|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$9,857.02 |
$9,857.02 |
$9,857.02 |
$512.20
|
|
Application finger splntstatic 29130
|
$653.00 |
$653.00 |
$653.00 |
$208.50
|
|
Application long leg splint 29505
|
$204.68 |
$204.68 |
$204.68 |
$338.25
|
|
Application lower leg splint 29515
|
$171.00 |
$171.00 |
$171.00 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$5,805.00 |
$5,805.00 |
$5,805.00 |
$375.06
|
|
Application of forearm cast 29075
|
$273.00 |
$273.00 |
$273.00 |
$358.20
|
|
Application of long arm cast 29065
|
$273.00 |
$273.00 |
$273.00 |
$396.77
|
|
Application of paste boot 29580
|
$380.90 |
$380.90 |
$380.90 |
$340.11
|
|
Application short leg cast 29405
|
$273.00 |
$273.00 |
$273.00 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$5,178.38 |
$5,178.38 |
$5,178.38 |
$2,123.50
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$9,857.02 |
$9,857.02 |
$9,857.02 |
$2,164.64
|
|
Applicator tag rfid localizer 12gx7cm
|
$2,783.02 |
$2,783.02 |
$2,783.02 |
$981.75
|
|
Appl modality 1/> areas paraffin bath 97018
|
$2,705.00 |
$2,705.00 |
$2,705.00 |
$69.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$37.70 |
$37.70 |
$37.70 |
$75.98
|
|
Apply hand/wrist cast 29085
|
$155.35 |
$155.35 |
$155.35 |
$271.80
|
|
Apply rigid leg cast 29445
|
$7,031.00 |
$7,031.00 |
$7,031.00 |
$555.00
|
|
Apply short leg castambul type 29425
|
$273.00 |
$273.00 |
$273.00 |
$404.74
|
|
App topical fluoride varnish
|
$37.70 |
$37.70 |
$37.70 |
$27.20
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$1,185.25 |
$1,185.25 |
$1,185.25 |
$955.43
|
|
Aqaprn-4 antb flo cytmtry ea
|
$330.85 |
$330.85 |
$330.85 |
$231.66
|
|
Aqmbf pet rest & rx stress
|
$3,615.95 |
$3,615.95 |
$3,615.95 |
$974.40
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$94.25 |
$94.25 |
$94.25 |
$100.75
|
|
Argatroban nonesrd use 1mg
|
$528.90 |
$528.90 |
$528.90 |
$881.10
|
|
Arm CT Scan (with contrast, both arms)
|
$4,612.90 |
$4,612.90 |
$4,612.90 |
$1,687.88
|
|
Arm CT Scan (without contrast, both arms)
|
$1,969.50 |
$1,969.50 |
$1,969.50 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$638.00 |
$638.00 |
$638.00 |
$426.00
|
|
Arterial blood draw/perc 36620
|
$152.00 |
$152.00 |
$152.00 |
$478.96
|
|
Artery-vein nonautograft
|
$64,843.91 |
$64,843.91 |
$64,843.91 |
$7,236.06
|
|
Artery xray each vessel 7577426
|
$51,668.03 |
$51,668.03 |
$51,668.03 |
$1,888.99
|
|
Artery xray of abdomen 75726-26
|
$79,948.84 |
$79,948.84 |
$79,948.84 |
$4,618.71
|
|
Artery x-rays arm/leg 75710-26
|
$43,858.67 |
$43,858.67 |
$43,858.67 |
$3,513.67
|
|
Artery x-rays arms/legs 75716-26
|
$46,702.83 |
$46,702.83 |
$46,702.83 |
$3,860.40
|
|
Artery x-rays chest
|
$8.45 |
$8.45 |
$8.45 |
$2,895.07
|
|
Artery xrays of pelvis 75736 26
|
