|
2d tte w or without fol w/con,co
|
$900.15 |
$900.15 |
$900.15 |
$1,108.76
|
|
88334 ap bill cytologic exam each additional site
|
$88.23 |
$88.23 |
$88.23 |
$97.65
|
|
99382 initial comp preventive med 1 to 4 years new
|
$109.65 |
$109.65 |
$109.65 |
$147.49
|
|
99383 initial comp preventive med 5 to 11 years new
|
$109.65 |
$109.65 |
$109.65 |
$162.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$82.62 |
$82.62 |
$82.62 |
$135.00
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$82.62 |
$82.62 |
$82.62 |
$135.00
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$109.65 |
$109.65 |
$109.65 |
$129.00
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$109.65 |
$109.65 |
$109.65 |
$147.92
|
|
99397 periodic comp preventive med 65+ years est
|
$164.73 |
$164.73 |
$164.73 |
$176.03
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$21.96 |
$21.96 |
$21.96 |
$52.25
|
|
Abdominal CT scan (with and without contrast)
|
$3,480.24 |
$3,480.24 |
$3,480.24 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,430.15 |
$2,430.15 |
$2,430.15 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$2,146.59 |
$2,146.59 |
$2,146.59 |
$1,358.76
|
|
Abdominal MRI (with contrast)
|
$2,415.36 |
$2,415.36 |
$2,415.36 |
$2,200.55
|
|
Abdominal MRI (without contrast)
|
$1,780.92 |
$1,780.92 |
$1,780.92 |
$1,975.74
|
|
Abdominal paracentesis w/image guidance
|
$2,832.03 |
$2,832.03 |
$2,832.03 |
$1,688.29
|
|
Abdominal Ultrasound (complete)
|
$1,960.44 |
$1,960.44 |
$1,960.44 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$1,504.50 |
$1,504.50 |
$1,504.50 |
$604.43
|
|
Abd paracentesis/w/o image guide 49082
|
$1,375.98 |
$1,375.98 |
$1,375.98 |
$1,248.00
|
|
Ablate inf turbinate superf 30801
|
$1,856.91 |
$1,856.91 |
$1,856.91 |
$2,122.56
|
|
Ablation cryo pq chest wall tumor(s) w/guid
|
$13,047.84 |
$13,047.84 |
$13,047.84 |
$339.18
|
|
Ablation of upper extremity nerves rf
|
$7,344.00 |
$7,344.00 |
$7,344.00 |
$825.60
|
|
Abobotulinumtoxina
|
$1,265.44 |
$1,265.44 |
$1,265.44 |
$1,066.88
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$145.35 |
$145.35 |
$145.35 |
$89.91
|
|
Acetaminophen level
|
$420.24 |
$420.24 |
$420.24 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$186.68 |
$186.68 |
$186.68 |
$137.80
|
|
Acetylcholine receptor modulating antibody
|
$22.57 |
$22.57 |
$22.57 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$180.91 |
$180.91 |
$180.91 |
$306.22
|
|
Acetylcysteine non-comp unit
|
$49.28 |
$49.28 |
$49.28 |
$29.01
|
|
Acne surgery 10040
|
$241.74 |
$241.74 |
$241.74 |
$265.20
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$270.30 |
$270.30 |
$270.30 |
$206.14
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$214.20 |
$214.20 |
$214.20 |
$160.50
|
|
Acute hepatitis panel
|
$735.93 |
$735.93 |
$735.93 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$145.69 |
$145.69 |
$145.69 |
$64.45
|
|
#acylcarnitineprfl
|
$87.72 |
$87.72 |
$87.72 |
$87.72
|
|
Adapter b 8 channel 10cm
|
$6,196.27 |
$6,196.27 |
$6,196.27 |
$6,875.44
|
|
Adding walker to prev cast
|
$195.33 |
$195.33 |
$195.33 |
$205.38
|
|
Adenosine 3 mg/250 ml bag for osm
|
$84.15 |
$84.15 |
$84.15 |
$217.04
|
|
Adenovirus antibody,serum - quest
|
$12.16 |
$12.16 |
$12.16 |
$60.00
|
|
Adh-sendout
|
$15.30 |
$15.30 |
$15.30 |
$109.28
|
|
Adjmt/revj ext fixj sys anes
|
$8,433.87 |
$8,433.87 |
$8,433.87 |
$7,907.11
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$2,200.65 |
$2,200.65 |
$2,200.65 |
$2,837.09
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$118.91 |
$118.91 |
$118.91 |
$158.18
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$251.94 |
$251.94 |
$251.94 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$176.97 |
$176.97 |
$176.97 |
$267.43
|
|
Administration immunization 1 vaccine
|
$97.41 |
$97.41 |
$97.41 |
$70.00
|
|
Administration immunization each additional component
|
$15.81 |
$15.81 |
$15.81 |
$27.20
|
|
Administration immunization each additional vaccine
|
$65.79 |
$65.79 |
$65.79 |
$46.23
|
|
Administration immunization first component each vaccine
|
$15.81 |
$15.81 |
$15.81 |
$45.50
