|
17-hydroxypregnenolone
|
$40.32 |
$40.32 |
$40.32 |
$89.25
|
|
1st hosp/birthing center care per day nml nb 99460
|
$81.60 |
$81.60 |
$81.60 |
$161.60
|
|
99381 initial comp preventive med less than 1 year new
|
$92.00 |
$92.00 |
$92.00 |
$132.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$96.80 |
$96.80 |
$96.80 |
$111.00
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$79.36 |
$79.36 |
$79.36 |
$115.50
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$83.20 |
$83.20 |
$83.20 |
$113.40
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$86.40 |
$86.40 |
$86.40 |
$127.20
|
|
99397 periodic comp preventive med 65+ years est
|
$106.24 |
$106.24 |
$106.24 |
$160.73
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$3,650.36 |
$3,650.36 |
$3,650.36 |
$3,128.29
|
|
Abdominal CT scan (with and without contrast)
|
$918.40 |
$918.40 |
$918.40 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$915.20 |
$915.20 |
$915.20 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$767.04 |
$767.04 |
$767.04 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,012.80 |
$1,012.80 |
$1,012.80 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$809.41 |
$809.41 |
$809.41 |
$2,268.20
|
|
Abdominal MRI (without contrast)
|
$799.36 |
$799.36 |
$799.36 |
$2,050.14
|
|
Abdominal paracentesis w/image guidance
|
$630.40 |
$630.40 |
$630.40 |
$1,651.20
|
|
Abdominal Ultrasound (complete)
|
$266.88 |
$266.88 |
$266.88 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$266.88 |
$266.88 |
$266.88 |
$590.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,275.52 |
$1,275.52 |
$1,275.52 |
$1,145.40
|
|
Ablate inf turbinate superf 30801
|
$78.21 |
$78.21 |
$78.21 |
$1,944.80
|
|
Ablation of upper extremity nerves rf
|
$719.36 |
$719.36 |
$719.36 |
$808.50
|
|
Acetaminophen 120 mg rectal suppository
|
$271.15 |
$271.15 |
$271.15 |
$75.09
|
|
Acetone qualitative
|
$19.20 |
$19.20 |
$19.20 |
$45.65
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$142.40 |
$142.40 |
$142.40 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$109.60 |
$109.60 |
$109.60 |
$167.04
|
|
Aco ccm; at least 20 min 99490aco
|
$69.60 |
$69.60 |
$69.60 |
$102.38
|
|
Aco depression screen annual medicare g0444aco
|
$14.40 |
$14.40 |
$14.40 |
$38.28
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$9.60 |
$9.60 |
$9.60 |
$41.67
|
|
Acute hepatitis panel
|
$112.00 |
$112.00 |
$112.00 |
$292.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$68.00 |
$68.00 |
$68.00 |
$257.40
|
|
Administration immunization 1 vaccine
|
$99.84 |
$99.84 |
$99.84 |
$69.21
|
|
Administration vaccine influenza virus
|
$48.00 |
$48.00 |
$48.00 |
$50.43
|
|
Administration vaccine pneumococcal
|
$48.00 |
$48.00 |
$48.00 |
$50.43
|
|
Aep thrshld est mlt freq i&r
|
$301.44 |
$301.44 |
$301.44 |
$605.15
|
|
Airway resistance by impulse oscillometry 94728
|
$105.92 |
$105.92 |
$105.92 |
$270.50
|
|
Albumin body fluid quantitative each specimen
|
$15.36 |
$15.36 |
$15.36 |
$46.23
|
|
Albumin (human), 25%, 50ml
|
$569.77 |
$569.77 |
$569.77 |
$244.70
|
|
Albumin, human 5 % intravenous solution
|
$96.33 |
$96.33 |
$96.33 |
$296.32
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$23.55 |
$23.55 |
$23.55 |
$57.00
|
|
Albumin serum plasma or whole blood
|
$19.20 |
$19.20 |
$19.20 |
$40.80
|
|
Albuterol comp con
|
$14.98 |
$14.98 |
$14.98 |
$12.80
|
|
Albuterol ipratrop non-comp
|
$14.98 |
$14.98 |
$14.98 |
$5.40
|
|
Alkaline phosphatase
|
$23.55 |
$23.55 |
$23.55 |
$46.40
|
|
Allergen egg white ige
|
$12.80 |
$12.80 |
$12.80 |
$38.00
|
|
Allergy injections; 2 or more 95117
|
$14.72 |
$14.72 |
$14.72 |
$43.75
|
|
Alpha-fetoprotein tumor marker
|
$21.12 |
$21.12 |
$21.12 |
$106.00
|
|
Alprostadil for injection
|
$540.28 |
$540.28 |
$540.28 |
$519.93
|
|
Alteplase 100 mg infusion from pyxis vial
|
$10,982.86 |
$10,982.86 |
$10,982.86 |
$15,857.45
|
|
Alt/sgpt
|
$25.60 |
$25.60 |
$25.60 |
$47.45
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$175.05 |
