|
17-hydroxypregnenolone
|
$171.75 |
$171.75 |
$171.75 |
$102.05
|
|
1st hosp/birthing center care per day nml nb 99460
|
$108.75 |
$108.75 |
$108.75 |
$172.80
|
|
99381 initial comp preventive med less than 1 year new
|
$73.50 |
$73.50 |
$73.50 |
$165.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$79.50 |
$79.50 |
$79.50 |
$164.40
|
|
99383 initial comp preventive med 5 to 11 years new
|
$80.25 |
$80.25 |
$80.25 |
$162.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$61.50 |
$61.50 |
$61.50 |
$138.00
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$73.50 |
$73.50 |
$73.50 |
$146.00
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$75.00 |
$75.00 |
$75.00 |
$129.00
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$90.75 |
$90.75 |
$90.75 |
$167.25
|
|
99397 periodic comp preventive med 65+ years est
|
$80.25 |
$80.25 |
$80.25 |
$176.03
|
|
Abdominal CT scan (with and without contrast)
|
$83.25 |
$83.25 |
$83.25 |
$1,951.30
|
|
Abdominal CT scan (with contrast)
|
$74.25 |
$74.25 |
$74.25 |
$1,610.00
|
|
Abdominal CT scan (without contrast)
|
$69.75 |
$69.75 |
$69.75 |
$1,238.25
|
|
Abdominal MRI (with and without contrast)
|
$132.00 |
$132.00 |
$132.00 |
$2,629.50
|
|
Abdominal MRI (without contrast)
|
$86.25 |
$86.25 |
$86.25 |
$1,830.00
|
|
Abdominal Ultrasound (complete)
|
$47.25 |
$47.25 |
$47.25 |
$732.03
|
|
Abdominal Ultrasound (limited)
|
$35.25 |
$35.25 |
$35.25 |
$586.52
|
|
Ablate inf turbinate superf 30801
|
$101.25 |
$101.25 |
$101.25 |
$1,745.72
|
|
Acetone qualitative
|
$10.50 |
$10.50 |
$10.50 |
$46.80
|
|
Acne surgery 10040
|
$171.00 |
$171.00 |
$171.00 |
$234.00
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$198.00 |
$198.00 |
$198.00 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$120.00 |
$120.00 |
$120.00 |
$160.50
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$142.50 |
$142.50 |
$142.50 |
$385.45
|
|
Aco depression screen annual medicare g0444aco
|
$19.50 |
$19.50 |
$19.50 |
$32.97
|
|
Acute hepatitis panel
|
$189.00 |
$189.00 |
$189.00 |
$297.70
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$3.00 |
$3.00 |
$3.00 |
$136.99
|
|
Administration immunization 1 vaccine
|
$20.25 |
$20.25 |
$20.25 |
$65.00
|
|
Administration immunization each additional component
|
$23.25 |
$23.25 |
$23.25 |
$27.20
|
|
Administration immunization each additional vaccine
|
$12.00 |
$12.00 |
$12.00 |
$46.23
|
|
Administration immunization first component each vaccine
|
$23.25 |
$23.25 |
$23.25 |
$46.00
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$40.50 |
$40.50 |
$40.50 |
$48.00
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$20.25 |
$20.25 |
$20.25 |
$33.60
|
|
Administration rsv monoclonal ab seasonal dose im w/counseling
|
$37.50 |
$37.50 |
$37.50 |
$41.00
|
|
Administration vaccine influenza virus
|
$9.00 |
$9.00 |
$9.00 |
$38.25
|
|
Administration vaccine pneumococcal
|
$14.25 |
$14.25 |
$14.25 |
$38.25
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$32.25 |
$32.25 |
$32.25 |
$41.45
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$20.25 |
$20.25 |
$20.25 |
$60.45
|
|
Albumin serum plasma or whole blood
|
$21.75 |
$21.75 |
$21.75 |
$40.00
|
|
Albuterol ipratrop non-comp
|
$2.25 |
$2.25 |
$2.25 |
$9.18
|
|
Albuterol non-comp con
|
$9.00 |
$9.00 |
$9.00 |
$28.80
|
|
Albuterol non-comp unit
|
$1.50 |
$1.50 |
$1.50 |
$8.00
|
|
Alkaline phosphatase
|
$21.00 |
$21.00 |
$21.00 |
$45.75
|
|
Allergen egg white ige
|
$29.25 |
$29.25 |
$29.25 |
$41.00
|
|
Allergen specific ige qual multi scrn ea
|
$29.25 |
$29.25 |
$29.25 |
$39.00
|
|
Allergy injections; 2 or more 95117
|
$23.25 |
$23.25 |
$23.25 |
$51.07
|
|
Allergy injection; single 95115
|
$18.75 |
$18.75 |
$18.75 |
$46.80
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$99.00 |
$99.00 |
$99.00 |
$206.70
|
|
Alpha-fetoprotein tumor marker
|
$114.75 |
