|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$204.00 |
$204.00 |
$204.00 |
$490.50
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$845.60 |
$845.60 |
$845.60 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$213.60 |
$213.60 |
$213.60 |
$1,132.20
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$213.60 |
$213.60 |
$213.60 |
$508.18
|
|
Application finger splntstatic 29130
|
$415.20 |
$415.20 |
$415.20 |
$208.50
|
|
Application long leg splint 29505
|
$413.60 |
$413.60 |
$413.60 |
$338.25
|
|
Application lower leg splint 29515
|
$413.60 |
$413.60 |
$413.60 |
$334.20
|
|
Application multi layer compression below knee (both sides)
|
$862.40 |
$862.40 |
$862.40 |
$370.92
|
|
Application of paste boot 29580
|
$430.40 |
$430.40 |
$430.40 |
$336.00
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$1,904.80 |
$1,904.80 |
$1,904.80 |
$2,109.00
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$4,908.80 |
$4,908.80 |
$4,908.80 |
$2,123.50
|
|
Appl modality 1/> areas paraffin bath 97018
|
$104.80 |
$104.80 |
$104.80 |
$68.00
|
|
Apply of finger splint 29131
|
$192.00 |
$192.00 |
$192.00 |
$177.45
|
|
Apply rigid leg cast 29445
|
$917.60 |
$917.60 |
$917.60 |
$555.00
|
|
Aquaporin-4 antibody cba each
|
$52.80 |
$52.80 |
$52.80 |
$140.84
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$256.00 |
$256.00 |
$256.00 |
$100.00
|
|
Aquatic exercise - group charge
|
$218.40 |
$218.40 |
$218.40 |
$87.15
|
|
Argatroban nonesrd use 1mg
|
$606.00 |
$606.00 |
$606.00 |
$881.10
|
|
Arterial blood draw/perc 36620
|
$1,788.00 |
$1,788.00 |
$1,788.00 |
$485.69
|
|
Artery xray each vessel 7577426
|
$3,147.20 |
$3,147.20 |
$3,147.20 |
$1,865.50
|
|
Artery xray of abdomen 75726-26
|
$10,811.20 |
$10,811.20 |
$10,811.20 |
$4,515.50
|
|
Artery x-rays arm/leg 75710-26
|
$6,960.00 |
$6,960.00 |
$6,960.00 |
$3,483.84
|
|
Artery x-rays arms/legs 75716-26
|
$6,960.00 |
$6,960.00 |
$6,960.00 |
$3,729.00
|
|
Artery xrays of pelvis 75736 26
|
$10,811.20 |
$10,811.20 |
$10,811.20 |
$4,306.40
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$781.60 |
$781.60 |
$781.60 |
$608.40
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$1,244.80 |
$1,244.80 |
$1,244.80 |
$901.60
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$526.40 |
$526.40 |
$526.40 |
$493.50
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$815.20 |
$815.20 |
$815.20 |
$726.66
|
|
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604
|
$889.60 |
$889.60 |
$889.60 |
$699.00
|
|
Asp & inj w/heparin pleurx cath
|
$349.60 |
$349.60 |
$349.60 |
$1,436.40
|
|
Aspirate bladder/sprapubic cath 51102
|
$3,553.60 |
$3,553.60 |
$3,553.60 |
$3,162.90
|
|
Aspirate pleura without imaging 32554
|
$911.20 |
$911.20 |
$911.20 |
$1,196.52
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$1,326.40 |
$1,326.40 |
$1,326.40 |
$1,226.87
|
|
Assay alkaline phosphatase
|
$34.40 |
$34.40 |
$34.40 |
$42.60
|
|
Assay dir meas fr estradiol
|
$140.00 |
$140.00 |
$140.00 |
$67.62
|
|
Assay of urine sulfate
|
$22.40 |
$22.40 |
$22.40 |
$28.20
|
|
Assess cyst contrast inject
|
$120.00 |
$120.00 |
$120.00 |
$447.33
|
|
Ast/sgot
|
$21.60 |
$21.60 |
$21.60 |
$45.60
|
|
Atropine 0.1 mg/ml injection syringe
|
$161.00 |
$161.00 |
$161.00 |
$53.24
|
|
Audiometry air + bone
|
$163.20 |
$163.20 |
$163.20 |
$185.15
|
|
Auditory function 60 min
|
$111.20 |
$111.20 |
$111.20 |
$210.40
|
|
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic
|
$11,607.20 |
$11,607.20 |
$11,607.20 |
$10,384.40
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$560.80 |
$560.80 |
$560.80 |
$326.27
|
|
Azathioprine 50 mg tablet
|
$10.60 |
$10.60 |
$10.60 |
$3.25
|
|
Azithromycin 500 mg intravenous solution
|
$25.40 |
$25.40 |
$25.40 |
$36.36
|
|
Aztreonam 1 gram solution for injection
|
$655.00 |
$655.00 |
$655.00 |
$157.30
|
|
Baclofen eval charges
|
$211.20 |
$211.20 |
$211.20 |
$87.50
|
|
Bacterial meningitis antigen
|
$48.00 |
$48.00 |
$48.00 |
$66.30
|
|
Bacterial vaginosis pcr
|
$292.00 |
$292.00 |
$292.00 |
$287.04
