|
Ghs nerve block brachial plexus
|
$803.04 |
$803.04 |
$803.04 |
$1,789.51
|
|
Ghs nerve block sciatic nerve
|
$1,556.24 |
$1,556.24 |
$1,556.24 |
$1,745.25
|
|
Ghs ot prosthetic training/15 min
|
$41.44 |
$41.44 |
$41.44 |
$92.35
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$529.20 |
$529.20 |
$529.20 |
$2,418.92
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$36.96 |
$36.96 |
$36.96 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$14,674.24 |
$14,674.24 |
$14,674.24 |
$25,226.40
|
|
Graft patch felt ptfe 2x2
|
$19,883.36 |
$19,883.36 |
$19,883.36 |
$19,883.36
|
|
Graft xenmtrx sft rect 15x20cm
|
$20,497.12 |
$20,497.12 |
$20,497.12 |
$32,353.75
|
|
Graft xenmtrx sft rect 19x28cm
|
$17,094.56 |
$17,094.56 |
$17,094.56 |
$3,827.40
|
|
Guide wire threaded 1.4x150mm
|
$1,058.40 |
$1,058.40 |
$1,058.40 |
$3,028.48
|
|
Guide worley csg 9fx50cm std
|
$684.32 |
$684.32 |
$684.32 |
$1,166.40
|
|
Gw stiffened micro access kit
|
$1,680.00 |
$1,680.00 |
$1,680.00 |
$1,960.00
|
|
Hand X-ray
|
$206.08 |
$206.08 |
$206.08 |
$317.78
|
|
Heparin assay
|
$76.16 |
$76.16 |
$76.16 |
$107.50
|
|
Hip X-ray
|
$262.64 |
$262.64 |
$262.64 |
$262.64
|
|
Hydration IV infusion each additional hour
|
$134.40 |
$134.40 |
$134.40 |
$125.45
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$200.48 |
$200.48 |
$200.48 |
$388.70
|
|
Icd cobalt xt dr MRI is1 df1
|
$16,934.40 |
$16,934.40 |
$16,934.40 |
$48,847.50
|
|
Icd crtd cobalt hf MRI is1 df1
|
$22,792.00 |
$22,792.00 |
$22,792.00 |
$44,003.25
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$17.92 |
$17.92 |
$17.92 |
$76.00
|
|
Infectious agent nucleic acid quantification bk virus
|
$48.72 |
$48.72 |
$48.72 |
$300.00
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$638.96 |
$638.96 |
$638.96 |
$1,391.40
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$803.04 |
$803.04 |
$803.04 |
$1,017.28
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$99.68 |
$99.68 |
$99.68 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$99.68 |
$99.68 |
$99.68 |
$150.00
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$119.28 |
$119.28 |
$119.28 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$48.72 |
$48.72 |
$48.72 |
$130.19
|
|
Inj w/fluor eval cv device
|
$277.20 |
$277.20 |
$277.20 |
$573.00
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$134.40 |
$134.40 |
$134.40 |
$186.55
|
|
IV infusion therapy/prophylaxis/diagnosis concurrent infusion
|
$134.40 |
$134.40 |
$134.40 |
$170.94
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$142.24 |
$142.24 |
$142.24 |
$153.40
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$200.48 |
$200.48 |
$200.48 |
$476.50
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$8.96 |
$8.96 |
$8.96 |
$52.50
|
|
Kit lead specify 5-6-5
|
$4,480.00 |
$4,480.00 |
$4,480.00 |
$13,784.80
|
|
Kit tissue closure sealant adhesive air leak progel 4 ml pleura
|
$1,136.24 |
$1,136.24 |
$1,136.24 |
$2,836.08
|
|
Knee X-ray
|
$263.20 |
$263.20 |
$263.20 |
$387.20
|
|
Laryngoscopy telescopic
|
$1,174.88 |
$1,174.88 |
$1,174.88 |
$685.43
|
|
Lead acuity x4 spiral l 86cm
|
$2,128.00 |
$2,128.00 |
$2,128.00 |
$4,863.24
|
|
Lead ingevity 45cm pfret MRI
|
$575.12 |
$575.12 |
$575.12 |
$4,132.20
|
|
Lead tachy durata sj4 58cm
|
$4,236.96 |
$4,236.96 |
$4,236.96 |
$13,488.75
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$349.72 |
$349.72 |
$349.72 |
$5,001.00
|
|
Liberta rc ipg
|
$20,160.00 |
$20,160.00 |
$20,160.00 |
$48,321.00
|
|
Lower Back (Lumbar Spine) X-ray
|
$197.12 |
$197.12 |
$197.12 |
$328.23
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$672.00 |
$672.00 |
$672.00 |
$1,922.13
|
|
Mayo cortisol free
|
$18.48 |
$18.48 |
$18.48 |
$109.85
|
|
Mayo ffspg allergen clam igg
|
$10.36 |
$10.36 |
$10.36 |
$37.05
|
|
Mayo paval fluorescent antibody screen agna type 1
|
$89.60 |
$89.60 |
$89.60 |
$187.00
|
|
Mayo valpg valproic acid free therapeutic drug level
|
$17.37 |
$17.37 |
$17.37 |
$80.00
|
|
Methotrexate sodium (pf) 1 gram solution for injection
|
$31.34 |
$31.34 |
$31.34 |
$52.04
|
|
Mitomycin 40 mg intravenous solution
|
$98.74 |
$98.74 |
$98.74 |
$262.93
|
|
Monitor reveal linq ii cardiac
|
