|
17-ketosteroids
|
$87.00 |
$87.00 |
$87.00 |
$55.00
|
|
5' nucleotidase - sendout
|
$136.80 |
$136.80 |
$136.80 |
$50.40
|
|
99383 initial comp preventive med 5 to 11 years new
|
$90.00 |
$90.00 |
$90.00 |
$111.00
|
|
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
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,489.00 |
$3,489.00 |
$3,489.00 |
$3,128.29
|
|
Abdominal CT scan (with and without contrast)
|
$2,410.20 |
$2,410.20 |
$2,410.20 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$2,016.60 |
$2,016.60 |
$2,016.60 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$1,636.80 |
$1,636.80 |
$1,636.80 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,950.80 |
$2,950.80 |
$2,950.80 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$2,628.00 |
$2,628.00 |
$2,628.00 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$2,773.80 |
$2,773.80 |
$2,773.80 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$1,939.20 |
$1,939.20 |
$1,939.20 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$958.20 |
$958.20 |
$958.20 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$579.00 |
$579.00 |
$579.00 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,317.60 |
$1,317.60 |
$1,317.60 |
$1,145.40
|
|
Abl1 gene
|
$1,353.00 |
$1,353.00 |
$1,353.00 |
$682.50
|
|
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
|
$150.00 |
$150.00 |
$150.00 |
$122.55
|
|
Acetone qualitative
|
$88.20 |
$88.20 |
$88.20 |
$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
|
|
Acute hepatitis panel
|
$316.80 |
$316.80 |
$316.80 |
$292.00
|
|
Acyclovir 400 mg tablet
|
$902.40 |
$902.40 |
$902.40 |
$45.06
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$37.80 |
$37.80 |
$37.80 |
$63.48
|
|
#acylcarnitineprfl
|
$160.20 |
$160.20 |
$160.20 |
$125.40
|
|
Adh-sendout
|
$354.60 |
$354.60 |
$354.60 |
$109.28
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$1.20 |
$1.20 |
$1.20 |
$181.12
|
|
Administration chemotherapy IV infusion each additional hour
|
$72.00 |
$72.00 |
$72.00 |
$230.35
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$444.00 |
$444.00 |
$444.00 |
$657.12
|
|
Administration immunization 1 vaccine
|
$73.80 |
$73.80 |
$73.80 |
$69.21
|
|
Administration immunization each additional vaccine
|
$37.80 |
$37.80 |
$37.80 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$64.20 |
$64.20 |
$64.20 |
$48.00
|
|
Administration vaccine hepatitis b
|
$52.80 |
$52.80 |
$52.80 |
$54.40
|
|
Air conduction bilat
|
$41.40 |
$41.40 |
$41.40 |
$133.00
|
|
Albumin body fluid quantitative each specimen
|
$5.40 |
$5.40 |
$5.40 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$257.40 |
$257.40 |
$257.40 |
$244.70
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$103.20 |
$103.20 |
$103.20 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$57.60 |
$57.60 |
$57.60 |
$40.80
|
|
Alkaline phosphatase
|
$78.60 |
$78.60 |
$78.60 |
$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
|
|
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 epieffect 2x3cm-q4186-cost per sq cm
|
$5,171.10 |
$5,171.10 |
$5,171.10 |
$874.65
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$3.60 |
$3.60 |
$3.60 |
$12.50
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$337.80 |
$337.80 |
$337.80 |
$175.20
|
|
Alpha-fetoprotein tumor marker
|
$36.00 |
$36.00 |
$36.00 |
$106.00
|
|
Alprostadil for injection
|
$396.00 |
$396.00 |
$396.00 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$32,310.00 |
$32,310.00 |
$32,310.00 |
$15,857.45
|
|
Alt/sgpt
|
$80.40 |
$80.40 |
$80.40 |
$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
|
$193.20 |
$193.20 |
$193.20 |
$119.70
|
|
Amphetamine confirm urine -sendout
|
$55.80 |
$55.80 |
$55.80 |
$92.61
|
|
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
|
$108.00 |
$108.00 |
$108.00 |
$89.04
|
|
Analysis gene f2 20210g>a variant
|
$273.00 |
$273.00 |
$273.00 |
$219.60
|
|
Analysis gene f5 leiden variant
|
$259.80 |
$259.80 |
$259.80 |
$230.40
|
|
An fluoro guide for cvp
|
$399.60 |
$399.60 |
$399.60 |
$515.00
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$853.20 |
$853.20 |
$853.20 |
$3,080.85
|
|
Ankle X-ray
|
$520.80 |
$520.80 |
$520.80 |
$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 bacterium, not elsewhere specified
|
$22.80 |
$22.80 |
$22.80 |
$57.81
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$60.60 |
$60.60 |
$60.60 |
$218.30
|
|
Antibody id rbc panel
|
$109.80 |
$109.80 |
$109.80 |
$274.56
|
|
Antibody screen rbc
|
$57.00 |
$57.00 |
$57.00 |
$100.00
|
|
Antinuclear antibodies
|
$82.20 |
$82.20 |
$82.20 |
$89.40
|
|
Antistreptolysin o titer
|
$25.80 |
$25.80 |
$25.80 |
$51.45
|
|
Antithrombin iii activity
|
$90.60 |
$90.60 |
$90.60 |
$114.00
|
|
Appendectomy
|
$1,065.00 |
$1,065.00 |
$1,065.00 |
$5,681.93
|
|
Appendectomy/open/rup/w/absc/peri 44960
|
$1,513.20 |
$1,513.20 |
$1,513.20 |
$1,562.44
|
|
Appendix Removal (Laparoscopic)
|
$1,398.60 |
$1,398.60 |
$1,398.60 |
$6,870.89
|
|
Application finger splntstatic 29130
|
$183.60 |
$183.60 |
$183.60 |
$208.16
|
|
Application long leg splint 29505
|
$445.80 |
$445.80 |
$445.80 |
$338.25
|
|
Application lower leg splint 29515
|
$445.80 |
$445.80 |
$445.80 |
$330.48
|
|
Application of forearm cast 29075
|
$64.20 |
$64.20 |
$64.20 |
$339.30
|
|
Application of long arm cast 29065
|
$145.80 |
$145.80 |
$145.80 |
$395.00
|
|
Application of paste boot 29580
|
$196.20 |
$196.20 |
$196.20 |
$331.74
|
|
Application short leg cast 29405
|
$113.40 |
$113.40 |
$113.40 |
$388.80
|
|
Appl modality 1/> areas paraffin bath 97018
|
$133.80 |
$133.80 |
$133.80 |
$66.00
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$170.40 |
$170.40 |
$170.40 |
$100.00
|
|
Arterial blood draw/perc 36620
|
$218.40 |
$218.40 |
$218.40 |
$485.69
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$145.80 |
$145.80 |
$145.80 |
$608.40
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$538.80 |
$538.80 |
$538.80 |
$889.20
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$145.80 |
$145.80 |
$145.80 |
$465.00
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$487.80 |
$487.80 |
$487.80 |
$715.37
|
|
Asp & inj bone cyst
|
$511.20 |
$511.20 |
$511.20 |
$974.90
|
|
Aspirate pleura without imaging 32554
|
$1,775.40 |
$1,775.40 |
$1,775.40 |
$1,196.52
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$933.00 |
$933.00 |
$933.00 |
$1,226.87
|
|
Assay of interleukin-6 (il-6)
|
$121.80 |
$121.80 |
$121.80 |
$79.97
|