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$97.41 |
$97.41 |
$97.41 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$15.81 |
$15.81 |
$15.81 |
$33.60
|
|
Administration vaccine pneumococcal
|
$46.92 |
$46.92 |
$46.92 |
$51.07
|
|
_afb id by dna probe rflx ast
|
$38.76 |
$38.76 |
$38.76 |
$105.00
|
|
Air conduction bilat
|
$257.55 |
$257.55 |
$257.55 |
$116.22
|
|
Albumin body fluid quantitative each specimen
|
$65.28 |
$65.28 |
$65.28 |
$48.00
|
|
Albumin (human), 25%, 50ml
|
$175.81 |
$175.81 |
$175.81 |
$277.87
|
|
Albumin (human), 5%, 250 ml
|
$222.65 |
$222.65 |
$222.65 |
$292.50
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$88.23 |
$88.23 |
$88.23 |
$58.00
|
|
Albumin serum plasma or whole blood
|
$74.97 |
$74.97 |
$74.97 |
$43.45
|
|
Albuterol ipratrop non-comp
|
$5.61 |
$5.61 |
$5.61 |
$9.93
|
|
Albuterol non-comp con
|
$5.96 |
$5.96 |
$5.96 |
$9.93
|
|
Albuterol non-comp unit
|
$5.61 |
$5.61 |
$5.61 |
$9.43
|
|
Alkaline phosphatase
|
$68.34 |
$68.34 |
$68.34 |
$46.50
|
|
Allergen alpha lactalbumin ige
|
$2.55 |
$2.55 |
$2.55 |
$56.35
|
|
Allergen egg white ige
|
$33.15 |
$33.15 |
$33.15 |
$39.78
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$4,118.96 |
$4,118.96 |
$4,118.96 |
$5,579.34
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$17,846.17 |
$17,846.17 |
$17,846.17 |
$15,083.48
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$7,084.95 |
$7,084.95 |
$7,084.95 |
$8,295.72
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$18,481.24 |
$18,481.24 |
$18,481.24 |
$25,508.83
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$14,195.39 |
$14,195.39 |
$14,195.39 |
$3,621.72
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$4,374.07 |
$4,374.07 |
$4,374.07 |
$4,898.43
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$5,452.92 |
$5,452.92 |
$5,452.92 |
$5,381.40
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$4,332.07 |
$4,332.07 |
$4,332.07 |
$5,538.22
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$4,737.11 |
$4,737.11 |
$4,737.11 |
$4,814.57
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$68.85 |
$68.85 |
$68.85 |
$187.20
|
|
Alpha-fetoprotein tumor marker
|
$140.76 |
$140.76 |
$140.76 |
$103.60
|
|
Alteplase 100 mg infusion from pyxis vial
|
$17,531.48 |
$17,531.48 |
$17,531.48 |
$9,600.63
|
|
Alt/sgpt
|
$79.56 |
$79.56 |
$79.56 |
$49.00
|
|
Aluminum - quest
|
$6.12 |
$6.12 |
$6.12 |
$83.05
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$84.15 |
$84.15 |
$84.15 |
$45.50
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$150.35 |
$150.35 |
$150.35 |
$174.72
|
|
Amiodarone 50 mg/ml intravenous solution
|
$84.15 |
$84.15 |
$84.15 |
$50.85
|
|
Ammonia
|
$219.81 |
$219.81 |
$219.81 |
$123.48
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$4,136.61 |
$4,136.61 |
$4,136.61 |
$3,969.00
|
|
Amphetamine confirm urine -sendout
|
$30.60 |
$30.60 |
$30.60 |
$94.50
|
|
Amphetamines 5 or more
|
$5.56 |
$5.56 |
$5.56 |
$93.60
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$352.88 |
$352.88 |
$352.88 |
$382.55
|
|
Ampicillin 1 gram solution for injection
|
$84.15 |
$84.15 |
$84.15 |
$68.44
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$93.72 |
$93.72 |
$93.72 |
$57.38
|
|
Amp metatarsal w/toe single 28810
|
$3,795.42 |
$3,795.42 |
$3,795.42 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$3,981.06 |
$3,981.06 |
$3,981.06 |
$3,839.54
|
|
Amylase
|
$146.37 |
$146.37 |
$146.37 |
$93.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$420.24 |
$420.24 |
$420.24 |
$117.01
|
|
Analysis gene f2 20210g>a variant
|
$83.00 |
$83.00 |
$83.00 |
$219.13
|
|
Analysis gene f5 leiden variant
|
$130.92 |
$130.92 |
$130.92 |
$226.60
|
|
Anca screen with reflex to titer -quest
|
$51.00 |
$51.00 |
$51.00 |
$103.20
|
|
An cholangiogram percutaneous compl
|
$5,773.20 |
$5,773.20 |
$5,773.20 |
$2,426.60
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$4,550.62 |
$4,550.62 |
$4,550.62 |
$6,048.00
|
|
Ankle X-ray
|
$901.17 |
$901.17 |
$901.17 |
$350.85
|
|
Annual Physical, Established Patient (age 18-39)
|
$137.19 |
$137.19 |
$137.19 |
$167.25
|
