|
3-d radiotherapy plan
|
$7,427.20 |
$7,427.20 |
$7,427.20 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$916.00 |
$916.00 |
$916.00 |
$508.13
|
|
5% dextrose and 0.45% saline
|
$75.59 |
$75.59 |
$75.59 |
$48.00
|
|
88334 ap bill cytologic exam each additional site
|
$164.00 |
$164.00 |
$164.00 |
$100.10
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$2,341.48 |
$2,341.48 |
$2,341.48 |
$3,138.72
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$916.00 |
$916.00 |
$916.00 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$832.80 |
$832.80 |
$832.80 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,484.80 |
$3,484.80 |
$3,484.80 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,987.20 |
$2,987.20 |
$2,987.20 |
$1,667.60
|
|
Abdominal CT scan (without contrast)
|
$2,472.80 |
$2,472.80 |
$2,472.80 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$3,967.92 |
$3,967.92 |
$3,967.92 |
$2,967.00
|
|
Abdominal MRI (with contrast)
|
$3,106.40 |
$3,106.40 |
$3,106.40 |
$2,240.00
|
|
Abdominal MRI (without contrast)
|
$2,619.20 |
$2,619.20 |
$2,619.20 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$1,389.60 |
$1,389.60 |
$1,389.60 |
$1,632.96
|
|
Abdominal Ultrasound (complete)
|
$936.80 |
$936.80 |
$936.80 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$824.80 |
$824.80 |
$824.80 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$335.20 |
$335.20 |
$335.20 |
$318.20
|
|
Abdominal X-ray Series (acute, with chest view)
|
$330.40 |
$330.40 |
$330.40 |
$418.63
|
|
Abdominal X-ray (single view)
|
$272.80 |
$272.80 |
$272.80 |
$260.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,080.80 |
$1,080.80 |
$1,080.80 |
$1,148.40
|
|
Ablation of upper extremity nerves rf
|
$380.00 |
$380.00 |
$380.00 |
$832.50
|
|
Abscess drain retroperitoneal surg code
|
$834.40 |
$834.40 |
$834.40 |
$3,050.40
|
|
Acetazolamide 500 mg solution for injection
|
$89.72 |
$89.72 |
$89.72 |
$122.55
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$91.20 |
$91.20 |
$91.20 |
$218.79
|
|
Acetylcysteine non-comp unit
|
$34.92 |
$34.92 |
$34.92 |
$31.21
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$342.40 |
$342.40 |
$342.40 |
$341.00
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$39.20 |
$39.20 |
$39.20 |
$38.50
|
|
Acyclovir 400 mg tablet
|
$5.20 |
$5.20 |
$5.20 |
$54.77
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$62.16 |
$62.16 |
$62.16 |
$64.45
|
|
Adenosine 3 mg/250 ml bag for osm
|
$61.86 |
$61.86 |
$61.86 |
$271.98
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$46.08 |
$46.08 |
$46.08 |
$193.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$220.00 |
$220.00 |
$220.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$220.00 |
$220.00 |
$220.00 |
$298.98
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$473.80 |
$473.80 |
$473.80 |
$668.98
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$292.80 |
$292.80 |
$292.80 |
$439.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$192.80 |
$192.80 |
$192.80 |
$212.80
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$192.80 |
$192.80 |
$192.80 |
$256.49
|
|
Administration immunization each additional vaccine
|
$59.20 |
$59.20 |
$59.20 |
$47.40
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$38.40 |
$38.40 |
$38.40 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$29.60 |
$29.60 |
$29.60 |
$30.24
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$10,172.16 |
$10,172.16 |
$10,172.16 |
$11,350.31
|
|
Albumin (human), 25%, 50ml
|
$111.92 |
$111.92 |
$111.92 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$190.23 |
$190.23 |
$190.23 |
$252.77
|
|
Albuterol ipratrop non-comp
|
$3.60 |
$3.60 |
$3.60 |
$5.67
|
|
Albuterol non-comp con
|
$71.50 |
$71.50 |
$71.50 |
$6.07
|
|
Albuterol non-comp unit
|
$4.70 |
$4.70 |
$4.70 |
$5.40
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$437.60 |
$437.60 |
$437.60 |
$6,285.56
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$504.80 |
$504.80 |
$504.80 |
$858.66
|
|
Alprostadil for injection
|
$245.01 |
$245.01 |
$245.01 |
$511.41
|
|
Als 1
|
$1,321.60 |
$1,321.60 |
$1,321.60 |
$853.44
|
