|
MRI upper extremity other than joint without contrast (both sides)
|
$1,364.20 |
$1,364.20 |
$4,687.80 |
$1,967.40
|
|
MRI upper extremity other than joint without & w/contrast (both sides)
|
$2,563.04 |
$2,563.04 |
$5,683.60 |
$2,669.70
|
|
MRI upper extremity w/dye
|
$2,563.04 |
$2,563.04 |
$2,563.04 |
$2,061.15
|
|
MRI w/cont, breast, bi
|
$1,779.08 |
$1,779.08 |
$1,779.08 |
$2,119.87
|
|
MRI w/cont, breast, uni
|
$1,420.27 |
$1,420.27 |
$1,420.27 |
$1,567.09
|
|
MRI without fol w/cont, breast
|
$1,779.08 |
$1,779.08 |
$3,129.75 |
$2,550.00
|
|
MRI without fol w/cont, brst, un
|
$1,779.08 |
$1,779.08 |
$2,764.45 |
$1,779.08
|
|
Mr safety determination physician/other qhp
|
$178.60 |
$178.60 |
$178.60 |
$161.40
|
|
Mr safety implant elec prepj
|
$207.20 |
$207.20 |
$207.20 |
$173.40
|
|
Mr safety implant&/fb assmt clin staff ea add 30
|
$92.80 |
$92.80 |
$92.80 |
$55.00
|
|
Mr safety implt pos&/immoblj
|
$268.00 |
$268.00 |
$268.00 |
$125.00
|
|
Mr sfty implt&/fb asmt stf 1
|
$49.68 |
$49.68 |
$49.68 |
$46.20
|
|
Mr sfty med physics xm cstmz
|
$490.31 |
$490.31 |
$490.31 |
$444.00
|
|
Mr spectroscopy
|
$1,018.40 |
$1,018.40 |
$1,018.40 |
$1,375.50
|
|
Msh2 gene dup/delete variant
|
$427.20 |
$427.20 |
$427.20 |
$422.64
|
|
Msh2 gene full seq
|
$764.00 |
$764.00 |
$764.00 |
$764.00
|
|
Msh2 gene known variants
|
$676.00 |
$676.00 |
$676.00 |
$466.07
|
|
Msh6 gene dup/delete variant
|
$476.00 |
$476.00 |
$476.00 |
$476.00
|
|
Msh6 gene full seq
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$1,160.50
|
|
Msh6 gene known variants
|
$616.00 |
$616.00 |
$616.00 |
$369.60
|
|
Mthfr gene analy common variants
|
$103.35 |
$103.35 |
$131.20 |
$184.00
|
|
M.tuberculo dna dir probe
|
$58.40 |
$58.40 |
$58.40 |
$58.40
|
|
M.tuberculo dna quant
|
$108.00 |
$108.00 |
$108.00 |
$59.12
|
|
Mucin synovial fluid
|
$33.57 |
$33.57 |
$33.57 |
$33.57
|
|
Mucopolysaccharides
|
$86.42 |
$86.42 |
$86.42 |
$178.36
|
|
Mucormycosis antibody
|
$38.40 |
$38.40 |
$38.40 |
$38.40
|
|
Multi den insert custom mold
|
$108.80 |
$108.80 |
$108.80 |
$56.00
|
|
Multi family grp psychotherapy
|
$80.80 |
$80.80 |
$80.80 |
$250.25
|
|
Multifocal erg w/i&r
|
$181.60 |
$181.60 |
$181.60 |
$386.40
|
|
Multiple sleep latency test
|
$1,592.50 |
$1,592.50 |
$1,781.30 |
$2,481.00
|
|
Mumps antibody igg
|
$48.57 |
$48.57 |
$118.95 |
$78.00
|
|
Muscle-skin graft arm
|
$3,014.40 |
$3,014.40 |
$3,014.40 |
$3,014.40
|
|
Muscle-skin graft leg
|
$3,197.60 |
$3,197.60 |
$3,197.60 |
$4,633.78
|
|
Muscle-skin graft trunk
|
$3,704.80 |
$3,704.80 |
$4,864.00 |
