|
Closed tx humerus fx with manip 23605
|
$500.80 |
$600.96 |
$752.40 |
|
|
Closed tx humerus fx without manip 23600
|
$62.80 |
$75.36 |
$125.55 |
|
|
Closed tx humerus fx w/manip 24505
|
$402.60 |
$454.48 |
$871.20 |
|
|
Closed tx metatarsophalangeal jnt disl without anes
|
$62.80 |
$78.50 |
$130.50 |
|
|
Closed tx post hip arthroplasty disloc w/anes 27266
|
$206.20 |
$531.50 |
$1,705.50 |
|
|
Closed tx septal&nose fx
|
$853.00 |
$853.00 |
$853.00 |
|
|
Close lac/mouth vest/2.5 cm or < 40830
|
$106.80 |
$128.16 |
$183.15 |
|
|
Clos txnose fx without stablz 21315
|
$594.00 |
$644.69 |
$1,235.70 |
|
|
Closure laceration vestibule mouth > 2.5 cm cmplx
|
$189.40 |
$227.28 |
$296.10 |
|
|
Closure paravalvlr leak pq
|
$8,387.40 |
$8,387.40 |
$9,645.51 |
|
|
Clot factor fletcher fact
|
$14.64 |
$14.64 |
$32.75 |
|
|
Clot factor wght kininogen
|
$14.64 |
$32.75 |
$334.20 |
|
|
Clot factor xii hageman
|
$50.50 |
$69.60 |
$172.73 |
|
|
Clot factor xiii fibrin scrn
|
$10.58 |
$66.00 |
$123.75 |
|
|
Clot factor xiii fibrin stab
|
$75.80 |
$87.17 |
$170.55 |
|
|
Clotting assay whole blood
|
$39.60 |
$45.54 |
$49.50 |
|
|
Clsd/shoulder dislo/manip/no anest 23650
|
$62.80 |
$75.36 |
$307.80 |
|
|
Clsd tx carpo/metacarpl disl thmb manip ea without anes
|
$87.00 |
$103.75 |
$251.28 |
|
|
Clsd tx/clavicular fx without manip 23500
|
$62.50 |
$82.80 |
$99.36 |
|
|
Clsd tx/dis phalan fx without manip/ea 26750
|
$62.50 |
$82.80 |
$251.28 |
|
|
Clsd tx dist fib fx w/manip 27788
|
$62.80 |
$75.36 |
$135.90 |
|
|
Clsd tx elbow dislocation child 24640
|
$62.80 |
$75.36 |
$125.55 |
|
|
Clsd tx/fem shaft fx/manipulation 27502
|
$384.20 |
$461.04 |
$1,027.80 |
|
|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$62.80 |
$75.36 |
$135.90 |
|
|
Clsd tx fx radius/ulna dist without manip 25600
|
$62.80 |
$75.36 |
$355.05 |
|
|
Clsd tx fx radius/ulna dist w/manip 25605
|
$402.60 |
$454.48 |
$871.20 |
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$402.60 |
$478.25 |
$871.20 |
|
|
Clsd tx hip disloc without anes 27265
|
$62.80 |
$75.36 |
$135.90 |
|
|
Clsd tx humerus fract without manip 24500
|
$62.80 |
$78.50 |
$372.60 |
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$62.80 |
$75.36 |
$256.95 |
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$62.80 |
$75.36 |
$135.90 |
|
|
Clsd tx metatarsal fracture w/manip 28475
|
$62.80 |
$75.36 |
$135.90 |
|
|
Clsd tx of ankle fracture w/manip 28435
|
$384.20 |
$461.04 |
$831.15 |
|
|
Clsd tx patella disloc without anes 27560
|
$60.00 |
$70.80 |
$103.95 |
|
|
Clsd tx/patellar fx without manip 27520
|
$62.80 |
$75.36 |
$367.20 |
|
|
Clsd tx pelvic ring fx
|
$70.80 |
$77.28 |
$81.75 |
|
|
Clsd tx pelvic ring fx
|
$70.80 |
$77.28 |
$81.75 |
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$402.60 |
$454.48 |
$871.20 |
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$62.50 |
$82.80 |
$251.28 |
|
|
Clsd tx radius fracture w/manip 24655
|
$114.39 |
$402.60 |
$750.24 |
|
|
Clsd tx shoulder dislc/fx 23665
|
$402.60 |
$454.48 |
$871.20 |
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$402.60 |
$454.48 |
$871.20 |
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$873.80 |
$1,025.04 |
$1,974.15 |
|
|
Clsd tx temporomandibular dislocat 21480
|
$62.50 |
$82.80 |
$147.12 |
|
|
Clsd tx toe dislocation without anes28660
|
$62.50 |
$82.80 |
$204.96 |
|
|
Clsd tx trimall ankle fx without manip 27816
|
$62.80 |
$75.36 |
$141.30 |
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$402.60 |
$454.48 |
$655.20 |
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$63.00 |
$71.07 |
$136.35 |
|
|
Cls tx of heel fracture w/manip 28405
|
$87.00 |
$98.90 |
$188.10 |
|
|
Cltx carpl scphd fx w/mnpj
