|
11-desoxycortisol - sendout
|
$39.36 |
$39.36 |
$39.36 |
$84.56
|
|
17-hydroxypregnenolone
|
$22.08 |
$22.08 |
$22.08 |
$85.15
|
|
1st hosp/birthing center care per day nml nb 99460
|
$73.28 |
$73.28 |
$73.28 |
$172.80
|
|
1st inpatient critical care pr day age 28 days/less than 99468
|
$528.96 |
$528.96 |
$528.96 |
$1,656.80
|
|
2nd order venous cath
|
$1,146.56 |
$1,146.56 |
$1,146.56 |
$1,635.60
|
|
3d recon without postprocess indpndt
|
$100.16 |
$100.16 |
$100.16 |
$480.00
|
|
5% dextrose and 0.45% saline
|
$15.52 |
$15.52 |
$15.52 |
$48.00
|
|
5' nucleotidase - sendout
|
$59.52 |
$59.52 |
$59.52 |
$45.90
|
|
88334 ap bill cytologic exam each additional site
|
$101.76 |
$101.76 |
$101.76 |
$97.65
|
|
99381 initial comp preventive med less than 1 year new
|
$53.76 |
$53.76 |
$53.76 |
$135.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$27.52 |
$27.52 |
$27.52 |
$135.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$57.60 |
$57.60 |
$57.60 |
$116.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$35.84 |
$35.84 |
$35.84 |
$113.52
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$39.68 |
$39.68 |
$39.68 |
$133.92
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$39.36 |
$39.36 |
$39.36 |
$120.25
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$42.88 |
$42.88 |
$42.88 |
$137.15
|
|
99397 periodic comp preventive med 65+ years est
|
$34.56 |
$34.56 |
$34.56 |
$164.73
|
|
Aa graft w/bp/aortic root replace 33863
|
$2,328.32 |
$2,328.32 |
$2,328.32 |
$7,697.60
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$23.04 |
$23.04 |
$23.04 |
$53.60
|
|
Abd aorta w/runoff s&i
|
$1,557.12 |
$1,557.12 |
$1,557.12 |
$3,569.56
|
|
Abd/low ext cath 1st
|
$788.80 |
$788.80 |
$788.80 |
$2,121.00
|
|
Abd/low ext cath 2nd
|
$788.80 |
$788.80 |
$788.80 |
$2,158.00
|
|
Abd/low ext cath 3rd
|
$862.40 |
$862.40 |
$862.40 |
$2,639.65
|
|
Abd/low ext cath addl
|
$508.80 |
$508.80 |
$508.80 |
$964.70
|
|
Abdominal CT scan (with and without contrast)
|
$838.72 |
$838.72 |
$838.72 |
$1,976.00
|
|
Abdominal CT scan (with contrast)
|
$733.76 |
$733.76 |
$733.76 |
$1,664.40
|
|
Abdominal CT scan (without contrast)
|
$696.96 |
$696.96 |
$696.96 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,145.60 |
$1,145.60 |
$1,145.60 |
$3,039.92
|
|
Abdominal MRI (with contrast)
|
$913.92 |
$913.92 |
$913.92 |
$2,210.00
|
|
Abdominal MRI (without contrast)
|
$802.24 |
$802.24 |
$802.24 |
$2,010.62
|
|
Abdominal paracentesis w/image guidance
|
$857.28 |
$857.28 |
$857.28 |
$1,637.98
|
|
Abdominal Ultrasound (complete)
|
$276.80 |
$276.80 |
$276.80 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$212.80 |
$212.80 |
$212.80 |
$600.00
|
|
Abd paracentesis/w/o image guide 49082
|
$888.96 |
$888.96 |
$888.96 |
$1,145.00
|
|
Abl1 gene
|
$474.24 |
$474.24 |
$474.24 |
$668.85
|
|
Ablate arrhythmia add on
|
$6,258.88 |
$6,258.88 |
$6,258.88 |
$6,913.20
|
|
Ablate heart dysrhythm focus
|
$4,748.80 |
$4,748.80 |
$4,748.80 |
$9,480.90
|
|
Ablate inf turbinate submuc 30802
|
$171.52 |
$171.52 |
$171.52 |
$1,752.89
|
|
Ablate inf turbinate superf 30801
|
$127.36 |
$127.36 |
$127.36 |
$1,944.80
|
|
Ablation cardiac vagal inputs atrium
|
$250.88 |
$250.88 |
$250.88 |
$2,260.30
|
|
Ablation cryo abd perit om
|
$763.52 |
$763.52 |
$763.52 |
$2,535.72
|
|
Abscess drain retroperitoneal surg code
|
$1,085.44 |
$1,085.44 |
$1,085.44 |
$2,903.45
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$42.24 |
$42.24 |
$42.24 |
$2,670.25
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$15.68 |
$15.68 |
$15.68 |
$80.14
|
|
Acetaminophen level
|
$19.84 |
$19.84 |
$19.84 |
$116.80
|
|
Acetazolamide 500 mg solution for injection
|
$57.35 |
$57.35 |
$57.35 |
$113.40
|
|
Acetone qualitative
|
$31.04 |
$31.04 |
$31.04 |
$43.80
|
|
Acetylcholinesterase assay
|
$10.88 |
$10.88 |
$10.88 |
$108.35
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$54.91 |
$54.91 |
$54.91 |
$244.95
