|
#a/b/c/c/h pnl-candida albicans ab
|
$12.01 |
$12.01 |
$12.01 |
$133.20
|
|
#acylcarnitineprfl
|
$16.87 |
$16.87 |
$16.87 |
$169.20
|
|
#afb mycobacteria suscep. #1
|
$7.31 |
$7.31 |
$7.31 |
$41.40
|
|
#aptt mix-1:1 incubated
|
$35.09 |
$35.09 |
$35.09 |
$256.80
|
|
#bac vag cand-c. albicans naa
|
$35.09 |
$35.09 |
$35.09 |
$220.80
|
|
#cbg+cort-cbg
|
$18.00 |
$18.00 |
$18.00 |
$156.75
|
|
#celiac hla-dq2
|
$94.74 |
$94.74 |
$94.74 |
$94.74
|
|
#celiac hla-dq8
|
$109.13 |
$109.13 |
$109.13 |
$1,607.40
|
|
#cf-97variants
|
$556.60 |
$556.60 |
$556.60 |
$3,108.00
|
|
#cms hgb-carboxyhemoglobin
|
$14.07 |
$14.07 |
$14.07 |
$14.07
|
|
#cms hgb-sulfhemoglobin
|
$8.80 |
$8.80 |
$8.80 |
$132.75
|
|
#cmvcul-virus inoculation shell
|
$19.56 |
$19.56 |
$19.56 |
$55.20
|
|
#covid19rsv-rsv
|
$70.20 |
$70.20 |
$70.20 |
$75.75
|
|
#coxa-coxsackie a serotype a16
|
$13.03 |
$13.03 |
$13.03 |
$110.40
|
|
#creutz-prot.,western blot
|
$29.21 |
$29.21 |
$29.21 |
$176.80
|
|
#fecal-sodium
|
$4.86 |
$4.86 |
$4.86 |
$86.25
|
|
#hypersens-actinomyces ab
|
$10.18 |
$10.18 |
$10.18 |
$10.18
|
|
#resp virpnl dfa-adenovirus
|
$14.43 |
$14.43 |
$14.43 |
$139.80
|
|
#resp virpnl dfa-parainfluenza
|
$16.43 |
$16.43 |
$16.43 |
$16.43
|
|
(both sides) smear without diff wbc count
|
$3.43 |
$3.43 |
$3.43 |
$121.80
|
|
11-desoxycortisol - sendout
|
$29.28 |
$29.28 |
$29.28 |
$148.20
|
|
17-hydroxypregnenolone
|
$22.81 |
$22.81 |
$22.81 |
$168.60
|
|
17-ketosteroids
|
$12.80 |
$12.80 |
$12.80 |
$249.60
|
|
1st hosp/birthing center care per day nml nb 99460
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
2019-ncov diagnostic p
|
$35.92 |
$35.92 |
$35.92 |
$35.92
|
|
24 hr ambulatory b/p monitor
|
$128.90 |
$128.90 |
$128.90 |
$162.60
|
|
2d tee w or without fol w/con,in
|
$790.06 |
$790.06 |
$790.06 |
$1,641.60
|
|
2d tte w or without fol w/con,co
|
$790.06 |
$790.06 |
$790.06 |
$1,278.75
|
|
3-d radiotherapy plan
|
$1,368.26 |
$1,368.26 |
$1,368.26 |
$4,423.20
|
|
3d anat seg imaging preop
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
3d bn img algor drvd fr MRI
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
5' nucleotidase - sendout
|
$11.15 |
$11.15 |
$11.15 |
$243.00
|
|
Abatacept (with maltose) 250 mg intravenous solution
|
$44.49 |
$44.49 |
$44.49 |
$213.00
|
|
Abd aorta w/runoff s&i
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,245.00
|
|
Abd paracentesis/w/o image guide 49082
|
$937.56 |
$937.56 |
$937.56 |
$1,505.25
|
|
Abdominal CT scan (with and without contrast)
|
$178.02 |
$178.02 |
$178.02 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$106.34 |
$106.34 |
$106.34 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$3,061.80
|
|
Abdominal MRI (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,077.14
|
|
Abdominal MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$106.34 |
$106.34 |
$106.34 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$106.34 |
$106.34 |
$106.34 |
$629.42
|
|
Abdominal paracentesis w/image guidance
|
$937.56 |
$937.56 |
$937.56 |
$1,689.00
|
|
Abdominoplasty 15830
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$3,040.80
|
|
Abl1 gene
|
$300.00 |
$300.00 |
$300.00 |
$1,282.20
|
|
Ablate bone tumor(s) cryo perq 20983
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,246.25
|
|
Ablate bone tumor(s) perq
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$5,092.50
|
|
Ablate heart dysrhythm focus
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$7,588.10
|
|
Ablate inf turbinate submuc 30802
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Ablate inf turbinate superf 30801
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,849.50
|
|
Ablate pulm tumor perq crybl
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Ablate pulm tumor perq rf
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Ablation cardiac vagal inputs atrium
|
$156.46 |
$156.46 |
$156.46 |
$377.40
|
|
Ablation cryo abd perit om
|
$937.56 |
$937.56 |
$937.56 |
$6,311.40
|
|
Ablation cryo adrenal tumor
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,790.75
|
|
Ablation cryo pq chest wall tumor(s) w/guid
|
$239.88 |
$239.88 |
$239.88 |
$234.00
|
|
Ablation cryo pq liver tumor(s)
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$8,080.50
|
|
Ablation cryo retro lymph node
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Ablation cryo thigh/knee
|
$239.88 |
$239.88 |
$239.88 |
$274.50
|
|
Ablation of upper extremity nerves rf
|
$295.19 |
$295.19 |
$295.19 |
$2,242.80
|
|
Ablt trurl prst8 tis trnsdcr
|
$12,992.42 |
$12,992.42 |
$12,992.42 |
$12,992.42
|
|
Abltj 1/+thyr ndul 1lobe prq
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Abltj mal prst8 tiss hifu
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Abobotulinumtoxina
|
$9.17 |
$9.17 |
$9.17 |
$61.20
|
|
Abortion (mpr)
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Abrasion lesion single
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Abscess drain retroperitoneal surg code
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$5,568.60
|
|
Acetaminophen level
|
$18.64 |
$18.64 |
$18.64 |
$159.60
|
|
Acetone qualitative
|
$4.52 |
$4.52 |
$4.52 |
$50.40
|
|
Acetylcholine receptor modulating antibody
|
$12.05 |
$12.05 |
$12.05 |
$300.00
|
|
Acetylcholinesterase assay
|
$12.29 |
$12.29 |
$12.29 |
$12.29
|
|
Acid perfusion of esophagus
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Acne surgery 10040
|
$198.70 |
$198.70 |
$198.70 |
$265.20
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$206.14 |
$206.14 |
$206.14 |
$225.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$160.69 |
$160.69 |
$160.69 |
$160.50
|
|
Aco ccm; at least 20 min 99490aco
|
$92.50 |
$92.50 |
$92.50 |
$92.50
|
|
Aco cmplx chron care without pt visit, 60 min 99487aco
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$128.87 |
$128.87 |
$128.87 |
$417.00
|
|
Aco depression screen annual medicare g0444aco
|
$29.79 |
$29.79 |
$29.79 |
$29.79
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$19.31 |
$19.31 |
$19.31 |
$30.00
|
|
Acoustic immitance testing
|
$156.46 |
$156.46 |
$156.46 |
$141.75
|
|
Acoustic refl threshold tst
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Acromp/acromionectomy prtl
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Actigraphy testing
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Actinotherapy uv light
|
$39.25 |
$39.25 |
$39.25 |
$138.75
|
|
Acup 1/> w/estim 1st 15 min
|
$24.49 |
$24.49 |
$24.49 |
$42.75
|
|
Acup 1/> wo estim 1st 15 min
|
$24.49 |
$24.49 |
$24.49 |
$42.75
|
|
Acute hepatitis panel
|
$47.63 |
$47.63 |
$47.63 |
$490.20
|
|
Acute venous thrombus image
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$632.25
|
|
Acylcarnitines qual
|
$16.49 |
$16.49 |
$16.49 |
$16.49
|
|
Adapt behavior tx phys/qhp
|
$160.67 |
$160.67 |
$160.67 |
$114.00
|
|
Adding walker to prev cast
|
$157.79 |
$157.79 |
$157.79 |
$157.79
|
|
Adenovirus ag ia
|
$11.98 |
$11.98 |
$11.98 |
$24.00
|
|
Adenovirus antibody,serum - quest
|
$12.87 |
$12.87 |
$12.87 |
$84.60
|
|
Adenovirus assay w/optic
|
$21.76 |
$21.76 |
$21.76 |
$21.76
|
|
Adh-sendout
|
$33.94 |
$33.94 |
$33.94 |
$360.00
|
|
Adj gastric band via subq port
|
$937.56 |
$937.56 |
$937.56 |
$2,977.20
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,955.80
|
|
Adjmt/revj ext fixj sys anes
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$4,493.40
|
|
Administration chemotherapy IV infusion each additional hour
|
$71.17 |
$71.17 |
$71.17 |
$269.60
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$71.17 |
$71.17 |
$71.17 |
$322.20
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$331.69 |
$331.69 |
$331.69 |
$771.00
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$331.69 |
$331.69 |
$331.69 |
$508.20
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$71.17 |
$71.17 |
$71.17 |
$254.40
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$71.17 |
$71.17 |
$71.17 |
$254.40
|
|
Administration immunization 1 vaccine
|
$71.17 |
$71.17 |
$71.17 |
$12.60
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$71.17 |
$71.17 |
$71.17 |
$40.50
|
|
Administration vaccine hepatitis b
|
$46.14 |
$46.14 |
$46.14 |
$12.60
|
|
Administration vaccine influenza virus
|
$46.14 |
$46.14 |
$46.14 |
$12.00
|
|
Administration vaccine pneumococcal
|
$46.14 |
$46.14 |
$46.14 |
$12.00
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$41.85 |
$41.85 |
$41.85 |
$106.80
|
|
Adrenal cortex & medulla img
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$1,703.40
|
|
Aep hearing status deter i&r
|
$311.40 |
$311.40 |
$311.40 |
$336.60
|
|
Aep neurodiagnostic i&r
|
$311.40 |
$311.40 |
$311.40 |
$519.60
|
|
Aep thrshld est mlt freq i&r
|
$311.40 |
$311.40 |
$311.40 |
$867.00
|
|
Afamelanotide implant, 1 mg
|
$2,943.42 |
$2,943.42 |
$2,943.42 |
$6,529.20
|
|
Aflibercept injection
|
$790.04 |
$790.04 |
$790.04 |
$790.04
|
|
After cataract laser surgery
|
$548.60 |
$548.60 |
$548.60 |
$1,380.00
|
|
Agalsidase beta 35 mg intravenous solution
|
$230.26 |
$230.26 |
$230.26 |
$27,295.80
|
|
Air conduction bilat
|
$128.90 |
$128.90 |
$128.90 |
$106.50
|
|
Airway resistance by impulse oscillometry 94728
|
$156.46 |
$156.46 |
$156.46 |
$393.00
|
|
Albumin (human), 5%, 250 ml
|
$53.08 |
$53.08 |
$53.08 |
$609.00
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$5.78 |
$5.78 |
$5.78 |
$63.75
|
|
Albumin body fluid quantitative each specimen
|
$7.78 |
$7.78 |
$7.78 |
$37.20
|
|
Albumin ischemia modified
|
$33.94 |
$33.94 |
$33.94 |
$33.94
|
|
Albumin serum plasma or whole blood
|
$4.95 |
$4.95 |
$4.95 |
$43.50
|
|
Albumin, human 25 % intravenous solution
|
$21.23 |
$21.23 |
$21.23 |
$21.23
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$17.27 |
$17.27 |
$17.27 |
$56.25
|
|
Alcohol/sub misuse assess
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Alcohol/subs interv >30 min
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Aldesleukin injection
|
$5,301.26 |
$5,301.26 |
$5,301.26 |
$6,538.20
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$2,440.70 |
$2,440.70 |
$2,440.70 |
$8,173.80
|
|
Alkaline phosphatase
|
$5.18 |
$5.18 |
$5.18 |
$45.75
|
|
All tstg perq&iq drugs/biol
|
$39.25 |
$39.25 |
$39.25 |
$70.50
|
|
All tstg perq&iq w/venoms
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Allergen alpha lactalbumin ige
|
$17.93 |
$17.93 |
$17.93 |
$57.60
|
|
Allergen egg white ige
|
$5.22 |
$5.22 |
$5.22 |
$57.60
|
|
Allergen specific ige qual multi scrn ea
|
$7.97 |
$7.97 |
$7.97 |
$39.00
|
|
Allergy Skin Testing
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$47.44
|
|
Allergy injection; single 95115
|
$46.14 |
$46.14 |
$46.14 |
$42.75
|
|
Allergy injections; 2 or more 95117
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Allg patch or app # of tests 95044
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$780.00
|
|
Allgrft implnt knee w/scope
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$5.19 |
$5.19 |
$5.19 |
$40.40
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$64.41 |
$64.41 |
$64.41 |
$326.40
|
|
Alpha-fetoprotein amniotic
|
$17.00 |
$17.00 |
$17.00 |
$138.60
|
|
Alpha-fetoprotein tumor marker
|
$16.77 |
$16.77 |
$16.77 |
$139.20
|
|
Alt/sgpt
|
$5.30 |
$5.30 |
$5.30 |
$77.25
|
|
Alteplase 100 mg infusion from pyxis vial
|
$94.15 |
$94.15 |
$94.15 |
$9,848.40
|
|
Altuviiio per factor viii iu
|
$4.67 |
$4.67 |
$4.67 |
$4.67
|
|
Aluminum - quest
|
$25.48 |
$25.48 |
$25.48 |
$168.00
|
|
Alveoloplasty each quadrant
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Alys cplx sp/pn npgt w/prgrm
|
$91.79 |
$91.79 |
$91.79 |
$1,074.00
|
|
Ambl bp mntr w/sw a/r
|
$128.90 |
$128.90 |
$128.90 |
$199.50
|
|
Amino acid screen, urine
|
$13.87 |
$13.87 |
$13.87 |
$13.87
|
|
Amino acid single qual
|
$14.18 |
$14.18 |
$14.18 |
$14.18
|
|
Amino acids quant 2-5
|
$19.61 |
$19.61 |
$19.61 |
$220.80
|
|
Aminolevulinic acid delta
|
$16.45 |
$16.45 |
$16.45 |
$178.80
|
|
Aminolevulinic acid hcl top
|
$393.87 |
$393.87 |
$393.87 |
$393.87
|
|
Aminolevulinic acid, 10% gel
|
$1.81 |
$1.81 |
$1.81 |
$1.81
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$22.21 |
$22.21 |
$22.21 |
$298.20
|
|
Ammonia
|
$14.57 |
$14.57 |
$14.57 |
$126.00
|
|
Amniocentesis therapeutic
|
$304.19 |
$304.19 |
$304.19 |
$747.75
|
|
Amniocentesisdiagnostic 59000
|
$870.74 |
$870.74 |
$870.74 |
$870.74
|
|
Amniotic fluid scan
|
$9.35 |
$9.35 |
$9.35 |
$202.80
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$4,150.20
|
|
Amp metatarsal w/toe single 28810
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amphotericin b lipid complex
|
$10.30 |
$10.30 |
$10.30 |
$272.40
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$22.62 |
$22.62 |
$22.62 |
$592.80
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$262.99 |
$262.99 |
$262.99 |
$280.20
|
|
Amputate hand at wrist
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Amputate metacarpal bone 26910
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amputation follow-up surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amputation follow-up surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amputation follow-up surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amputation follow-up surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Amputation follow-up surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amputation follow-up surgery
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Amputation follow-up surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amputation of foot at ankle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Amputation thru metatarsal
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amputation toe interphalangeal joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,304.80
|
|
Amputation toe metatarsophalangeal joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Amylase
|
$6.48 |
$6.48 |
$6.48 |
$113.40
|
|
An cholangiogram percutaneous compl
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,342.00
|
|
Ana ds-dna
|
$12.11 |
$12.11 |
$12.11 |
$178.80
|
|
Anacaulase-bcdb 8.8% gel 1 g
|
$58.32 |
$58.32 |
$58.32 |
$58.32
|
|
Anal pressure record
|
$311.40 |
$311.40 |
$311.40 |
$954.00
|
|
Anal/urinary muscle study
|
$243.21 |
$243.21 |
$243.21 |
$981.00
|
|
Anal/urinary muscle study
|
$156.46 |
$156.46 |
$156.46 |
$580.20
|
|
Analysis complx cranial nerve pulse gen prgrmg 95977
|
$91.79 |
$91.79 |
$91.79 |
$1,058.25
|
|
Analysis gene f2 20210g>a variant
|
$65.69 |
$65.69 |
$65.69 |
$2,361.60
|
|
Analysis gene f5 leiden variant
|
$73.37 |
$73.37 |
$73.37 |
$1,021.80
|
|
Analysis nerve
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Analysis tumor
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Analysis; simple cranial nerv pulse gen prgrmg 95976
|
$37.29 |
$37.29 |
$37.29 |
$1,038.00
|
|
Analyze neurostimulator simple w/reprogramming 95971
|
$91.79 |
$91.79 |
$91.79 |
$670.80
|
|
Anaplsma phgcytophlm amp prb
|
$35.09 |
$35.09 |
$35.09 |
$290.40
|
|
Anca screen with reflex to titer -quest
|
$15.05 |
$15.05 |
$15.05 |
$103.20
|
|
Androstanediol
|
$28.83 |
$28.83 |
$28.83 |
$103.80
|
|
Angio tib/peroneal/init ves/unila 37228
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$29,775.00
|
|
Angio trnslmnl balloon same artery ini
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$7,740.60
|
|
Angio trnslmnl balloon same vein ini
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$7,457.25
|
|
Angioplasty fem/pop unilat 37224
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$21,742.80
|
|
Angioplasty/iliac/init ves/unilat 37220
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$16,320.60
|
|
Angiotensin ii
|
$20.52 |
$20.52 |
$20.52 |
$276.60
|
|
Ankle X-ray
|
$88.05 |
$88.05 |
$88.05 |
$311.92
|
|
Ankle arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Ankle arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Ankle arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Ankle arthroscopy/surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Ankle arthroscopy/surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Ankle arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Ankle arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Anl sp inf pmp w/mdreprg&fil
|
$299.91 |
$299.91 |
$299.91 |
$639.00
|
|
Annual alcohol screen 15 min
|
$29.79 |
$29.79 |
$29.79 |
$29.79
|
|
Anodyne therapy charges pt
|
$8.81 |
$8.81 |
$8.81 |
$49.50
|
|
Anogenital exam child w imag
|
$201.17 |
$201.17 |
$201.17 |
$201.17
|
|
Anorectal myomectomy
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Anoscopy
|
$911.71 |
$911.71 |
$911.71 |
$1,067.25
|
|
Anoscopy ablation lesion 46615
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,367.00
|
|
Anoscopy and biopsy
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,380.00
|
|
Anoscopy and dilation 46604
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Anoscopy control bleeding 46614
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,982.25
|
|
Anoscopy remove fb 46608
|
$911.71 |
$911.71 |
$911.71 |
$1,950.00
|
|
Anoscopy remove lesion 46610
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,770.50
|
|
Anoscopy remove lesions w/cautery/snare 46612
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Ans parasymp & symp w/tilt
|
$311.40 |
$311.40 |
$311.40 |
$312.00
|
|
Ant colporrhaphy/rpr cyctocele 57240
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Ant sgm img i&r speclr mic
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Ant sgm img ir flrscn angrph
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Ant/post colporrhap/enterocele rpr 57265
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Anti mog serum - sendout
|
$12.05 |
$12.05 |
$12.05 |
$159.00
|
|
Anti-inhibitor
|
$2.45 |
$2.45 |
$2.45 |
$8.70
|
|
Anti-thymocyte glob (equine)(1:1000) intradermal test dose
|
$5,013.11 |
$5,013.11 |
$5,013.11 |
$5,013.11
|
|
Antibody
|
$15.99 |
$15.99 |
$15.99 |
$15.99
|
|
Antibody bacterium, not elsewhere specified
|
$12.88 |
$12.88 |
$12.88 |
$76.80
|
|
Antibody elution rbc reference
|
$171.36 |
$171.36 |
$171.36 |
$147.75
|
|
Antibody htlv-i
|
$9.09 |
$9.09 |
$9.09 |
$85.20
|
|
Antibody htlv-ii
|
$14.00 |
$14.00 |
$14.00 |
$195.00
|
|
Antibody htlv/hiv confirm test
|
$19.35 |
$19.35 |
$19.35 |
$246.60
|
|
Antibody id rbc panel
|
$359.72 |
$359.72 |
$359.72 |
$235.80
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$18.37 |
$18.37 |
$18.37 |
$621.00
|
|
Antibody influenza virus
|
$13.55 |
$13.55 |
$13.55 |
$147.00
|
|
Antibody lymphocytic choriomeningitis
|
$12.87 |
$12.87 |
$12.87 |
$111.20
|
|
Antibody screen rbc
|
$53.43 |
$53.43 |
$53.43 |
$102.75
|
|
Antibody tetanus
|
$14.80 |
$14.80 |
$14.80 |
$111.60
|
|
Antigen therapy services
|
$71.17 |
$71.17 |
$71.17 |
$71.17
|
|
Antigen therapy services
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Antigen therapy services
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Antigen therapy services
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Antigen therapy services
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Antigen therapy services
|
$71.17 |
$71.17 |
$71.17 |
$71.17
|
|
Antigen therapy services
|
$71.17 |
$71.17 |
$71.17 |
$71.17
|
|
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution
|
$1.49 |
$1.49 |
$1.49 |
$11.40
|
|
Antihemophilic viii/vwf comp
|
$1.23 |
$1.23 |
$1.23 |
$10.20
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$12.05 |
$12.05 |
$12.05 |
$117.00
|
|
Antineutrophil cytoplasmic antibody titer each antibody
|
$12.05 |
$12.05 |
$12.05 |
$156.00
|
|
Antinuclear antibodies
|
$12.09 |
$12.09 |
$12.09 |
$97.50
|
|
Antinuclear antibodies titer
|
$11.16 |
$11.16 |
$11.16 |
$91.20
|
|
Antiphosphatidylserine antibody
|
$16.07 |
$16.07 |
$16.07 |
$204.00
|
|
Antistreptolysin o screen
|
$5.77 |
$5.77 |
$5.77 |
$56.40
|
|
Antistreptolysin o titer
|
$7.30 |
$7.30 |
$7.30 |
$83.40
|
|
Antithrombin iii activity
|
$11.85 |
$11.85 |
$11.85 |
$157.80
|
|
Antithrombin iii injection
|
$4.09 |
$4.09 |
$4.09 |
$70.20
|
|
Antithymocyte globuln rabbit
|
$996.39 |
$996.39 |
$996.39 |
$4,139.25
|
|
Aortic dysfunction/dilation
|
$1,350.19 |
$1,350.19 |
$1,350.19 |
$9,101.40
|
|
Aortic dysfunction/dilation
|
$504.00 |
$504.00 |
$504.00 |
$7,431.60
|
|
Apc gene dup/delet variants
|
$200.00 |
$200.00 |
$200.00 |
$2,299.20
|
|
Apc gene full sequence
|
$780.00 |
$780.00 |
$780.00 |
$780.00
|
|
Apc gene known fam variants
|
$280.00 |
$280.00 |
$280.00 |
$40.80
|
|
Aphakia prosth service temp
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Apheresis immunoads slctv
|
$4,685.17 |
$4,685.17 |
$4,685.17 |
$4,685.17
|
|
Apheresis plasma
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$3,486.60
|
|
Apheresis platelets
|
$437.18 |
$437.18 |
$437.18 |
$1,177.80
|
|
Apheresis rbc
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$1,639.28
|
|
Apheresis wbc
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$1,168.80
|
|
Apl(pml-rara) quant - sendout
|
$207.31 |
$207.31 |
$207.31 |
$765.00
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,990.50
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,154.80
|
|
App mltpln uni xtrnl fix 1st
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
App mltpln uni xtrnl fix xch
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
App skn cl ssp agrft t/a/l 1
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
App skn cll ssp f/n/g/hf 1st
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Appendectomy
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$869.40
|
|
Appendix Removal (Laparoscopic)
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$6,376.26
|
|
Appl bdy cst sho to hip 1thi
|
$157.79 |
$157.79 |
$157.79 |
$157.79
|
|
Appl bdy cst sho to hip b th
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl bdy cst sho to hip head
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl body cast sho to hips
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl cast figure-of-eight
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl cast plaster velpeau
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl cast shoulder spica
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl halo type body cast
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl hip spica cast 1 leg
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl hip spica cast1&1/2
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl long leg cast brace
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Appl mltpln uni ext fixj sys
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Appl modality 1+lllt po pain
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Appl modality 1/> areas paraffin bath 97018
|
$7.89 |
$7.89 |
$7.89 |
$80.40
|
|
Appl modality 1/> areas vasopneumatic devices 97016
|
$14.87 |
$14.87 |
$14.87 |
$92.25
|
|
Appl multlay comprs arm/hand
|
$157.79 |
$157.79 |
$157.79 |
$378.75
|
|
Appl patllr tdn bearing cast
|
$265.58 |
$265.58 |
$265.58 |
$396.75
|
|
Appl unipln uni ext fixj sys
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$4,493.40
|
|
Application clubfoot cast
|
$157.79 |
$157.79 |
$157.79 |
$157.79
|
|
Application finger splntstatic 29130
|
$128.90 |
$128.90 |
$128.90 |
$192.75
|
|
Application halo femoral
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Application halo pelvic
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Application long leg splint 29505
|
$157.79 |
$157.79 |
$157.79 |
$569.60
|
|
Application lower leg splint 29515
|
$157.79 |
$157.79 |
$157.79 |
$471.00
|
|
Application multi layer compression below knee (both sides)
|
$157.79 |
$157.79 |
$157.79 |
$377.25
|
|
Application of body cast
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Application of body cast
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Application of cylinder cast 29365
|
$265.58 |
$265.58 |
$265.58 |
$718.80
|
|
Application of forearm cast 29075
|
$265.58 |
$265.58 |
$265.58 |
$370.80
|
|
Application of long arm cast 29065
|
$265.58 |
$265.58 |
$265.58 |
$440.40
|
|
Application of long leg cast
|
$265.58 |
$265.58 |
$265.58 |
$444.00
|
|
Application of long leg cast 29345
|
$265.58 |
$265.58 |
$265.58 |
$388.50
|
|
Application of paste boot 29580
|
$157.79 |
$157.79 |
$157.79 |
$366.60
|
|
Application short leg cast 29405
|
$265.58 |
$265.58 |
$265.58 |
$359.25
|
|
Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$2,109.00
|
|
Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$2,109.00
|
|
Apply finger cast 29086
|
$157.79 |
$157.79 |
$157.79 |
$157.79
|
|
Apply forearm splintdynamic 29126
|
$128.90 |
$128.90 |
$128.90 |
$366.60
|
|
Apply hand/wrist cast 29085
|
$157.79 |
$157.79 |
$157.79 |
$520.80
|
|
Apply interstit radiat compl
|
$693.81 |
$693.81 |
$693.81 |
$2,441.40
|
|
Apply intrcav radiat compl
|
$693.81 |
$693.81 |
$693.81 |
$693.81
|
|
Apply intrcav radiat interm
|
$578.47 |
$578.47 |
$578.47 |
$367.80
|
|
Apply intrcav radiat simple
|
$578.47 |
$578.47 |
$578.47 |
$319.20
|
|
Apply of finger splint 29131
|
$59.40 |
$59.40 |
$59.40 |
$460.20
|
|
Apply rem fixation device
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Apply rigid leg cast 29445
|
$265.58 |
$265.58 |
$265.58 |
$631.20
|
|
Apply short leg castambul type 29425
|
$265.58 |
$265.58 |
$265.58 |
$323.25
|
|
Apply surf ldr radionuclide
|
$109.50 |
$109.50 |
$109.50 |
$109.50
|
|
Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion
|
$1.77 |
$1.77 |
$1.77 |
$7.80
|
|
Aqaprn-4 antb flo cytmtry ea
|
$37.73 |
$37.73 |
$37.73 |
$281.40
