|
17-hydroxypregnenolone
|
$291.60 |
$291.60 |
$291.60 |
$89.25
|
|
17-ketosteroids
|
$85.20 |
$85.20 |
$85.20 |
$55.00
|
|
99381 initial comp preventive med less than 1 year new
|
$94.80 |
$94.80 |
$94.80 |
$132.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$93.60 |
$93.60 |
$93.60 |
$126.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$90.00 |
$90.00 |
$90.00 |
$111.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$86.40 |
$86.40 |
$86.40 |
$107.10
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$87.60 |
$87.60 |
$87.60 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$90.60 |
$90.60 |
$90.60 |
$113.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$101.40 |
$101.40 |
$101.40 |
$127.20
|
|
99397 periodic comp preventive med 65+ years est
|
$131.40 |
$131.40 |
$131.40 |
$160.73
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$95.40 |
$95.40 |
$95.40 |
$53.95
|
|
Abdominal CT scan (with and without contrast)
|
$2,650.80 |
$2,650.80 |
$2,650.80 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,220.60 |
$2,220.60 |
$2,220.60 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$1,801.80 |
$1,801.80 |
$1,801.80 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$3,135.00 |
$3,135.00 |
$3,135.00 |
$3,015.94
|
|
Abdominal MRI (without contrast)
|
$2,929.80 |
$2,929.80 |
$2,929.80 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,124.40 |
$1,124.40 |
$1,124.40 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$1,012.20 |
$1,012.20 |
$1,012.20 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$616.20 |
$616.20 |
$616.20 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,101.60 |
$1,101.60 |
$1,101.60 |
$1,145.40
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$49.20 |
$49.20 |
$49.20 |
$74.96
|
|
Acetaminophen 120 mg rectal suppository
|
$1,417.80 |
$1,417.80 |
$1,417.80 |
$75.09
|
|
Acetaminophen level
|
$34.20 |
$34.20 |
$34.20 |
$107.62
|
|
Acetazolamide 500 mg solution for injection
|
$138.60 |
$138.60 |
$138.60 |
$122.55
|
|
Acetone qualitative
|
$91.80 |
$91.80 |
$91.80 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$1,092.60 |
$1,092.60 |
$1,092.60 |
$64.50
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$114.60 |
$114.60 |
$114.60 |
$167.04
|
|
Aco ccm; at least 20 min 99490aco
|
$96.00 |
$96.00 |
$96.00 |
$102.38
|
|
Acute hepatitis panel
|
$331.80 |
$331.80 |
$331.80 |
$292.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$37.80 |
$37.80 |
$37.80 |
$63.48
|
|
Adh-sendout
|
$139.20 |
$139.20 |
$139.20 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1.20 |
$1.20 |
$1.20 |
$181.12
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$135.00 |
$135.00 |
$135.00 |
$257.40
|
|
Administration immunization 1 vaccine
|
$86.40 |
$86.40 |
$86.40 |
$69.21
|
|
Administration immunization each additional vaccine
|
$33.60 |
$33.60 |
$33.60 |
$47.40
|
|
Advance care planning each additional 30 min 99498
|
$157.20 |
$157.20 |
$157.20 |
$108.00
|
|
Albumin body fluid quantitative each specimen
|
$5.40 |
$5.40 |
$5.40 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$294.00 |
$294.00 |
$294.00 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$82.20 |
$82.20 |
$82.20 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$91.80 |
$91.80 |
$91.80 |
$40.80
|
|
Alkaline phosphatase
|
$82.80 |
$82.80 |
$82.80 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$112.80 |
$112.80 |
$112.80 |
$48.00
|
|
Allergen egg white ige
|
$39.60 |
$39.60 |
$39.60 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$19.20 |
$19.20 |
$19.20 |
$24.01
|
|
Allergy injections; 2 or more 95117
|
$18.60 |
$18.60 |
$18.60 |
$43.75
|
|
Allergy injection; single 95115
|
$18.00 |
$18.00 |
$18.00 |
$42.75
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$635.04 |
$635.04 |
$635.04 |
$5,401.92
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,313.47 |
$1,313.47 |
$1,313.47 |
$874.65
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$284.00 |
$284.00 |
$284.00 |
$4,677.40
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$380.73 |
