|
17-hydroxypregnenolone
|
$96.25 |
$180.70 |
$509.70 |
|
|
1st inpatient critical care pr day age 28 days/less than 99468
|
$1,780.50 |
$1,780.50 |
$1,780.50 |
|
|
1st psyc collab care mgmt
|
$215.90 |
$215.90 |
$215.90 |
|
|
1st/sbsq psyc collab care
|
$107.95 |
$107.95 |
$107.95 |
|
|
24 hr ambulatory b/p monitor
|
$135.00 |
$318.25 |
$348.10 |
|
|
2d tee w or without fol w/con,in
|
$2,213.30 |
$2,213.30 |
$2,213.30 |
|
|
2nd order venous cath
|
$1,077.10 |
$1,077.10 |
$1,077.10 |
|
|
3d ech img cgen car anomal
|
$116.50 |
$744.15 |
$744.15 |
|
|
3d recon without postprocess indpndt
|
$167.35 |
$361.30 |
$614.05 |
|
|
5' nucleotidase - sendout
|
$31.00 |
$110.50 |
$244.80 |
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$1,856.22 |
$3,614.34 |
$6,591.89 |
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$33.35 |
$39.20 |
$117.70 |
|
|
Abd aorta w/runoff s&i
|
$2,987.65 |
$2,987.65 |
$2,987.65 |
|
|
Abd/low ext cath 1st
|
$1,513.00 |
$1,513.00 |
$1,513.00 |
|
|
Abd/low ext cath 2nd
|
$1,692.80 |
$1,692.80 |
$1,692.80 |
|
|
Abd/low ext cath 3rd
|
$2,000.40 |
$2,000.40 |
$2,000.40 |
|
|
Abd/low ext cath addl
|
$333.50 |
$333.50 |
$333.50 |
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$786.25 |
$1,465.45 |
$2,244.55 |
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$409.75 |
$895.10 |
$1,813.95 |
|
|
Abdominal CT scan (with and without contrast)
|
$1,509.20 |
$2,503.35 |
$3,248.75 |
|
|
Abdominal CT scan (with contrast)
|
$1,325.95 |
$2,190.55 |
$3,251.40 |
|
|
Abdominal CT scan (without contrast)
|
$861.85 |
$1,382.10 |
$2,019.15 |
|
|
Abdominal MRI (with and without contrast)
|
$2,456.90 |
$3,105.85 |
$3,956.45 |
|
|
Abdominal MRI (with contrast)
|
$2,822.25 |
$3,061.10 |
$3,136.80 |
|
|
Abdominal MRI (without contrast)
|
$1,624.80 |
$2,181.10 |
$3,228.60 |
|
|
Abdominal paracentesis w/image guidance
|
$746.40 |
$1,804.95 |
$3,048.95 |
|
|
Abdominal Ultrasound (complete)
|
$699.65 |
$924.60 |
$1,453.60 |
|
|
Abdominal Ultrasound (limited)
|
$537.95 |
$753.20 |
$1,051.40 |
|
|
Abdominal X-ray (2 views)
|
$318.20 |
$464.45 |
$738.30 |
|
|
Abdominal X-ray Series (acute, with chest view)
|
$389.60 |
$645.15 |
$911.55 |
|
|
Abdominal X-ray (single view)
|
$199.50 |
$351.30 |
$473.75 |
|
|
Abd paracentesis/w/o image guide 49082
|
$59.30 |
$699.20 |
$2,858.80 |
|
|
Ablation cryo abd perit om
|
$1,059.50 |
$1,059.50 |
$1,832.00 |
|
|
Ablation cryo thigh/knee
|
$840.55 |
$912.10 |
$1,121.15 |
|
|
Ablation of upper extremity nerves rf
|
$394.10 |
$1,437.00 |
$2,528.95 |
|
|
Abscess drain retroperitoneal surg code
|
$794.15 |
$5,288.30 |
$6,730.65 |
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$60.45 |
$60.45 |
$93.06 |
|
|
Acetaminophen level
|
$221.10 |
$268.60 |
$502.25 |
|
|
Acetazolamide 500 mg solution for injection
|
$221.44 |
$254.72 |
$382.69 |
|
|
Acetone qualitative
|
$13.40 |
$52.55 |
$93.15 |
|
|
Acetylcholine receptor modulating antibody
|
$31.35 |
$83.20 |
$334.65 |
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$342.12 |
$389.81 |
$1,073.68 |
|
|
Acne surgery 10040
|
$209.15 |
$209.15 |
$209.15 |
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$411.85 |
$423.80 |
$454.85 |
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$26.95 |
$54.25 |
$141.65 |
|
|
Acoustic immitance testing
|
$264.60 |
$264.60 |
$283.40 |
|
|
Acoustic refl threshold tst
|
$105.30 |
$105.30 |
$206.55 |
|
|
Actigraphy testing
|
$508.80 |
$508.80 |
$508.80 |
|
|
Actinotherapy uv light
|
$103.85 |
$103.85 |
$178.15 |
|
|
Acup 1/> without estim ea add 15
|
$80.95 |
$80.95 |
$80.95 |
|
|
Acup 1/> wo estim 1st 15 min
