|
88334 ap bill cytologic exam each additional site
|
$101.00 |
$101.00 |
$101.00 |
$100.10
|
|
99381 initial comp preventive med less than 1 year new
|
$262.00 |
$262.00 |
$262.00 |
$135.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$274.00 |
$274.00 |
$274.00 |
$135.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$286.00 |
$286.00 |
$286.00 |
$131.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$236.00 |
$236.00 |
$236.00 |
$117.72
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$252.00 |
$252.00 |
$252.00 |
$132.30
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$251.00 |
$251.00 |
$251.00 |
$120.25
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$470.00 |
$470.00 |
$470.00 |
$137.15
|
|
99397 periodic comp preventive med 65+ years est
|
$323.00 |
$323.00 |
$323.00 |
$164.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$7,377.95 |
$7,377.95 |
$7,377.95 |
$3,138.72
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,295.00 |
$1,295.00 |
$1,295.00 |
$988.00
|
|
Abdominal CT scan (with and without contrast)
|
$3,002.00 |
$3,002.00 |
$3,002.00 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,448.00 |
$2,448.00 |
$2,448.00 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$1,986.00 |
$1,986.00 |
$1,986.00 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$5,351.00 |
$5,351.00 |
$5,351.00 |
$2,967.00
|
|
Abdominal MRI (without contrast)
|
$4,399.00 |
$4,399.00 |
$4,399.00 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$2,052.00 |
$2,052.00 |
$2,052.00 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$1,066.00 |
$1,066.00 |
$1,066.00 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$856.00 |
$856.00 |
$856.00 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$386.00 |
$386.00 |
$386.00 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$140.00 |
$140.00 |
$140.00 |
$418.63
|
|
Abdominal X-ray (single view)
|
$251.00 |
$251.00 |
$251.00 |
$260.00
|
|
Acetaminophen 120 mg rectal suppository
|
$8,944.98 |
$8,944.98 |
$8,944.98 |
$146.76
|
|
Acetone qualitative
|
$65.00 |
$65.00 |
$65.00 |
$46.80
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$244.95 |
$244.95 |
$244.95 |
$218.79
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$424.00 |
$424.00 |
$424.00 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$386.00 |
$386.00 |
$386.00 |
$160.69
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$549.00 |
$549.00 |
$549.00 |
$341.00
|
|
Aco depression screen annual medicare g0444aco
|
$52.00 |
$52.00 |
$52.00 |
$39.32
|
|
Acute hepatitis panel
|
$487.00 |
$487.00 |
$487.00 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$1.00 |
$1.00 |
$1.00 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$10.40 |
$10.40 |
$10.40 |
$64.45
|
|
Adapter b 8 channel 10cm
|
$30,555.23 |
$30,555.23 |
$30,555.23 |
$5,109.58
|
|
Adenosine 3 mg/250 ml bag for osm
|
$695.70 |
$695.70 |
$695.70 |
$271.98
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$78.60 |
$78.60 |
$78.60 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$524.00 |
$524.00 |
$524.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$491.00 |
$491.00 |
$491.00 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$836.00 |
$836.00 |
$836.00 |
$668.98
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$461.00 |
$461.00 |
$461.00 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$417.00 |
$417.00 |
$417.00 |
$256.49
|
|
Administration immunization each additional component
|
$43.00 |
$43.00 |
$43.00 |
$29.20
|
|
Administration immunization each additional vaccine
|
$100.00 |
$100.00 |
$100.00 |
$47.40
|
|
Administration immunization first component each vaccine
|
$65.00 |
$65.00 |
$65.00 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$72.00 |
$72.00 |
$72.00 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$43.00 |
$43.00 |
$43.00 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$60.00 |
$60.00 |
$60.00 |
$44.80
|
|
Administration vaccine hepatitis b
|
$88.00 |
$88.00 |
$88.00 |
$53.00
|
|
Administration vaccine influenza virus
|
$88.00 |
$88.00 |
$88.00 |
$51.07
|
|
Administration vaccine pneumococcal
|
$88.00 |
$88.00 |
