|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$924.30 |
$924.30 |
$924.30 |
$478.20
|
|
Clsd tx fx radius/ulna dist without manip 25600
|
$1,537.38 |
$1,537.38 |
$1,537.38 |
$639.60
|
|
Clsd tx fx radius/ulna dist w/manip 25605
|
$3,531.06 |
$3,531.06 |
$3,531.06 |
$1,912.80
|
|
Clsd tx fx radius/ulna without manip 25560
|
$840.06 |
$840.06 |
$840.06 |
$632.78
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$2,910.18 |
$2,910.18 |
$2,910.18 |
$1,790.00
|
|
Clsd tx/grt hum tube fx without manip 23620
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$476.00
|
|
Clsd tx hip disloc without anes 27265
|
$3,009.24 |
$3,009.24 |
$3,009.24 |
$716.95
|
|
Clsd tx humeral fract without manip 24530
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$623.93
|
|
Clsd tx humerus fract without manip 24500
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$568.92
|
|
Clsd tx iphal jnt disl w/manip req anes
|
$1,877.46 |
$1,877.46 |
$1,877.46 |
$1,066.00
|
|
Clsd tx mandibular fx without manip 21450
|
$1,754.22 |
$1,754.22 |
$1,754.22 |
$1,087.20
|
|
Clsd tx/metacar/interphal artic fx 26740
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$529.50
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$1,618.50 |
$1,618.50 |
$1,618.50 |
$529.08
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$1,780.74 |
$1,780.74 |
$1,780.74 |
$717.75
|
|
Clsd tx metacarp fx w/manip&ext fix ea bone 26607
|
$5,804.76 |
$5,804.76 |
$5,804.76 |
$3,345.60
|
|
Clsd tx metatarsal fracture w/manip 28475
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$580.30
|
|
Clsd tx/metatarsal fx without manip 28470
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$429.65
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$6,797.70 |
$6,797.70 |
$6,797.70 |
$3,600.75
|
|
Clsd tx of ankle fracture w/manip 28435
|
$6,633.12 |
$6,633.12 |
$6,633.12 |
$1,815.75
|
|
Clsd tx patella disloc without anes 27560
|
$1,003.86 |
$1,003.86 |
$1,003.86 |
$707.30
|
|
Clsd tx/patellar fx without manip 27520
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$576.00
|
|
Clsd tx pelvic ring fx
|
$404.04 |
$404.04 |
$404.04 |
$452.00
|
|
Clsd tx pelvic ring fx
|
$404.04 |
$404.04 |
$404.04 |
$824.00
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$3,531.06 |
$3,531.06 |
$3,531.06 |
$2,548.00
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$916.50 |
$916.50 |
$916.50 |
$484.00
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$510.95
|
|
Clsd tx radius fracture w/manip 24655
|
$2,592.72 |
$2,592.72 |
$2,592.72 |
$1,835.20
|
|
Clsd tx/scapular fx without manip 23570
|
$840.06 |
$840.06 |
$840.06 |
$454.50
|
|
Clsd tx shoulder dislc/fx 23665
|
$3,531.06 |
$3,531.06 |
$3,531.06 |
$2,066.17
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$2,797.08 |
$2,797.08 |
$2,797.08 |
$1,797.83
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$3,335.28 |
$3,335.28 |
$3,335.28 |
$2,423.85
|
|
Clsd tx/talotarsal dislocat/anes 28575
|
$5,804.76 |
$5,804.76 |
$5,804.76 |
$3,848.69
|
|
Clsd tx temporomandibular dislocat 21480
|
$624.78 |
$624.78 |
$624.78 |
$512.40
|
|
Clsd tx toe dislocation without anes28660
|
$840.06 |
$840.06 |
$840.06 |
$426.25
|
|
Clsd tx trimall ankle fx without manip 27816
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$666.60
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$3,531.06 |
$3,531.06 |
$3,531.06 |
$1,704.80
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$1,335.36 |
$1,335.36 |
$1,335.36 |
$510.40
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$464.88 |
$464.88 |
$464.88 |
$730.08
|
|
Clsd tx wrist carpal fx without manip 25630
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$494.00
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$1,617.72 |
$1,617.72 |
$1,617.72 |
$553.00
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$404.04 |
$404.04 |
$404.04 |
$744.22
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$1,698.84 |
$1,698.84 |
$1,698.84 |
$705.55
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$840.06 |
$840.06 |
$840.06 |
$518.40
|
|
Cls tx of heel fracture w/manip 28405
|
$1,186.38 |
$1,186.38 |
$1,186.38 |
$1,241.93
|
|
Cltx carpl scphd fx w/mnpj
|
$3,531.06 |
$3,531.06 |
$3,531.06 |
$2,368.00
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$5,293.86 |
$5,293.86 |
$5,293.86 |
$2,610.40
|
|
Cltx hum epcndylr fx wo mnpj
|
$840.06 |
