|
Revis reconst shoulder joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$9,257.14
|
|
Revj fem anast autog vn grf
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,035.20
|
|
Revj fem anast nonautog grf
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,019.00
|
|
Revj mstdc rsltg compl mstdc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,465.11
|
|
Revj mstdc rsltg tympanplsty
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,547.81
|
|
Revj prior hypspad repair
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,626.86
|
|
Revj/rmvl nea pn w/int nstim
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,069.59
|
|
Rev mastoidectomy rsltg modf rad mstdc 69602
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,465.11
|
|
Rev-rem impl neurostim gen-rec
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,069.59
|
|
Rev/rmv perph nstim eltrd ra
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,108.26
|
|
Rev/rmv prph sac/gstr npg/r
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,069.59
|
|
Rev/rplcmt sk-mnt crnl nstm
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
Rev/rplct hpglsl nstm ary pg
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$13,780.06
|
|
Rf abltj nrv nrvtg si jt
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,685.07
|
|
Rheumatoid factor qualitative
|
$6.75 |
$6.75 |
$6.75 |
$54.60
|
|
Rheumatoid factor quantitative
|
$6.24 |
$6.24 |
$6.24 |
$58.00
|
|
Rhinp prim lat&alr crtlge&/elvtn nsl tip
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
R hrt cath chd abnl nt cnj
|
$1,745.53 |
$1,745.53 |
$1,745.53 |
$4,880.85
|
|
R hrt cath chd nml nt cnj
|
$756.89 |
$756.89 |
$756.89 |
$4,925.61
|
|
Rib cartilage graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,167.50
|
|
Ring fx reform 11-13x17mm
|
$76.91 |
$76.91 |
$76.91 |
$1,155.09
|
|
R&l hrt cath chd abnl nt cnj
|
$2,051.20 |
$2,051.20 |
$2,051.20 |
$5,173.00
|
|
R&l hrt cath chd nml nt cnj
|
$1,832.89 |
$1,832.89 |
$1,832.89 |
$5,173.00
|
|
Rmv implant contraceptive capsule 11976
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$846.42
|
|
Rmvl esophgl sphnctr dev
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,022.89
|
|
Rmvl ext fixj sys under anes
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,159.40
|
|
Rmvl fb upr arm/elbow deep
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,638.88
|
|
Rmvl fecal impaction/fb spx under anes
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,111.46
|
|
Rmvl foreign body upper arm/elbow subcutaneous
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,917.33
|
|
Rmvl hpglsl nstim ary pg
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,839.00
|
|
Rmvl icd by tv extr
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,374.76
|
|
Rmvl icd gen w/rplc icd gen dual lead sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$26,317.20
|
|
Rmvl icd gen w/rplc icd gen mlt lead sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$34,798.50
|
|
Rmvl icd gen w/rplc icd gen sgl lead sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$26,561.92
|
|
Rmvl icd pulse gen only
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,114.00
|
|
Rmvl ndwellg tun pleural cath
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,217.97
|
|
Rmvl perm pm pulse gen
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,608.00
|
|
Rmvl phrnc nrv stim pg only
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,069.59
|
|
Rmvl phrnc nrv stim sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,110.00
|
|
Rmvl phrnc nrv stim transvns
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Rmvl pm gen w/rplc pm gen mlt lead sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$17,475.00
|
|
Rmvl pm gen w/rplc pm gen sgl lead sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$10,427.04
|
|
Rmvl prosthhumrl&ulnar cmpnt
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,881.00
|
|
Rmvl sq defib electrode
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,306.60
|
|
Rmvl subq card rhythm mntr
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,991.00
|
|
Rmvl tiss expndr without implant insrtn
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,386.84
|
|
Rmvl tongs/halo anthr indiv
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$504.90
|
|
Rmvl tv pm lead dual
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,069.52
|
|
Rmvl tv pm lead sgl
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,195.80
