|
Annual Physical, Established Patient (age 18-39)
|
$78.00 |
$78.00 |
$78.00 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$78.00 |
$78.00 |
$78.00 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$76.50 |
$76.50 |
$76.50 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$89.50 |
$89.50 |
$89.50 |
$165.10
|
|
Anora (draw only)
|
$12.00 |
$12.00 |
$12.00 |
$33.58
|
|
Anoscopy ablation lesion 46615
|
$1,377.67 |
$1,377.67 |
$1,377.67 |
$3,245.23
|
|
Anoscopy and biopsy
|
$629.00 |
$629.00 |
$629.00 |
$1,395.28
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$1,896.17 |
$1,896.17 |
$1,896.17 |
$5,463.96
|
|
Anterior thoracic extension
|
$503.00 |
$503.00 |
$503.00 |
$496.80
|
|
Antibody bacterium, not elsewhere specified
|
$102.00 |
$102.00 |
$102.00 |
$57.81
|
|
Antibody elution rbc reference
|
$126.50 |
$126.50 |
$126.50 |
$175.50
|
|
Antibody htlv/hiv confirm test
|
$72.00 |
$72.00 |
$72.00 |
$130.00
|
|
Antibody htlv-i
|
$121.00 |
$121.00 |
$121.00 |
$49.53
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$455.00 |
$455.00 |
$455.00 |
$218.30
|
|
Antibody id rbc panel
|
$119.37 |
$119.37 |
$119.37 |
$274.56
|
|
Antibody influenza virus
|
$82.50 |
$82.50 |
$82.50 |
$53.95
|
|
Antibody lymphocytic choriomeningitis
|
$25.50 |
$25.50 |
$25.50 |
$48.57
|
|
Antibody screen rbc
|
$68.50 |
$68.50 |
$68.50 |
$100.00
|
|
Antibody tetanus
|
$15.00 |
$15.00 |
$15.00 |
$53.95
|
|
Anticoag mgmt pt warfarin
|
$13.00 |
$13.00 |
$13.00 |
$26.40
|
|
Antidepressant not specified
|
$5.00 |
$5.00 |
$5.00 |
$61.80
|
|
Antidepressants class 3-5
|
$5.00 |
$5.00 |
$5.00 |
$59.46
|
|
Antidepressants class 6/more
|
$5.00 |
$5.00 |
$5.00 |
$29.21
|
|
Antiepileptics nos 4-6
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antiepileptics nos 7/more
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antigen therapy services
|
$54.00 |
$54.00 |
$54.00 |
$73.84
|
|
Antigen therapy services
|
$54.00 |
$54.00 |
$54.00 |
$83.72
|
|
Antigen therapy services
|
$83.00 |
$83.00 |
$83.00 |
$101.40
|
|
Antigen therapy services
|
$83.00 |
$83.00 |
$83.00 |
$96.72
|
|
Antigen therapy services
|
$83.00 |
$83.00 |
$83.00 |
$130.00
|
|
Antigen therapy services
|
$7.00 |
$7.00 |
$7.00 |
$70.07
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$6,372.00 |
$6,372.00 |
$6,372.00 |
$6.10
|
|
Anti mog serum - sendout
|
$785.00 |
$785.00 |
$785.00 |
$159.00
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$23.75 |
$23.75 |
$23.75 |
$37.05
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$86.00 |
$86.00 |
$86.00 |
$40.00
|
|
Antinuclear antibodies
|
$76.50 |
$76.50 |
$76.50 |
$89.40
|
|
Antinuclear antibodies titer
|
$82.50 |
$82.50 |
$82.50 |
$77.00
|
|
Antipsychotics nos 7/more
|
$5.00 |
$5.00 |
$5.00 |
$16.24
|
|
Antistreptolysin o titer
|
$44.50 |
$44.50 |
$44.50 |
$51.45
|
|
Antithrombin iii activity
|
$103.00 |
$103.00 |
$103.00 |
$114.00
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$2,250.33 |
$2,250.33 |
$2,250.33 |
$4,155.20
|
|
Apheresis wbc
|
$1,773.00 |
$1,773.00 |
$1,773.00 |
$2,968.80
|
|
Apl(pml-rara) quant - sendout
|
$165.00 |
$165.00 |
$165.00 |
$482.95
|
|
Appendectomy
|
$4,933.00 |
$4,933.00 |
$4,933.00 |
$5,681.93
|
|
Appendix Removal (Laparoscopic)
|
$4,781.00 |
$4,781.00 |
$4,781.00 |
$6,870.89
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$825.00 |
$825.00 |
$825.00 |
$851.85
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$812.75 |
$812.75 |
$812.75 |
$463.65
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$3,015.50 |
$3,015.50 |
$3,015.50 |
$3,345.60
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$811.50 |
$811.50 |
$811.50 |
$1,091.30
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$1,719.00 |
$1,719.00 |
$1,719.00 |
$498.81
|
|
Application clubfoot cast
|
$187.00 |
$187.00 |