$5,426.40 |
$5,426.40 |
$5,426.40 |
$10,575.00
|
|
Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain
|
$151.20 |
$151.20 |
$151.20 |
$428.00
|
|
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual
|
$78.12 |
$78.12 |
$78.12 |
$309.50
|
|
M/phmtrc alys ishquant/semiq
|
$235.20 |
$235.20 |
$235.20 |
$540.15
|
|
MRA chest wwo IV cont
|
$1,715.28 |
$1,715.28 |
$1,715.28 |
$1,309.75
|
|
MRA without cont, abd
|
$1,286.88 |
$1,286.88 |
$1,286.88 |
$1,028.25
|
|
MRA without fol w/cont, abd
|
$1,715.28 |
$1,715.28 |
$1,715.28 |
$1,972.32
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$14.56 |
$14.56 |
$14.56 |
$115.05
|
|
Njx aa&/strd lmbr plex nfs
|
$1,556.24 |
$1,556.24 |
$1,556.24 |
$1,555.85
|
|
Njx aa&/strd sc nrv nfs img
|
$1,556.24 |
$1,556.24 |
$1,556.24 |
$1,644.28
|
|
Observation per hour
|
$59.92 |
$59.92 |
$59.92 |
$75.15
|
|
Oral aprepitant
|
$7.27 |
$7.27 |
$7.27 |
$260.40
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$56.56 |
$56.56 |
$56.56 |
$94.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$102.60
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$105.50
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$96.11
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$95.65
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$94.25
|
|
Ot training self care/home management direct contact each 15 minutes
|
$54.88 |
$54.88 |
$54.88 |
$93.60
|
|
Penile rear tip xtnd 0.5cm
|
$10,917.76 |
$10,917.76 |
$10,917.76 |
$26,765.44
|
|
Pfc sigma fem post aug sz3 8mm
|
$20,503.84 |
$20,503.84 |
$20,503.84 |
$22,916.00
|
|
Pin caspar distraction 12mm
|
$6,048.00 |
$6,048.00 |
$6,048.00 |
$29,164.20
|
|
Platelets hla matched leukocytes reduced apheresis/pheresis each unit
|
$513.52 |
$513.52 |
$513.52 |
$1,532.70
|
|
Platelets leukocytes reduced each unit
|
$124.88 |
$124.88 |
$124.88 |
$274.95
|
|
Platelets leukocytes reduced irradiated each unit
|
$107.52 |
$107.52 |
$107.52 |
$334.10
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$479.36 |
$479.36 |
$479.36 |
$1,530.10
|
|
Probe cryo 1150mm endo flex ster disp
|
$2,744.00 |
$2,744.00 |
$2,744.00 |
$5,175.00
|
|
Protector nerve neurawrap 4cm
|
$1,723.68 |
$1,723.68 |
$1,723.68 |
$3,608.70
|
|
Pt application of modality >=1 area electrical stimulation each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$87.49
|
|
Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan
|
$40.88 |
$40.88 |
$40.88 |
$43.92
|
|
Pt therapeutic procedure >=1 area gait training each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$83.20
|
|
Pt therapeutic procedure >=1 area massage each 15 minutes
|
$54.88 |
$54.88 |
$54.88 |
$79.30
|
|
Pt wheelchair management each 15 minutes
|
$41.44 |
$41.44 |
$41.44 |
$84.90
|
|
Radphm lcl tomogr sgl area sgl day
|
$664.16 |
$664.16 |
$664.16 |
$2,177.00
|
|
Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit
|
$447.44 |
$447.44 |
$447.44 |
$537.70
|
|
Red blood cells leukocytes reduced irradiated each unit
|
$210.00 |
$210.00 |
$210.00 |
$645.45
|
|
Russell viper venom diluted
|
$8.43 |
$8.43 |
$8.43 |
$73.03
|
|
Scan duplex extremity veins unilateral/limited study
|
$253.12 |
$253.12 |
$253.12 |
$691.07
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$30.24 |
$30.24 |
$30.24 |
$27.44
|
|
Screening prostate cancer PSA
|
$52.08 |
$52.08 |
$52.08 |
$96.00
|
|
Screw cortex 2.0 x 10mm
|
$18,707.36 |
$18,707.36 |
$18,707.36 |
$22,380.00
|
|
Sheath gldlight lasr 12fx50cm
|
$3,091.20 |
$3,091.20 |
$3,091.20 |
$7,076.25
|
|
Shoulder X-ray
|
$281.12 |
$281.12 |
$281.12 |
$307.20
|
|
Shunt glaucoma baerveldt 350mm
|
$3,360.00 |
$3,360.00 |
$3,360.00 |
$4,050.00
|
|
Sling suprapubic suburetheral
|
$7,022.96 |
$7,022.96 |
$7,022.96 |
$7,586.40
|
|
Stent axios caut enh 15x10mm electrocaut
|
$17,814.16 |
$17,814.16 |
$17,814.16 |
$30,010.80
|
|
Stent bili dbl pgtl 10fx5cm
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$1,512.00
|
|
Stent bili rx wallflx 10x80 uncvr
|
$15,394.96 |
$15,394.96 |
$15,394.96 |
$23,887.50
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$278.32 |
$278.32 |
$278.32 |
$336.00
|
|
St evaluation swallow function
|
$137.76 |
$137.76 |
$137.76 |
$323.72
|