|
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 sgm img ir flrscn angrph
|
$489.45 |
$489.45 |
$489.45 |
$322.40
|
|
Ant sgm img i&r speclr mic
|
$499.85 |
$499.85 |
$499.85 |
$286.00
|
|
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 |
$620.10 |
$394.55
|
|
Aortic circulation assist 33971
|
$3,117.40 |
$3,117.40 |
$3,117.40 |
$1,719.20
|
|
Aortic dysfunction/dilation
|
$2,260.70 |
$2,260.70 |
$2,260.70 |
$1,153.60
|
|
Aortic hemiarch graft 33866
|
$5,076.50 |
$5,076.50 |
$5,076.50 |
$2,609.60
|
|
Aortic suspension
|
$4,492.80 |
$4,492.80 |
$4,492.80 |
$1,414.87
|
|
Apc gene known fam variants
|
$1,255.80 |
$1,255.80 |
$1,255.80 |
$319.20
|
|
Apheresis immunoads slctv
|
$17,511.00 |
$17,511.00 |
$17,511.00 |
$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
|
$6,126.90 |
$6,126.90 |
$6,126.90 |
$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
|
|
Appendico-vesicostomy
|
$5,839.60 |
$5,839.60 |
$5,839.60 |
$1,632.03
|
|
Appendix Removal (Laparoscopic)
|
$2,457.00 |
$17,444.70 |
$17,444.70 |
$7,202.00
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$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
|
|
Appl bdy cst sho to hip b th
|
$626.60 |
$626.60 |
$626.60 |
$561.60
|
|
Appl cast shoulder spica
|
$794.30 |
$794.30 |
$794.30 |
$486.03
|
|
Appl halo cranial 6+pins
|
$2,615.60 |
$2,615.60 |
$2,615.60 |
$2,211.05
|
|
Appl halo type body cast
|
$585.00 |
$585.00 |
$585.00 |
$561.60
|
|
Appl hip spica cast1&1/2
|
$603.20 |
$603.20 |
$603.20 |
$501.28
|
|
Appl hip spica cast 1 leg
|
$527.80 |
$527.80 |
$527.80 |
$499.20
|
|
Application clubfoot cast
|
$471.90 |
$471.90 |
$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 body cast
|
$794.30 |
$794.30 |
$794.30 |
$561.60
|
|
Application of cylinder cast 29365
|
$794.30 |
$794.30 |
$794.30 |
$431.08
|
|
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
|
$794.30 |
$794.30 |
$794.30 |
$435.54
|
|
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 long leg cast brace
|
$794.30 |
$794.30 |
$794.30 |
$468.00
|
|
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 patllr tdn bearing cast
|
$794.30 |
$794.30 |
$794.30 |
$420.21
|
|
Appl unipln uni ext fixj sys
|
$2,282.80 |
$2,282.80 |
$2,282.80 |
$5,810.00
|
|
Apply finger cast 29086
|
$161.20 |
$161.20 |
$161.20 |
$242.20
|
|
Apply forearm splintdynamic 29126
|
$385.45 |
$385.45 |
$385.45 |
$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
|
$3,111.55 |
$3,111.55 |
$5,622.50 |
$2,901.80
|
|
Apply intrcav radiat compl
|
$5,363.15 |
$5,363.15 |
$5,363.15 |
$1,813.50
|
|
Apply intrcav radiat simple
|
$3,595.15 |
$3,595.15 |
$3,595.15 |
$1,269.97
|
|
Apply of finger splint 29131
|
$177.45 |
$177.45 |
$177.45 |
$177.45
|
|
Apply rem fixation device
|
$4,785.30 |
$4,785.30 |
$4,785.30 |
$2,207.18
|
|
Apply rigid leg cast 29445
|
$794.30 |
$794.30 |
$794.30 |
$555.00
|
|
Apply r&l pulm art bands
|
$8,580.00 |
$8,580.00 |
$8,580.00 |
$5,532.80
|
|
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 mltpln uni xtrnl fix xch
|
$4,785.30 |
$4,785.30 |
$5,504.20 |
$3,526.50
|
|
App skn cll ssp f/n/g/hf 1st
|
$552.50 |
$3,567.20 |
$3,567.20 |
$3,567.20
|
|
App skn cl ssp agrft t/a/l 1
|
$453.05 |
$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
|
|
Aqueous shunt eye w/graft
|
$4,290.00 |
$4,290.00 |
$4,290.00 |
$6,105.79
|
|
Aqueous shunt eye without graft
|
$3,640.00 |
$3,640.00 |
$3,640.00 |
$6,105.79
|
|
Arch supp att to shoe metata
|
$23.17 |
$23.17 |
$23.17 |
$75.23
|
|
Argatroban nonesrd use 1mg
|
$1,106.49 |
$1,106.49 |
$1,106.49 |
$881.10
|
|
Ar gene charac alleles
|
$614.25 |
$614.25 |
$614.25 |
$287.70
|
|
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 |
$1,933.10 |
$1,687.88
|
|
Arm CT Scan (without contrast, both arms)
|
$477.10 |
$477.10 |
$763.10 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$477.10 |
$477.10 |
$674.70 |
$426.00
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$117.62 |
$117.62 |
$147.75 |
$1,303.25
|
|
Art byp aor celiac msn and renal 35631
|
$9,367.80 |
$9,367.80 |
$9,367.80 |
$5,926.00
|
|
Art byp aortofemoral 35647
|
$7,729.80 |
$7,729.80 |
$7,729.80 |
$2,358.00
|
|
Art byp aortoiliac 35637
|
$8,593.00 |
$8,593.00 |
$8,593.00 |
$2,942.40
|