$187.00 |
$297.33
|
|
Application finger splntstatic 29130
|
$199.50 |
$199.50 |
$199.50 |
$208.16
|
|
Application long leg splint 29505
|
$250.00 |
$250.00 |
$250.00 |
$338.25
|
|
Application lower leg splint 29515
|
$238.00 |
$238.00 |
$238.00 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$493.00 |
$493.00 |
$493.00 |
$373.20
|
|
Application of cylinder cast 29365
|
$321.50 |
$321.50 |
$321.50 |
$420.00
|
|
Application of forearm cast 29075
|
$443.00 |
$443.00 |
$443.00 |
$339.30
|
|
Application of long arm cast 29065
|
$342.00 |
$342.00 |
$342.00 |
$395.00
|
|
Application of long leg cast
|
$391.50 |
$391.50 |
$391.50 |
$426.00
|
|
Application of long leg cast 29345
|
$391.50 |
$391.50 |
$391.50 |
$455.00
|
|
Application of paste boot 29580
|
$493.00 |
$493.00 |
$493.00 |
$331.74
|
|
Application short leg cast 29405
|
$342.00 |
$342.00 |
$342.00 |
$388.80
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$4,688.00 |
$4,688.00 |
$4,688.00 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$2,462.67 |
$2,462.67 |
$2,462.67 |
$2,164.64
|
|
Applicator tag rfid localizer 12gx7cm
|
$512.00 |
$512.00 |
$512.00 |
$744.90
|
|
Appl mltpln uni ext fixj sys
|
$2,250.67 |
$2,250.67 |
$2,250.67 |
$5,668.20
|
|
Appl modality 1/> areas paraffin bath 97018
|
$69.00 |
$69.00 |
$69.00 |
$66.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$94.50 |
$94.50 |
$94.50 |
$75.60
|
|
Appl multlay comprs arm/hand
|
$254.00 |
$254.00 |
$254.00 |
$292.60
|
|
Appl patllr tdn bearing cast
|
$321.50 |
$321.50 |
$321.50 |
$420.21
|
|
Appl unipln uni ext fixj sys
|
$8,657.00 |
$8,657.00 |
$8,657.00 |
$5,801.00
|
|
Apply finger cast 29086
|
$187.00 |
$187.00 |
$187.00 |
$238.15
|
|
Apply forearm splintdynamic 29126
|
$232.00 |
$232.00 |
$232.00 |
$246.18
|
|
Apply hand/wrist cast 29085
|
$184.00 |
$184.00 |
$184.00 |
$259.20
|
|
Apply interstit radiat compl
|
$4,807.00 |
$4,807.00 |
$4,807.00 |
$2,910.05
|
|
Apply of finger splint 29131
|
$168.00 |
$168.00 |
$168.00 |
$168.00
|
|
Apply rigid leg cast 29445
|
$442.50 |
$442.50 |
$442.50 |
$555.00
|
|
Apply short leg castambul type 29425
|
$443.00 |
$443.00 |
$443.00 |
$381.00
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$543.67 |
$543.67 |
$543.67 |
$955.43
|
|
#aptt mix-1:1 incubated
|
$111.50 |
$111.50 |
$111.50 |
$157.30
|
|
Aqaprn-4 antb flo cytmtry ea
|
$487.50 |
$487.50 |
$487.50 |
$231.66
|
|
Aqmbf pet rest & rx stress
|
$224.00 |
$224.00 |
$224.00 |
$920.63
|
|
Aquaporin-4 antibody cba each
|
$785.00 |
$785.00 |
$785.00 |
$138.16
|
|
Aquaporin-4 antibody elisa
|
$560.00 |
$560.00 |
$560.00 |
$148.80
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$138.50 |
$138.50 |
$138.50 |
$100.00
|
|
Aquatic exercise - group charge
|
$44.50 |
$44.50 |
$44.50 |
$85.80
|
|
Aqueous shunt eye w/graft
|
$3,427.00 |
$3,427.00 |
$3,427.00 |
$5,716.03
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$76.89 |
$76.89 |
$76.89 |
$1,313.89
|
|
Arterial blood draw/perc 36620
|
$821.50 |
$821.50 |
$821.50 |
$485.69
|
|
Artery-vein nonautograft
|
$4,933.00 |
$4,933.00 |
$4,933.00 |
$6,396.89
|
|
Artery xray each vessel 7577426
|
$7,276.50 |
$7,276.50 |
$7,276.50 |
$1,844.46
|
|
Artery xray of abdomen 75726-26
|
$17,078.00 |
$17,078.00 |
$17,078.00 |
$4,446.00
|
|
Artery x-rays adrenal gland
|
$2,870.00 |
$2,870.00 |
$2,870.00 |
$3,439.84
|
|
Artery x-rays adrenals
|
$2,870.00 |
$2,870.00 |
$2,870.00 |
$3,764.59
|
|
Artery x-rays arm/leg 75710-26
|
$3,762.50 |
$3,762.50 |
$3,762.50 |
$3,480.00
|
|
Artery x-rays arms/legs 75716-26
|
$7,163.00 |
$7,163.00 |
$7,163.00 |
$3,729.00
|
|
Artery x-rays chest
|
$2,870.00 |
$2,870.00 |
$2,870.00 |
$2,870.00
|
|
Artery x-rays lung
|
$3,878.00 |
$3,878.00 |
$3,878.00 |
$3,279.12
|
|
Artery x-rays lung
|
$2,870.00 |
$2,870.00 |
$2,870.00 |
$2,451.75
|
