healthcosts.net

Hospital prices in Maryland

1 hospitals across 1 cities · systems: UPMC

Cities

Hospitals

Hospital City System Priced procedures
UPMC Western Maryland Cumberland UPMC 2184

What procedures cost in Maryland

Cash prices across hospitals in this state. The bar shows the state's min–median–max against the same range.

Procedure Lowest cash Median Highest Spread
#_benzodiazconfur $48.60 $48.60 $48.60
#a/b/c/c/h pnl-candida albicans ab $53.40 $53.40 $53.40
#acylcarnitineprfl $210.60 $210.60 $210.60
#bac vag cand-c. albicans naa $194.40 $194.40 $194.40
#cf-97variants $1,299.00 $1,299.00 $1,299.00
#cmvcul-virus inoculation shell $48.60 $48.60 $48.60
#coxa-coxsackie a serotype a16 $64.80 $64.80 $64.80
#creutz-prot.,western blot $121.80 $121.80 $121.80
(both sides) smear without diff wbc count $7.80 $7.80 $7.80
11-desoxycortisol - sendout $40.20 $40.20 $40.20
17-hydroxypregnenolone $40.20 $40.20 $40.20
17-ketosteroids $97.20 $97.20 $97.20
24 hr ambulatory b/p monitor $66.00 $66.00 $66.00
2d tee w or without fol w/con,in $405.00 $405.00 $405.00
2nd order venous cath $0.60 $0.60 $0.60
3-d radiotherapy plan $445.80 $445.80 $445.80
3d ech img cgen car anomal $66.00 $66.00 $66.00
3d recon without postprocess indpndt $259.20 $259.20 $259.20
5' nucleotidase - sendout $24.00 $24.00 $24.00
Abatacept (with maltose) 250 mg intravenous solution $1,429.80 $1,429.80 $1,429.80
Abd aorta w/runoff s&i $0.60 $0.60 $0.60
Abd/low ext cath 1st $0.60 $0.60 $0.60
Abd/low ext cath 2nd $0.60 $0.60 $0.60
Abd/low ext cath 3rd $0.60 $0.60 $0.60
Abd/low ext cath addl $0.60 $0.60 $0.60
Abdominal CT scan (with and without contrast) $160.80 $160.80 $160.80
Abdominal CT scan (with contrast) $140.40 $140.40 $140.40
Abdominal CT scan (without contrast) $74.40 $74.40 $74.40
Abdominal MRI (with and without contrast) $654.00 $654.00 $654.00
Abdominal MRI (with contrast) $607.20 $607.20 $607.20
Abdominal MRI (without contrast) $430.20 $430.20 $430.20
Abdominal Ultrasound (complete) $411.00 $411.00 $411.00
Abdominal Ultrasound (limited) $321.60 $321.60 $321.60
Abdominal paracentesis w/image guidance $0.60 $0.60 $0.60
Ablate arrhythmia add on $0.60 $0.60 $0.60
Ablate heart dysrhythm focus $0.60 $0.60 $0.60
Ablate pulm tumor perq rf $0.60 $0.60 $0.60
Abscess drain retroperitoneal surg code $0.60 $0.60 $0.60
Acetaminophen 10 mg/ml soln 100 ml glass cont $8.40 $8.40 $8.40
Acute hepatitis panel $145.80 $145.80 $145.80
Acyclovir 400 mg tablet $67.80 $67.80 $67.80
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr $6.00 $6.00 $6.00
Adapter b 8 channel 10cm $471.00 $471.00 $471.00
Adenosine 3 mg/250 ml bag for osm $55.20 $55.20 $55.20
Adenovirus antibody,serum - quest $53.40 $53.40 $53.40
Adh-sendout $40.20 $40.20 $40.20
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution $124.20 $124.20 $124.20
Administration chemotherapy IV infusion each additional hour $937.80 $937.80 $937.80
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr $28.80 $28.80 $28.80
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug $527.40 $527.40 $527.40
Administration chemotherapy IV push single/initial substance/drug $292.80 $292.80 $292.80
Administration chemotherapy subcutaneous/im anti neoplastic hormonal $204.60 $204.60 $204.60
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal $204.60 $204.60 $204.60
Ado-trastuzumab emtansine 100 mg intravenous solution $6,328.80 $6,328.80 $6,328.80
Albumin (microalbumin) 24 hour urine quantitative $24.00 $24.00 $24.00
Albumin body fluid quantitative each specimen $16.20 $16.20 $16.20
Albumin serum plasma or whole blood $3.00 $3.00 $3.00
Aldesleukin injection $3,847.80 $3,847.80 $3,847.80
Alkaline phosphatase $3.00 $3.00 $3.00
Allergen egg white ige $24.00 $24.00 $24.00
Allergen specific ige qual multi scrn ea $40.20 $40.20 $40.20
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet $3,161.40 $3,161.40 $3,161.40
Allograft graftjacket 2x12cm-q4107-cost per sq cm $3,402.60 $3,402.60 $3,402.60
Alloskin $759.00 $759.00 $759.00
Alpha-fetoprotein tumor marker $24.00 $24.00 $24.00
Alt/sgpt $3.00 $3.00 $3.00
Alteplase 100 mg infusion from pyxis vial $9,848.40 $9,848.40 $9,848.40
Aluminum - quest $64.80 $64.80 $64.80
Ambl bp mntr w/sw a/r $199.20 $199.20 $199.20
Amikacin 4 mg/ml intravitreal injection - cnr $12.00 $12.00 $12.00
Amino acids quant 2-5 $194.40 $194.40 $194.40
Aminolevulinic acid delta $42.00 $42.00 $42.00
Amiodarone 50 mg/ml intravenous solution $2.40 $2.40 $2.40
Amitriptyline (elavil) -sendout $48.60 $48.60 $48.60
Ammonia $32.40 $32.40 $32.40
Amphetamine confirm urine -sendout $64.80 $64.80 $64.80
Amphotericin b lipid complex $96.00 $96.00 $96.00
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr $109.80 $109.80 $109.80
Ampicillin 1 gram solution for injection $0.60 $0.60 $0.60
Amylase $9.60 $9.60 $9.60
An cholangiogram percutaneous compl $0.60 $0.60 $0.60
An fluoro guide for cvp $0.60 $0.60 $0.60
Ana ds-dna $49.80 $49.80 $49.80
Analgesics non-opioid definitive assay 1 or 2 acetaminophen $48.60 $48.60 $48.60
Analysis gene f2 20210g>a variant $259.80 $259.80 $259.80
Analysis gene f5 leiden variant $154.20 $154.20 $154.20
Anca screen with reflex to titer -quest $64.80 $64.80 $64.80
Angio balloon ctrl dialysis seg add-on $0.60 $0.60 $0.60
Angio tib/peroneal/init ves/unila 37228 $0.60 $0.60 $0.60
Angio trnslmnl balloon same artery ea addl $0.60 $0.60 $0.60
Angio trnslmnl balloon same artery ini $0.60 $0.60 $0.60
Angio trnslmnl balloon same vein ea addl $0.60 $0.60 $0.60
Angio trnslmnl balloon same vein ini $0.60 $0.60 $0.60
Angioplasty fem/pop unilat 37224 $0.60 $0.60 $0.60
Angioplasty tib/pero/unilat/ea add 37232 $0.60 $0.60 $0.60
Angioplasty/iliac/init ves/unilat 37220 $0.60 $0.60 $0.60
Angiotensin ii 0.5 mg/ml soln 1 ml vial $1,346.40 $1,346.40 $1,346.40
Ankle X-ray $106.80 $106.80 $106.80
Anti-inhibitor $2.40 $2.40 $2.40
Antibody bacterium, not elsewhere specified $53.40 $53.40 $53.40
Antibody elution rbc reference $32.40 $32.40 $32.40
Antibody htlv/hiv confirm test $121.80 $121.80 $121.80
Antibody id rbc panel $48.60 $48.60 $48.60
Antibody identification platelet antibodies heparin-pf4 igg $81.00 $81.00 $81.00
Antibody screen rbc $19.20 $19.20 $19.20
Antibody tetanus $40.20 $40.20 $40.20
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution $0.60 $0.60 $0.60
Antinuclear antibodies $24.00 $24.00 $24.00
Antinuclear antibodies titer $45.00 $45.00 $45.00
Antiphosphatidylserine antibody $32.40 $32.40 $32.40
Antistreptolysin o screen $19.20 $19.20 $19.20
Antistreptolysin o titer $40.20 $40.20 $40.20
Antithrombin iii activity $30.60 $30.60 $30.60
Antithymocyte globuln rabbit $905.40 $905.40 $905.40
Apl(pml-rara) quant - sendout $194.40 $194.40 $194.40
Appl modality 1/> areas paraffin bath 97018 $11.40 $11.40 $11.40
Appl modality 1/> areas vasopneumatic devices 97016 $22.80 $22.80 $22.80
Appl multlay comprs arm/hand $144.60 $144.60 $144.60
Application finger splntstatic 29130 $48.00 $48.00 $48.00
Application multi layer compression below knee (both sides) $240.00 $240.00 $240.00
Application of paste boot 29580 $148.20 $148.20 $148.20
Apply forearm splintdynamic 29126 $110.40 $110.40 $110.40
Apply interstit radiat compl $482.40 $482.40 $482.40
Apply intrcav radiat compl $475.80 $475.80 $475.80
Apply intrcav radiat interm $367.80 $367.80 $367.80
Apply intrcav radiat simple $319.20 $319.20 $319.20
Apply of finger splint 29131 $69.00 $69.00 $69.00
Apply rigid leg cast 29445 $217.20 $217.20 $217.20
Apply surf ldr radionuclide $102.00 $102.00 $102.00
Aquatic exercise - group charge $22.80 $22.80 $22.80
Argatroban nonesrd use 1mg $246.00 $246.00 $246.00
Arterial blood draw/perc 36620 $98.40 $98.40 $98.40
Artery x-rays adrenal gland $0.60 $0.60 $0.60
Artery x-rays adrenals $0.60 $0.60 $0.60
Artery x-rays arm/leg 75710-26 $0.60 $0.60 $0.60
Artery x-rays arms/legs 75716-26 $0.60 $0.60 $0.60
Artery x-rays lung $0.60 $0.60 $0.60
Artery x-rays lung $0.60 $0.60 $0.60
Artery x-rays lungs $0.60 $0.60 $0.60
Artery x-rays spine $0.60 $0.60 $0.60
Artery xray each vessel 7577426 $0.60 $0.60 $0.60
Artery xray of abdomen 75726-26 $0.60 $0.60 $0.60
Artery xrays of pelvis 75736 26 $0.60 $0.60 $0.60
Ascenda two piece catheter $16,771.20 $16,771.20 $16,771.20
Aspir/inj thyroid cyst 60300 $0.60 $0.60 $0.60
Aspirate bladder/sprapubic cath 51102 $0.60 $0.60 $0.60
Aspirate pleura without imaging 32554 $0.60 $0.60 $0.60
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion $0.60 $0.60 $0.60
Assay free hydroxyproline $97.20 $97.20 $97.20
Assay of corticosterone $40.20 $40.20 $40.20
Assay of fluoride $40.20 $40.20 $40.20
Assay of lrh hormone $40.20 $40.20 $40.20
Assay of osteocalcin $24.00 $24.00 $24.00
Assay of procainamide w/metab $48.60 $48.60 $48.60
Assay of prostaglandin $63.00 $63.00 $63.00
Assay of quinine $49.80 $49.80 $49.80
Assay of sialic acid $38.40 $38.40 $38.40
Assay of thiocyanate $24.00 $24.00 $24.00
Assess aphasia/interp/rpt/per hr 96105 $126.60 $126.60 $126.60
Assess cyst contrast inject $0.60 $0.60 $0.60
Assessment leukocyte fecal qualitative/semiquantitative $7.80 $7.80 $7.80
Ast/sgot $3.00 $3.00 $3.00
Atezolizumab 60 mg/ml intravenous solution (wrapper) $12,416.40 $12,416.40 $12,416.40
Athrectomy fem/pop/unilateral 37225 $0.60 $0.60 $0.60
Athrectomy tib/pero/unilat/ini ves 37229 $0.60 $0.60 $0.60
Attn at delivery+ 1 stabilization of newborn 99464 $95.40 $95.40 $95.40
Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body $0.60 $0.60 $0.60
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic $0.60 $0.60 $0.60
Autologous blood op salvage $852.60 $852.60 $852.60
Autologous blood process $276.00 $276.00 $276.00
Automated diff wbc count $6.00 $6.00 $6.00
Avelumab 20 mg/ml intravenous solution $2,189.40 $2,189.40 $2,189.40
Azacitidine injection $237.60 $237.60 $237.60
Azathioprine parenteral $250.80 $250.80 $250.80
Azithromycin 500 mg intravenous solution $4.80 $4.80 $4.80
Aztreonam 1 gram solution for injection $60.60 $60.60 $60.60
B cells total count $81.00 $81.00 $81.00
Baclofen 2,000 mcg/ml intrathecal solution (wrapper) $1,134.00 $1,134.00 $1,134.00
Baclofen 50 mcg/ml intrathecal solution (wrapper) $197.40 $197.40 $197.40
Baclofen eval charges $41.40 $41.40 $41.40
Bacterial meningitis antigen $24.00 $24.00 $24.00
Bacterial vaginosis pcr $194.40 $194.40 $194.40
Bag urine leg fbrc strap 32oz flipflo anti-reflux valve $42.00 $42.00 $42.00
Balloon dilate urtrl strix $0.60 $0.60 $0.60
Bendamustine 25 mg/ml intravenous solution (bendeka) $24.00 $24.00 $24.00
Beta 2 glycoprotein 1 antibody iga $32.40 $32.40 $32.40
Beta-2 microglobulin $24.00 $24.00 $24.00
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection $39.00 $39.00 $39.00
Bevacizumab 25 mg/ml intravenous solution $3,732.00 $3,732.00 $3,732.00
Bevacizumab-awwb 25 mg/ml intravenous solution $3,154.20 $3,154.20 $3,154.20
Bevacizumab-bvzr 25 mg/ml intravenous solution $620.40 $620.40 $620.40
Biliary endoscopy thru skin $0.60 $0.60 $0.60
Biliary endoscopy thru skin $0.60 $0.60 $0.60
Biliary endoscopy thru skin $0.60 $0.60 $0.60
Biliary endoscopy thru skin $0.60 $0.60 $0.60
Bilirubin direct $9.60 $9.60 $9.60
Bilirubin total $9.60 $9.60 $9.60
Biopsy abdominal mass $0.60 $0.60 $0.60
Biopsy bone trocar/needle superficial $0.60 $0.60 $0.60
Biopsy muscle percutaneous needle $0.60 $0.60 $0.60
Biopsy needle liver percutaneous $0.60 $0.60 $0.60
Biopsy needle lymph node superficial $0.60 $0.60 $0.60
Biopsy of heart lining $0.60 $0.60 $0.60
Biopsy of prostate $0.60 $0.60 $0.60
Biopsy renal percutaneous trocar/needle (both sides) $0.60 $0.60 $0.60
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides) $996.00 $996.00 $996.00
Bivalirudin $94.80 $94.80 $94.80
Bleomycin 15 unit solution for injection $48.00 $48.00 $48.00
Bln 1.2 mono emrg 15x1.2 $3,525.00 $3,525.00 $3,525.00
Bln 30frx10mmx12cm renal nephromax $1,200.00 $1,200.00 $1,200.00
Bln dil 900ml preperitnl $2,203.20 $2,203.20 $2,203.20
Bln inpact admiral 4x150x130cm $4,003.20 $4,003.20 $4,003.20
Bln press regulation 71-80cm $10,432.80 $10,432.80 $10,432.80
Bln stent lg 19mm diam 10-12mm palmaz gen trnshpat unmtd $1,683.00 $1,683.00 $1,683.00
Bln ureth 5ml 28f 2wy ltx st $101.40 $101.40 $101.40
Blood Clotting (PT/INR) Test $12.60 $12.60 $12.60
Blood Clotting (PTT) Test $12.60 $12.60 $12.60
Blood Count (CBC) Test $16.20 $16.20 $16.20
Blood Count (CBC) Test (without differential) $12.60 $12.60 $12.60
Blood Culture Test $64.80 $64.80 $64.80
Blood draw capillary 36416 $9.60 $9.60 $9.60
Blood gases o2 saturation direct measurement $49.80 $49.80 $49.80
Blood gases ph venous $24.00 $24.00 $24.00
Blood occult feces colorectal neoplasm screening qualitative $7.80 $7.80 $7.80
Blood occult peroxidase activity qualitative gastric $6.00 $6.00 $6.00
Blood smear microscopic w manual differential wbc count $16.20 $16.20 $16.20
Blood typing abo $6.00 $6.00 $6.00
Blood typing ag donor ea ag $24.00 $24.00 $24.00
Blood typing patient serum $19.20 $19.20 $19.20
Blood typing rbc ag non abo/rh ea $24.00 $24.00 $24.00
Blood typing rh (d) $6.00 $6.00 $6.00
Blood typing rh phenotype complete reference $48.60 $48.60 $48.60
Blood, l/r, irradiated $438.60 $438.60 $438.60
Bone Density Scan (DEXA) $160.80 $160.80 $160.80
Bone marrow biopsyneedle/trocar 38221 $0.60 $0.60 $0.60
Bone/joint imaging ltd area $161.40 $161.40 $161.40
Boot heel care softcare one sz $100.20 $100.20 $100.20
Boot walker genesis full shell 3-strap s $103.20 $103.20 $103.20
Borrelia burgdorferi (lyme disease) antibody nonspecific $40.20 $40.20 $40.20
Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection $1,923.60 $1,923.60 $1,923.60
Bowel imaging $318.60 $318.60 $318.60
Brace afo lg left 6607 $40.80 $40.80 $40.80
Brace ankle stablizing lg $60.60 $60.60 $60.60
Brace back pinnacle lo 627 lumbar $673.20 $673.20 $673.20
Brace back pinnacle tlso 464 $1,009.80 $1,009.80 $1,009.80
Brace knee extender plus 22-30in $504.60 $504.60 $504.60
Brace knee support neoprene padded open patella med $243.60 $243.60 $243.60
Brace ortho exos 28-50in sm $423.60 $423.60 $423.60
Brace ortho tlso 2xl 19in strnl y bar wst belt pd shldr $571.80 $571.80 $571.80
Brace oths wrist hnd fngr without $31.20 $31.20 $31.20
Brace tlso flex cust $289.20 $289.20 $289.20
Brach/thor cath 1st $0.60 $0.60 $0.60
Brach/thor cath 2nd $0.60 $0.60 $0.60
Brach/thor cath 3rd $0.60 $0.60 $0.60
Brach/thor cath addl $0.60 $0.60 $0.60
Brachytx isodose complex $337.20 $337.20 $337.20
Brachytx isodose intermed $247.20 $247.20 $247.20
Brachytx isodose plan simple $192.60 $192.60 $192.60
Braf gene $194.40 $194.40 $194.40
Brain MRA (blood vessel MRI, with and without contrast) $843.00 $843.00 $843.00
Brain MRA (blood vessel MRI, with contrast) $542.40 $542.40 $542.40
Brain MRA (blood vessel MRI, without contrast) $547.80 $547.80 $547.80
Brain MRI (with and without contrast) $436.20 $436.20 $436.20
Brain MRI (with contrast) $382.80 $382.80 $382.80
Brain MRI (without contrast) $259.20 $259.20 $259.20
Brain flow imaging only $172.20 $172.20 $172.20
Brain image w/flow 4 + views $318.60 $318.60 $318.60
Breast Biopsy (ultrasound-guided, percutaneous) $357.60 $357.60 $357.60
Brentuximab vedotin 50 mg intravenous solution $13,562.40 $13,562.40 $13,562.40
Bronchial challenge $276.00 $276.00 $276.00
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr $2.40 $2.40 $2.40
Bundle his recording $0.60 $0.60 $0.60
Bundled special stain group 1 microorganisms $24.00 $24.00 $24.00
Bundled special stain group 2 $16.20 $16.20 $16.20
Buprenorphine and metabolite - sendout $64.80 $64.80 $64.80
Bur rotalink 2.15mm $6,330.00 $6,330.00 $6,330.00
Bx bone trocar/ndl deep $0.60 $0.60 $0.60
Bx breast 1st lesion mr imag $754.20 $754.20 $754.20
Bx breast 1st lesion strtctc $607.80 $607.80 $607.80
