|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$201.00 |
$201.00 |
$201.00 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$46.00 |
$46.00 |
$46.00 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$417.00 |
$417.00 |
$417.00 |
$498.81
|
|
Application finger splntstatic 29130
|
$189.50 |
$189.50 |
$189.50 |
$208.16
|
|
Application long leg splint 29505
|
$107.00 |
$107.00 |
$107.00 |
$338.25
|
|
Application lower leg splint 29515
|
$155.50 |
$155.50 |
$155.50 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$385.00 |
$385.00 |
$385.00 |
$373.20
|
|
Application of cylinder cast 29365
|
$268.00 |
$268.00 |
$268.00 |
$420.00
|
|
Application of forearm cast 29075
|
$268.00 |
$268.00 |
$268.00 |
$339.30
|
|
Application of long arm cast 29065
|
$268.00 |
$268.00 |
$268.00 |
$395.00
|
|
Application of long leg cast 29345
|
$268.00 |
$268.00 |
$268.00 |
$455.00
|
|
Application of paste boot 29580
|
$419.00 |
$419.00 |
$419.00 |
$331.74
|
|
Application short leg cast 29405
|
$268.00 |
$268.00 |
$268.00 |
$388.80
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$2,560.50 |
$2,560.50 |
$2,560.50 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$2,731.00 |
$2,731.00 |
$2,731.00 |
$2,164.64
|
|
Appl mltpln uni ext fixj sys
|
$1,184.50 |
$1,184.50 |
$1,184.50 |
$5,668.20
|
|
Appl multlay comprs arm/hand
|
$15.00 |
$15.00 |
$15.00 |
$292.60
|
|
Appl unipln uni ext fixj sys
|
$623.00 |
$623.00 |
$623.00 |
$5,801.00
|
|
Apply forearm splintdynamic 29126
|
$212.00 |
$212.00 |
$212.00 |
$246.18
|
|
Apply hand/wrist cast 29085
|
$155.50 |
$155.50 |
$155.50 |
$259.20
|
|
Apply rigid leg cast 29445
|
$752.00 |
$752.00 |
$752.00 |
$555.00
|
|
Apply short leg castambul type 29425
|
$268.00 |
$268.00 |
$268.00 |
$381.00
|
|
App topical fluoride varnish
|
$10.50 |
$10.50 |
$10.50 |
$27.20
|
|
Aqaprn-4 antb flo cytmtry ea
|
$390.00 |
$390.00 |
$390.00 |
$231.66
|
|
Aquaporin-4 antibody cba each
|
$125.00 |
$125.00 |
$125.00 |
$138.16
|
|
Art byp aortofemoral 35647
|
$1,657.00 |
$1,657.00 |
$1,657.00 |
$2,358.00
|
|
Art byp aortoiliac 35637
|
$1,839.00 |
$1,839.00 |
$1,839.00 |
$2,942.40
|
|
Art bypass aortobifemoral 35646
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$3,443.40
|
|
Art bypass aortobi-iliac 35638
|
$1,914.50 |
$1,914.50 |
$1,914.50 |
$3,525.00
|
|
Art bypass axillary-femoral 35621
|
$1,199.50 |
$1,199.50 |
$1,199.50 |
$2,208.60
|
|
Art bypass axill-fem-femoral 35654
|
$1,498.50 |
$1,498.50 |
$1,498.50 |
$3,058.80
|
|
Art bypass fem-ant-post tib/prl 35666
|
$1,404.50 |
$1,404.50 |
$1,404.50 |
$3,313.72
|
|
Art bypass femoral-femoral 35661
|
$1,185.00 |
$1,185.00 |
$1,185.00 |
$5,291.20
|
|