$380.73 |
$380.73 |
$1,495.63
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$325.20 |
$325.20 |
$325.20 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$172.80 |
$172.80 |
$172.80 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$32,310.00 |
$32,310.00 |
$32,310.00 |
$15,857.45
|
|
Alt/sgpt
|
$118.80 |
$118.80 |
$118.80 |
$47.45
|
|
Amantadine (symmetrel)-sendout
|
$129.00 |
$129.00 |
$129.00 |
$169.80
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$154.80 |
$154.80 |
$154.80 |
$119.07
|
|
Amiodarone 50 mg/ml intravenous solution
|
$8.10 |
$8.10 |
$8.10 |
$55.86
|
|
Ammonia
|
$204.00 |
$204.00 |
$204.00 |
$119.70
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$127.80 |
$127.80 |
$127.80 |
$117.75
|
|
Ampicillin 1 gram solution for injection
|
$49.20 |
$49.20 |
$49.20 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$55.20 |
$55.20 |
$55.20 |
$53.86
|
|
Amylase
|
$365.40 |
$365.40 |
$365.40 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$309.00 |
$309.00 |
$309.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$258.60 |
$258.60 |
$258.60 |
$230.40
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$51.00 |
$51.00 |
$51.00 |
$3,080.85
|
|
Ankle X-ray
|
$642.00 |
$642.00 |
$642.00 |
$353.60
|
|
Annual Physical, Established Patient (age 18-39)
|
$118.80 |
$118.80 |
$118.80 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$121.20 |
$121.20 |
$121.20 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$115.80 |
$115.80 |
$115.80 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$139.80 |
$139.80 |
$139.80 |
$165.10
|
|
Anora (draw only)
|
$19.20 |
$19.20 |
$19.20 |
$33.58
|
|
Antibody id rbc panel
|
$195.60 |
$195.60 |
$195.60 |
$274.56
|
|
Antibody screen rbc
|
$88.20 |
$88.20 |
$88.20 |
$100.00
|
|
Antidepressant not specified
|
$31.80 |
$31.80 |
$31.80 |
$61.80
|
|
Antinuclear antibodies
|
$265.20 |
$265.20 |
$265.20 |
$89.40
|
|
Antithrombin iii activity
|
$193.20 |
$193.20 |
$193.20 |
$114.00
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$58.20 |
$58.20 |
$58.20 |
$463.65
|
|
Application finger splntstatic 29130
|
$203.40 |
$203.40 |
$203.40 |
$208.16
|
|
Application long leg splint 29505
|
$203.40 |
$203.40 |
$203.40 |
$338.25
|
|
Application lower leg splint 29515
|
$203.40 |
$203.40 |
$203.40 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$379.20 |
$379.20 |
$379.20 |
$373.20
|
|
Application of forearm cast 29075
|
$463.20 |
$463.20 |
$463.20 |
$339.30
|
|
Application of long arm cast 29065
|
$145.80 |
$145.80 |
$145.80 |
$395.00
|
|
Application of paste boot 29580
|
$391.80 |
$391.80 |
$391.80 |
$331.74
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$1,570.80 |
$1,570.80 |
$1,570.80 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$1,731.60 |
$1,731.60 |
$1,731.60 |
$2,164.64
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$120.60 |
$120.60 |
$120.60 |
$75.60
|
|
Apply forearm splintdynamic 29126
|
$130.80 |
$130.80 |
$130.80 |
$246.18
|
|
Apply hand/wrist cast 29085
|
$103.80 |
$103.80 |
$103.80 |
$259.20
|
|
Apply of finger splint 29131
|
$39.60 |
$39.60 |
$39.60 |
$168.00
|
|
Arterial blood draw/perc 36620
|
$127.20 |
$127.20 |
$127.20 |
$485.69
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$394.80 |
$394.80 |
$394.80 |
$608.40
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$489.60 |
$489.60 |
$489.60 |
$1,005.42
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$373.20 |
$373.20 |
$373.20 |
$465.00
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$637.80 |
$637.80 |
$637.80 |
$715.37
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$1,543.80 |
$1,543.80 |
$1,543.80 |
$4,240.08
|
|
Arthrt rdcrpl/midcarpl jt
|
$1,362.00 |
$1,362.00 |
$1,362.00 |
$3,839.54
|
|
Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah)
|
$1,894.80 |
$1,894.80 |
$1,894.80 |
$4,194.13
|
|
Aspirate pleura without imaging 32554
|
$1,504.20 |
$1,504.20 |
$1,504.20 |
$1,196.52
|
|
Assay of interleukin-6 (il-6)
|
$647.40 |
$647.40 |
$647.40 |
$79.97
|
