|
Antigen therapy services
|
$139.10 |
$139.10 |
$139.10 |
$101.40
|
|
Antigen therapy services
|
$139.10 |
$139.10 |
$139.10 |
$96.72
|
|
Antigen therapy services
|
$139.10 |
$139.10 |
$139.10 |
$130.00
|
|
Antigen therapy services
|
$80.60 |
$80.60 |
$80.60 |
$74.00
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$4.00 |
$4.00 |
$4.00 |
$6.10
|
|
Antihemophilic viii/vwf comp
|
$3.32 |
$3.32 |
$3.32 |
$3.67
|
|
Anti-inhibitor
|
$6.32 |
$6.32 |
$6.32 |
$8.33
|
|
Anti mog serum - sendout
|
$53.95 |
$53.95 |
$53.95 |
$132.60
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$53.95 |
$53.95 |
$53.95 |
$38.50
|
|
Ant instr 2-3 vert segm 22845
|
$3,415.10 |
$3,415.10 |
$3,415.10 |
$1,748.00
|
|
Ant instrumentation/4-7 vert seg 22846
|
$3,546.40 |
$3,546.40 |
$3,546.40 |
$1,430.40
|
|
Antinuclear antibodies
|
$53.95 |
$53.95 |
$53.95 |
$90.00
|
|
Antinuclear antibodies titer
|
$50.05 |
$50.05 |
$50.05 |
$80.04
|
|
Antiphosphatidylserine antibody
|
$72.15 |
$72.15 |
$72.15 |
$67.43
|
|
Antistreptolysin o titer
|
$32.50 |
$32.50 |
$32.50 |
$54.00
|
|
Antithrombin iii activity
|
$53.30 |
$53.30 |
$53.30 |
$115.15
|
|
Antithrombin iii injection
|
$10.74 |
$10.74 |
$10.74 |
$11.85
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$2,487.13 |
$2,487.13 |
$2,487.13 |
$8,214.07
|
|
Antithymocyte globuln rabbit
|
$2,685.05 |
$2,685.05 |
$2,685.05 |
$2,111.00
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$3,900.00 |
$3,900.00 |
$3,900.00 |
$4,155.20
|
|
Ant thrc vrt body tethrg <7
|
$9,152.00 |
$9,152.00 |
$9,152.00 |
$4,508.80
|
|
Ant thrc vrt body tethrg 8+
|
$10,153.00 |
$10,153.00 |
$10,153.00 |
$4,968.00
|
|
Aortic Aneurysm Screening Ultrasound
|
$477.10 |
$477.10 |
$477.10 |
$394.55
|
|
Aortic hemiarch graft 33866
|
$5,076.50 |
$5,076.50 |
$5,076.50 |
$2,609.60
|
|
Apheresis immunoads slctv
|
$445.90 |
$445.90 |
$445.90 |
$5,794.21
|
|
Apheresis plasma
|
$6,126.90 |
$6,126.90 |
$6,126.90 |
$3,226.34
|
|
Apheresis platelets
|
$1,634.10 |
$1,634.10 |
$1,634.10 |
$2,195.00
|
|
Apheresis rbc
|
$6,126.90 |
$6,126.90 |
$6,126.90 |
$3,290.80
|
|
Apheresis wbc
|
$572.00 |
$572.00 |
$572.00 |
$3,347.60
|
|
Apl(pml-rara) quant - sendout
|
$929.50 |
$929.50 |
$929.50 |
$513.00
|
|
Appendectomy
|
$2,756.00 |
$2,756.00 |
$2,756.00 |
$5,681.93
|
|
Appendectomy add-on 44955
|
$397.80 |
$397.80 |
$397.80 |
$206.40
|
|
Appendectomy/open/rup/w/absc/peri 44960
|
$3,770.00 |
$3,770.00 |
$3,770.00 |
$1,562.44
|
|
Appendix Removal (Laparoscopic)
|
$2,457.00 |
$2,457.00 |
$2,457.00 |
$7,202.00
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$260.00 |
$260.00 |
$260.00 |
$852.00
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$502.00
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$7,138.95 |
$7,138.95 |
$7,138.95 |
$3,593.46
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$7,138.95 |
$7,138.95 |
$7,138.95 |
$1,146.48
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$512.20
|
|
Application clubfoot cast
|
$594.75 |
$594.75 |
$594.75 |
$303.00
|
|
Application finger splntstatic 29130
|
$385.45 |
$385.45 |
$385.45 |
$208.50
|
|
Application long leg splint 29505
|
$471.90 |
$471.90 |
$471.90 |
$338.25
|
|
Application lower leg splint 29515
|
$471.90 |
$471.90 |
$471.90 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$471.90 |
$471.90 |
$471.90 |
$375.06
|
|
Application of forearm cast 29075
|
$794.30 |
$794.30 |
$794.30 |
$358.20
|
|
Application of long arm cast 29065
|
$794.30 |
$794.30 |
$794.30 |
$396.77
|
|
Application of long leg cast 29345
|
$794.30 |
$794.30 |
$794.30 |
$455.00
|
|
Application of paste boot 29580
|
$471.90 |
$471.90 |
$471.90 |
$340.11
|
|
Application short leg cast 29405
|
$794.30 |
$794.30 |
$794.30 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$2,123.50
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$2,164.64
|
|
Appl mltpln uni ext fixj sys
|
$4,230.20 |
$4,230.20 |
