|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$1,760.52 |
$1,760.52 |
$1,760.52 |
$549.08
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$3,593.46 |
$3,593.46 |
$3,593.46 |
$3,461.40
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$3,593.46 |
$3,593.46 |
$3,593.46 |
$1,300.71
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$1,759.50 |
$1,759.50 |
$1,759.50 |
$508.18
|
|
Appl body cast sho to hips
|
$1,110.78 |
$1,110.78 |
$1,110.78 |
$390.73
|
|
Appl cast figure-of-eight
|
$294.78 |
$294.78 |
$294.78 |
$314.28
|
|
Appl cast plaster velpeau
|
$294.78 |
$294.78 |
$294.78 |
$312.76
|
|
Appl cast shoulder spica
|
$459.00 |
$459.00 |
$459.00 |
$406.70
|
|
Appl hip spica cast1&1/2
|
$294.78 |
$294.78 |
$294.78 |
$501.28
|
|
Appl hip spica cast 1 leg
|
$294.78 |
$294.78 |
$294.78 |
$475.30
|
|
Application clubfoot cast
|
$297.33 |
$297.33 |
$297.33 |
$297.33
|
|
Application finger splntstatic 29130
|
$253.98 |
$253.98 |
$253.98 |
$226.20
|
|
Application long leg splint 29505
|
$224.40 |
$224.40 |
$224.40 |
$370.00
|
|
Application lower leg splint 29515
|
$245.82 |
$245.82 |
$245.82 |
$365.60
|
|
Application multi layer compression below knee (both sides)
|
$273.87 |
$273.87 |
$273.87 |
$393.75
|
|
Application of cylinder cast 29365
|
$294.78 |
$294.78 |
$294.78 |
$431.08
|
|
Application of forearm cast 29075
|
$345.78 |
$345.78 |
$345.78 |
$386.10
|
|
Application of long arm cast 29065
|
$363.12 |
$363.12 |
$363.12 |
$414.20
|
|
Application of long leg cast 29345
|
$391.68 |
$391.68 |
$391.68 |
$511.68
|
|
Application of paste boot 29580
|
$179.52 |
$179.52 |
$179.52 |
$336.00
|
|
Application short leg cast 29405
|
$535.50 |
$535.50 |
$535.50 |
$397.33
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$1,760.52 |
$1,760.52 |
$1,760.52 |
$2,164.64
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$2,332.74 |
$2,332.74 |
$2,332.74 |
$2,164.64
|
|
Applicator tag rfid localizer 12gx7cm
|
$642.80 |
$642.80 |
$642.80 |
$1,051.88
|
|
Appl long leg cast brace
|
$302.94 |
$302.94 |
$302.94 |
$375.00
|
|
Appl modality 1/> areas paraffin bath 97018
|
$141.78 |
$141.78 |
$141.78 |
$68.00
|
|
Apply finger cast 29086
|
$179.52 |
$179.52 |
$179.52 |
$242.20
|
|
Apply forearm splintdynamic 29126
|
$161.67 |
$161.67 |
$161.67 |
$263.20
|
|
Apply halo w/removal cranial
|
$958.80 |
$958.80 |
$958.80 |
$1,367.60
|
|
Apply hand/wrist cast 29085
|
$292.23 |
$292.23 |
$292.23 |
$275.80
|
|
Apply of finger splint 29131
|
$108.12 |
$108.12 |
$108.12 |
$177.45
|
|
Apply rem fixation device
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$1,980.00
|
|
Apply rigid leg cast 29445
|
$353.94 |
$353.94 |
$353.94 |
$608.00
|
|
Apply short leg castambul type 29425
|
$328.44 |
$328.44 |
$328.44 |
