|
Clsd tx fx radius/ulna without manip 25560
|
$428.00 |
$428.00 |
$542.40 |
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$610.40 |
$1,216.00 |
$1,738.40 |
|
|
Clsd tx/grt hum tube fx without manip 23620
|
$340.80 |
$354.40 |
$452.00 |
|
|
Clsd tx hip disloc without anes 27265
|
$432.00 |
$530.40 |
$585.60 |
|
|
Clsd tx humeral fract without manip 24530
|
$400.00 |
$400.00 |
$468.80 |
|
|
Clsd tx humerus fract without manip 24500
|
$406.40 |
$406.40 |
$480.80 |
|
|
Clsd tx iphal jnt disl w/manip req anes
|
$720.00 |
$960.00 |
$1,061.60 |
|
|
Clsd tx mandibular fx without manip 21450
|
$612.80 |
$612.80 |
$621.60 |
|
|
Clsd tx/metacar/interphal artic fx 26740
|
$404.80 |
$409.60 |
$437.60 |
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$360.80 |
$373.60 |
$492.80 |
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$512.80 |
$627.20 |
$827.20 |
|
|
Clsd tx metatarsal fracture w/manip 28475
|
$528.00 |
$588.80 |
$611.20 |
|
|
Clsd tx/metatarsal fx without manip 28470
|
$332.80 |
$344.80 |
$636.80 |
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$2,992.00 |
$2,992.00 |
$3,056.00 |
|
|
Clsd tx of ankle fracture w/manip 28435
|
$1,231.20 |
$1,237.60 |
$2,196.00 |
|
|
Clsd tx patella disloc without anes 27560
|
$365.60 |
$488.00 |
$532.00 |
|
|
Clsd tx/patellar fx without manip 27520
|
$408.80 |
$408.80 |
$444.00 |
|
|
Clsd tx pelvic ring fx
|
$358.40 |
$358.40 |
$358.40 |
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$2,246.40 |
$2,370.40 |
$2,825.60 |
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$370.40 |
$384.00 |
$524.80 |
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$373.60 |
$388.00 |
$522.40 |
|
|
Clsd tx radius fracture w/manip 24655
|
$1,201.60 |
$1,650.40 |
$1,835.20 |
|
|
Clsd tx/scapular fx without manip 23570
|
$324.00 |
$331.20 |
$344.00 |
|
|
Clsd tx shoulder dislc/fx 23665
|
$1,110.40 |
$1,221.60 |
$1,856.00 |
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$1,127.20 |
$1,127.20 |
$1,784.00 |
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$1,091.20 |
$1,873.60 |
$2,375.20 |
|
|
Clsd tx temporomandibular dislocat 21480
|
$454.40 |
$460.80 |
$506.40 |
|
|
Clsd tx toe dislocation without anes28660
|
$400.00 |
$415.20 |
$441.60 |
|
|
Clsd tx trimall ankle fx without manip 27816
|
$430.40 |
$440.80 |
$499.20 |
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$1,106.40 |
$1,690.40 |
$1,997.60 |
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$348.00 |
$348.00 |
$556.80 |
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$518.40 |
$518.40 |
$518.40 |
|
|
Clsd tx wrist carpal fx without manip 25630
|
$355.20 |
$368.80 |
$439.20 |
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$407.20 |
$423.20 |
$432.80 |
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$584.00 |
$606.40 |
$658.40 |
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$392.80 |
$407.20 |
$476.80 |
|
|
Cls tx of heel fracture w/manip 28405
|
$613.60 |
$613.60 |
$1,452.80 |
|
|
Cltx carpl scphd fx w/mnpj
|
$1,572.80 |
$1,572.80 |
$2,090.40 |
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$1,793.60 |
$1,793.60 |
$2,317.60 |
|
|
Cltx hum epcndylr fx wo mnpj
|
$396.00 |
$396.00 |
$413.60 |
|
|
Cltx humrl cndylr fx w/mnpj
|
$1,784.00 |
$1,784.00 |
$1,784.00 |
|
|
Cltx humrl cndylr fx wo mnpj
|
$432.80 |
$432.80 |
$443.20 |
|
|
Cltx lunate dislc w/mnpj
|
$2,466.40 |
$2,466.40 |
$2,502.40 |
|
|
Cltx mndblr fx w/mnpj
|
$5,202.40 |
$5,202.40 |
$5,202.40 |
|
|
Cltx mndblr/max alv ridge fx
|
$5,249.60 |
$5,249.60 |
$5,249.60 |
|
|
Cltx post ankle fx w/mnpj
|
$2,580.00 |
$2,580.00 |
$2,760.80 |
|
|
Cltx scap fx w/mnpj +-tractj
|
$1,587.20 |
$1,587.20 |
$1,587.20 |
|
|
Cltx strnclav dislc w/mnpj
|
$229.60 |
$229.60 |
$337.60 |
|
|
C motor evoked lwr limbs
|
$1,617.60 |
$1,617.60 |
$1,617.60 |
