|
Repair defect of artery 35011
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,988.54
|
|
Repair deformity of toe
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,594.44
|
|
Repair degenerated kneecap
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,855.00
|
|
Repair dental ellis ii fx
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$432.55
|
|
Repair detached retina
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,624.00
|
|
Repair detached retina
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,683.61
|
|
Repair detached retina
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,173.34
|
|
Repair detached retina crtx
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,764.80
|
|
Repair detached retina pc
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,170.32
|
|
Repair eardrum structures
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,855.00
|
|
Repair elbow deb/attch open
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair elbow perc
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,499.12
|
|
Repair elbow w/deb open
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair esophagus opening
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,819.23
|
|
Repair extns tendon finger without grft ea
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,702.15
|
|
Repair extra toe(s)
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,760.73
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,462.45
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,966.40
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,269.14
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,440.96
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,760.73
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,760.73
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,760.73
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,982.40
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,924.80
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,760.73
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,760.73
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,982.40
|
|
Repair eyelid defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,176.00
|
|
Repair eyelid wound
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,917.20
|
|
Repair eyelid wound
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,254.34
|
|
Repair facial nerve
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,553.49
|
|
Repair facial nerve
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,465.11
|
|
Repair fibula nonunion
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,879.60
|
|
Repair finger deformity
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,893.86
|
|
Repair finger/hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,108.00
|
|
Repair finger/hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,958.50
|
|
Repair finger/hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair finger/hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,842.58
|
|
Repair finger/hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,594.44
|
|
Repair finger/hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair finger tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,752.25
|
|
Repair foot dislocation
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,419.00
|
|
Repair foot dislocation
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,419.00
|
|
Repair foot dislocation
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,886.74
|
|
Repair forearm tendon/muscle
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair forearm tendon/muscle
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair forearm tendon/muscle
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair forearm tendon/muscle sec 25263
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,855.00
|
|
Repair forearm tendon sheath
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair/graft achilles tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$8,453.60
|
|
Repair/graft eye lesion
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,339.00
|
|
Repair/graft finger tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,791.08
|
|
Repair/graft finger tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,594.44
|
|
Repair/graft finger tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair/graft hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,560.25
|
|
Repair/graft hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,110.00
|
|
Repair/graft hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,703.55
|
|
Repair/graft hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,886.74
|
|
Repair/graft hand tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,931.20
|
|
Repair/graft kneecap tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,193.88
|
|
Repair/graft of foot tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,886.74
|
|
Repair/graft of foot tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$7,907.11
|
|
Repair/graft of thigh muscle
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,943.97
|
|
Repair/graft of tibia
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,311.00
|
|
Repair/graft radius or ulna
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$7,807.24
|
|
Repair/graft radius or ulna
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,886.74
|
|
Repair/graft radius & ulna
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$7,907.11
|
|
Repair/graft radius & ulna
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,881.00
|
|
Repair/graft wrist bone
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$7,897.93
|
|
Repair hand joint
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair hand joint with graft
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair hand joint with graft
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,594.44
|
|
Repair humerus with graft
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$11,718.66
|
|
Repair ing hernia sliding
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,906.18
|
|
Repair iris & ciliary body
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,698.92
|
|
Repair iris & ciliary body
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,110.11
|
|
Repair lac palate<2 cm
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$686.89
|
|
Repair leg fascia defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,699.61
|
|
Repair lip full thkns =<one-half vert height
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,326.51
|
|
Repair lip full thkns >one-half vert height/cmplx
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,928.07
|
|
Repair lower leg epiphyses
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,721.84
|
|
Repair lower leg tendons
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,591.33
|
|
Repair lower leg tendons
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,855.00
|
|
Repair lumbar hernia
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,457.82
|
|
Repair middle ear structures
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,966.40
|
|
Repair middle ear structures
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,837.72
|
|
Repair multi-comp penis pros
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,631.74
|
|
Repair muscles of hand
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,839.54
|
|
Repair nasal septum defect
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,589.62
|
|
Repair nasal stenosis
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,419.00
|
|
Repair nonunion carpal bone
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,095.33
|
|
Repair nonunion hand
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,886.74
|
|
Repair nose to lip fistula
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,339.00
|
|
Repair of achilles tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,110.00
|
|
Repair of anal sphincter
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,245.23
|
|
Repair of anal sphincter
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,245.23
|
|
Repair of anal stricture
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,245.23
|
|
Repair of ankle ligament
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$7,807.24
|