|
|
Aqua therapy w/exercise/ea 15 min 97113
|
$46.97 |
$46.97 |
$46.97 |
$129.75
|
|
Aquaporin-4 antibody cba each
|
$12.05 |
$12.05 |
$12.05 |
$132.60
|
|
Aquaporin-4 antibody elisa
|
$11.53 |
$11.53 |
$11.53 |
$132.60
|
|
Aquatic exercise - group charge
|
$22.65 |
$22.65 |
$22.65 |
$95.40
|
|
Aqueous shunt eye w/graft
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Aqueous shunt eye without graft
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Argatroban nonesrd (accord)
|
$1.82 |
$1.82 |
$1.82 |
$1.82
|
|
Argatroban nonesrd (auromed)
|
$1.45 |
$1.45 |
$1.45 |
$668.52
|
|
Argatroban nonesrd use 1mg
|
$0.74 |
$0.74 |
$0.74 |
$881.10
|
|
Aripiprazole 441 mg/1.6 ml inj
|
$3.33 |
$3.33 |
$3.33 |
$579.60
|
|
Arsenic trioxide 2 mg/ml intravenous solution
|
$5.86 |
$5.86 |
$5.86 |
$292.80
|
|
Art pressure waveform analys
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Artery to vein shunt
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Artery x-rays adrenal gland
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Artery x-rays adrenals
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Artery x-rays arm/leg 75710-26
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Artery x-rays arms/legs 75716-26
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Artery x-rays chest
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,255.50
|
|
Artery x-rays lung
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,919.00
|
|
Artery x-rays lung
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Artery x-rays lungs
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,831.60
|
|
Artery x-rays spine
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$4,294.50
|
|
Artery xray of abdomen 75726-26
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$4,130.40
|
|
Artery xrays of pelvis 75736 26
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$4,369.50
|
|
Artery-vein nonautograft
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Arthrd ant ntrbd min dsc crv
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthrd ant ntrbdy cervical
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthrd cmbn 1ntrspc lumbar
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Arthrd dst rad/ul jt sgm rsc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrd elbow jt autog graft
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthrd glenohumeral jt w/grf
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthrd pst tq 1ntrspc lum
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Arthrd si jt perq/min nvas
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$2,428.20
|
|
Arthrd si jt prq wo tfxj dev
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Arthrd wrist complete wo grf
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrd wrist lmtd without b1 grf
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrd wrist w/sliding graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrd wrist with autograft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrd wrst iliac/oth agrft
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah)
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthro/shoul surg; w/spacer
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604
|
$295.19 |
$295.19 |
$295.19 |
$514.50
|
|
Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides)
|
$295.19 |
$295.19 |
$295.19 |
$498.00
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa w/ultrasound guidance (both sides)
|
$692.52 |
$692.52 |
$692.52 |
$625.80
|
|
Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right
|
$295.19 |
$295.19 |
$295.19 |
$453.60
|
|
Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides)
|
$295.19 |
$295.19 |
$295.19 |
$723.60
|
|
Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance
|
$295.19 |
$295.19 |
$295.19 |
$453.60
|
|
Arthrodesis big toe joint 28760
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrodesis elbw joint local
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrodesis glenohumeral jt
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrodesis pantalar
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Arthrodesis subtalar
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Arthrodesis triple
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthroplasty finger joint 26535
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrotomy carpometacarpal joint 26070
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Arthrotomy glenhumrl jt w/bx
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrotomy glenohumeral jt
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrotomy strnclav joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrotomy/elbow/exp/drain/rmv fb 24000
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrp ntrcrp/crp/mtcr ntrps
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrp ntrcrpl/crp/mtcrp ssp
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrp prostc dstl scph crpl
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrp w/prostc dst rds&crps
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Arthrp w/prostc dstl rds
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthrp w/prostc dstl ulna
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Arthrp w/prostc lunate
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Arthrp w/prostc trapezium
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrs kne srg drlg ost diss
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrt ac sc jt exp/rmvl fb
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrt acrmclv/strnclav jt
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrt elbow w/synovectomy
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrt elbw capsl exc rls
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrt elbw jt expl bx rmvl
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrt elbw synovial bx only
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrt gh jt expl/drg/rmv fb
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Arthrt glenhumrl jt w/expl
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrt hip expl/rmv loose/fb
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Arthrt rdcrpl/midcarpl jt
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Artific inseminationintrauterine 58322
|
$201.17 |
$201.17 |
$201.17 |
$201.17
|
|
Artificial insemination
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Artiss fibrin sealant
|
$142.07 |
$142.07 |
$142.07 |
$3,217.53
|
|
Asp & inj bone cyst
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Asp & inj w/heparin pleurx cath
|
$618.26 |
$618.26 |
$618.26 |
$1,092.00
|
|
Asp core fat pad
|
$198.70 |
$198.70 |
$198.70 |
$174.00
|
|
Asp pq spinal cord cyst/syrinx
|
$890.29 |
$890.29 |
$890.29 |
$890.29
|
|
Aspa gene
|
$47.25 |
$47.25 |
$47.25 |
$1,108.20
|
|
Aspir/inj thyroid cyst 60300
|
$703.59 |
$703.59 |
$703.59 |
$873.00
|
|
Aspirate bladder/sprapubic cath 51102
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$3,146.25
|
|
Aspirate pleura without imaging 32554
|
$618.26 |
$618.26 |
$618.26 |
$1,212.00
|
|
Aspirate/inj ganglion cyst 20612
|
$295.19 |
$295.19 |
$295.19 |
$491.25
|
|
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion
|
$703.59 |
$703.59 |
$703.59 |
$971.40
|
|
Aspiration orbital contents
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Aspiration peritonsillar abscess
|
$232.22 |
$232.22 |
$232.22 |
$236.25
|
|
Assay acid phosphatase
|
$7.64 |
$7.64 |
$7.64 |
$62.25
|
|
Assay alkaline phosphatase
|
$8.26 |
$8.26 |
$8.26 |
$63.00
|
|
Assay blood catecholamines
|
$29.08 |
$29.08 |
$29.08 |
$29.08
|
|
Assay chondroitin sulfate
|
$20.65 |
$20.65 |
$20.65 |
$20.65
|
|
Assay dir meas fr estradiol
|
$27.94 |
$27.94 |
$27.94 |
$103.20
|
|
Assay duodenal fluid trypsin
|
$7.20 |
$7.20 |
$7.20 |
$195.00
|
|
Assay free hydroxyproline
|
$22.65 |
$22.65 |
$22.65 |
$97.20
|
|
Assay malate dehydrogenase
|
$7.37 |
$7.37 |
$7.37 |
$7.37
|
|
Assay myeloperoxidase
|
$50.86 |
$50.86 |
$50.86 |
$151.80
|
|
Assay of PSA complexed
|
$18.39 |
$18.39 |
$18.39 |
$18.39
|
|
Assay of adp & amp
|
$25.80 |
$25.80 |
$25.80 |
$246.75
|
|
Assay of androsterone
|
$25.55 |
$25.55 |
$25.55 |
$25.55
|
|
Assay of blood lipoprotein
|
$12.75 |
$12.75 |
$12.75 |
$12.75
|
|
Assay of bradykinin
|
$5.16 |
$5.16 |
$5.16 |
$5.16
|
|
Assay of breath ethanol
|
$30.00 |
$30.00 |
$30.00 |
$105.00
|
|
Assay of cathepsin-d
|
$18.06 |
$18.06 |
$18.06 |
$18.06
|
|
Assay of chloramphenicol
|
$12.67 |
$12.67 |
$12.67 |
$12.67
|
|
Assay of corticosterone
|
$22.52 |
$22.52 |
$22.52 |
$40.20
|
|
Assay of digoxin free
|
$13.28 |
$13.28 |
$13.28 |
$25.50
|
|
Assay of endocrine hormone
|
$71.23 |
$71.23 |
$71.23 |
$71.23
|
|
Assay of estrogen
|
$87.88 |
$87.88 |
$87.88 |
$87.88
|
|
Assay of etiocholanolone
|
$26.24 |
$26.24 |
$26.24 |
$26.24
|
|
Assay of feces for trypsin
|
$9.93 |
$9.93 |
$9.93 |
$9.93
|
|
Assay of feces porphyrins
|
$39.11 |
$39.11 |
$39.11 |
$204.60
|
|
Assay of feces/urobilinogen
|
$16.80 |
$16.80 |
$16.80 |
$16.80
|
|
Assay of fluoride
|
$18.54 |
$18.54 |
$18.54 |
$227.40
|
|
Assay of galactose
|
$11.20 |
$11.20 |
$11.20 |
$307.50
|
|
Assay of gdh enzyme
|
$13.15 |
$13.15 |
$13.15 |
$13.15
|
|
Assay of glucosidase
|
$21.48 |
$21.48 |
$21.48 |
$342.00
|
|
Assay of glutathione
|
$15.45 |
$15.45 |
$15.45 |
$77.40
|
|
Assay of haptoglobins
|
$26.89 |
$26.89 |
$26.89 |
$26.89
|
|
Assay of idh enzyme
|
$8.85 |
$8.85 |
$8.85 |
$8.85
|
|
Assay of interleukin-6 (il-6)
|
$17.27 |
$17.27 |
$17.27 |
$67.20
|
|
Assay of intrinsic factor
|
$19.82 |
$19.82 |
$19.82 |
$19.82
|
|
Assay of lap enzyme
|
$9.81 |
$9.81 |
$9.81 |
$9.81
|
|
Assay of leflunomide
|
$38.57 |
$38.57 |
$38.57 |
$147.00
|
|
Assay of lrh hormone
|
$17.19 |
$17.19 |
$17.19 |
$299.20
|
|
Assay of methemalbumin
|
$10.74 |
$10.74 |
$10.74 |
$10.74
|
|
Assay of neonatal thyroxine
|
$6.47 |
$6.47 |
$6.47 |
$6.47
|
|
Assay of osteocalcin
|
$29.85 |
$29.85 |
$29.85 |
$150.60
|
|
Assay of phenylketones
|
$3.98 |
$3.98 |
$3.98 |
$3.98
|
|
Assay of pregnanediol
|
$21.27 |
$21.27 |
$21.27 |
$21.27
|
|
Assay of pregnanetriol
|
$21.05 |
$21.05 |
$21.05 |
$21.05
|
|
Assay of procainamide w/metab
|
$16.75 |
$16.75 |
$16.75 |
$129.75
|
|
Assay of progesterone
|
$64.88 |
$64.88 |
$64.88 |
$64.88
|
|
Assay of prostaglandin
|
$41.77 |
$41.77 |
$41.77 |
$192.00
|
|
Assay of quinine
|
$11.63 |
$11.63 |
$11.63 |
$11.63
|
|
Assay of rbc pg6d enzyme
|
$9.44 |
$9.44 |
$9.44 |
$9.44
|
|
Assay of salicylate
|
$18.64 |
$18.64 |
$18.64 |
$159.60
|
|
Assay of semen fructose
|
$17.34 |
$17.34 |
$17.34 |
$17.34
|
|
Assay of sialic acid
|
$13.44 |
$13.44 |
$13.44 |
$188.40
|
|
Assay of silica
|
$25.21 |
$25.21 |
$25.21 |
$194.40
|
|
Assay of somatostatin
|
$18.28 |
$18.28 |
$18.28 |
$235.20
|
|
Assay of thiocyanate
|
$11.63 |
$11.63 |
$11.63 |
$72.60
|
|
Assay of troponin qual
|
$10.09 |
$10.09 |
$10.09 |
$10.09
|
|
Assay of tyrosine
|
$10.63 |
$10.63 |
$10.63 |
$123.00
|
|
Assay of urine sulfate
|
$5.49 |
$5.49 |
$5.49 |
$52.20
|
|
Assay of urine urobilinogen
|
$6.05 |
$6.05 |
$6.05 |
$6.05
|
|
Assay of urine urobilinogen
|
$9.55 |
$9.55 |
$9.55 |
$9.55
|
|
Assay phosphatidylglycerol
|
$16.52 |
$16.52 |
$16.52 |
$16.52
|
|
Assay phosphohexose enzymes
|
$10.73 |
$10.73 |
$10.73 |
$130.20
|
|
Assay rbc glutathione
|
$9.44 |
$9.44 |
$9.44 |
$9.44
|
|
Assay toxin or antitoxin
|
$19.74 |
$19.74 |
$19.74 |
$110.40
|
|
Asses tinnit/pitch/loud/match/mask 92625
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Assess aphasia/interp/rpt/per hr 96105
|
$124.17 |
$124.17 |
$124.17 |
$449.40
|
|
Assess care plan pt w/cog impair 99483
|
$92.50 |
$92.50 |
$92.50 |
$92.50
|
|
Assessment leukocyte fecal qualitative/semiquantitative
|
$4.27 |
$4.27 |
$4.27 |
$45.00
|
|
Assist oocyte fertilization
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Assist oocyte fertilization
|
$816.90 |
$816.90 |
$816.90 |
$816.90
|
|
Assistive tech assessment, ot
|
$48.65 |
$48.65 |
$48.65 |
$48.65
|
|
Ast/sgot
|
$5.18 |
$5.18 |
$5.18 |
$41.25
|
|
Atezolizumab 60 mg/ml intravenous solution (wrapper)
|
$91.02 |
$91.02 |
$91.02 |
$273.60
|
|
Athrectomy fem/pop/unilateral 37225
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$34,695.00
|
|
Athrectomy tib/pero/unilat/ini ves 37229
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$17,956.72
|
|
Atomic absorption
|
$15.90 |
$15.90 |
$15.90 |
$15.90
|
|
Attach ocular implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Aud brainstem implt programg
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Audiometry air + bone
|
$156.46 |
$156.46 |
$156.46 |
$138.00
|
|
Auditory function 60 min
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Augmentation cheek bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Augmentation lower jaw bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Augmentation lower jaw bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Augmentation of facial bones
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$9,145.50
|
|
Autgrft implnt knee w/scope
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Autochondrocyte implant knee
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Autoimmune rheumatoid arthr anl 12 mrk ia
|
$840.65 |
$840.65 |
$840.65 |
$802.50
|
|
Autolog prp diab wound ulcer
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Autolog prp not diab ulcer
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Autologous blood op salvage
|
$816.90 |
$816.90 |
$816.90 |
$240.00
|
|
Autologous blood process
|
$171.36 |
$171.36 |
$171.36 |
$276.00
|
|
Automated diff wbc count
|
$6.47 |
$6.47 |
$6.47 |
$32.40
|
|
Autonomic nrv adrenrg inervj
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Autonomic nrv parasym inervj
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Autonomic nrv syst funj test
|
$128.90 |
$128.90 |
$128.90 |
$604.80
|
|
Av fistula revision
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Av fuse uppr arm basilic
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Av fuse uppr arm cephalic
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Av fusion direct any site
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Av fusion/forearm vein 36820
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Avelumab 20 mg/ml intravenous solution
|
$100.30 |
$100.30 |
$100.30 |
$231.00
|
|
Avulsion nail plate partial/complete simple single nail plate
|
$198.70 |
$198.70 |
$198.70 |
$417.00
|
|
Axatilimab-csfr 22 mg/0.44ml soln 0.44 ml vial
|
$54.08 |
$54.08 |
$54.08 |
$100.20
|
|
Axicabtagene ciloleucel car+
|
$533,076.48 |
$533,076.48 |
$533,076.48 |
$1,861,987.05
|
|
Axillary lymphadenect/superficial 38740
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Azathioprine parenteral
|
$224.97 |
$224.97 |
$224.97 |
$771.30
|
|
B cells total count
|
$37.73 |
$37.73 |
$37.73 |
$112.80
|
|
B-hexosaminidase ea assay
|
$16.87 |
$16.87 |
$16.87 |
$104.25
|
|
Baclofen 2,000 mcg/ml intrathecal solution (wrapper)
|
$175.82 |
$175.82 |
$175.82 |
$1,459.20
|
|
Baclofen eval charges
|
$42.65 |
$42.65 |
$42.65 |
$118.20
|
|
Bacterial meningitis antigen
|
$11.54 |
$11.54 |
$11.54 |
$100.80
|
|
Bacterial vaginosis pcr
|
$70.20 |
$70.20 |
$70.20 |
$336.00
|
|
Bactericidal level serum
|
$15.02 |
$15.02 |
$15.02 |
$15.02
|
|
Bartholin gland cyst/marsupializat 56440
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Bartonella dna pcr-sendout
|
$35.09 |
$35.09 |
$35.09 |
$671.40
|
|
Basic vestibular evaluation
|
$156.46 |
$156.46 |
$156.46 |
$462.60
|
|
Basiliximab
|
$4,672.47 |
$4,672.47 |
$4,672.47 |
$7,420.80
|
|
Bckdhb gene
|
$94.99 |
$94.99 |
$94.99 |
$94.99
|
|
Behavior counsel obesity 15min medicare g0447
|
$92.50 |
$92.50 |
$92.50 |
$20.40
|
|
Belatacept 250 mg intravenous solution
|
$3.89 |
$3.89 |
$3.89 |
$3,406.85
|
|
Belimumab 120 mg intravenous solution
|
$56.01 |
$56.01 |
$56.01 |
$7,881.60
|
|
Bendamustine 100 mg intravenous powder for solution
|
$1.85 |
$1.85 |
$1.85 |
$56.40
|
|
Bendamustine 25 mg/ml intravenous solution (belrapzo)
|
$11.99 |
$11.99 |
$11.99 |
$11.99
|
|
Bendamustine 25 mg/ml intravenous solution (bendeka)
|
$13.12 |
$13.12 |
$13.12 |
$87.00
|
|
Bendamustine 25 mg/ml intravenous solution (vivimusta)
|
$28.06 |
$28.06 |
$28.06 |
$28.06
|
|
Benign lesion paring 2-4
|
$198.70 |
$198.70 |
$198.70 |
$295.50
|
|
Benign lesion paring 4+
|
$198.70 |
$198.70 |
$198.70 |
$368.25
|
|
Beta 2 glycoprotein 1 antibody iga
|
$25.45 |
$25.45 |
$25.45 |
$133.50
|
|
Beta-2 microglobulin
|
$16.18 |
$16.18 |
$16.18 |
$91.80
|
|
Bevacizumab 25 mg/ml intravenous solution
|
$73.05 |
$73.05 |
$73.05 |
$2,946.69
|
|
Bevacizumab injection
|
$1.83 |
$1.83 |
$1.83 |
$1.83
|
|
Bevacizumab-awwb 25 mg/ml intravenous solution
|
$28.85 |
$28.85 |
$28.85 |
$3,154.20
|
|
Bevacizumab-bvzr 25 mg/ml intravenous solution
|
$23.93 |
$23.93 |
$23.93 |
$162.60
|
|
Bfb train 1st 15min cntct 90912
|
$55.62 |
$55.62 |
$55.62 |
$55.62
|
|
Bfb train ea addl 15 min 90913
|
$31.13 |
$31.13 |
$31.13 |
$31.13
|
|
Bilateral n blobk inj pudendal 64430
|
$890.29 |
$890.29 |
$890.29 |
$2,632.20
|
|
Bilateral n block inj occipital 64405
|
$295.19 |
$295.19 |
$295.19 |
$951.00
|
|
Bilateral n block inj trigeminal 64400
|
$295.19 |
$295.19 |
$295.19 |
$885.75
|
|
Bile acids cholylglycine
|
$26.58 |
$26.58 |
$26.58 |
$26.58
|
|
Biliary endo perq dx w/speci
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,068.25
|
|
Biliary endoscopy thru skin
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$4,690.50
|
|
Biliary endoscopy thru skin
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Biliary endoscopy thru skin
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Biliary endoscopy thru skin
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,068.25
|
|
Bilicheck
|
$5.02 |
$5.02 |
$5.02 |
$25.20
|
|
Bilirubin direct
|
$5.02 |
$5.02 |
$5.02 |
$58.80
|
|
Bilirubin total
|
$5.02 |
$5.02 |
$5.02 |
$48.00
|
|
Biofeedback, pt
|
$25.17 |
$25.17 |
$25.17 |
$189.00
|
|
Biopsy abdominal mass
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,704.60
|
|
Biopsy arm/elbow soft tissue
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Biopsy bone trocar/needle superficial
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,629.60
|
|
Biopsy cervixsingle/multiple 57500
|
$870.74 |
$870.74 |
$870.74 |
$7,461.60
|
|
Biopsy conjunctiva
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Biopsy external ear 69100
|
$232.22 |
$232.22 |
$232.22 |
$876.00
|
|
Biopsy eye muscle
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Biopsy eyelid & lid margin
|
$298.93 |
$298.93 |
$298.93 |
$576.00
|
|
Biopsy finger joint lining
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Biopsy finger joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy forearm soft tissues
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Biopsy hand joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy knee joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy lower leg soft tissue
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,128.40
|
|
Biopsy lower leg soft tissue 27610
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy muscle percutaneous needle
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,629.60
|
|
Biopsy needle liver percutaneous
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,642.50
|
|
Biopsy needle lymph node superficial
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,533.00
|
|
Biopsy of cornea
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Biopsy of epididymis
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Biopsy of foot joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy of foot joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy of heart lining
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Biopsy of hip joint
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Biopsy of inestine 44100
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Biopsy of lip 40490
|
$232.22 |
$232.22 |
$232.22 |
$529.20
|
|
Biopsy of nail unit 11755
|
$703.59 |
$703.59 |
$703.59 |
$2,493.60
|
|
Biopsy of nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Biopsy of ovary(s) 58900
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$2,203.50
|
|
Biopsy of penis
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Biopsy of penis 54100
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,978.20
|
|
Biopsy of prostate
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Biopsy of prostate
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Biopsy of rectum wall anal approach 45100
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Biopsy of sacroiliac joint
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Biopsy of salivary gland 42400
|
$703.59 |
$703.59 |
$703.59 |
$1,175.20
|
|
Biopsy of salivary glnd;incisional 42405
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Biopsy of tear gland
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Biopsy of tear sac
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Biopsy of testis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Biopsy of testis
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Biopsy of toe joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy of upper nose/throat
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Biopsy of urethra
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Biopsy of wrist joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy oocyte polar body
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Biopsy oocyte polar body <=5
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Biopsy renal percutaneous trocar/needle (both sides)
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,717.20
|
|
Biopsy roof of mouth
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,404.00
|
|
Biopsy skin incisional single lesion
|
$612.13 |
$612.13 |
$612.13 |
$639.00
|
|
Biopsy thigh soft tissues
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Biopsy tongue anterior two-thirds
|
$509.25 |
$509.25 |
$509.25 |
$1,829.25
|
|
Biopsy vaginal mucosa xtnsv
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Biopsy vestibule of mouth 40808
|
$509.25 |
$509.25 |
$509.25 |
$981.00
|
|
Biopsy vrt bdy open lmbr/crv
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Biopsy vrt bdy open thoracic
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides)
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$1,745.40
|
|
Biopsy, bone open deep
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$3,819.60
|
|
Biopsy/excision of lymph node(s); open deep 38530
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Biopsy/removal lymph nodes
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,913.50
|
|
Biopsy/removal lymph nodes 38520
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Biopsy/soft tissue/neck or thorax 21550
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,512.20
|
|
Biospy of bladder
|
$243.21 |
$243.21 |
$243.21 |
$141.00
|
|
Biotinidase - quest
|
$16.87 |
$16.87 |
$16.87 |
$221.40
|
|
Bis xtracell fluid analysis
|
$156.46 |
$156.46 |
$156.46 |
$147.75
|
|
Bladder irrigate/lavage/instill 51700
|
$243.21 |
$243.21 |
$243.21 |
$664.20
|
|
Bld exchange truj oth thn nb
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Bld prd mix
|
$171.36 |
$171.36 |
$171.36 |
$140.25
|
|
Bld push tfuj 2 yr/<
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Blepharoplasty lower 15820
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Blepharoplasty upper 15822
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Blepharoplasty upper eyelid 15823
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Blepharp lwr eyelid fat pad
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Blinatumomab 35 mcg intravenous solution
|
$163.21 |
$163.21 |
$163.21 |
$417.00
|
|
Blind cor sinus reducer impl
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$11,340.57
|
|
Blind interatrial shunt ide
|
$17,500.50 |
$17,500.50 |
$17,500.50 |
$17,500.50
|
|
Blind myocar trpl bon marrow
|
$17,500.50 |
$17,500.50 |
$17,500.50 |
$17,500.50
|
|
Blind/nonblind trans atrial
|
$9,750.50 |
$9,750.50 |
$9,750.50 |
$9,750.50
|
|
Blinded conv. tx mdd clin tr
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Blink reflex test
|
$59.40 |
$59.40 |
$59.40 |
$310.20
|
|
Blm gene
|
$39.31 |
$39.31 |
$39.31 |
$663.60
|
|
Block brachial plexus w/cath plmt w/img
|
$890.29 |
$890.29 |
$890.29 |
$1,657.20
|
|
Block femoral nerve cont infusion cath w/img
|
$890.29 |
$890.29 |
$890.29 |
$1,381.20
|
|
Block paracervical nrv
|
$692.52 |
$692.52 |
$692.52 |
$982.50
|
|
Block plantar digital nerve
|
$295.19 |
$295.19 |
$295.19 |
$491.40
|
|
Blood Clotting (PT/INR) Test
|
$4.29 |
$4.29 |
$4.29 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$6.01 |
$6.01 |
$6.01 |
$64.35
|
|
Blood Count (CBC) Test
|
$7.77 |
$7.77 |
$7.77 |
$66.75
|
|
Blood Count (CBC) Test (without differential)
|
$6.47 |
$6.47 |
$6.47 |
$56.55
|
|
Blood Culture Test
|
$10.32 |
$10.32 |
$10.32 |
$112.20
|
|
Blood count spun microhematocrit
|
$7.00 |
$7.00 |
$7.00 |
$7.00
|
|
Blood gases o2 saturation direct measurement
|
$78.77 |
$78.77 |
$78.77 |
$225.75
|
|
Blood gases ph venous
|
$11.00 |
$11.00 |
$11.00 |
$60.00
|
|
Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic
|
$15.92 |
$15.92 |
$15.92 |
$32.40
|
|
Blood occult feces 1-3 determinations other than neoplasm screening qualitative
|
$4.23 |
$4.23 |
$4.23 |
$20.40
|
|
Blood occult feces colorectal neoplasm screening qualitative
