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Scottish Rite For Children Orthopedic And Sports Medicine Center

Texas · 1,500 published self-pay prices, from $1,720 to $87,622.

These items are published without a standard CPT or HCPCS code, so they cannot be reliably matched against the same service at another hospital. They are shown exactly as this facility published them, and are excluded from every median, average and comparison elsewhere on this site.

Showing the 300 lowest-priced of 1,500 published items.

ItemCash priceSetting
ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE$28,141Outpatient
ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE$22,425Outpatient
ABOVE ELBOW, MOLDED DOUBLE WALL SOCKET, INTERNAL LOCKING ELBOW, FOREARM$7,087Outpatient
ABOVE ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SHAPING$6,672Outpatient
ABOVE KNEE, FOR PROXIMAL FEMORAL FOCAL DEFICIENCY, CONSTANT FRICTION KNEE, SHIN, SACH FOOT$8,939Outpatient
ABOVE KNEE, MOLDED SOCKET, OPEN END, SACH FOOT, ENDOSKELETAL SYSTEM, SINGLE AXIS KNEE$8,253Outpatient
ABOVE KNEE, MOLDED SOCKET, SINGLE AXIS CONSTANT FRICTION KNEE, SHIN, SACH FOOT$8,123Outpatient
ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH ARTICULATED ANKLE/FOOT, DYNAMICALLY ALIGNED, EACH$7,542Outpatient
ABOVE KNEE, SHORT PROSTHESIS, NO KNEE JOINT ('STUBBIES'), WITH FOOT BLOCKS, NO ANKLE JOINTS, EACH$6,004Outpatient
ADDITION TO ENDOSKELETAL KNEE-SHIN SYSTEM, FLUID STANCE EXTENSION, DAMPENING FEATURE, WITH OR WITHOUT ADJUSTABILITY$2,333Outpatient
ADDITION TO HALO PROCEDURE, MAGNETIC RESONANCE IMAGE COMPATIBLE SYSTEMS, RINGS AND PINS, ANY MATERIAL$3,270Outpatient
ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE$40,311Outpatient
ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING AND STANCE PHASE, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE$52,069Outpatient
ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE$18,477Outpatient
ADDITION TO LOWER EXTREMITY PROSTHESIS, USER ADJUSTABLE HEEL HEIGHT$3,935Outpatient
ADDITION TO LOWER EXTREMITY, ABOVE KNEE, FLEXIBLE INNER SOCKET, EXTERNAL FRAME$3,435Outpatient
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE$2,854Outpatient
ADDITION TO LOWER EXTREMITY, BELOW KNEE/ABOVE KNEE, CUSTOM FABRICATED SOCKET INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIA$2,854Outpatient
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE - KNEE DISARTICULATION, 4 BAR LINKAGE, WITH FRICTION SWING PHASE CONTROL$3,456Outpatient
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE-KNEE DISARTICULATION, 4 BAR LINKAGE, WITH HYDRAULIC SWING PHASE CONTROL$5,324Outpatient
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, HYDRACADENCE SYSTEM$5,147Outpatient
ADDITION TO LOWER EXTREMITY, ENDOSKELETAL SYSTEM, ABOVE KNEE, UNIVERSAL MULTIPLEX SYSTEM, FRICTION SWING PHASE CONTROL$3,885Outpatient
ADDITION TO LOWER EXTREMITY, EXOSKELETAL SYSTEM, ABOVE KNEE-KNEE DISARTICULATION, 4 BAR LINKAGE, WITH PNEUMATIC SWING PHASE CONTROL$3,660Outpatient
ADDITION TO LOWER EXTREMITY, HIP DISARTICULATION, FLEXIBLE INNER SOCKET, EXTERNAL FRAME$3,592Outpatient
ADDITION TO LOWER EXTREMITY, ISCHIAL CONTAINMENT/NARROW M-L SOCKET$5,212Outpatient
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, METAL FRAME, RECIPROCATING HIP JOINT AND CABLES$3,374Outpatient
ADDITION TO LOWER EXTREMITY, PELVIC CONTROL, PLASTIC, MOLDED TO PATIENT MODEL, RECIPROCATING HIP JOINT AND CABLES$3,452Outpatient
ADDITION TO LOWER EXTREMITY, PROSTHETIC TYPE, (BK) SOCKET, MOLDED TO PATIENT MODEL, (USED FOR 'PTB' 'AFO' ORTHOSES)$1,911Outpatient
ADDITION TO LOWER EXTREMITY, THIGH/WEIGHT BEARING, ISCHIAL CONTAINMENT/NARROW M-L BRIM MOLDED TO PATIENT MODEL$2,455Outpatient
