|
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
|
$146.25 |
$146.25 |
$146.25 |
$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 CT scan (with contrast)
|
$1,591.20 |
$1,591.20 |
$1,591.20 |
$1,667.60
|
|
Abdominal MRI (with and without contrast)
|
$3,478.15 |
$3,478.15 |
$3,478.15 |
$2,967.00
|
|
Abdominal paracentesis w/image guidance
|
$1,333.80 |
$1,333.80 |
$1,333.80 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$692.90 |
$692.90 |
$692.90 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$556.40 |
$556.40 |
$556.40 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$250.90 |
$250.90 |
$250.90 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$327.60 |
$327.60 |
$327.60 |
$418.63
|
|
Abdominal X-ray (single view)
|
$163.15 |
$163.15 |
$163.15 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$1,148.40
|
|
Acetaminophen 120 mg rectal suppository
|
$9,149.29 |
$9,149.29 |
$9,149.29 |
$146.76
|
|
Acetazolamide 500 mg solution for injection
|
$55.20 |
$55.20 |
$55.20 |
$122.55
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$121.20 |
$121.20 |
$121.20 |
$218.79
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$424.00 |
$424.00 |
$424.00 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$360.00 |
$360.00 |
$360.00 |
$160.69
|
|
Aco depression screen annual medicare g0444aco
|
$52.00 |
$52.00 |
$52.00 |
$39.32
|
|
Acute hepatitis panel
|
$316.55 |
$316.55 |
$316.55 |
$284.95
|
|
Acyclovir 400 mg tablet
|
$1.00 |
$1.00 |
$1.00 |
$54.77
|
|
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 up to 1 hour single/initial substance/drug
|
$543.40 |
$543.40 |
$543.40 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$492.05 |
$492.05 |
$492.05 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$271.05 |
$271.05 |
$271.05 |
$256.49
|
|
Administration immunization each additional component
|
$27.95 |
$27.95 |
$27.95 |
$29.20
|
|
Administration immunization each additional vaccine
|
$65.00 |
$65.00 |
$65.00 |
$47.40
|
|
Administration immunization first component each vaccine
|
$42.25 |
$42.25 |
$42.25 |
$46.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$46.80 |
$46.80 |
$46.80 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$27.95 |
$27.95 |
$27.95 |
$30.24
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$39.00 |
$39.00 |
$39.00 |
$44.80
|
|
Administration vaccine hepatitis b
|
$57.20 |
$57.20 |
$57.20 |
$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
|
$27.95 |
$27.95 |
$27.95 |
$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
|
$47.45 |
$47.45 |
$47.45 |
$47.45
|
|
Albumin, human 25 % intravenous solution
|
$871.00 |
$871.00 |
$871.00 |
$234.94
|
|
Albumin, human 5 % intravenous solution
|
$332.50 |
$332.50 |
$332.50 |
$275.16
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$57.20 |
$57.20 |
$57.20 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$1,330.00 |
$1,330.00 |
$1,330.00 |
$43.00
|
|
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
|
$473.00 |
$473.00 |
$473.00 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$31.20 |
$31.20 |
$31.20 |
$48.57
|
|
Allergen egg white ige
|
$28.60 |
$28.60 |
$28.60 |
$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 tumor marker
|
$1,956.00 |
$1,956.00 |
$1,956.00 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$25,477.05 |
$25,477.05 |
$25,477.05 |
$15,857.45
|
|
Alt/sgpt
|
$802.00 |
$802.00 |
$802.00 |
$47.50
|
|
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
|
$9.20 |
$9.20 |
$9.20 |
$55.86
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$11,933.95 |
$11,933.95 |
$11,933.95 |
$9,084.45
|
|
Ammonia
|
$154.70 |
$154.70 |
$154.70 |
$119.70
|
|
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
|
$562.35 |
$562.35 |
$562.35 |
$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
|
$512.85 |
$512.85 |
$512.85 |
$262.99
|
|
Amylase
|
$71.50 |
$71.50 |
$71.50 |
$90.00
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$154.05 |
$154.05 |
$154.05 |
$117.01
|
|
Analysis gene f2 20210g>a variant
|
$110.50 |
$110.50 |
$110.50 |
$226.85
|
|
Analysis gene f5 leiden variant
|
$379.60 |
$379.60 |
$379.60 |
$249.60
|
|
Anchor suture 3.5mm pushlock
|
$2,155.00 |
$2,155.00 |
$2,155.00 |
$2,155.00
|
|
Ankle X-ray
|
$407.55 |
$407.55 |
$407.55 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$356.20 |
$356.20 |
$356.20 |
$282.96
|
|
Annual Physical, Established Patient (age 18-39)
|
$283.00 |
$283.00 |
$283.00 |
$153.51
|
|
Annual Physical, Established Patient (age 40-64)
|
$301.00 |
$301.00 |
$301.00 |
$160.73
|
|
Annual Physical, New Patient (age 18-39)
|
$313.00 |
$313.00 |
$313.00 |
$154.00
|
|
Annual Physical, New Patient (age 40-64)
|
$363.00 |
$363.00 |
$363.00 |
$167.25
|
|
Antibody elution rbc reference
|
$85.80 |
$85.80 |
$85.80 |
$177.29
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$257.40 |
$257.40 |
$257.40 |
$224.00
|
|
Antibody id rbc panel
|
$291.85 |
$291.85 |
$291.85 |
$291.75
|
|
Antibody screen rbc
|
$85.80 |
$85.80 |
$85.80 |
$108.55
|
|
Anticoag mgmt pt warfarin
|
$25.35 |
$25.35 |
$25.35 |
$26.40
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$5,144.60 |
$5,144.60 |
$5,144.60 |
$6.10
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$147.55 |
$147.55 |
$147.55 |
$38.50
|
|
Antinuclear antibodies
|
$105.95 |
$105.95 |
$105.95 |
$90.00
|
|
Antinuclear antibodies titer
|
$85.80 |
$85.80 |
$85.80 |
$80.04
|
|
Antistreptolysin o screen
|
$48.75 |
$48.75 |
$48.75 |
$58.56
|
|
Antithrombin iii activity
|
$135.20 |
$135.20 |
$135.20 |
$115.15
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$14,664.50 |
$14,664.50 |
$14,664.50 |
$8,214.07
|
|
Aortic Aneurysm Screening Ultrasound
|
$393.90 |
$393.90 |
$393.90 |
$394.55
|