|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$478.20
|
|
Clsd tx fx radius/ulna dist without manip 25600
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$639.60
|
|
Clsd tx fx radius/ulna dist w/manip 25605
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,912.80
|
|
Clsd tx fx radius/ulna without manip 25560
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$632.78
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,790.00
|
|
Clsd tx/grt hum tube fx without manip 23620
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$476.00
|
|
Clsd tx hip disloc without anes 27265
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$716.95
|
|
Clsd tx humeral fract without manip 24530
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$623.93
|
|
Clsd tx humerus fract without manip 24500
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$568.92
|
|
Clsd tx iphal jnt disl w/manip req anes
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,066.00
|
|
Clsd tx mandibular fx without manip 21450
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,087.20
|
|
Clsd tx/metacar/interphal artic fx 26740
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$529.50
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$529.08
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$717.75
|
|
Clsd tx metacarp fx w/manip&ext fix ea bone 26607
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,345.60
|
|
Clsd tx metatarsal fracture w/manip 28475
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$580.30
|
|
Clsd tx/metatarsal fx without manip 28470
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$429.65
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,600.75
|
|
Clsd tx of ankle fracture w/manip 28435
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,815.75
|
|
Clsd tx patella disloc without anes 27560
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$707.30
|
|
Clsd tx/patellar fx without manip 27520
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$576.00
|
|
Clsd tx pelvic ring fx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$452.00
|
|
Clsd tx pelvic ring fx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$824.00
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,548.00
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$484.00
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$510.95
|
|
Clsd tx radius fracture w/manip 24655
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,835.20
|
|
Clsd tx/scapular fx without manip 23570
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$454.50
|
|
Clsd tx shoulder dislc/fx 23665
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,066.17
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,797.83
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,423.85
|
|
Clsd tx/talotarsal dislocat/anes 28575
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,848.69
|
|
Clsd tx temporomandibular dislocat 21480
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$512.40
|
|
Clsd tx toe dislocation without anes28660
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$426.25
|
|
Clsd tx trimall ankle fx without manip 27816
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$666.60
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,704.80
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$510.40
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$730.08
|
|
Clsd tx wrist carpal fx without manip 25630
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$494.00
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$553.00
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$744.22
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$705.55
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$518.40
|
|
Cls tx of heel fracture w/manip 28405
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,241.93
|
|
Cltx carpl scphd fx w/mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,368.00
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,610.40
|
|
Cltx hum epcndylr fx wo mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$525.75
|
|
Cltx humrl cndylr fx w/mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,858.00
|
|
Cltx humrl cndylr fx wo mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$581.99
|
|
Cltx lunate dislc w/mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,952.64
|
|
Cltx mndblr fx ntrdntl fixj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,835.75
|
|
Cltx mndblr fx w/mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,432.15
|
|
Cltx mndblr/max alv ridge fx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,723.23
|
|
Cltx palatal/max fx wire fix
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,199.49
|
|
Cltx post ankle fx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$521.30
|
|
Cltx post ankle fx w/mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,621.81
|
|
Cltx scap fx w/mnpj +-tractj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,211.05
|
|
Cltx strnclav dislc w/mnpj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$804.79
|
|
Cltx thigh fx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,594.44
|
|
Cltx tmprmand dislc comp
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,040.04
|
|
Cmbn ant pst colprhy
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,194.98
|
|
#cms hgb-carboxyhemoglobin
|
$15.48 |
$15.48 |
$15.48 |
$29.27
|
|
#cms hgb-sulfhemoglobin
|
$9.68 |
$9.68 |
$9.68 |
$55.25
|
|
#cmvcul-virus inoculation shell
|
$21.52 |
$21.52 |
$21.52 |
$102.57
|
|
Cmv pcr-sendout
|
$38.60 |
$38.60 |
$38.60 |
$172.25
|
|
Coagulation time activated teg
|
$4.71 |
$4.71 |
$4.71 |
$53.72
|
|
Coagulation time otr method
|
$4.94 |
$4.94 |
$4.94 |
$11.20
|
|
Cold agglutinin screen (arc)
|
$8.88 |
$8.88 |
$8.88 |
$48.57
|
|
Cold agglutinin titer
|
$8.87 |
$8.87 |
$8.87 |
$49.95
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$10.55 |
$10.55 |
$10.55 |
$46.88
|
|
Collar cerv ascend 172 reg
|
$20.48 |
$20.48 |
$20.48 |
$174.01
|
|
Collar cerv patriot adlt
|
$17.50 |
$17.50 |
$17.50 |
$57.20
|
|
Collection blood specimen from completely implantable venous access device
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$159.60
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$166.94
|
|
Collection of venous blood by venipuncture
|
$9.71 |
$9.71 |
$9.71 |
$22.05
|
|
Colonoscopy (diagnostic)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,846.40
|
|
Colonoscopy flex with decompression 45393
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,946.25
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,537.25
|
|
Colonoscopy for bleeding 44391
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,658.40
|
|
Colonoscopy for foreign body
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,861.50
|
|
Colonoscopy & polypectomy 44392
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,645.43
|
|
Colonoscopy stoma w/endo mucosal rescj 44403
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,388.56
|
|
Colonoscopy stoma w/snare 44394
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,645.43
|
|
Colonoscopy submucous njx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,605.85
|
|
Colonoscopy thru stoma spx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,653.18
|
|
Colonoscopy w/ablation
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,029.00
|
|
Colonoscopy w/balloon dilat
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,645.43
|
|
Colonoscopy w/band ligation
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,448.00
|
|
Colonoscopy w/control bleed
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,352.75
|
|
Colonoscopy w/decompression
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,448.60
|
|
Colonoscopy w/dilation
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,495.25
|
|
Colonoscopy w/endoscope Ultrasound
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,805.40
|
|
Colonoscopy w/endoscopic fnb
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,645.43
|
|
Colonoscopy/w endoscopic stent 45389
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,364.75
|
|
Colonoscopy w/fb removal
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,764.60
|
|
Colonoscopy w/injection
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,448.60
|
|
Colonoscopy with ablation
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,495.25
|
|
Colonoscopy (with biopsy)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,538.00
|
|
Colonoscopy with biopsy
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,629.60
|
|
Colonoscopy (with polyp removal)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,472.75
|