Bx breast add lesion Ultrasound imag $214.20 $214.20 $214.20
Bx breast add lesion mr imag $76.20 $76.20 $76.20
Bx breast add lesion strtctc $303.60 $303.60 $303.60
Bx breast perq without image 19100 $178.80 $178.80 $178.80
Bx liver with other $0.60 $0.60 $0.60
Bx pancreas pq ndl $0.60 $0.60 $0.60
Bx pleura pq ndl $0.60 $0.60 $0.60
Bx skin punch ea sep/ addl les $0.60 $0.60 $0.60
Bx spinal cord pq ndl $0.60 $0.60 $0.60
Bx thyroid/percutan core needle 60100 $0.60 $0.60 $0.60
C-Section Delivery (full care) $5,346.60 $5,346.60 $5,346.60
C-peptide $24.00 $24.00 $24.00
C-reactive protein $24.00 $24.00 $24.00
C-reactive protein high sensitivity $25.80 $25.80 $25.80
C-reactive protein, quantitative $48.60 $48.60 $48.60
C1 esterase inhibitor func - sendout $40.20 $40.20 $40.20
CT Angiogram of Abdomen and Pelvis $232.80 $232.80 $232.80
CT Angiogram of the Chest (for blood clot) $175.80 $175.80 $175.80
CT Angiogram of the Head $172.80 $172.80 $172.80
CT Scan of Abdomen and Pelvis (with and without contrast) $211.80 $211.80 $211.80
CT Scan of Abdomen and Pelvis (with contrast) $184.80 $184.80 $184.80
CT Scan of Abdomen and Pelvis (without contrast) $95.40 $95.40 $95.40
CT angio hrt w/3d image $253.80 $253.80 $253.80
CT angio pelvis $202.80 $202.80 $202.80
CT guid parench tis ablat $0.60 $0.60 $0.60
CT guidance for needle placement $0.60 $0.60 $0.60
CT guidance for percutaneous drain w/catheter placement supervision & interpretation $0.60 $0.60 $0.60
CT heart w/evaluation of calcium without contrast $59.40 $59.40 $59.40
CT hrt c+ strux cgen hrt ds $220.80 $220.80 $220.80
CT hrt w/3d image $163.80 $163.80 $163.80
CT limited or localized follow-up study $80.40 $80.40 $80.40
CT lower extremity w/contrast (both sides) $140.40 $140.40 $140.40
CT lower extremity without contrast (both sides) $107.40 $107.40 $107.40
CT lwr extremity w/o&w/dye $178.80 $178.80 $178.80
CT neck soft tissue w/contrast $140.40 $140.40 $140.40
CT neck soft tissue without & w/contrast $172.80 $172.80 $172.80
CT neck soft tissue without contrast $107.40 $107.40 $107.40
CT orbit/sella/ or posterior outer inner or middle ear w/contrast $172.80 $172.80 $172.80
CT orbit/sella/ or posterior outer inner or middle ear without contrast $140.40 $140.40 $140.40
CT orbit/sella/fossa w/wo contrast $190.80 $190.80 $190.80
CT t-spine w /wo contrast $172.80 $172.80 $172.80
CT thoracic spine w/contrast $140.40 $140.40 $140.40
CT thoracic spine without contrast $107.40 $107.40 $107.40
CT thorax low dose for lung screening without contrast $107.40 $107.40 $107.40
CT upper extremity w/contrast (both sides) $137.40 $137.40 $137.40
CT upper extremity without contrast (both sides) $107.40 $107.40 $107.40
CT uppr extremity w/o&w/dye $98.40 $98.40 $98.40
Cabazitaxel 10 mg/ml (first dilution) intravenous solution $15,841.20 $15,841.20 $15,841.20
Cable cath 22-pin diag $495.00 $495.00 $495.00
Cadd pump refill $175.80 $175.80 $175.80
Calcium 24 hour urine $16.20 $16.20 $16.20
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution $10.80 $10.80 $10.80
Calcium ionized $24.00 $24.00 $24.00
Calcium total $3.00 $3.00 $3.00
Calculi urinary-sendout $64.80 $64.80 $64.80
Calprotectin fecal $24.00 $24.00 $24.00
Candida dna $194.40 $194.40 $194.40
Cap nerve 2x15mm $4,846.80 $4,846.80 $4,846.80
Cap trach decann 15mm $543.00 $543.00 $543.00
Carbamazepine total therapeutic drug level $24.00 $24.00 $24.00
Carbon dioxide $3.00 $3.00 $3.00
Carboplatin 10 mg/ml desensitization $2.40 $2.40 $2.40
Carcinoembryonic ag (cea) $40.20 $40.20 $40.20
Card MRI veloc flow mapping $70.20 $70.20 $70.20
Cardiac Stress Test $0.60 $0.60 $0.60
Cardiac perf spect sgl/ef/wm rst/strs $293.40 $293.40 $293.40
Cardiac rehabilitation op phase 2 w/continous ecg monitoring $146.40 $146.40 $146.40
Cardiolipin antibody iga $32.40 $32.40 $32.40
Cardioversion elective electrical conversion arrhythmia external $298.80 $298.80 $298.80
Carfilzomib 10 mg intravenous solution $3,574.20 $3,574.20 $3,574.20
Carmustine 100 mg intravenous powder for solution $2,407.80 $2,407.80 $2,407.80
Carotene $40.20 $40.20 $40.20
Carotid Artery Ultrasound (Duplex) $822.00 $822.00 $822.00
Cath 2lum 14.5frx43cm maxid kt mahurkar $799.20 $799.20 $799.20
Cath ablat bi-d d-d 8fr 115cm $705.60 $705.60 $705.60
Cath ablt clsfast 7fx100cmx $705.60 $705.60 $705.60
Cath acuity innr ic130 6f 63cm $3,488.40 $3,488.40 $3,488.40
Cath acunav ge 10frx90cm $1,402.80 $1,402.80 $1,402.80
Cath adherent clot 10mm 6f 10 $17,505.60 $17,505.60 $17,505.60
Cath baloon occl urnry 34f 7x2x65 $1,703.40 $1,703.40 $1,703.40
Cath blazer dx/20 2-10-2 space $2,019.60 $2,019.60 $2,019.60
Cath combo lt&rt heart w/inj/s $0.60 $0.60 $0.60
Cath council tip 16fr 5cc $59.40 $59.40 $59.40
Cath cv dl inj 7fx16cm $720.60 $720.60 $720.60
Cath del ampltz 12f 45d 80cm $2,010.00 $2,010.00 $2,010.00
Cath follower heyman 20f $50.40 $50.40 $50.40
Cath groshong MRI 8fr plstc port $1,153.20 $1,153.20 $1,153.20
Cath hawkone s directional $2,362.80 $2,362.80 $2,362.80
Cath imag ivus pv 8.5fx90 .035 $7,839.60 $7,839.60 $7,839.60
Cath left heart transseptal punc $0.60 $0.60 $0.60
Cath left heart/lv gram $0.60 $0.60 $0.60
Cath lt/rt pulm art $0.60 $0.60 $0.60
Cath malecot 28fr 4-wing ltx $1,562.40 $1,562.40 $1,562.40
Cath occl flo-rester 2.25x12mm cor internal vessel occluder $9,007.20 $9,007.20 $9,007.20
Cath place 1st order venous 36011 $0.60 $0.60 $0.60
Cath plc art ang/grft lt/rt hr $0.60 $0.60 $0.60
Cath plc art/angio/rt hrt cath $0.60 $0.60 $0.60
Cath plc art/grft/angio right hrt $0.60 $0.60 $0.60
Cath right heart w/o2 sat & card $0.60 $0.60 $0.60
Cath right hrt mnpul art $0.60 $0.60 $0.60
Cath segmntl pulm art $0.60 $0.60 $0.60
Cath steerable flex adv 12f $883.20 $883.20 $883.20
Cath uret open tp 6fx70cm $381.00 $381.00 $381.00
Catheter declot mechanical $0.60 $0.60 $0.60
Catheter stripping venous $0.60 $0.60 $0.60
Cdna analysis for variants $487.20 $487.20 $487.20
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr $10.80 $10.80 $10.80
Cefepime 1 gram solution for injection $6.00 $6.00 $6.00
Cefoxitin 1 gram intravenous solution $6.00 $6.00 $6.00
Ceftaroline fosamil 600 mg intravenous solution $249.00 $249.00 $249.00
Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr $6.60 $6.60 $6.60
Ceftazidime and avibactam $430.20 $430.20 $430.20
Ceftriaxone 1 gram solution for injection $18.00 $18.00 $18.00
Cefuroxime in ns IV syringe 30 mg/ml (neo/ped) - cnr $3.60 $3.60 $3.60
Cell count body fluid $32.40 $32.40 $32.40
Cell count w differential body fluid $40.20 $40.20 $40.20
Cell marker study $243.60 $243.60 $243.60
Cemiplimab-rwlc 50 mg/ml intravenous solution $10,920.00 $10,920.00 $10,920.00
Cetuximab 100 mg/50 ml intravenous solution $775.20 $775.20 $775.20
Change cystostomy tube simple $0.60 $0.60 $0.60
Change nephroureteral cath $0.60 $0.60 $0.60
Change stent via transureth $0.60 $0.60 $0.60
Change ureter stent percut $0.60 $0.60 $0.60
Chemo adm cns w/lmbr punct $351.60 $351.60 $351.60
Chemo extend IV infus w/pump $527.40 $527.40 $527.40
Chemotherapy injection 96542 $175.80 $175.80 $175.80
Chest 2 vws w oblique $124.80 $124.80 $124.80
Chest CT scan (with and without contrast) $172.80 $172.80 $172.80
Chest CT scan (with contrast) $140.40 $140.40 $140.40
Chest CT scan (without contrast) $107.40 $107.40 $107.40
Chest X-ray $89.40 $89.40 $89.40
Chest X-ray (single view) $71.40 $71.40 $71.40
Chest apical lordotic proj $124.80 $124.80 $124.80
Chg pr pul rehab for copd patients $58.80 $58.80 $58.80
Chg radiologic exam esophagus double contrast $375.00 $375.00 $375.00
Chlamydia culture $49.80 $49.80 $49.80
Chlamydia type $32.40 $32.40 $32.40
Chlnggrphy intraop addl s&i $0.60 $0.60 $0.60
Chloride $3.00 $3.00 $3.00
Chloride 24 hour urine $16.20 $16.20 $16.20
Chloroprocaine hcl injection $22.80 $22.80 $22.80
Chlorothiazide sodium 500 mg intravenous solution $48.00 $48.00 $48.00
Chmotx admn plrl cav thrcnts $351.60 $351.60 $351.60
Cholangiogram percutaneous compl $0.60 $0.60 $0.60
Cholangiography and/or pancreatography intraoperative supervision & interpretation $0.60 $0.60 $0.60
Cholecystostomy complete w/supervision & interpretation $0.60 $0.60 $0.60
Cholesterol $6.00 $6.00 $6.00
Cholesterol (Lipid) Test $30.60 $30.60 $30.60
Chromatography $40.20 $40.20 $40.20
Chromosome analysis 15-20 cell count $519.60 $519.60 $519.60
Chromosome analysis 5 $202.80 $202.80 $202.80
Chromosome count additional $32.40 $32.40 $32.40
Chromosome karyotype study $32.40 $32.40 $32.40
Chylomicron screen, bf - sendout $40.20 $40.20 $40.20
Cilastatin sodium injection $11.40 $11.40 $11.40
Cinacalcet 30 mg tablet $93.60 $93.60 $93.60
Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback $1.20 $1.20 $1.20
Circumcision (newborn) $433.20 $433.20 $433.20
Cisplatin 1 mg/ml desensitization $1.20 $1.20 $1.20
Cladribine 10 mg/10 ml intravenous solution $128.40 $128.40 $128.40
Clamp isol transpolr 5mmx6.5cm transpolar $2,157.00 $2,157.00 $2,157.00
Clearance of airways $23.40 $23.40 $23.40
Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback $6.00 $6.00 $6.00
Clip ligating vesolock lg $451.20 $451.20 $451.20
Clot factor xii hageman $97.20 $97.20 $97.20
Clot factor xiii fibrin stab $97.20 $97.20 $97.20
Cmv pcr-sendout $194.40 $194.40 $194.40
Co-treatment - group 15 mins, st $45.60 $45.60 $45.60
Coagulation factor viia 1,000 mcg/ml inj 1 ml $4,809.00 $4,809.00 $4,809.00
Cold agglutinin titer $42.00 $42.00 $42.00
Colistimethate sodium inj $12.00 $12.00 $12.00
Collar cerv ascend 172 reg $106.80 $106.80 $106.80
Collection blood specimen from completely implantable venous access device $234.00 $234.00 $234.00
Collection blood specimen using established central/peripheral catheter venous nos $263.40 $263.40 $263.40
Collection of venous blood by venipuncture $12.60 $12.60 $12.60
Compatibility test each unit antiglobulin technique $16.20 $16.20 $16.20
Compatibility test each unit electronic $9.60 $9.60 $9.60
Compatibility test each unit immediate spin technique $12.60 $12.60 $12.60
Compatibility test incubate $1.20 $1.20 $1.20
Complement antigen each component c3 $40.20 $40.20 $40.20
Complement fixation each $24.00 $24.00 $24.00
Concentration infection agents any type $32.40 $32.40 $32.40
Connect omega .5mm $55.80 $55.80 $55.80
Consultation pathology during surgery frozen section each additional block $7.80 $7.80 $7.80
Consultation pathology during surgery frozen section first tissue block $48.60 $48.60 $48.60
Contrast exam abdominl aorta 75625-26 $0.60 $0.60 $0.60
Contrast exam thoracic aorta 75605-26 $0.60 $0.60 $0.60
Contrast x-ray of knee joint $0.60 $0.60 $0.60
Contrast x-ray of wrist $0.60 $0.60 $0.60
Controller infinity pt dbs $2,937.60 $2,937.60 $2,937.60
Conversion ext bil drg cath $0.60 $0.60 $0.60
Convert nephrostomy catheter $0.60 $0.60 $0.60
Coombs direct $12.60 $12.60 $12.60
Coombs indirect qualitative each reagent red cell reference $19.20 $19.20 $19.20
Coombs indirect titer reference $51.60 $51.60 $51.60
Core ndl bx lng/med perq $0.60 $0.60 $0.60
Coronary angio/cath placement bypass graft/lv gram/lt heart $0.60 $0.60 $0.60
Coronary angio/lv gram/lt heart $0.60 $0.60 $0.60
Coronary angio/lv gram/rt&lt heart $0.60 $0.60 $0.60
Coronary art/grft angio s&i $0.60 $0.60 $0.60
Coronary catheterization w/angiography supervision & interpretation $0.60 $0.60 $0.60
Cortisol total am $24.00 $24.00 $24.00
Cosyntropin 0.25 mg solution for injection $20.40 $20.40 $20.40
Counseling smoke cess interm >10mins $31.80 $31.80 $31.80
Crbrospnl fld flw imag cistern $326.40 $326.40 $326.40
Creatine kinase $9.60 $9.60 $9.60
Creatine kinase isoenzymes $40.20 $40.20 $40.20
Creatine kinase mb $24.00 $24.00 $24.00
Creatinine $3.00 $3.00 $3.00
Creatinine 24 hour urine $16.20 $16.20 $16.20
Creatinine clearance urine $19.20 $19.20 $19.20
Crisis psychotherapy 90839 $263.40 $263.40 $263.40
Crisis psychotherapy additional 30 mins 90840 $146.40 $146.40 $146.40
Crotalidae poly immune fab $3,408.60 $3,408.60 $3,408.60
Crutches underarm other than wood adjustable or e0114 $34.20 $34.20 $34.20
Cryofibrinogen qualitative - sendout $22.20 $22.20 $22.20
Cryptococcus abs qn - sendout $76.20 $76.20 $76.20
Crystal identification light microscopy $24.00 $24.00 $24.00
Cta abdomen without & /or w/contrast $181.80 $181.80 $181.80
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast $220.80 $220.80 $220.80
Cta lower extremity without & w/contrast (both sides) $217.80 $217.80 $217.80
Cta neck without &/or w/contrast $169.80 $169.80 $169.80
Cta upper extremity w &/or without contrast left $202.80 $202.80 $202.80
Culture aerobic additional method definitive id each $16.20 $16.20 $16.20
Culture afb any source $97.20 $97.20 $97.20
Culture anaerobic additional method definitive id each $16.20 $16.20 $16.20
Culture anaerobic except blood $64.80 $64.80 $64.80
Culture bact stool aero addl path ea $16.20 $16.20 $16.20
Culture body fluid $64.80 $64.80 $64.80
Culture fungi definitive id mold $16.20 $16.20 $16.20
Culture fungi definitive id yeast $16.20 $16.20 $16.20
Culture fungi other (except blood) $40.20 $40.20 $40.20
Culture fungi skin/hair/nail $40.20 $40.20 $40.20
Culture mycobacteria definitive id each isolate $123.00 $123.00 $123.00
Culture mycoplasma any source $49.80 $49.80 $49.80
Culture quantitative aerobic other source $64.80 $64.80 $64.80
Culture screening strep group a $32.40 $32.40 $32.40
Culture typing nucleic acid probe amplified per culture/isolate each organism $40.20 $40.20 $40.20
Culture virus isolation $162.00 $162.00 $162.00
Cutter lead $3,494.40 $3,494.40 $3,494.40
Cv line/pic reposition $0.60 $0.60 $0.60
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution $2.40 $2.40 $2.40
Cyanocobalamin unsat binding capacity $37.20 $37.20 $37.20
Cyclic citrullinated peptide antibody $40.20 $40.20 $40.20
Cyclophosphamide 1 gram intravenous powder for solution $39.00 $39.00 $39.00
Cyclosporine 2 hour $32.40 $32.40 $32.40
Cylinder pump set 20cm titan zero angl $17,175.60 $17,175.60 $17,175.60
Cystatin c $81.00 $81.00 $81.00
Cystine urine quantitative $97.20 $97.20 $97.20
Cystogram >= 3 views supervision & interpretation $0.60 $0.60 $0.60
Cytarabine 20 mg/ml injection solution $8.40 $8.40 $8.40
Cytomegalovirus (cmv) antibody igg $24.00 $24.00 $24.00
Cytomegalovirus (cmv) antibody igm $40.20 $40.20 $40.20
Cytomegalovirus dfa $40.20 $40.20 $40.20
Cytopath smear oth prep screen & interp $113.40 $113.40 $113.40
Cytopath smear other source $48.60 $48.60 $48.60
Cytopath tbs c/v manual $32.40 $32.40 $32.40
Cytopathology cervical/vaginal thin layer manual screening $64.80 $64.80 $64.80
Cytopathology concentration technique smears & interpretation $113.40 $113.40 $113.40
Cytopathology fluids/washings/brushings smears with interpretation $48.60 $48.60 $48.60
Cytopathology fna adequacy evaluation first episode each site interp/rpt $145.80 $145.80 $145.80
Dacarbazine 100 mg intravenous solution $10.80 $10.80 $10.80
Dalbavancin 500 mg intravenous solution $18.00 $18.00 $18.00
Daptomycin 500 mg/10 ml intravenous solution $21.00 $21.00 $21.00
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln $9,477.00 $9,477.00 $9,477.00
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe $2,336.40 $2,336.40 $2,336.40
Daunorubicin 5 mg/ml intravenous solution $107.40 $107.40 $107.40
Dch validity tests $6.00 $6.00 $6.00
Debridement (>20 cm) charge pt $91.20 $91.20 $91.20
Decalcification $7.80 $7.80 $7.80
Decitabine 50 mg intravenous solution $108.00 $108.00 $108.00
Declotting thrombolytic agent implanted vas access device 36 $292.80 $292.80 $292.80
Deep muscle biopsy 20205 $0.60 $0.60 $0.60
Deferoxamine 500 mg solution for injection $27.00 $27.00 $27.00
