|
Clsd tx humeral fract without manip 24530
|
$599.00 |
$599.00 |
$599.00 |
$577.20
|
|
Clsd tx humerus fract without manip 24500
|
$685.00 |
$685.00 |
$685.00 |
$492.99
|
|
Clsd tx iphal jnt disl w/manip req anes
|
$1,142.00 |
$1,142.00 |
$1,142.00 |
$883.00
|
|
Clsd tx/metacar/interphal artic fx 26740
|
$853.00 |
$853.00 |
$853.00 |
$506.10
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$893.00 |
$893.00 |
$893.00 |
$507.00
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$893.00 |
$893.00 |
$893.00 |
$626.60
|
|
Clsd tx metatarsal fracture w/manip 28475
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
$523.70
|
|
Clsd tx/metatarsal fx without manip 28470
|
$869.00 |
$869.00 |
$869.00 |
$434.85
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$9,216.00 |
$9,216.00 |
$9,216.00 |
$3,745.50
|
|
Clsd tx of ankle fracture w/manip 28435
|
$5,606.00 |
$5,606.00 |
$5,606.00 |
$1,893.86
|
|
Clsd tx patella disloc without anes 27560
|
$599.00 |
$599.00 |
$599.00 |
$577.20
|
|
Clsd tx/patellar fx without manip 27520
|
$893.00 |
$893.00 |
$893.00 |
$507.20
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$5,606.00 |
$5,606.00 |
$5,606.00 |
$2,222.00
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$861.00 |
$861.00 |
$861.00 |
$419.73
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$599.00 |
$599.00 |
$599.00 |
$470.08
|
|
Clsd tx radius fracture w/manip 24655
|
$5,606.00 |
$5,606.00 |
$5,606.00 |
$1,782.86
|
|
Clsd tx/scapular fx without manip 23570
|
$536.00 |
$536.00 |
$536.00 |
$452.40
|
|
Clsd tx shoulder dislc/fx 23665
|
$5,460.00 |
$5,460.00 |
$5,460.00 |
$1,839.54
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$5,606.00 |
$5,606.00 |
$5,606.00 |
$1,720.32
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$6,486.00 |
$6,486.00 |
$6,486.00 |
$2,331.50
|
|
Clsd tx temporomandibular dislocat 21480
|
$893.00 |
$893.00 |
$893.00 |
$440.00
|
|
Clsd tx toe dislocation without anes28660
|
$1,431.00 |
$1,431.00 |
$1,431.00 |
$415.20
|
|
Clsd tx trimall ankle fx without manip 27816
|
$893.00 |
$893.00 |
$893.00 |
$497.00
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$5,606.00 |
$5,606.00 |
$5,606.00 |
$1,592.00
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$893.00 |
$893.00 |
$893.00 |
$473.00
|
|
Clsd tx wrist carpal fx without manip 25630
|
$536.00 |
$536.00 |
$536.00 |
$478.40
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$583.00 |
$583.00 |
$583.00 |
$535.60
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$893.00 |
$893.00 |
$893.00 |
$617.65
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$599.00 |
$599.00 |
$599.00 |
$487.15
|
|
Cls tx of heel fracture w/manip 28405
|
$748.00 |
$748.00 |
$748.00 |
$725.40
|
|
Cltx carpl scphd fx w/mnpj
|
$5,759.00 |
$5,759.00 |
$5,759.00 |
$1,906.80
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$5,093.00 |