$460.92
|
|
Arterial blood draw/perc 36620
|
$296.31 |
$296.31 |
$296.31 |
$500.82
|
|
Arthrd wrist lmtd without b1 grf
|
$4,634.88 |
$4,634.88 |
$4,634.88 |
$7,807.24
|
|
Arthrd wrist with autograft
|
$1,075.59 |
$1,075.59 |
$1,075.59 |
$6,605.25
|
|
Arthrd wrst iliac/oth agrft
|
$1,639.65 |
$1,639.65 |
$1,639.65 |
$7,389.50
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$634.44 |
$634.44 |
$634.44 |
$588.53
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$792.03 |
$792.03 |
$792.03 |
$1,005.42
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$1,647.81 |
$1,647.81 |
$1,647.81 |
$956.00
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$498.27 |
$498.27 |
$498.27 |
$471.34
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$1,676.37 |
$1,676.37 |
$1,676.37 |
$715.37
|
|
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604
|
$349.86 |
$349.86 |
$349.86 |
$700.80
|
|
Arthroplasty finger joint 26535
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$4,160.64
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$1,067.94 |
$1,067.94 |
$1,067.94 |
$3,839.54
|
|
Arthrotomy/elbow/exp/drain/rmv fb 24000
|
$884.85 |
$884.85 |
$884.85 |
$3,839.54
|
|
Arthrp ntrcrp/crp/mtcr ntrps
|
$990.93 |
$990.93 |
$990.93 |
$4,086.40
|
|
Arthrp ntrcrpl/crp/mtcrp ssp
|
$1,856.91 |
$1,856.91 |
$1,856.91 |
$3,591.33
|
|
Arthrs kne srg drlg ost diss
|
$1,180.65 |
$1,180.65 |
$1,180.65 |
$6,260.32
|
|
Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah)
|
$366.18 |
$366.18 |
$366.18 |
$1,742.40
|
|
Artiss fibrin sealant
|
$1,425.18 |
$1,425.18 |
$1,425.18 |
$1,145.23
|
|
Ascenda two piece catheter
|
$17,850.00 |
$17,850.00 |
$17,850.00 |
$22,951.20
|
|
Aspirate bladder/sprapubic cath 51102
|
$2,279.70 |
$2,279.70 |
$2,279.70 |
$3,199.51
|
|
Aspirate/inj ganglion cyst 20612
|
$386.58 |
$386.58 |
$386.58 |
$440.00
|
|
Aspirate pleura without imaging 32554
|
$2,204.22 |
$2,204.22 |
$2,204.22 |
$1,317.00
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$797.64 |
$797.64 |
$797.64 |
$1,306.50
|
|
Aspir/inj thyroid cyst 60300
|
$797.64 |
$797.64 |
$797.64 |
$850.78
|
|
Assay of salicylate
|
$82.62 |
$82.62 |
$82.62 |
$104.00
|
|
Assessment leukocyte fecal qualitative/semiquantitative
|
$58.65 |
$58.65 |
$58.65 |
$47.25
|
|
Ast/sgot
|
$42.33 |
$42.33 |
$42.33 |
$46.20
|
|
Atropine 0.1 mg/ml injection syringe
|
$84.15 |
$84.15 |
$84.15 |
$43.85
|
|
Augment injectable kit 3.0cc
|
$5,091.84 |
$5,091.84 |
$5,091.84 |
$6,394.75
|
|
Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body
|
$427.38 |
$427.38 |
$427.38 |
$7,713.54
|
|
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic
|
$1,020.51 |
$1,020.51 |
$1,020.51 |
$11,040.83
|
|
Avul nail plate addl
|
$150.96 |
$150.96 |
$150.96 |
$232.80
