|
3-d radiotherapy plan
|
$3,834.88 |
$3,834.88 |
$3,834.88 |
$5,002.69
|
|
5' nucleotidase - sendout
|
$75.50 |
$75.50 |
$75.50 |
$50.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$35.52 |
$35.52 |
$35.52 |
$127.20
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,551.25 |
$3,551.25 |
$3,551.25 |
$3,128.29
|
|
Abdominal CT scan (with and without contrast)
|
$542.00 |
$542.00 |
$542.00 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$510.75 |
$510.75 |
$510.75 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$476.88 |
$476.88 |
$476.88 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$803.75 |
$803.75 |
$803.75 |
$3,015.94
|
|
Abdominal MRI (without contrast)
|
$747.12 |
$747.12 |
$747.12 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$911.00 |
$911.00 |
$911.00 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$226.25 |
$226.25 |
$226.25 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$489.00 |
$489.00 |
$489.00 |
$590.00
|
|
Abobotulinumtoxina
|
$3,044.50 |
$3,044.50 |
$3,044.50 |
$1,541.21
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$51.09 |
$51.09 |
$51.09 |
$74.96
|
|
Acetaminophen level
|
$114.62 |
$114.62 |
$114.62 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$144.00 |
$144.00 |
$144.00 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$36.12 |
$36.12 |
$36.12 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$183.44 |
$183.44 |
$183.44 |
$216.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$40.08 |
$40.08 |
$40.08 |
$167.04
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$214.75 |
$214.75 |
$214.75 |
$345.15
|
|
Acute hepatitis panel
|
$136.38 |
$136.38 |
$136.38 |
$292.00
|
|
Acyclovir 400 mg tablet
|
$1,842.37 |
$1,842.37 |
$1,842.37 |
$45.06
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$101.88 |
$101.88 |
$101.88 |
$63.48
|
|
#acylcarnitineprfl
|
$49.62 |
$49.62 |
$49.62 |
$125.40
|
|
Adalimumab injection
|
$9,382.48 |
$9,382.48 |
$9,382.48 |
$6,853.40
|
|
Adapter b 8 channel 10cm
|
$1,999.20 |
$1,999.20 |
$1,999.20 |
$5,695.04
|
|
Adenosine 3 mg/250 ml bag for osm
|
$543.55 |
$543.55 |
$543.55 |
$255.41
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$410.47 |
$410.47 |
$410.47 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$199.38 |
$199.38 |
$199.38 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$365.00 |
$365.00 |
$365.00 |
$294.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$657.12 |
$657.12 |
$657.12 |
$657.12
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$407.75 |
$407.75 |
$407.75 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$143.62 |
$143.62 |
$143.62 |
$211.09
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$156.50 |
$156.50 |
$156.50 |
$257.40
|
|
Administration immunization 1 vaccine
|
$80.00 |
$80.00 |
$80.00 |
$69.21
|
|
Administration immunization each additional vaccine
|
$31.25 |
$31.25 |
$31.25 |
$47.40
|
|
Administration vaccine hepatitis b
|
$30.50 |
$30.50 |
$30.50 |
$54.40
|
|
Administration vaccine influenza virus
|
$42.88 |
$42.88 |
$42.88 |
$50.43
|
|
Administration vaccine pneumococcal
|
$34.50 |
$34.50 |
$34.50 |
$50.43
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$15,780.15 |
$15,780.15 |
$15,780.15 |
$11,350.31
|
|
Adrenalin epinephrine inject
|
$703.95 |
$703.95 |
$703.95 |
$229.69
|
|
Aep thrshld est mlt freq i&r
|
$2,316.50 |
$2,316.50 |
$2,316.50 |
$605.15
|
|
Afamelanotide implant, 1 mg
|
$60,749.40 |
$60,749.40 |
$60,749.40 |
$78,638.30
|
|
Agalsidase beta 35 mg intravenous solution
|
$17,255.38 |
$17,255.38 |
$17,255.38 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$30.88 |
$30.88 |
$30.88 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$482.51 |
$482.51 |
$482.51 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$262.82 |
$262.82 |
$262.82 |
$243.59
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$28.62 |
$28.62 |
$28.62 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$20.00 |
$20.00 |
$20.00 |
$40.80
