|
Clsd tx shoulder dislc/fx 23665
|
$3,791.20 |
$3,791.20 |
$3,791.20 |
$1,828.80
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$3,791.20 |
$3,791.20 |
$3,791.20 |
$2,331.50
|
|
Clsd tx temporomandibular dislocat 21480
|
$998.40 |
$998.40 |
$998.40 |
$424.38
|
|
Clsd tx toe dislocation without anes28660
|
$742.40 |
$742.40 |
$742.40 |
$412.00
|
|
Clsd tx trimall ankle fx without manip 27816
|
$998.40 |
$998.40 |
$998.40 |
$489.60
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$868.80 |
$868.80 |
$868.80 |
$1,592.00
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$998.40 |
$998.40 |
$998.40 |
$473.00
|
|
Clsd tx wrist carpal fx without manip 25630
|
$998.40 |
$998.40 |
$998.40 |
$476.00
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$998.40 |
$998.40 |
$998.40 |
$535.60
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$882.40 |
$882.40 |
$882.40 |
$612.80
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$998.40 |
$998.40 |
$998.40 |
$487.15
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$882.40 |
$882.40 |
$882.40 |
$2,274.40
|
|
Cltx hum epcndylr fx wo mnpj
|
$998.40 |
$998.40 |
$998.40 |
$525.75
|
|
Cltx humrl cndylr fx wo mnpj
|
$998.40 |
$998.40 |
$998.40 |
$535.60
|
|
Cltx lunate dislc w/mnpj
|
$998.40 |
$998.40 |
$998.40 |
$2,384.00
|
|
Cltx mndblr fx w/mnpj
|
$4,051.20 |
$4,051.20 |
$4,051.20 |
$2,343.00
|
|
Cltx scap fx w/mnpj +-tractj
|
$2,933.60 |
$2,933.60 |
$2,933.60 |
$2,021.04
|
|
#cmvcul-virus inoculation shell
|
$10.00 |
$10.00 |
$10.00 |
$89.76
|
|
Cmv pcr-sendout
|
$1,040.80 |
$1,040.80 |
$1,040.80 |
$175.70
|
|
Co2 monitor per day
|
$1,197.60 |
$1,197.60 |
$1,197.60 |
$459.20
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$32,266.20 |
$32,266.20 |
$32,266.20 |
$11,888.50
|
|
Coagulation time activated teg
|
$31.00 |
$31.00 |
$31.00 |
$52.47
|
|
Coagulation time otr method
|
$40.20 |
$40.20 |
$40.20 |
$20.00
|
|
Cold agglutinin titer
|
$120.80 |
$120.80 |
$120.80 |
$52.00
|
|
Colistimethate sodium inj
|
$129.00 |
$129.00 |
$129.00 |
$82.71
|
|
Collarbone (Clavicle) X-ray (both sides)
|
$312.00 |
$312.00 |
$312.00 |
$303.73
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$75.60 |
$75.60 |
$75.60 |
$61.20
|
|
Collar cerv ascend 172 reg
|
$163.20 |
$163.20 |
$163.20 |
$224.11
|
|
Collar cerv patriot adlt
|
$141.60 |
$141.60 |
$141.60 |
$134.66
|
|
Collection blood specimen from completely implantable venous access device
|
$196.00 |
$196.00 |
$196.00 |
$162.00
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$196.00 |
$196.00 |
$196.00 |
$155.40
|
|
Colonoscopy (diagnostic)
|
$2,000.00 |
$2,000.00 |
$2,000.00 |
$1,899.00
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,288.00
|
|
Colonoscopy for bleeding 44391
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,147.00
|
|
Colonoscopy for foreign body
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,288.00
|
|
Colonoscopy & polypectomy 44392
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$1,645.43
|
|
Colonoscopy stoma w/snare 44394
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$1,395.28
|
|
Colonoscopy submucous njx
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,080.00
|
|
Colonoscopy thru stoma spx
|
$3,816.80 |
$3,816.80 |
$3,816.80 |
$1,899.00
|
|
Colonoscopy w/ablation
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$3,029.00
|
|
Colonoscopy w/balloon dilat
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$1,681.30
|
|
Colonoscopy w/band ligation
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,288.00
|
|
Colonoscopy w/control bleed
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,101.71
|
|
Colonoscopy w/decompression
|
$3,816.80 |
$3,816.80 |
$3,816.80 |
$1,572.20
|
|
Colonoscopy w/endoscope Ultrasound
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,288.00
|
|
Colonoscopy w/endoscopic fnb
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,004.81
|
|
Colonoscopy/w endoscopic stent 45389
|
$7,896.80 |
$7,896.80 |
$7,896.80 |
$3,571.80
|
|
Colonoscopy w/fb removal
|
$2,431.20 |
$2,431.20 |
$2,431.20 |
$1,645.43
|
|
Colonoscopy w/injection
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,449.20
|
|
Colonoscopy with ablation
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$3,290.95