$4,332.25
|
|
Muscle test cran nerv unilat
|
$233.60 |
$233.60 |
$233.60 |
$385.07
|
|
Muscle test hemidiaphragm
|
$295.20 |
$295.20 |
$295.20 |
$296.40
|
|
Muscle test larynx
|
$335.20 |
$335.20 |
$335.20 |
$296.80
|
|
Muscle test one fiber
|
$442.40 |
$442.40 |
$442.40 |
$442.40
|
|
Muscle transfers
|
$2,810.40 |
$2,810.40 |
$2,810.40 |
$8,453.60
|
|
Muscle transfer shoulder/arm
|
$3,160.00 |
$3,160.00 |
$3,160.00 |
$8,434.13
|
|
Musc myoq/fscq flp h&n pedcl
|
$2,586.40 |
$2,586.40 |
$2,586.40 |
$4,331.73
|
|
Musc/tdn transfer upr a/e 1
|
$1,844.80 |
$1,844.80 |
$1,844.80 |
$7,807.24
|
|
Mycobacteria dna amp probe
|
$101.60 |
$101.60 |
$247.65 |
$234.00
|
|
Mycobacteria dna dir probe
|
$50.40 |
$50.40 |
$50.40 |
$65.17
|
|
Mycobacteria dna quant
|
$108.00 |
$108.00 |
$108.00 |
$141.45
|
|
Mycophenolate mofetil 250 mg capsule
|
$0.87 |
$0.87 |
$1.00 |
$10.79
|
|
Mycophenolic acid
|
$1.00 |
$1.00 |
$1.00 |
$12.84
|
|
Mycoplasma antibody igm
|
$48.57 |
$48.57 |
$104.65 |
$78.40
|
|
Myd88 gene p.leu265pro vrnt
|
$168.39 |
$168.39 |
$168.39 |
$417.00
|
|
Myelogphy 2/> spine regions
|
$1,721.15 |
$1,721.15 |
$1,721.15 |
$1,494.22
|
|
Myelography l-s spine
|
$1,583.79 |
$1,583.79 |
$1,583.79 |
$1,334.09
|
|
Myelography neck spine
|
$1,739.83 |
$1,739.83 |
$1,739.83 |
$1,241.50
|
|
Myelography thoracic spine
|
$549.43 |
$549.43 |
$549.43 |
$1,255.00
|
|
Myelography via inj w/s&i 2+ regions
|
$1,519.21 |
$1,519.21 |
$3,155.10 |
$2,267.34
|
|
Myelography via inj w/s&i cervical
|
$1,519.21 |
$1,519.21 |
$2,707.90 |
$1,784.80
|
|
Myelography via inj w/s&i lumbosacral
|
$1,519.21 |
$1,519.21 |
$2,919.15 |
$1,850.00
|
|
Myelography via inj w/s&i thoracic
|
$1,519.21 |
$1,519.21 |
$1,519.21 |
$1,745.94
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$64.28 |
$64.28 |
$91.65 |
$129.69
|
|
Myocardial resection 33542
|
$6,414.40 |
$6,414.40 |
$6,414.40 |
$6,414.40
|
|
Myocrd img pet 1std rst/strs
|
$2,753.60 |
$2,753.60 |
$2,753.60 |
$3,627.73
|
|
Myocrd img pet mlt rst&strs
|
$2,770.40 |
$2,770.40 |
$2,770.40 |
$4,060.00
|
|
Myocrd img pet rst&strs CT
|
$4,564.92 |
$4,564.92 |
$4,564.92 |
$4,846.40
|
|
Myocrd img pet rst/strs w/ct
|
$2,958.61 |
$2,958.61 |
$2,958.61 |
$3,311.85
|
|
Myomectomy abdom complex
|
$2,896.00 |
$2,896.00 |
$2,896.00 |
$1,893.60
|
|
Myomectomy abdom method
|
$2,315.20 |
$2,315.20 |
$2,802.00 |
$2,064.48
|
|
Myomectomy vag method
|
$1,399.20 |
$1,399.20 |
$1,399.20 |
$3,762.53
|
|
Myringoplasty
|
$3,449.60 |
$3,449.60 |
$3,449.60 |
$3,837.72
|
|
Nafcillin 2 gram solution for injection
|
$27.30 |
$27.30 |