|
|
Rmv ntr oi implt skl prq esp
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Rmv ntr oi imp sk tc>=100
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Rmv ntr oi imp sk tc esp<100
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,350.00
|
|
Rmv&rplcmt phrnc nrv stim ld
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$15,321.63
|
|
Rmv&rplcmt phrnc nrv stim pg
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$36,000.00
|
|
Rmv sk-mnt crnl nstm pg/rcvr
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,290.00
|
|
Rotavirus antibody
|
$20.05 |
$20.05 |
$20.05 |
$38.40
|
|
Rplcm oi implt sk tc esp<100
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$15,226.08
|
|
Rplcmt oi implt skl prq esp
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,359.08
|
|
Rplc oi implt sk tc esp>=100
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$14,241.77
|
|
Rpl non-tun cvc wo sbq prt/pmp
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,331.08
|
|
Rp loclzj tum 2+area 1+d img
|
$302.06 |
$302.06 |
$302.06 |
$1,458.95
|
|
Rpl picc wo subq port/pump incl image guidnc w/s&i
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,182.05
|
|
Rpl tun-cvad w subq port
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,738.00
|
|
Rpl tun-cvad w subq pump
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,602.08
|
|
Rpl tun cvc wo subq port
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,201.80
|
|
Rpr aa hrn 1st > 10 rdc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,500.75
|
|
Rpr aa hrn 1st 3-10 ncr/strn
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Rpr aa hrn 1st 3-10 rdc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,881.00
|
|
Rpr aa hrn 1st < 3 cm rdc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,176.15
|
|
Rpr aa hrn 1st < 3 ncr/strn
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,855.00
|
|
Rpr aa hrn rcr 3-10 rdc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,500.75
|
|
Rpr aa hrn rcr < 3 ncr/strn
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,110.00
|
|
Rpr aa hrn rcr < 3 rdc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,986.00
|
|
Rpr blood ves w/vein graft/up ext 35236
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,923.20
|
|
Rpr blood vsl grf oth vein lo ex
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,836.04
|
|
Rpr choanal atresia ntranasl
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,339.00
|
|
Rpr choanal atresia trsnpltn
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,311.00
|
|
Rpr fem hernia init blocked
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,909.56
|
|
Rpr hern preemie reduc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,074.24
|
|
Rpr hypspad comp dsj & urtp
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Rpr hypspad comp simple
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,081.37
|
|
Rpr ing hernia baby blocked
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,919.49
|
|
Rpr ing hernia baby reduc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,919.49
|
|
Rpr ing hernia init blocked
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,176.15
|
|
Rpr ing hernia init reduce
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,411.37
|
|
Rpr ing hern premie blocked
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,176.15
|
|
Rpr nsl vlv collapse w/implt
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,000.36
|
|
Rpr nsl vlv collapse w/rmdlg
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,000.36
|
|
Rpr rem hernia init reduce
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,856.84
|
|
Rpr xtnsr tndn leg prim without grft ea tndn
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,959.65
|
|
Rrp hypspad comp moblj&urtp
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,339.00
|
|
Rsv assay w/optic
|
$14.41 |
$14.41 |
$14.41 |
$73.80
|
|
Rubella antibody igg
|
$15.83 |
$15.83 |
$15.83 |
$73.10
|
|
Rubeola ag if
|
$66.88 |
$66.88 |
$66.88 |
$66.88
|
|
Rubeola antibody igg
|
$14.17 |
$14.17 |
$14.17 |
$79.68
|
|
Runx1 gene targeted seq alys
|
$362.46 |
$362.46 |
$362.46 |
$362.46
|
|
Russell viper venom diluted
|
$10.54 |
$10.54 |
$10.54 |
$70.16
|
|
Rx metab gen seq alys pnl 6
|
$1,008.79 |
$1,008.79 |
$1,008.79 |
$1,100.50
|
|
Salmonella antibody
|
$14.51 |
$14.51 |
$14.51 |
$37.58
|
|
Salpingostomy 58770
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,840.20
|
