|
Clsd tx/metatarsal fx without manip 28470
|
$275.80 |
$275.80 |
$275.80 |
$446.40
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$2,364.25 |
$2,364.25 |
$2,364.25 |
$3,678.17
|
|
Clsd tx of ankle fracture w/manip 28435
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$1,893.86
|
|
Clsd tx patella disloc without anes 27560
|
$275.80 |
$275.80 |
$275.80 |
$705.60
|
|
Clsd tx/patellar fx without manip 27520
|
$275.80 |
$275.80 |
$275.80 |
$525.85
|
|
Clsd tx pelvic ring fx
|
$242.20 |
$242.20 |
$242.20 |
$448.80
|
|
Clsd tx pelvic ring fx
|
$242.20 |
$242.20 |
$242.20 |
$705.60
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,557.07
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$275.80 |
$275.80 |
$275.80 |
$484.00
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$242.20 |
$242.20 |
$242.20 |
$488.40
|
|
Clsd tx radius fracture w/manip 24655
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$1,884.74
|
|
Clsd tx/scapular fx without manip 23570
|
$275.80 |
$275.80 |
$275.80 |
$454.50
|
|
Clsd tx shoulder dislc/fx 23665
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,055.00
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$1,828.80
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,466.40
|
|
Clsd tx/talotarsal dislocat/anes 28575
|
$2,150.75 |
$2,150.75 |
$2,150.75 |
$3,842.58
|
|
Clsd tx temporomandibular dislocat 21480
|
$275.80 |
$275.80 |
$275.80 |
$511.70
|
|
Clsd tx toe dislocation without anes28660
|
$275.80 |
$275.80 |
$275.80 |
$436.70
|
|
Clsd tx trimall ankle fx without manip 27816
|
$242.20 |
$242.20 |
$242.20 |
$594.00
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$1,707.42
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$242.20 |
$242.20 |
$242.20 |
$487.80
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$267.75 |
$267.75 |
$267.75 |
$705.60
|
|
Clsd tx wrist carpal fx without manip 25630
|
$242.20 |
$242.20 |
$242.20 |
$476.00
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$118.65 |
$118.65 |
$118.65 |
$543.23
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$242.20 |
$242.20 |
$242.20 |
$579.88
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$275.80 |
$275.80 |
$275.80 |
$692.03
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$242.20 |
$242.20 |
$242.20 |
$494.40
|
|
Cls tx of heel fracture w/manip 28405
|
$275.80 |
$275.80 |
$275.80 |
$857.50
|
|
Cltx carpl scphd fx w/mnpj
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,316.80
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,558.00
|
|
Cltx hum epcndylr fx wo mnpj
|
$242.20 |
$242.20 |
$242.20 |
$523.25
|
|
Cltx humrl cndylr fx w/mnpj
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$1,893.86
|
|
Cltx humrl cndylr fx wo mnpj
|
$242.20 |
$242.20 |
$242.20 |
$563.00
|
|
Cltx lunate dislc w/mnpj
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,893.80
|
|
Cltx mndblr fx ntrdntl fixj
|
$2,664.90 |
$2,664.90 |
$2,664.90 |
$6,776.64
|
|
Cltx mndblr fx w/mnpj
|
$1,027.25 |
$1,027.25 |
$1,027.25 |
$2,503.20
|
|
Cltx mndblr/max alv ridge fx
|
$2,687.65 |
$2,687.65 |
$2,687.65 |
$3,990.33
|
|
Cltx palatal/max fx wire fix
|
$1,879.15 |
$1,879.15 |
$1,879.15 |
$4,199.49
|
|
Cltx post ankle fx
|
$242.20 |
$242.20 |
$242.20 |
$497.00
|
|
Cltx post ankle fx w/mnpj
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,621.64
|
|
Cltx scap fx w/mnpj +-tractj
|
$1,203.65 |
$1,203.65 |
$1,203.65 |
$2,320.50
|
|
Cltx strnclav dislc w/mnpj
|
$438.20 |
$438.20 |
$438.20 |
$722.16
|
|
Cltx thigh fx
|
$2,377.90 |
$2,377.90 |
$2,377.90 |
$3,881.76
|
|
C motor evoked lwr limbs
|
$1,218.00 |
$1,218.00 |
$1,218.00 |
$627.89
|
|
C motor evoked uppr limbs
|
$1,218.00 |
$1,218.00 |
$1,218.00 |
$780.00
|
|
C motor evoked upr&lwr limbs
|
$2,436.00 |
$2,436.00 |
$2,436.00 |
$1,308.00
|
|
Coagulation time activated teg
|
$34.65 |
$34.65 |
$34.65 |
$50.05
|
|
Cocaine 4 % nasal solution
|
$133.85 |
$133.85 |
$133.85 |
$807.71
|
|
Cold agglutinin screen (arc)
|
$10.71 |
$10.71 |
$10.71 |
$47.19
|
|
Cold agglutinin titer
|
$83.30 |
$83.30 |
$83.30 |
$48.57
|
|
Colistimethate sodium inj
|
$39.43 |
$39.43 |
$39.43 |
$84.60
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$49.90 |
