|
Clsd tx toe dislocation without anes28660
|
$368.80 |
$447.20 |
$590.40 |
|
|
Clsd tx trimall ankle fx without manip 27816
|
$538.40 |
$538.40 |
$567.20 |
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$1,046.40 |
$1,368.00 |
$1,793.60 |
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$463.20 |
$531.20 |
$612.80 |
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$768.00 |
$768.00 |
$768.00 |
|
|
Clsd tx wrist carpal fx without manip 25630
|
$396.80 |
$396.80 |
$578.40 |
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$455.20 |
$455.20 |
$500.00 |
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$385.60 |
$652.00 |
$766.40 |
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$438.40 |
$529.60 |
$556.80 |
|
|
Cls tx of heel fracture w/manip 28405
|
$498.40 |
$498.40 |
$498.40 |
|
|
Cltx carpl scphd fx w/mnpj
|
$2,316.80 |
$2,316.80 |
$2,316.80 |
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$2,724.00 |
$2,724.00 |
$2,724.00 |
|
|
Cltx hum epcndylr fx wo mnpj
|
$457.60 |
$457.60 |
$530.40 |
|
|
Cltx humrl cndylr fx w/mnpj
|
$1,188.80 |
$1,188.80 |
$1,188.80 |
|
|
Cltx humrl cndylr fx wo mnpj
|
$579.20 |
$579.20 |
$579.20 |
|
|
Cltx lunate dislc w/mnpj
|
$2,717.60 |
$2,717.60 |
$2,717.60 |
|
|
Cltx mndblr fx w/mnpj
|
$6,891.20 |
$6,891.20 |
$6,891.20 |
|
|
Cltx mndblr/max alv ridge fx
|
$4,850.40 |
$4,850.40 |
$4,850.40 |
|
|
Cltx palatal/max fx wire fix
|
$5,281.60 |
$5,281.60 |
$5,281.60 |
|
|
Cltx scap fx w/mnpj +-tractj
|
$1,552.80 |
$1,552.80 |
$1,552.80 |
|
|
Cltx strnclav dislc w/mnpj
|
$340.80 |
$340.80 |
$340.80 |
|
|
Cltx thigh fx
|
$4,008.00 |
$4,008.00 |
$4,008.00 |
|
|
C motor evoked lwr limbs
|
$85.49 |
$418.26 |
$418.26 |
|
|
C motor evoked uppr limbs
|
$83.89 |
$83.89 |
$85.49 |
|
|
C motor evoked upr&lwr limbs
|
$171.02 |
$836.75 |
$836.75 |
|
|
Cmptr ophth img optic nerve
|
$258.62 |
$258.62 |
$258.62 |
|
|
#cmvcul-virus inoculation shell
|
$112.80 |
$159.20 |
$206.81 |
|
|
Cmv pcr-sendout
|
$86.40 |
$416.42 |
$528.42 |
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$3,224.72 |
$3,224.72 |
$15,810.04 |
|
|
Coagulation time activated teg
|
$16.51 |
$16.51 |
$16.51 |
|
|
Cocaine 4 % nasal solution
|
$281.84 |
$602.39 |
$702.78 |
|
|
Coch imp ext proc/contr rplc
|
$14,290.37 |
$16,672.10 |
$16,672.10 |
|
|
Codeine 15 mg/ml inj 2 ml
|
$54.65 |
$54.65 |
$54.65 |
|
|
Cold agglutinin titer
|
$32.26 |
$37.63 |
$133.60 |
|
|
Colistimethate sodium inj
|
$67.74 |
$67.74 |
$67.74 |
|
|
Collagen based wound filler
|
$25.92 |
$30.24 |
$1,128.00 |
|
|
Collarbone (Clavicle) X-ray (both sides)
|
$184.00 |
$278.60 |
$422.40 |
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$18.40 |
$71.40 |
$157.60 |
|
|
Collar cerv adlt perfit ace extric
|
$31.20 |
$94.70 |
$129.42 |
|
|
Collar cerv ascend 172 reg
|
$57.60 |
$262.46 |
$306.21 |
|
|
Collar cerv patriot adlt
|
$169.40 |
$231.39 |
$231.39 |
|
|
Collar extrication adult univ
|
$976.64 |
$1,111.97 |
$1,297.30 |
|
|
Collection blood specimen from completely implantable venous access device
|
$55.20 |
$137.70 |
$306.86 |
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$18.37 |
$53.23 |
$194.40 |
|
|
Colonoscopy (diagnostic)
|
$2,701.60 |
$2,701.60 |
$2,701.60 |
|
|
Colonoscopy w/ablation
|
$2,545.60 |
$2,545.60 |
$2,545.60 |
|
|
Colonoscopy w/control bleed
|
$2,769.60 |
$2,769.60 |
$2,769.60 |
|
|
Colpocentesis 57020
|
$1,060.94 |
$1,060.94 |
$1,060.94 |
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$6,548.00 |
$6,548.00 |
$6,548.00 |
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$523.20 |
$523.20 |
$523.20 |
|
|
Colposcopy vulva 56820
|
$380.00 |
$380.00 |
$380.00 |
|
|
Combination bilateral ho
|
$3,060.01 |
