 |
$6,965.60
|
|
Revise spine eltrd perq aray
|
$2,099.20 |
$2,099.20 |
$2,099.20 |
$7,766.27
|
|
Revise spine eltrd plate
|
$2,088.00 |
$2,088.00 |
$2,088.00 |
$14,756.87
|
