|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$852.00 |
$852.00 |
$1,182.40 |
|
|
Appl hip spica cast 1 leg
|
$446.40 |
$446.40 |
$446.40 |
|
|
Application finger splntstatic 29130
|
$252.00 |
$271.20 |
$274.40 |
|
|
Application long leg splint 29505
|
$277.60 |
$405.60 |
$417.60 |
|
|
Application lower leg splint 29515
|
$272.00 |
$372.80 |
$383.20 |
|
|
Application multi layer compression below knee (both sides)
|
$292.00 |
$303.20 |
$324.80 |
|
|
Application of forearm cast 29075
|
$336.00 |
$336.00 |
$469.60 |
|
|
Application of long arm cast 29065
|
$366.40 |
$366.40 |
$477.60 |
|
|
Application of long leg cast 29345
|
$380.00 |
$380.00 |
$502.40 |
|
|
Application of paste boot 29580
|
$251.20 |
$251.20 |
$278.40 |
|
|
Application short leg cast 29405
|
$352.80 |
$352.80 |
$477.60 |
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$2,618.40 |
$2,618.40 |
$2,818.40 |
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$2,521.60 |
$2,521.60 |
$2,822.40 |
|
|
Applicator tag rfid localizer 12gx7cm
|
$289.66 |
$289.66 |
$310.29 |
|
|
Appl long leg cast brace
|
$440.80 |
$440.80 |
$440.80 |
|
|
Appl modality 1/> areas paraffin bath 97018
|
$41.60 |
$49.60 |
$91.20 |
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$72.80 |
$88.80 |
$106.40 |
|
|
Appl multlay comprs arm/hand
|
$220.00 |
$220.00 |
$220.00 |
|
|
Apply finger cast 29086
|
$256.00 |
$256.00 |
$280.00 |
|
|
Apply forearm splintdynamic 29126
|
$196.80 |
$196.80 |
$249.60 |
|
|
Apply halo w/removal cranial
|
$3,181.60 |
$3,181.60 |
$3,181.60 |
|
|
Apply hand/wrist cast 29085
|
$262.40 |
$262.40 |
$446.40 |
|
|
Apply interstit radiat compl
|
$1,520.80 |
$1,520.80 |
$3,843.20 |
|
|
Apply intrcav radiat compl
|
$1,634.40 |
$1,634.40 |
$1,634.40 |
|
|
Apply intrcav radiat interm
|
$1,335.20 |
$1,335.20 |
$1,335.20 |
|
|
Apply intrcav radiat simple
|
$1,543.20 |
$1,543.20 |
$1,543.20 |
|
|
Apply of finger splint 29131
|
$218.40 |
$218.40 |
$264.00 |
|
|
Apply rigid leg cast 29445
|
$428.00 |
$428.00 |
$490.40 |
|
|
Apply short leg castambul type 29425
|
$380.00 |
$380.00 |
$426.40 |
|
|
Apply surf ldr radionuclide
|
$222.40 |
$222.40 |
$222.40 |
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$736.19 |
$736.19 |
$995.12 |
|
|
Aqmbf pet rest & rx stress
|
$386.40 |
$386.40 |
$386.40 |
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$124.80 |
$124.80 |
$135.20 |
|
|
Aquatic exercise - group charge
|
$80.00 |
$86.40 |
$128.00 |
|
|
Argatroban dialysis (accord)
|
$196.11 |
$196.11 |
$640.32 |
|
|
Argatroban dialysis, auromed
|
$215.12 |
$215.12 |
$511.56 |
|
|
Argatroban esrd dialysis 1mg
|
$629.00 |
$629.00 |
$2,564.20 |
|
|
Aripiprazole 441 mg/1.6 ml inj
|
$9,101.88 |
$9,101.88 |
$9,101.88 |
|
|
Arm CT Scan (with contrast, both arms)
|
$1,553.60 |
$2,022.40 |
$2,123.20 |
|
|
Arm CT Scan (without contrast, both arms)
|
$1,328.80 |
$1,575.20 |
$2,038.40 |
|
|
Arm or Leg Ultrasound (limited, left side)
|
$242.40 |
$248.00 |
$424.00 |
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$1,197.05 |
$1,197.05 |
$1,313.89 |
|
|
Art bypass femoral-femoral 35661
|
$3,454.40 |
$3,454.40 |
$9,807.20 |
|
|
Art bypass femoral-popliteal 35656
|
$16,856.00 |
$16,856.00 |
$16,856.00 |
|
|
Art bypass iliofemoral 35665
|
$3,454.40 |
$3,454.40 |
$3,454.40 |
|
|
Arterial blood draw/perc 36620
|
$359.20 |
$359.20 |
$710.40 |
|
|
Artery xray each vessel 7577426
|
$1,101.60 |
$1,101.60 |
$2,569.60 |
|
|
Artery xray of abdomen 75726-26
|
$4,988.80 |
$4,988.80 |
$5,132.00 |
|
|
Artery x-rays adrenal gland
|
$2,377.60 |
$2,377.60 |
$2,377.60 |
|
|
Artery x-rays adrenals
|
$4,252.80 |
$4,252.80 |
$4,252.80 |
|