|
|
Colonoscopy (with biopsy)
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,214.00
|
|
Colonoscopy with biopsy
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$1,555.20
|
|
Colonoscopy (with polyp removal)
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$2,288.00
|
|
Colonoscopy w/resection
|
$3,933.60 |
$3,933.60 |
$3,933.60 |
$3,035.44
|
|
Colonoscopy w/stent plcmt
|
$7,896.80 |
$7,896.80 |
$7,896.80 |
$5,824.00
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$434.40 |
$434.40 |
$434.40 |
$314.00
|
|
Colposcopy vulva 56820
|
$1,577.60 |
$1,577.60 |
$1,577.60 |
$333.20
|
|
Colposcopy vulva w/biopsy 56821
|
$2,133.60 |
$2,133.60 |
$2,133.60 |
$393.60
|
|
Colposcopy w/biopsy of cervix 57455
|
$2,084.80 |
$2,084.80 |
$2,084.80 |
$485.50
|
|
Compatibility test each unit antiglobulin technique
|
$524.00 |
$524.00 |
$524.00 |
$173.50
|
|
Compatibility test each unit electronic
|
$100.00 |
$100.00 |
$100.00 |
$171.00
|
|
Compatibility test each unit immediate spin technique
|
$266.40 |
$266.40 |
$266.40 |
$169.52
|
|
Comp cystometrogram/void presssure 51728
|
$2,793.60 |
$2,793.60 |
$2,793.60 |
$985.00
|
|
Comp cystometrogram/void/uret pres 51729
|
$2,826.40 |
$2,826.40 |
$2,826.40 |
$1,111.03
|
|
Complement antigen each component c3
|
$332.00 |
$332.00 |
$332.00 |
$110.00
|
|
Complement fixation each
|
$120.80 |
$120.80 |
$120.80 |
$29.12
|
|
Complex cystometrogram 51726
|
$4,291.20 |
$4,291.20 |
$4,291.20 |
$727.35
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$998.40 |
$998.40 |
$998.40 |
$893.41
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$2,627.20 |
$2,627.20 |
$2,627.20 |
$1,191.78
|
|
Complex uroflowmetry (electronic) 51741
|
$1,703.20 |
$1,703.20 |
$1,703.20 |
$344.68
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$2,627.20 |
$2,627.20 |
$2,627.20 |
$1,049.60
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$2,627.20 |
$2,627.20 |
$2,627.20 |
$1,212.00
|
|
Complx repair enel addl 5cm/< 13153
|
$798.40 |
$798.40 |
$798.40 |
$490.50
|
|
Complx repair fccmnaxghf 13131
|
$2,627.20 |
$2,627.20 |
$2,627.20 |
$805.20
|
|
Complx repair fccmnaxghf 13132
|
$2,627.20 |
$2,627.20 |
$2,627.20 |
$1,107.60
|
|
Complx repair sal addl 5 cm/> 13122
|
$998.40 |
$998.40 |
$998.40 |
$508.44
|
|
Composite drsg >16<=48 sq in
|
$5.40 |
$5.40 |
$5.40 |
$42.60
|
|
Concentration infection agents any type
|
$92.80 |
$92.80 |
$92.80 |
$51.32
|
|
Condylomata destruction 56420
|
$712.80 |
$712.80 |
$712.80 |
$467.35
|
|
Conform band n/s w>=3"<5"/yd
|
$4.80 |
$4.80 |
$4.80 |
$1.04
|
|
Conjugated estrogens 25 mg solution for injection
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$860.00
|
|
Consultation pathology during surgery
|
$192.00 |
$192.00 |
$192.00 |
$100.89
|
|
Consultation pathology during surgery cytological exam initial site
|
$213.60 |
$213.60 |
$213.60 |
$430.00
|
|
Consultation pathology during surgery frozen section each additional block
|
$256.00 |
$256.00 |
$256.00 |
$113.68
|
|
Consultation pathology during surgery frozen section first tissue block
|
$333.60 |
$333.60 |
$333.60 |
$226.50
|
|
Consultation/report referred material w/preparation of slides
|
$891.20 |
$891.20 |
$891.20 |
$224.83
|
|
Consultation/report referred slides prepared elsewhere
|
$222.40 |
$222.40 |
$222.40 |
$176.28
|
|
Consult comp w/report rfrd material
|
$212.80 |
$212.80 |
$212.80 |
$374.40
|
|
Contrast baths charges
|
$124.80 |
$124.80 |
$124.80 |
$75.60
|
|
Contrast x-ray gallbladder
|
$870.40 |
$870.40 |
$870.40 |
$341.00
|
|
Contrast x-ray of ankle
|
$868.80 |
$868.80 |
$868.80 |
$684.00
|
|
Contrast x-ray of elbow
|
$868.80 |
$868.80 |
$868.80 |
$708.00
|
|
Contrast x-ray of hip
|
$868.80 |
$868.80 |
$868.80 |
$796.38
|
|
Contrast x-ray of knee joint
|
$868.80 |
$868.80 |
$868.80 |
$790.50
|
|
Contrast x-ray of wrist
|
$868.80 |
$868.80 |
$868.80 |
$667.50
|
|
Control nosebleed pack+caut 30905
|
$569.60 |
$569.60 |
$569.60 |
$383.52
|
|
Control of nosebleed ant comp 30903
|
$569.60 |
$569.60 |
$569.60 |
$396.00
|
|
Control of nosebleedantersmpl 30901
|
$569.60 |
$569.60 |
$569.60 |
$352.80
|
|
Conv gtube to jtube
|
$4,128.80 |
$4,128.80 |
$4,128.80 |
$2,099.70
|
|
Coombs direct
|
$84.80 |
$84.80 |
$84.80 |
$76.80
|