$6,287.45 |
$6,287.45 |
$6,287.45 |
$4,306.40
|
|
Artery x-rays spine
|
$10,348.65 |
$10,348.65 |
$10,348.65 |
$4,792.33
|
|
Arthrd ant ntrbd min dsc crv
|
$76,184.36 |
$76,184.36 |
$76,184.36 |
$10,629.07
|
|
Arthrd ant ntrbd min dsc lum
|
$164,930.33 |
$164,930.33 |
$164,930.33 |
$3,720.00
|
|
Arthrd ant ntrbdy cervical
|
$72,791.76 |
$72,791.76 |
$72,791.76 |
$9,951.20
|
|
Arthrd cmbn 1ntrspc lumbar
|
$108,801.31 |
$108,801.31 |
$108,801.31 |
$8,434.40
|
|
Arthrd lat xtrcvtry tq thrc
|
$5,992.00 |
$5,992.00 |
$5,992.00 |
$4,312.80
|
|
Arthrd pst tq 1ntrspc lum
|
$133,349.81 |
$133,349.81 |
$133,349.81 |
$4,627.00
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$1,937.80 |
$1,937.80 |
$1,937.80 |
$609.00
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$1,630.20 |
$1,630.20 |
$1,630.20 |
$1,005.42
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$2,166.40 |
$2,166.40 |
$2,166.40 |
$910.79
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$421.85 |
$421.85 |
$421.85 |
$494.40
|
|
Arthrodes/ant/cerv below c2 ea add 22552
|
$76,377.81 |
$76,377.81 |
$76,377.81 |
$952.80
|
|
Arthrodesis/cerv/thor/lumb/ea add 22585
|
$1,078.00 |
$1,078.00 |
$1,078.00 |
$822.60
|
|
Arthrodesis/combine app/ea add 22634
|
$118,326.73 |
$118,326.73 |
$118,326.73 |
$1,193.60
|
|
Arthrodesis/post interbdy/ea add 22632
|
$169,011.15 |
$169,011.15 |
$169,011.15 |
$768.00
|
|
Arthrodesis/sg level/cerv/below c2 22600
|
$4,344.00 |
$4,344.00 |
$4,344.00 |
$3,083.20
|
|
Arthrodesis/sng lev/ea add ver seg 22614
|
$90,557.72 |
$90,557.72 |
$90,557.72 |
$3,099.50
|
|
Arthrodesis subtalar
|
$79,606.97 |
$79,606.97 |
$79,606.97 |
$13,057.20
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$61,484.07 |
$61,484.07 |
$61,484.07 |
$4,627.00
|
|
Arthrp ntrcrp/crp/mtcr ntrps
|
$53,202.23 |
$53,202.23 |
$53,202.23 |
$4,670.40
|
|
Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah)
|
$66,795.64 |
$66,795.64 |
$66,795.64 |
$5,241.60
|
|
Ascenda two piece catheter
|
$15,324.40 |
$15,324.40 |
$15,324.40 |
$22,792.00
|
|
Ascvd rsk mng clin stf pr mo
|
$60.45 |
$60.45 |
$60.45 |
$109.46
|
|
Asp core fat pad
|
$14,942.22 |
$14,942.22 |
$14,942.22 |
$1,123.50
|
|
Asp & inj w/heparin pleurx cath
|
$57,018.64 |
$57,018.64 |
$57,018.64 |
$1,546.46
|
|
Aspirate bladder/sprapubic cath 51102
|
$702.00 |
$702.00 |
$702.00 |
$3,226.20
|
|
Aspirate/inj ganglion cyst 20612
|
$223.00 |
$223.00 |
$223.00 |
$441.30
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$2,762.40 |
$2,762.40 |
$2,762.40 |
$1,250.04
|
|
Assay dir meas fr estradiol
|
$54.60 |
$54.60 |
$54.60 |
$68.00
|
|
Assay of breath ethanol
|
$125.45 |
$125.45 |
$125.45 |
$52.62
|
|
Assay of interleukin-6 (il-6)
|
$243.75 |
$243.75 |
$243.75 |
$79.00
|
|
Assay of leflunomide
|
