|
Clsd tx/ulnar shaft fx without manip 25530
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
|
|
Clsd tx wrist carpal fx without manip 25630
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$439.62 |
$1,520.36 |
$1,520.36 |
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$473.83 |
$1,520.36 |
$1,520.36 |
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$415.48 |
$1,520.36 |
$1,520.36 |
|
|
Cls tx of heel fracture w/manip 28405
|
$1,241.93 |
$1,241.93 |
$1,241.93 |
|
|
Cltx carpl scphd fx w/mnpj
|
$4,181.05 |
$4,181.05 |
$4,181.05 |
|
|
Cltx craniofacial separation
|
$8,292.12 |
$8,292.12 |
$8,292.12 |
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$4,181.05 |
$4,181.05 |
$4,181.05 |
|
|
Cltx hum epcndylr fx wo mnpj
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
|
|
Cltx humrl cndylr fx w/mnpj
|
$792.22 |
$4,181.05 |
$4,181.05 |
|
|
Cltx humrl cndylr fx wo mnpj
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
|
|
Cltx lunate dislc w/mnpj
|
$4,181.05 |
$4,181.05 |
$4,181.05 |
|
|
Cltx mndblr fx ntrdntl fixj
|
$15,563.00 |
$15,563.00 |
$15,563.00 |
|
|
Cltx mndblr fx w/mnpj
|
$4,045.88 |
$4,045.88 |
$4,045.88 |
|
|
Cltx mndblr/max alv ridge fx
|
$524.63 |
$8,292.12 |
$8,292.12 |
|
|
Cltx palatal/max fx wire fix
|
$8,292.12 |
$8,292.12 |
$8,292.12 |
|
|
Cltx post ankle fx
|
$1,241.93 |
$1,241.93 |
$1,241.93 |
|
|
Cltx post ankle fx w/mnpj
|
$4,181.05 |
$4,181.05 |
$4,181.05 |
|
|
Cltx scap fx w/mnpj +-tractj
|
$2,030.33 |
$2,030.33 |
$2,030.33 |
|
|
Cltx strnclav dislc w/mnpj
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
|
|
Cltx thigh fx
|
$8,675.77 |
$8,675.77 |
$8,675.77 |
|
|
Cltx thigh fx w/mnpj
|
$8,675.77 |
$8,675.77 |
$8,675.77 |
|
|
Cltx tmprmand dislc comp
|
$2,797.19 |
$2,797.19 |
$2,797.19 |
|
|
C motor evoked lwr limbs
|
$1,018.25 |
$2,909.75 |
$2,909.75 |
|
|
C motor evoked uppr limbs
|
$1,011.29 |
$2,904.28 |
$2,904.28 |
|
|
C motor evoked upr&lwr limbs
|
$2,140.53 |
$2,140.53 |
$2,140.53 |
|
|
#cms hgb-sulfhemoglobin
|
$466.75 |
$466.75 |
$466.75 |
|
|
#cmvcul-virus inoculation shell
|
$15.37 |
$313.16 |
$691.75 |
|
|
Cmv pcr-sendout
|
$15.37 |
$280.50 |
$2,592.43 |
|
|
Co2 monitor per day
|
$207.27 |
$660.33 |
$759.30 |
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$13.76 |
$13.76 |
$23,376.25 |
|
|
Coagulation time activated teg
|
$1.33 |
$320.57 |
$3,013.00 |
|
|
Cocaine 4 % nasal solution
|
$2,108.10 |
$2,108.10 |
$2,108.10 |
|
|
Cochlear implt f/up exam <7
|
$423.87 |
$423.87 |
$423.87 |
|
|
Cochlear implt f/up exam 7/>
|
$423.87 |
$423.87 |
$423.87 |
|
|
Codeine 15 mg/ml inj 2 ml
|
$266.26 |
$266.26 |
$266.26 |
|
|
Cogenex amnio memb per sq cm
|
$1.00 |
$1.00 |
$1.00 |
|
|
Coil axium 3d 14mmx40cm qc
|
$138.40 |
$175.23 |
$295.22 |
|
|
Cold agglutinin screen (arc)
|
$4.62 |
$206.48 |
$816.19 |
|
|
Cold agglutinin titer
|
$10.73 |
$130.72 |
$1,192.00 |
|
|
Colistimethate sodium inj
|
$77.00 |
$290.34 |
$375.68 |
|
|
Collagen imp urinary 2.5 ml
|
$1,596.67 |
$9,390.83 |
$11,035.00 |
|
|
Collarbone (Clavicle) X-ray (both sides)
|
$53.86 |
$820.74 |
$1,092.96 |
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$103.03 |
$103.03 |
$103.03 |
|
|
Collar cerv adlt perfit ace extric
|
$190.87 |
$190.87 |
$190.87 |
|
|
Collar cerv ascend 172 reg
|
$241.88 |
$241.88 |
$241.88 |
|
|
Collar cerv patriot adlt
|
$312.97 |
$312.97 |
$312.97 |
|
|
Collar extrication adult univ
|
$889.25 |
$889.25 |
$889.25 |
|
|
Collection blood specimen from completely implantable venous access device
|
$78.98 |
$551.21 |
$914.25 |
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$75.74 |
$589.23 |
$736.00 |
|
|
Coll-e-derm 1 sq cm