|
|
C motor evoked uppr limbs
|
$1,591.20 |
$1,591.20 |
$1,591.20 |
|
|
C motor evoked upr&lwr limbs
|
$3,635.20 |
$3,635.20 |
$3,635.20 |
|
|
#cmvcul-virus inoculation shell
|
$102.40 |
$102.40 |
$163.20 |
|
|
Cmv pcr-sendout
|
$86.40 |
$86.40 |
$86.40 |
|
|
Co2 monitor per day
|
$400.00 |
$400.00 |
$621.60 |
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$9,880.00 |
$9,880.00 |
$9,880.00 |
|
|
Cocaine 4 % nasal solution
|
$284.81 |
$284.81 |
$284.81 |
|
|
Cocaine hcl nasal (numbrino)
|
$172.32 |
$172.32 |
$172.32 |
|
|
Cold agglutinin screen (arc)
|
$99.20 |
$99.20 |
$99.20 |
|
|
Cold agglutinin titer
|
$40.80 |
$68.80 |
$86.40 |
|
|
Colistimethate sodium inj
|
$69.60 |
$69.60 |
$332.16 |
|
|
Collagenase, clost hist inj
|
$16,403.22 |
$16,403.22 |
$16,403.22 |
|
|
Collagen based wound filler
|
$1,584.00 |
$1,584.00 |
$3,168.00 |
|
|
Collarbone (Clavicle) X-ray (both sides)
|
$241.60 |
$314.40 |
$418.40 |
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$27.20 |
$38.40 |
$210.40 |
|
|
Collar cerv adlt perfit ace extric
|
$37.60 |
$45.60 |
$47.20 |
|
|
Collar cerv ascend 172 reg
|
$48.00 |
$105.60 |
$364.80 |
|
|
Collar extrication adult univ
|
$899.20 |
$899.20 |
$899.20 |
|
|
Collection blood specimen from completely implantable venous access device
|
$95.20 |
$134.40 |
$192.80 |
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$116.80 |
$124.00 |
$168.80 |
|
|
Colpocentesis 57020
|
$880.00 |
$880.00 |
$2,329.60 |
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$3,594.40 |
$3,594.40 |
$4,592.80 |
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$255.20 |
$255.20 |
$323.20 |
|
|
Colposcopy vulva 56820
|
$188.80 |
$188.80 |
$188.80 |
|
|
Compatibility test each unit antiglobulin technique
|
$138.40 |
$148.00 |
$200.00 |
|
|
Compatibility test each unit electronic
|
$52.80 |
$107.20 |
$143.20 |
|
|
Compatibility test each unit immediate spin technique
|
$54.29 |
$120.80 |
$154.40 |
|
|
Compatibility test incubate
|
$111.20 |
$145.60 |
$147.20 |
|
|
Comp cystometrogram/void presssure 51728
|
$1,084.80 |
$1,084.80 |
$1,084.80 |
|
|
Complement antigen each component c3
|
$60.00 |
$74.40 |
$96.80 |
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$701.60 |
$904.00 |
$980.80 |
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$928.00 |
$1,214.40 |
$2,527.20 |
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$928.00 |
$928.00 |
$1,071.20 |
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$912.00 |
$996.00 |
$1,283.20 |
|
|
Complx repair enel addl 5cm/< 13153
|
$656.80 |
$789.60 |
$816.00 |
|
|
Complx repair fccmnaxghf 13131
|
$471.20 |
$644.00 |
$811.20 |
|
|
Complx repair fccmnaxghf 13132
|
$896.00 |
$968.00 |
$1,518.40 |
|
|
Complx repair fccmnaxghf 13133
|
$651.20 |
$651.20 |
$725.60 |
|
|
Complx repair sal addl 5 cm/> 13122
|
$571.20 |
$682.40 |
$1,016.00 |
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$1,680.00 |
$1,680.00 |
$2,270.40 |
|
|
Complx repair trunk addl 5cm/< 13102
|
$681.60 |
$1,177.60 |
$1,233.60 |
|
|
Component ankle afo plastic jt mold to pt mdl foot cup
|
$220.80 |
$220.80 |
$1,388.80 |
|
|
Comprehensive hearing test
|
$200.80 |
$200.80 |
$200.80 |
|
|
Computed tomographic angiography head and neck with contrast
|
$2,834.40 |
$3,008.00 |
$3,371.20 |
|
|
Concentration infection agents any type
|
$38.40 |
$46.40 |
$73.60 |
|
|
Conditioning play audiometry 92582
|
$345.60 |
$345.60 |
$345.60 |
|
|
Condylomata destruction 56420
|
$356.00 |
$389.60 |
$400.00 |
|
|
Conjugated estrogens 25 mg solution for injection
|
$420.04 |
$546.28 |
$584.32 |
|
|
Connect omega .5mm
|
$3,414.40 |
$3,414.40 |
$3,414.40 |
|
|
Connector tis 2x10mm
|
$3,492.80 |
$3,492.80 |
$3,492.80 |
|
|
Consultation pathology during surgery cytological exam initial site
|
$88.00 |
$108.00 |
$1,336.00 |
|
