|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$550.27 |
$550.27 |
$611.64 |
$414.40
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$240.30 |
$240.30 |
$517.10 |
$466.14
|
|
Clsd tx radius fracture w/manip 24655
|
$294.84 |
$294.84 |
$1,868.38 |
$1,782.86
|
|
Clsd tx/scapular fx without manip 23570
|
$397.98 |
$397.98 |
$629.56 |
$452.40
|
|
Clsd tx shoulder dislc/fx 23665
|
$2,110.45 |
$2,110.45 |
$2,110.45 |
$1,828.80
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$742.58 |
$742.58 |
$742.58 |
$1,687.50
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$902.97 |
$902.97 |
$3,316.31 |
$2,331.50
|
|
Clsd tx/talotarsal dislocat/anes 28575
|
$2,086.57 |
$2,086.57 |
$2,086.57 |
$3,839.54
|
|
Clsd tx temporomandibular dislocat 21480
|
$105.12 |
$105.12 |
$445.15 |
$424.38
|
|
Clsd tx toe dislocation without anes28660
|
$151.29 |
$151.29 |
$662.02 |
$412.00
|
|
Clsd tx trimall ankle fx without manip 27816
|
$170.10 |
$170.10 |
$735.14 |
$489.60
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$621.27 |
$621.27 |
$1,602.79 |
$1,592.00
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$170.10 |
$170.10 |
$443.43 |
$473.00
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$648.34 |
$648.34 |
$648.34 |
$648.34
|
|
Clsd tx wrist carpal fx without manip 25630
|
$170.10 |
$170.10 |
$575.05 |
$476.00
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$178.02 |
$178.02 |
$673.55 |
$535.60
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$496.61 |
$496.61 |
$496.61 |
$490.00
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$170.10 |
$170.10 |
$636.49 |
$612.80
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$170.10 |
$170.10 |
$568.81 |
$487.15
|
|
Cls tx of heel fracture w/manip 28405
|
$125.91 |
$125.91 |
$2,635.14 |
$725.40
|
|
Cltx carpl scphd fx w/mnpj
|
$1,501.09 |
$1,501.09 |
$1,501.09 |
$1,893.86
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$2,072.29 |
$2,072.29 |
$2,072.29 |
$2,274.40
|
|
Cltx hum epcndylr fx wo mnpj
|
$170.10 |
$170.10 |
$735.14 |
$525.75
|
|
Cltx humrl cndylr fx w/mnpj
|
$1,877.71 |
$1,877.71 |
$1,877.71 |
$1,851.78
|
|
Cltx humrl cndylr fx wo mnpj
|
$294.84 |
$294.84 |
$581.99 |
$535.60
|
|
Cltx lunate dislc w/mnpj
|
$3,367.63 |
$3,367.63 |
$3,367.63 |
$2,384.00
|
|
Cltx mndblr fx ntrdntl fixj
|
$5,741.68 |
$5,741.68 |
$5,741.68 |
$6,776.64
|
|
Cltx mndblr fx w/mnpj
|
$2,963.90 |
$2,963.90 |
$2,963.90 |
$2,343.00
|
|
Cltx mndblr/max alv ridge fx
|
$1,077.03 |
$1,077.03 |
$4,419.42 |
$3,986.00
|
|
Cltx palatal/max fx wire fix
|
$4,199.49 |
$4,199.49 |
$4,199.49 |
$4,377.24
|
|
Cltx post ankle fx
|
$88.38 |
$88.38 |
$339.17 |
$497.00
|
|