$4,064.65 |
$4,064.65 |
|
|
Combo ankle/foot prosthesis
|
$735.06 |
$976.36 |
$976.36 |
|
|
Compatibility test each unit antiglobulin technique
|
$108.80 |
$144.00 |
$255.20 |
|
|
Compatibility test each unit electronic
|
$9.86 |
$9.86 |
$51.20 |
|
|
Compatibility test each unit immediate spin technique
|
$108.80 |
$136.80 |
$144.42 |
|
|
Compatibility test incubate
|
$103.20 |
$140.22 |
$144.26 |
|
|
Comp cystometrogram/void presssure 51728
|
$372.80 |
$1,117.39 |
$1,418.40 |
|
|
Comp cystometrogram/void/uret pres 51729
|
$1,117.39 |
$1,117.39 |
$1,512.80 |
|
|
Complement antigen each component c3
|
$61.60 |
$104.80 |
$136.80 |
|
|
Complex cystometrogram 51726
|
$525.67 |
$525.67 |
$525.67 |
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$771.20 |
$1,297.60 |
$1,433.60 |
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$1,427.20 |
$2,456.80 |
$2,720.80 |
|
|
Complex uroflowmetry (electronic) 51741
|
$169.06 |
$169.57 |
$260.00 |
|
|
Compl oph exam general anes
|
$44.80 |
$44.80 |
$44.80 |
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$1,040.80 |
$1,452.80 |
$1,629.60 |
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$1,218.40 |
$1,375.20 |
$1,837.60 |
|
|
Complx repair enel addl 5cm/< 13153
|
$768.00 |
$1,254.40 |
$1,254.40 |
|
|
Complx repair fccmnaxghf 13131
|
$789.60 |
$969.60 |
$969.60 |
|
|
Complx repair fccmnaxghf 13132
|
$962.40 |
$1,351.20 |
$1,518.40 |
|
|
Complx repair fccmnaxghf 13133
|
$706.40 |
$781.60 |
$1,153.60 |
|
|
Complx repair sal addl 5 cm/> 13122
|
$568.00 |
$639.20 |
$723.20 |
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$725.60 |
$1,151.20 |
$1,634.40 |
|
|
Complx repair trunk addl 5cm/< 13102
|
$844.00 |
$1,199.20 |
$1,910.40 |
|
|
Component ankle afo plastic jt mold to pt mdl foot cup
|
$331.20 |
$1,246.99 |
$1,454.82 |
|
|
Comprehensive hearing test
|
$184.00 |
$261.46 |
$340.94 |
|
|
Compre oph exam est pt 1/>
|
$23.02 |
$23.02 |
$23.02 |
|
|
Computed tomographic angiography head and neck with contrast
|
$863.71 |
$1,849.46 |
$4,000.00 |
|
|
Concentration infection agents any type
|
$40.00 |
$65.81 |
$89.60 |
|
|
Condylomata destruction 56420
|
$356.80 |
$490.40 |
$560.00 |
|
|
Conivaptan hcl
|
$1,378.58 |
$1,378.58 |
$1,378.58 |
|
|
Conjugated estrogens 25 mg solution for injection
|
$317.60 |
$637.85 |
$744.16 |
|
|
Connect omega .5mm
|
$1,463.38 |
$1,463.38 |
$1,463.38 |
|
|
Connector tis 2x10mm
|
$2,252.02 |
$2,627.35 |
$2,627.35 |
|
|
Consultation pathology during surgery cytological exam initial site
|
$34.94 |
$41.66 |
$1,336.00 |
|
|
Consultation pathology during surgery frozen section each additional block
|
$43.82 |
$63.20 |
$164.00 |
|
|
Consultation pathology during surgery frozen section first tissue block
|
$43.82 |
$120.00 |
$296.80 |
|
|
Consultation/report referred material w/preparation of slides
|
$164.00 |
$171.20 |
$171.20 |
|
|
Cont gluc mntr analysis i&r 95251
|
$101.60 |
$521.08 |
$521.08 |
|
|
Contrast baths charges
|
$65.46 |
$81.48 |
$110.40 |
|
|
Contrast exam abdominl aorta 75625-26
|
$3,103.92 |
$3,103.92 |
$5,635.20 |
|
|
Contrast exam thoracic aorta
|
$1,577.18 |
$1,577.18 |
$1,577.18 |
|
|
Contrast exam thoracic aorta 75605-26
|
$2,124.67 |
$2,124.67 |
$5,688.80 |
|
|
Contrast x-ray gallbladder
|
$190.42 |
$201.99 |
$201.99 |
|
|
Contrast x-ray of ankle
|
$277.34 |
$304.53 |
$1,014.40 |
|
|
Contrast x-ray of elbow
|
$295.96 |
$298.22 |
$936.80 |
|
|
Contrast x-ray of hip
|
$277.06 |
$278.66 |
$1,072.00 |
|
|
Contrast x-ray of knee joint
|
$277.06 |
$278.66 |
$1,136.00 |
|
|
Contrast x-ray of wrist
|
$277.06 |
$278.77 |
$962.40 |
|
|
Controler lvad heartmate 3 includes ebb
|
$9,606.69 |
$16,946.16 |
$16,946.16 |
|
