|
99381 initial comp preventive med less than 1 year new
|
$124.95 |
$124.95 |
$124.95 |
$151.20
|
|
99382 initial comp preventive med 1 to 4 years new
|
$134.64 |
$134.64 |
$134.64 |
$147.49
|
|
99383 initial comp preventive med 5 to 11 years new
|
$134.64 |
$134.64 |
$134.64 |
$162.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$107.10 |
$107.10 |
$107.10 |
$135.00
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$124.95 |
$124.95 |
$124.95 |
$135.00
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$124.95 |
$124.95 |
$124.95 |
$129.00
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$139.74 |
$139.74 |
$139.74 |
$147.92
|
|
99397 periodic comp preventive med 65+ years est
|
$136.17 |
$136.17 |
$136.17 |
$176.03
|
|
Abdominal CT scan (with and without contrast)
|
$1,945.65 |
$1,945.65 |
$1,945.65 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$1,728.39 |
$1,728.39 |
$1,728.39 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$878.73 |
$878.73 |
$878.73 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,993.70 |
$2,993.70 |
$2,993.70 |
$2,933.60
|
|
Abdominal MRI (without contrast)
|
$1,975.74 |
$1,975.74 |
$1,975.74 |
$1,975.74
|
|
Abdominal paracentesis w/image guidance
|
$2,265.93 |
$2,265.93 |
$2,265.93 |
$1,688.29
|
|
Abdominal Ultrasound (complete)
|
$467.16 |
$467.16 |
$467.16 |
$785.25
|
|
Abdominal Ultrasound (limited)
|
$467.16 |
$467.16 |
$467.16 |
$604.43
|
|
Abd paracentesis/w/o image guide 49082
|
$1,294.89 |
$1,294.89 |
$1,294.89 |
$1,248.00
|
|
Ablate inf turbinate superf 30801
|
$1,705.95 |
$1,705.95 |
$1,705.95 |
$2,122.56
|
|
Ablation cryo pq chest wall tumor(s) w/guid
|
$211.14 |
$211.14 |
$211.14 |
$339.18
|
|
Ablation cryo thigh/knee
|
$2,334.27 |
$2,334.27 |
$2,334.27 |
$531.95
|
|
Ablation of upper extremity nerves rf
|
$810.90 |
$810.90 |
$810.90 |
$825.60
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$84.15 |
$84.15 |
$84.15 |
$89.91
|
|
Acetaminophen level
|
$82.62 |
$82.62 |
$82.62 |
$117.01
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$156.00 |
$156.00 |
$156.00 |
$306.22
|
|
Acetylcysteine non-comp unit
|
$49.28 |
$49.28 |
$49.28 |
$29.01
|
|
Acne surgery 10040
|
$221.85 |
$221.85 |
$221.85 |
$265.20
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$576.30 |
$576.30 |
$576.30 |
$206.14
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$192.78 |
$192.78 |
$192.78 |
$160.50
|
|
Acute hepatitis panel
|
$233.07 |
$233.07 |
$233.07 |
$284.70
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$84.15 |
$84.15 |
$84.15 |
$64.45
|
|
Adapter b 8 channel 10cm
|
$7,122.15 |
$7,122.15 |
$7,122.15 |
$6,875.44
|
|
Adding walker to prev cast
|
$179.52 |
$179.52 |
$179.52 |
$205.38
|
|
Adenosine 3 mg/250 ml bag for osm
|
$84.15 |
$84.15 |
$84.15 |
$217.04
|
|
Adjmt/revj ext fixj sys anes
|
$6,746.79 |
$6,746.79 |
$6,746.79 |
$7,907.11
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$1,760.52 |
$1,760.52 |
$1,760.52 |
$2,837.09
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$370.34 |
$370.34 |
$370.34 |
$158.18
|
|
Administration chemotherapy IV infusion each additional hour
|
$597.72 |
$597.72 |
$597.72 |
$233.56
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$699.72 |
$699.72 |
$699.72 |
$695.37
|
|
Administration immunization 1 vaccine
|
$89.25 |
$89.25 |
$89.25 |
$70.00
|
|
Administration immunization each additional component
|
$17.85 |
$17.85 |
$17.85 |
$27.20
|
|
Administration immunization each additional vaccine
|
$46.92 |
$46.92 |
$46.92 |
$46.23
|
|
Administration immunization first component each vaccine
|
$87.72 |
$87.72 |
$87.72 |
$45.50
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$13.77 |
$13.77 |
$13.77 |
$33.60
|
|
_afb id by dna probe rflx ast
|
$67.83 |
$67.83 |
$67.83 |
$105.00
|
|
Air conduction bilat
|
$52.53 |
$52.53 |
$52.53 |
$116.22
|
|
Albumin body fluid quantitative each specimen
|
$74.46 |
$74.46 |
$74.46 |
$48.00
|
|
Albumin (human), 25%, 50ml
|
$163.95 |
$163.95 |
$163.95 |
$277.87
|
|