|
$1.00 |
$1.00 |
$1.00 |
|
|
Colon motility 6 hr study
|
$1,110.48 |
$1,110.48 |
$1,110.48 |
|
|
Colposcopy vulva 56820
|
$519.18 |
$519.18 |
$519.18 |
|
|
Colposcopy vulva w/biopsy 56821
|
$850.95 |
$850.95 |
$850.95 |
|
|
Compatibility test each unit antiglobulin technique
|
$132.78 |
$303.06 |
$1,178.98 |
|
|
Compatibility test each unit electronic
|
$132.78 |
$637.00 |
$1,178.98 |
|
|
Compatibility test each unit immediate spin technique
|
$132.78 |
$896.75 |
$1,504.00 |
|
|
Compatibility test incubate
|
$246.00 |
$246.00 |
$1,781.00 |
|
|
Comp cystometrogram/void/uret pres 51729
|
$6,349.23 |
$6,349.23 |
$6,349.23 |
|
|
Complement antigen each component c3
|
$54.02 |
$543.97 |
$543.97 |
|
|
Complement fixation each
|
$159.38 |
$159.38 |
$159.38 |
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$242.95 |
$2,345.59 |
$2,345.59 |
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$259.55 |
$2,654.00 |
$2,654.00 |
|
|
Complex uroflowmetry (electronic) 51741
|
$554.40 |
$916.67 |
$916.67 |
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$293.75 |
$2,045.57 |
$2,045.57 |
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$354.11 |
$2,045.57 |
$2,045.57 |
|
|
Complx repair enel addl 5cm/< 13153
|
$146.37 |
$2,045.57 |
$2,045.57 |
|
|
Complx repair fccmnaxghf 13131
|
$256.03 |
$2,345.59 |
$2,345.59 |
|
|
Complx repair fccmnaxghf 13132
|
$319.91 |
$2,863.40 |
$2,863.40 |
|
|
Complx repair fccmnaxghf 13133
|
$134.30 |
$2,045.57 |
$2,045.57 |
|
|
Complx repair sal addl 5 cm/> 13122
|
$88.03 |
$2,045.57 |
$2,045.57 |
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$211.26 |
$2,243.31 |
$2,243.31 |
|
|
Complx repair trunk addl 5cm/< 13102
|
$76.46 |
$2,045.57 |
$2,045.57 |
|
|
Component ankle afo plastic jt mold to pt mdl foot cup
|
$1,901.69 |
$1,901.69 |
$8,438.00 |
|
|
Comprehensive hearing test
|
$380.27 |
$522.45 |
$692.50 |
|
|
Computed tomographic angiography head and neck with contrast
|
$14,204.10 |
$14,204.10 |
$14,204.10 |
|
|
Concentration infection agents any type
|
$18.56 |
$151.63 |
$151.63 |
|
|
Conditioning play audiometry 92582
|
$403.75 |
$423.87 |
$423.87 |
|
|
Condylomata destruction 56420
|
$108.14 |
$1,635.16 |
$1,635.16 |
|
|
Conivaptan hcl
|
$4,185.63 |
$6,270.00 |
$7,202.97 |
|
|
Conjugated estrogens 25 mg solution for injection
|
$729.26 |
$1,198.95 |
$2,461.00 |
|
|
Connector tis 2x10mm
|
$2,264.96 |
$2,264.96 |
$2,460.32 |
|
|
Consultation pathology during surgery
|
$123.00 |
$320.78 |
$2,901.00 |
|
|
Consultation pathology during surgery cytological exam initial site
|
$360.95 |
$2,469.39 |
$4,803.71 |
|
|
Consultation pathology during surgery frozen section each additional block
|
$32.54 |
$188.01 |
$2,220.78 |
|
|
Consultation pathology during surgery frozen section first tissue block
|
$145.17 |
$1,058.49 |
$2,519.41 |
|
|
Consultation/report referred material w/preparation of slides
|
$53.24 |
$729.00 |
$2,028.92 |
|
|
Consultation/report referred slides prepared elsewhere
|
$38.95 |
$311.00 |
$1,280.91 |
|
|
Consult comp w/report rfrd material
|
$307.22 |
$772.26 |
$772.26 |
|
|
Contrast baths charges
|
$41.85 |
$48.83 |
$563.40 |
|
|
Contrast exam abdominl aorta 75625-26
|
$1,102.05 |
$7,884.68 |
$12,780.50 |
|
|
Contrast exam thoracic aorta
|
$10,024.00 |
$10,024.00 |
$10,024.00 |
|
|
Contrast exam thoracic aorta 75605-26
|
$1,906.41 |
$7,824.58 |
$11,761.04 |
|
|
Contrast x-ray gallbladder
|
$127.42 |
$940.54 |
$4,130.50 |
|
|
Contrast x-ray of ankle
|
$270.90 |
$3,895.09 |
$3,895.09 |
|
|
Contrast x-ray of brain
|
$7,608.00 |
$7,608.00 |
$7,608.00 |
|
|
Contrast x-ray of elbow
|
$226.08 |
$1,891.78 |
$1,891.78 |
|