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device $23.40 $23.40 $23.40
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution $24.00 $24.00 $24.00
Des thora aorta rpr without left sub art 33881 $0.60 $0.60 $0.60
Descend thora aorta rpr/lt sub art 33880 $0.60 $0.60 $0.60
Design mlc device for imrt $475.80 $475.80 $475.80
Desmopressin 4 mcg/ml injection solution $357.60 $357.60 $357.60
Desoxycorticosterone $40.20 $40.20 $40.20
Destroy cervthor facet jnt 64633 $0.60 $0.60 $0.60
Destroy cth facet jnt addl 64634 $0.60 $0.60 $0.60
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) $0.60 $0.60 $0.60
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) $0.60 $0.60 $0.60
Detect agent nos dna dir $194.40 $194.40 $194.40
Detect agnt mult dna direc $194.40 $194.40 $194.40
Developmental screen/score/document 96110 $34.20 $34.20 $34.20
Dexa bone density study >=1 sites appendicular skeleton (peripheral) $89.40 $89.40 $89.40
Dexamethasone 4 mg tablet $0.60 $0.60 $0.60
Dexrazoxane hcl 250 mg intravenous solution $397.80 $397.80 $397.80
Dextrose 5 % in water (d5w) intravenous solution (non-pvc) $0.60 $0.60 $0.60
Dhea-s (dehydroepiand sulfate) $24.00 $24.00 $24.00
Diabetes (HbA1c) Test $32.40 $32.40 $32.40
Diagnostic Mammogram (both breasts) $607.80 $607.80 $607.80
Diagnostic Mammogram (one breast) $464.40 $464.40 $464.40
Diagnostic digital breast tomosynthesis bil $124.80 $124.80 $124.80
Diagnostic digital breast tomosynthesis unil $124.80 $124.80 $124.80
Dialysis one evaluation $150.00 $150.00 $150.00
Diazepam 5 mg/ml injection solution (wrapper) $35.40 $35.40 $35.40
Diffusing capacity $65.40 $65.40 $65.40
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution $3.60 $3.60 $3.60
Digoxin total therapeutic drug level $24.00 $24.00 $24.00
Dilat xst trc ndurlgc px $0.60 $0.60 $0.60
Dilat xst trc new access rcs $0.60 $0.60 $0.60
Dilate biliary duct/ampulla $0.60 $0.60 $0.60
Dimethyl sulfoxide 50% 50 ml $644.40 $644.40 $644.40
Diphenhydramine 50 mg/ml injection (wrapper) $0.60 $0.60 $0.60
Disability dlco $62.40 $62.40 $62.40
Disaccharidases $64.80 $64.80 $64.80
Discography cerv/thor spine $0.60 $0.60 $0.60
Dissolve clot heart vessel $0.60 $0.60 $0.60
Dna antibody native/double stranded $49.80 $49.80 $49.80
Dna gardnerella $194.40 $194.40 $194.40
Dna probe chlamydia $72.60 $72.60 $72.60
Dna probe gc $72.60 $72.60 $72.60
Dna trichomonas $72.60 $72.60 $72.60
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution $31.20 $31.20 $31.20
Docetaxel 20 mg/ml intravenous solution (wrapper) $0.60 $0.60 $0.60
Dopamine 40 mg/ml intravenous solution (wrapper) $2.40 $2.40 $2.40
Doppler echo complete $66.00 $66.00 $66.00
Doppler intravascular pressure flow initial vessel $0.60 $0.60 $0.60
Doppler upper/lower extremity arteries complete bilateral $571.80 $571.80 $571.80
Doppler upper/lower extremity arteries limited bilateral $375.00 $375.00 $375.00
Doripenem 50 mg/ml inj 10 ml $43.20 $43.20 $43.20
Dostarlimab-gxly 50 mg/ml intravenous solution $279.00 $279.00 $279.00
Doxorubicin 2 mg/ml intravenous solution (wrapper) $232.80 $232.80 $232.80
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension $642.60 $642.60 $642.60
Drain cath image guided peri/retroperitoneal transvag/transrectal $0.60 $0.60 $0.60
Drain cath image guided visceral pq $0.60 $0.60 $0.60
Drainage of kidney lesion $0.60 $0.60 $0.60
Droperidol 2.5 mg/ml injection solution $7.80 $7.80 $7.80
Drsg interceed 3x4in adh wnd barr absorb $573.00 $573.00 $573.00
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm $237.60 $237.60 $237.60
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm $423.60 $423.60 $423.60
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm $10,534.20 $10,534.20 $10,534.20
Drug admin & hemodynmic meas $0.60 $0.60 $0.60
Drug assay caffeine $24.00 $24.00 $24.00
Drug of abuse screen urine $16.20 $16.20 $16.20
Drug test(s) presumptive any class instrument chemistry analyzers $103.80 $103.80 $103.80
Drvvt confirm - quest $81.00 $81.00 $81.00
Ductogram sgl duct $196.20 $196.20 $196.20
Dup scan/hemodialysis access 93990 $679.20 $679.20 $679.20
Dup scan/lwr xtr vasc stdy bilat 93924 $732.60 $732.60 $732.60
Dup scan/ue art/graft/bilat/comp 93930 $840.00 $840.00 $840.00
Duplex scan bilateral study 93985 $1,144.20 $1,144.20 $1,144.20
Duplex scan unilateral study 93986 $643.20 $643.20 $643.20
Durvalumab 50 mg/ml intravenous solution $1,036.80 $1,036.80 $1,036.80
ER Visit (level 1, minor) $97.80 $97.80 $97.80
ER Visit (level 2) $195.60 $195.60 $195.60
ER Visit (level 3) $293.40 $293.40 $293.40
ER Visit (level 4) $489.60 $489.60 $489.60
ER Visit (level 5, high severity) $783.60 $783.60 $783.60
Ecg 12 lead tracing only $79.20 $79.20 $79.20
Ecg external < 48 hours recording $66.00 $66.00 $66.00
Ecg external < 48 hours scanning analysis w/report $331.80 $331.80 $331.80
Ecg external > 48 hours up to 7 days recording $66.00 $66.00 $66.00
Ecg external >7 days up to 15 days recording $66.00 $66.00 $66.00
Ecg/1-3 leads/tracing only 93041 $33.00 $33.00 $33.00
Echo guide for artery repair $0.60 $0.60 $0.60
Echo stress $398.40 $398.40 $398.40
Echo tee probe placement image acquisition interpretation & report $398.40 $398.40 $398.40
Echo transthoracic $298.80 $298.80 $298.80
Echo transthoracic $132.60 $132.60 $132.60
Echo tte 2d comp wo ctrst wo clr/dplr $298.80 $298.80 $298.80
Echocardiogram (Heart Ultrasound) $405.00 $405.00 $405.00
Echocardiography doppler color flow mapping $33.00 $33.00 $33.00
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler $405.00 $405.00 $405.00
Echocardiography transthoracic 2d followup/limited $139.20 $139.20 $139.20
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast $139.20 $139.20 $139.20
Ecmo/ecls remove perph cannula 0-5yrs perq 33965 $0.60 $0.60 $0.60
Ecmo/ecls remove prph cannula 6yrs&older perq 33966 $0.60 $0.60 $0.60
Eeg monitor/record/awake/drowsy 95816 $421.80 $421.80 $421.80
Eeg recording awake and asleep $501.00 $501.00 $501.00
Egfr gene com variants $909.60 $909.60 $909.60
Electrd sq emblem s-icd $6,672.00 $6,672.00 $6,672.00
Electrolyte panel $12.60 $12.60 $12.60
Electron microscopy diagnostic $649.20 $649.20 $649.20
Electrophysiology evaluation $0.60 $0.60 $0.60
Electrophysiology evaluation $0.60 $0.60 $0.60
Electrophysiology evaluation $0.60 $0.60 $0.60
Electrophysiology evaluation $0.60 $0.60 $0.60
Electrophysiology evaluation $0.60 $0.60 $0.60
Electrophysiology evaluation $0.60 $0.60 $0.60
Electrophysiology evaluation $0.60 $0.60 $0.60
Elotuzumab 300 mg intravenous solution $3,061.20 $3,061.20 $3,061.20
Embo or occlude vascular arterial s&i $0.60 $0.60 $0.60
Embo or occlude vascular hemorrhage s&i $0.60 $0.60 $0.60
Embo or occlude vascular tumor/organ/infarct s&i $0.60 $0.60 $0.60
Embo or occlude vascular venous s&i $0.60 $0.60 $0.60
Embolization s&i $0.60 $0.60 $0.60
Emg 3 ext w-w/o paraspinal area 95863 $163.80 $163.80 $163.80
Endoluminal bx biliary tree $0.60 $0.60 $0.60
Endoluminl ivus oct c 1st $0.60 $0.60 $0.60
Endoluminl ivus oct c ea $0.60 $0.60 $0.60
Endovas iliac a device addon $0.60 $0.60 $0.60
Endovasc visc aorta 2 graft $0.60 $0.60 $0.60
Enfortumab vedotin-ejfv 20 mg intravenous solution $36.60 $36.60 $36.60
Enoxaparin 30 mg/0.3 ml subcutaneous syringe $35.40 $35.40 $35.40
Entamoeba histolytica ag eia - sendout $64.80 $64.80 $64.80
Enzyme histochemistry $81.00 $81.00 $81.00
Ep & ablate supravent arrhyt $0.60 $0.60 $0.60
Ep & ablate ventric tachy $0.60 $0.60 $0.60
Epirubicin 200 mg/100 ml intravenous solution $33.00 $33.00 $33.00
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr $667.20 $667.20 $667.20
Epoetin alfa, 100 units esrd $164.40 $164.40 $164.40
Epstein barr early antigen antibody $53.40 $53.40 $53.40
Epstein barr nuclear antigen antibody $53.40 $53.40 $53.40
Epstein barr viral capsid antigen antibody igm $76.20 $76.20 $76.20
Eptifibatide 0.75 mg/ml intravenous solution $62.40 $62.40 $62.40
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution $1,355.40 $1,355.40 $1,355.40
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr $55.80 $55.80 $55.80
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only $81.60 $81.60 $81.60
Esophageal dilat s&i $0.60 $0.60 $0.60
Esophageal motility $201.60 $201.60 $201.60
Establish access to artery $0.60 $0.60 $0.60
Established Patient Office Visit (level 1) $58.20 $58.20 $58.20
Established Patient Office Visit (level 2) $87.60 $87.60 $87.60
Established Patient Office Visit (level 3) $117.00 $117.00 $117.00
Established Patient Office Visit (level 4) $146.40 $146.40 $146.40
Established Patient Office Visit (level 5) $175.80 $175.80 $175.80
Estradiol total $24.00 $24.00 $24.00
Estrogens total-sendout $40.20 $40.20 $40.20
Ethylene glycol -sendout $24.00 $24.00 $24.00
Euglobulin lysis $12.60 $12.60 $12.60
Eval/fit voice prosthesis iii, st $207.60 $207.60 $207.60
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen $67.20 $67.20 $67.20
Evaluation of speech fluency 92521 $150.00 $150.00 $150.00
Evaluation psychiatric diagnostic $351.60 $351.60 $351.60
Evasc repair of iliac artery; endograft 34718 $0.60 $0.60 $0.60
Evasc rpr a-ao ndgft 34701 $0.60 $0.60 $0.60
Evasc rpr a-iliac ndgft 34717 $0.60 $0.60 $0.60
Event monitor $66.00 $66.00 $66.00
Evoked potential visual not glaucoma $153.60 $153.60 $153.60
Exchange biliary drg cath $0.60 $0.60 $0.60
Exchange drainage catheter $0.60 $0.60 $0.60
Exchange nephrostomy cath $0.60 $0.60 $0.60
Exercise w/hemodynamic meas $0.60 $0.60 $0.60
Expander tiss 133s-mv-12-t 300ml natrelle smth $15,240.60 $15,240.60 $15,240.60
External chromosome analysis 20-25 cells $649.20 $649.20 $649.20
External pretreatment of serum for use in antibody identification by dilution $49.80 $49.80 $49.80
External tissue culture neoplastic disorders bone marrow/blood cells $243.60 $243.60 $243.60
Extractable nuclear antigen/antibody any method each antibody centromere $45.00 $45.00 $45.00
F-18 fdg pet diag $234.00 $234.00 $234.00
Facial bones <3 $89.40 $89.40 $89.40
Factor ix $97.20 $97.20 $97.20
Factor ix recombinant nos $1.20 $1.20 $1.20
Factor viii $97.20 $97.20 $97.20
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution $31.20 $31.20 $31.20
Family therapy with patient 50 min 90847 $117.00 $117.00 $117.00
Family therapy without pt 50min 90846 $117.00 $117.00 $117.00
Fat/lipids feces qualitative $24.00 $24.00 $24.00
Feeding tube reposition $0.60 $0.60 $0.60
Fem/popl revasc w/stent $0.60 $0.60 $0.60
Feno poc $49.20 $49.20 $49.20
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) $0.60 $0.60 $0.60
Ferritin $24.00 $24.00 $24.00
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution $472.80 $472.80 $472.80
Fetal biophys profile w/nst 76818 $357.60 $357.60 $357.60
Fetal fibronectin $283.80 $283.80 $283.80
Fetal hemoglobin (kleihauer betke) $37.20 $37.20 $37.20
Fetal hemoglobin rosette $24.00 $24.00 $24.00
Fetal non stress test $722.40 $722.40 $722.40
Fibrin degradation d dimer quantitative $24.00 $24.00 $24.00
Fibrin degradation products $24.00 $24.00 $24.00
Fibrin degrade semiquant $24.00 $24.00 $24.00
Fibrinogen activity $14.40 $14.40 $14.40
Fibrinolytic antiplasmin $81.00 $81.00 $81.00
Fibrinolytic plasminogen $81.00 $81.00 $81.00
Fibrinolytic plasminogen xcpt antgnc asa $37.20 $37.20 $37.20
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr $617.40 $617.40 $617.40
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe $296.40 $296.40 $296.40
Filgrastim-sndz 300 mcg/0.5 ml injection syringe $372.60 $372.60 $372.60
Filter spider fx 3mmx320cm $2,570.40 $2,570.40 $2,570.40
Filter vena cava fem denali $5,440.20 $5,440.20 $5,440.20
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 $0.60 $0.60 $0.60
Fine needle aspiration biopsy w/us gdn; ea addtl 10006 $0.60 $0.60 $0.60
Finger joint sz00 swanson w/grommets $5,254.20 $5,254.20 $5,254.20
Fl exam g/colon tube w contrast $0.60 $0.60 $0.60
Flow cytometry marker each additional $81.00 $81.00 $81.00
Flow cytometry one marker technical component $81.00 $81.00 $81.00
Flt3 gene $243.60 $243.60 $243.60
Flt3 gene analysis $243.60 $243.60 $243.60
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback $6.00 $6.00 $6.00
Fludarabine 50 mg intravenous solution $103.80 $103.80 $103.80
Fluidotherapy charges pt $34.20 $34.20 $34.20
Fluorescent antibody titer dna $45.00 $45.00 $45.00
Fluoro polarize fetal lung $40.20 $40.20 $40.20
Fluoroguide needle placement $0.60 $0.60 $0.60
Fluoroscopy up to 1 hour $196.20 $196.20 $196.20
Fluorouracil 50 mg/ml intravenous solution (wrapper) $1.20 $1.20 $1.20
Fna bx w/ct gdn 1st les $0.60 $0.60 $0.60
Fna bx w/ct gdn ea addl $0.60 $0.60 $0.60
Folic acid $24.00 $24.00 $24.00
Follow-up angiography $0.60 $0.60 $0.60
Fomepizole 1 gram/ml intravenous solution $684.00 $684.00 $684.00
Fondaparinux sodium $34.20 $34.20 $34.20
Foot X-ray $106.80 $106.80 $106.80
Fosaprepitant 150 mg intravenous powder for solution $28.80 $28.80 $28.80
Fresh frozen plasma thawing ea un $6.00 $6.00 $6.00
Fructosamine glycated protein $24.00 $24.00 $24.00
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr $0.60 $0.60 $0.60
Galactokinase - sendout $55.20 $55.20 $55.20
Gamma glutamyltransferase $3.00 $3.00 $3.00
Gammaglobulin iga $24.00 $24.00 $24.00
Gammaglobulin ige $24.00 $24.00 $24.00
Gamunex-c/gammaked $1,390.20 $1,390.20 $1,390.20
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr $18.60 $18.60 $18.60
Gastric emptying imag study $373.80 $373.80 $373.80
Gastroesophageal reflux study $223.20 $223.20 $223.20
Gated heart multiple $234.60 $234.60 $234.60
Gemcitabine 1 gram intravenous solution $2.40 $2.40 $2.40
Generator barostim neo2 2014 $48,475.80 $48,475.80 $48,475.80
Generator emblem MRI sicd subq $28,356.00 $28,356.00 $28,356.00
Gentamicin 10 mg/ml liquid compound - enteral use only $3.60 $3.60 $3.60
Gentamicin peak therapeutic drug level $24.00 $24.00 $24.00
Ghs HIV antibody $40.20 $40.20 $40.20
Ghs IV inf sq injection, on-body injector $117.00 $117.00 $117.00
Ghs IV infusion bamlanivimab/etesevimab $573.60 $573.60 $573.60
Ghs IV infusion casirivimab/imdevimab $573.60 $573.60 $573.60
Ghs IV infusion sotrovimab $469.20 $469.20 $469.20
Ghs alcohol, methyl (methanol)-medtox $48.60 $48.60 $48.60
Ghs antibodies (torch) igm $40.20 $40.20 $40.20
Ghs bleeding time (ivy) $24.00 $24.00 $24.00
Ghs central line insert < age 5, failed $0.60 $0.60 $0.60
Ghs change cysto/gastrost $0.60 $0.60 $0.60
Ghs chemo IV push, ea addtl $117.00 $117.00 $117.00
Ghs community re-entry 15 minutes $57.00 $57.00 $57.00
Ghs diphtheria toxoid ab igg $53.40 $53.40 $53.40
Ghs ed peritoneal lavage w guidance if performed $0.60 $0.60 $0.60
Ghs fish cytogen $81.00 $81.00 $81.00
Ghs fish hybrid in situ 100-300 $373.20 $373.20 $373.20
Ghs hepatitis c virus (hcv riba) $162.00 $162.00 $162.00
Ghs histoplasma antigen $64.80 $64.80 $64.80
Ghs hla-dr/dq, multiple antigens $373.20 $373.20 $373.20
Ghs inf midline insertion $0.60 $0.60 $0.60
Ghs inhibitor screen $97.20 $97.20 $97.20
Ghs leukocyte alkaline phos (mayo) $32.40 $32.40 $32.40
Ghs mbp $97.20 $97.20 $97.20
Ghs myocardial strain img spckl track $6.60 $6.60 $6.60
Ghs ng placement w fluoro guidance $0.60 $0.60 $0.60
Ghs opcc repair cvp w subq port $0.60 $0.60 $0.60
Ghs opcc repair cvp without subq port $0.60 $0.60 $0.60
Ghs ot prosthetic training/15 min $79.80 $79.80 $79.80
Ghs ot sensory integrative tech/15min $96.60 $96.60 $96.60
Ghs pacing - transcutaneous $0.60 $0.60 $0.60
Ghs paravert facet/nerve cerv ea add bil $0.60 $0.60 $0.60
Ghs paravert facet/nerve lumb ea add bil $0.60 $0.60 $0.60
Ghs phenylketonurid $32.40 $32.40 $32.40
Ghs picc line insert < 5 $0.60 $0.60 $0.60
Ghs plt ct-manual $16.20 $16.20 $16.20
Ghs ppd (tb intradermal) $9.00 $9.00 $9.00
Ghs pr without cont pulse ox $55.80 $55.80 $55.80