Albumin (human), 5%, 250 ml
|
$172.25 |
$172.25 |
$172.25 |
$292.50
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$46.92 |
$46.92 |
$46.92 |
$58.00
|
|
Albumin serum plasma or whole blood
|
$40.29 |
$40.29 |
$40.29 |
$43.45
|
|
Albuterol ipratrop non-comp
|
$5.61 |
$5.61 |
$5.61 |
$9.93
|
|
Albuterol non-comp con
|
$5.61 |
$5.61 |
$5.61 |
$9.93
|
|
Albuterol non-comp unit
|
$18.36 |
$18.36 |
$18.36 |
$9.43
|
|
Alkaline phosphatase
|
$17.85 |
$17.85 |
$17.85 |
$46.50
|
|
Allergen egg white ige
|
$16.32 |
$16.32 |
$16.32 |
$39.78
|
|
Allergy injections; 2 or more 95117
|
$85.68 |
$85.68 |
$85.68 |
$47.20
|
|
Allergy injection; single 95115
|
$95.37 |
$95.37 |
$95.37 |
$42.75
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$4,456.58 |
$4,456.58 |
$4,456.58 |
$5,579.34
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$20,995.50 |
$20,995.50 |
$20,995.50 |
$15,083.48
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$8,455.30 |
$8,455.30 |
$8,455.30 |
$8,295.72
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$21,790.11 |
$21,790.11 |
$21,790.11 |
$25,508.83
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$16,700.46 |
$16,700.46 |
$16,700.46 |
$3,621.72
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$4,732.60 |
$4,732.60 |
$4,732.60 |
$4,898.43
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$6,146.93 |
$6,146.93 |
$6,146.93 |
$5,381.40
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$4,687.16 |
$4,687.16 |
$4,687.16 |
$5,538.22
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$5,245.25 |
$5,245.25 |
$5,245.25 |
$4,814.57
|
|
Alpha-fetoprotein tumor marker
|
$77.01 |
$77.01 |
$77.01 |
$103.60
|
|
Alteplase 100 mg infusion from pyxis vial
|
$17,531.48 |
$17,531.48 |
$17,531.48 |
$9,600.63
|
|
Alt/sgpt
|
$44.37 |
$44.37 |
$44.37 |
$49.00
|
|
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
|
$118.83 |
$118.83 |
$118.83 |
$123.48
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$3,969.00
|
|
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
|
$84.15 |
$84.15 |
$84.15 |
$57.38
|
|
Amp metatarsal w/toe single 28810
|
$3,036.03 |
$3,036.03 |
$3,036.03 |
$3,839.54
|
|
Amputation thru metatarsal
|
$1,224.00 |
$1,224.00 |
$1,224.00 |
$3,791.82
|
|
Amputation toe interphalangeal joint
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$3,839.54
|
|
Amputation toe metatarsophalangeal joint
|
$1,146.48 |
$1,146.48 |
$1,146.48 |
$3,777.93
|
|
Amylase
|
$53.04 |
$53.04 |
$53.04 |
$93.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$82.62 |
$82.62 |
$82.62 |
$117.01
|
|
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
|
$425.85 |
$425.85 |
$425.85 |
$350.85
|
|
Anl sp inf pmp w/mdreprg&fil
|
$170.85 |
$170.85 |
$170.85 |
$693.75
|
|
Annual Physical, Established Patient (age 18-39)
|
$165.75 |
$165.75 |
$165.75 |
$167.25
|
|
Annual Physical, Established Patient (age 40-64)
|
$160.14 |
$160.14 |
$160.14 |
$167.25
|
|
Annual Physical, New Patient (age 18-39)
|
$160.14 |
$160.14 |
$160.14 |
$167.25
|
|
Annual Physical, New Patient (age 40-64)
|
$197.37 |
$197.37 |
$197.37 |
$188.15
|
|
Anogenital exam child w imag
|
$307.02 |
$307.02 |
$307.02 |
$238.06
|
|
Anoscopy control bleeding 46614
|
$1,867.11 |
$1,867.11 |
$1,867.11 |
$1,777.86
|
|
Anoscopy remove fb 46608
|
$1,432.59 |
$1,432.59 |
$1,432.59 |
$1,313.97
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$1,158.72 |
$1,158.72 |
$1,158.72 |
$4,934.17
|
|
Antibody elution rbc reference
|
$102.00 |
$102.00 |
$102.00 |
$179.62
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$219.30 |
$219.30 |
$219.30 |
$218.30
|
|
Antibody id rbc panel
|
$193.80 |
$193.80 |
$193.80 |
$291.75
|
|
Antibody screen rbc
|
$42.84 |
$42.84 |
$42.84 |
$105.00
|
|
Appendix Removal (Laparoscopic)
|
$910.35 |
$910.35 |
$910.35 |
$6,376.26
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$1,760.52 |
$1,760.52 |
$1,760.52 |
$2,164.64
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$1,760.52 |
$1,760.52 |
$1,760.52 |
$908.05
|