|
Clsd tx/dis tib/wt bear no manip 27824
|
$426.72 |
$426.72 |
$426.72 |
$454.30
|
|
Clsd tx elbow dislocation child 24640
|
$149.28 |
$149.28 |
$149.28 |
$462.80
|
|
Clsd tx/fem shaft fx/manipulation 27502
|
$996.48 |
$996.48 |
$996.48 |
$2,184.08
|
|
Clsd tx fracture of radius 25500
|
$383.04 |
$383.04 |
$383.04 |
$442.50
|
|
Clsd tx/fx grt toe/phalanx/phalang 28490
|
$244.32 |
$244.32 |
$244.32 |
$376.11
|
|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$220.80 |
$220.80 |
$220.80 |
$411.73
|
|
Clsd tx fx radius/ulna dist without manip 25600
|
$455.52 |
$455.52 |
$455.52 |
$520.80
|
|
Clsd tx fx radius/ulna dist w/manip 25605
|
$720.48 |
$720.48 |
$720.48 |
$1,656.90
|
|
Clsd tx fx radius/ulna without manip 25560
|
$390.24 |
$390.24 |
$390.24 |
$459.00
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$693.60 |
$693.60 |
$693.60 |
$1,571.25
|
|
Clsd tx hip disloc without anes 27265
|
$543.84 |
$543.84 |
$543.84 |
$630.00
|
|
Clsd tx humeral fract without manip 24530
|
$512.64 |
$512.64 |
$512.64 |
$538.45
|
|
Clsd tx humerus fract without manip 24500
|
$485.76 |
$485.76 |
$485.76 |
$492.99
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$405.12 |
$405.12 |
$405.12 |
$496.80
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$445.44 |
$445.44 |
$445.44 |
$606.00
|
|
Clsd tx/metatarsal fx without manip 28470
|
$294.24 |
$294.24 |
$294.24 |
$418.20
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$1,275.36 |
$1,275.36 |
$1,275.36 |
$3,678.17
|
|
Clsd tx nose fx without manip 21310
|
$577.92 |
$577.92 |
$577.92 |
$323.95
|
|
Clsd tx patella disloc without anes 27560
|
$493.92 |
$493.92 |
$493.92 |
$566.72
|
|
Clsd tx/patellar fx without manip 27520
|
$437.28 |
$437.28 |
$437.28 |
$475.68
|
|
Clsd tx pelvic ring fx
|
$126.24 |
$126.24 |
$126.24 |
$416.35
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$582.72 |
$582.72 |
$582.72 |
$2,146.20
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$269.28 |
$269.28 |
$269.28 |
$412.00
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$355.20 |
$355.20 |
$355.20 |
$445.80
|
|
Clsd tx radius fracture w/manip 24655
|
$598.56 |
$598.56 |
$598.56 |
$1,782.86
|
|
Clsd tx/scapular fx without manip 23570
|
$315.84 |
$315.84 |
$315.84 |
$452.40
|
|
Clsd tx shoulder dislc/fx 23665
|
$579.36 |
$579.36 |
$579.36 |
$1,839.54
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$735.84 |
$735.84 |
$735.84 |
$1,690.70
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$545.28 |
$545.28 |
$545.28 |
$2,211.05
|
|
Clsd tx temporomandibular dislocat 21480
|
$190.08 |
$190.08 |
$190.08 |
$394.40
|
|
Clsd tx toe dislocation without anes28660
|
$163.20 |
$163.20 |
$163.20 |
$400.00
|
|
Clsd tx trimall ankle fx without manip 27816
|
$444.48 |
$444.48 |
$444.48 |
$488.40
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$652.80 |
$652.80 |
$652.80 |
$1,565.74
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$355.20 |
$355.20 |
$355.20 |
$452.40
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$413.76 |
$413.76 |
$413.76 |
$523.53
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$444.48 |
$444.48 |
$444.48 |
$600.60
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$393.12 |
$393.12 |
$393.12 |
$474.50
|
|
Cltx carpl scphd fx w/mnpj
|
$657.12 |
$657.12 |
$657.12 |
$1,893.86
|
|
Cltx humrl cndylr fx w/mnpj
|
$742.08 |
$742.08 |
$742.08 |
$1,815.75
|
|
Cltx humrl cndylr fx wo mnpj
|
$472.80 |
$472.80 |
$472.80 |
$535.60
|
|
Cltx lunate dislc w/mnpj
|
$653.76 |
$653.76 |
$653.76 |
$2,437.00
|
|
Cltx mndblr/max alv ridge fx
|
$942.72 |
$942.72 |
$942.72 |
$3,990.33
|
|
Cltx palatal/max fx wire fix
|
$1,423.20 |
$1,423.20 |
$1,423.20 |
$4,350.00
|
|
Cltx post ankle fx w/mnpj
|
$594.72 |
$594.72 |
$594.72 |
$1,893.86
|
|
#cmvcul-virus inoculation shell
|
$48.96 |
$48.96 |
$48.96 |
$100.80
|
|
Cmv pcr-sendout
|
$267.36 |
$267.36 |
$267.36 |
$177.50
|
|
Co2 monitor per day
|
$454.08 |
$454.08 |
$454.08 |
$450.60
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$26,371.20 |
$26,371.20 |
$26,371.20 |
$8,980.00
|
|
Cocaine 4 % nasal solution
|
$630.42 |
$630.42 |
$630.42 |
$629.41
|
|
