|
Clsd tx/dis tib/wt bear no manip 27824
|
$279.90 |
$279.90 |
$279.90 |
$454.30
|
|
Clsd tx elbow dislocation child 24640
|
$279.90 |
$279.90 |
$279.90 |
$462.80
|
|
Clsd tx/fem shaft fx/manipulation 27502
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,184.08
|
|
Clsd tx fracture of radius 25500
|
$256.95 |
$256.95 |
$256.95 |
$442.50
|
|
Clsd tx/fx grt toe/phalanx/phalang 28490
|
$194.40 |
$194.40 |
$194.40 |
$376.11
|
|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$211.95 |
$211.95 |
$211.95 |
$426.25
|
|
Clsd tx fx radius/ulna dist without manip 25600
|
$279.90 |
$279.90 |
$279.90 |
$520.80
|
|
Clsd tx fx radius/ulna dist w/manip 25605
|
$1,163.85 |
$1,163.85 |
$1,163.85 |
$1,656.90
|
|
Clsd tx fx radius/ulna without manip 25560
|
$279.90 |
$279.90 |
$279.90 |
$459.00
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$1,396.80 |
$1,396.80 |
$1,396.80 |
$1,571.25
|
|
Clsd tx hip disloc without anes 27265
|
$256.95 |
$256.95 |
$256.95 |
$630.00
|
|
Clsd tx humeral fract without manip 24530
|
$279.90 |
$279.90 |
$279.90 |
$538.45
|
|
Clsd tx humerus fract without manip 24500
|
$279.90 |
$279.90 |
$279.90 |
$494.90
|
|
Clsd tx iphal jnt disl w/manip req anes
|
$389.40 |
$389.40 |
$389.40 |
$883.00
|
|
Clsd tx mandibular fx without manip 21450
|
$523.95 |
$523.95 |
$523.95 |
$987.60
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$279.90 |
$279.90 |
$279.90 |
$496.80
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$279.90 |
$279.90 |
$279.90 |
$611.10
|
|
Clsd tx metatarsal fracture w/manip 28475
|
$429.45 |
$429.45 |
$429.45 |
$520.38
|
|
Clsd tx/metatarsal fx without manip 28470
|
$279.90 |
$279.90 |
$279.90 |
$418.20
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$4,616.10 |
$4,616.10 |
$4,616.10 |
$3,678.17
|
|
Clsd tx of ankle fracture w/manip 28435
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,893.86
|
|
Clsd tx patella disloc without anes 27560
|
$279.90 |
$279.90 |
$279.90 |
$566.72
|
|
Clsd tx/patellar fx without manip 27520
|
$256.95 |
$256.95 |
$256.95 |
$475.68
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,199.68
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$211.95 |
$211.95 |
$211.95 |
$412.00
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$279.90 |
$279.90 |
$279.90 |
$445.80
|
|
Clsd tx radius fracture w/manip 24655
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,782.86
|
|
Clsd tx/scapular fx without manip 23570
|
$211.95 |
$211.95 |
$211.95 |
$452.40
|
|
Clsd tx shoulder dislc/fx 23665
|
$1,396.80 |
$1,396.80 |
$1,396.80 |
$1,839.54
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,687.50
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$1,408.80 |
$1,408.80 |
$1,408.80 |
$2,211.05
|
|
Clsd tx temporomandibular dislocat 21480
|
$217.20 |
$217.20 |
$217.20 |
$399.50
|
|
Clsd tx toe dislocation without anes28660
|
$211.95 |
$211.95 |
$211.95 |
$400.00
|
|
Clsd tx trimall ankle fx without manip 27816
|
$279.90 |
$279.90 |
$279.90 |
$488.40
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$1,163.85 |
$1,163.85 |
$1,163.85 |
$1,565.74
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$279.90 |
$279.90 |
$279.90 |
$452.40
|
|
Clsd tx wrist carpal fx without manip 25630
|
$256.95 |
$256.95 |
$256.95 |
$476.00
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$279.90 |
$279.90 |
$279.90 |
$523.53
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$256.95 |
$256.95 |
$256.95 |
$496.61
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$279.90 |
$279.90 |
$279.90 |
$600.60
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$256.95 |
$256.95 |
$256.95 |
$474.50
|
|
Cls tx of heel fracture w/manip 28405
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$748.00
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,490.60
|
|
Cltx humrl cndylr fx w/mnpj
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,815.75
|
|
Cltx lunate dislc w/mnpj
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,437.00
|
|
Cltx scap fx w/mnpj +-tractj
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$2,021.04
|
|
Cltx strnclav dislc w/mnpj
|
$500.70 |
$500.70 |
$500.70 |
$619.30
|
|
Cltx tmprmand dislc comp
