|
Complx repair enel 2.6-7.5 cm 13152
|
$500.00 |
$945.00 |
$25,448.04 |
|
|
Complx repair enel addl 5cm/< 13153
|
$185.04 |
$465.00 |
$26,157.30 |
|
|
Complx repair fccmnaxghf 13131
|
$112.50 |
$820.00 |
$21,567.92 |
|
|
Complx repair fccmnaxghf 13132
|
$500.00 |
$945.00 |
$22,543.45 |
|
|
Complx repair fccmnaxghf 13133
|
$185.04 |
$470.16 |
$22,543.45 |
|
|
Complx repair sal addl 5 cm/> 13122
|
$112.50 |
$410.00 |
$37,782.95 |
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$377.40 |
$660.96 |
$51,358.14 |
|
|
Complx repair trunk addl 5cm/< 13102
|
$166.80 |
$410.00 |
$38,694.96 |
|
|
Component ankle afo plastic jt mold to pt mdl foot cup
|
$1,259.30 |
$1,259.30 |
$1,259.30 |
|
|
Composite byp grft 2 veins
|
$863.20 |
$863.20 |
$863.20 |
|
|
Composite byp grft 3/> segmt
|
$996.80 |
$996.80 |
$996.80 |
|
|
Composite byp grft pros&vein
|
$205.60 |
$205.60 |
$205.60 |
|
|
Composite drsg >16<=48 sq in
|
$3.00 |
$3.00 |
$58.32 |
|
|
Composite drsg <= 16 sq in
|
$7.92 |
$7.92 |
$23.40 |
|
|
Composite graft/pri close/don area 15760
|
$1,639.20 |
$2,195.00 |
$3,435.84 |
|
|
Comprehensive hearing test
|
$87.20 |
$256.90 |
$410.40 |
|
|
Compre oph exam est pt 1/>
|
$260.80 |
$260.80 |
$260.80 |
|
|
Compre oph exam new pt 1/>
|
$312.00 |
$312.00 |
$312.00 |
|
|
Compression stocking bk18-30
|
$64.20 |
$64.20 |
$99.40 |
|
|
Computed tomographic angiography head and neck with contrast
|
$1,624.80 |
$2,625.00 |
$7,464.10 |
|
|
Concentration infection agents any type
|
$14.52 |
$54.60 |
$260.00 |
|
|
Conditioning play audiometry 92582
|
$120.00 |
$222.50 |
$353.40 |
|
|
Conduit wrap neuomend 3mmx2.5cm
|
$746.09 |
$4,182.63 |
$9,127.43 |
|
|
Condylomata destruction 56420
|
$154.00 |
$472.50 |
$11,303.67 |
|
|
Conform band n/s w>=3"<5"/yd
|
$0.80 |
$15.84 |
$88.80 |
|
|
Conform band s w>=3" <5"/yd
|
$1.90 |
$1.90 |
$1.90 |
|
|
Conform band s w >=5"/yd
|
$1.84 |
$1.84 |
$1.84 |
|
|
Congo red blood test
|
$10.40 |
$10.40 |
$10.40 |
|
|
Conivaptan hcl
|
$48.25 |
$48.25 |
$4,824.92 |
|
|
Conization/cerv/loop electrode exc 57522
|
$511.20 |
$11,185.80 |
$15,761.82 |
|
|
Conization of cervix
|
$592.20 |
$3,820.00 |
$18,998.36 |
|
|
Conjugated estrogens 25 mg solution for injection
|
$260.90 |
$1,440.95 |
$3,988.94 |
|
|
Connect omega .5mm
|
$351.34 |
$1,024.20 |
$6,495.33 |
|
|
Connector tis 2x10mm
|
$3,978.88 |
$7,791.31 |
$15,915.89 |
|
|
Constj trachesophgl fstl
|
$1,304.00 |
$10,813.42 |
$10,813.42 |
|
|
Construct bowel bladder
|
$6,627.20 |
$6,627.20 |
$6,627.20 |
|
|
Construction of absent anus
|
$4,828.80 |
$4,828.80 |
$4,828.80 |
|
|
Construction of absent anus
|
$5,272.80 |
$5,272.80 |
$5,272.80 |
|
|
Construction of vagina
|
$1,352.00 |
$1,352.00 |
$1,352.00 |
|
|
Construct thumb replacement
|
$8,076.80 |
$8,076.80 |
$8,076.80 |
|
|
Construct vagina with graft
|
$2,063.20 |
$2,063.20 |
$81,876.72 |
|
|
Consultation pathology during surgery
|
$26.25 |
$100.00 |
$50,218.25 |
|
|
Consultation pathology during surgery cytological exam initial site
|
$81.25 |
$552.60 |
$37,312.26 |
|
|
Consultation pathology during surgery frozen section each additional block
|
$39.00 |
$187.50 |
$87,845.31 |
|
|
Consultation pathology during surgery frozen section first tissue block
|
$58.80 |
$235.80 |
$85,829.69 |
|
|
Consultation/report referred material w/preparation of slides
|
$75.00 |
$370.00 |
$24,959.26 |
|
|
Consultation/report referred slides prepared elsewhere
|
$25.20 |
$347.04 |
$98,255.77 |
|
|
Consultation with family
|
$67.20 |
$121.20 |
$195.20 |
|
|
Consult comp w/report rfrd material
