|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$280.80 |
$280.80 |
$280.80 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$7,907.76 |
$7,907.76 |
$7,907.76 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$767.52 |
$767.52 |
$767.52 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$280.80 |
$280.80 |
$280.80 |
$498.81
|
|
Application finger splntstatic 29130
|
$241.92 |
$241.92 |
$241.92 |
$208.16
|
|
Application long leg splint 29505
|
$340.56 |
$340.56 |
$340.56 |
$338.25
|
|
Application lower leg splint 29515
|
$296.64 |
$296.64 |
$296.64 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$454.32 |
$454.32 |
$454.32 |
$373.20
|
|
Application of cylinder cast 29365
|
$573.84 |
$573.84 |
$573.84 |
$420.00
|
|
Application of forearm cast 29075
|
$498.96 |
$498.96 |
$498.96 |
$339.30
|
|
Application of long arm cast 29065
|
$498.96 |
$498.96 |
$498.96 |
$395.00
|
|
Application of long leg cast 29345
|
$498.96 |
$498.96 |
$498.96 |
$455.00
|
|
Application of paste boot 29580
|
$432.00 |
$432.00 |
$432.00 |
$331.74
|
|
Application short leg cast 29405
|
$498.96 |
$498.96 |
$498.96 |
$388.80
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$3,435.84 |
$3,435.84 |
$3,435.84 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$3,435.84 |
$3,435.84 |
$3,435.84 |
$2,164.64
|
|
Appl modality 1/> areas paraffin bath 97018
|
$85.68 |
$85.68 |
$85.68 |
$66.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$106.56 |
$106.56 |
$106.56 |
$75.60
|
|
Apply forearm splintdynamic 29126
|
$411.84 |
$411.84 |
$411.84 |
$246.18
|
|
Apply hand/wrist cast 29085
|
$345.60 |
$345.60 |
$345.60 |
$259.20
|
|
Apply of finger splint 29131
|
$206.64 |
$206.64 |
$206.64 |
$168.00
|
|
Apply rigid leg cast 29445
|
$745.92 |
$745.92 |
$745.92 |
$555.00
|
|
Apply short leg castambul type 29425
|
$573.84 |
$573.84 |
$573.84 |
$381.00
|
|
Aqaprn-4 antb flo cytmtry ea
|
$526.32 |
$526.32 |
$526.32 |
$231.66
|
|
Aquaporin-4 antibody cba each
|
$460.08 |
$460.08 |
$460.08 |
$138.16
|
|
Aquaporin-4 antibody elisa
|
$426.96 |
$426.96 |
$426.96 |
$148.80
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$1,056.24 |
$1,056.24 |
$1,056.24 |
$608.40
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$1,637.28 |
$1,637.28 |
$1,637.28 |
$1,005.42
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$1,177.20 |
$1,177.20 |
$1,177.20 |
$889.20
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$1,077.84 |
$1,077.84 |
$1,077.84 |
$465.00
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$1,516.32 |
$1,516.32 |
$1,516.32 |
$715.37
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$7,008.48 |
$7,008.48 |
$7,008.48 |
$4,240.08
|
|
Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah)
|
$5,505.12 |
$5,505.12 |
$5,505.12 |
$4,194.13
|
|
Ascenda two piece catheter
|
$317.95 |
$317.95 |
$317.95 |
$22,951.20
|
|
Aspirate/inj ganglion cyst 20612
|
$554.40 |
$554.40 |
$554.40 |
$433.07
|
|
Aspirate pleura without imaging 32554
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$1,196.52
|
|
Assay alkaline phosphatase
|
$62.64 |
$62.64 |
$62.64 |
$51.60
|
|
Assay of osteocalcin
|
$176.40 |
$176.40 |
$176.40 |
$92.50
|
|
Assay of procainamide w/metab
|
$40.32 |
$40.32 |
$40.32 |
$70.50
|
|
Assay of prostaglandin
|
$357.84 |
$357.84 |
$357.84 |
$218.50
|
|
Assay of tyrosine
|
$89.28 |
$89.28 |
$89.28 |
$60.00
|
|
Assay of urine sulfate
|
$46.80 |
$46.80 |
$46.80 |
$29.04
|
|
Assessment leukocyte fecal qualitative/semiquantitative
|
$34.56 |
$34.56 |
$34.56 |
$49.80
|
|
Ast/sgot
|
$81.36 |
$81.36 |
$81.36 |
$45.65
|
|
Atezolizumab 60 mg/ml intravenous solution (wrapper)
|
$167.49 |
$167.49 |
$167.49 |
$23,166.53
|
|
Atropine 0.1 mg/ml injection syringe
|
$0.58 |
$0.58 |
$0.58 |
$51.28
|
|
Autologous blood process
|
$216.00 |
$216.00 |
$216.00 |
$262.50
|
|
Avul nail plate addl
|
$203.76 |
$203.76 |
$203.76 |
$194.22
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$596.00 |
$596.00 |
$596.00 |
$318.75