$4,230.20 |
$5,855.00
|
|
Appl modality 1/> areas paraffin bath 97018
|
$107.90 |
$107.90 |
$107.90 |
$69.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$131.95 |
$131.95 |
$131.95 |
$75.98
|
|
Appl multlay comprs arm/hand
|
$471.90 |
$471.90 |
$471.90 |
$289.60
|
|
Appl unipln uni ext fixj sys
|
$2,282.80 |
$2,282.80 |
$2,282.80 |
$5,810.00
|
|
Apply forearm splintdynamic 29126
|
$194.35 |
$194.35 |
$194.35 |
$255.20
|
|
Apply halo w/removal cranial
|
$1,367.60 |
$1,367.60 |
$1,367.60 |
$1,367.60
|
|
Apply hand/wrist cast 29085
|
$471.90 |
$471.90 |
$471.90 |
$271.80
|
|
Apply interstit radiat compl
|
$5,622.50 |
$5,622.50 |
$5,622.50 |
$2,901.80
|
|
Apply intrcav radiat compl
|
$2,251.60 |
$2,251.60 |
$2,251.60 |
$1,813.50
|
|
Apply intrcav radiat simple
|
$1,001.00 |
$1,001.00 |
$1,001.00 |
$1,269.97
|
|
Apply of finger splint 29131
|
$177.45 |
$177.45 |
$177.45 |
$177.45
|
|
Apply rem fixation device
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$2,207.18
|
|
Apply rigid leg cast 29445
|
$794.30 |
$794.30 |
$794.30 |
$555.00
|
|
Apply short leg castambul type 29425
|
$794.30 |
$794.30 |
$794.30 |
$404.74
|
|
Apply srs headframe add-on
|
$585.00 |
$585.00 |
$585.00 |
$585.00
|
|
App mdlty 1+hubbrd tnk ea 15
|
$150.80 |
$150.80 |
$150.80 |
$141.39
|
|
App mltpln uni xtrnl fix 1st
|
$4,565.60 |
$4,565.60 |
$4,565.60 |
$16,139.55
|
|
App skn cll ssp f/n/g/hf 1st
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$3,567.20
|
|
App skn cl ssp agrft t/a/l 1
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$3,567.20
|
|
App topical fluoride varnish
|
$52.00 |
$52.00 |
$52.00 |
$27.20
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$60.27 |
$60.27 |
$60.27 |
$955.43
|
|
#aptt mix-1:1 incubated
|
$157.30 |
$157.30 |
$157.30 |
$157.30
|
|
Aqaprn-4 antb flo cytmtry ea
|
$169.00 |
$169.00 |
$169.00 |
$231.66
|
|
Aqmbf pet rest & rx stress
|
$2,249.65 |
$2,249.65 |
$2,249.65 |
$974.40
|
|
Aquaporin-4 antibody cba each
|
$53.95 |
$53.95 |
$53.95 |
$138.16
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$211.90 |
$211.90 |
$211.90 |
$100.75
|
|
Aquatic exercise - group charge
|
$152.10 |
$152.10 |
$152.10 |
$87.45
|
|
Argatroban nonesrd use 1mg
|
$1,106.49 |
$1,106.49 |
$1,106.49 |
$881.10
|
|
Aripiprazole 441 mg/1.6 ml inj
|
$2,328.61 |
$2,328.61 |
$2,328.61 |
$6,387.85
|
|
Arm CT Scan (with contrast, both arms)
|
$1,601.60 |
$1,601.60 |
$1,601.60 |
$1,687.88
|
|
Arm CT Scan (without contrast, both arms)
|
$763.10 |
$763.10 |
$763.10 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$674.70 |
$674.70 |
$674.70 |
$426.00
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$117.62 |
$117.62 |
$117.62 |
$1,303.25
|
|
Art byp aortofemoral 35647
|
$7,729.80 |
$7,729.80 |
$7,729.80 |
$2,358.00
|
|
Art bypass aortobifemoral 35646
|
$8,574.80 |
$8,574.80 |
$8,574.80 |
$3,443.40
|
|
Art bypass aortobi-iliac 35638
|
$8,736.00 |
$8,736.00 |
$8,736.00 |
$3,525.00
|
|
Art bypass axillary-femoral 35621
|
$5,467.80 |
$5,467.80 |
$5,467.80 |
$2,208.60
|
|
Art bypass axill-fem-femoral 35654
|
$6,832.80 |
$6,832.80 |
$6,832.80 |
$3,058.80
|
|
Art bypass carotid-subclavian 35606
|
$18,484.05 |
$18,484.05 |
$18,484.05 |
$5,724.80
|
|
Art bypass common ipsi carotid 35601
|
$7,043.40 |
$7,043.40 |
$7,043.40 |
$1,958.50
|
|
Art bypass fem-ant-post tib/prl 35666
|
$6,151.60 |
$6,151.60 |
$6,151.60 |
$4,735.49
|
|
Art bypass femoral-femoral 35661
|
$13,756.60 |
$13,756.60 |
$13,756.60 |
$5,291.20
|
|
Art bypass femoral-popliteal 35656
|
$5,322.20 |
$5,322.20 |
$5,322.20 |
$5,273.60
|
|
Art bypass iliofemoral 35665
|
$5,811.00 |
$5,811.00 |
$5,811.00 |
$2,933.07
|
|
Art bypass subclav-subclavian 35612
|
$3,066.70 |
$3,066.70 |
$3,066.70 |
$2,272.80
|
|
Art byp grft axill-brachial
|
$6,019.00 |
$6,019.00 |
$6,019.00 |
$1,644.28
|
|
Art byp grft fem-femoral 35558
|
$6,013.80 |
$6,013.80 |
$6,013.80 |
$2,477.40
|
