|
Open nasoethmoid fx without fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,547.81
|
|
Open periprosthetic breast capsule 19370
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,242.15
|
|
Open tenotomy tendon flexor foot single or multiple 28230
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,180.80
|
|
Open thrombectomy of av fistula without revision 36831
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,182.35
|
|
Open tx nose fx w/skele fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,977.18
|
|
Open tx nose & septal fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,837.72
|
|
Open tx rib 1-3 fx w/fix 21811
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,986.00
|
|
Open tx rib 4-6 fx w/fix 21812
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,986.00
|
|
Open tx rib 7+ fx w/fix 21813
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,716.88
|
|
Opn impltj crnl nrv nea&pg
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$33,303.98
|
|
Opn impltj nea neuromuscular
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,855.00
|
|
Opn impltj nea perph nerve
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,674.95
|
|
Opn impltj nea sacral nerve
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,359.38
|
|
Opn mpltj hpglsl nstm ary pg
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$36,061.23
|
|
Opn tx complx malar fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,465.11
|
|
Opn tx complx malar w/grft
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,553.49
|
|
Opn tx dprsd zygomatic arch
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,832.78
|
|
Opn tx nasomax fx multple
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,547.81
|
|
Opn tx nasomax fx w/fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,724.50
|
|
Opn tx orbit fx combined
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,493.99
|
|
Opn tx orbit fx periorbital
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,547.81
|
|
Opn tx orbit fx transantral
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Opn tx orbit fx w/bone grft
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Opn tx orbit fx w/implant
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,487.79
|
|
Opn tx orbit fx without impl 21406
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,553.49
|
|
Opn tx orbit periorbtl implt
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Opn tx orbit periorbt w/grft
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,419.00
|
|
Optx acrclv dslc aq/chrn grf
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,807.24
|
|
Optx acromclv dislc aqt/chrn
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,095.72
|
|
Optx acute shoulder dislc
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,554.95
|
|
Optx carpl scphd fx int fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Optx clavicular fx w/int fix
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$8,453.60
|
|
Optx complicated mndblr fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,465.11
|
|
Optx crpl fx oth/thn scph ea
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,839.54
|
|
Optx gr hmrl tbrs fx int fix
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,157.53
|
|
Optx lunate dislocation
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,907.11
|
|
Optx medial ankle fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,807.24
|
|
Optx mndblr cndylr fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,553.49
|
|
Optx mndblr fx wo ntrdntl
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,547.81
|
|
Optx mndblr fx xtrnl fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,289.89
|
|
Optx mndblr/max alv ridge fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,808.50
|
|
Optx palatal/max fracture
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,547.81
|
|
Optx partclr fx&/dslc elbw w
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$9,008.32
|
|
Optx post ankle fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,886.74
|
|
Optx prox humrl fx w/int fix
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$12,734.70
|
|
Optx prx hmrl fx fix rpr rpl
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$13,527.80
|
|
Optx radial shaft fracture
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,287.97
|
|
Optx rad/uln dislc aqt/chrnc
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,883.95
|
|
Optx rdcrpl/ntrcrpl dislc 1+
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,110.00
|
|
Optx rdl shft fx&cltx rad/ul
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,386.73
|
|
Optx rdl shft fx&dstl rad/ul
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,807.24
|
|
Optx rdl&uln shft fx rds&uln
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,839.00
|
|
Optx rdl&uln shft fx rds/uln
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,665.84
|
|
Optx scapular fx w/int fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,807.24
|
|
Optx sho dislc fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,807.24
|
|
Optx sho dislc neck fx fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$10,629.07
|
|
Optx strclv dslc aq/chrn grf
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,886.74
|
|
Optx strnclav dislc aqt/chrn
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,072.59
|
|
Optx tmprmand dislocation
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,986.00
|
|
Optx trns-scphprlnr fx dislc
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,627.00
|
|
Optx ulnar shft fx int fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,913.97
|
|
Optx ulnar styloid fracture
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,886.74
|
|
Orchiectomy partial
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,081.37
|
|
Orchiopexy (fowler-stephens)
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,906.18
|
|
Orchiopexy ingun/scrot appr
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,176.15
|
|
Organic acids total quant ea spec
|
$25.96 |
$25.96 |
$25.96 |
$151.36
|
|
Oropharyngeal biopsy 42800
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,855.10
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$609.04 |
$609.04 |
$609.04 |
$772.99
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$82.48 |
$82.48 |
$82.48 |
$231.00
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$98.24 |
$98.24 |
$98.24 |
$306.00
|
|
Ortho hnd without jnt w/fit&adj
|
$189.08 |
$189.08 |
$189.08 |
$225.00
|
|
Orthopantogram
|
$23.22 |
$23.22 |
$23.22 |
$219.22
|
|
Orthosis lso rigd frm hyperex
|
$158.74 |
$158.74 |
$158.74 |
$813.61
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$75.78 |
$75.78 |
$75.78 |
$420.76
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$225.38 |
$225.38 |
$225.38 |
$410.92
|
|
Oscillation chest wall mechanical per session
|
$49.66 |
$49.66 |
$49.66 |
$221.34
|
|
Osmolality blood
|
$7.27 |
$7.27 |
$7.27 |
$67.60
|
|
Osmolality urine
|
$7.50 |
$7.50 |
$7.50 |
$65.65
|
|
Ostectomy complete 1st metatarsal head 28111
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,821.05
|
|
Ostectomy scapula partial
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,594.44
|
|
Osteochondral knee allograft
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,862.94
|
|
Osteochondral knee autograft
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$7,907.11
|
|
Osteochondral talus autogrft
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,731.17
|
|
Osteoplasty humerus
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,311.00
|
|
Osteot humerus w/wo int fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,886.74
|
|
Osteotomy/graft tarsal/calcaneus/talus 28305
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,855.00
|
|
Other immunoelectrophoresis
|
$25.44 |
$25.44 |
$25.44 |
$46.40
|
|
Oth resp proc, group
|
$46.56 |
$46.56 |
$46.56 |
$137.05
|
|
Otoplasty 69300
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,589.62
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$19.99 |
$19.99 |
$19.99 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$28.12 |
$28.12 |
$28.12 |
$91.80
|
|
Ovarian cystectomy 58925
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,813.46
|
|
Palb2 gene full gene seq
|
$744.15 |
$744.15 |
$744.15 |
$649.44
|
|
Palb2 gene known famil vrnt
|
$331.49 |
$331.49 |
$331.49 |
$398.20
|
|
Parathormone (pth) intact
|
$45.41 |
$45.41 |
$45.41 |
$200.23
|
|
Parathyroid planar imaging
|
$180.72 |
$180.72 |
$180.72 |
$1,166.00
|
|
Parathyroid planar img w/tomo spect
|
$278.64 |
$278.64 |
$278.64 |
$1,398.75
|
|
Paravaginal defect repair 57284
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,468.70
|
|
Parial mast w/lymph removal 19302
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,428.78
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$270.00
|
