|
Angioplasty/iliac/init ves/unilat 37220
|
$6,886.00 |
$6,886.00 |
$6,886.00 |
$9,765.79
|
|
Angioplasty tib/pero/unilat/ea add 37232
|
$9,106.00 |
$9,106.00 |
$9,106.00 |
$5,950.50
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$6,083.51 |
$6,083.51 |
$6,083.51 |
$2,979.43
|
|
Angio tib/peroneal/init ves/unila 37228
|
$8,687.00 |
$8,687.00 |
$8,687.00 |
$10,413.45
|
|
Angio trnslmnl balloon same artery ea addl
|
$3,616.00 |
$3,616.00 |
$3,616.00 |
$4,560.40
|
|
Angio trnslmnl balloon same artery ini
|
$7,233.00 |
$7,233.00 |
$7,233.00 |
$9,074.63
|
|
Angio trnslmnl balloon same vein ea addl
|
$1,808.00 |
$1,808.00 |
$1,808.00 |
$4,350.00
|
|
Angio trnslmnl balloon same vein ini
|
$7,233.00 |
$7,233.00 |
$7,233.00 |
$8,359.11
|
|
Ankle arthroscopy/surgery
|
$8,718.00 |
$8,718.00 |
$8,718.00 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$8,718.00 |
$8,718.00 |
$8,718.00 |
$6,839.00
|
|
Ankle arthroscopy/surgery
|
$8,718.00 |
$8,718.00 |
$8,718.00 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$8,264.00 |
$8,264.00 |
$8,264.00 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$8,718.00 |
$8,718.00 |
$8,718.00 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$8,718.00 |
$8,718.00 |
$8,718.00 |
$3,839.54
|
|
Ankle arthroscopy/surgery
|
$8,718.00 |
$8,718.00 |
$8,718.00 |
$8,334.74
|
|
Ankle X-ray
|
$378.00 |
$378.00 |
$378.00 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$351.00 |
$351.00 |
$351.00 |
$282.96
|
|
Anl sp inf pmp w/mdreprg&fil
|
$1,224.00 |
$1,224.00 |
$1,224.00 |
$630.96
|
|
Annual Physical, Established Patient (age 18-39)
|
$501.00 |
$501.00 |
$501.00 |
$153.51
|
|
Annual Physical, Established Patient (age 40-64)
|
$532.00 |
$532.00 |
$532.00 |
$160.73
|
|
Annual Physical, New Patient (age 18-39)
|
$557.00 |
$557.00 |
$557.00 |
$154.00
|
|
Annual Physical, New Patient (age 40-64)
|
$642.00 |
$642.00 |
$642.00 |
$167.25
|
|
Anoscopy ablation lesion 46615
|
$5,544.00 |
$5,544.00 |
$5,544.00 |
$3,245.23
|
|
Anoscopy and biopsy
|
$4,894.00 |
$4,894.00 |
$4,894.00 |
$2,288.00
|
|
Anoscopy and dilation 46604
|
$5,849.00 |
$5,849.00 |
$5,849.00 |
$1,645.43
|
|
Anoscopy remove lesion 46610
|
$7,384.00 |
$7,384.00 |
$7,384.00 |
$3,816.64
|
|
Ans parasymp & symp w/tilt
|
$826.00 |
$826.00 |
$826.00 |
$368.50
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$9,290.00 |
$9,290.00 |
$9,290.00 |
$5,841.60
|
|
Antibody
|
$78.00 |
$78.00 |
$78.00 |
$38.40
|
|
Antibody bacterium, not elsewhere specified
|
$304.00 |
$304.00 |
$304.00 |
$57.85
|
|
Antibody elution rbc reference
|
$523.00 |
$523.00 |
$523.00 |
$177.29
|
|
Antibody htlv/hiv confirm test
|
$807.00 |
$807.00 |
$807.00 |
$131.56
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$468.00 |
$468.00 |
$468.00 |
$224.00
|
|
Antibody id rbc panel
|
$874.00 |
$874.00 |
$874.00 |
$291.75
|
|
Antibody influenza virus
|
$538.00 |
$538.00 |
$538.00 |
$54.00
|
|
Antibody lymphocytic choriomeningitis
|
$166.00 |
$166.00 |
$166.00 |
$46.58
|
|
Antibody screen rbc
|
$244.00 |
$244.00 |
$244.00 |
$108.55
|
|
Antidepressant not specified
|
$164.00 |
$164.00 |
$164.00 |
$72.14
|
|
Antigen therapy services
|
$109.00 |
$109.00 |
$109.00 |
$74.00
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$3.44 |
$3.44 |
$3.44 |
$6.10
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$54.00 |
$54.00 |
$54.00 |
$38.50
|
|
Antinuclear antibodies
|
$317.00 |
$317.00 |
$317.00 |
$90.00
|
|
Antinuclear antibodies titer
|
$124.00 |
$124.00 |
$124.00 |
$80.04
|
|
Antiphosphatidylserine antibody
|
$281.00 |
$281.00 |
$281.00 |
$67.43
|
|
Antistreptolysin o screen
|
$34.00 |
$34.00 |
$34.00 |
$58.56
|
|
Antistreptolysin o titer
|
$90.00 |
$90.00 |
$90.00 |
$54.00
|
|
Antithrombin iii activity
|
$198.00 |
$198.00 |
$198.00 |
$115.15
|
|
Antithrombin iii injection
|
$10.38 |
$10.38 |
$10.38 |
$11.85
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$9,419.58 |
$9,419.58 |
$9,419.58 |
$8,214.07
|
|
Antithymocyte globuln rabbit
|
$2,648.84 |
$2,648.84 |
$2,648.84 |
$2,111.00
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$12,866.00 |