$114.75 |
$114.75 |
$115.70
|
|
Alt/sgpt
|
$21.75 |
$21.75 |
$21.75 |
$44.68
|
|
Alys cplx sp/pn npgt w/prgrm
|
$125.25 |
$125.25 |
$125.25 |
$417.47
|
|
Aminolevulinic acid delta
|
$30.75 |
$30.75 |
$30.75 |
$95.80
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$39.00 |
$39.00 |
$39.00 |
$41.59
|
|
Amitriptyline (elavil) -sendout
|
$42.75 |
$42.75 |
$42.75 |
$96.35
|
|
Ammonia
|
$39.00 |
$39.00 |
$39.00 |
$96.53
|
|
Amphetamine confirm urine -sendout
|
$59.25 |
$59.25 |
$59.25 |
$93.61
|
|
Amputation follow-up surgery
|
$634.50 |
$634.50 |
$634.50 |
$3,591.33
|
|
Amylase
|
$29.25 |
$29.25 |
$29.25 |
$84.50
|
|
Analgesics non-opioid definitive assay 1 or 2 acetaminophen
|
$47.25 |
$47.25 |
$47.25 |
$98.87
|
|
Analysis gene f2 20210g>a variant
|
$59.25 |
$59.25 |
$59.25 |
$244.00
|
|
Analysis gene f5 leiden variant
|
$53.25 |
$53.25 |
$53.25 |
$253.11
|
|
Anca screen with reflex to titer -quest
|
$145.50 |
$145.50 |
$145.50 |
$112.45
|
|
Ankle X-ray
|
$65.25 |
$65.25 |
$65.25 |
$325.59
|
|
Annual Physical, Established Patient (age 18-39)
|
$72.00 |
$72.00 |
$72.00 |
$203.45
|
|
Annual Physical, Established Patient (age 40-64)
|
$76.50 |
$76.50 |
$76.50 |
$191.00
|
|
Annual Physical, New Patient (age 18-39)
|
$96.75 |
$96.75 |
$96.75 |
$199.00
|
|
Annual Physical, New Patient (age 40-64)
|
$84.75 |
$84.75 |
$84.75 |
$218.00
|
|
Anogenital exam child w imag
|
$231.00 |
$231.00 |
$231.00 |
$195.96
|
|
Antibody screen rbc
|
$47.25 |
$47.25 |
$47.25 |
$102.05
|
|
Antinuclear antibodies
|
$41.25 |
$41.25 |
$41.25 |
$97.60
|
|
Antinuclear antibodies titer
|
$45.00 |
$45.00 |
$45.00 |
$78.65
|
|
Antistreptolysin o titer
|
$52.50 |
$52.50 |
$52.50 |
$58.50
|
|
Antithrombin iii activity
|
$173.25 |
$173.25 |
$173.25 |
$135.20
|
|
Ant sgm img ir flrscn angrph
|
$205.50 |
$205.50 |
$205.50 |
$322.40
|
|
Application clubfoot cast
|
$303.00 |
$303.00 |
$303.00 |
$370.58
|
|
Application long leg splint 29505
|
$106.50 |
$106.50 |
$106.50 |
$338.25
|
|
Application lower leg splint 29515
|
$48.00 |
$48.00 |
$48.00 |
$345.60
|
|
Application of forearm cast 29075
|
$192.75 |
$192.75 |
$192.75 |
$375.00
|
|
Application of long arm cast 29065
|
$201.00 |
$201.00 |
$201.00 |
$404.63
|
|
Application of paste boot 29580
|
$82.50 |
$82.50 |
$82.50 |
$331.74
|
|
Apply hand/wrist cast 29085
|
$99.75 |
$99.75 |
$99.75 |
$264.75
|
|
Apply short leg castambul type 29425
|
$185.25 |
$185.25 |
$185.25 |
$384.59
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$111.75 |
$111.75 |
$111.75 |
$567.78
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$66.00 |
$66.00 |
$66.00 |
$451.48
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$59.25 |
$59.25 |
$59.25 |
$696.00
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$654.75 |
$654.75 |
$654.75 |
$3,705.22
|
|
Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah)
|
$660.75 |
$660.75 |
$660.75 |
$1,060.80
|
|
Aspirate/inj ganglion cyst 20612
|
$139.50 |
$139.50 |
$139.50 |
$433.07
|
|
Assay of pregnanediol
|
$34.50 |
$34.50 |
$34.50 |
$34.50
|
|
Assay of troponin qual
|
$22.50 |
$22.50 |
$22.50 |
$22.40
|
|
Assay toxin or antitoxin
|
$57.00 |
$57.00 |
$57.00 |
$70.92
|
|
Assessment leukocyte fecal qualitative/semiquantitative
|
$47.25 |
$47.25 |
$47.25 |
$43.55
|
|
Ast/sgot
|
$21.75 |
$21.75 |
$21.75 |
$43.40
|
|
Automated diff wbc count
|
$22.50 |
$22.50 |
$22.50 |
$35.10
|
|
Avul nail plate addl
|
$54.75 |
$54.75 |
$54.75 |
$244.70
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$67.50 |
$67.50 |
$67.50 |
$356.00
|
|
B cells total count
|
$111.75 |
$111.75 |
$111.75 |
$131.30
|
|
Benign lesion paring 2-4
|
$71.25 |
$71.25 |
$71.25 |
$276.00
|
|
#_benzodiazconfur
|
$236.25 |
$236.25 |
$236.25 |
$99.45
|
|
Beta 2 glycoprotein 1 antibody iga
|
$101.25 |
$101.25 |
$101.25 |
$109.60
|
|
Beta-2 microglobulin
|
$299.25 |
$299.25 |
$299.25 |
$84.00
|