|
$2,247.45 |
$2,247.45 |
$2,247.45 |
$3,986.00
|
|
#cmvcul-virus inoculation shell
|
$160.95 |
$160.95 |
$160.95 |
$100.20
|
|
Cmv pcr-sendout
|
$226.05 |
$226.05 |
$226.05 |
$177.10
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$7,332.48 |
$7,332.48 |
$7,332.48 |
$8,980.00
|
|
Coagulation time activated teg
|
$53.55 |
$53.55 |
$53.55 |
$53.72
|
|
Cocaine 4 % nasal solution
|
$529.20 |
$529.20 |
$529.20 |
$629.41
|
|
Cold agglutinin screen (arc)
|
$156.90 |
$156.90 |
$156.90 |
$45.00
|
|
Cold agglutinin titer
|
$34.50 |
$34.50 |
$34.50 |
$50.00
|
|
Colistimethate sodium inj
|
$35.27 |
$35.27 |
$35.27 |
$68.47
|
|
Collagen based wound filler
|
$3,108.00 |
$3,108.00 |
$3,108.00 |
$1,823.25
|
|
Collagen dressing <=16 sq in
|
$56.02 |
$56.02 |
$56.02 |
$42.50
|
|
Collagen drsg>16<=48 sq in
|
$3,348.00 |
$3,348.00 |
$3,348.00 |
$24.71
|
|
Collagen gel/paste wound fil
|
$9.65 |
$9.65 |
$9.65 |
$9.65
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$86.48 |
$86.48 |
$86.48 |
$58.65
|
|
Collar cerv ascend 172 reg
|
$136.56 |
$136.56 |
$136.56 |
$213.89
|
|
Collar cerv patriot adlt
|
$16.50 |
$16.50 |
$16.50 |
$154.00
|
|
Collar extrication adult univ
|
$1,370.20 |
$1,370.20 |
$1,370.20 |
$764.15
|
|
Collection of venous blood by venipuncture
|
$23.85 |
$23.85 |
$23.85 |
$21.00
|
|
Coll-e-derm 1 sq cm
|
$342.21 |
$342.21 |
$342.21 |
$171.12
|
|
Colonoscopy (diagnostic)
|
$1,899.00 |
$1,899.00 |
$1,899.00 |
$1,899.00
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$760.95 |
$760.95 |
$760.95 |
$2,288.00
|
|
Colonoscopy stoma w/snare 44394
|
$760.95 |
$760.95 |
$760.95 |
$1,395.28
|
|
Colonoscopy submucous njx
|
$760.95 |
$760.95 |
$760.95 |
$2,080.00
|
|
Colonoscopy thru stoma spx
|
$1,899.00 |
$1,899.00 |
$1,899.00 |
$1,899.00
|
|
Colonoscopy w/ablation
|
$760.95 |
$760.95 |
$760.95 |
$2,708.80
|
|
Colonoscopy w/balloon dilat
|
$760.95 |
$760.95 |
$760.95 |
$1,645.43
|
|
Colonoscopy w/control bleed
|
$760.95 |
$760.95 |
$760.95 |
$2,071.85
|
|
Colonoscopy w/endoscope Ultrasound
|
$760.95 |
$760.95 |
$760.95 |
$1,846.00
|
|
Colonoscopy w/endoscopic fnb
|
$760.95 |
$760.95 |
$760.95 |
$1,645.43
|
|
Colonoscopy/w endoscopic stent 45389
|
$3,571.80 |
$3,571.80 |
$3,571.80 |
$3,571.80
|
|
Colonoscopy w/fb removal
|
$760.95 |
$760.95 |
$760.95 |
$1,395.28
|
|
Colonoscopy (with biopsy)
|
$760.95 |
$760.95 |
$760.95 |
$2,080.00
|
|
Colonoscopy with biopsy
|
$760.95 |
$760.95 |
$760.95 |
$1,395.28
|
|
Colonoscopy (with polyp removal)
|
$760.95 |
$760.95 |
$760.95 |
$2,288.00
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$2,070.30 |
$2,070.30 |
$2,070.30 |
$3,762.53
|
|
Compatibility test each unit antiglobulin technique
|
$156.90 |
$156.90 |
$156.90 |
$170.25
|
|
Compatibility test each unit electronic
|
$171.00 |
$171.00 |
$171.00 |
$174.00
|
|
Compatibility test each unit immediate spin technique
|
$177.90 |
$177.90 |
$177.90 |
$169.52
|
|
Complement antigen each component c3
|
$265.50 |
$265.50 |
$265.50 |
$108.55
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$478.95 |
$478.95 |
$478.95 |
$876.00
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$695.40 |
$695.40 |
$695.40 |
$1,191.78
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$478.95 |
$478.95 |
$478.95 |
$1,049.60
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$487.20 |
$487.20 |
$487.20 |
$1,194.25
|
|
Complx repair enel addl 5cm/< 13153
|
$490.50 |
$490.50 |
$490.50 |
$490.50
|
|
Complx repair fccmnaxghf 13131
|
$449.25 |
$449.25 |
$449.25 |
$810.40
|
|
Complx repair fccmnaxghf 13132
|
$478.95 |
$478.95 |
$478.95 |
$1,108.88
|
|
Complx repair fccmnaxghf 13133
|
$490.50 |
$490.50 |
$490.50 |
$490.50
|
|
Complx repair sal addl 5 cm/> 13122
|
$478.95 |
$478.95 |
$478.95 |
$502.50
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$423.45 |
$423.45 |
$423.45 |
$1,000.00
|
|
Complx repair trunk addl 5cm/< 13102
|
$382.80 |
$382.80 |
$382.80 |
$537.00
|
|
Component ankle afo plastic jt mold to pt mdl foot cup
|
$1,350.27 |
$1,350.27 |
$1,350.27 |
$1,350.27
|
|
Composite drsg >16<=48 sq in
|
$147.60 |
$147.60 |
$147.60 |
$42.60
|
|
Composite drsg <= 16 sq in
|
$31.98 |
$31.98 |
$31.98 |
$6.62
|