Ghs prostatic acid phosphatase (mayo) $24.00 $24.00 $24.00
Ghs protoporphyrins fract $87.60 $87.60 $87.60
Ghs quinidine $24.00 $24.00 $24.00
Ghs sedimentation rate $9.60 $9.60 $9.60
Ghs semen analysis fert $46.80 $46.80 $46.80
Ghs semen analysis, post-vas $12.60 $12.60 $12.60
Ghs sensitivity (per antimicro) $16.20 $16.20 $16.20
Ghs sp train/fitting sp device - kx $172.80 $172.80 $172.80
Ghs speech-gen aug dev eval iii, st $80.40 $80.40 $80.40
Ghs st - re-eval for alt comm $91.80 $91.80 $91.80
Ghs urine, hydroxproline total $97.20 $97.20 $97.20
Ghs urine, porphyrins quant $56.40 $56.40 $56.40
Gi inhouse confirmation $48.60 $48.60 $48.60
Glucagon 1 mg solution for injection $95.40 $95.40 $95.40
Glucagon plasma - sendout $40.20 $40.20 $40.20
Glucose 1 hr post dose $6.00 $6.00 $6.00
Glucose blood by monitoring device cleared by fda for home use $12.60 $12.60 $12.60
Glucose blood quantitative $6.00 $6.00 $6.00
Glucose body fluid $6.00 $6.00 $6.00
Glucose tolerance test (gtt) 3 specimens $24.00 $24.00 $24.00
Glucose tolerance test (gtt) >3 specimens each additional $6.00 $6.00 $6.00
Gonadotropin follicle stimulating hormone (fsh) $24.00 $24.00 $24.00
Gonadotropin luteinizing hormone (lh) $40.20 $40.20 $40.20
Goserelin 10.8 mg subcutaneous implant $1,831.20 $1,831.20 $1,831.20
Graft axiofill 1000mg $2,287.80 $2,287.80 $2,287.80
Graft nerve adv 3-4x70mm $19,465.20 $19,465.20 $19,465.20
Graft patch felt ptfe 2x2 $5,095.20 $5,095.20 $5,095.20
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm $2,860.20 $2,860.20 $2,860.20
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm $1,879.20 $1,879.20 $1,879.20
Graft xenmtrx sft rect 15x20cm $30,786.60 $30,786.60 $30,786.60
Graft xenmtrx sft rect 19x28cm $1,882.20 $1,882.20 $1,882.20
Granisetron hcl injection $3.00 $3.00 $3.00
Gu dilat ureter/urethra s&i $0.60 $0.60 $0.60
Guid loc target vol rad tx $120.60 $120.60 $120.60
Guide endoanchr sg-64 aaa 62cm $169.80 $169.80 $169.80
Guide wire threaded 1.4x150mm $1,409.40 $1,409.40 $1,409.40
Guide worley csg 9fx50cm std $221.40 $221.40 $221.40
Guided cath fluid drainage 10030 $0.60 $0.60 $0.60
Gw stiffened micro access kit $5,951.40 $5,951.40 $5,951.40
H pylori (c-13) breath $32.40 $32.40 $32.40
Haloperidol decanoate 50 mg/ml intramuscular solution $22.80 $22.80 $22.80
Hand X-ray $106.80 $106.80 $106.80
Haptoglobin quantitative $24.00 $24.00 $24.00
Hbot, full body chamber, 30m $756.60 $756.60 $756.60
Hc fl sm bowel enteroclss tube w kub double contrast $1,930.80 $1,930.80 $1,930.80
Hc i-131 sodium iodide cap dx per mci $11.40 $11.40 $11.40
Hc nm myocard infarct avid plnr tomo spect w/wo quant $194.40 $194.40 $194.40
Hcg qualitative $16.20 $16.20 $16.20
Hcg quantitative $38.40 $38.40 $38.40
Hdr rdncl ntrstl/icav brchtx $886.20 $886.20 $886.20
Hdr rdncl ntrstl/icav brchtx $542.40 $542.40 $542.40
Hdr rdncl ntrstl/icav brchtx $277.20 $277.20 $277.20
Head CT scan (with and without contrast) $107.40 $107.40 $107.40
Head CT scan (with contrast) $89.40 $89.40 $89.40
Head CT scan (without contrast) $62.40 $62.40 $62.40
Helicobacter pylori antibody igm $40.20 $40.20 $40.20
Hematocrit $6.00 $6.00 $6.00
Hemodialysis one evaluation $871.20 $871.20 $871.20
Hemoglobin $6.00 $6.00 $6.00
Hemoglobin methemoglobin quantitative $32.40 $32.40 $32.40
Hemoglobin plasma $19.20 $19.20 $19.20
Hemolysin acid $12.60 $12.60 $12.60
Hemolysins and agglutinins incubated $28.80 $28.80 $28.80
Hepagam b im injection $165.60 $165.60 $165.60
Heparin assay $37.20 $37.20 $37.20
Heparin bolus from bag $9.00 $9.00 $9.00
Hepatitis a antibody igm $32.40 $32.40 $32.40
Hepatitis b core antibody igm $32.40 $32.40 $32.40
Hepatitis b core antibody total $32.40 $32.40 $32.40
Hepatitis b surface antibody $32.40 $32.40 $32.40
Hepatitis c antibody $40.20 $40.20 $40.20
Hepatobiliary system imaging $315.00 $315.00 $315.00
Herpes simplex type 1 antibody igg $40.20 $40.20 $40.20
Herpes simplex type 2 antibody igg $40.20 $40.20 $40.20
Herpes simplex virus isolation $97.20 $97.20 $97.20
Heterophile antibodies screening $12.60 $12.60 $12.60
Hip X-ray $142.80 $142.80 $142.80
Histochemical stains add-on $48.60 $48.60 $48.60
Hla class i high defin qual $227.40 $227.40 $227.40
Hla typing a b or c $202.80 $202.80 $202.80
Hldr trach tb tie ad $95.40 $95.40 $95.40
Home sleep test/type 3 porta $148.80 $148.80 $148.80
Homocysteine $48.60 $48.60 $48.60
Homogenization tissue $243.60 $243.60 $243.60
Homovanillic acid (hva) $48.60 $48.60 $48.60
Hyaluronidase, human recombinant 150 unit/ml injection solution $57.00 $57.00 $57.00
Hydration IV infusion each additional hour $703.20 $703.20 $703.20
Hydration IV infusion initial 31minutes - 1 hour $234.00 $234.00 $234.00
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr $121.20 $121.20 $121.20
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge $18.60 $18.60 $18.60
Hysterosalpingography s&i $0.60 $0.60 $0.60
I-123 sod iodide diag per 100 uci $39.60 $39.60 $39.60
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour $204.60 $204.60 $204.60
IV infusion therapy/prophylaxis/diagnosis concurrent infusion $117.00 $117.00 $117.00
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour $937.80 $937.80 $937.80
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour $527.40 $527.40 $527.40
Ibutilide fumarate 0.1 mg/ml intravenous solution $279.60 $279.60 $279.60
Icd cobalt xt dr MRI is1 df1 $22,518.00 $22,518.00 $22,518.00
Icd crtd cobalt hf MRI is1 df1 $28,568.40 $28,568.40 $28,568.40
Icd crtp serena MRI $8,439.60 $8,439.60 $8,439.60
Icd reliance df4 ib 64cm $4,837.20 $4,837.20 $4,837.20
Ifosfamide 1 gram intravenous solution $97.20 $97.20 $97.20
Igh gene rearrange amp meth $194.40 $194.40 $194.40
Igh@ var region somatic mutation analy $194.40 $194.40 $194.40
Igk rearrangeabn clonal pop $194.40 $194.40 $194.40
Ihc/icc per specimen each additional single antibody stain $97.20 $97.20 $97.20
Ihc/icc per specimen each multiplex antibody stain $97.20 $97.20 $97.20
Ihc/icc per specimen initial single antibody stain $97.20 $97.20 $97.20
Iliac revasc add-on 37222 $0.60 $0.60 $0.60
Immobilizer shldr dlx str 24-36in med $44.40 $44.40 $44.40
Immune complex assay $58.20 $58.20 $58.20
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution $660.60 $660.60 $660.60
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution $1,080.00 $1,080.00 $1,080.00
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution $779.40 $779.40 $779.40
Immunoassay tumor antigen quantitative ca 125 $53.40 $53.40 $53.40
Immunoassay tumor antigen quantitative ca 19-9 $53.40 $53.40 $53.40
Immunodiffusion nes $12.60 $12.60 $12.60
Immunofixation electrophoresis serum $64.80 $64.80 $64.80
Immunofluorescence per specimen each additional single antibody stain $97.20 $97.20 $97.20
Immunofluorescence per specimen initial single antibody stain $97.20 $97.20 $97.20
Immunoglobulin assay $64.80 $64.80 $64.80
Implant cartilage 10mm synthetic $56,712.00 $56,712.00 $56,712.00
Imuglucerase injection $1,903.20 $1,903.20 $1,903.20
In situ hybridization per specimen each additional single probe stain $243.60 $243.60 $243.60
In situ hybridization per specimen initial single probe stain $243.60 $243.60 $243.60
In-111 oxyquinolin per 0.5 mci $680.40 $680.40 $680.40
In-111 pentetate dtpa / 0.5 mci $820.20 $820.20 $820.20
In-111 pentetreotide $1,116.00 $1,116.00 $1,116.00
Infect ag ia optc obs influenza $40.20 $40.20 $40.20
Infect ag if legionella pneumophila $40.20 $40.20 $40.20
Infect ag na influenza r/amp 1st 2 types $259.80 $259.80 $259.80
Infect ag na resp virus 12-25 targets $292.20 $292.20 $292.20
Infectious agent antigen immunoassay direct optical observation sars-cov-2 $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step giardia $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool $48.60 $48.60 $48.60
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step legionella urine $40.20 $40.20 $40.20
Infectious agent antigen immunoassay ql/sq multi step rotavirus $40.20 $40.20 $40.20
Infectious agent nucleic acid amplified probe $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe chlamydia trachomatis $72.60 $72.60 $72.60
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe hsv-1 $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae $72.60 $72.60 $72.60
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe streptococcus group a $194.40 $194.40 $194.40
Infectious agent nucleic acid amplified probe trichomonas vaginalis $72.60 $72.60 $72.60
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets $292.20 $292.20 $292.20
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets $97.20 $97.20 $97.20
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets $194.40 $194.40 $194.40
Infectious agent nucleic acid quantification bk virus $259.80 $259.80 $259.80
Infectious agent nucleic acid quantification hepatitis b $259.80 $259.80 $259.80
Infectious agent nucleic acid quantification hepatitis c $259.80 $259.80 $259.80
Infectious agent nucleic acid quantification hiv-1 $259.80 $259.80 $259.80
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets $97.20 $97.20 $97.20
Infliximab 100 mg intravenous solution $540.60 $540.60 $540.60
Infliximab-axxq 100 mg intravenous solution $55.80 $55.80 $55.80
Infliximab-dyyb 100 mg intravenous solution $37.80 $37.80 $37.80
Influenza virus vaccine, inact hemagglutinin tiv pf inj $75.60 $75.60 $75.60
Infuse radioactive materials $186.60 $186.60 $186.60
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis $95.40 $95.40 $95.40
Initiation & management bipap/cpap initial day $190.80 $190.80 $190.80
Inj ceftolozane tazobactam $164.40 $164.40 $164.40
Inj cntr knee arthro incl ct/mri $0.60 $0.60 $0.60
Inj crotalidae im f(ab')2 eq $1,134.60 $1,134.60 $1,134.60
Inj dx for sinogram $0.60 $0.60 $0.60
Inj for ext venography $0.60 $0.60 $0.60
Inj hrt cath w/s&i nonsel p-art angrp $0.60 $0.60 $0.60
Inj hrt cath w/s&i sel left vent $0.60 $0.60 $0.60
Inj hrt cath w/s&i sel right vent $0.60 $0.60 $0.60
Inj hydroxocobalamin IV 25mg $1,125.60 $1,125.60 $1,125.60
Inj ivig privigen 500 mg $4,935.60 $4,935.60 $4,935.60
Inj levocarnitine per 1 gm $16.20 $16.20 $16.20
Inj melpha hydroch nos 50 mg $1,156.20 $1,156.20 $1,156.20
Inj meropenem (wg crit care) $34.20 $34.20 $34.20
Inj nephrosto/ureterogram w/img exstng access $0.60 $0.60 $0.60
Inj ogivri 10 mg $1,344.00 $1,344.00 $1,344.00
Inj pegfilgrastim-bmez 0.5mg $5,157.00 $5,157.00 $5,157.00
Inj peritoneal venous shunt $0.60 $0.60 $0.60
Inj retro urethrocysto $0.60 $0.60 $0.60
Inj secretin synthetic human $630.00 $630.00 $630.00
Inj w/fluor eval cv device $0.60 $0.60 $0.60
Inj, cefepime hcl (b braun) $20.40 $20.40 $20.40
Inj, clevidipine butyrate $94.20 $94.20 $94.20
Inj, lanreotide, (cipla) 1mg $8,487.60 $8,487.60 $8,487.60
Inj, sutimlimab-jome, 10 mg $2,256.00 $2,256.00 $2,256.00
Inj, tislelizumab-jsgr $64.20 $64.20 $64.20
Inj., benralizumab, 1 mg $5,853.00 $5,853.00 $5,853.00
Inj., lumoxiti, 0.01 mg $31.20 $31.20 $31.20
Inj., meropenem, vaborbactam $198.00 $198.00 $198.00
Injection during cath supravalvular aortography $0.60 $0.60 $0.60
Injection for bladder x-ray $0.60 $0.60 $0.60
Injection for ureter x-ray $0.60 $0.60 $0.60
Injection into brain canal $117.00 $117.00 $117.00
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug $292.80 $292.80 $292.80
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug $117.00 $117.00 $117.00
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug $28.80 $28.80 $28.80
Injection therapeutic/prophylactic/diagnostic subcutaneous/im $58.20 $58.20 $58.20
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level $0.60 $0.60 $0.60
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level $0.60 $0.60 $0.60
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance $0.60 $0.60 $0.60
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level $0.60 $0.60 $0.60
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) $0.60 $0.60 $0.60
Injection, cangrelor $1,013.40 $1,013.40 $1,013.40
Injection, daratumumab 10 mg $3,195.00 $3,195.00 $3,195.00
Injection, fulvestrant $71.40 $71.40 $71.40
Injection, renflexis $798.00 $798.00 $798.00
Injection,onabotulinumtoxina $721.20 $721.20 $721.20
Ins cath ren art 1st bi $0.60 $0.60 $0.60
Ins cath ren art 1st uni $0.60 $0.60 $0.60
Ins cath ren art 2nd+ bi $0.60 $0.60 $0.60
Ins cath ren art 2nd+ uni $0.60 $0.60 $0.60
Ins icd gen exist mlt leads $0.60 $0.60 $0.60
Ins icd gen exist sgl lead $0.60 $0.60 $0.60
Ins lv lead exist pm/icd $0.60 $0.60 $0.60
Ins picad w subq port 5yr> $0.60 $0.60 $0.60
Ins pm gen exist dual lead $0.60 $0.60 $0.60
Ins pm gen w/exist mlt leads $0.60 $0.60 $0.60
Ins pq tunnld ip cath w/img $0.60 $0.60 $0.60
Ins tun cv cath wo subq prt/pm $0.60 $0.60 $0.60
Ins tun cv cath wo subq prt/pm $0.60 $0.60 $0.60
Ins tun cvad 2 cath w/subq port(s) $0.60 $0.60 $0.60
Ins tun intraperit dia cath $0.60 $0.60 $0.60
Ins/rpl ldless pm right vent w img & eval $0.60 $0.60 $0.60
Ins/rpl pm gen exist dual lead $0.60 $0.60 $0.60
Ins/rpl pm gen exist sgl lead $0.60 $0.60 $0.60
Ins/rpl pm w/tv ld atrl $0.60 $0.60 $0.60
Insert abdomen-venous drain $0.60 $0.60 $0.60
Insert hepatic shunt (tips) $0.60 $0.60 $0.60
Insert picvad cath $0.60 $0.60 $0.60
Insert pm/icd lead dual $0.60 $0.60 $0.60
Insert sq defib electrode $0.60 $0.60 $0.60
Insert swan-ganz cath $0.60 $0.60 $0.60
Insert tunneled cv 2cath 2sits without port/pmp 36565 $0.60 $0.60 $0.60
Insert tunneled cv cath $0.60 $0.60 $0.60
Insert tunneled cv cath $0.60 $0.60 $0.60
Insert vad art access left hrt arterial access $0.60 $0.60 $0.60
Insert/repl sq defib w/eltrd $0.60 $0.60 $0.60
Insertion catheter bladder non indwelling $117.00 $117.00 $117.00
Insertion catheter bladder temporary simple $117.00 $117.00 $117.00
Insertion catheter pleural indwelling tunneled with cuff $0.60 $0.60 $0.60
Insertion intra aortic balloon assist device percutaneous $0.60 $0.60 $0.60
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance $0.60 $0.60 $0.60
Insertion nontunneled centrally inserted central venous catheter >= 5 years old $0.60 $0.60 $0.60
Insertion of catheter vein $0.60 $0.60 $0.60
Insertion of catheter vein $0.60 $0.60 $0.60
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular $0.60 $0.60 $0.60
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular $0.60 $0.60 $0.60
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator $0.60 $0.60 $0.60
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years $0.60 $0.60 $0.60
Insertion single tranvenous electrode/ppm/implantable defibrillator $0.60 $0.60 $0.60
Insertion subcutaneous cardiac rhythm monitor $0.60 $0.60 $0.60
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) $0.60 $0.60 $0.60
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber $0.60 $0.60 $0.60
Insertion/replacement temporary single chamber electrode/pacemaker catheter $0.60 $0.60 $0.60
Insitu hybridization auto $267.60 $267.60 $267.60
Insitu hybridization manual $243.60 $243.60 $243.60
Instillation anticarcinogenic agent bladder $117.00 $117.00 $117.00
Insulin total $24.00 $24.00 $24.00
Interferon alfa-2b inj $1,585.20 $1,585.20 $1,585.20
Interrog evl pm/ldls pm ip $0.60 $0.60 $0.60
Intra-atrial pacing $0.60 $0.60 $0.60
Intra-atrial recording $0.60 $0.60 $0.60
Intracard echo interv w/s&i $0.60 $0.60 $0.60
Intraventricular pacing $0.60 $0.60 $0.60
Intrinsic factor antibody $56.40 $56.40 $56.40
Intro cath dialysis circuit $0.60 $0.60 $0.60
Intro cath dialysis circuit w/pta $0.60 $0.60 $0.60
Intro cath dialysis circuit w/stent plcmnt $0.60 $0.60 $0.60
Intro cath svc/ivc $0.60 $0.60 $0.60
Intro catheter aorta $0.60 $0.60 $0.60
Intrvasc Ultrasound noncoronary 1st vessel $0.60 $0.60 $0.60
Intrvasc Ultrasound noncoronary addl vessel $0.60 $0.60 $0.60