|
$4.38 |
$4.38 |
$4.38 |
$20.40
|
|
Blood occult peroxidase activity qualitative gastric
|
$5.32 |
$5.32 |
$5.32 |
$32.40
|
|
Blood smear microscopic w manual differential wbc count
|
$3.80 |
$3.80 |
$3.80 |
$59.40
|
|
Blood split unit
|
$141.80 |
$141.80 |
$141.80 |
$247.80
|
|
Blood typing abo
|
$128.90 |
$128.90 |
$128.90 |
$41.40
|
|
Blood typing ag donor ea ag
|
$359.72 |
$359.72 |
$359.72 |
$102.00
|
|
Blood typing patient serum
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Blood typing rbc ag non abo/rh ea
|
$359.72 |
$359.72 |
$359.72 |
$84.60
|
|
Blood typing rh (d)
|
$39.25 |
$39.25 |
$39.25 |
$57.00
|
|
Blood typing rh phenotype complete reference
|
$39.25 |
$39.25 |
$39.25 |
$53.25
|
|
Blood volume
|
$538.27 |
$538.27 |
$538.27 |
$1,284.00
|
|
Blood, l/r, irradiated
|
$84.17 |
$84.17 |
$84.17 |
$438.60
|
|
Bone Density Scan (DEXA)
|
$106.34 |
$106.34 |
$106.34 |
$398.56
|
|
Bone biopsy open superficial
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$5,396.40
|
|
Bone imaging multiple areas
|
$401.83 |
$401.83 |
$401.83 |
$1,168.20
|
|
Bone marrow biopsyneedle/trocar 38221
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,200.00
|
|
Bone marrow harvest allogen
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$91,568.25
|
|
Bone marrow harvest autolog
|
$4,685.17 |
$4,685.17 |
$4,685.17 |
$4,685.17
|
|
Bone marrow imaging body
|
$401.83 |
$401.83 |
$401.83 |
$2,315.40
|
|
Bone marrow imaging ltd
|
$401.83 |
$401.83 |
$401.83 |
$745.20
|
|
Bone marrow imaging mult
|
$401.83 |
$401.83 |
$401.83 |
$1,090.80
|
|
Bone marrow interpretation
|
$816.90 |
$816.90 |
$816.90 |
$304.00
|
|
Bone marrow;aspiration only 38220
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,253.25
|
|
Bone survey-lead poisoning
|
$106.34 |
$106.34 |
$106.34 |
$619.50
|
|
Bone/joint imaging ltd area
|
$401.83 |
$401.83 |
$401.83 |
$857.40
|
|
Bone/skin graft great toe
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Bone/skin graft metatarsal
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Borrelia antibody
|
$13.38 |
$13.38 |
$13.38 |
$176.40
|
|
Borrelia burgdorferi (lyme disease) antibody nonspecific
|
$17.03 |
$17.03 |
$17.03 |
$94.80
|
|
Borrelia miyamotoi amp prb
|
$35.09 |
$35.09 |
$35.09 |
$290.40
|
|
Bowel imaging
|
$401.83 |
$401.83 |
$401.83 |
$1,365.75
|
|
Brachioplasty 15836
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Brachy source i-125 injection
|
$37.04 |
$37.04 |
$37.04 |
$37.04
|
|
Brachy source iodine-125 nonstranded
|
$35.11 |
$35.11 |
$35.11 |
$35.11
|
|
Brachy source palladium
|
$69.69 |
$69.69 |
$69.69 |
$69.69
|
|
Brachy source palladium-103 nonstranded
|
$79.77 |
$79.77 |
$79.77 |
$79.77
|
|
Brachy source yttrium-90
|
$17,485.10 |
$17,485.10 |
$17,485.10 |
$37,851.00
|
|
Brachy src nonstrand c-131
|
$96.56 |
$96.56 |
$96.56 |
$96.56
|
|
Brachy src nonstrand hdr ir-192
|
$342.39 |
$342.39 |
$342.39 |
$1,164.60
|
|
Brachy src stranded c-131
|
$107.86 |
$107.86 |
$107.86 |
$107.86
|
|
Brachytx isodose complex
|
$366.07 |
$366.07 |
$366.07 |
$984.60
|
|
Brachytx isodose intermed
|
$366.07 |
$366.07 |
$366.07 |
$384.00
|
|
Brachytx isodose plan simple
|
$366.07 |
$366.07 |
$366.07 |
$817.20
|
|
Braf gene
|
$175.40 |
$175.40 |
$175.40 |
$349.20
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,604.00
|
|
Brain MRA (blood vessel MRI, with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$1,998.00
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$1,790.00
|
|
Brain MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,884.20
|
|
Brain MRI (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$1,825.59
|
|
Brain flow imaging only
|
$538.27 |
$538.27 |
$538.27 |
$627.00
|
|
Brain image 4+ views
|
$538.27 |
$538.27 |
$538.27 |
$1,015.80
|
|
Brain image < 4 views
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Brain image w/flow 4 + views
|
$538.27 |
$538.27 |
$538.27 |
$1,138.20
|
|
Brain image w/flow < 4 views
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Brca1 dna gene analy known fam var
|
$375.25 |
$375.25 |
$375.25 |
$235.80
|
|
Brca1 gene full dup/del alys
|
$301.35 |
$301.35 |
$301.35 |
$301.35
|
|
Brca1 gene full seq alys
|
$282.88 |
$282.88 |
$282.88 |
$282.88
|
|
Brca1&2 gen ful dup/del alys
|
$584.23 |
$584.23 |
$584.23 |
$2,287.20
|
|
Brca1&2 gene full seq alys
|
$468.00 |
$468.00 |
$468.00 |
$468.00
|
|
Brca2 dna gene analy full seq analy
|
$185.12 |
$185.12 |
$185.12 |
$185.12
|
|
Brca2 dna gene analy known fam var
|
$375.25 |
$375.25 |
$375.25 |
$235.80
|
|
Brca2 gene full dup/del alys
|
$282.88 |
$282.88 |
$282.88 |
$282.88
|
|
Brcassure ashkenazi panel-sendout
|
$440.00 |
$440.00 |
$440.00 |
$440.00
|
|
Brcassure comprehensive panel-sendout
|
$1,824.88 |
$1,824.88 |
$1,824.88 |
$1,920.00
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,069.25
|
|
Breast augmentation 19325
|
$9,569.05 |
$9,569.05 |
$9,569.05 |
$9,569.05
|
|
Breast punct aspir cyst, bil
|
$703.59 |
$703.59 |
$703.59 |
$845.40
|
|
Breast reconstruction 19357
|
$17,398.35 |
$17,398.35 |
$17,398.35 |
$17,398.35
|
|
Breast reduction
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Breath hydrogen test 91065
|
$156.46 |
$156.46 |
$156.46 |
$333.00
|
|
Breath recording infant
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Breath test analysis c-14
|
$94.41 |
$94.41 |
$94.41 |
$94.41
|
|
Breath tst attain/anal c-14
|
$11.06 |
$11.06 |
$11.06 |
$592.80
|
|
Breathing response hypoxia
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Brentuximab vedotin 50 mg intravenous solution
|
$258.52 |
$258.52 |
$258.52 |
$25,683.00
|
|
Brexucabtagene car pos t
|
$489,720.00 |
$489,720.00 |
$489,720.00 |
$1,475,302.50
|
|
Bronch ebus samplng 1/2 node
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Bronch ebus samplng 3/> node
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$4,214.40
|
|
Bronch thermoplsty 1 lobe
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Bronch thermoplsty 2/> lobes
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$7,765.50
|
|
Bronch w/balloon occlusion
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$7,870.50
|
|
Bronch w/debrdmt subgltc & uppr trach
|
$194.14 |
$194.14 |
$194.14 |
$2,203.80
|
|
Bronch/asp/tracheobronch tree/subs 31646
|
$388.31 |
$388.31 |
$388.31 |
$388.31
|
|
Bronchial allergy tests
|
$530.60 |
$530.60 |
$530.60 |
$573.00
|
|
Bronchial brush biopsy
|
$388.31 |
$388.31 |
$388.31 |
$388.31
|
|
Bronchial challenge
|
$311.40 |
$311.40 |
$311.40 |
$761.40
|
|
Bronchial valve init insert
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Bronchial valve remov addl
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,639.50
|
|
Bronchial valve remov init
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,618.00
|
|
Bronchoscopy bronch stents
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Bronchoscopy clear airways 31645
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,487.00
|
|
Bronchoscopy dilate w/stent
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,768.75
|
|
Bronchoscopy dilate/fx repr
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Bronchoscopy revise stent
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$3,515.40
|
|
Bronchoscopy treat blockage
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Bronchoscopy w/biopsy(s) 31625
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,168.40
|
|
Bronchoscopy w/fb removal 31635
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$3,279.00
|
|
Bronchoscopy w/markers
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Bronchoscopy w/tumor excise
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Bronchoscopy/lung bx each 31628
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Bronchoscopy/needle bx each 31629
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,846.60
|
|
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr
|
$0.61 |
$0.61 |
$0.61 |
$8.20
|
|
Bundle his recording
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$5,625.00
|
|
Bundled special stain group 1 microorganisms
|
$53.43 |
$53.43 |
$53.43 |
$116.40
|
|
Bundled special stain group 2
|
$128.90 |
$128.90 |
$128.90 |
$131.25
|
|
Bupivacaine implant, 1 mg
|
$2.64 |
$2.64 |
$2.64 |
$2.64
|
|
Buprenorph X-ray 100 mg or less
|
$1,976.55 |
$1,976.55 |
$1,976.55 |
$7,360.99
|
|
Buprenorphine X-ray over 100 mg
|
$1,976.55 |
$1,976.55 |
$1,976.55 |
$7,360.99
|
|
Busulfan injection
|
$1.84 |
$1.84 |
$1.84 |
$783.10
|
|
Buttock fasciotomy
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Buttock fasciotomy w/dbrdmt
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Bx arm/elbow soft tissue supf 24065
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bx bone trocar/ndl deep
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,179.80
|
|
Bx breast 1st lesion mr imag
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,955.75
|
|
Bx breast 1st lesion strtctc
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,438.75
|
|
Bx breast perq without image 19100
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,748.25
|
|
Bx breast pq tomo guide
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Bx leg/ankle soft tissue deep 27614
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Bx muscle
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$250.80
|
|
Bx nasopharynx/unknown pri lesion 42806
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Bx of breast open 19101
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Bx of cervix w/scope leep 57460
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,876.00
|
|
Bx pancreas pq ndl
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,900.50
|
|
Bx perianal mass
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Bx pleura pq ndl
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bx prst8 ndl sat sampling
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Bx shoulder tissues deep 23066
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Bx shoulder tissues supf 23065
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bx soft tiss pelvis+hip area supf 27040
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bx soft tiss pelvis/hip deep 27041
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,352.80
|
|
Bx soft tissue back/flank deep 21925
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bx soft tissue back/flank supf 21920
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bx spinal cord pq ndl
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bx thigh/knee soft tiss supf 27323
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,566.00
|
|
Bx thyroid/percutan core needle 60100
|
$703.59 |
$703.59 |
$703.59 |
$979.50
|
|
Bx vag mucos smpl (sep proc)
|
$870.74 |
$870.74 |
$870.74 |
$966.60
|
|
Bx vulva or perineum/1 lesion 56605
|
$870.74 |
$870.74 |
$870.74 |
$2,765.25
|
|
Bx/curett of cervix w/scope 57454
|
$304.19 |
$304.19 |
$304.19 |
$785.40
|
|
Bx/exc lymph node/open/deep cervic 38510
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$1,159.20
|
|
Bx/exc lymph node/open/superfic 38500
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Bx/soft tis/forearm/wrist/superfic 25065
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Bypass temp external fem-fem
|
$618.26 |
$618.26 |
$618.26 |
$2,349.00
|
|
C motor evoked lwr limbs
|
$530.60 |
$530.60 |
$530.60 |
$457.80
|
|
C motor evoked uppr limbs
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$429.00
|
|
C motor evoked upr&lwr limbs
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$780.00
|
|
C-1 esterase, berinert
|
$75.86 |
$75.86 |
$75.86 |
$156.00
|
|
C-1 esterase, cinryze
|
$65.73 |
$65.73 |
$65.73 |
$5,831.40
|
|
C-kit mutation liquid tumor - sendout
|
$329.51 |
$329.51 |
$329.51 |
$4,054.80
|
|
C-lens fitg corneosclrl lens
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
C-lens fitg tech aphakia 1
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
C-lens fitg tech aphakia ou
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
C-lens fitg tech corneosclrl
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
C-peptide
|
$20.81 |
$20.81 |
$20.81 |
$156.60
|
|
C-reactive protein
|
$5.18 |
$5.18 |
$5.18 |
$126.00
|
|
C-reactive protein high sensitivity
|
$12.95 |
$12.95 |
$12.95 |
$129.00
|
|
C-reactive protein, quantitative
|
$10.64 |
$10.64 |
$10.64 |
$138.00
|
|
C1 esterase inhibitor func - sendout
|
$12.00 |
$12.00 |
$12.00 |
$132.75
|
|
CT Angiogram of Abdomen and Pelvis
|
$357.13 |
$357.13 |
$357.13 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$178.02 |
$178.02 |
$178.02 |
$2,094.23
|
|
CT Angiogram of the Head
|
$178.02 |
$178.02 |
$178.02 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$3,630.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$3,180.75
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$2,418.75
|
|
CT angio hrt w/3d image
|
$357.13 |
$357.13 |
$357.13 |
$2,243.25
|
|
CT angio pelvis
|
$178.02 |
$178.02 |
$178.02 |
$2,494.20
|
|
CT bone density axial
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
CT colonography dx
|
$106.34 |
$106.34 |
$106.34 |
$2,139.00
|
|
CT colonography dx w/dye
|
$178.02 |
$178.02 |
$178.02 |
$2,860.20
|
|
CT colonography screening
|
$241.72 |
$241.72 |
$241.72 |
$689.40
|
|
CT guid cryo ablat intramuscular
|
$239.88 |
$239.88 |
$239.88 |
$879.75
|
|
CT heart w/evaluation of calcium without contrast
|
$88.05 |
$88.05 |
$88.05 |
$120.00
|
|
CT hrt c+ strux cgen hrt ds
|
$357.13 |
$357.13 |
$357.13 |
$2,418.75
|
|
CT hrt w/3d image
|
$357.13 |
$357.13 |
$357.13 |
$2,883.00
|
|
CT limited or localized follow-up study
|
$88.05 |
$88.05 |
$88.05 |
$654.40
|
|
CT lower extremity w/contrast (both sides)
|
$178.02 |
$178.02 |
$178.02 |
$1,619.25
|
|
CT lower extremity without contrast (both sides)
|
$106.34 |
$106.34 |
$106.34 |
$1,471.50
|
|
CT lwr extremity w/o&w/dye
|
$178.02 |
$178.02 |
$178.02 |
$1,983.75
|
|
CT neck soft tissue w/contrast
|
$178.02 |
$178.02 |
$178.02 |
$1,953.00
|
|
CT neck soft tissue without & w/contrast
|
$178.02 |
$178.02 |
$178.02 |
$2,149.50
|
|
CT neck soft tissue without contrast
|
$106.34 |
$106.34 |
$106.34 |
$1,689.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$178.02 |
$178.02 |
$178.02 |
$1,834.50
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$106.34 |
$106.34 |
$106.34 |
$1,623.00
|
|
CT orbit/sella/fossa w/wo contrast
|
$178.02 |
$178.02 |
$178.02 |
$1,923.00
|
|
CT t-spine w /wo contrast
|
$178.02 |
$178.02 |
$178.02 |
$2,228.25
|
|
CT thoracic spine w/contrast
|
$178.02 |
$178.02 |
$178.02 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$106.34 |
$106.34 |
$106.34 |
$1,473.75
|
|
CT thorax low dose for lung screening without contrast
|
$106.34 |
$106.34 |
$106.34 |
$253.20
|
|
CT upper extremity w/contrast (both sides)
|
$357.13 |
$357.13 |
$357.13 |
$1,764.00
|
|
CT upper extremity without contrast (both sides)
|
$106.34 |
$106.34 |
$106.34 |
$1,518.75
|
|
CT uppr extremity w/o&w/dye
|
$178.02 |
$178.02 |
$178.02 |
$2,785.80
|
|
Ca screen;flexi sigmoidscope
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Cabazitaxel 10 mg/ml (first dilution) intravenous solution
|
$227.10 |
$227.10 |
$227.10 |
$495.60
|
|
Cabotegravir ER 400 mg/2 ml-rilpivirine ER 600 mg/2ml im suspension,er
|
$23.63 |
$23.63 |
$23.63 |
$23.63
|
|
Cacna1a gene full gene seq
|
$846.27 |
$846.27 |
$846.27 |
$635.25
|
|
Cadd pump refill
|
$210.69 |
$210.69 |
$210.69 |
$210.69
|
|
Calcitonin (salmon) 200 unit/ml injection solution
|
$835.80 |
$835.80 |
$835.80 |
$9,437.60
|
|
Calcium 24 hour urine
|
$6.03 |
$6.03 |
$6.03 |
$78.60
|
|
Calcium ionized
|
$13.68 |
$13.68 |
$13.68 |
$107.40
|
|
Calcium total
|
$5.16 |
$5.16 |
$5.16 |
$39.60
|
|
Calculi urinary-sendout
|
$12.87 |
$12.87 |
$12.87 |
$12.87
|
|
Calculus analysis qual
|
$11.58 |
$11.58 |
$11.58 |
$11.58
|
|
Caloric vstblr test w/rec
|
$156.46 |
$156.46 |
$156.46 |
$465.75
|
|
Calprotectin fecal
|
$19.63 |
$19.63 |
$19.63 |
$250.20
|
|
Campylobacter antibody
|
$13.12 |
$13.12 |
$13.12 |
$93.60
|
|
Canakinumab injection
|
$141.00 |
$141.00 |
$141.00 |
$10,902.60
|
|
Candida dna
|
$20.05 |
$20.05 |
$20.05 |
$197.40
|
|
Candida skin test
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Cannula declotting 36861
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Cantharidin top, applicator
|
$669.59 |
$669.59 |
$669.59 |
$669.59
|
|
Canthotomy 67715
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,709.00
|
|
Capecitabine, oral, 50 mg
|
$0.05 |
$0.05 |
$0.05 |
$8.40
|
|
Capsaicin 8% patch
|
$3.38 |
$3.38 |
$3.38 |
$9.75
|
|
Capsular contracture release
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Capsulotomy mpj ea joint (sep proc)
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Capsulotomy; interphalangeal joint, each joint (separate proc)
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Car ion chnnlpath inc 10 gns
|
$584.90 |
$584.90 |
$584.90 |
$584.90
|
|
Car ion chnnlpath inc 2 gns
|
$584.90 |
$584.90 |
$584.90 |
$584.90
|
|
Car seat/bed test 60 minutes
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Car-t admn autologous
|
$331.69 |
$331.69 |
$331.69 |
$828.60
|
|
Carbamazepine free
|
$13.25 |
$13.25 |
$13.25 |
$117.00
|
|
Carbamazepine free -sendout
|
$18.64 |
$18.64 |
$18.64 |
$168.75
|
|
Carbamazepine total therapeutic drug level
|
$14.57 |
$14.57 |
$14.57 |
$113.25
|
|
Carbidopa levodopa ent 100ml
|
$243.15 |
$243.15 |
$243.15 |
$243.15
|
|
Carbohydrate deficient transf - sendout
|
$18.06 |
$18.06 |
$18.06 |
$111.60
|
|
Carbohydrate urine - sendout
|
$5.50 |
$5.50 |
$5.50 |
$30.60
|
|
Carbon dioxide
|
$4.88 |
$4.88 |
$4.88 |
$39.60
|
|
Carboxyhemoglobin quantitative
|
$12.32 |
$12.32 |
$12.32 |
$102.00
|
|
Carcinoembryonic ag (cea)
|
$18.96 |
$18.96 |
$18.96 |
$144.75
|
|
Cardiac MRI seg dys strain
|
$548.30 |
$548.30 |
$548.30 |
$548.30
|
|
Cardiac MRI seg dys stress
|
$548.30 |
$548.30 |
$548.30 |
$548.30
|
|
Cardiac MRI w/stress img
|
$548.30 |
$548.30 |
$548.30 |
$3,213.60
|
|
Cardiac drug stress test
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Cardiac perf planar mult/ef/wm
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$2,607.75
|
|
Cardiac perf planar sgl/ef/wm
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$3,198.60
|
|
Cardiac perf spect sgl/ef/wm rst/strs
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$3,772.20
|
|
Cardiac rehabilitation op phase 2 w/continous ecg monitoring
|
$125.91 |
$125.91 |
$125.91 |
$218.40
|
|
Cardiac rehabilitation op phase 2 without continous ecg monitoring
|
$125.91 |
$125.91 |
$125.91 |
$106.20
|
|
Cardiac shunt imaging
|
$401.83 |
$401.83 |
$401.83 |
$1,657.80
|
|
Cardiokymography
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Cardiolipin antibody iga
|
$25.45 |
$25.45 |
$25.45 |
$186.60
|
|
Cardioversion elective electrical conversion arrhythmia external
|
$654.38 |
$654.38 |
$654.38 |
$1,461.75
|
|
Cardioversion/elective/internal 92961
|
$654.38 |
$654.38 |
$654.38 |
$865.20
|
|
Caregiver training strategies&tq 1st 30 minutes
|
$61.33 |
$61.33 |
$61.33 |
$105.00
|
|
Caregiver training strategies&tq ea addl 15 min
|
$33.04 |
$33.04 |
$33.04 |
$52.20
|
|
Carfilzomib 10 mg intravenous solution
|
$55.09 |
$55.09 |
$55.09 |
$149.40
|
|
Carmustine 100 mg intravenous powder for solution
|
$173.64 |
$173.64 |
$173.64 |
$2,713.80
|
|
Carotene
|
$9.22 |
$9.22 |
$9.22 |
$85.50
|
|
Carotid Artery Ultrasound (Duplex)
|
$241.72 |
$241.72 |
$241.72 |
$1,059.82
|
|
Carpal Tunnel Release Surgery
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$3,503.75
|
|
Cataract Surgery
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,715.20
|
|
Cataract surg w/iol 1 stage
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Catecholamines,fractionated, urine
|
$27.30 |
$27.30 |
$27.30 |
$226.20
|
|
Cath combo lt&rt heart w/inj/s
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$8,708.40
|
|
Cath left heart/lv gram
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$7,483.80
|
|
Cath plc art ang/grft lt/rt hr
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$11,503.20
|
|
Cath plc art/angio/rt hrt cath
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$8,979.00
|
|
Cath plc art/grft/angio right hrt
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$8,859.00
|
|
Cath right heart w/o2 sat & card
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$4,762.80
|
|
Catheter declot mechanical
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$1,523.25
|
|
Catheter stripping venous
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$5,745.60
|
|
Catheterization collection of specimen single patient all places of service
|
$9.09 |
$9.09 |
$9.09 |
$42.60
|
|
Cathj rmvl dev ischmc rmdlg
|
$243.21 |
$243.21 |
$243.21 |
$243.21
|
|
Cauterization chemical granulation tissue
|
$198.70 |
$198.70 |
$198.70 |
$408.60
|
|
Cauterization of cervix 57510
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Ccnd1/igh translocation alys
|
$207.31 |
$207.31 |
$207.31 |
$207.31
|
|
Cdna analysis for variants
|
$185.20 |
$185.20 |
$185.20 |
$1,792.80
|
|
Cdp-sot 6 cond w/i&r
|
$128.90 |
$128.90 |
$128.90 |
$282.00
|
|
Cdp-sot 6 cond w/i&r mct&adt
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Cebpa gene full sequence
|
$241.90 |
$241.90 |
$241.90 |
$1,686.00
|
|
Ceftaroline fosamil 600 mg intravenous solution
|
$4.24 |
$4.24 |
$4.24 |
$552.60
|
|
Ceftazidime and avibactam
|
$104.95 |
$104.95 |
$104.95 |
$991.80
|
|
Cell count body fluid
|
$4.72 |
$4.72 |
$4.72 |
$60.75
|
|
Cell count w differential body fluid
|
$5.60 |
$5.60 |
$5.60 |
$131.40
|
|
Cell cryopreserve/storage
|
$13.07 |
$13.07 |
$13.07 |
$117.60
|
|
Cell enumeration & id
|
$250.78 |
$250.78 |
$250.78 |
$250.78
|
|
Cell function assay w/stim
|
$135.86 |
$135.86 |
$135.86 |
$898.80
|
|
Cell marker study
|
$53.43 |
$53.43 |
$53.43 |
$212.40
|
|
Cemiplimab-rwlc 50 mg/ml intravenous solution
|
$28.70 |
$28.70 |
$28.70 |
$527.40
|
|
Centralization wrist on ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Centruroides immune f(ab)
|
$4,859.01 |
$4,859.01 |
$4,859.01 |
$4,859.01
|
|
Cerclage of uterine cervix nonob 57700
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Cerebrospinal fld flw imag
|
$538.27 |
$538.27 |
$538.27 |
$1,124.25
|
|
Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit
|
$4.49 |
$4.49 |
$4.49 |
$34.60
|
|
Cervical lymphadenectomy 38720
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Cervical or vaginal cancer screening g0101
|
$92.50 |
$92.50 |
$92.50 |
$123.75
|
|
Cetuximab 100 mg/50 ml intravenous solution
|
$78.47 |
$78.47 |
$78.47 |
$775.20
|
|
Cftr gene dup/delet variants
|
$435.07 |
$435.07 |
$435.07 |
$918.00
|
|
Cftr gene intron poly t
|
$168.75 |
$168.75 |
$168.75 |
$283.80
|
|
Cftr gene known fam variants
|
$97.22 |
$97.22 |
$97.22 |
$321.00
|
|
Change cystostomy tube simple
|
$243.21 |
$243.21 |
$243.21 |
$411.00
|
|
Change cystostomy tube; complex 51710
|
$667.47 |
$667.47 |
$667.47 |
$2,813.40
|
|
Change g-tube to g-j perc
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,534.60
|
|
Change gastric port open
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Change nephroureteral cath
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$3,154.80
|
|
Change of ureter tube/stent
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,397.00
|
|
Change of windpipe airway 31502
|
$232.22 |
$232.22 |
$232.22 |
$472.80
|
|
Change stent via transureth
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Change ureter stent percut
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$4,067.25
|
|
Chct for mal hyperthermia
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Chemical exfoliation acne 17360
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Chemical peel face epiderm 15788
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Chemical peel nonfacial 15793
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Chemical peel nonfacial; epidermal
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Chemo adm cns w/lmbr punct
|
$331.69 |
$331.69 |
$331.69 |
$1,119.00
|
|
Chemo extend IV infus w/pump
|
$331.69 |
$331.69 |
$331.69 |
$696.00
|
|
Chemo ia infuse each addl hr
|
$46.14 |
$46.14 |
$46.14 |
$184.80
|
|
Chemo ia infusion up to 1 hr
|
$331.69 |
$331.69 |
$331.69 |
$335.40
|
|
Chemo ia push tecnique
|
$331.69 |
$331.69 |
$331.69 |
$540.75
|
|
Chemo intralesional over 7
|
$210.69 |
$210.69 |
$210.69 |
$246.75
|
|
Chemo intralesional up to 7 96405
|
$71.17 |
$71.17 |
$71.17 |
$83.25
|
|
Chemodener muscle larynx emg
|
$692.52 |
$692.52 |
$692.52 |
$668.25
|
|
Chemodenerv 1 extrem 5/> mus 64644
|
$692.52 |
$692.52 |
$692.52 |
$692.52
|
|
Chemodenerv 1 extremity 1-4 64642
|
$692.52 |
$692.52 |
$692.52 |
$692.52
|
|
Chemodenerv eccrine glands
|
$295.19 |
$295.19 |
$295.19 |
$295.19
|
|
Chemodenerv eccrine glands 64650
|
$295.19 |
$295.19 |
$295.19 |
$510.00
|
|
Chemodenerv musc migraine 64615
|
$295.19 |
$295.19 |
$295.19 |
$512.25
|
|
Chemodenerv musc neck dyston 64616
|
$295.19 |
$295.19 |
$295.19 |
$819.00
|
|
Chemodenerv saliv glands bilat 64611
|
$295.19 |
$295.19 |
$295.19 |
$358.50
|
|
Chemodenerv trunk musc 1-5 64646
|
$692.52 |
$692.52 |
$692.52 |
$697.20
|
|
Chemodenerv trunk musc 6/] 64647
|
$692.52 |
$692.52 |
$692.52 |
$772.20
|
|
Chemodenervation anal musc
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Chemodenervation nerve of eye muscle 67345
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Chemodenervation/face muscl/unilat 64612
|
$295.19 |
$295.19 |
$295.19 |