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$21.59 |
$21.59 |
$21.59 |
$93.60
|
|
Aldesleukin injection
|
$2,830.85 |
$2,830.85 |
$2,830.85 |
$9,030.11
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$0.01 |
$0.01 |
$0.01 |
$47,974.31
|
|
Alkaline phosphatase
|
$42.00 |
$42.00 |
$42.00 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$24.00 |
$24.00 |
$24.00 |
$48.00
|
|
Allergen egg white ige
|
$33.38 |
$33.38 |
$33.38 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$20.00 |
$20.00 |
$20.00 |
$43.75
|
|
Allergy injection; single 95115
|
$16.00 |
$16.00 |
$16.00 |
$42.75
|
|
Allergy Skin Testing
|
$2.10 |
$2.10 |
$2.10 |
$47.44
|
|
Allg patch or app # of tests 95044
|
$10.00 |
$10.00 |
$10.00 |
$445.00
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$13,687.41 |
$13,687.41 |
$13,687.41 |
$5,401.92
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$11,215.90 |
$11,215.90 |
$11,215.90 |
$6,414.50
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$35,921.86 |
$35,921.86 |
$35,921.86 |
$23,373.60
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$4,370.56 |
$4,370.56 |
$4,370.56 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$7,046.40 |
$7,046.40 |
$7,046.40 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$5,478.40 |
$5,478.40 |
$5,478.40 |
$4,725.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$11,490.25 |
$11,490.25 |
$11,490.25 |
$4,561.83
|
|
All tstg perq&iq drugs/biol
|
$7.52 |
$7.52 |
$7.52 |
$64.80
|
|
All tstg perq&iq w/venoms
|
$3.15 |
$3.15 |
$3.15 |
$41.34
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$1,176.00 |
$1,176.00 |
$1,176.00 |
$12.50
|
|
Alpha-fetoprotein tumor marker
|
$104.50 |
$104.50 |
$104.50 |
$106.00
|
|
Alprostadil for injection
|
$327.86 |
$327.86 |
$327.86 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$21,257.00 |
$21,257.00 |
$21,257.00 |
$15,857.45
|
|
Alt/sgpt
|
$27.00 |
$27.00 |
$27.00 |
$47.45
|
|
Aluminum - quest
|
$122.50 |
$122.50 |
$122.50 |
$83.05
|
|
Amifostine
|
$1,743.30 |
$1,743.30 |
$1,743.30 |
$2,121.39
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$91.22 |
$91.22 |
$91.22 |
$39.84
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$83.53 |
$83.53 |
$83.53 |
$45.02
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$250.90 |
$250.90 |
$250.90 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$94.60 |
$94.60 |
$94.60 |
$55.86
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$9,141.88 |
$9,141.88 |
$9,141.88 |
$7,994.03
|
|
Ammonia
|
$85.75 |
$85.75 |
$85.75 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$87.32 |
$87.32 |
$87.32 |
$942.60
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$254.50 |
$254.50 |
$254.50 |
$117.75
|
|
Amphotericin b lipid complex
|
$270.60 |
$270.60 |
$270.60 |
$226.80
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$266.72 |
$266.72 |
$266.72 |
$543.85
|
|
Ampicillin 1 gram solution for injection
|
$127.37 |
$127.37 |
$127.37 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$158.44 |
$158.44 |
$158.44 |
$53.86
|
|
Amylase
|
$40.00 |
$40.00 |
$40.00 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$45.50 |
$45.50 |
$45.50 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$97.62 |
$97.62 |
$97.62 |
$230.40
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$3,440.00 |
$3,440.00 |
$3,440.00 |
$3,080.85
|
|
Ankle X-ray
|
$273.50 |
$273.50 |
$273.50 |
$353.60
|
|
Anl sp inf pmp w/mdreprg&fil
|
$83.30 |
$83.30 |
$83.30 |
$627.94
|
|
Annual Physical, Established Patient (age 18-39)
|
$41.12 |
$41.12 |
$41.12 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$43.75 |
$43.75 |
$43.75 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$47.08 |
$47.08 |
$47.08 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$53.02 |
$53.02 |
$53.02 |
$165.10
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$19.50 |
$19.50 |
$19.50 |
$218.30
|
|
Antibody id rbc panel
|
$231.50 |
$231.50 |
$231.50 |
$274.56
|
|
Antibody screen rbc
|
$72.75 |
$72.75 |
$72.75 |
$100.00
|