Art bypass femoral-popliteal 35656
|
$1,176.00 |
$1,176.00 |
$1,176.00 |
$4,717.50
|
|
Art bypass iliofemoral 35665
|
$1,289.00 |
$1,289.00 |
$1,289.00 |
$2,457.18
|
|
Art bypass subclav-subclavian 35612
|
$1,156.50 |
$1,156.50 |
$1,156.50 |
$2,272.80
|
|
Art byp axillary-axillary 35650
|
$1,132.00 |
$1,132.00 |
$1,132.00 |
$1,099.50
|
|
Art byp grft aortbifemoral 35540
|
$2,710.50 |
$2,710.50 |
$2,710.50 |
$4,336.80
|
|
Art byp grft aortobi-iliac 35538
|
$2,590.00 |
$2,590.00 |
$2,590.00 |
$2,630.50
|
|
Art byp grft aortofemoral
|
$2,431.00 |
$2,431.00 |
$2,431.00 |
$2,431.00
|
|
Art byp grft aortoiliac
|
$2,312.00 |
$2,312.00 |
$2,312.00 |
$2,312.00
|
|
Art byp grft aortorenal
|
$1,890.00 |
$1,890.00 |
$1,890.00 |
$8,297.60
|
|
Art byp grft axillary-axilry
|
$1,265.50 |
$1,265.50 |
$1,265.50 |
$1,231.00
|
|
Art byp grft axill-brachial
|
$1,296.50 |
$1,296.50 |
$1,296.50 |
$1,644.28
|
|
Art byp grft axill/fem/fem
|
$1,670.50 |
$1,670.50 |
$1,670.50 |
$1,670.50
|
|
Art byp grft axill-femoral
|
$1,360.00 |
$1,360.00 |
$1,360.00 |
$1,728.11
|
|
Art byp grft brachial-brchl
|
$1,218.00 |
$1,218.00 |
$1,218.00 |
$1,724.40
|
|
Art byp grft brchl-ulnr-rdl
|
$1,361.00 |
$1,361.00 |
$1,361.00 |
$1,361.00
|
|
Art byp grft fem-femoral 35558
|
$1,334.00 |
$1,334.00 |
$1,334.00 |
$2,477.40
|
|
Art byp grft fem-popliteal 35556
|
$1,527.50 |
$1,527.50 |
$1,527.50 |
$2,672.40
|
|
Art byp grft ilioiliac
|
$1,465.50 |
$1,465.50 |
$1,465.50 |
$1,465.50
|
|
Art byp grft subclav-axilary
|
$1,352.00 |
$1,352.00 |
$1,352.00 |
$1,352.00
|
|
Art byp grft subclav-brchial
|
$1,336.00 |
$1,336.00 |
$1,336.00 |
$1,696.81
|
|
Art byp grft subclav-carotid
|
$1,412.00 |
$1,412.00 |
$1,412.00 |
$1,412.00
|
|
Art byp grft subclav-subclav
|
$1,242.50 |
$1,242.50 |
$1,242.50 |
$1,205.50
|
|
Art byp ilioiliac 35663
|
$1,349.00 |
$1,349.00 |
$1,349.00 |
$1,714.11
|
|
Art byp pop-tibl-prl-other 35571
|
$1,456.00 |
$1,456.00 |
$1,456.00 |
$2,674.20
|
|
Art byp tibial-tib/peroneal
|
$1,633.00 |
$1,633.00 |
$1,633.00 |
$1,633.00
|
|
Arterial blood draw/perc 36620
|
$1,860.50 |
$1,860.50 |
$1,860.50 |
$485.69
|
|
Artery by graft; iliofemoral 35565
|
$1,413.00 |
$1,413.00 |
$1,413.00 |
$1,875.00
|
|
Artery to vein shunt
|
$551.00 |
$551.00 |
$551.00 |
$4,316.00
|
|
Artery-vein nonautograft
|
$727.50 |
$727.50 |
$727.50 |
$6,396.89
|
|
Arthrd pst tq 1ntrspc lum
|
$1,780.00 |
$1,780.00 |
$1,780.00 |
$4,627.00
|
|
Arthrd si jt perq/min nvas
|
$870.50 |
$870.50 |
$870.50 |
$15,372.00
|
|
Arthrd si jt prq wo tfxj dev
|
$493.50 |
$493.50 |
$493.50 |
$21,762.05
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$1,177.50 |
$1,177.50 |
$1,177.50 |
$608.40