$891.75
|
|
Chemotaxis assay
|
$15.99 |
$15.99 |
$15.99 |
$15.99
|
|
Chemotherapy injection 96542
|
$331.69 |
$331.69 |
$331.69 |
$331.69
|
|
Chemotx admn pertl cav impl
|
$331.69 |
$331.69 |
$331.69 |
$642.75
|
|
Chest 2 vws w oblique
|
$106.34 |
$106.34 |
$106.34 |
$419.40
|
|
Chest CT scan (with and without contrast)
|
$178.02 |
$178.02 |
$178.02 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$106.34 |
$106.34 |
$106.34 |
$1,350.03
|
|
Chest X-ray
|
$88.05 |
$88.05 |
$88.05 |
$303.24
|
|
Chest X-ray (single view)
|
$88.05 |
$88.05 |
$88.05 |
$225.00
|
|
Chest apical lordotic proj
|
$88.05 |
$88.05 |
$88.05 |
$405.00
|
|
Chg pr pul rehab for copd patients
|
$59.40 |
$59.40 |
$59.40 |
$134.25
|
|
Chg radiologic exam esophagus double contrast
|
$178.02 |
$178.02 |
$178.02 |
$713.40
|
|
Chimerism anal no cell selec
|
$207.46 |
$207.46 |
$207.46 |
$1,437.75
|
|
Chimerism anal w/cell select
|
$260.79 |
$260.79 |
$260.79 |
$759.75
|
|
Chlamydia culture
|
$19.60 |
$19.60 |
$19.60 |
$109.80
|
|
Chlamydia trachomatis ag if
|
$11.98 |
$11.98 |
$11.98 |
$66.60
|
|
Chlamydia type
|
$5.57 |
$5.57 |
$5.57 |
$42.60
|
|
Chloride
|
$4.60 |
$4.60 |
$4.60 |
$39.60
|
|
Chloride 24 hour urine
|
$5.75 |
$5.75 |
$5.75 |
$60.00
|
|
Chloroprocaine opht gel, 1mg
|
$0.60 |
$0.60 |
$0.60 |
$0.60
|
|
Chmotx admn plrl cav thrcnts
|
$331.69 |
$331.69 |
$331.69 |
$331.69
|
|
Cholangiogram percutaneous compl
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Cholecystostomy complete w/supervision & interpretation
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Cholesterol
|
$4.35 |
$4.35 |
$4.35 |
$40.80
|
|
Cholesterol (Lipid) Test
|
$13.39 |
$13.39 |
$13.39 |
$100.00
|
|
Choline c-11
|
$2,062.94 |
$2,062.94 |
$2,062.94 |
$2,062.94
|
|
Cholinesterase
|
$7.87 |
$7.87 |
$7.87 |
$103.20
|
|
Cholinesterase challenge
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Chorion biopsy
|
$870.74 |
$870.74 |
$870.74 |
$870.74
|
|
Chrom analysis
|
$34.81 |
$34.81 |
$34.81 |
$309.60
|
|
Chromatogram assay sugars
|
$39.00 |
$39.00 |
$39.00 |
$39.00
|
|
Chromatography
|
$18.06 |
$18.06 |
$18.06 |
$178.80
|
|
Chromo high res and frag x - sendout
|
$57.04 |
$57.04 |
$57.04 |
$770.40
|
|
Chromogenic substrate assay
|
$11.89 |
$11.89 |
$11.89 |
$158.40
|
|
Chromosome analys amniotic
|
$173.66 |
$173.66 |
$173.66 |
$173.66
|
|
Chromosome analys placenta
|
$188.57 |
$188.57 |
$188.57 |
$642.00
|
|
Chromosome analysis 100
|
$173.17 |
$173.17 |
$173.17 |
$519.00
|
|
Chromosome analysis 15-20 cell count
|
$125.49 |
$125.49 |
$125.49 |
$988.50
|
|
Chromosome analysis 20-25
|
$173.17 |
$173.17 |
$173.17 |
$173.17
|
|
Chromosome analysis 45
|
$150.29 |
$150.29 |
$150.29 |
$1,109.60
|
|
Chromosome analysis 5
|
$264.34 |
$264.34 |
$264.34 |
$1,046.25
|
|
Chromosome analysis 50-100
|
$173.17 |
$173.17 |
$173.17 |
$519.00
|
|
Chromosome banding study
|
$68.60 |
$68.60 |
$68.60 |
$68.60
|
|
Chromosome count additional
|
$26.91 |
$26.91 |
$26.91 |
$57.00
|
|
Chromosome karyotype study
|
$33.47 |
$33.47 |
$33.47 |
$181.80
|
|
Chromosome study additional
|
$34.43 |
$34.43 |
$34.43 |
$181.50
|
|
Chronic urticaria - sendout
|
$12.46 |
$12.46 |
$12.46 |
$131.40
|
|
Chylomicron screen, bf - sendout
|
$61.50 |
$61.50 |
$61.50 |
$334.80
|
|
Cidofovir injection
|
$529.38 |
$529.38 |
$529.38 |
$1,615.67
|
|
Ciliary transsleral therapy
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$4,288.80
|
|
Ciltacabtagene car-pos t
|
$553,378.83 |
$553,378.83 |
$553,378.83 |
$553,378.83
|
|
Cine/video x-rays
|
$106.34 |
$106.34 |
$106.34 |
$523.20
|
|
Circum 28 days or older
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Circumcise/surg/28 days or < 54160
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Circumcision (newborn)
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$1,549.50
|
|
Cladribine 10 mg/10 ml intravenous solution
|
$9.73 |
$9.73 |
$9.73 |
$355.41
|
|
Claviculectomy partial
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Claviculectomy total
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Clean out mastoid cavity
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Clearance of airways
|
$203.39 |
$203.39 |
$203.39 |
$166.50
|
|
Clearance of tear duct
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Clitoroplasty intersex state
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Clofarabine 1 mg/ml intravenous solution
|
$14.72 |
$14.72 |
$14.72 |
$11,963.49
|
|
Clos txnose fx without stablz 21315
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Close lac/mouth vest/2.5 cm or < 40830
|
$232.22 |
$232.22 |
$232.22 |
$777.60
|
|
Close mastoid fistula
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Close tear duct opening
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Close tear duct opening
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Close tear system fistula
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Closed carpo/metacarpal disl thumb w/manip
|
$239.88 |
$239.88 |
$239.88 |
$273.00
|
|
Closed carpo/metacarpal fx disl thumb w/manip
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,815.75
|
|
Closed tx humerus fx w/manip 24505
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Closed tx humerus fx with manip 23605
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,448.00
|
|
Closed tx humerus fx without manip 23600
|
$239.88 |
$239.88 |
$239.88 |
$447.60
|
|
Closed tx metatarsophalangeal jnt disl without anes
|
$239.88 |
$239.88 |
$239.88 |
$643.20
|
|
Closed tx nose/jaw fx
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Closed tx orbit w/manipulj
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Closed tx orbit without manipulj
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Closed tx post hip arthroplasty disloc w/anes 27266
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,134.50
|
|
Closed tx septal&nose fx
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Closed tx sesamoid fx 28530
|
$239.88 |
$239.88 |
$239.88 |
$525.75
|
|
Closed tx vert fx w/manj
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Closed tx/acetabululm without manip 27220
|
$239.88 |
$239.88 |
$239.88 |
$261.75
|
|
Closed tx/talus fracture without manip 28430
|
$239.88 |
$239.88 |
$239.88 |
$327.60
|
|
Clostridium toxin a w/optic
|
$16.00 |
$16.00 |
$16.00 |
$16.00
|
|
Closure laceration vestibule mouth > 2.5 cm cmplx
|
$509.25 |
$509.25 |
$509.25 |
$1,663.80
|
|
Closure of eyelid by suture
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Closure of salivary fistula
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Closure of windpipe lesion 31820
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Closure paravalvlr leak pq
|
$618.26 |
$618.26 |
$618.26 |
$5,734.80
|
|
Clot factor fletcher fact
|
$18.93 |
$18.93 |
$18.93 |
$231.00
|
|
Clot factor viii reltd antgn
|
$20.42 |
$20.42 |
$20.42 |
$288.00
|
|
Clot factor wght kininogen
|
$18.93 |
$18.93 |
$18.93 |
$320.40
|
|
Clot factor xii hageman
|
$19.35 |
$19.35 |
$19.35 |
$197.60
|
|
Clot factor xiii fibrin scrn
|
$9.11 |
$9.11 |
$9.11 |
$47.25
|
|
Clot factor xiii fibrin stab
|
$16.34 |
$16.34 |
$16.34 |
$97.20
|
|
Cls tx of heel fracture w/manip 28405
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Clsd tx bimalleol ank fx without manip 27808
|
$239.88 |
$239.88 |
$239.88 |
$998.40
|
|
Clsd tx carpo/metacarpl disl thmb manip ea without anes
|
$239.88 |
$239.88 |
$239.88 |
$327.60
|
|
Clsd tx clav dislc without manip 23520
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,055.00
|
|
Clsd tx clavicle dislocation without manip 23540
|
$239.88 |
$239.88 |
$239.88 |
$537.00
|
|
Clsd tx clavicle fracture w/manip 23505
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Clsd tx coccygeal fracture 27200
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Clsd tx dist fib fx w/manip 27788
|
$239.88 |
$239.88 |
$239.88 |
$868.80
|
|
Clsd tx elbow dislocation child 24640
|
$239.88 |
$239.88 |
$239.88 |
$525.75
|
|
Clsd tx finger tendon w/wo perq pin 26432
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Clsd tx fracture of radius 25500
|
$239.88 |
$239.88 |
$239.88 |
$442.50
|
|
Clsd tx fx radius/ulna dist w/manip 25605
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,912.80
|
|
Clsd tx fx radius/ulna dist without manip 25600
|
$239.88 |
$239.88 |
$239.88 |
$520.80
|
|
Clsd tx fx radius/ulna w/manip 25565
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,055.00
|
|
Clsd tx fx radius/ulna without manip 25560
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Clsd tx hip disloc without anes 27265
|
$239.88 |
$239.88 |
$239.88 |
$868.80
|
|
Clsd tx humeral fract without manip 24530
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Clsd tx humerus fract without manip 24500
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Clsd tx iphal jnt disl w/manip req anes
|
$265.58 |
$265.58 |
$265.58 |
$3,964.20
|
|
Clsd tx mandibular fx without manip 21450
|
$509.25 |
$509.25 |
$509.25 |
$961.80
|
|
Clsd tx metacarp fx w/manip&ext fix ea bone 26607
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Clsd tx metatarsal fracture w/manip 28475
|
$239.88 |
$239.88 |
$239.88 |
$647.20
|
|
Clsd tx of ankle fracture w/manip 28435
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,815.75
|
|
Clsd tx patella disloc without anes 27560
|
$239.88 |
$239.88 |
$239.88 |
$998.40
|
|
Clsd tx pelvic ring fx
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Clsd tx pelvic ring fx
|
$239.88 |
$239.88 |
$239.88 |
$1,195.80
|
|
Clsd tx prox fib/shaft fx w/manip 27781
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,614.60
|
|
Clsd tx radius fracture w/manip 24655
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,712.00
|
|
Clsd tx shoulder dislc/fx 23665
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,135.00
|
|
Clsd tx shoulder disloc w/anatom neck fx w/manip 23675
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,073.00
|
|
Clsd tx temporomandibular dislocat 21480
|
$239.88 |
$239.88 |
$239.88 |
$942.60
|
|
Clsd tx toe dislocation without anes28660
|
$239.88 |
$239.88 |
$239.88 |
$520.80
|
|
Clsd tx trimall ankle fx w/manip 27818
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Clsd tx trimall ankle fx without manip 27816
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Clsd tx vert body fx without manip req &w/csting/bracing
|
$239.88 |
$239.88 |
$239.88 |
$756.75
|
|
Clsd tx wrist carpal fx without manip 25630
|
$239.88 |
$239.88 |
$239.88 |
$370.80
|
|
Clsd tx wrist scaphoid fx without manip 25622
|
$239.88 |
$239.88 |
$239.88 |
$520.80
|
|
Clsd tx wrist trans-scaph fx w/manip 25680
|
$239.88 |
$239.88 |
$239.88 |
$597.60
|
|
Clsd tx wrist ulnar styloid fx 25650
|
$239.88 |
$239.88 |
$239.88 |
$672.00
|
|
Clsd tx/clavicular fx without manip 23500
|
$239.88 |
$239.88 |
$239.88 |
$819.60
|
|
Clsd tx/dis phalan fx without manip/ea 26750
|
$239.88 |
$239.88 |
$239.88 |
$370.80
|
|
Clsd tx/dis tib/wt bear no manip 27824
|
$239.88 |
$239.88 |
$239.88 |
$633.60
|
|
Clsd tx/fem shaft fx/manipulation 27502
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,319.00
|
|
Clsd tx/fx grt toe/phalanx/phalang 28490
|
$239.88 |
$239.88 |
$239.88 |
$370.80
|
|
Clsd tx/fx/phalanx/phalang/manip 28515
|
$239.88 |
$239.88 |
$239.88 |
$429.60
|
|
Clsd tx/grt hum tube fx without manip 23620
|
$239.88 |
$239.88 |
$239.88 |
$372.00
|
|
Clsd tx/metacar/interphal artic fx 26740
|
$239.88 |
$239.88 |
$239.88 |
$529.50
|
|
Clsd tx/metacarpal fx/sg without manip 26600
|
$239.88 |
$239.88 |
$239.88 |
$377.25
|
|
Clsd tx/metacarpal fx/sng/w manip 26605
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Clsd tx/metatarsal fx without manip 28470
|
$239.88 |
$239.88 |
$239.88 |
$520.80
|
|
Clsd tx/nasal bone fx/stabilize 21320
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Clsd tx/patellar fx without manip 27520
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Clsd tx/prox/mid phalnx fx/no manp 26720
|
$239.88 |
$239.88 |
$239.88 |
$327.75
|
|
Clsd tx/radial head/neck fx/no manip 24650
|
$239.88 |
$239.88 |
$239.88 |
$434.25
|
|
Clsd tx/scapular fx without manip 23570
|
$239.88 |
$239.88 |
$239.88 |
$496.20
|
|
Clsd tx/shoulder dislo/manip/anest 23655
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,139.60
|
|
Clsd tx/talotarsal dislocat/anes 28575
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Clsd tx/ulnar shaft fx without manip 25530
|
$239.88 |
$239.88 |
$239.88 |
$370.50
|
|
Clsd/shoulder dislo/manip/no anest 23650
|
$239.88 |
$239.88 |
$239.88 |
$856.20
|
|
Clsd/ulnar fx/prox end without manip 24670
|
$239.88 |
$239.88 |
$239.88 |
$494.40
|
|
Cltx carpl scphd fx w/mnpj
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,184.20
|
|
Cltx gr hmrl tbrs fx w/mnpj
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Cltx hum epcndylr fx wo mnpj
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Cltx humrl cndylr fx w/mnpj
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,815.75
|
|
Cltx humrl cndylr fx wo mnpj
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Cltx lunate dislc w/mnpj
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Cltx mndblr fx ntrdntl fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Cltx mndblr fx w/mnpj
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,756.50
|
|
Cltx mndblr/max alv ridge fx
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,600.75
|
|
Cltx palatal/max fx wire fix
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Cltx post ankle fx
|
$239.88 |
$239.88 |
$239.88 |
$333.75
|
|
Cltx post ankle fx w/mnpj
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,198.50
|
|
Cltx scap fx w/mnpj +-tractj
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,450.40
|
|
Cltx strnclav dislc w/mnpj
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Cltx thigh fx
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Cltx tmprmand dislc comp
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Cmbn ant pst colprhy
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Cmptr ophth dx img ant segmt
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Cmptr ophth img optic nerve
|
$59.40 |
$59.40 |
$59.40 |
$97.50
|
|
Cmv pcr-sendout
|
$35.09 |
$35.09 |
$35.09 |
$501.75
|
|
Co-treatment - group 15 mins, st
|
$30.03 |
$30.03 |
$30.03 |
$108.00
|
|
Co2 monitor per day
|
$311.40 |
$311.40 |
$311.40 |
$337.50
|
|
Coagulation factor viia 1,000 mcg/ml inj 1 ml
|
$2.65 |
$2.65 |
$2.65 |
$16,994.46
|
|
Coagulation time activated teg
|
$4.28 |
$4.28 |
$4.28 |
$31.00
|
|
Coagulation time otr method
|
$4.49 |
$4.49 |
$4.49 |
$40.20
|
|
Cochlear implt f/up exam 7/>
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Cochlear implt f/up exam <7
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Cold agglutinin screen (arc)
|
$8.07 |
$8.07 |
$8.07 |
$45.00
|
|
Cold agglutinin titer
|
$8.06 |
$8.06 |
$8.06 |
$85.20
|
|
Collagenase, clost hist inj
|
$73.16 |
$73.16 |
$73.16 |
$26,281.91
|
|
Collection blood specimen from completely implantable venous access device
|
$128.90 |
$128.90 |
$128.90 |
$131.25
|
|
Collection blood specimen using established central/peripheral catheter venous nos
|
$128.90 |
$128.90 |
$128.90 |
$196.00
|
|
Collection of venous blood by venipuncture
|
$9.09 |
$9.09 |
$9.09 |
$20.25
|
|
Colon motility 6 hr study
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Colonoscopy & polypectomy 44392
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$3,114.00
|
|
Colonoscopy (diagnostic)
|
$911.71 |
$911.71 |
$911.71 |
$1,500.00
|
|
Colonoscopy (with biopsy)
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,846.40
|
|
Colonoscopy (with polyp removal)
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,875.00
|
|
Colonoscopy flex w/rem of tumor(s)/polyp(s)/lesion(s) by hot biopsy(s) forceps (rest meth ii cah)
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$3,043.50
|
|
Colonoscopy flex with decompression 45393
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,946.25
|
|
Colonoscopy for bleeding 44391
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,505.60
|
|
Colonoscopy for foreign body
|
$911.71 |
$911.71 |
$911.71 |
$1,861.50
|
|
Colonoscopy stoma w/endo mucosal rescj 44403
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,286.40
|
|
Colonoscopy stoma w/snare 44394
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,854.80
|
|
Colonoscopy submucous njx
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$3,528.00
|
|
Colonoscopy thru stoma spx
|
$911.71 |
$911.71 |
$911.71 |
$1,895.40
|
|
Colonoscopy w/ablation
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,571.00
|
|
Colonoscopy w/balloon dilat
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,876.80
|
|
Colonoscopy w/band ligation
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,495.25
|
|
Colonoscopy w/control bleed
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,352.75
|
|
Colonoscopy w/decompression
|
$911.71 |
$911.71 |
$911.71 |
$2,786.40
|
|
Colonoscopy w/dilation
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,310.00
|
|
Colonoscopy w/endoscope Ultrasound
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$3,201.00
|
|
Colonoscopy w/endoscopic fnb
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$3,201.00
|
|
Colonoscopy w/fb removal
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,431.20
|
|
Colonoscopy w/injection
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,449.20
|
|
Colonoscopy w/ndl aspir/bx
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,439.25
|
|
Colonoscopy w/resection
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,712.75
|
|
Colonoscopy w/stent plcmt
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$4,379.25
|
|
Colonoscopy w/ultrasound
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,439.25
|
|
Colonoscopy with ablation
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,740.00
|
|
Colonoscopy with biopsy
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,788.60
|
|
Colonoscopy/w endoscopic stent 45389
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$4,379.25
|
|
Colpocentesis 57020
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Colpocleisis (le forte type) 57120
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Colpopexy extraperitoneal
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Colpopexy intraperitoneal
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Colpopexy, min/inv, ex-perit
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Colporrhapy/vag injury sut/non ob 57200
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,435.60
|
|
Colposcopy vulva 56820
|
$201.17 |
$201.17 |
$201.17 |
$435.00
|
|
Colposcopy vulva w/biopsy 56821
|
$304.19 |
$304.19 |
$304.19 |
$1,626.60
|
|
Colposcopy w/biopsy of cervix 57455
|
$304.19 |
$304.19 |
$304.19 |
$1,147.50
|
|
Colposcopy/cervix/ conization 57461
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$4,866.75
|
|
Colposcopy/cervix/bx vagina/cervix 57421
|
$870.74 |
$870.74 |
$870.74 |
$1,446.00
|
|
Colposcopy/cervix/inc up/adjacent vag 57452
|
$201.17 |
$201.17 |
$201.17 |
$434.40
|
|
Colpotomy drng of abscess 57010
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Colpotomy w/exploration 57000
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,114.00
|
|
Comp cystometrogram/void presssure 51728
|
$667.47 |
$667.47 |
$667.47 |
$933.75
|
|
Comp cystometrogram/void/uret pres 51729
|
$667.47 |
$667.47 |
$667.47 |
$1,216.50
|
|
Compatibility test each unit antiglobulin technique
|
$171.36 |
$171.36 |
$171.36 |
$179.40
|
|
Compatibility test each unit electronic
|
$171.36 |
$171.36 |
$171.36 |
$131.25
|
|
Compatibility test each unit immediate spin technique
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Compatibility test incubate
|
$171.36 |
$171.36 |
$171.36 |
$1.20
|
|
Compl oph exam general anes
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Complement antigen each component c3
|
$12.00 |
$12.00 |
$12.00 |
$148.20
|
|
Complement fixation each
|
$10.01 |
$10.01 |
$10.01 |
$84.60
|
|
Complete removal of vulva
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Complex cystometrogram 51726
|
$243.21 |
$243.21 |
$243.21 |
$243.21
|
|
Complex repair trunk 1.1-2.5cm 13120
|
$612.13 |
$612.13 |
$612.13 |
$1,919.40
|
|
Complex repair trunk 2.6-7.5cm 13101
|
$612.13 |
$612.13 |
$612.13 |
$2,172.00
|
|
Complex uroflowmetry (electronic) 51741
|
$311.40 |
$311.40 |
$311.40 |
$607.50
|
|
Complx repair enel 1.1-2.5 cm 13151
|
$612.13 |
$612.13 |
$612.13 |
$2,929.50
|
|
Complx repair enel 2.6-7.5 cm 13152
|
$612.13 |
$612.13 |
$612.13 |
$2,938.80
|
|
Complx repair fccmnaxghf 13131
|
$399.53 |
$399.53 |
$399.53 |
$2,172.00
|
|
Complx repair fccmnaxghf 13132
|
$612.13 |
$612.13 |
$612.13 |
$2,172.00
|
|
Complx repair trunk 1.1-2.5 cm 13100
|
$612.13 |
$612.13 |
$612.13 |
$3,769.20
|
|
Composite graft/pri close/don area 15760
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,734.40
|
|
Compre oph exam est pt 1/>
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Compre oph exam new pt 1/>
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Comprehensive hearing test
|
$156.46 |
$156.46 |
$156.46 |
$190.50
|
|
Concentration infection agents any type
|
$6.68 |
$6.68 |
$6.68 |
$42.00
|
|
Conditioning play audiometry 92582
|
$156.46 |
$156.46 |
$156.46 |
$123.00
|
|
Condylomata destruction 56420
|
$201.17 |
$201.17 |
$201.17 |
$831.60
|
|
Conization of cervix
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,577.50
|
|
Conization/cerv/loop electrode exc 57522
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$4,198.50
|
|
Conjugated estrogens 25 mg solution for injection
|
$390.74 |
$390.74 |
$390.74 |
$1,291.95
|
|
Constj trachesophgl fstl
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Construct thumb replacement
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Construct vagina with graft
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Construction of vagina
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Consult comp w/report rfrd material
|
$171.36 |
$171.36 |
$171.36 |
$212.80
|
|
Consultation pathology during surgery
|
$59.40 |
$59.40 |
$59.40 |
$141.75
|
|
Consultation pathology during surgery cytological exam initial site
|
$816.90 |
$816.90 |
$816.90 |
$213.60
|
|
Consultation pathology during surgery frozen section first tissue block
|
$171.36 |
$171.36 |
$171.36 |
$245.40
|
|
Consultation/report referred material w/preparation of slides
|
$53.43 |
$53.43 |
$53.43 |
$737.40
|
|
Consultation/report referred slides prepared elsewhere
|
$39.25 |
$39.25 |
$39.25 |
$213.60
|
|
Contact lens fitg aphakia 1
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Contact lens fitg aphakia ou
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Contour cranial bone lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Contour of face bone lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Contrast baths charges
|
$17.37 |
$17.37 |
$17.37 |
$96.00
|
|
Contrast exam abdominl aorta 75625-26
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,356.00
|
|
Contrast exam thoracic aorta
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Contrast exam thoracic aorta 75605-26
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,378.25
|
|
Contrast x-ray gallbladder
|
$178.02 |
$178.02 |
$178.02 |
$719.40
|
|
Contrast x-ray of ankle
|
$357.13 |
$357.13 |
$357.13 |
$868.80
|
|
Contrast x-ray of brain
|
$790.06 |
$790.06 |
$790.06 |
$790.06
|
|
Contrast x-ray of brain
|
$357.13 |
$357.13 |
$357.13 |
$357.13
|
|
Contrast x-ray of elbow
|
$357.13 |
$357.13 |
$357.13 |
$793.80
|
|
Contrast x-ray of hip
|
$357.13 |
$357.13 |
$357.13 |
$814.20
|
|
Contrast x-ray of knee joint
|
$357.13 |
$357.13 |
$357.13 |
$868.80
|
|
Contrast x-ray of wrist
|
$357.13 |
$357.13 |
$357.13 |
$417.75
|
|
Control nose/throat bleeding w/pst nsl packs 42970
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Control nose/throat bleeding with surg ivntj 42972
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Control nosebleed pack+caut 30905
|
$128.90 |
$128.90 |
$128.90 |
$569.60
|
|
Control of nosebleed ant comp 30903
|
$128.90 |
$128.90 |
$128.90 |
$569.60
|
|
Control of nosebleedantersmpl 30901
|
$128.90 |
$128.90 |
$128.90 |
$471.00
|
|
Control oropharyngeal hemorr/simp 42960
|
$509.25 |
$509.25 |
$509.25 |
$1,546.80
|
|
Control throat bleeding
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Conv gtube to jtube
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,489.75
|
|
Conversion ext bil drg cath
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Convert nephrostomy catheter
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,643.00
|
|
Coombs direct
|
$59.40 |
$59.40 |
$59.40 |
$75.00
|
|
Coombs indirect qualitative each reagent red cell reference
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Coombs indirect titer reference
|
$171.36 |
$171.36 |
$171.36 |
$186.75
|
|
Copper cu 64 dotatate diag
|
$595.10 |
$595.10 |
$595.10 |
$2,083.80
|
|
Cor artery disease mrna
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$1,050.00
|
|
Cor hlx vlgs double osteot
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Cor hlx vlgs dstl mtar osteo
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Cor hlx vlgs prx phlx osteot
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Core ndl bx lng/med perq
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,052.80
|
|
Corneal hysteresis deter
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Corneal smear
