|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$397.60 |
$412.80 |
$464.80 |
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$398.40 |
$476.80 |
$613.60 |
|
|
Clsd tx radius fracture w/manip 24655
|
$1,594.40 |
$1,594.40 |
$2,040.80 |
|
|
Clsd tx/scapular fx without manip 23570
|
$452.00 |
$452.00 |
$656.00 |
|
|
Clsd tx shoulder dislc/fx 23665
|
$1,657.60 |
$1,657.60 |
$2,040.80 |
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$1,657.60 |
$1,657.60 |
$2,040.80 |
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$2,422.40 |
$2,422.40 |
$2,617.60 |
|
|
Clsd tx/talotarsal dislocat/anes 28575
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
|
|
Clsd tx temporomandibular dislocat 21480
|
$394.40 |
$483.20 |
$607.20 |
|
|
Clsd tx toe dislocation without anes28660
|
$357.60 |
$357.60 |
$587.20 |
|
|
Clsd tx trimall ankle fx without manip 27816
|
$590.40 |
$590.40 |
$590.40 |
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$1,329.60 |
$1,329.60 |
$2,066.40 |
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$380.00 |
$450.40 |
$716.80 |
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$881.60 |
$881.60 |
$881.60 |
|
|
Clsd tx wrist carpal fx without manip 25630
|
$388.00 |
$388.00 |
$546.40 |
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$576.00 |
$576.00 |
$576.00 |
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$445.60 |
$445.60 |
$761.60 |
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$388.00 |
$560.80 |
$629.60 |
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$380.00 |
$518.40 |
$554.40 |
|
|
Cltx carpl scphd fx w/mnpj
|
$1,861.60 |
$1,861.60 |
$1,861.60 |
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$2,274.40 |
$2,274.40 |
$2,610.40 |
|
|
Cltx hum epcndylr fx wo mnpj
|
$491.20 |
$491.20 |
$653.60 |
|
|
Cltx humrl cndylr fx w/mnpj
|
$2,296.80 |
$2,296.80 |
$2,296.80 |
|
|
Cltx humrl cndylr fx wo mnpj
|
$651.20 |
$651.20 |
$651.20 |
|
|
Cltx lunate dislc w/mnpj
|
$2,208.80 |
$2,208.80 |
$2,318.40 |
|
|
Cltx mndblr fx w/mnpj
|
$2,790.40 |
$2,790.40 |
$2,815.20 |
|
|
Cltx mndblr/max alv ridge fx
|
$4,404.00 |
$4,404.00 |
$4,627.20 |
|
|
Cltx palatal/max fx wire fix
|
$5,743.20 |
$5,743.20 |
$5,743.20 |
|
|
Cltx post ankle fx
|
$717.60 |
$717.60 |
$717.60 |
|
|
Cltx post ankle fx w/mnpj
|
$2,316.80 |
$2,316.80 |
$2,400.80 |
|
|
Cltx scap fx w/mnpj +-tractj
|
$1,611.20 |
$1,611.20 |
$2,040.80 |
|
|
Cltx thigh fx
|
$3,455.20 |
$3,455.20 |
$3,455.20 |
|
|
Cmv ig IV
|
$1,825.08 |
$1,825.08 |
$2,712.96 |
|
|
Cmv pcr-sendout
|
$295.20 |
$295.20 |
$295.20 |
|
|
Co2 monitor per day
|
$568.00 |
$568.00 |
$568.00 |
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$10,320.00 |
$10,320.00 |
$16,819.68 |
|
|
Cocaine 4 % nasal solution
|
$298.03 |
$298.03 |
$897.92 |
|
|
Cocaine hcl nasal (numbrino)
|
$442.37 |
$442.37 |
$442.37 |
|
|
Cold agglutinin screen (arc)
|
$39.20 |
$39.20 |
$39.20 |
|
|
Cold agglutinin titer
|
$33.60 |
$33.60 |
$33.60 |
|
|
Colistimethate sodium inj
|
$60.96 |
$60.96 |
$90.35 |
|
|
Collagenase, clost hist inj
|
$5,049.32 |
$5,049.32 |
$10,956.12 |
|
|
Collagen based wound filler
|
$827.20 |
$827.20 |
$1,663.20 |
|
|
Collarbone (Clavicle) X-ray (both sides)
|
$144.80 |
$220.00 |
$400.80 |
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$21.39 |
$21.39 |
$213.40 |
|
|
Collar cerv adlt perfit ace extric
|
$53.69 |
$53.69 |
$77.06 |
|
|
Collar cerv ascend 172 reg
|
$161.44 |
$161.44 |
$547.20 |
|
|
Collar extrication adult univ
|
$1,049.05 |
$1,049.05 |
$1,258.86 |
|
|
Collection blood specimen from completely implantable venous access device
|
$166.40 |
$166.40 |
$184.80 |
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$157.60 |
$157.60 |
$187.20 |
|
|
