|
17-hydroxypregnenolone
|
$128.05 |
$128.05 |
$128.05 |
$92.65
|
|
1st hosp/birthing center care per day nml nb 99460
|
$230.00 |
$230.00 |
$230.00 |
$161.60
|
|
1st inpatient critical care pr day age 28 days/less than 99468
|
$2,315.00 |
$2,315.00 |
$2,315.00 |
$1,656.80
|
|
3-d radiotherapy plan
|
$5,969.60 |
$5,969.60 |
$5,969.60 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$386.10 |
$386.10 |
$386.10 |
$508.13
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$7,377.95 |
$7,377.95 |
$7,377.95 |
$3,138.72
|
|
Abd aorta w/runoff s&i
|
$6,659.25 |
$6,659.25 |
$6,659.25 |
$3,629.42
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$1,005.55 |
$1,005.55 |
$1,005.55 |
$988.00
|
|
Abdominal CT scan (with and without contrast)
|
$2,189.85 |
$2,189.85 |
$2,189.85 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,052.70 |
$2,052.70 |
$2,052.70 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$2,001.35 |
$2,001.35 |
$2,001.35 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$1,800.50 |
$1,800.50 |
$1,800.50 |
$2,967.00
|
|
Abdominal MRI (without contrast)
|
$1,286.35 |
$1,286.35 |
$1,286.35 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,661.13 |
$1,661.13 |
$1,661.13 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$1,084.20 |
$1,084.20 |
$1,084.20 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$624.00 |
$624.00 |
$624.00 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$321.10 |
$321.10 |
$321.10 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$358.80 |
$358.80 |
$358.80 |
$418.63
|
|
Abdominal X-ray (single view)
|
$234.00 |
$234.00 |
$234.00 |
$260.00
|
|
Abdominoplasty 15830
|
$52,082.48 |
$52,082.48 |
$52,082.48 |
$6,442.80
|
|
Abd paracentesis/w/o image guide 49082
|
$616.85 |
$616.85 |
$616.85 |
$1,148.40
|
|
Acetaminophen 120 mg rectal suppository
|
$11,910.01 |
$11,910.01 |
$11,910.01 |
$146.76
|
|
Acetazolamide 500 mg solution for injection
|
$55.20 |
$55.20 |
$55.20 |
$122.55
|
|
Acetylcholine receptor modulating antibody
|
$39.65 |
$39.65 |
$39.65 |
$67.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$244.95 |
$244.95 |
$244.95 |
$218.79
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$70.85 |
$70.85 |
$70.85 |
$160.69
|
|
Aco depression screen annual medicare g0444aco
|
$33.80 |
$33.80 |
$33.80 |
$39.32
|
|
Acute hepatitis panel
|
$328.25 |
$328.25 |
$328.25 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$64.85 |
$64.85 |
$64.85 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$20.70 |
$20.70 |
$20.70 |
$64.45
|
|
#acylcarnitineprfl
|
$88.40 |
$88.40 |
$88.40 |
$121.55
|
|
Adapter b 8 channel 10cm
|
$19,860.90 |
$19,860.90 |
$19,860.90 |
$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
|
$126.75 |
$126.75 |
$126.75 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$167.70 |
$167.70 |
$167.70 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$831.35 |
$831.35 |
$831.35 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$523.90 |
$523.90 |
$523.90 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$104.00 |
$104.00 |
$104.00 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$159.25 |
$159.25 |
$159.25 |
$256.49
|
|
Administration immunization each additional component
|
$20.80 |
$20.80 |
$20.80 |
$29.20
|
|
Administration immunization each additional vaccine
|
$27.95 |
$27.95 |
$27.95 |
$47.40
|
|
Administration immunization first component each vaccine
|
$42.90 |
$42.90 |
$42.90 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$39.65 |
$39.65 |
$39.65 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$23.40 |
$23.40 |
$23.40 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$39.00 |
$39.00 |
$39.00 |
$44.80
|
|
Administration vaccine hepatitis b
|
$33,066.51 |
$33,066.51 |
$33,066.51 |
$53.00
|
|