|
Artery x-rays arm/leg 75710-26
|
$4,323.20 |
$4,323.20 |
$5,014.40 |
|
|
Artery x-rays arms/legs 75716-26
|
$4,136.80 |
$4,136.80 |
$4,875.20 |
|
|
Artery x-rays chest
|
$3,067.20 |
$3,067.20 |
$3,836.00 |
|
|
Artery x-rays lung
|
$2,384.00 |
$2,384.00 |
$4,487.20 |
|
|
Artery x-rays lung
|
$396.00 |
$396.00 |
$1,994.40 |
|
|
Artery x-rays lungs
|
$4,293.60 |
$4,293.60 |
$4,532.00 |
|
|
Artery xrays of pelvis 75736 26
|
$4,551.20 |
$4,551.20 |
$5,102.40 |
|
|
Artery x-rays spine
|
$3,516.80 |
$3,516.80 |
$5,004.00 |
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$572.80 |
$572.80 |
$1,042.40 |
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$1,107.20 |
$1,107.20 |
$1,227.20 |
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$1,216.00 |
$1,216.00 |
$1,328.00 |
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$636.80 |
$636.80 |
$1,095.20 |
|
|
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604
|
$476.80 |
$476.80 |
$1,180.00 |
|
|
Arthrotomy carpometacarpal joint 26070
|
$2,178.40 |
$2,178.40 |
$3,239.20 |
|
|
Ascenda two piece catheter
|
$20,820.80 |
$20,820.80 |
$22,713.60 |
|
|
Asp core fat pad
|
$2,021.60 |
$2,021.60 |
$3,884.80 |
|
|
Asp & inj bone cyst
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
|
|
Asp & inj w/heparin pleurx cath
|
$1,206.40 |
$1,206.40 |
$2,221.60 |
|
|
Aspirate bladder/sprapubic cath 51102
|
$3,886.40 |
$3,886.40 |
$4,516.00 |
|
|
Aspirate/inj ganglion cyst 20612
|
$504.00 |
$504.00 |
$917.60 |
|
|
Aspirate pleura without imaging 32554
|
$1,323.20 |
$1,323.20 |
$1,514.40 |
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$1,326.40 |
$1,326.40 |
$1,940.00 |
|
|
Aspiration peritonsillar abscess
|
$408.00 |
$408.00 |
$1,035.20 |
|
|
Aspir/inj thyroid cyst 60300
|
$990.40 |
$990.40 |
$1,114.40 |
|
|
Asp pq spinal cord cyst/syrinx
|
$1,788.80 |
$1,788.80 |
$1,946.40 |
|
|
Assay myeloperoxidase
|
$169.60 |
$169.60 |
$169.60 |
|
|
Assay of interleukin-6 (il-6)
|
$100.00 |
$100.00 |
$100.00 |
|
|
Assay of salicylate
|
$175.20 |
$175.20 |
$175.20 |
|
|
Assay of tyrosine
|
$56.00 |
$56.00 |
$56.00 |
|
|
Assay of urine sulfate
|
$29.60 |
$29.60 |
$29.60 |
|
|
Assess aphasia/interp/rpt/per hr 96105
|
$300.80 |
$346.40 |
$359.20 |
|
|
Assess cyst contrast inject
|
$610.40 |
$610.40 |
$744.80 |
|
|
Assessment leukocyte fecal qualitative/semiquantitative
|
$27.20 |
$27.20 |
$27.20 |
|
|
Assistive tech assessment, ot
|
$129.60 |
$129.60 |
$129.60 |
|
|
Assist oocyte fertilization
|
$1,280.00 |
$1,280.00 |
$1,280.00 |
|
|
Assist oocyte fertilization
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
|
|
Ast/sgot
|
$36.80 |
$36.80 |
$36.80 |
|
|
Atezolizumab 60 mg/ml intravenous solution (wrapper)
|
$12,006.00 |
$12,006.00 |
$12,006.00 |
|
|
Atropine 0.1 mg/ml injection syringe
|
$15.74 |
$16.80 |
$27.64 |
|
|
Audiometry air + bone
|
$100.80 |
$100.80 |
$100.80 |
|
|
Aud rehab postling hear loss
|
$204.80 |
$204.80 |
$204.80 |
|
|
Aud rehab pre-ling hear loss
|
$199.20 |
$199.20 |
$199.20 |
|
|
Augment injectable kit 3.0cc
|
$6,320.16 |
$6,320.16 |
$7,469.28 |
|
|
Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body
|
$4,879.20 |
$4,879.20 |
$5,128.80 |
|
|
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic
|
$11,984.80 |
$11,984.80 |
$14,078.40 |
|
|
Automated diff wbc count
|
$32.80 |
$32.80 |
$32.80 |
|
|
Avelumab 20 mg/ml intravenous solution
|
$2,453.81 |
$2,453.81 |
$2,572.71 |
|
|
Avul nail plate addl
|
$88.80 |
$216.00 |
$232.80 |
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$324.80 |
$501.60 |
$532.00 |
|
|
Axicabtagene ciloleucel car+
|
$1,546,196.80 |
$1,546,196.80 |
$1,546,196.80 |
|
