|
Clsd tx radius fracture w/manip 24655
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,843.20
|
|
Clsd tx/scapular fx without manip 23570
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$454.50
|
|
Clsd tx shoulder dislc/fx 23665
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,055.00
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,797.83
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,423.85
|
|
Clsd tx/talotarsal dislocat/anes 28575
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,848.69
|
|
Clsd tx temporomandibular dislocat 21480
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$512.40
|
|
Clsd tx toe dislocation without anes28660
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$420.80
|
|
Clsd tx trimall ankle fx without manip 27816
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$666.60
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,707.42
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$510.40
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$730.08
|
|
Clsd tx wrist carpal fx without manip 25630
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$476.00
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$543.23
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$682.00
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$692.03
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$494.77
|
|
Cls tx of heel fracture w/manip 28405
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,232.40
|
|
Cltx carpl scphd fx w/mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,368.00
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,558.00
|
|
Cltx hum epcndylr fx wo mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$525.75
|
|
Cltx humrl cndylr fx w/mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,858.61
|
|
Cltx humrl cndylr fx wo mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$581.99
|
|
Cltx lunate dislc w/mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,952.64
|
|
Cltx mndblr fx ntrdntl fixj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,835.75
|
|
Cltx mndblr fx w/mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,343.00
|
|
Cltx mndblr/max alv ridge fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,819.23
|
|
Cltx palatal/max fx wire fix
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,986.00
|
|
Cltx post ankle fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$521.30
|
|
Cltx post ankle fx w/mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,400.80
|
|
Cltx scap fx w/mnpj +-tractj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,050.29
|
|
Cltx strnclav dislc w/mnpj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$786.11
|
|
Cltx thigh fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,743.15
|
|
Cltx tmprmand dislc comp
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,986.00
|
|
Cmbn ant pst colprhy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
#cms hgb-carboxyhemoglobin
|
$15.48 |
$15.48 |
$15.48 |
$19.42
|
|
#cms hgb-sulfhemoglobin
|
$9.68 |
$9.68 |
$9.68 |
$53.30
|
|
#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 |
$52.25
|
|
Coagulation time otr method
|
$4.94 |
$4.94 |
$4.94 |
$6.37
|
|
Cold agglutinin screen (arc)
|
$8.88 |
$8.88 |
$8.88 |
$48.10
|
|
Cold agglutinin titer
|
$8.87 |
$8.87 |
$8.87 |
$49.50
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$8.71 |
$8.71 |
$8.71 |
$46.88
|
|
Collar cerv ascend 172 reg
|
$16.91 |
$16.91 |
$16.91 |
$174.01
|
|
Collar cerv patriot adlt
|
$14.44 |
$14.44 |
$14.44 |
$57.20
|
|
Collection blood specimen from completely implantable venous access device
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$159.60
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$165.00
|
|
Collection of venous blood by venipuncture
|
$9.71 |
$9.71 |
$9.71 |
$22.00
|
|
Colonoscopy (diagnostic)
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,653.60
|
|
Colonoscopy flex with decompression 45393
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,670.25
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,476.20
|
|
Colonoscopy for bleeding 44391
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,658.40
|
|
Colonoscopy for foreign body
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,507.20
|
|
Colonoscopy & polypectomy 44392
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,395.28
|
|
Colonoscopy stoma w/endo mucosal rescj 44403
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,395.28
|
|
Colonoscopy stoma w/snare 44394
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,645.43
|
|
Colonoscopy submucous njx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,482.35
|
|
Colonoscopy thru stoma spx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,390.87
|
|
Colonoscopy w/ablation
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,904.85
|
|
Colonoscopy w/balloon dilat
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,645.43
|
|
Colonoscopy w/band ligation
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,080.80
|
|
Colonoscopy w/control bleed
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,352.75
|
|
Colonoscopy w/decompression
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,278.72
|
|
Colonoscopy w/dilation
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,495.25
|
|
Colonoscopy w/endoscope Ultrasound
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,496.00
|
|
Colonoscopy w/endoscopic fnb
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,645.43
|
|
Colonoscopy/w endoscopic stent 45389
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,379.25
|
|
Colonoscopy w/fb removal
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,645.43
|
|
Colonoscopy w/injection
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,448.60
|
|
Colonoscopy with ablation
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,495.25
|
|
Colonoscopy (with biopsy)
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,538.00
|
|
Colonoscopy with biopsy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,395.28
|
|
Colonoscopy (with polyp removal)
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,472.75
|
|
Colonoscopy w/ndl aspir/bx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,395.28
|
|
Colonoscopy w/resection
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,254.25
|
|
Colonoscopy w/stent plcmt
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,435.60
|
|
Colonoscopy w/ultrasound
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,495.25
|
|
Colpocentesis 57020
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,344.50
|
|
Colpocleisis (le forte type) 57120
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Colpopexy extraperitoneal
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,110.00
|
|
Colpopexy intraperitoneal
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,755.92
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,762.53
|
|
Colposcopy/cervix/bx vagina/cervix 57421
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$964.62
|
|
Colposcopy/cervix/ conization 57461
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,519.29
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$314.00
|
|
Colposcopy vulva 56820
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$295.20
|
|
Colposcopy vulva w/biopsy 56821
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$393.60
|
|
Colposcopy w/biopsy of cervix 57455
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$573.30
|
|
Colpotomy drng of abscess 57010
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,309.79
|
|
Colpotomy w/exploration 57000
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,519.29
|
|
Compatibility test each unit antiglobulin technique
|
$33.92 |
$33.92 |
$33.92 |
$158.95
|
|
Compatibility test each unit electronic
|
$46.56 |
$46.56 |
$46.56 |
$163.80
|
|
Compatibility test each unit immediate spin technique
|
$40.11 |
$40.11 |
$40.11 |
$159.00
|
|
Comp cystometrogram/void presssure 51728
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$958.81
|
|
Comp cystometrogram/void/uret pres 51729
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,099.00
|
|
Complement antigen each component c3
|
$13.20 |
$13.20 |
$13.20 |
$113.30
|
|
Complement fixation each
|
$11.01 |
$11.01 |
$11.01 |
$30.27
|
|
Complete removal of vulva
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,762.53
|
|
Complex cystometrogram 51726
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$710.40
|