|
$895.20 |
$1,074.24 |
$2,014.20 |
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$384.20 |
$461.04 |
$831.15 |
|
|
Cltx humrl cndylr fx w/mnpj
|
$402.60 |
$454.48 |
$871.20 |
|
|
Cltx lunate dislc w/mnpj
|
$931.00 |
$1,117.20 |
$2,094.75 |
|
|
Cltx post ankle fx w/mnpj
|
$402.60 |
$454.48 |
$871.20 |
|
|
Cltx scap fx w/mnpj +-tractj
|
$402.60 |
$454.48 |
$871.20 |
|
|
#cmvcul-virus inoculation shell
|
$14.26 |
$27.00 |
$39.50 |
|
|
Cmv pcr-sendout
|
$27.36 |
$292.74 |
$398.00 |
|
|
Co2 monitor per day
|
$304.00 |
$304.00 |
$304.00 |
|
|
Coagulation time activated teg
|
$22.50 |
$36.57 |
$47.00 |
|
|
Cocaine 4 % nasal solution
|
$1,155.62 |
$1,328.97 |
$1,444.53 |
|
|
Cold agglutinin screen (arc)
|
$6.50 |
$6.50 |
$6.50 |
|
|
Cold agglutinin titer
|
$52.40 |
$60.26 |
$89.04 |
|
|
Colistimethate sodium inj
|
$38.86 |
$44.69 |
$48.57 |
|
|
Collection blood specimen from completely implantable venous access device
|
$92.66 |
$101.70 |
$114.40 |
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$91.40 |
$101.70 |
$109.68 |
|
|
Collection of venous blood by venipuncture
|
$7.60 |
$9.20 |
$12.15 |
|
|
Colonoscopy w/balloon dilat
|
$668.75 |
$668.75 |
$668.75 |
|
|
Colonoscopy w/control bleed
|
$258.40 |
$297.16 |
$323.00 |
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$1,834.80 |
$2,201.76 |
$4,128.30 |
|
|
Compatibility test each unit antiglobulin technique
|
$60.75 |
$63.48 |
$113.20 |
|
|
Compatibility test each unit electronic
|
$58.80 |
$69.00 |
$153.00 |
|
|
Compatibility test each unit immediate spin technique
|
$63.48 |
$70.80 |
$153.00 |
|
|
Compatibility test incubate
|
$26.24 |
$26.24 |
$28.80 |
|
|
Complement antigen each component c3
|
$88.56 |
$97.20 |
$198.80 |
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$133.20 |
$159.50 |
$739.92 |
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$146.74 |
$207.46 |
$739.92 |
|
|
Complx repair enel addl 5cm/< 13153
|
$100.32 |
$100.32 |
$159.50 |
|
|
Complx repair fccmnaxghf 13131
|
$137.50 |
$177.79 |
$473.04 |
|
|
Complx repair fccmnaxghf 13132
|
$126.00 |
$157.50 |
$739.92 |
|
|
Complx repair fccmnaxghf 13133
|
$110.00 |
$126.50 |
$473.04 |
|
|
Complx repair sal addl 5 cm/> 13122
|
$86.80 |
$108.50 |
$161.28 |
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$191.50 |
$208.69 |
$229.05 |
|
|
Concentration infection agents any type
|
$6.90 |
$25.83 |
$62.88 |
|
|
Condylomata destruction 56420
|
$57.40 |
$68.88 |
$139.05 |
|
|
Consultation pathology during surgery cytological exam initial site
|
$231.20 |
$252.48 |
$265.88 |
|
|
Consultation pathology during surgery frozen section each additional block
|
$7.60 |
$9.12 |
$9.50 |
|
|
Consultation pathology during surgery frozen section first tissue block
|
$63.00 |
$68.88 |
$72.75 |
|
|
Consultation/report referred material w/preparation of slides
|
$60.49 |
$60.49 |
$65.75 |
|
|
Consultation/report referred slides prepared elsewhere
|
$52.20 |
$62.64 |
$117.45 |
|
|
Consult comp w/report rfrd material
|
$286.12 |
$286.12 |
$286.12 |
|
|
Contrast baths charges
|
$29.93 |
$41.25 |
$47.76 |
|
|
Contrast exam abdominl aorta 75625-26
|
$1,559.60 |
$1,637.25 |
$1,793.54 |
|
|
Contrast exam thoracic aorta 75605-26
|
$1,328.00 |
$1,527.20 |
$2,070.00 |
|
|
Contrast x-ray gallbladder
|
$112.80 |
$137.28 |
$163.75 |
|
|
Contrast x-ray of ankle
|
$293.94 |
$293.94 |
$356.40 |
|
|
Contrast x-ray of brain
|
$523.02 |
$523.02 |
$568.50 |
|
|
Contrast x-ray of elbow
|
$263.20 |
$324.76 |
$356.40 |
|
|
Contrast x-ray of hip
|
$241.00 |
$302.88 |
$391.92 |
|
|
Contrast x-ray of knee joint
|
$250.60 |
$287.00 |
$372.24 |
|
|
Contrast x-ray of wrist
|
$252.40 |
$286.32 |
$308.89 |
|