$12,866.00 |
$12,866.00 |
$4,155.20
|
|
Aortic Aneurysm Screening Ultrasound
|
$834.00 |
$834.00 |
$834.00 |
$394.55
|
|
Apheresis immunoads slctv
|
$17,274.00 |
$17,274.00 |
$17,274.00 |
$5,794.21
|
|
Apheresis plasma
|
$9,330.00 |
$9,330.00 |
$9,330.00 |
$3,226.34
|
|
Apheresis platelets
|
$6,005.00 |
$6,005.00 |
$6,005.00 |
$2,195.00
|
|
Apheresis rbc
|
$6,005.00 |
$6,005.00 |
$6,005.00 |
$3,290.80
|
|
Apheresis wbc
|
$6,005.00 |
$6,005.00 |
$6,005.00 |
$3,347.60
|
|
Apl(pml-rara) quant - sendout
|
$2,061.00 |
$2,061.00 |
$2,061.00 |
$513.00
|
|
Appendix Removal (Laparoscopic)
|
$10,651.00 |
$10,651.00 |
$10,651.00 |
$7,202.00
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$6,195.00 |
$6,195.00 |
$6,195.00 |
$2,114.00
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$3,586.00 |
$3,586.00 |
$3,586.00 |
$502.00
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$6,234.00 |
$6,234.00 |
$6,234.00 |
$3,593.46
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$5,864.00 |
$5,864.00 |
$5,864.00 |
$1,146.48
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$3,586.00 |
$3,586.00 |
$3,586.00 |
$512.20
|
|
Application finger splntstatic 29130
|
$4,609.00 |
$4,609.00 |
$4,609.00 |
$208.50
|
|
Application long leg splint 29505
|
$384.00 |
$384.00 |
$384.00 |
$338.25
|
|
Application lower leg splint 29515
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$685.00 |
$685.00 |
$685.00 |
$375.06
|
|
Application of body cast
|
$716.00 |
$716.00 |
$716.00 |
$561.60
|
|
Application of long leg cast 29345
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$455.00
|
|
Application of paste boot 29580
|
$685.00 |
$685.00 |
$685.00 |
$340.11
|
|
Application short leg cast 29405
|
$821.00 |
$821.00 |
$821.00 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$5,778.00 |
$5,778.00 |
$5,778.00 |
$2,123.50
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$4,815.00 |
$4,815.00 |
$4,815.00 |
$2,164.64
|
|
Applicator tag rfid localizer 12gx7cm
|
$4,620.00 |
$4,620.00 |
$4,620.00 |
$981.75
|
|
Appl mltpln uni ext fixj sys
|
$6,653.00 |
$6,653.00 |
$6,653.00 |
$5,855.00
|
|
Appl modality 1/> areas paraffin bath 97018
|
$118.00 |
$118.00 |
$118.00 |
$69.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$38.00 |
$38.00 |
$38.00 |
$75.98
|
|
Appl unipln uni ext fixj sys
|
$5,810.00 |
$5,810.00 |
$5,810.00 |
$5,810.00
|
|
Apply forearm splintdynamic 29126
|
$336.00 |
$336.00 |
$336.00 |
$255.20
|
|
Apply interstit radiat compl
|
$4,667.00 |
$4,667.00 |
$4,667.00 |
$2,901.80
|
|
Apply intrcav radiat compl
|
$7,626.00 |
$7,626.00 |
$7,626.00 |
$1,813.50
|
|
Apply intrcav radiat interm
|
$4,169.00 |
$4,169.00 |
$4,169.00 |
$1,521.98
|
|
Apply intrcav radiat simple
|
$3,389.00 |
$3,389.00 |
$3,389.00 |
$1,269.97
|
|
Apply rem fixation device
|
$6,281.00 |
$6,281.00 |
$6,281.00 |
$2,207.18
|
|
Apply rigid leg cast 29445
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$555.00
|
|
Apply surf ldr radionuclide
|
$4,377.00 |
$4,377.00 |
$4,377.00 |
$282.80
|
|
App mltpln uni xtrnl fix 1st
|
$13,654.00 |
$13,654.00 |
$13,654.00 |
$16,139.55
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$8.37 |
$8.37 |
$8.37 |
$955.43
|
|
Aqaprn-4 antb flo cytmtry ea
|
$54.00 |
$54.00 |
$54.00 |
$231.66
|
|
Aqmbf pet rest & rx stress
|
$1,049.00 |
$1,049.00 |
$1,049.00 |
$974.40
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$169.00 |
$169.00 |
$169.00 |
$100.75
|
|
Aquatic exercise - group charge
|
$161.00 |
$161.00 |
$161.00 |
$87.45
|
|
Aqueous shunt eye w/graft
|
$7,564.00 |
$7,564.00 |
$7,564.00 |
$6,105.79
|
|
Argatroban nonesrd use 1mg
|
$8.83 |
$8.83 |
$8.83 |
$881.10
|
|
Arm CT Scan (with contrast, both arms)
|
$1,963.00 |
$1,963.00 |
$1,963.00 |
$1,687.88
|
|
Arm CT Scan (without contrast, both arms)
|
$1,289.00 |
$1,289.00 |
$1,289.00 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$1,709.00 |
$1,709.00 |
$1,709.00 |
$426.00
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$165.19 |
$165.19 |
$165.19 |
$1,303.25
|
|
Art bypass aortobifemoral 35646
|
$48,000.00 |
$48,000.00 |
$48,000.00 |
$3,443.40
|