ADDITION TO LOWER EXTREMITY, USER ADJUSTABLE, MECHANICAL, RESIDUAL LIMB VOLUME MANAGEMENT SYSTEM$6,575Outpatient
ADDITION TO LOWER LIMB PROSTHESIS, MULTIAXIAL ANKLE WITH SWING PHASE ACTIVE DORSIFLEXION FEATURE$7,882Outpatient
ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT AND MOISTURE EVACUATION SYSTEM$8,679Outpatient
ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENT AND MOISTURE EVACUATION SYSTEM, HEAVY DUTY$9,149Outpatient
ADDITION TO LOWER LIMB PROSTHESIS, VERTICAL SHOCK REDUCING PYLON FEATURE$4,333Outpatient
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM FABRICATED SOCKET INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INIT$2,854Outpatient
ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM FABRICATED SOCKET INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHE$2,854Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING, AND STANCE PHASE CONTROL$2,085Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, HYDRAULIC SWING PHASE CONTROL, MECHANICAL STANCE PHASE LOCK$8,055Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE LOCK$2,079Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL$6,057Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL$3,919Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, HYDRAULIC SWING PHASE CONTROL, WITH MINIATURE HIGH ACTIVITY FRAME$6,774Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION STANCE PHASE CONTROL$3,653Outpatient
ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/ SWING PHASE CONTROL$4,468Outpatient
ADDITION, ENDOSKELETAL KNEE/SHIN SYSTEM, 4-BAR LINKAGE OR MULTIAXIAL, PNEUMATIC SWING PHASE CONTROL$7,525Outpatient
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, FLEXIBLE PROTECTIVE OUTER SURFACE COVERING SYSTEM$2,009Outpatient
ADDITION, ENDOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)$2,224Outpatient
ADDITION, ENDOSKELETAL SYSTEM, HIGH ACTIVITY KNEE CONTROL FRAME$7,302Outpatient
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, FLEXIBLE PROTECTIVE OUTER SURFACE COVERING SYSTEM$2,560Outpatient
ADDITION, ENDOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)$2,758Outpatient
ADDITION, ENDOSKELETAL SYSTEM, POLYCENTRIC HIP JOINT, PNEUMATIC OR HYDRAULIC CONTROL, ROTATION CONTROL, WITH OR WITHOUT FLEXION AND/OR EXTENSION CONTROL$10,281Outpatient
ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, STANCE FLEXION FEATURE, ADJUSTABLE$3,887Outpatient
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING AND STANCE PHASE CONTROL$2,008Outpatient
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, MECHANICAL STANCE PHASE LOCK$1,819Outpatient
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, EXTERNAL JOINTS FLUID SWING PHASE CONTROL$4,976Outpatient
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING AND STANCE PHASE CONTROL$5,316Outpatient
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FLUID SWING PHASE CONTROL$4,316Outpatient
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC SWING, FRICTION STANCE PHASE CONTROL$1,952Outpatient
ADDITION, EXOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, PNEUMATIC/HYDRA PNEUMATIC SWING PHASE CONTROL$2,830Outpatient
ADDITION, EXOSKELETAL SYSTEM, ABOVE KNEE, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)$2,057Outpatient
ADDITION, EXOSKELETAL SYSTEM, HIP DISARTICULATION, ULTRA-LIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL)$3,071Outpatient
Advancement of tendons of outer forearm at wrist joint$2,892Outpatient
ALL LOWER EXTREMITY PROSTHESES, FLEX FOOT SYSTEM$8,413Outpatient
ALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL$6,426Outpatient
ALL LOWER EXTREMITY PROSTHESIS, MULTI-AXIAL ANKLE, DYNAMIC RESPONSE FOOT, ONE PIECE SYSTEM$4,895Outpatient
ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON$15,603Outpatient
Amputation of arm through forearm bones$2,283Outpatient
Amputation of arm through forearm bones leaving wound$2,371Outpatient
Amputation of arm through upper arm bone leaving wound$2,254Outpatient
Amputation of arm through upper arm bone with closure$2,425Outpatient
Amputation of arm through upper arm bone with implant$2,578Outpatient
Amputation of both lower leg bones$2,957Outpatient
Amputation of both lower leg bones leaving wound$1,970Outpatient
Amputation of both lower leg bones with immediate fitting$2,814Outpatient
Amputation of entire arm with removal shoulder blade and a portion of collar bone$4,574Outpatient
Amputation of finger or thumb with direct closure$2,051Outpatient
Amputation of finger or thumb with tissue flap$2,051Outpatient
Amputation of fingers and part of hand at midhand bones$2,696Outpatient
Amputation of foot across instep$2,527Outpatient
Amputation of foot at ankle with reconstruction of skin and tissue$2,189Outpatient
Amputation of midfoot bone$1,793Outpatient
Amputation of pelvic structures$5,385Outpatient
Amputation of thigh through thigh bone$2,616Outpatient
Amputation of thigh through thigh bone leaving wound$2,343Outpatient
Amputation of thigh through thigh bone with immediate fitting for prosthesis$2,941Outpatient
Anchoring of biceps tendon$2,417Outpatient
Anchoring of biceps tendon at elbow$1,974Outpatient
Anchoring of extending tendon of fingers to wrist bone$2,047Outpatient
Anchoring of flexing tendon of fingers to wrist bone$2,340Outpatient
ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, CUSTOM FABRICATED$2,341Outpatient
ANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION), CUSTOM FABRICATED$1,864Outpatient
ANKLE FOOT ORTHOSIS, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE$1,931Outpatient
ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), PLASTIC OR OTHER MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE$1,817Outpatient
ANKLE, SYMES, MOLDED SOCKET, SACH FOOT$6,205Outpatient
ANKLE, SYMES, MOLDED TO PATIENT MODEL, SOCKET WITHOUT SOLID ANKLE CUSHION HEEL (SACH) FOOT, REPLACEMENT ONLY$5,717Outpatient
Application and removal of dental fixation device$2,241Outpatient
Application of cranial halo (stabilization device for skull)$2,711Outpatient
Arthroplasty or replacement of the end of the forearm bone on the small finger side at the wrist level$2,645Outpatient
Arthroplasty or replacement of the end of the forearm bone on the thumb side at the wrist level$3,033Outpatient
Arthroplasty or replacement of the entire wrist joint$3,920Outpatient
Arthroplasty or replacement of wrist bone, one wrist bone (lunate bone)$2,685Outpatient
Arthroplasty or replacement of wrist bone, one wrist bone (scaphoid or navicular bone)$2,603Outpatient
Arthroplasty or replacement of wrist bone, one wrist bone (trapezium bone)$2,410Outpatient
Aspiration of spinal disc tissue for diagnostic purposes$1,900Outpatient
AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB ELECTRIC PROSTHETIC TERMINAL DEVICE$8,868Outpatient
BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE$18,564Outpatient
BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE$16,878Outpatient
BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STEP-UP HINGES, HALF CUFF$6,061Outpatient
BELOW ELBOW, MOLDED DOUBLE WALL SPLIT SOCKET, STUMP ACTIVATED LOCKING HINGE, HALF CUFF$5,617Outpatient
BELOW ELBOW, MOLDED SOCKET, (MUENSTER OR NORTHWESTERN SUSPENSION TYPES)$5,377Outpatient
BELOW ELBOW, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SHAPING$5,380Outpatient
BELOW ELBOW, MOLDED SOCKET, FLEXIBLE ELBOW HINGE, TRICEPS PAD$5,065Outpatient
BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT$6,097Outpatient