Intubation endotracheal emergency procedure $39.60 $39.60 $39.60
Iopamidol 300 mg iodine/ml (61 %) intravenous solution $61.20 $61.20 $61.20
Ipilimumab 5 mg/ml intravenous solution (wrapper) $200.40 $200.40 $200.40
Irinotecan 20 mg/ml intravenous solution (wrapper) $2.40 $2.40 $2.40
Irinotecan liposomal 4.3 mg/ml intravenous $78.00 $78.00 $78.00
Iron $9.60 $9.60 $9.60
Iron binding capacity $19.20 $19.20 $19.20
Iron dextran 50 mg/ml injection solution $38.40 $38.40 $38.40
Iron sucrose 20 mg iron/ml intravenous solution (wrapper) $35.40 $35.40 $35.40
Irradiation of blood product each unit reference $129.60 $129.60 $129.60
Irrigation implantable venous access device for drug delivery systems $87.60 $87.60 $87.60
Ivc venogram s&i $0.60 $0.60 $0.60
Ixabepilone 15 mg intravenous solution $1,650.60 $1,650.60 $1,650.60
Ketone body(s) beta-hydroxybutyrate quantitative $21.00 $21.00 $21.00
Ketorolac 15 mg/ml injection (wrapper) $1.20 $1.20 $1.20
Kidney (Retroperitoneal) Ultrasound (complete) $393.00 $393.00 $393.00
Kidney img w/bldflw sgl without rx $198.00 $198.00 $198.00
Kit lead specify 5-6-5 $8,840.40 $8,840.40 $8,840.40
Kit monitr cath camino icp w/integratd licox bolt fitting $448.20 $448.20 $448.20
Kit tissue closure sealant adhesive air leak progel 4 ml pleura $1,122.00 $1,122.00 $1,122.00
Knee MRI (with and without contrast) $601.20 $601.20 $601.20
Knee MRI (with contrast) $495.00 $495.00 $495.00
Knee MRI (without contrast) $276.60 $276.60 $276.60
Knee X-ray $142.80 $142.80 $142.80
Kras gene addl variants $243.60 $243.60 $243.60
Kras gene variants exon 2 $389.40 $389.40 $389.40
L/s ratio fetal lung $194.40 $194.40 $194.40
Lacosamide 200 mg/20 ml intravenous solution $63.60 $63.60 $63.60
Lactate dehydrogenase (ldh) $6.00 $6.00 $6.00
Lactated ringers intravenous solution $1.20 $1.20 $1.20
Lactic acid $32.40 $32.40 $32.40
Lactoferrin fecal qualitative $40.20 $40.20 $40.20
Lanreotide 120 mg/0.5 ml subcutaneous syringe $11,474.40 $11,474.40 $11,474.40
Lanthanum carbonate oral 5mg $6.60 $6.60 $6.60
Lead acuity x4 spiral l 86cm $2,570.40 $2,570.40 $2,570.40
Lead capillary $40.20 $40.20 $40.20
Lead ingevity 45cm pfret MRI $4,174.20 $4,174.20 $4,174.20
Lead tachy durata sj4 58cm $4,950.00 $4,950.00 $4,950.00
Leg Vein Ultrasound (DVT study, both legs) $822.00 $822.00 $822.00
Lens iol ant bicnvx 24.0 multi $1,993.80 $1,993.80 $1,993.80
Leucovorin calcium 100 mg solution for injection (1 mg rounding) $4.80 $4.80 $4.80
Leukacyte transfusion $974.40 $974.40 $974.40
Leuprolide 3.75 mg intramuscular syringe kit $4,876.80 $4,876.80 $4,876.80
Leuprolide 30 mg (4 month) intramuscular syringe kit $6,209.40 $6,209.40 $6,209.40
Levetiracetam 500 mg/5 ml intravenous solution $13.20 $13.20 $13.20
Levetiracetam therapeutic drug level $24.00 $24.00 $24.00
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback $2.40 $2.40 $2.40
Liberta rc ipg $32,526.00 $32,526.00 $32,526.00
Lidocaine therapeutic drug level $24.00 $24.00 $24.00
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback $37.80 $37.80 $37.80
Lipase $12.60 $12.60 $12.60
Lipoprotein direct measurement hdl $24.00 $24.00 $24.00
Lipoprotein direct measurement ldl $24.00 $24.00 $24.00
Lithium therapeutic drug level $24.00 $24.00 $24.00
Lithotripsy transluminal coronary percutaneous $0.60 $0.60 $0.60
Liver Function Test $17.40 $17.40 $17.40
Lorazepam 2 mg/ml injection (wrapper) $4.80 $4.80 $4.80
Low frequency non-thermal Ultrasound $45.60 $45.60 $45.60
Lower Back (Lumbar Spine) CT scan (with and without contrast) $172.80 $172.80 $172.80
Lower Back (Lumbar Spine) CT scan (with contrast) $140.40 $140.40 $140.40
Lower Back (Lumbar Spine) CT scan (without contrast) $107.40 $107.40 $107.40
Lower Back (Lumbar Spine) MRI (with and without contrast) $436.20 $436.20 $436.20
Lower Back (Lumbar Spine) MRI (with contrast) $382.80 $382.80 $382.80
Lower Back (Lumbar Spine) MRI (without contrast) $247.20 $247.20 $247.20
Lower Back (Lumbar Spine) X-ray $124.80 $124.80 $124.80
Lumbar diskogram s&i $0.60 $0.60 $0.60
Lung Function Test (Spirometry) $82.20 $82.20 $82.20
Lung perfusion imaging $216.00 $216.00 $216.00
Lurbinectedin 4 mg intravenous solution $234.60 $234.60 $234.60
Luspatercept-aamt 25 mg subcutaneous solution $44.40 $44.40 $44.40
Lymphatics/lymph node imaging $318.60 $318.60 $318.60
M/phmtrc alys ishquant/semiq $324.60 $324.60 $324.60
M/phmtrc alys ishquant/semiq $267.60 $267.60 $267.60
M/phmtrc alysishquant/semiq $243.60 $243.60 $243.60
MRA abdomen post contrast $518.40 $518.40 $518.40
MRA aorta thoracic w/wo contrast $513.00 $513.00 $513.00
MRA ext low(run-off)pst cntrst $513.00 $513.00 $513.00
MRA upper extremity post contrast-bil $536.40 $536.40 $536.40
MRI breast c- unilateral $565.80 $565.80 $565.80
MRI breast c-+ w/cad uni $760.20 $760.20 $760.20
MRI breast w IV cont bi $754.20 $754.20 $754.20
MRI breast without cont bi $565.80 $565.80 $565.80
MRI cardiac morph & func wo IV cont $336.00 $336.00 $336.00
MRI cardiac morph & func wwo IV cont $489.00 $489.00 $489.00
MRI chest without & w/contrast $772.20 $772.20 $772.20
MRI chest without contrast $565.80 $565.80 $565.80
MRI lower extremity other than joint without & w/contrast (both sides) $654.00 $654.00 $654.00
MRI lower extremity other than joint without contrast (both sides) $489.00 $489.00 $489.00
MRI orbit fac&nck w IV cont $424.20 $424.20 $424.20
MRI orbit/face/neck without & w/contrast $513.00 $513.00 $513.00
MRI orbit/face/neck without contrast $388.80 $388.80 $388.80
MRI tmj $412.20 $412.20 $412.20
MRI upper extremity other than joint without & w/contrast (both sides) $648.60 $648.60 $648.60
MRI upper extremity other than joint without contrast (both sides) $495.00 $495.00 $495.00
Magnesium $9.60 $9.60 $9.60
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback $7.80 $7.80 $7.80
Magnetic image bone marrow $513.00 $513.00 $513.00
Manipulation chest wall demonstration/evaluation subsequent $39.60 $39.60 $39.60
Manipulation chest wall initial demonstration/evaluation $47.40 $47.40 $47.40
Margetuximab-cmkb 25 mg/ml intravenous solution $258.00 $258.00 $258.00
Mastoids complete $178.80 $178.80 $178.80
Mayo a1app alpha 1 antitrypsin phenotype $64.80 $64.80 $64.80
Mayo aathr protein s free $81.00 $81.00 $81.00
Mayo activated protein c resistance assay $97.20 $97.20 $97.20
Mayo alcohol definitive assay volatile screen $48.60 $48.60 $48.60
Mayo alkaline phosphatase isoenzyme $40.20 $40.20 $40.20
Mayo alpha 1 antitrypsin $24.00 $24.00 $24.00
Mayo amikacin trough therapeutic drug level $24.00 $24.00 $24.00
Mayo amphu methylenedioxyamphetamines definitive assay urine $40.20 $40.20 $40.20
Mayo analysis gene jak2 p.val617phe variant $194.40 $194.40 $194.40
Mayo androstenedione $40.20 $40.20 $40.20
Mayo angiotensin 1 converting enzyme (ace) csf $32.40 $32.40 $32.40
Mayo aspergillus fumigatus antibody $53.40 $53.40 $53.40
Mayo barbiturates definitive assay confirmation urine $40.20 $40.20 $40.20
Mayo bart bartonella henselae antibody igg $53.40 $53.40 $53.40
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative $194.40 $194.40 $194.40
Mayo blastomyces antibody immunodiffusion $53.40 $53.40 $53.40
Mayo bordetella pertussis antibody igg $53.40 $53.40 $53.40
Mayo brcmg brucella antibody igm $53.40 $53.40 $53.40
Mayo c1 esterase inhibitor $24.00 $24.00 $24.00
Mayo cannabinoids natural definitive assay thc confirmation urine $64.80 $64.80 $64.80
Mayo carnitine total and free quantitative each specimen plasma $243.60 $243.60 $243.60
Mayo ceruloplasmin $24.00 $24.00 $24.00
Mayo chemiluminescent parathyroid related peptide $24.00 $24.00 $24.00
Mayo chlap chlamydia pneumoniae antibody igg $32.40 $32.40 $32.40
Mayo chlap chlamydia pneumoniae antibody igm $32.40 $32.40 $32.40
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte $162.00 $162.00 $162.00
Mayo chromium $64.80 $64.80 $64.80
Mayo cocaine definitive assay confirmation urine $48.60 $48.60 $48.60
Mayo coccidioides antibody $53.40 $53.40 $53.40
Mayo cocou cortisone urine $48.60 $48.60 $48.60
Mayo cortisol free $48.60 $48.60 $48.60
Mayo covid-19 antibody nucleocapsid total $48.60 $48.60 $48.60
Mayo coxiella brunetii (q fever) igg antibody $53.40 $53.40 $53.40
Mayo cyanide $46.80 $46.80 $46.80
Mayo deoxyribonuclease antibody titer $33.60 $33.60 $33.60
Mayo dhea (dehydroepiandrosterone) $24.00 $24.00 $24.00
Mayo dihydrotestosterone $48.60 $48.60 $48.60
Mayo estriol $24.00 $24.00 $24.00
Mayo estrone $40.20 $40.20 $40.20
Mayo ethosuximide therapeutic drug level $24.00 $24.00 $24.00
Mayo factor ii $97.20 $97.20 $97.20
Mayo factor v $97.20 $97.20 $97.20
Mayo factor vii $97.20 $97.20 $97.20
Mayo factor viii vw factor antigen $97.20 $97.20 $97.20
Mayo factor viii vw factor ristocetin cofactor $97.20 $97.20 $97.20
Mayo factor x $97.20 $97.20 $97.20
Mayo factor xi $97.20 $97.20 $97.20
Mayo fat/lipids feces quantitative $64.80 $64.80 $64.80
Mayo fbl culture fungi blood $48.60 $48.60 $48.60
Mayo ffspg allergen clam igg $24.00 $24.00 $24.00
Mayo gabapentin bld/srm/plasma therapeutic drug level $24.00 $24.00 $24.00
Mayo hiser histoplasma antibodies immunodiffusion $32.40 $32.40 $32.40
Mayo hla typing a/b/c single antigen $72.60 $72.60 $72.60
Mayo hvdip HIV 1 antibody $40.20 $40.20 $40.20
Mayo hvdip HIV 2 antibody $53.40 $53.40 $53.40
Mayo hydroxyprogesterone 17-d $56.40 $56.40 $56.40
Mayo immunoassay c1 esterase inhibitor antibody quantitative $40.20 $40.20 $40.20
Mayo immunoassay infectious agent antibody quantitative diptheria igg $40.20 $40.20 $40.20
Mayo immunoassay tumor antigen quantitative ca 27.29 $53.40 $53.40 $53.40
Mayo immunoassay tumor antigen quantitative chromogranin a $53.40 $53.40 $53.40
Mayo infectious agent antigen immunoassay direct optical observation cryptococcus $40.20 $40.20 $40.20
Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal $40.20 $40.20 $40.20
Mayo infectious agent nucleic acid amplified probe enterovirus $194.40 $194.40 $194.40
Mayo infectious agent nucleic acid quantification cytomegalovirus $259.80 $259.80 $259.80
Mayo infectious disease hepatitis c chronic six biochemical assays $88.80 $88.80 $88.80
Mayo inhab inhibin a $38.40 $38.40 $38.40
Mayo insulin antibodies $60.00 $60.00 $60.00
Mayo iodine $64.80 $64.80 $64.80
Mayo lamotrigine therapeutic drug level $24.00 $24.00 $24.00
Mayo ld_i lactate dehydrogenase isoenzymes $40.20 $40.20 $40.20
Mayo legionella antibody $32.40 $32.40 $32.40
Mayo leptospira antibody igm $32.40 $32.40 $32.40
Mayo lipoprotein electrophoresis $40.20 $40.20 $40.20
Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory $97.20 $97.20 $97.20
Mayo manganese $40.20 $40.20 $40.20
Mayo metanephrines plasma $48.60 $48.60 $48.60
Mayo methadone definitive assay confirmation urine $48.60 $48.60 $48.60
Mayo microsomal antibody liver-kidney $35.40 $35.40 $35.40
Mayo mitotane (lysodren) therapeutic drug level $64.80 $64.80 $64.80
Mayo molecular pathology procedure level 2 apoe genotype $194.40 $194.40 $194.40
Mayo muramidase $53.40 $53.40 $53.40
Mayo myoglobin $32.40 $32.40 $32.40
Mayo opatu opiates definitive assay >=1 $64.80 $64.80 $64.80
Mayo opatu opioid/analogs definitive assay 1 or 2 $40.20 $40.20 $40.20
Mayo opatu oxycodone definitive assay $40.20 $40.20 $40.20
Mayo organic acid methylmalonic single quantitative $64.80 $64.80 $64.80
Mayo oxalate 24 hour urine $24.00 $24.00 $24.00
Mayo pancreatic elastase fecal qualitative or semi quantitative $40.20 $40.20 $40.20
Mayo parvs parvovirus b19 antibody igg $48.60 $48.60 $48.60
Mayo paval fluorescent antibody screen agna type 1 $24.00 $24.00 $24.00
Mayo phospholipid neutralization hexagonal lupus anticoagulant $81.00 $81.00 $81.00
Mayo pntft phenytoin free therapeutic drug level $24.00 $24.00 $24.00
Mayo prmb primidone therapeutic drug level $48.60 $48.60 $48.60
Mayo proinsulin $194.40 $194.40 $194.40
Mayo psaft prostate specific antigen free $40.20 $40.20 $40.20
Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative $40.20 $40.20 $40.20
Mayo receptor assay transferrin soluble $121.80 $121.80 $121.80
Mayo renin $24.00 $24.00 $24.00
Mayo repu protein electrophoresis urine $40.20 $40.20 $40.20
Mayo selenium $64.80 $64.80 $64.80
Mayo serotonin $48.60 $48.60 $48.60
Mayo sfgp rickettsia rickettsii antibody igg $32.40 $32.40 $32.40
Mayo sirolimus therapeutic drug level $48.60 $48.60 $48.60
Mayo syphilis test non-treponemal antibody qualitative vdrl $12.60 $12.60 $12.60
Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification $194.40 $194.40 $194.40
Mayo tgrp testosterone free $24.00 $24.00 $24.00
Mayo tgrp testosterone total $24.00 $24.00 $24.00
Mayo thyroglobulin $40.20 $40.20 $40.20
Mayo ticks anaplasma phagocytophilum antibody igg $53.40 $53.40 $53.40
Mayo ticks babesia microti antibody igg $53.40 $53.40 $53.40
Mayo tramadol definitive assay w metabolite quantitative urine $48.60 $48.60 $48.60
Mayo vasoactive intestinal peptide $40.20 $40.20 $40.20
Mayo vitamin b-2 (riboflavin) $40.20 $40.20 $40.20
Mayo vitamin b3 (niacin) $81.00 $81.00 $81.00
Mayo vitamin k $40.20 $40.20 $40.20
Measure kidney pressure $0.60 $0.60 $0.60
Medroxyprogesterone 150 mg/ml im injection (wrapper) $20.40 $20.40 $20.40
Meperidine (pf) 25 mg/ml injection (wrapper) $6.60 $6.60 $6.60
Mepolizumab 100 mg/ml subcutaneous auto-injector $3,571.80 $3,571.80 $3,571.80
Meropenem 1 gram intravenous solution $6.60 $6.60 $6.60
Mesna 100 mg/ml intravenous solution $1.80 $1.80 $1.80
Metabolic Blood Panel (Basic) $17.40 $17.40 $17.40
Metabolic Blood Panel (Comprehensive) $24.00 $24.00 $24.00
Methotrexate sodium (pf) 1 gram solution for injection $19.80 $19.80 $19.80
Methotrexate sodium 2.5 mg tablet $3.00 $3.00 $3.00
Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) $150.00 $150.00 $150.00
Methylprednisolone sodium succinate 1,000 mg intravenous solution $45.00 $45.00 $45.00
Micafungin 100 mg intravenous solution $52.20 $52.20 $52.20
Microsatellite instability $471.00 $471.00 $471.00
Midazolam 1 mg/ml injection solution $33.00 $33.00 $33.00
Middle cerebral artery echo $285.60 $285.60 $285.60
Minocycline hydrochloride $216.60 $216.60 $216.60
Mirvetuximab soravtansine-gynx 5 mg/ml intravenous solution $77.40 $77.40 $77.40
Mitomycin 40 mg intravenous solution $1,516.20 $1,516.20 $1,516.20
Mitoxantrone 2 mg/ml concentrate,intravenous $145.20 $145.20 $145.20
Mlh1 gene $259.80 $259.80 $259.80
Monitor reveal linq ii cardiac $8,081.40 $8,081.40 $8,081.40
Mopath procedure level 3 $243.60 $243.60 $243.60
Mopath procedure level 5 $584.40 $584.40 $584.40
Morphine (pf) 0.25 mg/0.5 ml injection (neo/ped) - cnr $302.40 $302.40 $302.40
Morphine 4 mg/ml injection (wrapper) $1.80 $1.80 $1.80
Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain $349.20 $349.20 $349.20
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted $145.80 $145.80 $145.80
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual $121.80 $121.80 $121.80
Mthfr gene analy common variants $243.60 $243.60 $243.60
Mucin synovial fluid $14.40 $14.40 $14.40
Multiple sleep latency test $511.20 $511.20 $511.20
Mumps antibody igg $32.40 $32.40 $32.40
Mycoplasma antibody igm $32.40 $32.40 $32.40
Myelography via inj w/s&i 2+ regions $0.60 $0.60 $0.60
Myelography via inj w/s&i cervical $0.60 $0.60 $0.60
Myelography via inj w/s&i lumbosacral $0.60 $0.60 $0.60
Myelography via inj w/s&i thoracic $0.60 $0.60 $0.60
Myeloperoxidase ab multi step qualitative/semiquantitative $40.20 $40.20 $40.20
Natalizumab 300 mg/15 ml intravenous solution $8,221.80 $8,221.80 $8,221.80
Natriuretic peptide $48.60 $48.60 $48.60
Natural killer cells total count $81.00 $81.00 $81.00
Neck (Cervical Spine) CT scan (with and without contrast) $172.80 $172.80 $172.80
Neck (Cervical Spine) CT scan (with contrast) $140.40 $140.40 $140.40