|
$68.90 |
$94.50 |
$94.50 |
|
|
Acute hepatitis panel
|
$434.55 |
$487.25 |
$776.15 |
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$62.73 |
$130.53 |
$424.53 |
|
|
#acylcarnitineprfl
|
$72.65 |
$81.75 |
$154.30 |
|
|
Adapt behavior tx phys/qhp
|
$54.15 |
$54.15 |
$54.15 |
|
|
Adapter b 8 channel 10cm
|
$100.00 |
$100.00 |
$361.00 |
|
|
Adaptive behavior tx by tech
|
$18.45 |
$18.45 |
$18.45 |
|
|
Adenosine 3 mg/250 ml bag for osm
|
$150.08 |
$150.08 |
$210.25 |
|
|
Adh-sendout
|
$78.90 |
$267.40 |
$374.35 |
|
|
Adj gastric band via subq port
|
$1,530.35 |
$1,530.35 |
$2,726.00 |
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$226.13 |
$512.14 |
$1,967.15 |
|
|
Admin ecg contrast agent
|
$69.45 |
$263.65 |
$305.90 |
|
|
Administration chemotherapy IV infusion each additional hour
|
$152.45 |
$179.50 |
$541.85 |
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$178.15 |
$214.60 |
$541.85 |
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$533.10 |
$743.70 |
$854.40 |
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$120.05 |
$412.50 |
$668.55 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$120.05 |
$186.00 |
$207.20 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$134.95 |
$157.90 |
$430.50 |
|
|
Administration immunization each additional vaccine
|
$24.35 |
$36.15 |
$134.25 |
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$64.70 |
$64.70 |
$64.70 |
|
|
Administration vaccine hepatitis b
|
$39.10 |
$41.75 |
$134.25 |
|
|
Administration vaccine influenza virus
|
$56.95 |
$56.95 |
$56.95 |
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$6.75 |
$56.15 |
$134.25 |
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$15,242.28 |
$16,679.19 |
$16,802.39 |
|
|
Adrenalin epinephrine inject
|
$513.23 |
$726.62 |
$1,108.47 |
|
|
Advance care planning each additional 30 min 99498
|
$133.70 |
$155.20 |
$286.10 |
|
|
Aep thrshld est mlt freq i&r
|
$151.15 |
$151.15 |
$151.15 |
|
|
_afb id by dna probe rflx ast
|
$59.60 |
$59.90 |
$209.15 |
|
|
Aflibercept injection
|
$4,991.31 |
$4,991.31 |
$4,991.31 |
|
|
Agalsidase beta 35 mg intravenous solution
|
$20,452.40 |
$20,452.40 |
$20,603.47 |
|
|
Air conduction bilat
|
$82.35 |
$82.35 |
$145.80 |
|
|
Albumin body fluid quantitative each specimen
|
$37.25 |
$57.95 |
$98.55 |
|
|
Albumin (human), 25%, 50ml
|
$293.25 |
$395.87 |
$727.76 |
|
|
Albumin (human), 5%, 250 ml
|
$878.38 |
$878.38 |
$878.38 |
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$62.00 |
$62.85 |
$197.05 |
|
|
Albumin serum plasma or whole blood
|
$16.15 |
$50.90 |
$95.80 |
|
|
Alginate dressing <=16 sq in
|
$9.00 |
$9.00 |
$9.00 |
|
|
Alginate drsg >16 <=48 sq in
|
$47.00 |
$47.00 |
$47.00 |
|
|
Alginate drsg wound filler
|
$47.00 |
$47.00 |
$47.00 |
|
|
Alkaline phosphatase
|
$36.75 |
$76.75 |
$90.45 |
|
|
Allergen alpha lactalbumin ige
|
$46.65 |
$53.60 |
$175.50 |
|
|
Allergen egg white ige
|
$23.65 |
$39.10 |
$98.75 |
|
|
Allergen specific ige qual multi scrn ea
|
$23.70 |
$56.85 |
$157.05 |
|
|
Allergy injections; 2 or more 95117
|
$85.00 |
$89.95 |
$91.60 |
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$258.00 |
$2,266.31 |
$8,800.00 |
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$1,704.75 |
$3,947.00 |
$3,986.00 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$750.00 |
$750.00 |
$1,411.85 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$1,144.00 |
$1,144.00 |
$1,294.00 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$1,212.00 |
$1,212.00 |
$1,212.00 |
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$415.63 |
$415.63 |
$440.93 |
|