|
$71.61 |
$570.00 |
$16,682.88 |
|
|
Contact layer >16<= 48 sq in
|
$58.32 |
$58.32 |
$58.32 |
|
|
Contact lens fitg aphakia 1
|
$216.80 |
$216.80 |
$663.60 |
|
|
Contact lens fitg aphakia ou
|
$204.00 |
$204.00 |
$252.00 |
|
|
Contact lens fitting for tx
|
$158.40 |
$158.40 |
$158.40 |
|
|
Cont gluc mntr analysis i&r 95251
|
$76.32 |
$80.00 |
$85.80 |
|
|
Cont intraop neuro monitor
|
$73.60 |
$73.60 |
$73.60 |
|
|
Contour cranial bone lesion
|
$1,836.80 |
$1,836.80 |
$1,836.80 |
|
|
Contour of face bone lesion
|
$1,235.40 |
$1,235.40 |
$6,129.00 |
|
|
Contrast baths charges
|
$15.84 |
$56.65 |
$89.28 |
|
|
Contrast exam abdominl aorta 75625-26
|
$120.60 |
$4,498.20 |
$14,321.30 |
|
|
Contrast exam thoracic aorta
|
$47.40 |
$3,616.90 |
$6,798.24 |
|
|
Contrast exam thoracic aorta 75605-26
|
$114.00 |
$5,428.80 |
$24,595.90 |
|
|
Contrast x-ray gallbladder
|
$153.60 |
$260.40 |
$417.50 |
|
|
Contrast x-ray of ankle
|
$373.80 |
$888.00 |
$1,267.20 |
|
|
Contrast x-ray of brain
|
$163.20 |
$163.20 |
$445.20 |
|
|
Contrast x-ray of brain
|
$329.60 |
$900.00 |
$1,445.40 |
|
|
Contrast x-ray of elbow
|
$426.00 |
$765.80 |
$1,276.80 |
|
|
Contrast x-ray of hip
|
$231.25 |
$1,100.00 |
$1,993.60 |
|
|
Contrast x-ray of knee joint
|
$231.25 |
$1,000.00 |
$2,560.60 |
|
|
Contrast x-ray of wrist
|
$231.25 |
$887.40 |
$1,993.60 |
|
|
Controler lvad heartmate 3 includes ebb
|
$2,823.49 |
$13,477.75 |
$21,483.97 |
|
|
Controller infinity pt dbs
|
$979.46 |
$3,246.17 |
$71,654.27 |
|
|
Control nosebleed pack+caut 30905
|
$43.75 |
$332.64 |
$4,592.00 |
|
|
Control nose/throat bleeding comp req hospital 42971
|
$907.20 |
$907.20 |
$1,120.80 |
|
|
Control nose/throat bleeding with surg ivntj 42972
|
$1,014.60 |
$1,014.60 |
$14,443.34 |
|
|
Control nose/throat bleeding w/pst nsl packs 42970
|
$223.20 |
$392.50 |
$33,538.64 |
|
|
Control of nosebleed ant comp 30903
|
$43.75 |
$300.00 |
$7,788.91 |
|
|
Control of nosebleedantersmpl 30901
|
$43.75 |
$300.00 |
$57,165.37 |
|
|
Control oropharyngeal hemorr/simp 42960
|
$322.50 |
$520.00 |
$13,443.48 |
|
|
Control throat bleeding
|
$832.20 |
$832.20 |
$1,031.20 |
|
|
Control throat bleeding
|
$1,027.20 |
$1,273.60 |
$55,544.50 |
|
|
Conversion ext bil drg cath
|
$2,430.00 |
$4,588.80 |
$22,646.25 |
|
|
Convert nephrostomy catheter
|
$915.00 |
$2,110.00 |
$14,342.53 |
|
|
Conv gtube to jtube
|
$291.00 |
$484.00 |
$10,152.60 |
|
|
Coombs direct
|
$24.75 |
$85.68 |
$298.90 |
|
|
Coombs indirect qualitative each reagent red cell reference
|
$5.00 |
$144.00 |
$520.20 |
|
|
Coombs indirect titer reference
|
$57.14 |
$184.80 |
$442.40 |
|
|
Copper cu 64 dotatate diag
|
$1,040.00 |
$3,836.00 |
$13,282.50 |
|
|
Copper intrauterine device
|
$1,318.40 |
$2,624.00 |
$6,869.27 |
|
|
Cor artery disease mrna
|
$2,100.00 |
$2,100.00 |
$2,100.00 |
|
|
Core ndl bx lng/med perq
|
$600.00 |
$2,165.00 |
$20,302.10 |
|
|
Corf related serv 15 mins ea
|
$42.40 |
$42.40 |
$42.40 |
|
|
Corf skilled nursing service
|
$17.60 |
$17.60 |
$17.60 |
|
|
Cor hlx vlgs double osteot
|
$1,080.00 |
$1,722.60 |
$5,036.80 |
|
|
Cor hlx vlgs dstl mtar osteo
|
$1,375.20 |
$1,375.20 |
$4,539.20 |
|
|
Cor hlx vlgs prx phlx osteot
|
$805.20 |
$1,371.60 |
$4,203.20 |
|
|
Cornea 1/2moon str split thick
|
$19,415.76 |
$19,415.76 |
$36,828.12 |
|
|
Corneal hysteresis deter
|
$30.40 |
$30.40 |
$30.40 |
|
|
Corneal smear
|
$576.00 |
$576.00 |
$576.00 |
|
|
Corneal transplant
|
$5,588.80 |
$5,588.80 |
$57,343.33 |
|
|
Corneal transplant
|
$6,182.40 |
$48,273.71 |
$48,273.71 |
|