$5,093.00 |
$5,093.00 |
$2,274.45
|
|
Cltx hum epcndylr fx wo mnpj
|
$597.00 |
$597.00 |
$597.00 |
$525.75
|
|
Cltx humrl cndylr fx w/mnpj
|
$5,021.00 |
$5,021.00 |
$5,021.00 |
$1,858.00
|
|
Cltx humrl cndylr fx wo mnpj
|
$893.00 |
$893.00 |
$893.00 |
$543.75
|
|
Cltx lunate dislc w/mnpj
|
$5,021.00 |
$5,021.00 |
$5,021.00 |
$2,384.00
|
|
Cltx mndblr/max alv ridge fx
|
$9,553.00 |
$9,553.00 |
$9,553.00 |
$3,990.33
|
|
Cltx post ankle fx w/mnpj
|
$5,606.00 |
$5,606.00 |
$5,606.00 |
$1,940.40
|
|
Cltx scap fx w/mnpj +-tractj
|
$5,810.00 |
$5,810.00 |
$5,810.00 |
$2,021.04
|
|
Cltx thigh fx w/mnpj
|
$8,295.00 |
$8,295.00 |
$8,295.00 |
$3,388.70
|
|
Cltx tmprmand dislc comp
|
$4,528.00 |
$4,528.00 |
$4,528.00 |
$3,762.02
|
|
C motor evoked lwr limbs
|
$1,515.00 |
$1,515.00 |
$1,515.00 |
$648.00
|
|
C motor evoked uppr limbs
|
$2,902.00 |
$2,902.00 |
$2,902.00 |
$889.91
|
|
C motor evoked upr&lwr limbs
|
$3,208.00 |
$3,208.00 |
$3,208.00 |
$1,411.62
|
|
Cmptr ophth dx img ant segmt
|
$210.00 |
$210.00 |
$210.00 |
$83.20
|
|
Cmptr ophth img optic nerve
|
$210.00 |
$210.00 |
$210.00 |
$98.00
|
|
Cmv pcr-sendout
|
$74.00 |
$74.00 |
$74.00 |
$175.70
|
|
Coagulation time activated teg
|
$346.00 |
$346.00 |
$346.00 |
$52.47
|
|
Cold agglutinin titer
|
$18.00 |
$18.00 |
$18.00 |
$52.00
|
|
Collarbone (Clavicle) X-ray (both sides)
|
$359.00 |
$359.00 |
$359.00 |
$304.15
|
|
Collection blood specimen from completely implantable venous access device
|
$439.00 |
$439.00 |
$439.00 |
$163.50
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$204.00 |
$204.00 |
$204.00 |
$155.40
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$12,686.00 |
$12,686.00 |
$12,686.00 |
$3,907.93
|
|
Colposcopy/cervix/bx vagina/cervix 57421
|
$2,689.00 |
$2,689.00 |
$2,689.00 |
$1,030.40
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$574.00 |
$574.00 |
$574.00 |
$314.00
|
|
Colposcopy vulva 56820
|
$1,498.00 |
$1,498.00 |
$1,498.00 |
$333.20
|
|
Colposcopy vulva w/biopsy 56821
|
$1,498.00 |
$1,498.00 |
$1,498.00 |
$393.60
|
|
Colposcopy w/biopsy of cervix 57455
|
$936.00 |
$936.00 |
$936.00 |
$485.50
|
|
Compatibility test each unit antiglobulin technique
|
$191.00 |
$191.00 |
$191.00 |
$173.50
|
|
Compatibility test each unit electronic
|
$191.00 |
$191.00 |
$191.00 |
$171.00
|
|
Compatibility test each unit immediate spin technique
|
$191.00 |
$191.00 |
$191.00 |
$169.52
|
|
Comp cystometrogram/void presssure 51728
|
$2,303.00 |
$2,303.00 |
$2,303.00 |
$985.00
|
|
Comp cystometrogram/void/uret pres 51729
|
$2,303.00 |
$2,303.00 |
$2,303.00 |
$1,111.03
|
|
Complement antigen each component c3
|
$92.00 |
$92.00 |
$92.00 |
$109.20
|
|
Complex cystometrogram 51726
|
$1,753.00 |
$1,753.00 |
$1,753.00 |
$727.35
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$2,056.00 |
$2,056.00 |
$2,056.00 |
$898.92
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$1,561.00 |