$35.28 |
$84.00
|
|
Nalbuphine 10 mg/ml injection solution
|
$28.50 |
$28.50 |
$77.16 |
$37.81
|
|
Naloxone 0.4 mg/ml injection (wrapper)
|
$26.35 |
$26.35 |
$95.36 |
$70.87
|
|
Naltrexone, depot form
|
$4.80 |
$4.80 |
$8,240.35 |
$3,249.40
|
|
Narcosynthesis
|
$378.40 |
$378.40 |
$378.40 |
$378.40
|
|
Nasal endoscopy dx uni/bi separate proc
|
$471.20 |
$471.20 |
$919.00 |
$353.62
|
|
Nasal function studies
|
$129.60 |
$129.60 |
$129.60 |
$348.00
|
|
Nasal/sinus endoscopy surg
|
$1,003.20 |
$1,003.20 |
$1,003.20 |
$4,881.00
|
|
Nasal/sinus endoscopy surg
|
$5,662.40 |
$5,662.40 |
$5,662.40 |
$5,662.40
|
|
Nasal/sinus endoscopy surg w/bx 31237
|
$1,243.20 |
$1,243.20 |
$32,405.09 |
$2,831.51
|
|
Nasal/sinus endo spendt remove tiss 31288
|
$1,166.40 |
$1,166.40 |
$1,166.40 |
$5,741.00
|
|
Nasal/sinus endo surg w/concha bullosa resct 31240
|
$508.00 |
$508.00 |
$785.60 |
$2,040.67
|
|
Nasal/sinus endo w/ethmoidectomy part 31254
|
$2,067.20 |
$2,067.20 |
$2,067.20 |
$6,698.00
|
|
Nasal/sinus endo w/ethmoidectomy tot 31255
|
$1,617.60 |
$1,617.60 |
$2,584.00 |
$7,662.21
|
|
Nasal/sinus endo w/front sinus expl 31276
|
$1,888.00 |
$1,888.00 |
$60,862.53 |
$6,698.00
|
|
Nasal/sinus maxillary endoscopy dx 31233
|
$1,281.60 |
$1,281.60 |
$1,281.60 |
$973.39
|
|
Nasal/sinus sphenoid endoscopy dx 31235
|
$1,465.60 |
$1,465.60 |
$1,465.60 |
$2,232.24
|
|
Nasal sinus therapy
|
$364.80 |
$364.80 |
$364.80 |
$1,752.89
|
|
Nasopharyngoscopy w/endoscope
|
$206.05 |
$206.05 |
$272.80 |
$293.58
|
|
Natalizumab 300 mg/15 ml intravenous solution
|
$45.77 |
$45.77 |
$26,637.70 |
$16,254.52
|
|
Natriuretic peptide
|
$96.80 |
$96.80 |
$155.35 |
$176.15
|
|
Natural killer cells total count
|
$110.00 |
$110.00 |
$168.35 |
$135.00
|
|
Navigational bronchoscopy 31627
|
$1,159.00 |
$1,159.00 |
$3,104.80 |
$1,751.25
|
|
Nav srv peer sup 60 min pr m
|
$151.20 |
$151.20 |
$151.20 |
$109.46
|
|
N block inj common digit
|
$574.48 |
$574.48 |
$574.48 |
$540.80
|
|
N block inj hypogas plxs
|
$1,681.24 |
$1,681.24 |
$1,681.24 |
$1,912.00
|
|
Nctrnl pen tmscn&/rgdity tst
|
$313.60 |
$313.60 |
$313.60 |
$442.68
|
|
Ndl emg musc 1 xtr/non-limb
|
$195.20 |
$195.20 |
$195.20 |
$233.82
|
|
Ndl insj without njx 1 or 2 musc
|
$24.00 |
$24.00 |
$42.90 |
$39.77
|
|
Ndl insj without njx 3+ musc
|
$24.00 |
$24.00 |
$42.90 |
$45.00
|
|
Ndl oculoelectromyography 1+
|
$180.00 |
$180.00 |
$180.00 |
$158.50
|
|
Ndl round specialty proguide
|
$1,221.47 |
$1,221.47 |
$1,221.47 |
$324.40
|
|
Ndsc dcmprn 1 ntrspc lumbar
|
$3,521.60 |
$3,521.60 |
$3,521.60 |
$8,412.89
|