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$136.96 |
$136.96 |
$136.96 |
$246.40
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$108.16 |
$108.16 |
$108.16 |
$190.20
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$11.52 |
$11.52 |
$11.52 |
$40.20
|
|
Acute hepatitis panel
|
$221.76 |
$221.76 |
$221.76 |
$281.05
|
|
Acyclovir 400 mg tablet
|
$23.70 |
$23.70 |
$23.70 |
$51.36
|
|
#acylcarnitineprfl
|
$15.36 |
$15.36 |
$15.36 |
$121.55
|
|
Adapter b 8 channel 10cm
|
$1,097.28 |
$1,097.28 |
$1,097.28 |
$6,142.50
|
|
Adenosine 3 mg/250 ml bag for osm
|
$10.19 |
$10.19 |
$10.19 |
$271.98
|
|
Adenovirus antibody,serum - quest
|
$26.24 |
$26.24 |
$26.24 |
$60.00
|
|
Adh-sendout
|
$170.88 |
$170.88 |
$170.88 |
$109.28
|
|
Adj gastric band via subq port
|
$106.72 |
$106.72 |
$106.72 |
$1,666.86
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$623.36 |
$623.36 |
$623.36 |
$2,995.08
|
|
Adjustment gastric band
|
$46.40 |
$46.40 |
$46.40 |
$89.04
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$10.57 |
$10.57 |
$10.57 |
$171.07
|
|
Admin ecg contrast agent
|
$42.24 |
$42.24 |
$42.24 |
$162.60
|
|
Administration chemotherapy IV infusion each additional hour
|
$65.60 |
$65.60 |
$65.60 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$85.12 |
$85.12 |
$85.12 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$308.80 |
$308.80 |
$308.80 |
$644.28
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$156.48 |
$156.48 |
$156.48 |
$439.45
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$108.16 |
$108.16 |
$108.16 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$129.60 |
$129.60 |
$129.60 |
$264.00
|
|
Administration immunization 1 vaccine
|
$40.64 |
$40.64 |
$40.64 |
$66.51
|
|
Administration immunization each additional vaccine
|
$39.04 |
$39.04 |
$39.04 |
$46.23
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$11.20 |
$11.20 |
$11.20 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$5.44 |
$5.44 |
$5.44 |
$31.20
|
|
Administration vaccine hepatitis b
|
$11.20 |
$11.20 |
$11.20 |
$54.60
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$5,147.57 |
$5,147.57 |
$5,147.57 |
$11,350.31
|
|
Adrenal cortex & medulla img
|
$729.28 |
$729.28 |
$729.28 |
$1,818.05
|
|
_afb id by dna probe rflx ast
|
$19.84 |
$19.84 |
$19.84 |
$93.52
|
|
#afb mycobacteria suscep. #1
|
$47.04 |
$47.04 |
$47.04 |
$38.58
|
|
_afb org id by sequencing rflx ast-sendout
|
$105.60 |
$105.60 |
$105.60 |
$289.60
|
|
Air conduction bilat
|
$106.56 |
$106.56 |
$106.56 |
$122.40
|
|
Albumin body fluid quantitative each specimen
|
$48.96 |
$48.96 |
$48.96 |
$47.50
|
|
Albumin (human), 25%, 50ml
|
$193.61 |
$193.61 |
$193.61 |
$219.30
|
|
Albumin (human), 5%, 250 ml
|
$114.49 |
$114.49 |
$114.49 |
$227.91
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$44.80 |
$44.80 |
$44.80 |
$55.90
|
|
Albumin serum plasma or whole blood
|
$43.52 |
$43.52 |
$43.52 |
$40.00
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$11.20 |
$11.20 |
$11.20 |
$94.90
|
|
Alcohols biomarkers 3/more
|
$89.60 |
$89.60 |
$89.60 |
$16.24
|
|
Alkaline phosphatase
|
$44.16 |
$44.16 |
$44.16 |
$46.50
|
|
Allergen alpha lactalbumin ige
|
$25.28 |
$25.28 |
$25.28 |
$46.80
|
|
Allergen egg white ige
|
$74.24 |
$74.24 |
$74.24 |
$33.50
|
|
Allergen specific ige qual multi scrn ea
|
$16.96 |
$16.96 |
$16.96 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$18.88 |
$18.88 |
$18.88 |
$42.00
|
|
Allergy injection; single 95115
|
$18.24 |
$18.24 |
$18.24 |
$42.75
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$64.00 |
$64.00 |
$64.00 |
$158.40
|
|
Alpha-fetoprotein tumor marker
|
$53.76 |
$53.76 |
$53.76 |
$100.20
|
|
Alteplase 100 mg infusion from pyxis vial
|
$199.09 |
$199.09 |
$199.09 |
$15,815.36
|
|
Alt/sgpt
|
$45.44 |
$45.44 |
$45.44 |
$47.45
|
|
Aluminum - quest
|
$99.20 |
$99.20 |
$99.20 |
$81.49
|
|
Amantadine (symmetrel)-sendout
|
$40.32 |
$40.32 |
$40.32 |
$178.10
|
