|
Amputation toe interphalangeal joint
|
$975.00 |
$975.00 |
$975.00 |
$4,196.50
|
|
Amylase
|
$118.30 |
$118.30 |
$118.30 |
$90.00
|
|
Anal/urinary muscle study
|
$585.00 |
$585.00 |
$585.00 |
$407.00
|
|
Anal/urinary muscle study
|
$909.35 |
$909.35 |
$909.35 |
$602.80
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$514.15 |
$514.15 |
$514.15 |
$320.40
|
|
Analysis gene f2 20210g>a variant
|
$520.00 |
$520.00 |
$520.00 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$65.65 |
$65.65 |
$65.65 |
$249.60
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$208.65 |
$208.65 |
$208.65 |
$122.20
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$514.15 |
$514.15 |
$514.15 |
$375.00
|
|
Anaplsma phgcytophlm amp prb
|
$63.05 |
$63.05 |
$63.05 |
$85.80
|
|
Anca screen with reflex to titer -quest
|
$53.95 |
$53.95 |
$53.95 |
$101.50
|
|
An cholangiogram percutaneous compl
|
$13,190.45 |
$13,190.45 |
$13,190.45 |
$2,480.94
|
|
An fluoro guide for cvp
|
$668.85 |
$668.85 |
$668.85 |
$525.85
|
|
Angio balloon ctrl dialysis seg add-on
|
$13,184.60 |
$13,184.60 |
$13,184.60 |
$5,728.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$1,263.33 |
$1,263.33 |
$1,263.33 |
$2,979.43
|
|
Angio trnslmnl balloon same artery ea addl
|
$5,855.20 |
$5,855.20 |
$5,855.20 |
$4,560.40
|
|
Angio trnslmnl balloon same artery ini
|
$26,637.00 |
$26,637.00 |
$26,637.00 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$4,390.75 |
$4,390.75 |
$4,390.75 |
$4,350.00
|
|
Angio trnslmnl balloon same vein ini
|
$26,637.00 |
$26,637.00 |
$26,637.00 |
$8,359.11
|
|
Anidulafungin injection
|
$446.69 |
$446.69 |
$446.69 |
$312.30
|
|
Ankle X-ray
|
$494.00 |
$494.00 |
$494.00 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$494.00 |
$494.00 |
$494.00 |
$282.96
|
|
Anl sp inf pmp w/mdreprg&fil
|
$257.40 |
$257.40 |
$257.40 |
$630.96
|
|
Annual alcohol screen 15 min
|
$167.70 |
$167.70 |
$167.70 |
$40.00
|
|
Annual Physical, Established Patient (age 18-39)
|
$455.00 |
$455.00 |
$455.00 |
$153.51
|
|
Annual Physical, Established Patient (age 40-64)
|
$494.00 |
$494.00 |
$494.00 |
$160.73
|
|
Annual Physical, New Patient (age 18-39)
|
$499.20 |
$499.20 |
$499.20 |
$154.00
|
|
Annual Physical, New Patient (age 40-64)
|
$605.80 |
$605.80 |
$605.80 |
$167.25
|
|
Anogenital exam child w imag
|
$500.50 |
$500.50 |
$500.50 |
$277.99
|
|
Anora (draw only)
|
$31.20 |
$31.20 |
$31.20 |
$35.00
|
|
Anoscopy ablation lesion 46615
|
$390.00 |
$390.00 |
$390.00 |
$3,245.23
|
|
Anoscopy and biopsy
|
$4,407.00 |
$4,407.00 |
$4,407.00 |
$2,288.00
|
|
Anoscopy control bleeding 46614
|
$260.00 |
$260.00 |
$260.00 |
$2,140.60
|
|
Anoscopy remove fb 46608
|
$3,407.95 |
$3,407.95 |
$3,407.95 |
$1,375.98
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$2,620.80 |
$2,620.80 |
$2,620.80 |
$5,841.60
|
|
Antibody bacterium, not elsewhere specified
|
$79.95 |
$79.95 |
$79.95 |
$57.85
|
|
Antibody elution rbc reference
|
$356.85 |
$356.85 |
$356.85 |
$177.29
|
|
Antibody htlv/hiv confirm test
|
$63.70 |
$63.70 |
$63.70 |
$131.56
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$273.00 |
$273.00 |
$273.00 |
$224.00
|
|
Antibody id rbc panel
|
$243.10 |
$243.10 |
$243.10 |
$291.75
|
|
Antibody influenza virus
|
$69.55 |
$69.55 |
$69.55 |
$54.00
|
|
Antibody screen rbc
|
$68.25 |
$68.25 |
$68.25 |
$108.55
|
|
Antidepressant not specified
|
$88.40 |
$88.40 |
$88.40 |
$72.14
|
|
Antigen therapy services
|
$112.45 |
$112.45 |
$112.45 |
$73.84
|
|
Antigen therapy services
|
$112.45 |
$112.45 |
$112.45 |
$83.72
|
|
Antigen therapy services
|
$174.20 |
$174.20 |
$174.20 |
$101.40
|
|
Antigen therapy services
|
$174.20 |
$174.20 |
$174.20 |
$96.72
|
|
Antigen therapy services
|
$174.20 |
$174.20 |
$174.20 |
$130.00
|
|
Antigen therapy services
|
$80.60 |
$80.60 |
$80.60 |
$74.00
|
|
Antigen therapy services
|
$15.60 |
$15.60 |
$15.60 |
$64.39
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$4.00 |
$4.00 |
$4.00 |