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$552.33 |
$552.33 |
$552.33 |
$356.00
|
|
Azathioprine 50 mg tablet
|
$5.61 |
$5.61 |
$5.61 |
$5.61
|
|
Azithromycin 500 mg intravenous solution
|
$84.15 |
$84.15 |
$84.15 |
$55.63
|
|
Aztreonam 1 gram solution for injection
|
$140.53 |
$140.53 |
$140.53 |
$175.89
|
|
Bartholin gland cyst/marsupializat 56440
|
$3,474.63 |
$3,474.63 |
$3,474.63 |
$3,762.53
|
|
Bausch health Ultrasound surg
|
$2,172.60 |
$2,172.60 |
$2,172.60 |
$2,054.61
|
|
Benign lesion paring 2-4
|
$491.13 |
$491.13 |
$491.13 |
$280.20
|
|
Benign lesion paring 4+
|
$552.33 |
$552.33 |
$552.33 |
$307.50
|
|
Benztropine 1 mg/ml injection solution
|
$106.46 |
$106.46 |
$106.46 |
$116.84
|
|
Beta-2 microglobulin
|
$53.04 |
$53.04 |
$53.04 |
$86.40
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$84.15 |
$84.15 |
$84.15 |
$70.37
|
|
Bilateral n blobk inj pudendal 64430
|
$1,047.03 |
$1,047.03 |
$1,047.03 |
$1,584.16
|
|
Bilateral n block inj occipital 64405
|
$755.82 |
$755.82 |
$755.82 |
$825.60
|
|
Bilateral n block inj trigeminal 64400
|
$755.82 |
$755.82 |
$755.82 |
$667.26
|
|
Bilirubin direct
|
$41.82 |
$41.82 |
$41.82 |
$49.31
|
|
Bilirubin total
|
$41.82 |
$41.82 |
$41.82 |
$51.50
|
|
Binder abdominal lg 12 x 62-74
|
$18.57 |
$18.57 |
$18.57 |
$31.07
|
|
Biopsy, bone open deep
|
$3,327.24 |
$3,327.24 |
$3,327.24 |
$3,491.15
|
|
Biopsy cervixsingle/multiple 57500
|
$2,360.79 |
$2,360.79 |
$2,360.79 |
$1,268.54
|
|
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides)
|
$3,174.75 |
$3,174.75 |
$3,174.75 |
$3,211.00
|
|
Biopsy of rectum wall anal approach 45100
|
$533.46 |
$533.46 |
$533.46 |
$3,329.95
|
|
Biopsy skin incisional single lesion
|
$808.35 |
$808.35 |
$808.35 |
$724.37
|
|
Biopsy/soft tissue/neck or thorax 21550
|
$1,842.63 |
$1,842.63 |
$1,842.63 |
$2,310.84
|
|
Biospy of bladder
|
$219.30 |
$219.30 |
$219.30 |
$1,024.45
|
|
Bladder irrigate/lavage/instill 51700
|
$420.75 |
$420.75 |
$420.75 |
$440.70
|
|
Bld push tfuj 2 yr/<
|
$501.33 |
$501.33 |
$501.33 |
$794.82
|
|
Bln 1.2 mono emrg 15x1.2
|
$7,191.00 |
$7,191.00 |
$7,191.00 |
$8,172.05
|
|
Bln 30frx10mmx12cm renal nephromax
|
$8,726.10 |
$8,726.10 |
$8,726.10 |
$5,793.60
|
|
Bln dil 900ml preperitnl
|
$1,090.20 |
$1,090.20 |
$1,090.20 |
$920.08
|
|
Bln inpact admiral 4x150x130cm
|
$4,161.60 |
$4,161.60 |
$4,161.60 |
$4,914.00
|
|
Bln press regulation 71-80cm
|
$11,138.40 |
$11,138.40 |
$11,138.40 |
$13,234.32
|
|
Bln stent lg 19mm diam 10-12mm palmaz gen trnshpat unmtd
|
$4,703.99 |
$4,703.99 |
$4,703.99 |
$4,206.48
|
|
Block brachial plexus w/cath plmt w/img
|
$1,047.03 |
$1,047.03 |
$1,047.03 |
$1,396.62
|
|
Block femoral nerve cont infusion cath w/img
|
$792.03 |
$792.03 |
$792.03 |
$1,576.68
|