Colonoscopy (diagnostic)
|
$1,846.40 |
$1,846.40 |
$2,662.40 |
|
|
Colonoscopy flex with decompression 45393
|
$2,020.80 |
$2,020.80 |
$2,020.80 |
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$1,846.40 |
$1,846.40 |
$2,661.60 |
|
|
Colonoscopy for bleeding 44391
|
$2,308.80 |
$2,308.80 |
$2,308.80 |
|
|
Colonoscopy & polypectomy 44392
|
$2,308.80 |
$2,308.80 |
$2,308.80 |
|
|
Colonoscopy stoma w/endo mucosal rescj 44403
|
$1,517.60 |
$1,517.60 |
$1,517.60 |
|
|
Colonoscopy stoma w/snare 44394
|
$2,252.00 |
$2,252.00 |
$2,708.80 |
|
|
Colonoscopy submucous njx
|
$1,846.40 |
$1,846.40 |
$2,662.40 |
|
|
Colonoscopy thru stoma spx
|
$2,118.40 |
$2,118.40 |
$2,311.20 |
|
|
Colonoscopy w/ablation
|
$2,708.80 |
$2,708.80 |
$2,708.80 |
|
|
Colonoscopy w/balloon dilat
|
$2,586.40 |
$2,586.40 |
$2,586.40 |
|
|
Colonoscopy w/band ligation
|
$2,080.80 |
$2,080.80 |
$2,080.80 |
|
|
Colonoscopy w/control bleed
|
$2,661.60 |
$2,661.60 |
$2,661.60 |
|
|
Colonoscopy w/decompression
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
|
|
Colonoscopy w/dilation
|
$1,517.60 |
$1,517.60 |
$1,517.60 |
|
|
Colonoscopy w/endoscope Ultrasound
|
$2,900.80 |
$2,900.80 |
$2,900.80 |
|
|
Colonoscopy w/endoscopic fnb
|
$3,258.40 |
$3,258.40 |
$3,258.40 |
|
|
Colonoscopy/w endoscopic stent 45389
|
$5,888.80 |
$5,888.80 |
$5,888.80 |
|
|
Colonoscopy w/fb removal
|
$2,740.00 |
$2,740.00 |
$2,740.00 |
|
|
Colonoscopy w/injection
|
$1,517.60 |
$1,517.60 |
$1,517.60 |
|
|
Colonoscopy with ablation
|
$1,517.60 |
$1,517.60 |
$1,517.60 |
|
|
Colonoscopy (with biopsy)
|
$1,846.40 |
$1,846.40 |
$2,662.40 |
|
|
Colonoscopy with biopsy
|
$2,194.40 |
$2,194.40 |
$2,467.20 |
|
|
Colonoscopy (with polyp removal)
|
$1,958.40 |
$1,958.40 |
$2,662.40 |
|
|
Colonoscopy w/ndl aspir/bx
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
|
|
Colonoscopy w/resection
|
$1,871.20 |
$1,871.20 |
$2,843.20 |
|
|
Colonoscopy w/stent plcmt
|
$5,805.60 |
$5,805.60 |
$5,805.60 |
|
|
Colonoscopy w/ultrasound
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$2,983.20 |
$2,983.20 |
$4,563.20 |
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$637.60 |
$637.60 |
$637.60 |
|
|
Colposcopy vulva 56820
|
$519.20 |
$519.20 |
$519.20 |
|
|
Compatibility test each unit antiglobulin technique
|
$188.80 |
$188.80 |
$188.80 |
|
|
Compatibility test each unit immediate spin technique
|
$151.20 |
$151.20 |
$151.20 |
|
|
Compatibility test incubate
|
$140.00 |
$140.00 |
$140.00 |
|
|
Complement antigen each component c3
|
$81.60 |
$81.60 |
$81.60 |
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$748.80 |
$748.80 |
$1,348.80 |
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$914.40 |
$1,556.00 |
$1,585.60 |
|
|
Compl oph exam general anes
|
$1,663.20 |
$1,663.20 |
$1,663.20 |
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$1,187.20 |
$1,187.20 |
$1,512.00 |
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$1,215.20 |
$1,215.20 |
$1,556.00 |
|
|
Complx repair enel addl 5cm/< 13153
|
$781.60 |
$781.60 |
$913.60 |
|
|
Complx repair fccmnaxghf 13131
|
$780.00 |
$780.00 |
$1,310.40 |
|
|
Complx repair fccmnaxghf 13132
|
$983.20 |
$983.20 |
$1,556.00 |
|
|
Complx repair fccmnaxghf 13133
|
$807.20 |
$807.20 |
$1,310.40 |
|
|
Complx repair sal addl 5 cm/> 13122
|
$321.60 |
$321.60 |
$807.20 |
|
|
Complx repair trunk addl 5cm/< 13102
|
$778.40 |
$778.40 |
$807.20 |
|
|
Component ankle afo plastic jt mold to pt mdl foot cup
|
$312.80 |
$312.80 |
$1,598.31 |
|
|
Composite graft/pri close/don area 15760
|
$3,408.80 |
$3,408.80 |
$3,408.80 |
|
|
Comprehensive hearing test
|
$212.80 |
$212.80 |
$212.80 |
|
|
Computed tomographic angiography head and neck with contrast
|
$4,080.00 |
$4,080.00 |
$4,849.60 |
|