Administration vaccine influenza virus
|
$78.00 |
$78.00 |
$78.00 |
$51.07
|
|
Administration vaccine pneumococcal
|
$78.00 |
$78.00 |
$78.00 |
$49.68
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$36.40 |
$36.40 |
$36.40 |
$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
|
$18.20 |
$18.20 |
$18.20 |
$47.45
|
|
Albumin, human 25 % intravenous solution
|
$2,227.28 |
$2,227.28 |
$2,227.28 |
$234.94
|
|
Albumin, human 5 % intravenous solution
|
$332.50 |
$332.50 |
$332.50 |
$275.16
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$78.00 |
$78.00 |
$78.00 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$555.10 |
$555.10 |
$555.10 |
$43.00
|
|
Albuterol non-comp unit
|
$1.00 |
$1.00 |
$1.00 |
$5.40
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$94.90 |
$94.90 |
$94.90 |
$96.00
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$89,232.75 |
$89,232.75 |
$89,232.75 |
$47,974.31
|
|
Alkaline phosphatase
|
$44.20 |
$44.20 |
$44.20 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$91.00 |
$91.00 |
$91.00 |
$48.57
|
|
Allergen egg white ige
|
$844.35 |
$844.35 |
$844.35 |
$38.00
|
|
Allograft 160mg placental salera mini membrane
|
$43.26 |
$43.26 |
$43.26 |
$5,835.10
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$424.66 |
$424.66 |
$424.66 |
$5,399.16
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$3,961.09 |
$3,961.09 |
$3,961.09 |
$9,900.02
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$3,663.49 |
$3,663.49 |
$3,663.49 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$159.49 |
$159.49 |
$159.49 |
$20,311.34
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$2,097.63 |
$2,097.63 |
$2,097.63 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$238.13 |
$238.13 |
$238.13 |
$4,677.40
|
|
Allograft membrn amnio 1x2cm hu ambriodry
|
$5,609.82 |
$5,609.82 |
$5,609.82 |
$5,096.00
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$232.74 |
$232.74 |
$232.74 |
$5,278.73
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$815.54 |
$815.54 |
$815.54 |
$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 afp-l3 frac & total
|
$188.50 |
$188.50 |
$188.50 |
$198.60
|
|
Alpha-fetoprotein tumor marker
|
$155.35 |
$155.35 |
$155.35 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$25,477.05 |
$25,477.05 |
$25,477.05 |
$15,857.45
|
|
Alt/sgpt
|
$52.65 |
$52.65 |
$52.65 |
$47.50
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$32.20 |
$32.20 |
$32.20 |
$39.84
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$49.90 |
$49.90 |
$49.90 |
$37.33
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$101.15 |
$101.15 |
$101.15 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$212.00 |
$212.00 |
$212.00 |
$108.13
|
|
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
|
$178.10 |
$178.10 |
$178.10 |
$119.70
|
|
Amphetamines 5 or more
|
$52.00 |
$52.00 |
$52.00 |
$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
|
$21.85 |
$21.85 |
$21.85 |
$54.57
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$200.20 |
$200.20 |
$200.20 |
$262.99
|
|
Amp metatarsal w/toe single 28810
|
$20,294.75 |
$20,294.75 |
$20,294.75 |
$3,986.00
|
|
Amputation leg thr tib/fib 27880
|
$3,870.00 |
$3,870.00 |
$3,870.00 |
$3,870.00
|
|
Amputation toe interphalangeal joint
|
$14,223.27 |
$14,223.27 |
$14,223.27 |
$4,196.50
|
|
Amputation toe metatarsophalangeal joint
|
$1,318.00 |
$1,318.00 |
$1,318.00 |
$3,839.54
|
|
Amylase
|
$84.50 |
$84.50 |
$84.50 |
$90.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$274.30 |
$274.30 |
$274.30 |
$117.01
|
|
Analysis gene f2 20210g>a variant
|
$446.55 |
$446.55 |
$446.55 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$126.10 |
$126.10 |
$126.10 |
$249.60
|
|
Anchor suture 3.5mm pushlock
|
$2,155.00 |
$2,155.00 |
$2,155.00 |
$2,155.00
|