|
|
#bac vag cand-c. albicans naa
|
$140.00 |
$140.00 |
$140.00 |
$109.20
|
|
B cells total count
|
$157.60 |
$157.60 |
$157.60 |
$131.30
|
|
Benztropine 1 mg/ml injection solution
|
$229.00 |
$229.00 |
$229.00 |
$106.46
|
|
Beta 2 glycoprotein 1 antibody iga
|
$105.60 |
$105.60 |
$105.60 |
$82.20
|
|
Beta-2 microglobulin
|
$67.20 |
$67.20 |
$67.20 |
$84.75
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$432.80 |
$432.80 |
$432.80 |
$65.00
|
|
Bilateral n block inj occipital 64405
|
$2,314.40 |
$2,314.40 |
$2,314.40 |
$808.17
|
|
Bilateral n block inj trigeminal 64400
|
$1,064.80 |
$1,064.80 |
$1,064.80 |
$586.30
|
|
Bilicheck
|
$24.80 |
$24.80 |
$24.80 |
$27.00
|
|
Bilirubin direct
|
$24.80 |
$24.80 |
$24.80 |
$50.40
|
|
Bilirubin total
|
$10.00 |
$10.00 |
$10.00 |
$53.84
|
|
Binder abdominal lg 12 x 62-74
|
$80.80 |
$80.80 |
$80.80 |
$50.14
|
|
Biopsy abdominal mass
|
$2,391.20 |
$2,391.20 |
$2,391.20 |
$1,716.00
|
|
Biopsy bone trocar/needle superficial
|
$1,646.40 |
$1,646.40 |
$1,646.40 |
$1,680.35
|
|
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides)
|
$2,620.80 |
$2,620.80 |
$2,620.80 |
$2,716.95
|
|
Biopsy muscle percutaneous needle
|
$2,362.40 |
$2,362.40 |
$2,362.40 |
$1,632.98
|
|
Biopsy needle liver percutaneous
|
$2,307.20 |
$2,307.20 |
$2,307.20 |
$1,827.42
|
|
Biopsy needle lymph node superficial
|
$2,307.20 |
$2,307.20 |
$2,307.20 |
$1,879.09
|
|
Biopsy of salivary gland 42400
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$1,145.90
|
|
Biopsy renal percutaneous trocar/needle (both sides)
|
$1,992.80 |
$1,992.80 |
$1,992.80 |
$2,092.00
|
|
Biopsy skin incisional single lesion
|
$617.60 |
$617.60 |
$617.60 |
$661.80
|
|
Bivalirudin
|
$1,489.00 |
$1,489.00 |
$1,489.00 |
$1,038.91
|
|
Bladder irrigate/lavage/instill 51700
|
$1,051.20 |
$1,051.20 |
$1,051.20 |
$408.00
|
|
Bld prd mix
|
$653.60 |
$653.60 |
$653.60 |
$140.25
|
|
Bld push tfuj 2 yr/<
|
$694.40 |
$694.40 |
$694.40 |
$965.30
|
|
Blood Clotting (PT/INR) Test
|
$15.00 |
$15.00 |
$15.00 |
$53.30
|
|
Blood Clotting (PTT) Test
|
$30.00 |
$30.00 |
$30.00 |
$73.80
|
|
Blood Count (CBC) Test
|
$15.00 |
$15.00 |
$15.00 |
$74.70
|
|
Blood Count (CBC) Test (without differential)
|
$15.00 |
$15.00 |
$15.00 |
$61.80
|
|
Blood count spun microhematocrit
|
$28.80 |
$28.80 |
$28.80 |
$25.00
|
|
Blood Culture Test
|
$43.20 |
$43.20 |
$43.20 |
$145.60
|
|
Blood gases o2 saturation direct measurement
|
$328.00 |
$328.00 |
$328.00 |
$226.20
|
|
Blood gases ph venous
|
$45.60 |
$45.60 |
$45.60 |
$64.60
|
|
Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic
|
$36.00 |
$36.00 |
$36.00 |
$57.60
|
|
Blood occult feces 1-3 determinations other than neoplasm screening qualitative
|
$16.80 |
$16.80 |
$16.80 |
$32.50
|
|
Blood occult feces colorectal neoplasm screening qualitative
|
$15.00 |
$15.00 |
$15.00 |
$33.15
|
|
Blood occult peroxidase activity qualitative gastric
|
$21.60 |
$21.60 |
$21.60 |
$34.65
|
|
Blood smear microscopic w manual differential wbc count
|
$27.20 |
$27.20 |
$27.20 |
$38.35
|
|
Blood split unit
|
$861.60 |
$861.60 |
$861.60 |
$282.88
|
|
Blood typing abo
|
$146.00 |
$146.00 |
$146.00 |
$84.75
|
|
Blood typing ag donor ea ag
|
$166.40 |
$166.40 |
$166.40 |
$204.84
|
|
Blood typing rbc ag non abo/rh ea
|
$257.60 |
$257.60 |
$257.60 |
$206.33
|
|
Blood typing rh (d)
|
$43.00 |
$43.00 |
$43.00 |
$57.14
|
|
Bone Density Scan (DEXA)
|
$237.00 |
$237.00 |
$237.00 |
$398.56
|
|
Bone/joint imaging ltd area
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$1,035.16
|
|
Bone marrow biopsyneedle/trocar 38221
|
$2,307.20 |
$2,307.20 |
$2,307.20 |
$1,667.40
|
|
Borrelia burgdorferi (lyme disease) antibody nonspecific
|
$70.40 |
$70.40 |
$70.40 |
$91.20
|
|
Borrelia miyamotoi amp prb
|
$162.40 |
$162.40 |
$162.40 |
$81.20
|
|
(both sides) smear without diff wbc count
|
$27.20 |
$27.20 |
$27.20 |
$30.68
|
|
Braf gene
|
$729.60 |
$729.60 |
$729.60 |
$436.47
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$473.50 |
$473.50 |
$473.50 |
$1,875.25
|