|
$399.04 |
$399.04 |
$399.04 |
$315.75
|
|
Corneal transplant
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Corneal transplant
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Corneal transplant
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Corneal transplant
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Corneal trnspl endothelial
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Coronary angio/cath placement bypass graft/lv gram/lt heart
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$10,920.00
|
|
Coronary angio/lv gram/lt heart
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$8,070.00
|
|
Coronary angio/lv gram/rt< heart
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$10,049.40
|
|
Coronary art/grft angio s&i
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$8,006.25
|
|
Coronary catheterization w/angiography supervision & interpretation
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$7,491.00
|
|
Coronary thrombolysis/iv infusion 92977
|
$331.69 |
$331.69 |
$331.69 |
$477.60
|
|
Correct bunion/keller/mcbride/mayo 28292
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Correct cock-up 5th toe/plast clos 28286
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Correct finger deformity
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Correct inverted nipple(s)
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Correct metacarpal flaw
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Correct rectal prolapse
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$8,616.60
|
|
Correct skin color 6.0 cm/<
|
$612.13 |
$612.13 |
$612.13 |
$876.00
|
|
Correction claw finger other
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Correction eyelid w/implant
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Correction hallux valgus sesamoidectomy;prox meta osteotomy
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Correction of astigmatism
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Correction of astigmatism
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Correction of everted punctum 68705
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Correction trichiasis epilation forcep 67820
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Correction trichiasis inccision lid margin 67830
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Corrj halux rigdus w/implt
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$3,042.00
|
|
Corrj halux rigdus without implt
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Cortisol acth stimulation test - sendout
|
$32.62 |
$32.62 |
$32.62 |
$63.75
|
|
Cortisol total am
|
$16.30 |
$16.30 |
$16.30 |
$162.00
|
|
Costotransversectomy
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Counseling smoke cess interm >10mins
|
$29.79 |
$29.79 |
$29.79 |
$48.00
|
|
Counseling visit to discuss need for ldct g0296
|
$92.50 |
$92.50 |
$92.50 |
$92.50
|
|
Cover eye w/membrane
|
$968.54 |
$968.54 |
$968.54 |
$14,438.40
|
|
Cover eye w/membrane suture
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Covid-19 IV infusion and post admin monitoring tocilizumab 1st dose
|
$450.50 |
$450.50 |
$450.50 |
$1,020.00
|
|
Covid-19 IV infusion and post admin monitoring tocilizumab 2nd dose
|
$450.50 |
$450.50 |
$450.50 |
$1,020.00
|
|
Covid-19 administration immunization im inj 1st/only component
|
$41.52 |
$41.52 |
$41.52 |
$24.00
|
|
Covid-19 lab test non-cdc
|
$51.31 |
$51.31 |
$51.31 |
$51.31
|
|
Cptr ophth dx img post segmt
|
$59.40 |
$59.40 |
$59.40 |
$97.50
|
|
Cptrized corneal topography
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Cptrz oph img pst sg rta oct
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Crbrospnl fld flw imag cistern
|
$538.27 |
$538.27 |
$538.27 |
$1,859.25
|
|
Creat artery-vein fistula autograft 36825
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Create eardrum opening
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$7,126.80
|
|
Create passage to kidney
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Create tear duct drain
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Create tear duct drain
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Create tear sac drain
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Creatine - sendout
|
$4.64 |
$4.64 |
$4.64 |
$45.60
|
|
Creatine isoforms
|
$11.87 |
$11.87 |
$11.87 |
$11.87
|
|
Creatine kinase
|
$6.51 |
$6.51 |
$6.51 |
$80.25
|
|
Creatine kinase isoenzymes
|
$13.39 |
$13.39 |
$13.39 |
$66.00
|
|
Creatine kinase mb
|
$11.55 |
$11.55 |
$11.55 |
$114.75
|
|
Creatinine
|
$5.12 |
$5.12 |
$5.12 |
$43.80
|
|
Creatinine 24 hour urine
|
$5.18 |
$5.18 |
$5.18 |
$75.00
|
|
Creatinine clearance urine
|
$9.46 |
$9.46 |
$9.46 |
$146.40
|
|
Cricopharyngeal myotomy 43030
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Cricotracheal resection
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Crisis psychotherapy 90839
|
$160.67 |
$160.67 |
$160.67 |
$263.40
|
|
Critical care 30-74 minutes
|
$842.61 |
$842.61 |
$842.61 |
$2,085.75
|
|
Crizanlizumab-tmca 10 mg/ml intravenous solution
|
$129.58 |
$129.58 |
$129.58 |
$436.20
|
|
Cross-over vein graft
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Crotalidae poly immune fab
|
$1,861.13 |
$1,861.13 |
$1,861.13 |
$6,069.00
|
|
Cryo fib comp path redu each
|
$313.77 |
$313.77 |
$313.77 |
$313.77
|
|
Cryoablate prostate
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Cryocautery of cervix 57511
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Cryofibrinogen qualitative - sendout
|
$14.14 |
$14.14 |
$14.14 |
$56.25
|
|
Cryoprecipitate each unit
|
$63.57 |
$63.57 |
$63.57 |
$235.20
|
|
Cryopreservation embryo(s)
|
$816.90 |
$816.90 |
$816.90 |
$816.90
|
|
Cryopreservation oocyte(s)
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Cryopreservation sperm
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Cryopreserve stem cells
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Cryopreserve testicular tiss
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Cryosurg ablate fa each
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Cryosurgery penis lesion(s) 54056
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Cryotherapy of acne 17340
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Cryptococcus abs qn - sendout
|
$14.41 |
$14.41 |
$14.41 |
$138.60
|
|
Cryptosporidium antigen
|
$11.98 |
$11.98 |
$11.98 |
$162.60
|
|
Crystal identification light microscopy
|
$7.33 |
$7.33 |
$7.33 |
$58.50
|
|
Csf leakage imaging
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$1,645.50
|
|
Csf shunt reprogram 62252
|
$299.91 |
$299.91 |
$299.91 |
$299.91
|
|
Csf ventriculography
|
$538.27 |
$538.27 |
$538.27 |
$538.27
|
|
Cta abdomen without & /or w/contrast
|
$178.02 |
$178.02 |
$178.02 |
$2,422.50
|
|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$178.02 |
$178.02 |
$178.02 |
$2,395.20
|
|
Cta lower extremity without & w/contrast (both sides)
|
$178.02 |
$178.02 |
$178.02 |
$2,212.50
|
|
Cta neck without &/or w/contrast
|
$178.02 |
$178.02 |
$178.02 |
$1,987.50
|
|
Cta upper extremity w &/or without contrast left
|
$178.02 |
$178.02 |
$178.02 |
$2,025.75
|
|
Ctrl nosebld postir subsq 30906
|
$232.22 |
$232.22 |
$232.22 |
$2,487.00
|
|
Cult skin graft fnhfg 15155
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Cult skin grft t/arm/leg
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Cultr oocyte/embryo <4 days
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Cultr oocyte/embryo <4 days
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Culture aerobic additional method definitive id each
|
$8.08 |
$8.08 |
$8.08 |
$67.80
|
|
Culture afb any source
|
$10.80 |
$10.80 |
$10.80 |
$92.80
|
|
Culture anaerobic additional method definitive id each
|
$8.08 |
$8.08 |
$8.08 |
$117.00
|
|
Culture anaerobic except blood
|
$9.47 |
$9.47 |
$9.47 |
$126.00
|
|
Culture bact stool aero addl path ea
|
$9.44 |
$9.44 |
$9.44 |
$52.80
|
|
Culture body fluid
|
$8.62 |
$8.62 |
$8.62 |
$130.50
|
|
Culture fungi definitive id mold
|
$10.32 |
$10.32 |
$10.32 |
$81.75
|
|
Culture fungi definitive id yeast
|
$10.32 |
$10.32 |
$10.32 |
$70.50
|
|
Culture fungi other (except blood)
|
$8.41 |
$8.41 |
$8.41 |
$130.50
|
|
Culture fungi skin/hair/nail
|
$7.71 |
$7.71 |
$7.71 |
$80.40
|
|
Culture mycobacteria definitive id each isolate
|
$14.61 |
$14.61 |
$14.61 |
$114.60
|
|
Culture mycoplasma any source
|
$15.39 |
$15.39 |
$15.39 |
$145.50
|
|
Culture quantitative aerobic other source
|
$9.89 |
$9.89 |
$9.89 |
$96.75
|
|
Culture screening strep group a
|
$6.63 |
$6.63 |
$6.63 |
$105.75
|
|
Culture typing added method
|
$7.74 |
$7.74 |
$7.74 |
$7.74
|
|
Culture typing immunologic
|
$5.18 |
$5.18 |
$5.18 |
$29.40
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$218.06 |
$218.06 |
$218.06 |
$408.75
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$35.09 |
$35.09 |
$35.09 |
$343.20
|
|
Culture urine each isolate
|
$8.09 |
$8.09 |
$8.09 |
$74.40
|
|
Culture virus isolation
|
$19.56 |
$19.56 |
$19.56 |
$19.56
|
|
Curette/treat cornea
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Curette/treat cornea
|
$968.54 |
$968.54 |
$968.54 |
$1,200.60
|
|
Cv line/pic reposition
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$1,629.75
|
|
Cyanocobalamin unsat binding capacity
|
$14.32 |
$14.32 |
$14.32 |
$93.60
|
|
Cyclic citrullinated peptide antibody
|
$12.95 |
$12.95 |
$12.95 |
$178.50
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$0.62 |
$0.62 |
$0.62 |
$3.75
|
|
Cyclosporine 2 hour
|
$18.05 |
$18.05 |
$18.05 |
$115.50
|
|
Cyp2c19 gene com variants
|
$291.36 |
$291.36 |
$291.36 |
$916.20
|
|
Cyp2c9 gene com variants
|
$174.81 |
$174.81 |
$174.81 |
$1,852.80
|
|
Cyp2d6 gene com variants
|
$450.91 |
$450.91 |
$450.91 |
$269.40
|
|
Cyp3a4 gene common variants
|
$174.81 |
$174.81 |
$174.81 |
$328.50
|
|
Cyp3a5 gene common variants
|
$174.81 |
$174.81 |
$174.81 |
$328.50
|
|
Cystatin c
|
$18.52 |
$18.52 |
$18.52 |
$119.40
|
|
Cystic fibrosis cftr
|
$499.00 |
$499.00 |
$499.00 |
$4,054.80
|
|
Cystine urine quantitative
|
$22.98 |
$22.98 |
$22.98 |
$125.40
|
|
Cysto cgen post urtl valves
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cysto impl 4 or more
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Cysto insj dev ischmc rmdlg
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Cysto rx balo cath urtl strx
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cysto w/renal stricture tx
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cysto w/up stricture tx
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cysto w/ureter stricture tx
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cysto, litho, vacuum kidney
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Cysto/uretero stricture tx
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cysto/uretero w/lithotripsy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cysto/uretero w/up stricture
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystogram >= 3 views supervision & interpretation
|
$357.13 |
$357.13 |
$357.13 |
$896.40
|
|
Cystometrogram w/up 51727
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Cystorrhaphy wound simple 51860
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Cystoscopy & duct catheter
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Cystoscopy & revise urethra
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy & revise urethra
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy & ureter catheter
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$3,417.00
|
|
Cystoscopy (Bladder Scope)
|
$667.47 |
$667.47 |
$667.47 |
$1,636.00
|
|
Cystoscopy and biopsy
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and radiotracer
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy and treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cystoscopy and treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy and treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$4,102.20
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Cystoscopy and treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cystoscopy and treatment
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy and treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cystoscopy chemodenervation
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$975.75
|
|
Cystoscopy implant stent
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy inject material
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cystoscopy prostatic imp 1-3
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,953.80
|
|
Cystoscopy removal of clots
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystoscopy stone removal
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cystostomy cystotomy w/drainage 51040
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$4,228.80
|
|
Cystotomy excise/incise/repair 51535
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystotomy/cystostomy fulg+/insj radact matrl 51020
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystouretero & or pyeloscope
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystouretero w/biopsy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cystouretero w/excise tumor
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cystouretero w/lithotripsy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$10,899.75
|
|
Cystouretero w/renal strict
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Cystouretero w/stone remove
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystourethro cut ejacul duct
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Cystourethroscop/calib/dilat stric 52281
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$3,442.20
|
|
Cystourethroscopy w/biopsy(s) 52204
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Cytogenetics 25-99
|
$42.38 |
$42.38 |
$42.38 |
$292.80
|
|
Cytogenetics 3-5
|
$40.70 |
$40.70 |
$40.70 |
$40.70
|
|
Cytogenom microarray copy nmbr var
|
$900.00 |
$900.00 |
$900.00 |
$900.00
|
|
Cytogenomic neo microra alys
|
$1,160.00 |
$1,160.00 |
$1,160.00 |
$1,343.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$14.39 |
$14.39 |
$14.39 |
$146.40
|
|
Cytomegalovirus (cmv) antibody igm
|
$16.85 |
$16.85 |
$16.85 |
$131.25
|
|
Cytomegalovirus dfa
|
$13.42 |
$13.42 |
$13.42 |
$13.42
|
|
Cytomegalovirus imm IV /vial
|
$1,809.44 |
$1,809.44 |
$1,809.44 |
$5,413.80
|
|
Cytopath c/v auto in fluid
|
$25.37 |
$25.37 |
$25.37 |
$25.37
|
|
Cytopath c/v index add-on
|
$14.65 |
$14.65 |
$14.65 |
$14.65
|
|
Cytopath fl nongyn filter
|
$24.49 |
$24.49 |
$24.49 |
$91.20
|
|
Cytopath smear oth prep screen & interp
|
$24.49 |
$24.49 |
$24.49 |
$100.20
|
|
Cytopath smear other source
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Cytopath smear other source
|
$24.49 |
$24.49 |
$24.49 |
$54.60
|
|
Cytopath tbs c/v manual
|
$18.19 |
$18.19 |
$18.19 |
$36.60
|
|
Cytopathology cellular enhancement technique non-gyn
|
$53.43 |
$53.43 |
$53.43 |
$240.75
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$26.61 |
$26.61 |
$26.61 |
$78.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$20.26 |
$20.26 |
$20.26 |
$61.20
|
|
Cytopathology concentration technique smears & interpretation
|
$39.25 |
$39.25 |
$39.25 |
$85.80
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$39.25 |
$39.25 |
$39.25 |
$111.00
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$171.36 |
$171.36 |
$171.36 |
$85.60
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$53.43 |
$53.43 |
$53.43 |
$186.75
|
|
Cytotoxic antibody screening
|
$78.65 |
$78.65 |
$78.65 |
$78.65
|
|
Cytotoxic antibody screening
|
$29.68 |
$29.68 |
$29.68 |
$363.75
|
|
Cytp urine 3-5 probes cmptr
|
$171.36 |
$171.36 |
$171.36 |
$907.50
|
|
D&c after delivery 59160
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,102.00
|
|
D&c of cervical stump
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
D&c/diagnostic/therapeutic/non ob 58120
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$2,361.75
|
|
Dactinomycin 0.5 mg intravenous solution
|
$302.92 |
$302.92 |
$302.92 |
$1,624.80
|
|
Dalbavancin 500 mg intravenous solution
|
$15.55 |
$15.55 |
$15.55 |
$6,061.91
|
|
Daptomycin (xellia) unrefrig
|
$0.05 |
$0.05 |
$0.05 |
$0.05
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$54.67 |
$54.67 |
$54.67 |
$109.20
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$3.00 |
$3.00 |
$3.00 |
$5,546.48
|
|
Darbepoetin alfa, esrd use
|
$3.00 |
$3.00 |
$3.00 |
$2,151.00
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$255.09 |
$255.09 |
$255.09 |
$681.00
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$19.76 |
$19.76 |
$19.76 |
$300.73
|
|
Dbrdmt prmlg les w/pdt
|
$198.70 |
$198.70 |
$198.70 |
$1,000.20
|
|
Dch glucoscan
|
$5.04 |
$5.04 |
$5.04 |
$19.50
|
|
Dch pulmonary stress test
|
$311.40 |
$311.40 |
$311.40 |
$650.40
|
|
Dch validity tests
|
$3.48 |
$3.48 |
$3.48 |
$27.00
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,809.00
|
|
Dcmprn orbit only transcrnl
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Dcmprn plantar digital nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Deamidated gliadin antibody iga
|
$12.05 |
$12.05 |
$12.05 |
$80.40
|
|
Debr musc/fascia 20sq cm/< 11043
|
$612.13 |
$612.13 |
$612.13 |
$997.50
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$612.13 |
$612.13 |
$612.13 |
$622.20
|
|
Debrid mastoidectomy cavity simple 69220
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$703.59 |
$703.59 |
$703.59 |
$1,778.40
|
|
Debride nail1-5 11720
|
$59.40 |
$59.40 |
$59.40 |
$274.20
|
|
Debride nail6 or more 11721
|
$59.40 |
$59.40 |
$59.40 |
$300.75
|
|
Debride skin bone at fx site
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$3,710.40
|
|
Debride/rmv fb/open fx/skin/sq/musc11011
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Debridement bone <= 20 sq cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,359.20
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$399.53 |
$399.53 |
$399.53 |
$1,148.25
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$331.69 |
$331.69 |
$331.69 |
$543.00
|
|
Decomp fasct leg ant+/lat+pst cmprt 27602
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decomp forearm 1 space 25020
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Decomp forearm 2 spaces w/debrid 25025
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Decompres spinal cord;thoracic 63055
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Decompress fasciotomyhand 26037
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompress fingers/hand
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompress forearm 1 space
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompress forearm 2 spaces
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompress optic nerve
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Decompress spinal cord lmbr
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Decompress spinal cord thrc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Decompression fasct forearm
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Decompression of leg
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Decompression of leg
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompression of leg
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompression of lower leg
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompression of lower leg
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompression of thigh/knee
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Decompression of thigh/knee
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Decompression of thigh/knee
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompression of thigh/knee
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Decompression of tibia nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Decompression unspecified nerve 64722
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Deep muscle biopsy 20205
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$0.60
|
|
Degarelix 120 mg subcutaneous solution
|
$4.36 |
$4.36 |
$4.36 |
$2,262.60
|
|
Delay flap arms/legs
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Delay flap eye/nos/ear/lip
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Delay flap fccnaxghf 15620
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Delay flap trunk 15600
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Delayed breast prosthesis 19342
|
$9,569.05 |
$9,569.05 |
$9,569.05 |
$9,569.05
|
|
Delivery of placenta 59414
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Demonstrate use home inr mon
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$203.39 |
$203.39 |
$203.39 |
$196.50
|
|
Denervation of hip joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$29.24 |
$29.24 |
$29.24 |
$10,269.00
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$128.90 |
$128.90 |
$128.90 |
$712.80
|
|
Derm autograft face/nck/hf/g
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Derm autograft trnk/arm/leg
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Derma-fat-fascia graft 15770
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Dermabrasion other than face
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Dermabrasion segmental face 15781
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Dermabrasion suprfl any site
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Dermabrasion total face
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Dermal filler injection(s)
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Design custom breast implant
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Design mlc device for imrt
|
$366.07 |
$366.07 |
$366.07 |
$1,479.60
|
|
Desmopressin 4 mcg/ml injection solution
|
$3.89 |
$3.89 |
$3.89 |
$172.46
|
|
Desoxycorticosterone
|
$30.98 |
$30.98 |
$30.98 |
$285.60
|
|
Dest mal lesion feenlm 0.6-1cm 17281
|
$198.70 |
$198.70 |
$198.70 |
$861.60
|
|
Dest mal lesion feenlm 1.1 - 2.0 cm 17282
|
$198.70 |
$198.70 |
$198.70 |
$246.00
|
|
Dest mal lesion feenlm <0.5cm 17280
|
$198.70 |
$198.70 |
$198.70 |
$1,044.60
|
|
Dest mal lesion snhfg 0.6-1cm 17271
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Dest mal lesion snhfg 1.1-2cm 17272
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Dest mal lesion snhfg <0.5cm 17270
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Dest mal lesion tal 0.6-1.0cm 17261
|
$198.70 |
$198.70 |
$198.70 |
$686.40
|
|
Dest mal lesion tal 1.1-2.0cm 17262
|
$198.70 |
$198.70 |
$198.70 |
$860.40
|
|
Dest mal lesion tal 2.1-3.0cm 17263
|
$198.70 |
$198.70 |
$198.70 |
$952.80
|
|
Dest mal lesion tal <0.5 17260
|
$198.70 |
$198.70 |
$198.70 |
$366.75
|
|
Destroy cervthor facet jnt 64633
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$2,841.60
|
|
Destroy internal hemorrhoids destroy 46930
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,522.80
|
|
Destroy premlg lesns;1st lesn 17000
|
$198.70 |
$198.70 |
$198.70 |
$199.50
|
|
Destroy vulva lesion extensive 56515
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Destroy vulva lesion simple 56501
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,691.50
|
|
Destruct ben lesion 15/> 17111
|
$198.70 |
$198.70 |
$198.70 |
$228.00
|
|
Destruct cut vasl lesions 10-50cm 17107
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Destruct cut vasl lesions <10cm 17106
|
$399.53 |
$399.53 |
$399.53 |
$666.75
|
|
Destruct cut vasl lesions >50cm 17108
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,442.25
|
|
Destruct penis les/smp/electrodesi 54055
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Destruction anal lesion(s)
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,783.50
|
|
Destruction anal lesion(s)
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$1,638.00
|
|
Destruction anal lesion(s) smpl chem 46900
|
$399.53 |
$399.53 |
$399.53 |
$468.00
|
|
Destruction benign lesions < 14 lesions
|
$198.70 |
$198.70 |
$198.70 |
$268.50
|
|
Destruction by injection tx of nerve 64630
|
$890.29 |
$890.29 |
$890.29 |
$2,203.50
|
|
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides)
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$2,908.20
|
|
Destruction ciliary body
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Destruction ciliary body
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Destruction ciliary body
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Destruction cryosurgery anal lesion(s) simpl 46916
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Destruction laser surgery anal lesions 46917
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Destruction les conjunctiva
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Destruction mal lsn s/n/h/f/g 2.1-3cm
|
$399.53 |
$399.53 |
$399.53 |
$1,378.20
|
|
Destruction mal lsn s/n/h/f/g 3.1-4cm
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Destruction mal lsn t/a/l 3.1-4cm
|
$399.53 |
$399.53 |
$399.53 |
$1,033.80
|
|
Destruction mal lsn t/a/l >4cm
|
$399.53 |
$399.53 |
$399.53 |
$954.75
|
|
Destruction penis lesion(s) chem 54050
|
$399.53 |
$399.53 |
$399.53 |
$229.20
|
|
Destruction penis lesion(s) exten 54065
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Destruction premal lesions 15/> 17004
|
$399.53 |
$399.53 |
$399.53 |
$521.25
|
|
Destruction rectal tumor 45190
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Destruction vag lesions complex 57065