Neck (Cervical Spine) CT scan (without contrast) $110.40 $110.40 $110.40
Neck (Cervical Spine) MRI (with and without contrast) $436.20 $436.20 $436.20
Neck (Cervical Spine) MRI (with contrast) $388.80 $388.80 $388.80
Neck (Cervical Spine) MRI (without contrast) $247.20 $247.20 $247.20
Neck MRA (blood vessel MRI, with contrast) $583.20 $583.20 $583.20
Neck MRA (blood vessel MRI, without contrast) $553.80 $553.80 $553.80
Nerve conduction studies 13+ $153.60 $153.60 $153.60
New Patient Office Visit (level 2) $87.60 $87.60 $87.60
New Patient Office Visit (level 3) $117.00 $117.00 $117.00
New Patient Office Visit (level 4) $146.40 $146.40 $146.40
New Patient Office Visit (level 5) $175.80 $175.80 $175.80
Nfct ds bv&vaginitis dna alg $462.60 $462.60 $462.60
Nitroblue tetrazolium dye $81.00 $81.00 $81.00
Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous $26.40 $26.40 $26.40
Nivolumab 10 mg/ml intravenous solution (wrapper) $8,805.60 $8,805.60 $8,805.60
Njx px nfrosgrm &/urtrgrm $0.60 $0.60 $0.60
Nm imaging bone/joint 3 phase study $318.60 $318.60 $318.60
Nm imaging bone/joint whole body $223.20 $223.20 $223.20
Nm imaging cardiac blood pooling planar single study at rest or stress $194.40 $194.40 $194.40
Nm imaging gastric emptying study $318.60 $318.60 $318.60
Nm imaging gastrointestinal acute blood loss $322.80 $322.80 $322.80
Nm imaging hepatobiliary system w/pharmacologic intervention $432.60 $432.60 $432.60
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention $124.20 $124.20 $124.20
Nm imaging pulmonary ventilation/perfusion $300.60 $300.60 $300.60
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) $231.00 $231.00 $231.00
Nm radiopharmaceutical therapy oral administration $51.00 $51.00 $51.00
Nr lnr acclrtr tx max 5 sessions $2,272.80 $2,272.80 $2,272.80
Nras gene variants exon 2&3 $487.20 $487.20 $487.20
Ntsty modul rad tx dlvr cplx $675.00 $675.00 $675.00
Ntsty modul rad tx dlvr smpl $675.00 $675.00 $675.00
Nuclear Stress Test (Heart) $421.80 $421.80 $421.80
Obinutuzumab 1,000 mg/40 ml intravenous solution $8,218.20 $8,218.20 $8,218.20
Observation per hour $144.00 $144.00 $144.00
Ocrelizumab 30 mg/ml intravenous solution $19,500.00 $19,500.00 $19,500.00
Octreotide acetate 100 mcg/ml injection (wrapper) $12.60 $12.60 $12.60
Octreotide,microspheres ER 20 mg intramuscular susp, extended release $7,433.40 $7,433.40 $7,433.40
Ofatumumab 20 mg/ml intravenous solution (wrapper) $5,899.80 $5,899.80 $5,899.80
Omalizumab 150 mg/ml subcutaneous syringe (wrapper) $1,465.20 $1,465.20 $1,465.20
Oritavancin 400 mg intravenous solution $27.60 $27.60 $27.60
Osmolality blood $16.20 $16.20 $16.20
Osmolality urine $16.20 $16.20 $16.20
Ot evaluation high complexity patient/family $165.60 $165.60 $165.60
Ot evaluation low complexity patient/family $55.20 $55.20 $55.20
Ot evaluation moderate complexity patient/family $110.40 $110.40 $110.40
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes $125.40 $125.40 $125.40
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes $102.60 $102.60 $102.60
Ot manual therpy techniques >=1 region each 15 minutes $274.20 $274.20 $274.20
Ot re-evaluation patient/family $41.40 $41.40 $41.40
Ot therapeutic activities direct patient contact each 15 minutes $480.00 $480.00 $480.00
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes $45.60 $45.60 $45.60
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes $45.60 $45.60 $45.60
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes $182.40 $182.40 $182.40
Ot therapeutic procedure neuromuscular reeducate each 15 minutes $57.00 $57.00 $57.00
Ot training self care/home management direct contact each 15 minutes $57.00 $57.00 $57.00
Oth resp proc, group $49.20 $49.20 $49.20
Oth resp proc, indiv $49.20 $49.20 $49.20
Oxaliplatin 5 mg/ml desensitization $13.20 $13.20 $13.20
Oxytocin 10 unit/ml injection solution $6.60 $6.60 $6.60
PSA (Prostate) Test $32.40 $32.40 $32.40
Paclitaxel protein-bound 100 mg intravenous suspension $1,656.00 $1,656.00 $1,656.00
Palivizumab 50 mg/0.5 ml inj $3,154.20 $3,154.20 $3,154.20
Palonosetron hcl $15.00 $15.00 $15.00
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution $31.80 $31.80 $31.80
Panitumumab 20 mg/ml intravenous solution (wrapper) $6,081.60 $6,081.60 $6,081.60
Parathormone (pth) intact $24.00 $24.00 $24.00
Parathyroid planar imaging $278.40 $278.40 $278.40
Paricalcitol $10.80 $10.80 $10.80
Passy muir valve metal trach $241.20 $241.20 $241.20
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector $6,121.20 $6,121.20 $6,121.20
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe $2,714.40 $2,714.40 $2,714.40
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe $3,872.40 $3,872.40 $3,872.40
Pelvic CT scan (with and without contrast) $166.80 $166.80 $166.80
Pelvic CT scan (with contrast) $140.40 $140.40 $140.40
Pelvic CT scan (without contrast) $77.40 $77.40 $77.40
Pelvic MRI (with and without contrast) $648.60 $648.60 $648.60
Pelvic MRI (with contrast) $536.40 $536.40 $536.40
Pelvic MRI (without contrast) $501.00 $501.00 $501.00
Pelvic Ultrasound (complete) $375.00 $375.00 $375.00
Pelvic Ultrasound (limited) $124.80 $124.80 $124.80
Pembrolizumab 25 mg/ml intravenous solution $6,668.40 $6,668.40 $6,668.40
Pemetrexed disodium 100 mg intravenous powder for solution $124.80 $124.80 $124.80
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr $4.20 $4.20 $4.20
Penile rear tip xtnd 0.5cm $12,691.80 $12,691.80 $12,691.80
Penile vascular study $303.60 $303.60 $303.60
Pentostatin 10 mg intravenous solution $2,382.00 $2,382.00 $2,382.00
Perc cryo ablate renal tum $0.60 $0.60 $0.60
Perc rf ablate renal tumor $0.60 $0.60 $0.60
Percut ablate liver rf $0.60 $0.60 $0.60
Peri-proc device eval pm $0.60 $0.60 $0.60
Pericardiocentesis wwo imaging $0.60 $0.60 $0.60
Peritoneogram rs&i $0.60 $0.60 $0.60
Perq clsr tcat l atr apndge $0.60 $0.60 $0.60
Perq dev breast 1st mr guide $754.20 $754.20 $754.20
Perq nl/pl lithotrp cplx>2cm $0.60 $0.60 $0.60
Perq nl/pl lithotrp smpl<2cm $0.60 $0.60 $0.60
Perq plmt bile duct stent $0.60 $0.60 $0.60
Perq plmt bile duct stent $0.60 $0.60 $0.60
Perq plmt bile duct stent $0.60 $0.60 $0.60
Perq transcath closure pda $0.60 $0.60 $0.60
Perq transcath septal reduxn $0.60 $0.60 $0.60
Pertuzumab 30 mg/ml desensitization $7,603.80 $7,603.80 $7,603.80
Pet CT skull-mid thgh initial $1,595.40 $1,595.40 $1,595.40
Pet CT whole body initial $1,815.60 $1,815.60 $1,815.60
Pet fdg brain metoblic eval sb $1,320.00 $1,320.00 $1,320.00
Pet image ltd area $990.00 $990.00 $990.00
Pet image skull-thigh $1,320.00 $1,320.00 $1,320.00
Pet image w/ct lmtd $1,320.00 $1,320.00 $1,320.00
Pfc sigma fem post aug sz3 8mm $12,792.60 $12,792.60 $12,792.60
Ph body fluid $12.60 $12.60 $12.60
Phencyclidine (pcp) $24.00 $24.00 $24.00
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr $20.40 $20.40 $20.40
Phenobarbital therapeutic drug level $24.00 $24.00 $24.00
Phenytoin total therapeutic drug level $24.00 $24.00 $24.00
Phlebotomy therapeutic $292.80 $292.80 $292.80
Phosphorus $3.00 $3.00 $3.00
Phytonadione (vitamin k1) 10 mg/ml injection solution $52.80 $52.80 $52.80
Piflu f-18, dia 1 millicurie $6,267.00 $6,267.00 $6,267.00
Pin caspar distraction 12mm $9,426.00 $9,426.00 $9,426.00
Pinworm exam $9.60 $9.60 $9.60
Piperacillin-tazobactam 3.375 gram intravenous solution $81.60 $81.60 $81.60
Place cath intracranial art $0.60 $0.60 $0.60
Place cath xtrnl carotid $0.60 $0.60 $0.60
Place gastrostomy tube perc $0.60 $0.60 $0.60
Place non-slctv cath thoracic arta $0.60 $0.60 $0.60
Place slctv cath carotd art uni $0.60 $0.60 $0.60
Place slctv cath carotid/inom art excrn uni $0.60 $0.60 $0.60
Place slctv cath carotid/inom art intcrn uni $0.60 $0.60 $0.60
Place slctv cath subclavian art $0.60 $0.60 $0.60
Place slctv cath vertebral art uni $0.60 $0.60 $0.60
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) $607.80 $607.80 $607.80
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left $303.60 $303.60 $303.60
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) $357.60 $357.60 $357.60
Placement nephrostomy catheter (both sides) $0.60 $0.60 $0.60
Placement stent(s) intravascular transcatheter artery initial $0.60 $0.60 $0.60
Platelet aggregation each agent teg $97.20 $97.20 $97.20
Platelet automated $6.00 $6.00 $6.00
Platelets irradiated ea unit $105.00 $105.00 $105.00
Platelets leukocytes reduced each unit $97.20 $97.20 $97.20
Platelets leukocytes reduced irradiated each unit $113.40 $113.40 $113.40
Platelets pheresis leukocytes reduced each unit $811.80 $811.80 $811.80
Platelets pheresis leukocytes reduced irradiated each unit $942.00 $942.00 $942.00
Platelets pheresis pathogen-reduced each unit $876.60 $876.60 $876.60
Plc pq device breast ea addl lesion Ultrasound guide $214.20 $214.20 $214.20
Plcmnt biliary drainage cath w/img ext $0.60 $0.60 $0.60
Plcmnt stent transcath ctrl dialysis seg add-on $0.60 $0.60 $0.60
Plcmnt ureteral stent pq w/img exstng trct $0.60 $0.60 $0.60
Plcmnt ureteral stent pq w/img new w/cath $0.60 $0.60 $0.60
Plmt access bil tree sm bwl $0.60 $0.60 $0.60
Plmt biliary drainage cath $0.60 $0.60 $0.60
Plmt nephroureteral catheter $0.60 $0.60 $0.60
Plmt ureteral stent prq $0.60 $0.60 $0.60
Poct blood gases ph pco2 po2 arterial calculated o2 $49.80 $49.80 $49.80
Polatuzumab vedotin-piiq 140 mg intravenous solution $19,860.00 $19,860.00 $19,860.00
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap $734.40 $734.40 $734.40
Potassium 24 hour urine $16.20 $16.20 $16.20
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback $5.40 $5.40 $5.40
Potassium serum/plasma/whole blood $6.00 $6.00 $6.00
Pq biliary strict dil s&i $0.60 $0.60 $0.60
Pq dr cath chg w cont s&i $0.60 $0.60 $0.60
Pq kyphplsty 1 bdy lumb w/img $0.60 $0.60 $0.60
Pq thr inj ext pse $0.60 $0.60 $0.60
Pq vrtbrplst 1 bdy inj crv-thr w/img ini $0.60 $0.60 $0.60
Pq vrtbrplst 1 bdy inj crv-thr/lmb-scr w/img addl $0.60 $0.60 $0.60
Pq vrtbrplst 1 bdy inj lmb-scr w/img ini $0.60 $0.60 $0.60
Pr application of long arm splint $103.20 $103.20 $103.20
Pr application splint static short arm $96.60 $96.60 $96.60
Pr biopsy skin punch single lesion $0.60 $0.60 $0.60
Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes $15.60 $15.60 $15.60
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< $251.40 $251.40 $251.40
Pr tube thoracostomy w/connection to drainage open $0.60 $0.60 $0.60
Pralatrexate injection $5,614.80 $5,614.80 $5,614.80
Pralidoxime 1 gram solution for injection $97.80 $97.80 $97.80
Prcrd drg 6+yr without anomly $0.60 $0.60 $0.60
Prealbumin $24.00 $24.00 $24.00
Prednisone 1 mg tablet $0.60 $0.60 $0.60
Pregabalin - sendout $64.80 $64.80 $64.80
Pregnancy Ultrasound (complete, after first trimester) $464.40 $464.40 $464.40
Pregnancy Ultrasound (first trimester) $375.00 $375.00 $375.00
Pressure max expiratory/inspiratory $190.80 $190.80 $190.80
Pressure velocity wire add ves $0.60 $0.60 $0.60
Pretreat rbc absorption reference $162.00 $162.00 $162.00
Pretreat rbc density gradient separation reference $49.80 $49.80 $49.80
Pretreat rbc w chem/drugs reference $49.80 $49.80 $49.80
Pretreat rbc w enzyme reference $49.80 $49.80 $49.80
Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref $49.80 $49.80 $49.80
Prgr stim/pace a/iv drug $0.60 $0.60 $0.60
Prgrmg dev eval pm/ldls pm $0.60 $0.60 $0.60
Prim art mech thrmbc non-intracranial $0.60 $0.60 $0.60
Prim art mech thrmbc non-intracranial add-on $0.60 $0.60 $0.60
Procalcitonin $243.60 $243.60 $243.60
Progesterone $24.00 $24.00 $24.00
Prolactin $32.40 $32.40 $32.40
Propofol infusion 10 mg/ml $11.40 $11.40 $11.40
Protein c activity $97.20 $97.20 $97.20
Protein electrophoretic fractionation & quantitation serum $40.20 $40.20 $40.20
Protein s total $97.20 $97.20 $97.20
Protein total 24 hour urine $16.20 $16.20 $16.20
Protein total body fluid $16.20 $16.20 $16.20
Protein total serum plasma whole blood $3.00 $3.00 $3.00
Prothrombin complex kcentra $1.80 $1.80 $1.80
Prq card revasc chronic addl $0.60 $0.60 $0.60
Prq card revasc mi 1 vsl $0.60 $0.60 $0.60
Prq card stent w/angio addl $0.60 $0.60 $0.60
Prq cardiac angio addl art $0.60 $0.60 $0.60
Prq revasc byp graft 1 art and/or branches $0.60 $0.60 $0.60
Prq revasc byp graft addl $0.60 $0.60 $0.60
Prq tcat plmt ntrac st 1 les $0.60 $0.60 $0.60
Prq trlml c athrc st angiop1 $0.60 $0.60 $0.60
Prq trluml c angiop 1art&/br $0.60 $0.60 $0.60
Prq trluml c athrc 1 art&/br $0.60 $0.60 $0.60
Prq trluml revsc ch occ ant $0.60 $0.60 $0.60
Psychotherapy group therapy $58.20 $58.20 $58.20
Psychotherapy patient individual therapy 30 minutes $146.40 $146.40 $146.40
Psychotherapy patient individual therapy 45 minutes $175.80 $175.80 $175.80
Psychotherapy patient individual therapy 60 minutes $263.40 $263.40 $263.40
Pt application of modality >=1 area electrical stimulation each 15 minutes $22.80 $22.80 $22.80
Pt application of modality >=1 area iontophoresis each 15 minutes $34.20 $34.20 $34.20
Pt application of modality >=1 area ultrasound each 15 minutes $22.80 $22.80 $22.80
Pt application of modality traction mechanical $22.80 $22.80 $22.80
Pt evaluation high complexity patient/family $274.20 $274.20 $274.20
Pt evaluation low complexity patient/family $91.20 $91.20 $91.20
Pt evaluation moderate complexity patient/family $182.40 $182.40 $182.40
Pt re-evaluation patient/family $68.40 $68.40 $68.40
Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan $34.20 $34.20 $34.20
Pt therapeutic procedure >=1 area gait training each 15 minutes $45.60 $45.60 $45.60
Pt therapeutic procedure >=1 area massage each 15 minutes $57.00 $57.00 $57.00
Pt wheelchair management each 15 minutes $57.00 $57.00 $57.00
Pulmonary vent imaging $172.20 $172.20 $172.20
Pulse ox continuous overnight monitoring $98.40 $98.40 $98.40
Pulse ox multiple $98.40 $98.40 $98.40
Pulse ox single $25.80 $25.80 $25.80
Puncture arterial withdrawal blood for diagnosis $49.20 $49.20 $49.20
Puncture spinal lumbar diagnostic $175.80 $175.80 $175.80
Pyruvate $48.60 $48.60 $48.60
Quant diff pulm perf and vent w/imaging $282.00 $282.00 $282.00
Quant diff pulm perf w/imaging $179.40 $179.40 $179.40
Quest t3 uptake $24.00 $24.00 $24.00
Radiation handling $72.00 $72.00 $72.00
Radiation physics consult $126.60 $126.60 $126.60
Radiation therapy dose plan $54.00 $54.00 $54.00
Radiation treatment aid(s) $120.60 $120.60 $120.60
Radiation treatment aid(s) $150.60 $150.60 $150.60
Radiation treatment aid(s) $90.00 $90.00 $90.00
Radiation treatment delivery $271.20 $271.20 $271.20
Radiation treatment delivery $463.80 $463.80 $463.80
Radiology port images(s) $18.00 $18.00 $18.00
Radiotherapy dose plan imrt $2,562.60 $2,562.60 $2,562.60
Radphm lcl tmr plnr bdy sgl day img $300.60 $300.60 $300.60
Radphm lcl tmr plnr bdy two day img $550.20 $550.20 $550.20
Radphm lcl tomogr sgl area sgl day $311.40 $311.40 $311.40
Radphm lcl tumor plr sgl day $168.60 $168.60 $168.60
Ramucirumab 10 mg/ml intravenous solution $8,319.60 $8,319.60 $8,319.60
Rasburicase 1.5 mg intravenous solution $3,184.20 $3,184.20 $3,184.20
Rbc count only automated $6.00 $6.00 $6.00
Rbc deglycerolized each unit $421.80 $421.80 $421.80
Rbc serum pretx incubj drugs $49.80 $49.80 $49.80
Red blood cells each unit $145.80 $145.80 $145.80
Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit $641.40 $641.40 $641.40
Red blood cells leukocytes reduced cmv negative irradiated each unit $397.80 $397.80 $397.80
Red blood cells leukocytes reduced each unit $438.60 $438.60 $438.60
Red blood cells leukocytes reduced irradiated each unit $365.40 $365.40 $365.40
Red blood cells washed each unit $259.80 $259.80 $259.80
Redo endovas vena cava filtr $0.60 $0.60 $0.60