$840.06 |
$840.06 |
$525.75
|
|
Cltx humrl cndylr fx w/mnpj
|
$1,943.76 |
$1,943.76 |
$1,943.76 |
$1,858.00
|
|
Cltx humrl cndylr fx wo mnpj
|
$1,619.28 |
$1,619.28 |
$1,619.28 |
$581.99
|
|
Cltx lunate dislc w/mnpj
|
$6,633.12 |
$6,633.12 |
$6,633.12 |
$2,952.64
|
|
Cltx mndblr fx ntrdntl fixj
|
$10,412.22 |
$10,412.22 |
$10,412.22 |
$5,835.75
|
|
Cltx mndblr fx w/mnpj
|
$2,706.60 |
$2,706.60 |
$2,706.60 |
$2,432.15
|
|
Cltx mndblr/max alv ridge fx
|
$6,380.40 |
$6,380.40 |
$6,380.40 |
$3,723.23
|
|
Cltx palatal/max fx wire fix
|
$6,380.40 |
$6,380.40 |
$6,380.40 |
$4,199.49
|
|
Cltx post ankle fx
|
$840.06 |
$840.06 |
$840.06 |
$521.30
|
|
Cltx post ankle fx w/mnpj
|
$1,295.58 |
$1,295.58 |
$1,295.58 |
$2,621.81
|
|
Cltx scap fx w/mnpj +-tractj
|
$2,035.80 |
$2,035.80 |
$2,035.80 |
$2,211.05
|
|
Cltx strnclav dislc w/mnpj
|
$8,450.52 |
$8,450.52 |
$8,450.52 |
$804.79
|
|
Cltx thigh fx
|
$6,675.24 |
$6,675.24 |
$6,675.24 |
$3,594.44
|
|
#cmvcul-virus inoculation shell
|
$86.58 |
$86.58 |
$86.58 |
$102.57
|
|
Cmv pcr-sendout
|
$184.86 |
$184.86 |
$184.86 |
$172.25
|
|
Coagulation time activated teg
|
$9.36 |
$9.36 |
$9.36 |
$53.72
|
|
Collection blood specimen from completely implantable venous access device
|
$189.54 |
$189.54 |
$189.54 |
$159.60
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$226.20 |
$226.20 |
$226.20 |
$166.94
|
|
Collection of venous blood by venipuncture
|
$50.70 |
$50.70 |
$50.70 |
$22.05
|
|
Colonoscopy (diagnostic)
|
$1,620.84 |
$1,620.84 |
$1,620.84 |
$1,846.40
|
|
Colonoscopy w/control bleed
|
$2,111.46 |
$2,111.46 |
$2,111.46 |
$2,352.75
|
|
Colpocentesis 57020
|
$9,038.64 |
$9,038.64 |
$9,038.64 |
$4,344.50
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$6,340.62 |
$6,340.62 |
$6,340.62 |
$3,792.60
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$347.10 |
$347.10 |
$347.10 |
$321.10
|
|
Colposcopy vulva 56820
|
$347.10 |
$347.10 |
$347.10 |
$295.20
|
|
Colpotomy drng of abscess 57010
|
$6,340.62 |
$6,340.62 |
$6,340.62 |
$3,309.79
|
|
Colpotomy w/exploration 57000
|
$6,340.62 |
$6,340.62 |
$6,340.62 |
$3,474.84
|
|
Compatibility test each unit antiglobulin technique
|
$214.50 |
$214.50 |
$214.50 |
$158.51
|
|
Compatibility test each unit immediate spin technique
|
$148.20 |
$148.20 |
$148.20 |
$158.27
|
|
Complement antigen each component c3
|
$219.18 |
$219.18 |
$219.18 |
$113.30
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$1,069.38 |
$1,069.38 |
$1,069.38 |
$952.60
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$1,184.82 |
$1,184.82 |
$1,184.82 |
$1,445.50
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$1,531.92 |
$1,531.92 |
$1,531.92 |
$1,247.95
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$2,992.86 |
$2,992.86 |
$2,992.86 |
$1,279.20
|
|
Complx repair enel addl 5cm/< 13153
|
$1,201.98 |
$1,201.98 |
$1,201.98 |
$486.20
|
|
Complx repair fccmnaxghf 13131
|
$1,524.12 |
$1,524.12 |
$1,524.12 |
$942.00
|
|
Complx repair fccmnaxghf 13132
|
$2,379.78 |
$2,379.78 |
$2,379.78 |
$1,212.00
|
|
Complx repair fccmnaxghf 13133
|
$945.36 |
$945.36 |
$945.36 |
$781.60
|
|
Complx repair sal addl 5 cm/> 13122
|
$844.74 |
$844.74 |
$844.74 |
$590.20
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$822.90 |
$822.90 |
$822.90 |
$1,193.40
|
|
Complx repair trunk addl 5cm/< 13102
|
$471.12 |
$471.12 |
$471.12 |
$741.60
|
|
Composite graft/pri close/don area 15760
|
$3,870.36 |
$3,870.36 |
$3,870.36 |
$2,478.19
|
|
Concentration infection agents any type
|
$53.04 |
$53.04 |
$53.04 |
$51.32
|
|
Condylomata destruction 56420
|
$856.44 |
$856.44 |
$856.44 |
$509.81
|
|
Conjugated estrogens 25 mg solution for injection
|
$1,684.61 |
$1,684.61 |
$1,684.61 |
$839.07
|
|
Contrast baths charges
|
$146.64 |
$146.64 |
$146.64 |
$77.98
|
|
Control nosebleed pack+caut 30905
|
$1,087.32 |
$1,087.32 |
$1,087.32 |
$460.17
|
|
Control of nosebleed ant comp 30903
|
$896.22 |
$896.22 |
$896.22 |
$410.06
|
|
Control of nosebleedantersmpl 30901
|
$608.40 |
$608.40 |
$608.40 |
$385.45
|
|
Control oropharyngeal hemorr/simp 42960
|
$624.78 |
$624.78 |
$624.78 |
$632.80
|
|
Control throat bleeding
|
$6,380.40 |
$6,380.40 |
$6,380.40 |
$3,723.23
|
|
Conversion ext bil drg cath
|
$7,942.74 |
$7,942.74 |
$7,942.74 |
$4,143.00
|
|
Coombs direct
|
$12.48 |
$12.48 |
$12.48 |
$72.45
|
|
Core ndl bx lng/med perq
|
$2,924.22 |
$2,924.22 |
$2,924.22 |
$3,033.57
|