$1,561.00 |
$1,561.00 |
$1,191.78
|
|
Complex uroflowmetry (electronic) 51741
|
$572.00 |
$572.00 |
$572.00 |
$344.98
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$2,056.00 |
$2,056.00 |
$2,056.00 |
$1,066.20
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$2,056.00 |
$2,056.00 |
$2,056.00 |
$1,212.00
|
|
Complx repair enel addl 5cm/< 13153
|
$1,332.00 |
$1,332.00 |
$1,332.00 |
$490.50
|
|
Complx repair fccmnaxghf 13131
|
$1,322.00 |
$1,322.00 |
$1,322.00 |
$810.40
|
|
Complx repair fccmnaxghf 13132
|
$2,056.00 |
$2,056.00 |
$2,056.00 |
$1,107.60
|
|
Complx repair fccmnaxghf 13133
|
$872.00 |
$872.00 |
$872.00 |
$527.52
|
|
Complx repair sal addl 5 cm/> 13122
|
$937.00 |
$937.00 |
$937.00 |
$523.71
|
|
Complx repair trunk addl 5cm/< 13102
|
$1,004.00 |
$1,004.00 |
$1,004.00 |
$537.00
|
|
Comprehensive hearing test
|
$435.00 |
$435.00 |
$435.00 |
$261.46
|
|
Computed tomographic angiography head and neck with contrast
|
$3,370.00 |
$3,370.00 |
$3,370.00 |
$2,237.25
|
|
Concentration infection agents any type
|
$19.00 |
$19.00 |
$19.00 |
$51.32
|
|
Conditioning play audiometry 92582
|
$552.00 |
$552.00 |
$552.00 |
$189.44
|
|
Condylomata destruction 56420
|
$723.00 |
$723.00 |
$723.00 |
$469.00
|
|
Consultation pathology during surgery
|
$146.00 |
$146.00 |
$146.00 |
$104.65
|
|
Consultation pathology during surgery cytological exam initial site
|
$940.00 |
$940.00 |
$940.00 |
$434.60
|
|
Consultation pathology during surgery frozen section each additional block
|
$103.00 |
$103.00 |
$103.00 |
$113.68
|
|
Consultation pathology during surgery frozen section first tissue block
|
$214.00 |
$214.00 |
$214.00 |
$225.96
|
|
Cont gluc mntr analysis i&r 95251
|
$230.00 |
$230.00 |
$230.00 |
$80.00
|
|
Contrast exam abdominl aorta 75625-26
|
$9,334.00 |
$9,334.00 |
$9,334.00 |
$3,483.84
|
|
Contrast exam thoracic aorta
|
$10,859.00 |
$10,859.00 |
$10,859.00 |
$3,648.84
|
|
Contrast exam thoracic aorta 75605-26
|
$6,675.00 |
$6,675.00 |
$6,675.00 |
$3,780.00
|
|
Control nosebleed pack+caut 30905
|
$440.00 |
$440.00 |
$440.00 |
$383.52
|
|
Control of nosebleed ant comp 30903
|
$457.00 |
$457.00 |
$457.00 |
$399.85
|
|
Control of nosebleedantersmpl 30901
|
$474.00 |
$474.00 |
$474.00 |
$356.00
|
|
Control oropharyngeal hemorr/simp 42960
|
$2,212.00 |
$2,212.00 |
$2,212.00 |
$624.78
|
|
Conversion ext bil drg cath
|
$10,996.00 |
$10,996.00 |
$10,996.00 |
$4,143.00
|
|
Convert nephrostomy catheter
|
$6,264.00 |
$6,264.00 |
$6,264.00 |
$2,777.60
|
|
Coombs direct
|
$81.00 |
$81.00 |
$81.00 |
$76.80
|
|
Coombs indirect titer reference
|
$90.00 |
$90.00 |
$90.00 |
$156.71
|
|
Copper intrauterine device
|
$1,413.00 |
$1,413.00 |
$1,413.00 |
$1,899.20
|
|
Core ndl bx lng/med perq
|
$5,821.00 |
$5,821.00 |
$5,821.00 |
$2,911.80
|
|
Corneal smear
|
$1,369.00 |
$1,369.00 |
$1,369.00 |
$472.21
|