Refill/maint pump/resvr syst $175.80 $175.80 $175.80
Regadenoson 0.4 mg/5 ml intravenous syringe $231.60 $231.60 $231.60
Relocation skin pocket aicd $0.60 $0.60 $0.60
Relocation skin pocket pm $0.60 $0.60 $0.60
Rem endovas vena cava filter $0.60 $0.60 $0.60
Remdesivir 100 mg intravenous powder for solution $685.20 $685.20 $685.20
Removal biliary drg cath $0.60 $0.60 $0.60
Removal central venous catheter tunneled without port/pump $0.60 $0.60 $0.60
Removal central venous device tunneled w/port/pump central/peripheral insertion $0.60 $0.60 $0.60
Removal cerclage without anes $722.40 $722.40 $722.40
Removal duct glbldr calculi $0.60 $0.60 $0.60
Removal of shunt $0.60 $0.60 $0.60
Removal tunnled intprtnl cath $0.60 $0.60 $0.60
Removal/replacement ppm generator dual lead system $0.60 $0.60 $0.60
Remove renal tube w/fluoro $0.60 $0.60 $0.60
Remove ureter stent percut $0.60 $0.60 $0.60
Renal cyst study s&i $0.60 $0.60 $0.60
Renal function panel $19.20 $19.20 $19.20
Renal venogram bil s&i $0.60 $0.60 $0.60
Repair pm/icd lead dual $0.60 $0.60 $0.60
Repair pm/icd lead sgl $0.60 $0.60 $0.60
Replace aortic valve open axillry 33363 $0.60 $0.60 $0.60
Replace aortic valve open femoral 33362 $0.60 $0.60 $0.60
Replace aortic valve open iliac 33364 $0.60 $0.60 $0.60
Replace aortic valve open transaortic 33365 $0.60 $0.60 $0.60
Replace aortic valve w/byp cntrl aprch 33369 $0.60 $0.60 $0.60
Replace aortic valve w/byp open aprch 33368 $0.60 $0.60 $0.60
Replace aortic valve w/byp prq aprch 33367 $0.60 $0.60 $0.60
Replace duod/jej tube perc $0.60 $0.60 $0.60
Replace g-j tube perc $0.60 $0.60 $0.60
Replace g/c tube perc $0.60 $0.60 $0.60
Replace picvad cath $0.60 $0.60 $0.60
Replace tunneled cv cath $0.60 $0.60 $0.60
Repos lv lead pm/icd $0.60 $0.60 $0.60
Repos sq defib eltrd $0.60 $0.60 $0.60
Reposition pm/icd lead $0.60 $0.60 $0.60
Reposition vad w/image rt/lt sep session $0.60 $0.60 $0.60
Respirator motion mgmt simul $609.00 $609.00 $609.00
Resuscitation cardiopulmonary $127.20 $127.20 $127.20
Reteplase injection $2,774.40 $2,774.40 $2,774.40
Reticulocyte automated $16.20 $16.20 $16.20
Revise abdomen-venous shunt $0.60 $0.60 $0.60
Revision of cervix $1,444.80 $1,444.80 $1,444.80
Revision tips $0.60 $0.60 $0.60
Revsc opn/prq tib/pero stent $0.60 $0.60 $0.60
Rheumatoid factor qualitative $12.60 $12.60 $12.60
Rheumatoid factor quantitative $16.20 $16.20 $16.20
Rho d immune globulin inj $96.60 $96.60 $96.60
Rho(d) immune globulin h, sd $1,551.00 $1,551.00 $1,551.00
Right ventric recording $0.60 $0.60 $0.60
Ring fx reform 11-13x17mm $898.20 $898.20 $898.20
Rituximab 10 mg/ml concentrate,intravenous $5,961.00 $5,961.00 $5,961.00
Rituximab-abbs 10 mg/ml intravenous solution $3,977.40 $3,977.40 $3,977.40
Rituximab-pvvr 10 mg/ml intravenous solution $3,402.00 $3,402.00 $3,402.00
Rmvl icd by tv extr $0.60 $0.60 $0.60
Rmvl icd gen w/rplc icd gen dual lead sys $0.60 $0.60 $0.60
Rmvl icd gen w/rplc icd gen mlt lead sys $0.60 $0.60 $0.60
Rmvl icd gen w/rplc icd gen sgl lead sys $0.60 $0.60 $0.60
Rmvl icd pulse gen only $0.60 $0.60 $0.60
Rmvl ndwellg tun pleural cath $0.60 $0.60 $0.60
Rmvl perm pm pulse gen $0.60 $0.60 $0.60
Rmvl pm gen w/rplc pm gen mlt lead sys $0.60 $0.60 $0.60
Rmvl pm gen w/rplc pm gen sgl lead sys $0.60 $0.60 $0.60
Rmvl pq vad left hrt vein sep session $0.60 $0.60 $0.60
Rmvl sq defib electrode $0.60 $0.60 $0.60
Rmvl subq card rhythm mntr $0.60 $0.60 $0.60
Rmvl tv pm lead dual $0.60 $0.60 $0.60
Rmvl tv pm lead sgl $0.60 $0.60 $0.60
Romiplostim 125 mcg subcutaneous solution $2,861.40 $2,861.40 $2,861.40
Ropivacaine 0.2 % epidural pca - 1 hour dose limit $5.40 $5.40 $5.40
Rp loclzj tum 2+area 1+d img $238.20 $238.20 $238.20
Rpl non-tun cvc wo sbq prt/pmp $0.60 $0.60 $0.60
Rpl picc wo subq port/pump incl image guidnc w/s&i $0.60 $0.60 $0.60
Rpl tun cvc wo subq port $0.60 $0.60 $0.60
Rpl tun-cvad w subq port $0.60 $0.60 $0.60
Rpl tun-cvad w subq pump $0.60 $0.60 $0.60
Rsv assay w/optic $40.20 $40.20 $40.20
Rubella antibody igg $24.00 $24.00 $24.00
Rubeola antibody igg $32.40 $32.40 $32.40
Russell viper venom diluted $24.00 $24.00 $24.00
Sacituzumab govitecan-hziy 180 mg intravenous solution $35.40 $35.40 $35.40
Scan duplex abd/pelvis/retroperitoneal complete $1,126.20 $1,126.20 $1,126.20
Scan duplex abd/pelvis/retroperitoneal limited $625.80 $625.80 $625.80
Scan duplex aorta/ivc/iliac or bypass grafts complete $768.60 $768.60 $768.60
Scan duplex aorta/ivc/iliac unilateral/limited $482.40 $482.40 $482.40
Scan duplex extracranial arteries unilateral/limited study $518.40 $518.40 $518.40
Scan duplex extremity veins unilateral/limited study $500.40 $500.40 $500.40
Scan duplex lower extremity arteries complete bilateral $1,108.20 $1,108.20 $1,108.20
Scan duplex lower extremity arteries unilateral/limited study left $643.20 $643.20 $643.20
Scan duplex upper extremity arteries unilateral/limited study left $518.40 $518.40 $518.40
Screening Mammogram $500.40 $500.40 $500.40
Screening prostate cancer PSA $32.40 $32.40 $32.40
Screw cortex 2.0 x 10mm $15,714.60 $15,714.60 $15,714.60
Sec art mech thrmbc non-intracranial add-on $0.60 $0.60 $0.60
Sedimentation rate erythrocyte automated $7.80 $7.80 $7.80
Semen analysis presence/motility $12.60 $12.60 $12.60
Sertraline (zoloft) - sendout $48.60 $48.60 $48.60
Set radiation therapy field $723.60 $723.60 $723.60
Set radiation therapy field $627.00 $627.00 $627.00
Set radiation therapy field $397.80 $397.80 $397.80
Sheath gldlight lasr 12fx50cm $4,828.80 $4,828.80 $4,828.80
Shoulder MRI (with and without contrast) $601.20 $601.20 $601.20
Shoulder MRI (with contrast) $489.00 $489.00 $489.00
Shoulder MRI (without contrast) $276.60 $276.60 $276.60
Shoulder X-ray $89.40 $89.40 $89.40
Shunt glaucoma baerveldt 350mm $2,356.20 $2,356.20 $2,356.20
Shuntogram nonvascular supervision & interpretation $0.60 $0.60 $0.60
Sialography s&i $0.60 $0.60 $0.60
Sickling rbc $16.20 $16.20 $16.20
Sinus CT scan (with and without contrast) $119.40 $119.40 $119.40
Sinus CT scan (with contrast) $92.40 $92.40 $92.40
Sinus CT scan (without contrast) $80.40 $80.40 $80.40
Sinus/juglr venogram s&i $0.60 $0.60 $0.60
Sleep Study (Polysomnography) $694.80 $694.80 $694.80
Sleep study unattended $148.80 $148.80 $148.80
Sling arm deluxe w/pad xs $177.00 $177.00 $177.00
Sling suprapubic suburetheral $3,395.40 $3,395.40 $3,395.40
Slp eval non-spch gen comm dev $103.80 $103.80 $103.80
Slp ther svc non-spch gen $103.80 $103.80 $103.80
Sm-153 lexidron ther $4,290.00 $4,290.00 $4,290.00
Smear fluorescent and/or acid fast stain $32.40 $32.40 $32.40
Smear gram stain $32.40 $32.40 $32.40
Smear special stain inclusion bodies/parasites $24.00 $24.00 $24.00
Smear wet mount $12.60 $12.60 $12.60
Sodium 24 hour urine $16.20 $16.20 $16.20
Sodium chloride 0.9 % IV bolus $75.00 $75.00 $75.00
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous $9.60 $9.60 $9.60
Sodium serum/plasma/whole blood $3.00 $3.00 $3.00
Special physics consult $192.60 $192.60 $192.60
Special radiation dosimetry $30.00 $30.00 $30.00
Special radiation treatment $78.00 $78.00 $78.00
Special teletx port plan $72.00 $72.00 $72.00
Specific gravity body fluid $6.00 $6.00 $6.00
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance $0.60 $0.60 $0.60
Spirometry bronchodilation responsiveness pre/post bronchodilator administration $121.20 $121.20 $121.20
Splint arm vnyl coated padded lft med $49.80 $49.80 $49.80
Split blood or products $32.40 $32.40 $32.40
Srs linear based $1,790.40 $1,790.40 $1,790.40
St analysis behavior qualitative voice/resonance $150.00 $150.00 $150.00
St evaluate speech sound production $150.00 $150.00 $150.00
St evaluate speech sound production comprehensive/expressive $334.80 $334.80 $334.80
St evaluation motion fluoroscopic swallow function cine/video $265.20 $265.20 $265.20
St evaluation swallow function $138.00 $138.00 $138.00
St treatment speech individual $103.80 $103.80 $103.80
St treatment swallow dysfunction/oral $138.00 $138.00 $138.00
Staph a dna amp probe $194.40 $194.40 $194.40
Stent axios caut enh 15x10mm electrocaut $26,519.40 $26,519.40 $26,519.40
Stent bili dbl pgtl 10fx5cm $447.60 $447.60 $447.60
Stent bili rx wallflx 10x80 uncvr $3,783.00 $3,783.00 $3,783.00
Stent bronch dumon sil 10x40mm $544.20 $544.20 $544.20
Stent iliac/open or perc/uni/init 37221 $0.60 $0.60 $0.60
Stent iliac/open/perc/ea ad/ipsila 37223 $0.60 $0.60 $0.60
Stent/athrectomy/fem/pop/unilat 37227 $0.60 $0.60 $0.60
Stent/tib/peroneal/unilat/initial 37230 $0.60 $0.60 $0.60
Strep a ag ia $40.20 $40.20 $40.20
Strep b dna amp probe $194.40 $194.40 $194.40
Streptozocin injection $375.60 $375.60 $375.60
Stress test pulmonary $98.40 $98.40 $98.40
Sugars single quant $6.00 $6.00 $6.00
Sumatriptan 6 mg/0.5 ml subcutaneous solution $5.40 $5.40 $5.40
Support clav 29.6-40.5in med $86.40 $86.40 $86.40
Surgical pathology level 1 gross examination only $32.40 $32.40 $32.40
Surgical pathology level 2 gross & microscopic examination $40.20 $40.20 $40.20
Surgical pathology level 3 gross & microscopic examination $64.80 $64.80 $64.80
Surgical pathology level 4 gross & microscopic examination $97.20 $97.20 $97.20
Surgical pathology level 5 gross & microscopic examination $162.00 $162.00 $162.00
Surgical pathology level 6 gross & microscopic examination $202.80 $202.80 $202.80
Susceptibility agar dilution per agent $16.20 $16.20 $16.20
Susceptibility enzyme detection per enzyme $7.80 $7.80 $7.80
Susceptibility mic per plate $16.20 $16.20 $16.20
Svc venogram s&i $0.60 $0.60 $0.60
Syphilis test non-treponemal antibody quantitative rpr $16.20 $16.20 $16.20
System pacing micra av $6,455.40 $6,455.40 $6,455.40
System pcmkr dual chamber leadless micra av2 intrdcr cath $7,971.60 $7,971.60 $7,971.60
T cells absolute cd 4 count $81.00 $81.00 $81.00
T cells absolute cd4/cd8 including ratio $162.00 $162.00 $162.00
T cells total count $81.00 $81.00 $81.00
T3 (triiodothyronine) free $24.00 $24.00 $24.00
T3 (triiodothyronine) total $24.00 $24.00 $24.00
T4 (thyroxine) free $24.00 $24.00 $24.00
T4 (thyroxine) total $24.00 $24.00 $24.00
Tacrolimus therapeutic drug level $48.60 $48.60 $48.60
Target gsa panel organ neop $828.00 $828.00 $828.00
Tavr perq femoral $0.60 $0.60 $0.60
Tb test cell mediated immunity antigen response gamma interferon $56.40 $56.40 $56.40
Tc-99m apcitide diag $420.00 $420.00 $420.00
Tc-99m diag per dose $240.00 $240.00 $240.00
Tc-99m disofenin $51.60 $51.60 $51.60
Tc-99m exame autol wbc diag per dose $576.00 $576.00 $576.00
Tc-99m fanolesomab diag $1,020.00 $1,020.00 $1,020.00
Tc-99m labeled rbc $49.20 $49.20 $49.20
Tc-99m maa $165.60 $165.60 $165.60
Tc-99m mebrofenin $48.00 $48.00 $48.00
Tc-99m oxidronate $15.00 $15.00 $15.00
Tc-99m pentetate dtpa $22.20 $22.20 $22.20
Tc-99m pyroph diag per dose up to 25 mci $51.60 $51.60 $51.60
Tc-99m sestamibi p study dose $103.20 $103.20 $103.20
Tc-99m succimer (dmsa) $129.60 $129.60 $129.60
Tc-99m sulfur colloid $49.20 $49.20 $49.20
Telethx isodose plan cplx $222.60 $222.60 $222.60
Telethx isodose plan simple $120.60 $120.60 $120.60
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln $77.40 $77.40 $77.40
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) $8,405.40 $8,405.40 $8,405.40
Test for porphobilinogen $19.20 $19.20 $19.20
Test stress cardiovascular tracing only $199.20 $199.20 $199.20
Test urine for porphyrins $25.80 $25.80 $25.80
Tetanus immune globulin inj $676.80 $676.80 $676.80
Theophylline therapeutic drug level $24.00 $24.00 $24.00
Therapeutic procd strg endur $49.20 $49.20 $49.20
Therapy nutrition individual initial f2f w/patient each 15 minutes $87.60 $87.60 $87.60
Thiamine hcl (vitamin b1) 100 mg/ml injection solution $4.20 $4.20 $4.20
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) $0.60 $0.60 $0.60
Thrombectmy crnry perq mechanical $0.60 $0.60 $0.60
Thrombectomy/inf pq dialysis circuit $0.60 $0.60 $0.60
Thrombectomy/inf pq dialysis circuit w/pta $0.60 $0.60 $0.60
Thrombectomy/inf pq dialysis circuit w/stent plcmnt $0.60 $0.60 $0.60
Thrombin time $16.20 $16.20 $16.20
Thromboplastin time partial (ptt) substitution fractions each $38.40 $38.40 $38.40
Thyroglobulin antibody $40.20 $40.20 $40.20
Thyroid (TSH) Test $24.00 $24.00 $24.00
Thyroid Ultrasound $447.00 $447.00 $447.00
Thyroid mets imag whole body $289.20 $289.20 $289.20
Thyrotropin alfa 0.9 mg intramuscular solution $2,199.00 $2,199.00 $2,199.00
Thyroxine binding globulin (tbg) $24.00 $24.00 $24.00
Tib/per revasc stent & ather 37231 $0.60 $0.60 $0.60
Tib/per revasc stnt & ather $0.60 $0.60 $0.60
Tib/per revasc w/ather add-on 37233 $0.60 $0.60 $0.60
Tigecycline injection $58.20 $58.20 $58.20
Tisotumab vedotin-tftv 40 mg intravenous solution $190.20 $190.20 $190.20
Tissue culture skin/biopsy $324.60 $324.60 $324.60
Tl-201 thallium diag per mci $140.40 $140.40 $140.40
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr $1.80 $1.80 $1.80
Tobramycin peak therapeutic drug level $24.00 $24.00 $24.00
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector $7.20 $7.20 $7.20
Tomosynthesis breast screen bilateral $124.80 $124.80 $124.80
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution $0.60 $0.60 $0.60
Toxoplasma antibody igg $40.20 $40.20 $40.20
Toxoplasma antibody igm $40.20 $40.20 $40.20
Trabectedin 1 mg intravenous solution $386.40 $386.40 $386.40
Trans cath replace aortic valve 33366 $0.60 $0.60 $0.60
Transcath closure of asd $0.60 $0.60 $0.60
Transcath closure of vsd $0.60 $0.60 $0.60
Transcath rmvl perm ldss pmkr rv $0.60 $0.60 $0.60
Transcatheter bx s&i $0.60 $0.60 $0.60
Transferrin $24.00 $24.00 $24.00
Transfusion blood/blood component(s) $1,347.60 $1,347.60 $1,347.60
Trastuzumab 150 mg intravenous solution $2,629.80 $2,629.80 $2,629.80
Trastuzumab-anns 150 mg intravenous solution $1,410.00 $1,410.00 $1,410.00
Trastuzumab-qyyp 150 mg intravenous solution $1,743.60 $1,743.60 $1,743.60
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour $54.00 $54.00 $54.00
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour $44.40 $44.40 $44.40
Treatment inhalation pressurized/nonpressurized acute airway obstruction $765.00 $765.00 $765.00
Treatment radiation delivery level 2 $433.80 $433.80 $433.80
Tremelimumab-actl 20 mg/ml intravenous solution $156.00 $156.00 $156.00
Treponema pallidum antibody $27.60 $27.60 $27.60
Trg gene rearrangement anal $194.40 $194.40 $194.40
Triglycerides $3.00 $3.00 $3.00
Trnscath plc stent crv crtd w/prtct $0.60 $0.60 $0.60
Trnscath plc stent crv crtd without prtct $0.60 $0.60 $0.60
Trnscath plc stnt ante carotid art $0.60 $0.60 $0.60
Trnscath plc vas stent w/s&i ea addl artery $0.60 $0.60 $0.60
Trnscath plc vas stent w/s&i ea addl vein $0.60 $0.60 $0.60
Trnscath plc vas stent w/s&i ini vein $0.60 $0.60 $0.60
Trnscath retrv pq vasc fb w/guide $0.60 $0.60 $0.60
Trnscath tx thromblytc art/ven sbsq day $0.60 $0.60 $0.60
Trnscath tx thromblytc artery non-intracrn ini day $0.60 $0.60 $0.60
Trnscath tx thromblytc cath rmv sbsq day $0.60 $0.60 $0.60
Trnscath tx thromblytc vein ini day $0.60 $0.60 $0.60
Troponin quantitative $40.20 $40.20 $40.20
Tte w or without fol w/con,stres $405.00 $405.00 $405.00
Tube drain vert dev st 5-40f $29.40 $29.40 $29.40
Tube trach disp innr can 5 xlt $645.60 $645.60 $645.60
Tube trach fen sz 6 uncuffed $119.40 $119.40 $119.40
Tx atrial fib pulm vein isol $0.60 $0.60 $0.60
Ultrasound abdomen aorta screening study aaa $339.60 $339.60 $339.60
Ultrasound breast complete $357.60 $357.60 $357.60
Ultrasound breast unilateral limited (both sides) $268.20 $268.20 $268.20
Ultrasound chest $303.60 $303.60 $303.60
Ultrasound doppler velocimetry fetal umbilical artery $106.80 $106.80 $106.80
Ultrasound elastography ea l target les $142.80 $142.80 $142.80