$49.90 |
$49.90 |
$66.69
|
|
Collar cerv adlt perfit ace extric
|
$16.15 |
$16.15 |
$16.15 |
$29.25
|
|
Collar cerv ascend 172 reg
|
$213.89 |
$213.89 |
$213.89 |
$241.88
|
|
Collar cerv patriot adlt
|
$87.00 |
$87.00 |
$87.00 |
$153.57
|
|
Collar extrication adult univ
|
$110.25 |
$110.25 |
$110.25 |
$567.53
|
|
Collection blood specimen from completely implantable venous access device
|
$166.95 |
$166.95 |
$166.95 |
$164.50
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$165.90 |
$165.90 |
$165.90 |
$170.68
|
|
Collection of venous blood by venipuncture
|
$17.15 |
$17.15 |
$17.15 |
$22.00
|
|
Colonoscopy (diagnostic)
|
$498.40 |
$498.40 |
$498.40 |
$1,612.62
|
|
Colonoscopy w/control bleed
|
$651.00 |
$651.00 |
$651.00 |
$2,101.71
|
|
Colpocentesis 57020
|
$2,312.80 |
$2,312.80 |
$2,312.80 |
$5,419.00
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$3,441.90 |
$3,441.90 |
$3,441.90 |
$3,907.93
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$312.90 |
$312.90 |
$312.90 |
$326.30
|
|
Colposcopy vulva 56820
|
$242.20 |
$242.20 |
$242.20 |
$295.20
|
|
Colpotomy drng of abscess 57010
|
$2,202.20 |
$2,202.20 |
$2,202.20 |
$3,744.41
|
|
Colpotomy w/exploration 57000
|
$2,202.20 |
$2,202.20 |
$2,202.20 |
$3,762.53
|
|
Compatibility test each unit antiglobulin technique
|
$117.25 |
$117.25 |
$117.25 |
$173.25
|
|
Compatibility test each unit electronic
|
$164.85 |
$164.85 |
$164.85 |
$180.00
|
|
Compatibility test each unit immediate spin technique
|
$250.60 |
$250.60 |
$250.60 |
$169.52
|
|
Complement antigen each component c3
|
$56.00 |
$56.00 |
$56.00 |
$111.15
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$453.25 |
$453.25 |
$453.25 |
$940.00
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$453.25 |
$453.25 |
$453.25 |
$1,357.20
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$453.25 |
$453.25 |
$453.25 |
$1,206.00
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$453.25 |
$453.25 |
$453.25 |
$1,388.40
|
|
Complx repair enel addl 5cm/< 13153
|
$275.80 |
$275.80 |
$275.80 |
$541.50
|
|
Complx repair fccmnaxghf 13131
|
$275.80 |
$275.80 |
$275.80 |
$942.00
|
|
Complx repair fccmnaxghf 13132
|
$453.25 |
$453.25 |
$453.25 |
$1,244.09
|
|
Complx repair fccmnaxghf 13133
|
$189.00 |
$189.00 |
$189.00 |
$753.35
|
|
Complx repair sal addl 5 cm/> 13122
|
$210.35 |
$210.35 |
$210.35 |
$576.66
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$397.95 |
$397.95 |
$397.95 |
$1,193.40
|
|
Complx repair trunk addl 5cm/< 13102
|
$138.60 |
$138.60 |
$138.60 |
$683.25
|
|
Composite graft/pri close/don area 15760
|
$2,247.00 |
$2,247.00 |
$2,247.00 |
$2,692.80
|
|
Computed tomographic angiography head and neck with contrast
|
$415.10 |
$415.10 |
$415.10 |
$2,313.35
|
|
Concentration infection agents any type
|
$66.85 |
$66.85 |
$66.85 |
$51.32
|
|
Condylomata destruction 56420
|
$275.80 |
$275.80 |
$275.80 |
$509.81
|
|
Conjugated estrogens 25 mg solution for injection
|
$1,354.59 |
$1,354.59 |
$1,354.59 |
$986.92
|
|
Connect omega .5mm
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$1,069.43
|
|
Connector tis 2x10mm
|
$3,180.28 |
$3,180.28 |
$3,180.28 |
$3,934.53
|
|
Consultation pathology during surgery cytological exam initial site
|
$479.85 |
$479.85 |
$479.85 |
$428.00
|
|
Consultation pathology during surgery frozen section each additional block
|
$57.40 |
$57.40 |
$57.40 |
$112.20
|
|
Consultation pathology during surgery frozen section first tissue block
|
$133.70 |
$133.70 |
$133.70 |
$214.00
|
|
Consultation/report referred material w/preparation of slides
|
$236.25 |
$236.25 |
$236.25 |
$239.85
|
|
Cont intraop neuro monitor
|
$88.20 |
$88.20 |
$88.20 |
$335.25
|
|
Contrast baths charges
|
$80.85 |
$80.85 |
$80.85 |
$75.35
|
|
Contrast exam abdominl aorta 75625-26
|
$1,863.40 |
$1,863.40 |
$1,863.40 |
$3,458.54
|
|
Contrast exam thoracic aorta
|
$2,325.40 |
$2,325.40 |
$2,325.40 |
$3,724.63
|
|
Contrast exam thoracic aorta 75605-26
|
$2,325.40 |
$2,325.40 |
$2,325.40 |
$4,178.00
|
|
Contrast x-ray gallbladder
|
$363.30 |
$363.30 |
$363.30 |
$312.00
|
|
Contrast x-ray of ankle
|
$642.95 |
$642.95 |
$642.95 |
$602.40
|