Cold agglutinin titer
|
$118.56 |
$118.56 |
$118.56 |
$50.00
|
|
Colistimethate sodium inj
|
$63.96 |
$63.96 |
$63.96 |
$68.47
|
|
Collagenase, clost hist inj
|
$12,561.34 |
$12,561.34 |
$12,561.34 |
$12,906.28
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$283.31 |
$283.31 |
$283.31 |
$60.84
|
|
Collar cerv adlt perfit ace extric
|
$51.40 |
$51.40 |
$51.40 |
$70.00
|
|
Collar cerv ascend 172 reg
|
$339.36 |
$339.36 |
$339.36 |
$213.89
|
|
Collection blood specimen from completely implantable venous access device
|
$102.24 |
$102.24 |
$102.24 |
$159.60
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$56.16 |
$56.16 |
$56.16 |
$153.30
|
|
Collection of venous blood by venipuncture
|
$54.24 |
$54.24 |
$54.24 |
$21.00
|
|
Colonoscopy (diagnostic)
|
$1,128.96 |
$1,128.96 |
$1,128.96 |
$1,899.00
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$1,037.76 |
$1,037.76 |
$1,037.76 |
$2,288.00
|
|
Colonoscopy for bleeding 44391
|
$896.64 |
$896.64 |
$896.64 |
$2,288.00
|
|
Colonoscopy for foreign body
|
$560.16 |
$560.16 |
$560.16 |
$2,288.00
|
|
Colonoscopy & polypectomy 44392
|
$529.44 |
$529.44 |
$529.44 |
$1,645.43
|
|
Colonoscopy stoma w/snare 44394
|
$606.24 |
$606.24 |
$606.24 |
$1,395.28
|
|
Colonoscopy submucous njx
|
$616.80 |
$616.80 |
$616.80 |
$2,080.00
|
|
Colonoscopy thru stoma spx
|
$433.92 |
$433.92 |
$433.92 |
$1,899.00
|
|
Colonoscopy w/ablation
|
$3,514.08 |
$3,514.08 |
$3,514.08 |
$2,708.80
|
|
Colonoscopy w/balloon dilat
|
$857.76 |
$857.76 |
$857.76 |
$1,645.43
|
|
Colonoscopy w/control bleed
|
$935.04 |
$935.04 |
$935.04 |
$2,030.25
|
|
Colonoscopy w/endoscope Ultrasound
|
$345.12 |
$345.12 |
$345.12 |
$1,645.43
|
|
Colonoscopy w/endoscopic fnb
|
$406.56 |
$406.56 |
$406.56 |
$1,645.43
|
|
Colonoscopy/w endoscopic stent 45389
|
$387.84 |
$387.84 |
$387.84 |
$3,571.80
|
|
Colonoscopy w/fb removal
|
$601.92 |
$601.92 |
$601.92 |
$1,395.28
|
|
Colonoscopy with ablation
|
$3,405.12 |
$3,405.12 |
$3,405.12 |
$3,405.12
|
|
Colonoscopy (with biopsy)
|
$1,518.24 |
$1,518.24 |
$1,518.24 |
$2,080.00
|
|
Colonoscopy with biopsy
|
$572.16 |
$572.16 |
$572.16 |
$1,395.28
|
|
Colonoscopy (with polyp removal)
|
$1,094.88 |
$1,094.88 |
$1,094.88 |
$2,288.00
|
|
Colonoscopy w/stent plcmt
|
$350.40 |
$350.40 |
$350.40 |
$5,824.00
|
|
Colpocentesis 57020
|
$410.88 |
$410.88 |
$410.88 |
$4,232.80
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$1,038.24 |
$1,038.24 |
$1,038.24 |
$3,762.53
|
|
Colposcopy/cervix/bx vagina/cervix 57421
|
$72.96 |
$72.96 |
$72.96 |
$1,030.40
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$148.32 |
$148.32 |
$148.32 |
$312.90
|
|
Colposcopy vulva w/biopsy 56821
|
$110.40 |
$110.40 |
$110.40 |
$393.60
|
|
Colposcopy w/biopsy of cervix 57455
|
$148.32 |
$148.32 |
$148.32 |
$502.80
|
|
Compatibility test each unit antiglobulin technique
|
$151.68 |
$151.68 |
$151.68 |
$170.05
|
|
Compatibility test each unit electronic
|
$152.16 |
$152.16 |
$152.16 |
$172.26
|
|
Compatibility test each unit immediate spin technique
|
$55.68 |
$55.68 |
$55.68 |
$169.52
|
|
Compatibility test incubate
|
$56.16 |
$56.16 |
$56.16 |
$155.40
|
|
Complement antigen each component c3
|
$84.96 |
$84.96 |
$84.96 |
$108.55
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$483.36 |
$483.36 |
$483.36 |
$876.00
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$540.96 |
$540.96 |
$540.96 |
$1,191.78
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$574.08 |
$574.08 |
$574.08 |
$1,049.60
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$674.40 |
$674.40 |
$674.40 |
$1,194.25
|
|
Complx repair enel addl 5cm/< 13153
|
$256.80 |
$256.80 |
$256.80 |
$490.50
|
|
Complx repair fccmnaxghf 13131
|
$527.52 |
$527.52 |
$527.52 |
$810.40
|
|
Complx repair fccmnaxghf 13132
|
$641.28 |
$641.28 |
$641.28 |
$1,107.60
|
|
Complx repair fccmnaxghf 13133
|
$256.80 |
$256.80 |
$256.80 |
$490.50
|
|
Complx repair sal addl 5 cm/> 13122
|
$256.80 |
$256.80 |
$256.80 |
$502.50
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$463.68 |
$463.68 |
$463.68 |
$1,000.00
|
|
Complx repair trunk addl 5cm/< 13102
|
$256.80 |
$256.80 |
$256.80 |
$537.00
|