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Destruction vag lesions simple 57061
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Detect agent nos dna dir
|
$30.03 |
$30.03 |
$30.03 |
$30.03
|
|
Detect agnt mult dna direc
|
$43.67 |
$43.67 |
$43.67 |
$120.00
|
|
Devel tst phys/qhp 1st hr
|
$156.46 |
$156.46 |
$156.46 |
$337.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$88.05 |
$88.05 |
$88.05 |
$127.20
|
|
Dexametha opth insert 0.1 mg
|
$101.49 |
$101.49 |
$101.49 |
$505.80
|
|
Dexamethasone intra implant
|
$205.28 |
$205.28 |
$205.28 |
$521.40
|
|
Dexmedetomidine film, 1 mcg
|
$0.64 |
$0.64 |
$0.64 |
$0.64
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$32.09 |
$32.09 |
$32.09 |
$1,087.80
|
|
Dhea-s (dehydroepiand sulfate)
|
$22.23 |
$22.23 |
$22.23 |
$204.00
|
|
Diab manage trn ind/group
|
$19.66 |
$19.66 |
$19.66 |
$57.75
|
|
Diabetes (HbA1c) Test
|
$9.71 |
$9.71 |
$9.71 |
$69.55
|
|
Diabetes training group per 30 min g0109
|
$29.79 |
$29.79 |
$29.79 |
$29.79
|
|
Diag bronchoscope/catheter
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,379.00
|
|
Diag laparo separate proc 49320
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$853.80
|
|
Diagnostic Mammogram (both breasts)
|
$207.95 |
$207.95 |
$207.95 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$164.52 |
$164.52 |
$164.52 |
$297.05
|
|
Diagnostic anoscopy
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Diagnostic anoscopy & biopsy
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Diagnostic anoscopy spx 46600
|
$128.90 |
$128.90 |
$128.90 |
$341.40
|
|
Diagnostic laryngoscopy 31505
|
$194.14 |
$194.14 |
$194.14 |
$338.40
|
|
Diagnostic laryngoscopy 31575
|
$194.14 |
$194.14 |
$194.14 |
$489.75
|
|
Diagnostic radio unlisted proc
|
$88.05 |
$88.05 |
$88.05 |
$170.40
|
|
Dialysis one evaluation
|
$425.82 |
$425.82 |
$425.82 |
$1,013.40
|
|
Diathermy eg microwave
|
$9.28 |
$9.28 |
$9.28 |
$9.28
|
|
Difelikefalin, esrd on dialy
|
$0.08 |
$0.08 |
$0.08 |
$0.08
|
|
Digoxin immune fab 40 mg intravenous solution
|
$4,968.58 |
$4,968.58 |
$4,968.58 |
$11,176.20
|
|
Digoxin total therapeutic drug level
|
$13.28 |
$13.28 |
$13.28 |
$126.00
|
|
Dilat xst trc ndurlgc px
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Dilat xst trc new access rcs
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Dilate esophagus
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Dilate esophagus 1/mult pass
|
$937.56 |
$937.56 |
$937.56 |
$1,547.40
|
|
Dilate tear duct opening
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Dilate urethra stricture
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Dilate urethra stricture
|
$243.21 |
$243.21 |
$243.21 |
$534.00
|
|
Dilate urethra stricture
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Dilate urethra stricture
|
$243.21 |
$243.21 |
$243.21 |
$243.21
|
|
Dilation of anal sphincter
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Dilation of cervical canal 57800
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Dilation of rectal stricture 45910
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,375.50
|
|
Dilation of salivary duct
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Dilation of urethra
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Dilation of urethra
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Dilation of vagina
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Dilation salivary duct 42650
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Dilation/female urethra/initial 53660
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Dilation/urethral strict/male/ini 53620
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Dimethyl sulfoxide 50% 50 ml
|
$742.90 |
$742.90 |
$742.90 |
$2,501.55
|
|
Dir nsl mucous membrane test
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Disability dlco
|
$156.46 |
$156.46 |
$156.46 |
$234.00
|
|
Disaccharidases
|
$22.17 |
$22.17 |
$22.17 |
$163.80
|
|
Disarticulation sho sec clsr
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Discography cerv/thor spine
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$2,062.50
|
|
Dise eval slp do brth flx dx
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Dist revas ligation hemo
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$9,842.40
|
|
Diverticulectomy/hypophar/esoph 43130
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Dmd dup/delet analysis
|
$279.00 |
$279.00 |
$279.00 |
$2,106.00
|
|
Dmpk gene detc abnor allele
|
$137.00 |
$137.00 |
$137.00 |
$567.75
|
|
Dna antibody native/double stranded
|
$13.74 |
$13.74 |
$13.74 |
$135.75
|
|
Dna gardnerella
|
$20.05 |
$20.05 |
$20.05 |
$197.40
|
|
Dna probe chlamydia
|
$22.75 |
$22.75 |
$22.75 |
$82.20
|
|
Dna probe gc
|
$26.88 |
$26.88 |
$26.88 |
$72.60
|
|
Dna trichomonas
|
$20.05 |
$20.05 |
$20.05 |
$203.40
|
|
Docetaxel (docivyx), 1 mg
|
$49.08 |
$49.08 |
$49.08 |
$49.08
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$156.46 |
$156.46 |
$156.46 |
$901.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$128.90 |
$128.90 |
$128.90 |
$547.20
|
|
Dostarlimab-gxly 50 mg/ml intravenous solution
|
$243.82 |
$243.82 |
$243.82 |
$544.20
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$109.28 |
$109.28 |
$109.28 |
$2,245.20
|
|
Dpyd gene common variants
|
$174.81 |
$174.81 |
$174.81 |
$2,358.60
|
|
Drain bladder by trocar/cath
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$451.20
|
|
Drain blood from under nail 11740
|
$128.90 |
$128.90 |
$128.90 |
$266.40
|
|
Drain cath image guided peri/retroperitoneal transvag/transrectal
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,976.00
|
|
Drain cath image guided visceral pq
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$4,627.80
|
|
Drain cerebro spinal fluid 62272
|
$692.52 |
$692.52 |
$692.52 |
$1,485.75
|
|
Drain chest lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Drain finger abscess;simple 26010
|
$198.70 |
$198.70 |
$198.70 |
$318.00
|
|
Drain lower leg bursa
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Drain lower leg lesion 27603
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$3,022.50
|
|
Drain neck/chest lesion 21501
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Drain ovarn cyst abd
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$4,140.00
|
|
Drain ovary abscess open
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Drain penis lesion
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Drain shoulder bone lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Drain shoulder bursa 23031
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Drain shoulder lesion
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Drain thigh/knee lesion 27301
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$5,397.60
|
|
Drain thyroid/tongue cyst
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$703.59 |
$703.59 |
$703.59 |
$824.40
|
|
Drainage ext aud canal abscess 69020
|
$703.59 |
$703.59 |
$703.59 |
$1,440.00
|
|
Drainage external ear complex 69005
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$4,074.75
|
|
Drainage external ear simple 69000
|
$703.59 |
$703.59 |
$703.59 |
$709.50
|
|
Drainage lymph node lesion 38300
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Drainage lymph node lesion 38305
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Drainage mouth roof lesion
|
$232.22 |
$232.22 |
$232.22 |
$837.00
|
|
Drainage of arm bursa 23931
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,638.50
|
|
Drainage of bladder abscess
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Drainage of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Drainage of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Drainage of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Drainage of forearm bursa
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Drainage of kidney lesion
|
$703.59 |
$703.59 |
$703.59 |
$1,989.75
|
|
Drainage of mouth lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Drainage of mouth lesion
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Drainage of mouth lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Drainage of mouth lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Drainage of mouth lesion
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Drainage of mouth lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,430.80
|
|
Drainage of mouth lesion
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Drainage of mouth lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$2,270.40
|
|
Drainage of mouth lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$4,468.20
|
|
Drainage of nose lesion int 30000
|
$232.22 |
$232.22 |
$232.22 |
$649.80
|
|
Drainage of nose lesion sept 30020
|
$509.25 |
$509.25 |
$509.25 |
$637.50
|
|
Drainage of pelvis bursa
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Drainage of pelvis lesion 26990
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,355.20
|
|
Drainage of prostate abscess
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Drainage of prostate abscess
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Drainage of prostate abscess
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Drainage of rectal abscess
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$3,520.20
|
|
Drainage of rectal abscess 45020
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$5,376.00
|
|
Drainage of salivary gland
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Drainage of salivary gland
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Drainage of throat abscess
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Drainage of urethra abscess
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Drainage of urethra abscess 53060
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Drainage of urinary leakage
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Drainage of urinary leakage
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Dress/debrid prtl-thick burn l 16030
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$198.70 |
$198.70 |
$198.70 |
$451.20
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$198.70 |
$198.70 |
$198.70 |
$408.60
|
|
Dressing change not for burn w/anes 15852
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Drng hand tendon sheath 26020
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$4,150.20
|
|
Drng of eyelid abscess 67700
|
$298.93 |
$298.93 |
$298.93 |
$3,479.40
|
|
Drng of finger abscess comp 26011
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,875.00
|
|
Drng of hydrocele 55000
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Drng of mouth lesion 40801
|
$509.25 |
$509.25 |
$509.25 |
$3,040.20
|
|
Drng of ovarian cyst(s) 58800
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Drng of palm multi bursas 26030
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Drng of palm single bursa 26025
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Drng of pelvic abscess transrectal 45000
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Drng of salivary cyst 42409
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Drng of scrotum abscess 55100
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,630.40
|
|
Drng salivary gland simple 42300
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Drng salivary gland submax/subling 42310
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Drug assay caffeine
|
$38.57 |
$38.57 |
$38.57 |
$55.50
|
|
Drug assay posaconazole
|
$27.11 |
$27.11 |
$27.11 |
$171.75
|
|
Drug assay rufinamide
|
$27.11 |
$27.11 |
$27.11 |
$135.75
|
|
Drug assay vedolizumab
|
$38.57 |
$38.57 |
$38.57 |
$298.80
|
|
Drug assay voriconazole
|
$27.11 |
$27.11 |
$27.11 |
$186.00
|
|
Drug asy hydroxychloroquine
|
$18.64 |
$18.64 |
$18.64 |
$196.20
|
|
Drug of abuse screen urine
|
$12.60 |
$12.60 |
$12.60 |
$48.00
|
|
Drug screen quant tiagabine
|
$27.11 |
$27.11 |
$27.11 |
$188.40
|
|
Drug test def 1-7 classes
|
$114.43 |
$114.43 |
$114.43 |
$316.80
|
|
Drug test def 15-21 classes
|
$198.74 |
$198.74 |
$198.74 |
$198.74
|
|
Drug test def 22+ classes
|
$246.92 |
$246.92 |
$246.92 |
$246.92
|
|
Drug test def 8-14 classes
|
$156.59 |
$156.59 |
$156.59 |
$345.00
|
|
Drug test prsmv instrmnt
|
$17.14 |
$17.14 |
$17.14 |
$17.14
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$62.14 |
$62.14 |
$62.14 |
$383.20
|
|
Drvvt confirm - quest
|
$17.98 |
$17.98 |
$17.98 |
$174.60
|
|
Dstr mal les s/n/h/f/g >4.0
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Dstr mal ls f/e/e/n/l/m2.1-3
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Dstr mal ls f/e/e/n/l/m3.1-4
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Dstr mal ls f/e/e/n/l/m>4.0
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Dstrj extensive retinopathy
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Dstrj nulyt agt gnclr nrv
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,614.75
|
|
Dstry eye lesn,fdr vssl tech
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Ductogram sgl duct
|
$241.72 |
$241.72 |
$241.72 |
$547.80
|
|
Duodenal motility study
|
$530.60 |
$530.60 |
$530.60 |
$1,347.75
|
|
Dup scan/hemodialysis access 93990
|
$106.34 |
$106.34 |
$106.34 |
$684.60
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$156.46 |
$156.46 |
$156.46 |
$914.40
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$241.72 |
$241.72 |
$241.72 |
$840.00
|
|
Duplex scan bilateral study 93985
|
$241.72 |
$241.72 |
$241.72 |
$1,144.80
|
|
Duplex scan unilateral study 93986
|
$106.34 |
$106.34 |
$106.34 |
$643.20
|
|
Durvalumab 50 mg/ml intravenous solution
|
$85.25 |
$85.25 |
$85.25 |
$213.60
|
|
Dx aly aud oi snd prcsr 1st
|
$156.46 |
$156.46 |
$156.46 |
$153.00
|
|
Dx bronchoscope/brush 31623
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,159.25
|
|
Dx bronchoscope/lavage 31624
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,886.75
|
|
Dx bronchoscope/wash 31622
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,168.40
|
|
Dx dark adaptation exam i&r
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Dx duod intub w/asp spec 43756
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Dx duod intub w/asp specs
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Dx gastr intub w/asp spec
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Dx gastr intub w/asp specs
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Dx laryngoscopy newborn
|
$388.31 |
$388.31 |
$388.31 |
$388.31
|
|
Dx laryngoscopy w/oper scope
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Dxa bone density axl vrt fx
|
$106.34 |
$106.34 |
$106.34 |
$591.75
|
|
Dynamic cavernosometry
|
$243.21 |
$243.21 |
$243.21 |
$243.21
|
|
Dynamic surface emg
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
E coli 0157 ag ia
|
$12.66 |
$12.66 |
$12.66 |
$12.66
|
|
E equine encephalitis igg
|
$13.19 |
$13.19 |
$13.19 |
$122.40
|
|
EKG tracing for initial prev
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
ER Visit (level 1, minor)
|
$88.05 |
$88.05 |
$88.05 |
$286.51
|
|
ER Visit (level 2)
|
$158.36 |
$158.36 |
$158.36 |
$469.39
|
|
ER Visit (level 3)
|
$276.89 |
$276.89 |
$276.89 |
$827.20
|
|
ER Visit (level 4)
|
$425.82 |
$425.82 |
$425.82 |
$1,330.00
|
|
ER Visit (level 5, high severity)
|
$613.10 |
$613.10 |
$613.10 |
$1,892.80
|
|
Ear and throat examination
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Ear canal biopsy 69105
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,353.00
|
|
Ear cartilage graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Ear irrigation 69209
|
$59.40 |
$59.40 |
$59.40 |
$128.25
|
|
Ear protector evaluation
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Ecallantide injection
|
$579.99 |
$579.99 |
$579.99 |
$579.99
|
|
Ecg 12 lead tracing only
|
$59.40 |
$59.40 |
$59.40 |
$271.80
|
|
Ecg < 30 days transmission & analysis
|
$91.79 |
$91.79 |
$91.79 |
$624.75
|
|
Ecg external < 48 hours recording
|
$128.90 |
$128.90 |
$128.90 |
$500.25
|
|
Ecg external < 48 hours scanning analysis w/report
|
$59.40 |
$59.40 |
$59.40 |
$567.00
|
|
Ecg external > 48 hours up to 7 days recording
|
$39.25 |
$39.25 |
$39.25 |
$72.60
|
|
Ecg external >7 days up to 15 days recording
|
$39.25 |
$39.25 |
$39.25 |
$75.00
|
|
Ecg/1-3 leads/tracing only 93041
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Echo exam of eye
|
$106.34 |
$106.34 |
$106.34 |
$106.34
|
|
Echo exam of eye
|
$88.05 |
$88.05 |
$88.05 |
$430.20
|
|
Echo exam of eye
|
$106.34 |
$106.34 |
$106.34 |
$106.34
|
|
Echo exam of eye thickness
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Echo exam of fetal heart
|
$106.34 |
$106.34 |
$106.34 |
$250.50
|
|
Echo exam of fetal heart
|
$548.30 |
$548.30 |
$548.30 |
$548.30
|
|
Echo exam of fetal heart
|
$241.72 |
$241.72 |
$241.72 |
$398.25
|
|
Echo exam of fetal heart
|
$106.34 |
$106.34 |
$106.34 |
$424.80
|
|
Echo exam uterus 76831-
|
$241.72 |
$241.72 |
$241.72 |
$695.40
|
|
Echo guide for artery repair
|
$311.40 |
$311.40 |
$311.40 |
$1,009.20
|
|
Echo stress
|
$548.30 |
$548.30 |
$548.30 |
$1,056.00
|
|
Echo tee cngntl wo ctrst probe plcmnt
|
$548.30 |
$548.30 |
$548.30 |
$548.30
|
|
Echo tee probe placement image acquisition interpretation & report
|
$548.30 |
$548.30 |
$548.30 |
$1,724.25
|
|
Echo transesophageal
|
$548.30 |
$548.30 |
$548.30 |
$1,626.00
|
|
Echo transesophageal
|
$548.30 |
$548.30 |
$548.30 |
$58.80
|
|
Echo transesophageal intraop
|
$548.30 |
$548.30 |
$548.30 |
$2,142.60
|
|
Echo transthoracic
|
$548.30 |
$548.30 |
$548.30 |
$1,094.40
|
|
Echo transthoracic
|
$548.30 |
$548.30 |
$548.30 |
$548.30
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$241.72 |
$241.72 |
$241.72 |
$1,026.40
|
|
Echocardiogram (Heart Ultrasound)
|
$548.30 |
$548.30 |
$548.30 |
$2,021.12
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$790.06 |
$790.06 |
$790.06 |
$2,126.25
|
|
Echocardiography transthoracic 2d followup/limited
|
$241.72 |
$241.72 |
$241.72 |
$691.20
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$357.13 |
$357.13 |
$357.13 |
$667.50
|
|
Echograp trans r pros study
|
$106.34 |
$106.34 |
$106.34 |
$576.60
|
|
Ecog impltd brn npgt <30 d
|
$37.29 |
$37.29 |
$37.29 |
$37.29
|
|
Ecp ciliary body destruction
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$44.77 |
$44.77 |
$44.77 |
$268.80
|
|
Edetate calcium disodium inj
|
$6,454.57 |
$6,454.57 |
$6,454.57 |
$20,833.61
|
|
Eeg 41-60 minutes 95812-26
|
$311.40 |
$311.40 |
$311.40 |
$1,081.50
|
|
Eeg monitor/record/awake/drowsy 95816
|
$311.40 |
$311.40 |
$311.40 |
$855.60
|
|
Eeg monitoring/function test
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$2,440.50
|
|
Eeg monitoring/giving drugs
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Eeg over 1 hour 95813 - 26
|
$311.40 |
$311.40 |
$311.40 |
$907.80
|
|
Eeg recording awake and asleep
|
$311.40 |
$311.40 |
$311.40 |
$1,173.00
|
|
Eeg without vid 2-12 hr unmntr
|
$311.40 |
$311.40 |
$311.40 |
$586.20
|
|
Eeg without vid 2-12hr cont mntr
|
$311.40 |
$311.40 |
$311.40 |
$623.40
|
|
Eeg without vid ea 12-26hr cont
|
$530.60 |
$530.60 |
$530.60 |
$1,194.00
|
|
Eeg without vid ea 12-26hr intmt
|
$530.60 |
$530.60 |
$530.60 |
$1,126.20
|
|
Eeg wo vid 2-12hr intmt mntr
|
$311.40 |
$311.40 |
$311.40 |
$602.40
|
|
Eeg wo vid ea 12-26hr unmntr
|
$530.60 |
$530.60 |
$530.60 |
$1,126.20
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$530.60 |
$530.60 |
$530.60 |
$1,177.80
|
|
Eeg/record in coma or sleep only 95822
|
$311.40 |
$311.40 |
$311.40 |
$1,095.60
|
|
Efgartigimod alfa-fcab 20 mg/ml intravenous solution
|
$32.40 |
$32.40 |
$32.40 |
$79.20
|
|
Egd Ultrasound exam duodenum/jejunum
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,414.00
|
|
Egd Ultrasound fine needle bx/aspir
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,322.50
|
|
Egd Ultrasound fine needle bx/aspir
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,414.00
|
|
Egd Ultrasound transmural injxn/mark
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,127.50
|
|
Egd balloon dil esoph30 mm/>
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,903.50
|
|
Egd control bleeding any
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,547.00
|
|
Egd dilate stricture
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,148.50
|
|
Egd endo mucosal resection
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Egd endoscopic stent place
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$4,379.25
|
|
Egd esophagogastrc fndoplsty
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Egd flx trnsorl dplmnt balo
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Egd flx trnsorl rmvl balo
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Egd guide wire insertion
|
$937.56 |
$937.56 |
$937.56 |
$2,765.25
|
|
Egd injection varices
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,241.20
|
|
Egd lesion ablation
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,360.75
|
|
Egd optical endomicroscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Egd remove foreign body
|
$937.56 |
$937.56 |
$937.56 |
$2,501.40
|
|
Egd remove lesion snare
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,501.40
|
|
Egd varices ligation
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,061.20
|
|
Egd w/thrml txmnt gerd
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$6,529.80
|
|
Egd w/transmural drain cyst
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$5,952.81
|
|
Egd/insert intraluminal tube/cath 43241
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,502.75
|
|
Egd/remov tum/polyp/hot bx forcep 43250
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,736.75
|
|
Egfr gene com variants
|
$324.58 |
$324.58 |
$324.58 |
$808.80
|
|
Ehrlicha chaffeensis amp prb
|
$35.09 |
$35.09 |
$35.09 |
$290.40
|
|
Elbow arthroscopy
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Elbow arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Elbow arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Elbow arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Elbow arthroscopy/surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Elbow arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Elec analys infus pump w/reprog 62368
|
$299.91 |
$299.91 |
$299.91 |
$669.75
|
|
Elec stim unattend for press
|
$14.52 |
$14.52 |
$14.52 |
$14.52
|
|
Elect analysis of infusion pump 62367
|
$299.91 |
$299.91 |
$299.91 |
$508.50
|
|
Elect anlys sp inf pmp w/reprg&fill 62369
|
$299.91 |
$299.91 |
$299.91 |
$843.00
|
|
Electrical bone stim 20974
|
$61.91 |
$61.91 |
$61.91 |
$61.91
|
|
Electro-oculography w/i&r
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Electrocochleography
|
$156.46 |
$156.46 |
$156.46 |
$349.80
|
|
Electroconvulsive therapy 90870
|
$530.60 |
$530.60 |
$530.60 |
$1,226.40
|
|
Electrode stimulation brain
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,137.75
|
|
Electroejaculation
|
$870.74 |
$870.74 |
$870.74 |
$870.74
|
|
Electrogastrography
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Electrogastrography w/test
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Electrolyte panel
|
$7.01 |
$7.01 |
$7.01 |
$120.00
|
|
Electron microscopy diagnostic
|
$816.90 |
$816.90 |
$816.90 |
$1,386.00
|
|
Electronic analysis with brain program first 15 min 95983
|
$91.79 |
$91.79 |
$91.79 |
$990.75
|
|
Electrophysiologic study
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$5,773.20
|
|
Electrophysiology evaluation
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$5,625.00
|
|
Electrophysiology evaluation
|
$1,213.99 |
$1,213.99 |
$1,213.99 |
$1,735.80
|
|
Electrophysiology evaluation
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$7,588.10
|
|
Elosulfase alfa, injection
|
$306.80 |
$306.80 |
$306.80 |
$306.80
|
|
Elotuzumab 300 mg intravenous solution
|
$7.88 |
$7.88 |
$7.88 |
$1,749.60
|
|
Elranatamab-bcmm 40 mg/ml subcutaneous solution
|
$185.31 |
$185.31 |
$185.31 |
$463.20
|
|
Emb without cervical dilation 58100
|
$201.17 |
$201.17 |
$201.17 |
$2,115.00
|
|
Emb/throm/fempop/aor/ilia/leg inc 34201
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Emb/throm/pop-tib-pero art/leg inc 34203
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Embedded ip cath exit-site 49436
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$432.00
|
|
Embo or occlude vascular arterial s&i
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$13,812.00
|
|
Embo or occlude vascular hemorrhage s&i
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$11,680.50
|
|
Embo or occlude vascular tumor/organ/infarct s&i
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$11,680.50
|
|
Embo or occlude vascular venous s&i
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$12,721.80
|
|
Embryo hatching
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Embryo transfer intrauterine
|
$870.74 |
$870.74 |
$870.74 |
$870.74
|
|
Emg 2 ext w-w/o paraspinal area 95861
|
$128.90 |
$128.90 |
$128.90 |
$665.40
|
|
Emg 3 ext w-w/o paraspinal area 95863
|
$156.46 |
$156.46 |
$156.46 |
$447.00
|
|
Emg cranial nerve bilateral
|
$311.40 |
$311.40 |
$311.40 |
$529.80
|
|
Emg needle test 1-extremity
|
$128.90 |
$128.90 |
$128.90 |
$362.25
|
|
Emg needle test 4-extremities
|
$156.46 |
$156.46 |
$156.46 |
$1,050.00
|
|
Emg thor paraspinal without t1/t2
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Encephalitis, california igg/igm
|
$13.19 |
$13.19 |
$13.19 |
$122.40
|