$175.05 |
$175.05 |
$119.07
|
|
Ammonia
|
$64.00 |
$64.00 |
$64.00 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$369.73 |
$369.73 |
$369.73 |
$942.60
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$1,015.83 |
$1,015.83 |
$1,015.83 |
$543.85
|
|
Amp metatarsal w/toe single 28810
|
$1,006.08 |
$1,006.08 |
$1,006.08 |
$4,271.00
|
|
Amp thigh through femur re-amp 27596
|
$1,169.60 |
$1,169.60 |
$1,169.60 |
$2,935.40
|
|
Amputate metacarpal bone 26910
|
$917.76 |
$917.76 |
$917.76 |
$3,821.05
|
|
Amputate thigh through femur 27590
|
$1,621.76 |
$1,621.76 |
$1,621.76 |
$3,342.87
|
|
Amputation follow-up surgery
|
$628.00 |
$628.00 |
$628.00 |
$3,839.54
|
|
Amputation leg thr tib/fib 27880
|
$1,591.20 |
$1,591.20 |
$1,591.20 |
$2,241.60
|
|
Amputation leg; tib/fib f/u 27886
|
$1,078.40 |
$1,078.40 |
$1,078.40 |
$1,461.89
|
|
Amputation thru metatarsal
|
$1,166.40 |
$1,166.40 |
$1,166.40 |
$3,839.54
|
|
Amputation toe interphalangeal joint
|
$413.60 |
$413.60 |
$413.60 |
$3,998.20
|
|
Amputation toe metatarsophalangeal joint
|
$1,006.08 |
$1,006.08 |
$1,006.08 |
$3,839.54
|
|
Amylase
|
$32.00 |
$32.00 |
$32.00 |
$89.04
|
|
Analysis gene f5 leiden variant
|
$160.00 |
$160.00 |
$160.00 |
$230.40
|
|
Analysis nerve
|
$161.28 |
$161.28 |
$161.28 |
$274.49
|
|
Analysis tumor
|
$37.76 |
$37.76 |
$37.76 |
$237.89
|
|
An fluoro guide for cvp
|
$155.84 |
$155.84 |
$155.84 |
$515.00
|
|
Ankle arthroscopy/surgery
|
$858.40 |
$858.40 |
$858.40 |
$3,797.90
|
|
Ankle X-ray
|
$105.60 |
$105.60 |
$105.60 |
$353.60
|
|
Annual Physical, Established Patient (age 18-39)
|
$87.04 |
$87.04 |
$87.04 |
$141.00
|
|
Annual Physical, Established Patient (age 40-64)
|
$95.36 |
$95.36 |
$95.36 |
$158.76
|
|
Annual Physical, New Patient (age 18-39)
|
$106.24 |
$106.24 |
$106.24 |
$143.25
|
|
Annual Physical, New Patient (age 40-64)
|
$124.16 |
$124.16 |
$124.16 |
$165.10
|
|
Antibody htlv/hiv confirm test
|
$100.80 |
$100.80 |
$100.80 |
$130.00
|
|
Antibody id rbc panel
|
$134.40 |
$134.40 |
$134.40 |
$274.56
|
|
Antibody screen rbc
|
$38.40 |
$38.40 |
$38.40 |
$100.00
|
|
Anti-inhibitor
|
$18.82 |
$18.82 |
$18.82 |
$8.33
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$16.00 |
$16.00 |
$16.00 |
$37.05
|
|
Antinuclear antibodies
|
$26.88 |
$26.88 |
$26.88 |
$89.40
|
|
Antinuclear antibodies titer
|
$9.60 |
$9.60 |
$9.60 |
$77.00
|
|
Antithrombin iii activity
|
$102.40 |
$102.40 |
$102.40 |
$114.00
|
|
Appendix Removal (Laparoscopic)
|
$777.60 |
$777.60 |
$777.60 |
$6,870.89
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$1,568.00 |
$1,568.00 |
$1,568.00 |
$2,114.00
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$5,196.80 |
$5,196.80 |
$5,196.80 |
$3,345.60
|
|
Application finger splntstatic 29130
|
$145.28 |
$145.28 |
$145.28 |
$208.16
|
|
Application long leg splint 29505
|
$225.28 |
$225.28 |
$225.28 |
$338.25
|
|
Application lower leg splint 29515
|
$225.28 |
$225.28 |
$225.28 |
$330.48
|
|
Application multi layer compression below knee (both sides)
|
$488.32 |
$488.32 |
$488.32 |
$373.20
|
|
Application of cylinder cast 29365
|
$394.24 |
$394.24 |
$394.24 |
$420.00
|
|
Application of forearm cast 29075
|
$394.24 |
$394.24 |
$394.24 |
$339.30
|
|
Application of long arm cast 29065
|
$136.96 |
$136.96 |
$136.96 |
$395.00
|
|
Application of long leg cast 29345
|
$394.24 |
$394.24 |
$394.24 |
$455.00
|
|
Application of paste boot 29580
|
$488.32 |
$488.32 |
$488.32 |
$331.74
|
|
Application short leg cast 29405
|
$394.24 |
$394.24 |
$394.24 |
$388.80
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$1,568.00 |
$1,568.00 |
$1,568.00 |
$2,148.25
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$1,568.00 |
$1,568.00 |
$1,568.00 |
$2,164.64
|
|
Appl long leg cast brace
|
$394.24 |
$394.24 |
$394.24 |
$468.00
|
|
Appl modality 1/> areas paraffin bath 97018
|
$17.86 |
$17.86 |
$17.86 |
$66.00
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$44.74 |
$44.74 |
$44.74 |
$75.60
|