BELOW KNEE, MOLDED SOCKET, SHIN, SACH FOOT, ENDOSKELETAL SYSTEM$5,917Outpatient
BELOW KNEE, PLASTIC SOCKET, JOINTS AND THIGH LACER, SACH FOOT$7,452Outpatient
Biopsy of deep bone$2,003Outpatient
Biopsy of deep tissue of pelvis and hip$2,267Outpatient
Biopsy of hip joint$1,863Outpatient
Bone graft at lower leg with microvascular connection$8,031Outpatient
Bone graft of foot bone with microvascular connection$7,385Outpatient
Bone graft of pelvic bone with microvascular connection$8,610Outpatient
Bone graft to upper thigh bone$3,728Outpatient
Bone graft with microvascular connection$7,566Outpatient
BREAST RECONSTRUCTION WITH OTHER TECHNIQUE$4,631Outpatient
Breast reduction$3,779Outpatient
Bypass of diseased or blocked upper arm to arm artery with vein$3,644Outpatient
CATHETER, TRANSLUMINAL ATHERECTOMY, DIRECTIONAL$3,974Outpatient
CERVICAL-THORACIC-LUMBAR-SACRAL ORTHOSIS (CTLSO) (MILWAUKEE), INCLUSIVE OF FURNISHING INITIAL ORTHOSIS, INCLUDING MODEL$4,445Outpatient
CERVICAL-THORACIC-LUMBAR-SACRAL-ORTHOSES (CTLSO), ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, (MINERVA TYPE)$4,132Outpatient
CERVICOPLASTY$2,546Outpatient
Closed treatment of broken and dislocated forearm bones at elbow with manipulation$1,838Outpatient
Closed treatment of broken below neck of thigh bone with manipulation$3,201Outpatient
Closed treatment of broken bones of cheek, nose, and face with placement of stabilizing device to teeth$2,302Outpatient
Closed treatment of broken head of thigh bone with manipulation$1,774Outpatient
Closed treatment of broken hip socket$1,748Outpatient
Closed treatment of broken hip socket with manipulation$3,265Outpatient
Closed treatment of broken lower jaw bone with manipulation$2,142Outpatient
Closed treatment of broken lower jaw bone with placement of stabilizing device to teeth$2,648Outpatient
Closed treatment of broken midpart of forearm bone on thumb side and dislocated wrist joint$1,774Outpatient
Closed treatment of broken nose and upper jaw bones with placement of stabilizing device to teeth$2,170Outpatient
Closed treatment of broken or dislocated spine bone with cast or brace and traction$2,575Outpatient
Closed treatment of broken roof of mouth or upper jaw bone with placement of stabilizing device to teeth$2,235Outpatient
Closed treatment of broken shin bone with traction$1,926Outpatient
Closed treatment of broken thigh bone at far end with manipulation$2,674Outpatient
Closed treatment of broken thigh bone at knee area with manipulation$2,196Outpatient
Closed treatment of broken thigh bone at midportion with manipulation$2,462Outpatient
Closed treatment of broken upper thigh bone with manipulation$2,552Outpatient
Closed treatment of dislocated hip prosthesis under anesthesia$1,865Outpatient
Closed treatment of dislocated hip under anesthesia$2,453Outpatient
Closed treatment of dislocated knee under anesthesia$2,088Outpatient
Closed treatment of growth plate broken at end of thigh bone with manipulation$2,282Outpatient
Closed treatment of upper arm bone broken at elbow with manipulation$1,895Outpatient
COMBINATION, BILATERAL, LUMBO-SACRAL, HIP, FEMUR ORTHOSIS PROVIDING ADDUCTION AND INTERNAL ROTATION CONTROL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT$4,187Outpatient
Complete fusion of wrist joint$2,454Outpatient
Complete reconstruction of lower or upper jaw bone with jaw bone implant (endosteal)$4,133Outpatient
Complete reconstruction of lower or upper jaw bone with jaw bone implant (subperiosteal)$2,816Outpatient
Complete removal of second to fifth foot bones$2,816Outpatient
Complex repair of each webbed finger$4,103Outpatient
Complex repair of muscle separating chest and abdominal cavities$3,688Outpatient