|
Encephalitis, st louis igg/igm
|
$13.19 |
$13.19 |
$13.19 |
$122.40
|
|
Encephalitis, western equine igg/igm
|
$13.19 |
$13.19 |
$13.19 |
$122.40
|
|
Endo abl/incom vein/ext/laser/#1 36478
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$6,423.75
|
|
Endo abl/incom vein/ext/rad fre/#1 36475
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$6,527.25
|
|
Endo cholangiopancreatograph
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,831.00
|
|
Endo cholangiopancreatograph
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,546.00
|
|
Endo defect closure gi tract
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Endo outlet restrict w/tube
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Endo sleeve gastro w/tube
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Endocerv curettage w/scope 57456
|
$304.19 |
$304.19 |
$304.19 |
$585.00
|
|
Endocervical curettage 57505
|
$870.74 |
$870.74 |
$870.74 |
$956.25
|
|
Endome abla/them without hystero guide 58353
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Endometrial cryoablation w/us 58356
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Endoscopic Ultrasound exam esoph
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,517.00
|
|
Endoscopic injection/implant
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Endoscopy bowel pouch/biop
|
$911.71 |
$911.71 |
$911.71 |
$1,896.00
|
|
Endoscopy ligate perf veins 37500
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Endoscopy maxillary sinus
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Endoscopy of bowel pouch 44385
|
$911.71 |
$911.71 |
$911.71 |
$1,696.20
|
|
Endoscopy of ureter
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Endoscopy of ureter
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Endoscopy swallow (fees) vid
|
$85.66 |
$85.66 |
$85.66 |
$510.00
|
|
Endoscpy nsl/sns w/cntrl nsl hmrrgh
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,377.20
|
|
Endovasc tempory vessel occl
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$9,294.60
|
|
Endoven ther chem adhes 1st 36482
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Endovenous mchnchem 1st vein
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,102.20
|
|
Enfortumab vedotin-ejfv 20 mg intravenous solution
|
$36.66 |
$36.66 |
$36.66 |
$64.20
|
|
Entamoeba histolytica ag eia - sendout
|
$11.98 |
$11.98 |
$11.98 |
$89.25
|
|
Enzyme cell activity ra
|
$44.03 |
$44.03 |
$44.03 |
$547.20
|
|
Enzyme histochemistry
|
$816.90 |
$816.90 |
$816.90 |
$573.60
|
|
Ep & ablate supravent arrhyt
|
$24,532.30 |
$24,532.30 |
$24,532.30 |
$24,532.30
|
|
Ep & ablate ventric tachy
|
$24,532.30 |
$24,532.30 |
$24,532.30 |
$30,975.00
|
|
Ep induct arrhy by elect pacing
|
$1,213.99 |
$1,213.99 |
$1,213.99 |
$3,663.00
|
|
Epcoritamab-bysp 48 mg/0.8 ml subcutaneous solution
|
$55.66 |
$55.66 |
$55.66 |
$102.60
|
|
Epidrm a-grft face/nck/hf/g 15115
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Epidrm agrft t/a/l 1st 100
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Epidural lysis mult sessions
|
$890.29 |
$890.29 |
$890.29 |
$890.29
|
|
Epidural lysis on single day 62264
|
$890.29 |
$890.29 |
$890.29 |
$2,673.00
|
|
Epiglottidectomy
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Epilepsy gen seq alys panel
|
$2,448.56 |
$2,448.56 |
$2,448.56 |
$2,448.56
|
|
Epiphysl arrst dstl rds&ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Epiphysl arrst dstl rds/ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Episiotomy/vag rpr oth/thn attending phys 59300
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$2,952.75
|
|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$7.68 |
$7.68 |
$7.68 |
$255.20
|
|
Epoetin alfa-epbx 40,000 unit/ml injection solution
|
$7.57 |
$7.57 |
$7.57 |
$336.66
|
|
Epoetin beta non esrd
|
$1.41 |
$1.41 |
$1.41 |
$1.41
|
|
Epstein barr early antigen antibody
|
$13.12 |
$13.12 |
$13.12 |
$105.00
|
|
Epstein barr nuclear antigen antibody
|
$15.29 |
$15.29 |
$15.29 |
$120.75
|
|
Epstein barr viral capsid antigen antibody igm
|
$18.14 |
$18.14 |
$18.14 |
$133.20
|
|
Eptinezumab-jjmr 100 mg/ml intravenous solution
|
$19.85 |
$19.85 |
$19.85 |
$3,637.20
|
|
Ercp bil/panc duct; each stent plcmt 43274
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$4,282.20
|
|
Ercp ea duct/ampulla dilate
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,882.75
|
|
Ercp lesion ablate w/dilate 43278
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$4,640.25
|
|
Ercp lithotripsy calculi
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$5,378.40
|
|
Ercp remove duct calculi 43264
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,955.50
|
|
Ercp remove forgn body duct 43275
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,726.00
|
|
Ercp sphincter pressure meas
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,771.25
|
|
Ercp stent exchange w/dilate
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$4,497.75
|
|
Ercp w/specimen collection
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$4,277.25
|
|
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution
|
$104.58 |
$104.58 |
$104.58 |
$387.60
|
|
Esd endoscopy or colonoscopy
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$4,282.20
|
|
Esoph balloon distension tst
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Esoph egd dilation <30 mm
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,501.40
|
|
Esoph endoscopy dilation
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,205.75
|
|
Esoph imped funct test > 1hr
|
$530.60 |
$530.60 |
$530.60 |
$1,122.00
|
|
Esoph imped function test
|
$311.40 |
$311.40 |
$311.40 |
$603.00
|
|
Esoph optical endomicroscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esoph scope w/sclerosis inj
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esoph scope w/submucous inj
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,078.00
|
|
Esophag muc integ w/eso egd
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,804.53
|
|
Esophageal motility
|
$401.83 |
$401.83 |
$401.83 |
$499.20
|
|
Esophageal recording
|
$1,213.99 |
$1,213.99 |
$1,213.99 |
$1,213.99
|
|
Esophageal recording
|
$1,213.99 |
$1,213.99 |
$1,213.99 |
$1,213.99
|
|
Esophagosc dilate balloon 30
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esophagosc flex trnsn biopsy
|
$937.56 |
$937.56 |
$937.56 |
$2,062.50
|
|
Esophagoscop mucosal resect
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,992.50
|
|
Esophagoscop stent placement
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$5,952.81
|
|
Esophagoscop ultrasound exam
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,414.00
|
|
Esophagoscopy balloon <30mm
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,794.80
|
|
Esophagoscopy control bleed
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,598.75
|
|
Esophagoscopy flex biopsy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,676.75
|
|
Esophagoscopy flex dx brush
|
$937.56 |
$937.56 |
$937.56 |
$1,930.50
|
|
Esophagoscopy flex remove fb
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,361.00
|
|
Esophagoscopy lesion ablate
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,804.53
|
|
Esophagoscopy lesion removal
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,946.75
|
|
Esophagoscopy retro balloon
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esophagoscopy rigid balloon
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,804.53
|
|
Esophagoscopy rigid trnso 43180
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Esophagoscopy snare les remv
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,680.50
|
|
Esophagoscopy w/us needle bx
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,940.50
|
|
Esophagoscopy/flex/diagnostic 43200
|
$937.56 |
$937.56 |
$937.56 |
$2,623.50
|
|
Esophagoscopy/rigid/diagnostic 43191
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esophagoscp guide wire dilat 43196
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esophagoscp rig trnso biopsy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esophagoscp rig trnso inject
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esophagoscp rig trnso rem fb
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Esophagus endoscopy/ligation
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,386.25
|
|
Esophagus motility study
|
$530.60 |
$530.60 |
$530.60 |
$1,232.25
|
|
Essure 58565
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Estradiol total
|
$27.94 |
$27.94 |
$27.94 |
$226.50
|
|
Estrogens total-sendout
|
$21.70 |
$21.70 |
$21.70 |
$270.00
|
|
Etanercept injection
|
$1,080.88 |
$1,080.88 |
$1,080.88 |
$1,801.80
|
|
Ethanolamine oleate 100 mg
|
$519.52 |
$519.52 |
$519.52 |
$1,605.00
|
|
Ethmoidectomy extranasal total 31205
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Ethylene glycol -sendout
|
$14.90 |
$14.90 |
$14.90 |
$104.40
|
|
Euflexxa inj per dose
|
$114.48 |
$114.48 |
$114.48 |
$1,186.77
|
|
Euglobulin lysis
|
$8.41 |
$8.41 |
$8.41 |
$61.80
|
|
Evacuate mole of uterus
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$5,835.00
|
|
Eval aud rehab status/first hr 92626
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Eval/fit voice prosthesis iii, st
|
$155.22 |
$155.22 |
$155.22 |
$431.25
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$98.11 |
$98.11 |
$98.11 |
$237.00
|
|
Evaluation of speech fluency 92521
|
$170.83 |
$170.83 |
$170.83 |
$393.00
|
|
Evaluation psychiatric diagnostic
|
$160.67 |
$160.67 |
$160.67 |
$265.80
|
|
Event monitor
|
$37.29 |
$37.29 |
$37.29 |
$330.00
|
|
Evoked auditory tst complete
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Evoked oa emissions ltd
|
$311.40 |
$311.40 |
$311.40 |
$234.00
|
|
Evoked potential visual not glaucoma
|
$311.40 |
$311.40 |
$311.40 |
$572.40
|
|
Evoked potentials upper limbs
|
$311.40 |
$311.40 |
$311.40 |
$491.40
|
|
Ex arm/elbow tum deep 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Ex arm/elbow tum deep < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Ex palate/uvula lesion without closure 42104
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Ex sq tumor/face or scalp 2 cm/> 21012
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Ex sq tumor/face or scalp < 2 cm 21011
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exam of vagina w/scope 57420
|
$304.19 |
$304.19 |
$304.19 |
$615.60
|
|
Exam plvc w/anes othr thn lcl
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Exc abd les sc 3 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$1,144.80
|
|
Exc abdl tum deep 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc abdl tum deep < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$1,464.00
|
|
Exc arm/elbo les sc <3cm 24075
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,880.25
|
|
Exc arm/elbo les sc >=3cm 24071
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc aurl glomus tum trnscanl
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exc aurl glomus tum trnsmstd
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exc back les sbq <3 cm 21930
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,531.25
|
|
Exc back tum deep 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc bartholins gland/cyst
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Exc ben+marg excep skin tag feenlm 1.1-2cm 11442
|
$703.59 |
$703.59 |
$703.59 |
$2,184.60
|
|
Exc ben+marg excep skin tag feenlm 2.1-3cm 11443
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,184.60
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$703.59 |
$703.59 |
$703.59 |
$1,447.50
|
|
Exc ben+marg excep skin tag snhfg 0.6-1cm 11421
|
$703.59 |
$703.59 |
$703.59 |
$1,989.75
|
|
Exc ben+marg excep skin tag snhfg 2.1-3cm 11423
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,967.25
|
|
Exc ben+marg excep skin tag snhfg >4cm 11426
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,901.00
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$399.53 |
$399.53 |
$399.53 |
$1,501.50
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$703.59 |
$703.59 |
$703.59 |
$1,743.00
|
|
Exc benign feenlm 3.1-4.0cm 11444
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,910.75
|
|
Exc benign feenlm >4.0cm 11446
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$3,515.40
|
|
Exc benign snhfg 3.1-4.0cm 11424
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,417.00
|
|
Exc benign tal 0.5 < cm 11400
|
$703.59 |
$703.59 |
$703.59 |
$1,527.60
|
|
Exc breast duct fistula 19112
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Exc cervix repair bowel 57556
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Exc cervix/repair vagina 57555
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Exc chest wall tumor w/ribs 21601
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc coccygl pr ulc flap clsr
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Exc coccygl pr ulc prim sutr
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc constrict ring finger w/mlt z-plasties 26596
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Exc excessive skin buttock
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc excessive skin hip
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc excessive skin leg
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc excessive skin thigh
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc excsv skin forearm/hand
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc excsv submental fat pad
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc ext ear/partial/simple repair 69110
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc face tum deep 2cm/> 21014
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$6,184.50
|
|
Exc face tum deep < 2 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc feenl mal+mrg 0.6-1 11641
|
$703.59 |
$703.59 |
$703.59 |
$1,534.40
|
|
Exc feenl mal+mrg 2.1-3 11643
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,185.50
|
|
Exc foot/toe tum dep 1.5cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc foot/toe tum subq < 1.5 cm 28043
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc forearm les sc 3 cm/>
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,778.50
|
|
Exc forearm tum deep 3 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc forearm tum deep < 3 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc hand les sc < 1.5 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc hand tum deep 1.5 cm/>
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc hand tum deep < 1.5 cm 26116
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc hidradenitis ing simpl 11462
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$621.60
|
|
Exc hidradenitis peri/umb comp 11471
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc hidradenitis peri/umb int 11470
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc hip/pelv tum deep 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc hip/pelv tum deep < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc im tumor/back/flank/ < 5 cm 21932
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc im tumor/foot/toe < 1.5 cm 28045
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc im tumor/shoulder area 5cm/> 23073
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,745.00
|
|
Exc isch pr ulc prm sut ostc
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc isch pr ulc skn flp clsr
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Exc isch pr ulc skn flp ostc
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Exc ischial pr ulc prim sutr
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc ischial pr ulcer w/ostc musc/myoq flap/skin 15946
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Exc leg/ankle tum dep 5 cm/ > 27634
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc leg/ankle tum subfasc<5cm 27619
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc les conjunctiva <1 cm
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Exc les conjunctiva >1 cm
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Exc les conjunctiva adj scl
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Exc les/mucos/sub/ves mouth/no rpr 40810
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Exc mal+marg tal 1.1-2 cm 11602
|
$399.53 |
$399.53 |
$399.53 |
$2,151.75
|
|
Exc mal+marg tal 2.1-3 cm 11603
|
$703.59 |
$703.59 |
$703.59 |
$1,521.75
|
|
Exc mal+marg tal 3.1-4 cm 11604
|
$703.59 |
$703.59 |
$703.59 |
$1,891.50
|
|
Exc malig feenl 1.1-2 11642
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Exc malig feenl 3.1-4.0 11644
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc malig feenl <0.5cm 11640
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Exc malig feenl >4cm 11646
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc malig snhfg 0.5cm or less 11620
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,105.20
|
|
Exc malig snhfg 0.6-1.0 cm 11621
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Exc malig snhfg 2.1-3 cm 11623
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc malig tal 0.6-1.0cm 11601
|
$703.59 |
$703.59 |
$703.59 |
$1,407.75
|
|
Exc malig tal <0.5cm 11600
|
$703.59 |
$703.59 |
$703.59 |
$1,407.75
|
|
Exc mandible 21025
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exc neck tum deep 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc neck tum deep < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc of facial bones/osteomy/abcess 21026
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exc of residual cervix via aginal approach 57550
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Exc prtl bn phlnx toe
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,126.75
|
|
Exc rect tum transanal full
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Exc rect tum transanal part
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Exc sac pr ulc prim str ostc
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc sac pr ulc skn flp ostc
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Exc sacral pr ulc prim sutr
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc sacral pr ulc skn flap
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Exc shoulder tum deep < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc skn hdrdnt ax complex
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$846.00
|
|
Exc skn hdrdnt ax smpl/ntrm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$652.80
|
|
Exc skn hdrdnt ing complex
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$703.59 |
$703.59 |
$703.59 |
$2,185.50
|
|
Exc snhfg mal+mrg 3.1-4 11624
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,444.25
|
|
Exc snhfg mal+mrg >4 cm 11626
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc sq tum/leg or ankle area <3 cm 27618
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc sq tum/neck or ant thorax <3cm 21555
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,343.20
|
|
Exc sq tum/neck/ant thorax 3cm/> 21552
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc sq tum/vasc malform/hand/fngr 26111
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc sq tumor/foot or toe < 1.5 cm 28039
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc sq tumor/forearm/wrist/<3cm 25075
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,342.00
|
|
Exc sq tumor/leg/ankle 3cm/> 27632
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc sq tumor/shoulder area 3cm/> 23071
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc sq tumor/thigh/knee area 3cm/> 27337
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc subq tum/sft tis/pel/hip 3cm/> 27043
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc tendon sheath or cap lesion 26160
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Exc thigh/knee les sc<3cm 27327
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,897.50
|
|
Exc thigh/knee tum deep <5cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc thigh/knee tum dep 5cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc thrombosed hemorrhoid 46320
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,491.20
|
|
Exc tmr sft tiss shldr subq <3cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc torus mandibularis 21031
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Exc tr-ext mal+marg tal >4 cm 11606
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,577.75
|
|
Exc trchntr pr ulc flp clsr
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Exc trchntr pr ulc flp ostc
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Exc trchntr pr ulc prep flap
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Exc trchntr pr ulc prep ostc
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Exc trchntr pr ulc prim sutr
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Exc trchntric pr ulcer w/prim sutr w/ostectomy 15951
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Exc vagina lesion 57135
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Exc/crtg b1 cst/b9 tum rds
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Exc/crtg b1 cst/tum hum agrf
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Exc/crtg b1 cst/tum hum algr
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Exc/crtg b1 cst/tum rds agrf
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Exc/crtg b1 cst/tum rds algr
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Exc/curetg cst/tum tarsal/metar w/iliac/agrf 28106
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Exc/curtg b1 cst/b9 tum hum
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$4,284.00
|
|
Exchange biliary drg cath
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Exchange blood transfusion newborn 36450
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Exchange drainage catheter
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,610.75
|
|
Exchange lens prosthesis
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Exchange nephrostomy cath
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,572.20
|
|
Excimer lsr psriasis 250-500
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Excimer lsr psriasis<250sqcm
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Excimer lsr psriasis>500sqcm
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Excis partial tal calc
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Excis uppr jaw cyst w/repair
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise anal ext tag/papilla
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,813.40
|
|
Excise epiphyseal bar
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Excise foot tendon sheath
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Excise foot tendon sheath
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Excise inferior turbinate
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excise intraspinl lesion crv
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Excise intrspinl lesion lmbr
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Excise intrspinl lesion scrl
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Excise lesion testis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Excise lip or cheek fold
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Excise lwr jaw cyst w/repair
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise mandible lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excise max/zygoma b9 tumor
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise max/zygoma mal tumor
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise oral mucosa for graft 40818
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Excise parotid gland/lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise parotid gland/lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise parotid gland/lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise parotid gland/lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise pharynx lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excise sublingual gland
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise submaxillary gland
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excise subq tumor/abd wall <3 cm 22902
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Excise tendon forearm/wrist
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Excise wrist tendon sheath
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Excise/repair mouth lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Excision aural polyp
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm
|
$703.59 |
$703.59 |
$703.59 |
$2,184.60
|
|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,064.75
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$703.59 |
$703.59 |
$703.59 |
$1,520.25
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,265.20
|
|
Excision breast lesion
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Excision floor mouth lesion 41116
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision graft extremity
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$504.00
|
|
Excision gum each quadrant
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision hand/finger tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Excision lesion mouth roof
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excision lesion mouth roof
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision nasal polyp(s) simple 30110
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Excision of anal lesion(s)