Cltx post ankle fx w/mnpj
|
$661.84 |
$661.84 |
$661.84 |
$1,939.00
|
|
Cltx scap fx w/mnpj +-tractj
|
$1,271.75 |
$1,271.75 |
$1,271.75 |
$2,021.04
|
|
Cltx strnclav dislc w/mnpj
|
$91.89 |
$91.89 |
$804.79 |
$619.30
|
|
Cltx thigh fx
|
$1,996.56 |
$1,996.56 |
$1,996.56 |
$3,986.00
|
|
Cltx thigh fx w/mnpj
|
$989.98 |
$989.98 |
$989.98 |
$3,276.70
|
|
Cltx tmprmand dislc comp
|
$702.72 |
$702.72 |
$4,040.04 |
$3,740.85
|
|
Cmbn ant pst colprhy
|
$5,194.98 |
$5,194.98 |
$5,194.98 |
$4,928.00
|
|
C motor evoked lwr limbs
|
$209.79 |
$209.79 |
$648.00 |
$627.89
|
|
C motor evoked uppr limbs
|
$209.79 |
$209.79 |
$677.30 |
$859.50
|
|
C motor evoked upr&lwr limbs
|
$922.79 |
$922.79 |
$994.32 |
$1,333.36
|
|
Cmptr ophth dx img ant segmt
|
$144.13 |
$144.13 |
$144.13 |
$83.20
|
|
Cmptr ophth img optic nerve
|
$166.21 |
$166.21 |
$166.21 |
$98.00
|
|
#cms hgb-carboxyhemoglobin
|
$67.80 |
$67.80 |
$67.80 |
$61.60
|
|
#cms hgb-sulfhemoglobin
|
$75.58 |
$75.58 |
$75.58 |
$74.00
|
|
#cmvcul-virus inoculation shell
|
$124.00 |
$124.00 |
$124.00 |
$89.76
|
|
Cmv pcr-sendout
|
$90.63 |
$90.63 |
$568.11 |
$175.70
|
|
Cnbp gene detc abnor allele
|
$7,487.95 |
$7,487.95 |
$7,487.95 |
$313.60
|
|
Co2 monitor per day
|
$450.60 |
$450.60 |
$450.60 |
$459.20
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$4.68 |
$4.68 |
$26.45 |
$11,888.50
|
|
Coagulation time activated teg
|
$51.48 |
$51.48 |
$84.58 |
$52.47
|
|
Coagulation time otr method
|
$36.01 |
$36.01 |
$36.01 |
$20.00
|
|
Coch implant headset replace
|
$1,083.39 |
$1,083.39 |
$1,083.39 |
$1,064.00
|
|
Coch implant microphone repl
|
$1,083.39 |
$1,083.39 |
$1,083.39 |
$890.83
|
|
Coch implant tran cable repl
|
$434.37 |
$434.37 |
$434.37 |
$193.52
|
|
Coch implant trans coil repl
|
$1,359.90 |
$1,359.90 |
$1,359.90 |
$677.57
|
|
Cochlear implt f/up exam <7
|
$853.70 |
$853.70 |
$853.70 |
$423.87
|
|
Cochlear implt f/up exam 7/>
|
$552.29 |
$552.29 |
$552.29 |
$386.64
|
|
Cocm by rhc/fqhc 60 min mo
|
$85.42 |
$85.42 |
$85.42 |
$87.13
|
|
Cogenex amnio memb per sq cm
|
$0.01 |
$0.01 |
$0.01 |
$1.00
|
|
Cold agglutinin screen (arc)
|
$91.12 |
$91.12 |
$91.12 |
$48.10
|
|
Cold agglutinin titer
|
$31.95 |
$31.95 |
$78.30 |
$52.00
|
|
Colistimethate sodium inj
|
$103.76 |
$103.76 |
$131.85 |
$82.71
|
|
Collagen based wound filler
|
$1,096.43 |
$1,096.43 |
$1,096.43 |
$1,794.78
|
|
Collagen dressing <=16 sq in
|
$26.01 |
$26.01 |
$26.01 |
$42.50
|
|
Collarbone (Clavicle) X-ray (both sides)
|
$117.99 |
$117.99 |
$286.09 |
$303.73
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$97.80 |
$97.80 |
$97.80 |
$61.20
|
|
Collar cerv adlt perfit ace extric
|
$60.00 |
$60.00 |
$60.00 |
$67.73