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$681.50 |
$681.50 |
$681.50 |
$1,005.42
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$611.00 |
$611.00 |
$611.00 |
$889.20
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$785.00 |
$785.00 |
$785.00 |
$465.00
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$1,069.00 |
$1,069.00 |
$1,069.00 |
$715.37
|
|
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604
|
$407.00 |
$407.00 |
$407.00 |
$699.00
|
|
Arthrodes/ant/cerv below c2 ea add 22552
|
$428.00 |
$428.00 |
$428.00 |
$952.80
|
|
Arthrodesis big toe joint 28760
|
$601.50 |
$601.50 |
$601.50 |
$5,886.74
|
|
Arthrodesis subtalar
|
$820.50 |
$820.50 |
$820.50 |
$13,057.20
|
|
Arthro, loose body + chondro
|
$86.00 |
$86.00 |
$86.00 |
$224.00
|
|
Arthroplasty finger joint 26535
|
$1,396.75 |
$1,396.75 |
$1,396.75 |
$3,981.06
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$717.50 |
$717.50 |
$717.50 |
$4,240.08
|
|
Arthro/shoul surg; w/spacer
|
$662.00 |
$662.00 |
$662.00 |
$15,226.08
|
|
Arthrotomy hip w/drainage
|
$983.00 |
$983.00 |
$983.00 |
$3,549.00
|
|
Arthrp ntrcrp/crp/mtcr ntrps
|
$833.50 |
$833.50 |
$833.50 |
$4,627.00
|
|
Arthrp ntrcrpl/crp/mtcrp ssp
|
$920.50 |
$920.50 |
$920.50 |
$3,839.54
|
|
Arthr si jt opn b1grf instrm
|
$1,504.50 |
$1,504.50 |
$1,504.50 |
$5,200.00
|
|
Arthrt ac sc jt exp/rmvl fb
|
$613.00 |
$613.00 |
$613.00 |
$3,786.00
|
|
Arthrt gh jt expl/drg/rmv fb
|
$760.00 |
$760.00 |
$760.00 |
$3,839.54
|
|
Arthrt rdcrpl/midcarpl jt
|
$590.00 |
$590.00 |
$590.00 |
$3,839.54
|
|
Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah)
|
$174.00 |
$174.00 |
$174.00 |
$4,194.13
|
|
Asp core fat pad
|
$511.00 |
$511.00 |
$511.00 |
$939.95
|
|
Aspirate bladder/sprapubic cath 51102
|
$145.50 |
$145.50 |
$145.50 |
$3,162.72
|
|
Aspirate/inj ganglion cyst 20612
|
$416.50 |
$416.50 |
$416.50 |
$433.07
|
|
Aspirate pleura without imaging 32554
|
$623.00 |
$623.00 |
$623.00 |
$1,196.52
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$1,517.50 |
$1,517.50 |
$1,517.50 |
$1,226.87
|
|
Aspir/inj thyroid cyst 60300
|
$48.50 |
$48.50 |
$48.50 |
$850.78
|
|
Asp pq spinal cord cyst/syrinx
|
$854.50 |
$854.50 |
$854.50 |
$1,270.92
|
|
Assay dir meas fr estradiol
|
$36.00 |
$36.00 |
$36.00 |
$67.44
|
|
Assay neurflmnt light chain
|
$225.00 |
$225.00 |
$225.00 |
$380.00
|
|
Assay of androsterone
|
$195.00 |
$195.00 |
$195.00 |
$194.79
|
|
Assay of breath ethanol
|
$15.00 |
$15.00 |
$15.00 |
$47.30
|
|
Assay of corticosterone
|
$176.50 |
$176.50 |
$176.50 |
$56.80
|
|
Assay of interleukin-6 (il-6)
|
$95.00 |
$95.00 |
$95.00 |
$79.97
|
|
Assay of lrh hormone
|
$187.00 |
$187.00 |
$187.00 |
$189.50
|