$6.10
|
|
Antihemophilic viii/vwf comp
|
$3.32 |
$3.32 |
$3.32 |
$3.67
|
|
Anti-inhibitor
|
$6.32 |
$6.32 |
$6.32 |
$8.33
|
|
Anti mog serum - sendout
|
$131.95 |
$131.95 |
$131.95 |
$132.60
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$84.50 |
$84.50 |
$84.50 |
$38.50
|
|
Ant instr 2-3 vert segm 22845
|
$3,415.10 |
$3,415.10 |
$3,415.10 |
$1,748.00
|
|
Ant instrumentation/4-7 vert seg 22846
|
$3,546.40 |
$3,546.40 |
$3,546.40 |
$1,430.40
|
|
Antinuclear antibodies
|
$81.25 |
$81.25 |
$81.25 |
$90.00
|
|
Antinuclear antibodies titer
|
$48.75 |
$48.75 |
$48.75 |
$80.04
|
|
Antiphosphatidylserine antibody
|
$29.90 |
$29.90 |
$29.90 |
$67.43
|
|
Antistreptolysin o titer
|
$11.05 |
$11.05 |
$11.05 |
$54.00
|
|
Antithrombin iii activity
|
$13.00 |
$13.00 |
$13.00 |
$115.15
|
|
Antithrombin iii injection
|
$10.74 |
$10.74 |
$10.74 |
$11.85
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$2,487.13 |
$2,487.13 |
$2,487.13 |
$8,214.07
|
|
Antithymocyte globuln rabbit
|
$2,685.05 |
$2,685.05 |
$2,685.05 |
$2,111.00
|
|
Ant thrc vrt body tethrg <7
|
$9,152.00 |
$9,152.00 |
$9,152.00 |
$4,508.80
|
|
Ant thrc vrt body tethrg 8+
|
$10,153.00 |
$10,153.00 |
$10,153.00 |
$4,968.00
|
|
Aortic Aneurysm Screening Ultrasound
|
$596.70 |
$596.70 |
$596.70 |
$394.55
|
|
Aortic hemiarch graft 33866
|
$5,076.50 |
$5,076.50 |
$5,076.50 |
$2,609.60
|
|
Appendectomy
|
$2,756.00 |
$2,756.00 |
$2,756.00 |
$5,681.93
|
|
Appendectomy add-on 44955
|
$397.80 |
$397.80 |
$397.80 |
$206.40
|
|
Appendectomy/open/rup/w/absc/peri 44960
|
$3,770.00 |
$3,770.00 |
$3,770.00 |
$1,562.44
|
|
Appendix Removal (Laparoscopic)
|
$21,806.20 |
$21,806.20 |
$21,806.20 |
$7,202.00
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$4,459.00 |
$4,459.00 |
$4,459.00 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$4,459.00 |
$4,459.00 |
$4,459.00 |
$852.00
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$4,459.00 |
$4,459.00 |
$4,459.00 |
$502.00
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$8,923.85 |
$8,923.85 |
$8,923.85 |
$3,593.46
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$8,923.85 |
$8,923.85 |
$8,923.85 |
$1,146.48
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$4,459.00 |
$4,459.00 |
$4,459.00 |
$512.20
|
|
Application finger splntstatic 29130
|
$481.65 |
$481.65 |
$481.65 |
$208.50
|
|
Application long leg splint 29505
|
$590.20 |
$590.20 |
$590.20 |
$338.25
|
|
Application lower leg splint 29515
|
$590.20 |
$590.20 |
$590.20 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$590.20 |
$590.20 |
$590.20 |
$375.06
|
|
Application of forearm cast 29075
|
$993.20 |
$993.20 |
$993.20 |
$358.20
|
|
Application of paste boot 29580
|
$590.20 |
$590.20 |
$590.20 |
$340.11
|
|
Application short leg cast 29405
|
$993.20 |
$993.20 |
$993.20 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$4,459.00 |
$4,459.00 |
$4,459.00 |
$2,123.50
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$4,459.00 |
$4,459.00 |
$4,459.00 |
$2,164.64
|
|
Appl long leg cast brace
|
$993.20 |
$993.20 |
$993.20 |
$468.00
|
|
Appl modality 1/> areas paraffin bath 97018
|
$135.20 |
$135.20 |
$135.20 |
$69.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$165.10 |
$165.10 |
$165.10 |
$75.98
|
|
Appl multlay comprs arm/hand
|
$590.20 |
$590.20 |
$590.20 |
$289.60
|
|
Appl unipln uni ext fixj sys
|
$2,282.80 |
$2,282.80 |
$2,282.80 |
$5,810.00
|
|
Apply forearm splintdynamic 29126
|
$481.65 |
$481.65 |
$481.65 |
$255.20
|
|
Apply halo w/removal cranial
|
$1,367.60 |
$1,367.60 |
$1,367.60 |
$1,367.60
|
|
Apply hand/wrist cast 29085
|
$590.20 |
$590.20 |
$590.20 |
$271.80
|
|
Apply interstit radiat compl
|
$2,510.95 |
$2,510.95 |
$2,510.95 |
$2,901.80
|
|
Apply intrcav radiat compl
|
$2,251.60 |
$2,251.60 |
$2,251.60 |
$1,813.50
|
|
Apply intrcav radiat interm
|
$1,647.10 |
$1,647.10 |
$1,647.10 |
$1,521.98
|
|
Apply intrcav radiat simple
|
$3,242.85 |
$3,242.85 |
$3,242.85 |
$1,269.97
|