Complicated removal of cyst of tailbone$1,898Outpatient
Complicated repair of broken face and skull bones$5,586Outpatient
Complicated repair of broken face and skull bones with placement of stabilizing device$4,654Outpatient
Complicated repair of broken face and skull bones with placement of stabilizing device and bone graft$6,971Outpatient
Complicated repair of dislocated jaw joint with placement of stabilizing device$1,957Outpatient
Complicated treatment of broken lower jaw bone with placement of stabilizing device to teeth$4,076Outpatient
Complicated treatment of broken roof of mouth or upper jaw bone$2,708Outpatient
Complicated treatment of dislocated midhand bone at wrist$2,073Outpatient
CONNECTIVE TISSUE, HUMAN (INCLUDES FASCIA LATA)$1,888Outpatient
CONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)$4,580Outpatient
CONNECTOR RSS,4.5 5.0-4.5 5.0MM ROD O-C$2,300Outpatient
Conversion of wrist amputation stump to grasping function$3,535Outpatient
Correction of bunion with 2 areas of realignment$2,157Outpatient
Correction of bunion with alignment correction of midfoot bone toward ankle$1,848Outpatient
Correction of bunion with forefoot and midfoot bone fusion$1,986Outpatient
Correction of claw finger$2,643Outpatient
Correction of inverted nipple$1,895Outpatient
Correction of rigid deformity of first joint of big toe$1,853Outpatient
CRANIAL CERVICAL ORTHOSIS, CONGENITAL TORTICOLLIS TYPE, WITH OR WITHOUT SOFT INTERFACE MATERIAL, ADJUSTABLE RANGE OF MOTION JOINT, CUSTOM FABRICATED$3,030Outpatient
Creation of flap graft to eyelids, nose, ears, lips, or mouth$2,286Outpatient
Creation of flap graft to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet$2,460Outpatient
Creation of flap graft to head and/or neck$3,875Outpatient
Creation of flap graft to nose, forehead, temple, or scalp$3,467Outpatient
Creation of flap graft to scalp, arms, or legs$2,377Outpatient
Creation of flap graft to trunk$2,473Outpatient
Creation of muscle graft to arm$3,707Outpatient
Creation of muscle graft to leg$4,006Outpatient
Creation of muscle graft to trunk$3,115Outpatient
Creation of nerve and blood vessel skin graft$2,935Outpatient
Creation of skin and tissue graft$2,766Outpatient
Creation of skin, fat and muscle graft$2,157Outpatient
CTLSO, ANTERIOR-POSTERIOR-LATERAL-CONTROL, MOLDED TO PATIENT MODEL, WITH INTERFACE MATERIAL, (MINERVA TYPE)$4,452Outpatient
CUSTOM SHAPED PROTECTIVE COVER, ABOVE KNEE$2,054Outpatient
CUSTOM SHAPED PROTECTIVE COVER, HIP DISARTICULATION$2,655Outpatient
CUSTOM SHAPED PROTECTIVE COVER, KNEE DISARTICULATION$2,014Outpatient
Deep layer self skin graft of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area of infants and children, or less$2,451Outpatient
Deep layer self skin graft of trunk, arms, or legs, 100.0 sq cm or 1% body area of infants and children, or less$1,812Outpatient
Dermabrasion of skin of total face$2,136Outpatient
DERMACELL, DERMACELL AWM OR DERMACELL AWM POROUS, PER SQUARE CENTIMETER$1,736Outpatient
Destruction of birthmark, more than 50.0 sq cm$1,770Outpatient
Diagnostic exam of hip using an endoscope$2,140Outpatient
Diagnostic exam of jaw joint using an endoscope$1,726Outpatient
Drainage of abscess of deep tissue of lower spine or sacrum$2,890Outpatient
Drainage of abscess of deep tissue of upper or middle spine$2,979Outpatient
Drainage of deep abscess or blood accumulation in soft tissue of neck or chest with partial removal of rib$1,784Outpatient
Drainage of deep abscess or blood accumulation of forearm or wrist$1,754Outpatient
Drainage of deep abscess or blood accumulation of pelvis or hip near joint$2,082Outpatient
Drainage of fluid collection in soft tissue using imaging guidance$2,004Outpatient