$88.00 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$56.46 |
$56.46 |
$56.46 |
$41.45
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$19,916.25 |
$19,916.25 |
$19,916.25 |
$11,350.31
|
|
Agalsidase beta 35 mg intravenous solution
|
$18,756.30 |
$18,756.30 |
$18,756.30 |
$14,475.20
|
|
Albumin body fluid quantitative each specimen
|
$73.00 |
$73.00 |
$73.00 |
$47.45
|
|
Albumin, human 25 % intravenous solution
|
$331.50 |
$331.50 |
$331.50 |
$234.94
|
|
Albumin, human 5 % intravenous solution
|
$332.50 |
$332.50 |
$332.50 |
$275.16
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$88.00 |
$88.00 |
$88.00 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$89.00 |
$89.00 |
$89.00 |
$43.00
|
|
Albuterol ipratrop non-comp
|
$2.70 |
$2.70 |
$2.70 |
$5.67
|
|
Albuterol non-comp unit
|
$1.00 |
$1.00 |
$1.00 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$146.00 |
$146.00 |
$146.00 |
$96.00
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$89,232.75 |
$89,232.75 |
$89,232.75 |
$47,974.31
|
|
Alkaline phosphatase
|
$63.00 |
$63.00 |
$63.00 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$48.00 |
$48.00 |
$48.00 |
$48.57
|
|
Allergen egg white ige
|
$44.00 |
$44.00 |
$44.00 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$50.00 |
$50.00 |
$50.00 |
$45.00
|
|
Allergy injection; single 95115
|
$51.00 |
$51.00 |
$51.00 |
$46.80
|
|
Allergy Skin Testing
|
$30.00 |
$30.00 |
$30.00 |
$47.44
|
|
Allograft 160mg placental salera mini membrane
|
$66.55 |
$66.55 |
$66.55 |
$5,835.10
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$653.33 |
$653.33 |
$653.33 |
$5,399.16
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$6,093.98 |
$6,093.98 |
$6,093.98 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$5,636.14 |
$5,636.14 |
$5,636.14 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$245.37 |
$245.37 |
$245.37 |
$20,311.34
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$3,227.12 |
$3,227.12 |
$3,227.12 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$366.35 |
$366.35 |
$366.35 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$8,630.50 |
$8,630.50 |
$8,630.50 |
$5,096.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$358.06 |
$358.06 |
$358.06 |
$5,278.73
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$1,254.67 |
$1,254.67 |
$1,254.67 |
$1,225.35
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$2,450.00 |
$2,450.00 |
$2,450.00 |
$13.14
|
|
Alpha-fetoprotein tumor marker
|
$199.00 |
$199.00 |
$199.00 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$25,477.05 |
$25,477.05 |
$25,477.05 |
$15,857.45
|
|
Alt/sgpt
|
$481.00 |
$481.00 |
$481.00 |
$47.50
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$17.05 |
$17.05 |
$17.05 |
$39.84
|
|
Amino acids quant 2-5
|
$145.00 |
$145.00 |
$145.00 |
$112.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$47.20 |
$47.20 |
$47.20 |
$37.33
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$101.15 |
$101.15 |
$101.15 |
$47.06
|
|
Amiodarone 50 mg/ml intravenous solution
|
$73.00 |
$73.00 |
$73.00 |
$55.86
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$11,933.95 |
$11,933.95 |
$11,933.95 |
$9,084.45
|
|
Ammonia
|
$238.00 |
$238.00 |
$238.00 |
$119.70
|
|
Amphetamines 5 or more
|
$50.00 |
$50.00 |
$50.00 |
$90.48
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$8.75 |
$8.75 |
$8.75 |
$123.53
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$1,507.85 |
$1,507.85 |
$1,507.85 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$38.85 |
$38.85 |
$38.85 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$14.55 |
$14.55 |
$14.55 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$789.00 |
$789.00 |
$789.00 |
$262.99
|
|
Amp metatarsal w/toe single 28810
|
$6,888.00 |
$6,888.00 |
$6,888.00 |
$3,986.00
|
|
Amputation toe interphalangeal joint
|
$9,011.63 |
$9,011.63 |
$9,011.63 |
$4,196.50
|
|
Amputation toe metatarsophalangeal joint
|
$11,785.18 |
$11,785.18 |
$11,785.18 |
$3,839.54
|
|
Amylase
|
$125.00 |
$125.00 |
$125.00 |
$90.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$237.00 |
$237.00 |
$237.00 |
$117.01
|
|
Analysis gene f2 20210g>a variant
|
$170.00 |
$170.00 |
$170.00 |
$226.85
|