|
|
Azithromycin 500 mg intravenous solution
|
$49.82 |
$49.82 |
$49.82 |
$35.06
|
|
Aztreonam 1 gram solution for injection
|
$11.57 |
$11.57 |
$11.57 |
$157.30
|
|
Baclofen eval charges
|
$69.84 |
$69.84 |
$69.84 |
$85.00
|
|
Bacterial vaginosis pcr
|
$250.56 |
$250.56 |
$250.56 |
$278.40
|
|
#bac vag cand-c. albicans naa
|
$43.92 |
$43.92 |
$43.92 |
$105.00
|
|
B cells total count
|
$237.60 |
$237.60 |
$237.60 |
$131.30
|
|
Bcg live 50 mg intravesical suspension
|
$13.65 |
$13.65 |
$13.65 |
$378.28
|
|
Bendamustine 25 mg/ml intravenous solution (bendeka)
|
$43.14 |
$43.14 |
$43.14 |
$4,702.68
|
|
Benign lesion paring 2-4
|
$429.12 |
$429.12 |
$429.12 |
$257.50
|
|
Benign lesion paring 4+
|
$429.12 |
$429.12 |
$429.12 |
$287.00
|
|
#_benzodiazconfur
|
$98.64 |
$98.64 |
$98.64 |
$114.40
|
|
Beta 2 glycoprotein 1 antibody iga
|
$87.84 |
$87.84 |
$87.84 |
$78.50
|
|
Beta-2 microglobulin
|
$60.48 |
$60.48 |
$60.48 |
$85.94
|
|
Beta-amyloid 1-40
|
$468.00 |
$468.00 |
$468.00 |
$184.80
|
|
Beta-amyloid 1-42
|
$468.00 |
$468.00 |
$468.00 |
$312.50
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$38.05 |
$38.05 |
$38.05 |
$64.15
|
|
Bevacizumab-awwb 25 mg/ml intravenous solution
|
$218.20 |
$218.20 |
$218.20 |
$3,291.73
|
|
Bilateral n blobk inj pudendal 64430
|
$2,029.68 |
$2,029.68 |
$2,029.68 |
$1,460.90
|
|
Bilateral n block inj occipital 64405
|
$637.92 |
$637.92 |
$637.92 |
$768.60
|
|
Bilateral n block inj trigeminal 64400
|
$643.68 |
$643.68 |
$643.68 |
$556.40
|
|
Bilicheck
|
$40.32 |
$40.32 |
$40.32 |
$28.80
|
|
Bilirubin direct
|
$70.56 |
$70.56 |
$70.56 |
$50.00
|
|
Bilirubin total
|
$84.96 |
$84.96 |
$84.96 |
$52.57
|
|
Biopsy bone trocar/needle superficial
|
$3,499.92 |
$3,499.92 |
$3,499.92 |
$1,770.73
|
|
Biopsy external ear 69100
|
$689.76 |
$689.76 |
$689.76 |
$416.52
|
|
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides)
|
$743.76 |
$743.76 |
$743.76 |
$2,716.95
|
|
Biopsy lower leg soft tissue 27610
|
$142.56 |
$142.56 |
$142.56 |
$3,839.54
|
|
Biopsy muscle percutaneous needle
|
$3,499.92 |
$3,499.92 |
$3,499.92 |
$1,629.60
|
|
Biopsy needle liver percutaneous
|
$3,499.92 |
$3,499.92 |
$3,499.92 |
$1,892.80
|
|
Biopsy needle lymph node superficial
|
$3,499.92 |
$3,499.92 |
$3,499.92 |
$1,878.14
|
|
Biopsy of prostate
|
$4,425.12 |
$4,425.12 |
$4,425.12 |
$2,412.45
|
|
Biopsy skin incisional single lesion
|
$1,933.92 |
$1,933.92 |
$1,933.92 |
$657.66
|
|
Bladder irrigate/lavage/instill 51700
|
$525.60 |
$525.60 |
$525.60 |
$408.00
|
|
Bln 1.2 mono emrg 15x1.2
|
$8.75 |
$8.75 |
$8.75 |
$8,530.55
|
|
Bln 30frx10mmx12cm renal nephromax
|
$463.45 |
$463.45 |
$463.45 |
$5,169.58
|
|
Block brachial plexus w/cath plmt w/img
|
$1,923.12 |
$1,923.12 |
$1,923.12 |
$1,533.60
|
|
Block femoral nerve cont infusion cath w/img
|
$1,923.12 |
$1,923.12 |
$1,923.12 |
$1,661.40
|
|
Block plantar digital nerve
|
$1,624.32 |
$1,624.32 |
$1,624.32 |
$530.40
|
|
Blood Clotting (PT/INR) Test
|
$61.92 |
$61.92 |
$61.92 |
$53.00
|
|
Blood Clotting (PTT) Test
|
$102.96 |
$102.96 |
$102.96 |
$73.44
|
|
Blood Count (CBC) Test
|
$122.40 |
$122.40 |
$122.40 |
$74.75
|
|
Blood Count (CBC) Test (without differential)
|
$108.72 |
$108.72 |
$108.72 |
$61.80
|
|
Blood Culture Test
|
$398.88 |
$398.88 |
$398.88 |
$145.80
|
|
Blood draw capillary 36416
|
$27.36 |
$27.36 |
$27.36 |
$20.00
|
|
Blood gases o2 saturation direct measurement
|
$231.12 |
$231.12 |
$231.12 |
$220.35
|
|
Blood gases ph venous
|
$120.96 |
$120.96 |
$120.96 |
$64.60
|
|
Blood occult feces 1-3 determinations other than neoplasm screening qualitative
|
$48.96 |
$48.96 |
$48.96 |
$33.15
|
|
Blood occult feces colorectal neoplasm screening qualitative
|
$51.84 |
$51.84 |
$51.84 |
$33.57
|
|
Blood occult peroxidase activity qualitative gastric
|
$48.96 |
$48.96 |
$48.96 |
$34.00
|
|
Blood smear microscopic w manual differential wbc count
|
$38.16 |
$38.16 |
$38.16 |
$38.61
|
|
Blood typing abo
|
$141.12 |
$141.12 |
$141.12 |
$83.03
|