Drainage of fluid filled sacs beneath connective tissue in multiple foot joints$1,898Outpatient
Drainage of infected fluid-filled sac near pelvis or hip joint$1,754Outpatient
ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE$23,860Outpatient
ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE$21,092Outpatient
ELBOW DISARTICULATION, MOLDED SOCKET WITH EXPANDABLE INTERFACE, OUTSIDE LOCKING HINGES, FOREARM$7,812Outpatient
ELBOW DISARTICULATION, MOLDED SOCKET, ENDOSKELETAL SYSTEM, INCLUDING SOFT PROSTHETIC TISSUE SHAPING$6,613Outpatient
ELBOW DISARTICULATION, MOLDED SOCKET, OUTSIDE LOCKING HINGE, FOREARM$6,833Outpatient
ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, ADJUSTABLE POSITION LOCK WITH ACTIVE CONTROL, CUSTOM FABRICATED$2,808Outpatient
ELBOW ORTHOSIS, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/ FLEXION ASSIST, CUSTOM FABRICATED$2,187Outpatient
ELBOW WRIST HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT$2,674Outpatient
ELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT$1,905Outpatient
ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, ADULT$9,842Outpatient
ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, INDEPENDENTLY ARTICULATING DIGITS, ANY GRASP PATTERN OR COMBINATION OF GRASP PATTERNS, INCLUDES MOTOR(S)$52,097Outpatient
ELECTRIC HAND, SWITCH OR MYOELECTRIC, CONTROLLED, PEDIATRIC$15,491Outpatient
ELECTRIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, ADULT$10,042Outpatient
ELECTRIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, PEDIATRIC$4,623Outpatient
ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED$21,607Outpatient
ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED$16,981Outpatient
ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED$26,052Outpatient
ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED$24,510Outpatient
ELECTRONIC ELBOW, HOSMER OR EQUAL, SWITCH CONTROLLED$16,770Outpatient
ELECTRONIC ELBOW, MICROPROCESSOR SEQUENTIAL CONTROL OF ELBOW AND TERMINAL DEVICE$87,622Outpatient
ELECTRONIC ELBOW, MICROPROCESSOR SIMULTANEOUS CONTROL OF ELBOW AND TERMINAL DEVICE$86,910Outpatient
ELECTRONIC WRIST ROTATOR, ANY TYPE$8,268Outpatient
ENBREL 25 MG KIT$1,821Outpatient
ENDOSKELETAL ANKLE FOOT SYSTEM, MICROPROCESSOR CONTROLLED FEATURE, DORSIFLEXION AND/OR PLANTAR FLEXION CONTROL, INCLUDES POWER SOURCE$37,318Outpatient
Enlargement of chin by movement of bone$2,142Outpatient
Enlargement of chin by movement of multiple bones$2,190Outpatient
Enlargement of lower jaw with implant$2,657Outpatient
Exam of jaw joint using an endoscope$2,170Outpatient
Exam, washing, and drainage of infected knee joint using an endoscope$1,720Outpatient
Exploration of arm or leg for bleeding, blood clot, or infection after surgery$2,434Outpatient
Exploration of spine fusion$2,708Outpatient
Exploration of wound of neck$2,000Outpatient
Extensive or complicated repair of surface wound reopening$2,568Outpatient
Extensive removal of bony growth and tissue from elbow to increase elbow motion$3,920Outpatient
Extensive removal of breast, chest muscle, and underarm lymph nodes$3,720Outpatient
Extensive removal of breast, chest muscle, underarm lymph nodes, and breast lymph nodes$3,938Outpatient
Extensive removal of chest bone$4,215Outpatient
Extensive removal of growth at end of finger bone$2,102Outpatient
Extensive removal of growth of back or lower side, 5.0 cm or more$4,708Outpatient
Extensive removal of growth of back or lower side, less than 5.0 cm$3,446Outpatient
Extensive removal of growth of base of pelvis and upper end of thigh bone$6,647Outpatient
Extensive removal of growth of collar bone$4,879Outpatient
Extensive removal of growth of face or scalp, 2.0 cm or more$3,516Outpatient