Ultrasound elastography parenchyma $321.60 $321.60 $321.60
Ultrasound encephalogram $429.00 $429.00 $429.00
Ultrasound exam k transpl w/doppler $607.80 $607.80 $607.80
Ultrasound fetal biophysical profile without non-stress testing $250.20 $250.20 $250.20
Ultrasound guidance for vascular access $0.60 $0.60 $0.60
Ultrasound guide intraoperative $196.20 $196.20 $196.20
Ultrasound guided needle placement supervision & interpretation $0.60 $0.60 $0.60
Ultrasound hips infant dynamic $553.80 $553.80 $553.80
Ultrasound infant hips ltd without stress $393.00 $393.00 $393.00
Ultrasound joint complete left $447.00 $447.00 $447.00
Ultrasound joint/nonvascular extremity limited left $53.40 $53.40 $53.40
Ultrasound ob >=14wks ea addl gest $214.20 $214.20 $214.20
Ultrasound pregnant uterus < 14 weeks each additional gestation $106.80 $106.80 $106.80
Ultrasound pregnant uterus detailed fetal exam single/1st gestation $429.00 $429.00 $429.00
Ultrasound pregnant uterus follow up per fetus $357.60 $357.60 $357.60
Ultrasound pregnant uterus limited >= 1 fetuses $268.20 $268.20 $268.20
Ultrasound pregnant uterus transvaginal $303.60 $303.60 $303.60
Ultrasound prostate/transrectal $303.60 $303.60 $303.60
Ultrasound retroperitoneal limited $142.80 $142.80 $142.80
Ultrasound scrotum and contents $178.80 $178.80 $178.80
Ultrasound spinal canal and contents $411.00 $411.00 $411.00
Ultrasound transvaginal non obstetric $447.00 $447.00 $447.00
Unlisted fluoroscopic px $0.60 $0.60 $0.60
Unlisted mr procedure $1,037.40 $1,037.40 $1,037.40
Unlisted procedure liver $0.60 $0.60 $0.60
Unlisted px casting/strpg $136.80 $136.80 $136.80
Unlisted transfusion med px $1,015.20 $1,015.20 $1,015.20
Unlisted ultrasound procedure $0.60 $0.60 $0.60
Upgrade pm system $0.60 $0.60 $0.60
Upper Back (Thoracic Spine) MRI (with and without contrast) $442.20 $442.20 $442.20
Upper Back (Thoracic Spine) MRI (with contrast) $388.80 $388.80 $388.80
Upper Back (Thoracic Spine) MRI (without contrast) $247.20 $247.20 $247.20
Urea nitrogen $3.00 $3.00 $3.00
Urea nitrogen 24 hour urine $16.20 $16.20 $16.20
Urea nitrogen clearance $19.20 $19.20 $19.20
Urethrcystgrphy rtrgrde s&i $0.60 $0.60 $0.60
Urethrocystography void s&i $0.60 $0.60 $0.60
Uric acid blood $3.00 $3.00 $3.00
Uric acid urine $16.20 $16.20 $16.20
Urinalysis (with microscopy) $14.40 $14.40 $14.40
Urinalysis (without microscopy) $6.00 $6.00 $6.00
Urinalysis microscopic only $7.80 $7.80 $7.80
Urinalysis qual/semiquant excpt ia $14.40 $14.40 $14.40
Urine Culture Test $32.40 $32.40 $32.40
Urine pregnancy test $16.20 $16.20 $16.20
Urography, antegrade $0.60 $0.60 $0.60
Use 1st target lesion $321.60 $321.60 $321.60
Ustekinumab 45 mg/0.5 ml subcutaneous solution $246.60 $246.60 $246.60
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml $115.80 $115.80 $115.80
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im $11.40 $11.40 $11.40
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im $297.00 $297.00 $297.00
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im $98.40 $98.40 $98.40
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im $25.20 $25.20 $25.20
Vaccine mengingoccocal serogroup b 2 dose im $156.60 $156.60 $156.60
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im $127.80 $127.80 $127.80
Vaccine pneumonococcal conjugate 20 valent (pcv20) im $270.60 $270.60 $270.60
Vaccine respiratory syncytial virus bivalent subunit/preservative free im $327.00 $327.00 $327.00
Vaccine varicella live subcutaneous $162.00 $162.00 $162.00
Vaginal Delivery (full care) $4,624.20 $4,624.20 $4,624.20
Valproic acid total therapeutic drug level $24.00 $24.00 $24.00
Valvuloplasty aortic $0.60 $0.60 $0.60
Valvuloplasty mitral $0.60 $0.60 $0.60
Valvuloplasty pulmonary $0.60 $0.60 $0.60
Vancomycin hcl injection $33.60 $33.60 $33.60
Vancomycin peak therapeutic drug level $24.00 $24.00 $24.00
Varicella zoster antibody igg $32.40 $32.40 $32.40
Varicella-zoster immue globin im $1,567.20 $1,567.20 $1,567.20
Vein x-ray adrenal gland $0.60 $0.60 $0.60
Vein x-ray adrenal glands $0.60 $0.60 $0.60
Vein x-ray eye socket $0.60 $0.60 $0.60
Vein x-ray kidney $0.60 $0.60 $0.60
Vein x-ray liver $0.60 $0.60 $0.60
Vein x-ray liver w/hemodynam $0.60 $0.60 $0.60
Vein x-ray liver w/hemodynam $0.60 $0.60 $0.60
Vein x-ray skull $0.60 $0.60 $0.60
Vein x-ray skull epidural $0.60 $0.60 $0.60
Venogram ext bil s&i $0.60 $0.60 $0.60
Venogram extremity supervision & interpretation unilateral $0.60 $0.60 $0.60
Venous m-thrombectomy add-on $0.60 $0.60 $0.60
Venous mech thrombectomy $0.60 $0.60 $0.60
Venous sampling s&i $0.60 $0.60 $0.60
Ventilator each subsequent day $478.20 $478.20 $478.20
Ventilator initial day $478.20 $478.20 $478.20
Version cephalic external $1,444.80 $1,444.80 $1,444.80
Very long chain fatty acids $194.40 $194.40 $194.40
Vinblastine 1 mg/ml intravenous solution $3.60 $3.60 $3.60
Vincristine 1 mg/ml intravenous solution $10.80 $10.80 $10.80
Vinorelbine 10 mg/ml intravenous solution (wrapper) $9.60 $9.60 $9.60
Virus isolation addl studies ea $40.20 $40.20 $40.20
Visc & infraren abd 1 prosth $0.60 $0.60 $0.60
Visc & infraren abd 2 prosth $0.60 $0.60 $0.60
Vital capacity test $28.20 $28.20 $28.20
Vitamin D Test $24.00 $24.00 $24.00
Vitamin b-12 $24.00 $24.00 $24.00
Vol reduction of blood/prod $32.40 $32.40 $32.40
Volume measurement urine timed $3.00 $3.00 $3.00
Warde 1003990 aldosterone $40.20 $40.20 $40.20
Warde 1005020 citrate 24 hour urine $24.00 $24.00 $24.00
Warde 1005055 5-hiaa 24 hour urine $48.60 $48.60 $48.60
Warde 1006955 catecholamines fractionated 24 hour urine $145.80 $145.80 $145.80
Warde 1007138 vanillymandelic acid 24 hour urine $48.60 $48.60 $48.60
Warde 3004000 immunoglobulin subclass 1 $24.00 $24.00 $24.00
Warde 3008005 oligoclonal bands $40.20 $40.20 $40.20
Warde 3016300 saccharomyces cerevisiae iga antibody $24.00 $24.00 $24.00
Warde 3400652 ova & parasites direct smear concentration and id $64.80 $64.80 $64.80
Warde 3400852 arsenic $64.80 $64.80 $64.80
Warde 3708165 mercury urine $40.20 $40.20 $40.20
Warde actin (smooth muscle) antibody each $24.00 $24.00 $24.00
Warde adenosine deaminase pleural fluid $40.20 $40.20 $40.20
Warde adrenocorticotropic hormone (acth) $48.60 $48.60 $48.60
Warde aldolase $24.00 $24.00 $24.00
Warde amino acids 6 or more quantitative each specimen $243.60 $243.60 $243.60
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative $194.40 $194.40 $194.40
Warde apolipoprotein b $24.00 $24.00 $24.00
Warde bile acids $40.20 $40.20 $40.20
Warde cadmium blood $64.80 $64.80 $64.80
Warde calcitonin $48.60 $48.60 $48.60
Warde calculus (stone) infrared $64.80 $64.80 $64.80
Warde clozapine therapeutic drug level $48.60 $48.60 $48.60
Warde cobalt heavy metal quantitative each nes $48.60 $48.60 $48.60
Warde collagen cross links c-telopeptide $40.20 $40.20 $40.20
Warde complement total hemolytic $40.20 $40.20 $40.20
Warde copper $40.20 $40.20 $40.20
Warde cryoglobulin $22.20 $22.20 $22.20
Warde erythropoietin $24.00 $24.00 $24.00
Warde estrogen fractionated $40.20 $40.20 $40.20
Warde folic acid rbc $24.00 $24.00 $24.00
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative $24.00 $24.00 $24.00
Warde gastrin $24.00 $24.00 $24.00
Warde growth hormone (hgh) $51.60 $51.60 $51.60
Warde haloperidol therapeutic drug level $48.60 $48.60 $48.60
Warde helminth antibody strongyloides igg $53.40 $53.40 $53.40
Warde hemoglobin fractionation/quantitation electrophoresis $40.20 $40.20 $40.20
Warde hepatitis a antibody $32.40 $32.40 $32.40
Warde hepatitis be antibody $32.40 $32.40 $32.40
Warde immunofixation electrophoresis urine $71.40 $71.40 $71.40
Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn $32.40 $32.40 $32.40
Warde infectious agent nucleic acid genotype hepatitis c $552.00 $552.00 $552.00
Warde islet cell antibody zinc transporter 8 $32.40 $32.40 $32.40
Warde lipoprotein (a) $40.20 $40.20 $40.20
Warde neutralization rabies $81.00 $81.00 $81.00
Warde oxcarbazepine therapeutic drug level $24.00 $24.00 $24.00
Warde pancreatic elastase fecal quantitative $40.20 $40.20 $40.20
Warde protein c antigen $97.20 $97.20 $97.20
Warde sex hormone binding globulin $40.20 $40.20 $40.20
Warde somatomedin $24.00 $24.00 $24.00
Warde sugars single qualitative each specimen stool $12.60 $12.60 $12.60
Warde t3 (triiodothyronine) reverse $24.00 $24.00 $24.00
Warde thyroid stimulating immunoglobulins $40.20 $40.20 $40.20
Warde topiramate therapeutic drug level $24.00 $24.00 $24.00
Warde virus isolation tissue culture innoculation presumptive id herpes simplex $162.00 $162.00 $162.00
Warde viscosity $40.20 $40.20 $40.20
Warde vitamin a $48.60 $48.60 $48.60
Warde vitamin b-1 (thiamine) $79.20 $79.20 $79.20
Warde vitamin b6 (pyridoxine) $81.00 $81.00 $81.00
Warde vitamin c (ascorbic acid) $40.20 $40.20 $40.20
Warde vitamin d (1 25 dihydroxy) $40.20 $40.20 $40.20
Warde vitamin e (alpha-tocopherol) $48.60 $48.60 $48.60
Warde zinc $40.20 $40.20 $40.20
Wbc automated $6.00 $6.00 $6.00
Western blot test $97.20 $97.20 $97.20
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit $511.20 $511.20 $511.20
Whole blood/red blood cells leukocytes reduced cmv negative each unit $267.60 $267.60 $267.60
Wound therapy negative pressure per session <= 50 sq cm $125.40 $125.40 $125.40
Wound therapy negative pressure per session <= 50 sq cm dme $125.40 $125.40 $125.40
Wound therapy negative pressure per session > 50 sq cm $136.80 $136.80 $136.80
Wound therapy negative pressure per session > 50 sq cm dme $136.80 $136.80 $136.80
Wrist X-ray $124.80 $124.80 $124.80
X-ray abdomen 1 view $71.40 $71.40 $71.40
X-ray abdomen 2 views $124.80 $124.80 $124.80
X-ray abdomen >=3 views $124.80 $124.80 $124.80
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest $142.80 $142.80 $142.80
X-ray acromioclavicular joints without or w/weighted distraction bilateral $124.80 $124.80 $124.80
X-ray ankle 2 views (both sides) $106.80 $106.80 $106.80
X-ray arthrogram shoulder supervision & interpretation (both sides) $0.60 $0.60 $0.60
X-ray bone age studies $71.40 $71.40 $71.40
X-ray bone length studies $106.80 $106.80 $106.80
X-ray bone survey complete $303.60 $303.60 $303.60
X-ray bone survey infant $303.60 $303.60 $303.60
X-ray cervical spine 2-3 views $106.80 $106.80 $106.80
X-ray cervical spine 4-5 views $142.80 $142.80 $142.80
X-ray cervical spine >= 6 views $196.20 $196.20 $196.20
X-ray clavicle complete (both sides) $89.40 $89.40 $89.40
X-ray colon abdominal radiograph(s) & delayed images single contrast study $571.80 $571.80 $571.80
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study $822.00 $822.00 $822.00
X-ray elbow 2 views (both sides) $89.40 $89.40 $89.40
X-ray elbow >= 3 views (both sides) $106.80 $106.80 $106.80
X-ray esophogram chest radiograph(s) & delayed images single contrast study $321.60 $321.60 $321.60
X-ray exam entire spi 4/5 vw $250.20 $250.20 $250.20
X-ray exam entire spi 6/> vw $303.60 $303.60 $303.60
X-ray exam of arm infant $89.40 $89.40 $89.40
X-ray exam of eye sockets $142.80 $142.80 $142.80
X-ray exam of femur 1 $89.40 $89.40 $89.40
X-ray exam of jaw joint $106.80 $106.80 $106.80
X-ray exam of mastoids $124.80 $124.80 $124.80
X-ray exam of middle ear $58.80 $58.80 $58.80
X-ray exam of sinuses $106.80 $106.80 $106.80
X-ray exam si joints $89.40 $89.40 $89.40
X-ray exam thorac spine4/>vw $142.80 $142.80 $142.80
X-ray eye detection foreign body (both sides) $89.40 $89.40 $89.40
X-ray facial bones complete > 3 views $142.80 $142.80 $142.80
X-ray femur >=2 views (both sides) $106.80 $106.80 $106.80
X-ray finger(s) >= 2 views (both sides) $124.80 $124.80 $124.80
X-ray foot 2 views (both sides) $89.40 $89.40 $89.40
X-ray forearm 2 views (both sides) $89.40 $89.40 $89.40
X-ray hand 2 views (both sides) $89.40 $89.40 $89.40
X-ray heel/calcaneus > 2 views (both sides) $89.40 $89.40 $89.40
X-ray hip uni w/wo pelvis min 4 views $178.80 $178.80 $178.80
X-ray hip with pelvis when performed bilateral 2 views $142.80 $142.80 $142.80
X-ray hip with pelvis when performed bilateral 3-4 views $160.80 $160.80 $160.80
X-ray hip with pelvis when performed bilateral >= 5 views $196.20 $196.20 $196.20
X-ray hip with pelvis when performed unilateral 1 view left $106.80 $106.80 $106.80
X-ray humerus >= 2 views left $106.80 $106.80 $106.80
X-ray joint survey 1 view $106.80 $106.80 $106.80
X-ray knee 1-2 views (both sides) $106.80 $106.80 $106.80
X-ray knee 3 views (both sides) $124.80 $124.80 $124.80
X-ray knee ap standing bilateral $142.80 $142.80 $142.80
X-ray l/s-spine bend vw only 2-3 vw $142.80 $142.80 $142.80
X-ray lower extremities infant > 2 views (both sides) $89.40 $89.40 $89.40
X-ray lumbosacral spine >= 4 views $160.80 $160.80 $160.80
X-ray lumbosacral spine complete including bending views >= 6 views $232.20 $232.20 $232.20
X-ray mandible complete > 4 views $124.80 $124.80 $124.80
X-ray mandible ltd <4 views $124.80 $124.80 $124.80
X-ray nasal bones complete > 3 views $124.80 $124.80 $124.80
X-ray neck soft tissue $89.40 $89.40 $89.40
X-ray nose to rectum for foreign body child $89.40 $89.40 $89.40
X-ray optic foramina $29.40 $29.40 $29.40
X-ray pelvis 1-2 views $106.80 $106.80 $106.80
X-ray pelvis complete > 3 views $142.80 $142.80 $142.80
X-ray ribs 2 views left $106.80 $106.80 $106.80
X-ray ribs 3 views bilateral $124.80 $124.80 $124.80
X-ray ribs w/posterior anterior chest 3 views left $106.80 $106.80 $106.80
X-ray ribs w/posterior anterior chest > 4 views bilateral $160.80 $160.80 $160.80
X-ray sacroiliac joints >= 3 views $124.80 $124.80 $124.80
X-ray sacrum/coccyx >= 2 views $89.40 $89.40 $89.40
X-ray scapula complete (both sides) $106.80 $106.80 $106.80
X-ray sella turcica $39.00 $39.00 $39.00
X-ray shoulder 1 view (both sides) $71.40 $71.40 $71.40
X-ray sinus tract/fistula/abscess $142.80 $142.80 $142.80
X-ray sinuses paranasal complete > 3 views $124.80 $124.80 $124.80
X-ray skull < 4 views $124.80 $124.80 $124.80
X-ray skull > 4 views complete $142.80 $142.80 $142.80
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study $393.00 $393.00 $393.00
X-ray small intestine follow-through study $232.20 $232.20 $232.20
X-ray spine single view $71.40 $71.40 $71.40
X-ray sternoclavicular joint(s) > 3 views $124.80 $124.80 $124.80
X-ray sternum > 2 views $89.40 $89.40 $89.40
X-ray surgical specimen $35.40 $35.40 $35.40
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study $500.40 $500.40 $500.40
X-ray temporomandibular joint open/closed mouth bilateral $178.80 $178.80 $178.80
X-ray thoracic spine 2 views $106.80 $106.80 $106.80
X-ray thoracic spine 3 views $124.80 $124.80 $124.80
X-ray thoracolumbar spine >=2 views $89.40 $89.40 $89.40
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view $124.80 $124.80 $124.80
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views $232.20 $232.20 $232.20
X-ray tibia/fibula 2 views (both sides) $106.80 $106.80 $106.80
X-ray toe(s) > 2 views (both sides) $106.80 $106.80 $106.80
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast $464.40 $464.40 $464.40
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study $393.00 $393.00 $393.00
X-ray wrist 2 views (both sides) $106.80 $106.80 $106.80
Xe133 xenon 10mci $23.40 $23.40 $23.40
Xm archive tissue molec anal $40.20 $40.20 $40.20
Xyntha inj $1.80 $1.80 $1.80
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr $32.40 $32.40 $32.40
Zika virus dna/rna amp probe $194.40 $194.40 $194.40
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) $1,920.00 $1,920.00 $1,920.00
Zoledronic acid 4 mg/5 ml intravenous solution $52.80 $52.80 $52.80
Zoster vaccine-live inj $262.20 $262.20 $262.20
_afb id by dna probe rflx ast $40.20 $40.20 $40.20