|
|
Collar cerv ascend 172 reg
|
$151.61 |
$151.61 |
$151.61 |
$224.11
|
|
Collar cerv patriot adlt
|
$94.80 |
$94.80 |
$94.80 |
$134.66
|
|
Collar extrication adult univ
|
$521.40 |
$521.40 |
$521.40 |
$766.23
|
|
Collection blood specimen from completely implantable venous access device
|
$88.02 |
$88.02 |
$186.73 |
$162.00
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$88.02 |
$88.02 |
$170.68 |
$155.40
|
|
Colon motility 6 hr study
|
$501.82 |
$501.82 |
$501.82 |
$477.92
|
|
Colpocentesis 57020
|
$3,562.33 |
$3,562.33 |
$3,562.33 |
$4,232.80
|
|
Colpocleisis (le forte type) 57120
|
$4,279.19 |
$4,279.19 |
$4,279.19 |
$5,813.46
|
|
Colpopexy extraperitoneal
|
$4,423.50 |
$4,423.50 |
$4,423.50 |
$6,570.00
|
|
Colpopexy intraperitoneal
|
$4,755.92 |
$4,755.92 |
$4,755.92 |
$7,212.40
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$3,703.81 |
$3,703.81 |
$3,703.81 |
$3,907.93
|
|
Colposcopy/cervix/bx vagina/cervix 57421
|
$939.92 |
$939.92 |
$939.92 |
$1,030.40
|
|
Colposcopy/cervix/ conization 57461
|
$3,155.82 |
$3,155.82 |
$3,155.82 |
$3,762.53
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$481.48 |
$481.48 |
$481.48 |
$314.00
|
|
Colposcopy vulva 56820
|
$139.00 |
$139.00 |
$139.00 |
$333.20
|
|
Colposcopy vulva w/biopsy 56821
|
$424.19 |
$424.19 |
$424.19 |
$393.60
|
|
Colposcopy w/biopsy of cervix 57455
|
$891.87 |
$891.87 |
$891.87 |
$485.50
|
|
Colpotomy drng of abscess 57010
|
$3,309.79 |
$3,309.79 |
$3,309.79 |
$3,762.53
|
|
Colpotomy w/exploration 57000
|
$3,905.53 |
$3,905.53 |
$3,905.53 |
$4,075.20
|
|
Compatibility test each unit antiglobulin technique
|
$131.76 |
$131.76 |
$131.76 |
$173.50
|
|
Compatibility test each unit electronic
|
$211.75 |
$211.75 |
$211.75 |
$171.00
|
|
Compatibility test each unit immediate spin technique
|
$158.27 |
$158.27 |
$158.27 |
$169.52
|
|
Comp cystometrogram/void presssure 51728
|
$1,068.95 |
$1,068.95 |
$1,068.95 |
$985.00
|
|
Comp cystometrogram/void/uret pres 51729
|
$978.47 |
$978.47 |
$978.47 |
$1,111.03
|
|
Complement antigen each component c3
|
$52.56 |
$52.56 |
$542.33 |
$110.00
|
|
Complement fixation each
|
$106.80 |
$106.80 |
$106.80 |
$29.12
|
|
Complete removal of vulva
|
$3,905.53 |
$3,905.53 |
$3,905.53 |
$3,786.00
|
|
Complex body section x-rays
|
$532.33 |
$532.33 |
$532.33 |
$532.33
|
|
Complex cystometrogram 51726
|
$1,091.05 |
$1,091.05 |
$1,091.05 |
$727.35
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$172.26 |
$172.26 |
$893.41 |
$893.41
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$500.67 |
$500.67 |
$1,612.19 |
$1,191.78
|
|
Complex uroflowmetry (electronic) 51741
|
$178.94 |
$178.94 |
$178.94 |
$344.68
|
