|
Clsd tx fracture of radius 25500
|
$256.95 |
$256.95 |
$256.95 |
$442.50
|
|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$211.95 |
$211.95 |
$211.95 |
$411.73
|
|
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 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 humerus fract without manip 24500
|
$279.90 |
$279.90 |
$279.90 |
$492.99
|
|
Clsd tx iphal jnt disl w/manip req anes
|
$389.40 |
$389.40 |
$389.40 |
$883.00
|
|
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 |
$606.00
|
|
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 prox fib/shaft fx w/manip 27781
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,146.20
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$211.95 |
$211.95 |
$211.95 |
$412.00
|
|
Clsd tx radius fracture w/manip 24655
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,782.86
|
|
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 |
$1,690.70
|
|
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 |
$394.40
|
|
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 wrist trans-scaph fx w/manip 25680
|
$256.95 |
$256.95 |
$256.95 |
$496.61
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,317.60
|
|
Cltx humrl cndylr fx w/mnpj
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,815.75
|
|
Cltx post ankle fx
|
$294.15 |
$294.15 |
$294.15 |
$483.60
|
|
Cltx post ankle fx w/mnpj
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,893.86
|
|
Cltx scap fx w/mnpj +-tractj
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$2,021.04
|
|
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 |
$100.80
|
|
Cmv pcr-sendout
|
$226.05 |
$226.05 |
$226.05 |
$177.50
|
|
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
|
$113.70 |
$113.70 |
$113.70 |
$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
|
$209.85 |
$209.85 |
$209.85 |
$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 |
$60.84
|
|
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 blood specimen from completely implantable venous access device
|
$77.40 |
$77.40 |
$77.40 |
$159.60
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$94.50 |
$94.50 |
$94.50 |
$153.30
|
|
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/band ligation
|
$760.95 |
$760.95 |
$760.95 |
$2,080.80
|
|
Colonoscopy w/control bleed
|
$760.95 |
$760.95 |
$760.95 |
$2,030.25
|
|
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 w/injection
|
$760.95 |
$760.95 |
$760.95 |
$2,449.20
|
|
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
|
|
Compatibility test each unit antiglobulin technique
|
$156.90 |
$156.90 |
$156.90 |
$170.05
|
|
Compatibility test each unit electronic
|
$171.00 |
$171.00 |
$171.00 |
$172.26
|
|
Compatibility test each unit immediate spin technique
|
$177.90 |
$177.90 |
$177.90 |
$169.52
|
|
Comp cystometrogram/void/uret pres 51729
|
$791.55 |
$791.55 |
$791.55 |
$1,111.03
|
|
Complement antigen each component c3
|
$265.50 |
$265.50 |
$265.50 |
$108.55
|
|
Complex cystometrogram 51726
|
$791.55 |
$791.55 |
$791.55 |
$727.35
|
|
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 |
$1,107.60
|
|
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
|
|
Compression stocking bk18-30
|
$186.96 |
$186.96 |
$186.96 |
$97.50
|
|
Concentration infection agents any type
|
$133.35 |
$133.35 |
$133.35 |
$49.95
|
|
Conduit wrap neuomend 3mmx2.5cm
|
$5,061.60 |
$5,061.60 |
$5,061.60 |
$3,322.20
|
|
Condylomata destruction 56420
|
$306.90 |
$306.90 |
$306.90 |
$469.00
|
|
Conivaptan hcl
|
$1,838.43 |
$1,838.43 |
$1,838.43 |
$1,625.08
|
|
Conjugated estrogens 25 mg solution for injection
|
$794.99 |
$794.99 |
$794.99 |
$871.08
|
|
Connect omega .5mm
|
$1,393.59 |
$1,393.59 |
$1,393.59 |
$1,260.00
|
|
Connector tis 2x10mm
|
$6,223.20 |
$6,223.20 |
$6,223.20 |
$4,091.00
|
|
Consultation pathology during surgery frozen section each additional block
|
$377.25 |
$377.25 |
$377.25 |
$113.68
|
|
Consultation pathology during surgery frozen section first tissue block
|
$832.50 |
$832.50 |
$832.50 |
$225.96
|
|
Consultation/report referred material w/preparation of slides
|
$97.05 |
$97.05 |
$97.05 |
$224.80
|
|
Consult comp w/report rfrd material
|
$446.85 |
$446.85 |
$446.85 |
$365.60
|
|
Contact layer >16<= 48 sq in
|
$285.36 |
$285.36 |
$285.36 |
$36.17
|
|
Contrast x-ray of elbow
|
$594.30 |
$594.30 |
$594.30 |
$649.80
|
|
Contrast x-ray of hip
|
$468.00 |
$468.00 |
$468.00 |
$771.12
|
|
Contrast x-ray of wrist
|
$564.45 |
$564.45 |
$564.45 |
$637.00
|