Extensive removal of growth of face or scalp, less than 2.0 cm$2,315Outpatient
Extensive removal of growth of finger$2,567Outpatient
Extensive removal of growth of foot bone$2,566Outpatient
Extensive removal of growth of foot or toe, 3.0 cm or more$3,490Outpatient
Extensive removal of growth of foot or toe, less than 3.0 cm$2,492Outpatient
Extensive removal of growth of forearm bone (radius or ulna)$4,705Outpatient
Extensive removal of growth of forearm or wrist, 3.0 cm or more$3,724Outpatient
Extensive removal of growth of forearm or wrist, less than 3.0 cm$2,820Outpatient
Extensive removal of growth of hand bone$3,430Outpatient
Extensive removal of growth of hand or finger, 3.0 cm or more$3,586Outpatient
Extensive removal of growth of hand or finger, less than 3.0 cm$2,476Outpatient
Extensive removal of growth of heel bone$3,487Outpatient
Extensive removal of growth of hip bone$7,028Outpatient
Extensive removal of growth of inner forearm bone$4,336Outpatient
Extensive removal of growth of leg or ankle, 5.0 cm or more$4,266Outpatient
Extensive removal of growth of leg or ankle, less than 5.0 cm$3,420Outpatient
Extensive removal of growth of lower jaw bone$4,174Outpatient
Extensive removal of growth of middle portion of foot bone$2,830Outpatient
Extensive removal of growth of neck or front of chest, 5.0 cm or more$4,533Outpatient
Extensive removal of growth of neck or front of chest, less than 5.0 cm$3,112Outpatient
Extensive removal of growth of outer leg bone$4,991Outpatient
Extensive removal of growth of pelvis and hip, 5.0 cm or more$6,024Outpatient
Extensive removal of growth of pelvis and hip, less than 5.0 cm$4,472Outpatient
Extensive removal of growth of shin bone$5,763Outpatient
Extensive removal of growth of shoulder blade$5,715Outpatient
Extensive removal of growth of shoulder, 5.0 cm or more$4,756Outpatient
Extensive removal of growth of shoulder, less than 5.0 cm$3,849Outpatient
Extensive removal of growth of side of pelvic bone$9,412Outpatient
Extensive removal of growth of soft tissue of abdominal wall, 5.0 cm or more$4,463Outpatient
Extensive removal of growth of soft tissue of abdominal wall, less than 5.0 cm$3,521Outpatient
Extensive removal of growth of soft tissue structures in palm side of wrist$2,591Outpatient
Extensive removal of growth of soft tissue structures in top side of wrist$2,059Outpatient
Extensive removal of growth of thigh or knee bone$6,701Outpatient
Extensive removal of growth of thigh or knee, 5.0 cm or more$5,226Outpatient
Extensive removal of growth of thigh or knee, less than 5.0 cm$3,470Outpatient
Extensive removal of growth of upper arm bone$5,041Outpatient
Extensive removal of growth of upper arm or elbow, 5.0 cm or more$4,215Outpatient
Extensive removal of growth of upper arm or elbow, less than 5.0 cm$3,430Outpatient
Extensive removal of growth of upper end of upper arm$6,266Outpatient
Extensive removal of growth of upper pelvic bone including hip socket, base of pelvic bone, or both pubic bones$8,249Outpatient
Extensive repair of foot defect with tendon lengthening and relief of tension in foot$3,684Outpatient
Follow-up inpatient or observation ventilation assistance and management$2,726Outpatient
Full thickness skin graft to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 20.0 sq cm or less$2,584Outpatient
Full thickness skin graft to nose, ears, eyelids, or lips, 20.0 sq cm or less$2,931Outpatient
Full thickness skin graft to scalp, arms, or legs, 20.0 sq cm or less$1,990Outpatient
Full thickness skin graft to trunk, 20.0 sq cm or less$2,264Outpatient
Fusion of 3 bones of ankle$2,982Outpatient
Fusion of all bones of ankle and hindfoot$4,310Outpatient

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