|
Apheresis plasma
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,381.53
|
|
Apheresis platelets
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,427.52
|
|
Apheresis rbc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,348.50
|
|
Apheresis wbc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,342.71
|
|
Apl(pml-rara) quant - sendout
|
$228.04 |
$228.04 |
$228.04 |
$465.60
|
|
Appendectomy
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,786.00
|
|
Appendix Removal (Laparoscopic)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,311.00
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,141.08
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,150.00
|
|
Appl bdy cst sho to hip 1thi
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$682.40
|
|
Appl bdy cst sho to hip b th
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$748.00
|
|
Appl bdy cst sho to hip head
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$696.00
|
|
Appl body cast sho to hips
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$390.73
|
|
Appl cast figure-of-eight
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$278.22
|
|
Appl cast plaster velpeau
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$293.96
|
|
Appl cast shoulder spica
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$462.80
|
|
Appl halo type body cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$808.80
|
|
Appl hip spica cast1&1/2
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$501.28
|
|
Appl hip spica cast 1 leg
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$544.48
|
|
Application clubfoot cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$370.58
|
|
Application finger splntstatic 29130
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$219.00
|
|
Application halo femoral
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,821.05
|
|
Application halo pelvic
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,858.61
|
|
Application long leg splint 29505
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$370.00
|
|
Application lower leg splint 29515
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$363.10
|
|
Application multi layer compression below knee (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$406.40
|
|
Application of body cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$557.18
|
|
Application of body cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$390.73
|
|
Application of cylinder cast 29365
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$431.08
|
|
Application of forearm cast 29075
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$384.59
|
|
Application of long arm cast 29065
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$404.63
|
|
Application of long leg cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$426.00
|
|
Application of long leg cast 29345
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$511.68
|
|
Application of paste boot 29580
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$331.74
|
|
Application short leg cast 29405
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,109.00
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,109.00
|
|
Appl long leg cast brace
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$375.00
|
|
Appl mltpln uni ext fixj sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,447.85
|
|
Appl multlay comprs arm/hand
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$339.69
|
|
Appl patllr tdn bearing cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$426.75
|
|
Appl unipln uni ext fixj sys
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,339.00
|
|
Apply finger cast 29086
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$238.15
|
|
Apply forearm splintdynamic 29126
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$265.00
|
|
Apply hand/wrist cast 29085
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$279.40
|
|
Apply of finger splint 29131
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$177.45
|
|
Apply rem fixation device
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,207.18
|
|
Apply rigid leg cast 29445
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$646.40
|
|
Apply short leg castambul type 29425
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$474.88
|
|
App mltpln uni xtrnl fix 1st
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,339.00
|
|
App mltpln uni xtrnl fix xch
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,545.26
|
|
#aptt mix-1:1 incubated
|
$38.60 |
$38.60 |
$38.60 |
$157.30
|
|
Aqaprn-4 antb flo cytmtry ea
|
$41.50 |
$41.50 |
$41.50 |
$231.66
|
|
Aquaporin-4 antibody cba each
|
$13.26 |
$13.26 |
$13.26 |
$116.80
|
|
Aquaporin-4 antibody elisa
|
$12.68 |
$12.68 |
$12.68 |
$135.20
|
|
Aqueous shunt eye w/graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,656.00
|
|
Aqueous shunt eye without graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,356.80
|
|
Artery to vein shunt
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,706.68
|
|
Artery-vein nonautograft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,325.50
|
|
Artery xray each vessel 7577426
|
$310.42 |
$310.42 |
$310.42 |
$1,710.91
|
|
Artery xray of abdomen 75726-26
|
$1,420.68 |
$1,420.68 |
$1,420.68 |
$4,268.50
|
|
Artery x-rays adrenals
|
$936.68 |
$936.68 |
$936.68 |
$3,440.40
|
|
Artery x-rays arms/legs 75716-26
|
$1,030.43 |
$1,030.43 |
$1,030.43 |
$3,844.10
|
|
Artery x-rays lung
|
$936.68 |
$936.68 |
$936.68 |
$2,921.88
|
|
Artery x-rays lung
|
$862.27 |
$862.27 |
$862.27 |
$2,211.12
|
|
Artery x-rays lungs
|
$954.38 |
$954.38 |
$954.38 |
$3,535.57
|
|
Artery xrays of pelvis 75736 26
|
$1,331.19 |
$1,331.19 |
$1,331.19 |
$3,993.41
|
|
Arthrd ant ntrbd min dsc crv
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Arthrd ant ntrbdy cervical
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,989.04
|
|
Arthrd cmbn 1ntrspc lumbar
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,855.00
|
|
Arthrd dst rad/ul jt sgm rsc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,839.00
|
|
Arthrd elbow jt autog graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
Arthrd glenohumeral jt w/grf
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,304.00
|
|
Arthrd pst tq 1ntrspc lum
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
Arthrd si jt perq/min nvas
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$15,959.91
|
|
Arthrd si jt prq wo tfxj dev
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$20,372.87
|
|
Arthrd wrist complete wo grf
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,855.00
|
|
Arthrd wrist lmtd without b1 grf
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,839.00
|
|
Arthrd wrist with autograft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,855.00
|
|
Arthrd wrist w/sliding graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,839.00
|
|
Arthrd wrst iliac/oth agrft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,311.00
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$572.80
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,005.42
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$910.79
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$469.58
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$715.37
|
|
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$699.00
|
|
Arthrodesis big toe joint 28760
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Arthrodesis elbw joint local
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
Arthrodesis glenohumeral jt
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$7,807.24
|
|
Arthrodesis pantalar
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,839.00
|
|
Arthrodesis subtalar
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,560.13
|
|
Arthrodesis triple
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,553.60
|
|
Arthroplasty finger joint 26535
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,821.05
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,240.08
|
|
Arthrotomy carpometacarpal joint 26070
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,884.74
|
|
Arthrotomy/elbow/exp/drain/rmv fb 24000
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,743.15
|
|
Arthrotomy glenhumrl jt w/bx
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,591.33
|
|
Arthrotomy glenohumeral jt
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,110.00
|
|
Arthrotomy strnclav joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,591.33
|