$227.50 |
$227.50 |
$227.50 |
$92.50
|
|
Assay of osteocalcin
|
$183.95 |
$183.95 |
$183.95 |
$93.60
|
|
Assay of prostaglandin
|
$64.35 |
$64.35 |
$64.35 |
$230.00
|
|
Assay of urine sulfate
|
$22.75 |
$22.75 |
$22.75 |
$28.20
|
|
Assess cyst contrast inject
|
$2,062.90 |
$2,062.90 |
$2,062.90 |
$453.04
|
|
Assessment leukocyte fecal qualitative/semiquantitative
|
$354.90 |
$354.90 |
$354.90 |
$46.80
|
|
Assist-bilat spinal disk surgery add-on 63035
|
$66,693.75 |
$66,693.75 |
$66,693.75 |
$1,003.60
|
|
Ast/sgot
|
$35.75 |
$35.75 |
$35.75 |
$45.90
|
|
Athrectomy fem/pop/unilateral 37225
|
$73,534.54 |
$73,534.54 |
$73,534.54 |
$16,141.30
|
|
Athrectomy tib/pero/unilat/ini ves 37229
|
$44,077.15 |
$44,077.15 |
$44,077.15 |
$15,188.25
|
|
Atropine 0.1 mg/ml injection syringe
|
$143.35 |
$143.35 |
$143.35 |
$53.24
|
|
Attn at delivery+ 1 stabilization of newborn 99464
|
$189.00 |
$189.00 |
$189.00 |
$188.16
|
|
Audit/dast 15-30 min
|
$81.00 |
$81.00 |
$81.00 |
$79.80
|
|
Audit/dast over 30 min
|
$161.00 |
$161.00 |
$161.00 |
$110.95
|
|
Augment injectable kit 3.0cc
|
$4,652.05 |
$4,652.05 |
$4,652.05 |
$6,963.84
|
|
Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body
|
$6,632.60 |
$6,632.60 |
$6,632.60 |
$7,109.05
|
|
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic
|
$19,865.95 |
$19,865.95 |
$19,865.95 |
$10,415.40
|
|
Av fusion direct any site
|
$54,356.60 |
$54,356.60 |
$54,356.60 |
$5,419.00
|
|
Avul nail plate addl
|
$239.85 |
$239.85 |
$239.85 |
$189.10
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$405.00 |
$405.00 |
$405.00 |
$326.27
|
|
Azathioprine 50 mg tablet
|
$3.00 |
$3.00 |
$3.00 |
$3.44
|
|
Azithromycin 500 mg intravenous solution
|
$23.50 |
$23.50 |
$23.50 |
$37.53
|
|
Aztreonam 1 gram solution for injection
|
$282.40 |
$282.40 |
$282.40 |
$157.30
|
|
Baclofen 50 mcg/ml intrathecal solution (wrapper)
|
$367.20 |
$367.20 |
$367.20 |
$158.07
|
|
Baclofen eval charges
|
$113.75 |
$113.75 |
$113.75 |
$87.50
|
|
Bacterial meningitis antigen
|
$40.95 |
$40.95 |
$40.95 |
$66.30
|
|
Bacterial vaginosis pcr
|
$631.15 |
$631.15 |
$631.15 |
$287.04
|
|
Bag urine leg fbrc strap 32oz flipflo anti-reflux valve
|
$63.46 |
$63.46 |
$63.46 |
$16.00
|
|
Balance and Coordination Retraining (each 15 minutes)
|
$1,689.00 |
$1,689.00 |
$1,689.00 |
$102.20
|
|
Balloon dilate urtrl strix
|
$1,534.65 |
$1,534.65 |
$1,534.65 |
$2,118.00
|
|
Barium Enema (Colon X-ray, barium only)
|
$436.80 |
$436.80 |
$436.80 |
$666.90
|
|
Barium Swallow (Esophagus X-ray)
|
$369.20 |
$369.20 |
$369.20 |
$484.80
|
|
Barrier film 1.0ml wipe
|
$0.23 |
$0.23 |
$0.23 |
$17.66
|
|
Barrier film 28ml spray no stng cavilon
|
$19.11 |
$19.11 |
$19.11 |
$19.50
|
|
Barrier skin flat ctf 2.75in
|
$0.44 |
$0.44 |
$0.44 |
$0.44
|