|
Als1-emergency
|
$1,500.80 |
$1,500.80 |
$1,500.80 |
$1,103.37
|
|
Als 2
|
$1,691.20 |
$1,691.20 |
$1,691.20 |
$1,288.56
|
|
Alteplase 100 mg infusion from pyxis vial
|
$321.73 |
$321.73 |
$321.73 |
$15,857.45
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$63.49 |
$63.49 |
$63.49 |
$37.33
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$67.92 |
$67.92 |
$67.92 |
$47.06
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$167.23 |
$167.23 |
$167.23 |
$108.13
|
|
Amiodarone 50 mg/ml intravenous solution
|
$61.29 |
$61.29 |
$61.29 |
$55.86
|
|
Amniocentesisdiagnostic 59000
|
$632.80 |
$632.80 |
$632.80 |
$942.60
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$213.38 |
$213.38 |
$213.38 |
$519.03
|
|
Ampicillin 1 gram solution for injection
|
$61.93 |
$61.93 |
$61.93 |
$56.70
|
|
Ampicillin-sulbactam 1.5 gram solution for injection
|
$66.54 |
$66.54 |
$66.54 |
$54.57
|
|
Anastrozole 1 mg
|
$4.44 |
$4.44 |
$4.44 |
$22.40
|
|
An cholangiogram percutaneous compl
|
$644.00 |
$644.00 |
$644.00 |
$2,480.94
|
|
Angiotensin ii 0.5 mg/ml soln 1 ml vial
|
$252.42 |
$252.42 |
$252.42 |
$2,979.43
|
|
Ankle X-ray
|
$353.60 |
$353.60 |
$353.60 |
$356.32
|
|
Ankle X-ray (2 views, both ankles)
|
$303.20 |
$303.20 |
$303.20 |
$282.96
|
|
Anti-inhibitor
|
$61.57 |
$61.57 |
$61.57 |
$8.33
|
|
Aortic Aneurysm Screening Ultrasound
|
$618.40 |
$618.40 |
$618.40 |
$394.55
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$940.00 |
$940.00 |
$940.00 |
$2,114.00
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$1,806.40 |
$1,806.40 |
$1,806.40 |
$852.00
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$1,174.40 |
$1,174.40 |
$1,174.40 |
$502.00
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$618.40 |
$618.40 |
$618.40 |
$512.20
|
|
Application finger splntstatic 29130
|
$196.00 |
$196.00 |
$196.00 |
$208.50
|
|
Application long leg splint 29505
|
$292.80 |
$292.80 |
$292.80 |
$338.25
|
|
Application lower leg splint 29515
|
$270.40 |
$270.40 |
$270.40 |
$340.20
|
|
Application multi layer compression below knee (both sides)
|
$353.60 |
$353.60 |
$353.60 |
$375.06
|
|
Application of forearm cast 29075
|
$212.80 |
$212.80 |
$212.80 |
$358.20
|
|
Application of long arm cast 29065
|
$256.00 |
$256.00 |
$256.00 |
$396.77
|
|
Application of long leg cast 29345
|
$313.60 |
$313.60 |
$313.60 |
$455.00
|
|
Application of paste boot 29580
|
$252.80 |
$252.80 |
$252.80 |
$340.11
|
|
Application short leg cast 29405
|
$258.40 |
$258.40 |
$258.40 |
$393.98
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$2,909.60 |
$2,909.60 |
$2,909.60 |
$2,123.50
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$1,440.00 |
$1,440.00 |
$1,440.00 |
$2,164.64
|
|
Applicator tag rfid localizer 12gx7cm
|
$88.80 |
$88.80 |
$88.80 |
$981.75
|
|
Appl modality 1/> areas paraffin bath 97018
|
$97.60 |
$97.60 |
$97.60 |
$69.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$68.00 |
$68.00 |
$68.00 |
$75.98
|
|
Appl multlay comprs arm/hand
|
$266.40 |
$266.40 |
$266.40 |
$289.60
|
|
Apply forearm splintdynamic 29126
|
$279.20 |
$279.20 |
$279.20 |
$255.20
|
|
Apply hand/wrist cast 29085
|
$167.20 |
$167.20 |
$167.20 |
$271.80
|
|
Apply rigid leg cast 29445
|
$271.20 |
$271.20 |
$271.20 |
$555.00
|
|
Apply short leg castambul type 29425
|
$244.80 |
$244.80 |
$244.80 |
$404.74
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$281.91 |
$281.91 |
$281.91 |
$955.43
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$125.60 |
$125.60 |
$125.60 |
$100.75
|
|
Arm CT Scan (with contrast, both arms)
|
$2,063.20 |
$2,063.20 |
$2,063.20 |
$1,687.88
|
|
Arm CT Scan (without contrast, both arms)
|
$1,750.40 |
$1,750.40 |
$1,750.40 |
$1,380.00
|
|
Arm or Leg Ultrasound (limited, left side)
|
$577.60 |
$577.60 |
$577.60 |
$426.00
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$269.28 |
$269.28 |
$269.28 |
$1,303.25
|
|
Arterial blood draw/perc 36620
|
$505.60 |
$505.60 |
$505.60 |
$478.96
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$488.80 |
$488.80 |
$488.80 |
$609.00
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$457.60 |
$457.60 |
$457.60 |
$494.40
|