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$3,114.00
|
|
Excision of gum flap
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Excision of gum lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Excision of gum lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of gum lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excision of gum lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Excision of gum lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excision of gum lesion 41825
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of lingual tonsil
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excision of mouth lesion complex 40816
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of neck cyst
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Excision of neck cyst confined 42810
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of penis lesion(s) 54060
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,976.25
|
|
Excision of rectal lesion
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Excision of rectal stricture
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Excision of salivary cyst
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of tongue lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of tongue lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of tongue lesion w/closure 41113
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of tonsil tags
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of umbilicus 49250
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Excision of uvula
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision of vaginal septum 57130
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Excision olecranon bursa
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$2,271.60
|
|
Excision radial head
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Excision tongue lesion without closure 41110
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Excision tumor soft tissue back/flank subcutaneous >= 3 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,255.75
|
|
Exercise tst brncspsm w/ecg
|
$128.90 |
$128.90 |
$128.90 |
$337.50
|
|
Exercise tst brncspsm wo ecg
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Exome sequence analysis
|
$4,780.00 |
$4,780.00 |
$4,780.00 |
$7,002.00
|
|
Exp w remove/deep fb/forearm/wrist 25248
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Exploration for testis
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Exploration for testis
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Exploration maxillary sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exploration maxillary sinus
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Exploration of ankle joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Exploration of foot joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Exploration of foot joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Exploration of frontal sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exploration of frontal sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exploration of knee joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$5,891.40
|
|
Exploration of middle ear
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Exploration of sinuses
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Exploration of toe joint
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Explore deep node(s) neck
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Explore epididymis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Explore inner ear
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Explore inner ear
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Explore limb vessels 35860
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,583.20
|
|
Explore parathyroid glands
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$1,307.40
|
|
Explore penetrating wnd/extremity 20103
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,349.80
|
|
Explore scrotum
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Explore wound abdomen 20102
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,845.40
|
|
Explore wound neck 20100
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Explore woundchest 20101
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Explore/biopsy eye socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Explore/biopsy eye socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Explore/drain eye socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Explore/drain eye socket
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Explore/irrigate tear ducts
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Explore/treat ankle joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Explore/treat eye socket
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Explore/treat eye socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Explore/treat eye socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Explore/treat eye socket 67413
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Explore/treat finger joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Explore/treat finger joint
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$4,131.00
|
|
Explore/treat knee joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Explore/treat wrist joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$5,268.60
|
|
Explr/decompress eye socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Explr/decompress eye socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Ext ecg>48hr<7d scan a/r
|
$128.90 |
$128.90 |
$128.90 |
$238.50
|
|
Ext ecg>7d<15d scan a/r
|
$128.90 |
$128.90 |
$128.90 |
$238.50
|
|
Extended culture of oocytes
|
$816.90 |
$816.90 |
$816.90 |
$816.90
|
|
Extended visual field xm
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Extensive ear canal surgery 69150
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Extensive hand surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Extensive mastoid surgery
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Extensive mastoid surgery
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Extensive surgery of throat
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Extensive surgery of throat
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Extensive testis surgery
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
External cannula declotting
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$1,553.44
|
|
External chromosome analysis 20-25 cells
|
$144.61 |
$144.61 |
$144.61 |
$869.40
|
|
External ocular photography
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$24.49 |
$24.49 |
$24.49 |
$146.40
|
|
External profiling gene expression oncology (breast) mrna 21 genes
|
$3,873.00 |
$3,873.00 |
$3,873.00 |
$3,873.00
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$143.75 |
$143.75 |
$143.75 |
$903.75
|
|
Extnd color vision xm
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$17.93 |
$17.93 |
$17.93 |
$159.00
|
|
Extraction erupted tooth/exr
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Extraction of lens
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Extraction of lens
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Extraction of lens 66920
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Extrnl counterpulse, per tx
|
$128.90 |
$128.90 |
$128.90 |
$573.75
|
|
Eye allergy tests
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
F-18 florbetapir less than or equal to 10 mci
|
$2,194.62 |
$2,194.62 |
$2,194.62 |
$5,679.38
|
|
F-18 fluciclovine per mci
|
$268.42 |
$268.42 |
$268.42 |
$710.40
|
|
F9 full gene sequence
|
$600.00 |
$600.00 |
$600.00 |
$600.00
|
|
Face bone graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Facial bones <3
|
$88.05 |
$88.05 |
$88.05 |
$320.40
|
|
Facial nerve function test
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Facility svs dental rehab
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Factor ix
|
$19.04 |
$19.04 |
$19.04 |
$186.75
|
|
Factor ix alprolix recomb
|
$3.63 |
$3.63 |
$3.63 |
$38,712.83
|
|
Factor ix complex
|
$1.70 |
$1.70 |
$1.70 |
$7.80
|
|
Factor ix idelvion inj
|
$5.34 |
$5.34 |
$5.34 |
$36,235.50
|
|
Factor ix non-recombinant
|
$1.34 |
$1.34 |
$1.34 |
$1.34
|
|
Factor ix recomb gly rebinyn
|
$4.58 |
$4.58 |
$4.58 |
$4.58
|
|
Factor ix recombinant nos
|
$1.88 |
$1.88 |
$1.88 |
$34.65
|
|
Factor viii
|
$17.90 |
$17.90 |
$17.90 |
$213.00
|
|
Factor viii
|
$1.13 |
$1.13 |
$1.13 |
$1.13
|
|
Factor viii fc fusion recomb
|
$2.42 |
$2.42 |
$2.42 |
$17,969.85
|
|
Factor viii nuwiq recomb 1iu
|
$1.18 |
$1.18 |
$1.18 |
$1.18
|
|
Factor viii pegylated recomb
|
$2.15 |
$2.15 |
$2.15 |
$11.10
|
|
Factor viii recomb novoeight
|
$1.52 |
$1.52 |
$1.52 |
$3.40
|
|
Factor viii recomb obizur
|
$3.23 |
$3.23 |
$3.23 |
$5,435.33
|
|
Factor viii recombinant nos
|
$1.54 |
$1.54 |
$1.54 |
$11.10
|
|
Factor xiii anti-hem factor
|
$10.78 |
$10.78 |
$10.78 |
$10.78
|
|
Factor xiii recomb a-subunit
|
$18.29 |
$18.29 |
$18.29 |
$68.26
|
|
Fallopian tube recnl
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$2,904.00
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$30.00 |
$30.00 |
$30.00 |
$52.80
|
|
Family therapy with patient 50 min 90847
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Family therapy without pt 50min 90846
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Fancc gene
|
$36.62 |
$36.62 |
$36.62 |
$502.20
|
|
Fat/lipids feces qualitative
|
$5.10 |
$5.10 |
$5.10 |
$39.60
|
|
Fatty acids nonesterified
|
$18.77 |
$18.77 |
$18.77 |
$121.50
|
|
Fecal bilirubin test
|
$4.56 |
$4.56 |
$4.56 |
$4.56
|
|
Fecal microbiota prep instil
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Fecal microbiota, live-jslm 150 ml rectal suspension enema
|
$64.03 |
$64.03 |
$64.03 |
$64.03
|
|
Fees w/laryngeal sense test
|
$127.75 |
$127.75 |
$127.75 |
$127.75
|
|
Felbamate (felbatol(r)) - sendout
|
$18.64 |
$18.64 |
$18.64 |
$133.50
|
|
Fem/popl revasc w/stent
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$34,620.00
|
|
Feno poc
|
$39.25 |
$39.25 |
$39.25 |
$153.75
|
|
Fern test
|
$9.74 |
$9.74 |
$9.74 |
$9.74
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$1.14 |
$1.14 |
$1.14 |
$3,736.68
|
|
Ferritin
|
$13.63 |
$13.63 |
$13.63 |
$212.40
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$0.31 |
$0.31 |
$0.31 |
$3,963.60
|
|
Ferumoxytol, esrd use
|
$0.31 |
$0.31 |
$0.31 |
$0.31
|
|
Fetal biophys profile w/nst 76818
|
$106.34 |
$106.34 |
$106.34 |
$656.25
|
|
Fetal chrom aneuploidy gsa panel
|
$759.05 |
$759.05 |
$759.05 |
$3,621.60
|
|
Fetal contract stress test 59020 - 26
|
$201.17 |
$201.17 |
$201.17 |
$201.17
|
|
Fetal cord puncture prenatal
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Fetal fibronectin
|
$64.41 |
$64.41 |
$64.41 |
$727.80
|
|
Fetal fluid drainage w/us
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Fetal hemoglobin (kleihauer betke)
|
$7.73 |
$7.73 |
$7.73 |
$121.20
|
|
Fetal hemoglobin rosette
|
$9.36 |
$9.36 |
$9.36 |
$78.60
|
|
Fetal lung maturity assess lam body dnst
|
$19.32 |
$19.32 |
$19.32 |
$19.32
|
|
Fetal non stress test
|
$201.17 |
$201.17 |
$201.17 |
$391.50
|
|
Fetal scalp blood sampling 59030
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Fetal shunt placement w/us
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Fiasp for insulin pump use
|
$7.76 |
$7.76 |
$7.76 |
$7.76
|
|
Fibrin degradation d dimer quantitative
|
$10.18 |
$10.18 |
$10.18 |
$87.60
|
|
Fibrin degradation products
|
$6.89 |
$6.89 |
$6.89 |
$91.80
|
|
Fibrin degrade semiquant
|
$9.72 |
$9.72 |
$9.72 |
$70.20
|
|
Fibrinogen activity
|
$9.72 |
$9.72 |
$9.72 |
$80.40
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$15.48 |
$15.48 |
$15.48 |
$72.00
|
|
Fibrinolytic antiplasmin
|
$7.71 |
$7.71 |
$7.71 |
$81.00
|
|
Fibrinolytic plasminogen
|
$17.19 |
$17.19 |
$17.19 |
$159.60
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$6.53 |
$6.53 |
$6.53 |
$83.40
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$0.99 |
$0.99 |
$0.99 |
$1,964.97
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$0.29 |
$0.29 |
$0.29 |
$492.48
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$0.37 |
$0.37 |
$0.37 |
$1,504.82
|
|
Filleted finger/toe flap
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Filtered speech hearing test
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Fine needle asp without image guide 10021
|
$399.53 |
$399.53 |
$399.53 |
$722.40
|
|
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007
|
$703.59 |
$703.59 |
$703.59 |
$777.00
|
|
Finger tendon transfer
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Finger tendon transfer
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fit aphakia spectcl monofocl
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Fit aphakia spectcl multifoc
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Fitg spect low vis 1system
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Fitg spect lw vis cmpnd lens
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Fitting of diaphragm/cap 57170
|
$201.17 |
$201.17 |
$201.17 |
$201.17
|
|
Fix g/colon tube w/device
|
$937.56 |
$937.56 |
$937.56 |
$3,659.40
|
|
Fixation of ankle joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fixation of knee joint
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Fixation of shoulder blade
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fixtn pq skel dstl rad fx/epiphysl sep
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fl exam g/colon tube w contrast
|
$241.72 |
$241.72 |
$241.72 |
$626.40
|
|
Flebogamma injection
|
$55.76 |
$55.76 |
$55.76 |
$3,562.92
|
|
Flecainide (tambocor)-sendout
|
$18.64 |
$18.64 |
$18.64 |
$129.60
|
|
Flexible Sigmoidoscopy
|
$911.71 |
$911.71 |
$911.71 |
$1,158.00
|
|
Flexor-plasty elbow
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Flexor-plasty elbw w/advmnt
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Floor of mouth biopsy 41108
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$996.60
|
|
Florbetaben f18 diagnostic
|
$1,273.76 |
$1,273.76 |
$1,273.76 |
$1,273.76
|
|
Flortaucipir inj 1 millicuri
|
$3,710.00 |
$3,710.00 |
$3,710.00 |
$3,710.00
|
|
Flotufolastat f18 diag 1 mci
|
$671.22 |
$671.22 |
$671.22 |
$1,173.60
|
|
Flow cytometry one marker technical component
|
$359.72 |
$359.72 |
$359.72 |
$288.60
|
|
Floxuridine injection
|
$4,125.55 |
$4,125.55 |
$4,125.55 |
$8,522.40
|
|
Flt3 gene
|
$165.51 |
$165.51 |
$165.51 |
$277.80
|
|
Flt3 gene analysis
|
$83.00 |
$83.00 |
$83.00 |
$83.00
|
|
Fludarabine 50 mg intravenous solution
|
$71.65 |
$71.65 |
$71.65 |
$601.96
|
|
Fluid pressure muscle 20950
|
$703.59 |
$703.59 |
$703.59 |
$445.50
|
|
Fluidotherapy charges pt
|
$20.16 |
$20.16 |
$20.16 |
$95.40
|
|
Fluocinol acet intravit imp
|
$497.80 |
$497.80 |
$497.80 |
$497.80
|
|
Fluocinolone acetonide implt
|
$339.76 |
$339.76 |
$339.76 |
$70,344.94
|
|
Fluorescein angioscopy i&r
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Fluorescein angrph mltiframe
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Fluorescein&icg angiography
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Fluorescent antibody titer dna
|
$12.05 |
$12.05 |
$12.05 |
$186.60
|
|
Fluoro polarize fetal lung
|
$18.91 |
$18.91 |
$18.91 |
$18.91
|
|
Fluorodopa f-18 diag per mci
|
$498.62 |
$498.62 |
$498.62 |
$498.62
|
|
Fluoroestradiol f 18
|
$498.67 |
$498.67 |
$498.67 |
$1,413.00
|
|
Fluoroscopy up to 1 hour
|
$241.72 |
$241.72 |
$241.72 |
$534.60
|
|
Flutemetamol f18 diagnostic
|
$1,866.58 |
$1,866.58 |
$1,866.58 |
$1,866.58
|
|
Fmri brain by phys/psych
|
$241.72 |
$241.72 |
$241.72 |
$1,741.80
|
|
Fmri brain by tech
|
$241.72 |
$241.72 |
$241.72 |
$1,337.25
|
|
Fna bx w/ct gdn 1st les
|
$703.59 |
$703.59 |
$703.59 |
$900.75
|
|
Fna bx w/mr gdn 1st les
|
$703.59 |
$703.59 |
$703.59 |
$738.00
|
|
Foam stability fetal lung
|
$18.91 |
$18.91 |
$18.91 |
$18.91
|
|
Folic acid
|
$14.70 |
$14.70 |
$14.70 |
$117.00
|
|
Follow-up angiography
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,599.50
|
|
Follow-up surgery of eye
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Followup eval of foot pt lop
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Fomepizole 1 gram/ml intravenous solution
|
$6.03 |
$6.03 |
$6.03 |
$1,261.49
|
|
Foot X-ray
|
$88.05 |
$88.05 |
$88.05 |
$339.50
|
|
Forehead flap w/vasc pedicle 15731
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Forensic cytopathology
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$243.21 |
$243.21 |
$243.21 |
$285.00
|
|
Foscarnet sodium injection
|
$15.58 |
$15.58 |
$15.58 |
$1,101.86
|
|
Fractionation ketosteroids
|
$28.50 |
$28.50 |
$28.50 |
$28.50
|
|
Fracture assessment via dxa
|
$88.05 |
$88.05 |
$88.05 |
$530.25
|
|
Fragmenting of kidney stone
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$9,085.50
|
|
Frenectomy 41115
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Frenotomy 40806
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Frenulotomy of penis
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$71.09 |
$71.09 |
$71.09 |
$243.00
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$84.29 |
$84.29 |
$84.29 |
$237.00
|
|
Fresh frozen plasma thawing ea un
|
$171.36 |
$171.36 |
$171.36 |
$121.20
|
|
Frozen blood freeze/thaw
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Frozen blood prep
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Frozen blood thaw
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Frozen cell preparation
|
$12.09 |
$12.09 |
$12.09 |
$12.09
|
|
Frozen plasma, pooled, sd
|
$62.31 |
$62.31 |
$62.31 |
$62.31
|
|
Fructosamine glycated protein
|
$16.76 |
$16.76 |
$16.76 |
$85.20
|
|
Ftl cgen abnor four anal
|
$153.50 |
$153.50 |
$153.50 |
$153.50
|
|
Full field erg w/i&r
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Full mouth x-ray of teeth
|
$241.72 |
$241.72 |
$241.72 |
$241.72
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,955.80
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$2,910.75
|
|
Fundus photography with i&r 92250
|
$128.90 |
$128.90 |
$128.90 |
$139.80
|
|
Fusion of ankle joint open
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Fusion of big toe joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of big toe joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of finger joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion of finger tendons
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Fusion of finger tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion of foot bones
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of foot bones
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Fusion of foot bones
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Fusion of hand joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of knuckle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of knuckle joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion of knuckle joints
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of knuckle joints
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion of knuckle with graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of spermatic ducts
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Fusion of spermatic ducts
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Fusion of tendons at wrist
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion of tendons at wrist
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion of thumb
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Fusion of tibiofibular joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Fusion of toes
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion/graft of finger joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Fusion/graft of hand joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
G-esoph reflx tst w/electrod
|
$530.60 |
$530.60 |
$530.60 |
$1,306.80
|
|
G-tube reposition
|
$243.21 |
$243.21 |
$243.21 |
$865.50
|
|
G6pc gene
|
$58.49 |
$58.49 |
$58.49 |
$343.80
|
|
G6pd full gene sequence
|
$600.00 |
$600.00 |
$600.00 |
$600.00
|
|
G6pd gene alys cmn variant
|
$174.81 |
$174.81 |
$174.81 |
$174.81
|
|
G6pd known familial variant
|
$375.25 |
$375.25 |
$375.25 |
$375.25
|
|
Ga-68 gallium 68 dotatate
|
$51.09 |
$51.09 |
$51.09 |
$156.00
|
|
Galac-1-phosphate uridyltran - sendout
|
$21.07 |
$21.07 |
$21.07 |
$41.40
|
|
Galactokinase - sendout
|
$21.48 |
$21.48 |
$21.48 |
$21.48
|
|
Galactose transferase test
|
$11.74 |
$11.74 |
$11.74 |
$11.74
|
|
Galectin-3
|
$44.25 |
$44.25 |
$44.25 |
$78.00
|
|
Gallbladder Removal (Laparoscopic)
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$6,672.53
|
|
Gallium ga-68 dotatoc
|
$4.05 |
$4.05 |
$4.05 |
$4.05
|
|
Gallium ga-68 psma-11 ucsf
|
$534.91 |
$534.91 |
$534.91 |
$534.91
|
|
Gallium ga-68 psma-11, ucla
|
$372.17 |
$372.17 |
$372.17 |
$372.17
|
|
Gallium illuccix 1 millicure
|
$973.64 |
$973.64 |
$973.64 |
$1,900.80
|
|
Gallium locametz 1 millicuri
|
$873.44 |
$873.44 |
$873.44 |
$873.44
|
|
Gamma globulin 1 cc inj
|
$48.42 |
$48.42 |
$48.42 |
$106.20
|
|
Gamma globulin > 10 cc inj
|
$167.06 |
$167.06 |
$167.06 |
$167.06
|
|
Gamma glutamyltransferase
|
$7.20 |
$7.20 |
$7.20 |
$88.20
|
|
Gammaglobulin iga
|
$9.30 |
$9.30 |
$9.30 |
$169.50
|
|
Gammaglobulin ige
|
$16.46 |
$16.46 |
$16.46 |
$144.60
|
|
Gammaplex injection
|
$62.47 |
$62.47 |
$62.47 |
$6.00
|
|
Gamunex-c/gammaked
|
$48.03 |
$48.03 |
$48.03 |
$338.40
|
|
Gardner vag dna quant
|
$41.76 |
$41.76 |
$41.76 |
$351.20
|
|
Gastric analy w/ph ea spec
|
$6.71 |
$6.71 |
$6.71 |
$6.71
|
|
Gastric emptying imag study
|
$538.27 |
$538.27 |
$538.27 |
$538.27
|
|
Gastric emptying imag study
|
$401.83 |
$401.83 |
$401.83 |
$373.80
|
|
Gastric motility studies
|
$530.60 |
$530.60 |
$530.60 |
$1,317.00
|
|
Gastric mucosa imaging
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Gastrin test
|
$17.69 |
$17.69 |
$17.69 |
$106.50
|
|
Gastroesophageal reflux study
|
$401.83 |
$401.83 |
$401.83 |
$1,139.25
|
|
Gastroesophageal reflux test
|
$530.60 |
$530.60 |
$530.60 |
$1,115.40
|
|
Gastrostomy open neonatal
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Gated heart multiple
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Gba gene
|
$47.25 |
$47.25 |
$47.25 |
$1,191.60
|
|
Gel-one
|
$524.02 |
$524.02 |
$524.02 |
$524.02
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$236.62 |
$236.62 |
$236.62 |
$236.62
|
|
Genetic tstg severe inh cond
|
$2,448.56 |
$2,448.56 |
$2,448.56 |
$11,208.75
|
|
Geniop sldg augmentation
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Geniop sldg osteot 1
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Geniop sldg osteot 2/>
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Genioplasty augmentation
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Genome sequence analysis
|
$5,031.20 |
$5,031.20 |
$5,031.20 |
$4,439.40
|
|
Gentamicin peak therapeutic drug level
|
$16.38 |
$16.38 |
$16.38 |
$156.75
|
|
Genvisc 850, inj, 1mg
|
$6.02 |
$6.02 |
$6.02 |
$6.02
|
|
Ghs HIV antibody
|
$13.71 |
$13.71 |
$13.71 |
$103.20
|
|
Ghs IV inf sq injection, on-body injector
|
$46.14 |
$46.14 |
$46.14 |
$138.60
|
|
Ghs IV thrombolytics - cerebral
|
$331.69 |
$331.69 |
$331.69 |
$541.50
|
|
Ghs abscess perianal iandd
|
$911.71 |
$911.71 |
$911.71 |
$1,829.60
|
|
Ghs abscess postoperative iandd complex
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$3,993.00
|
|
Ghs acetylcholinesterase, rbc
|
$9.81 |
$9.81 |
$9.81 |
$119.25
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$17.11 |
$17.11 |
$17.11 |
$147.60
|
|
Ghs alpha thalasemia, 7 deletions
|
$102.26 |
$102.26 |
$102.26 |
$1,687.20
|
|
Ghs analysis neurostim without reprogramming
|
$128.90 |
$128.90 |
$128.90 |
$574.80
|
|
Ghs antibodies (torch) igm
|
$14.39 |
$14.39 |
$14.39 |
$131.25
|
|
Ghs aspiration bladder - needle
|
$243.21 |
$243.21 |
$243.21 |
$616.80
|
|
Ghs bladder cath - complex-foley
|
$156.46 |
$156.46 |
$156.46 |
$492.00
|
|
Ghs bleeding time (ivy)
|
$4.82 |
$4.82 |
$4.82 |
$4.82
|
|
Ghs block ilioinguinal/gentitofemoral
|
$692.52 |
$692.52 |
$692.52 |
$1,260.60
|
|
Ghs central line insert < age 5, failed
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,145.80
|
|
Ghs change cysto/gastrost
|
$243.21 |
$243.21 |
$243.21 |
$1,265.40
|
|
Ghs chemo >8 hrs
|
$331.69 |
$331.69 |
$331.69 |
$772.50
|
|
Ghs chemo IV push, ea addtl
|
$71.17 |
$71.17 |
$71.17 |
$378.00
|
|
Ghs chemo infusion >8 hrs
|
$331.69 |
$331.69 |
$331.69 |
$331.69
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$35.09 |
$35.09 |
$35.09 |
$360.00
|
|
Ghs cl tx knee disl; wo anesth
|
$239.88 |
$239.88 |
$239.88 |
$1,961.40
|
|
Ghs cl tx metacarpophal disloc without anes
|
$239.88 |
$239.88 |
$239.88 |
$471.75
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$239.88 |
$239.88 |
$239.88 |
$630.00
|
|
Ghs closed reduction ankle dislocation
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,635.60
|
|
Ghs closed tx radiocarpal disloc w manip
|
$239.88 |
$239.88 |
$239.88 |
$273.00
|
|
Ghs closed tx tibial fracture w/manip
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Ghs closure surg wound/dehiscence-13160
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$2,182.50
|
|
Ghs clsd red med malleolus fx w manip
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,632.20
|
|
Ghs clsd red med malleolus fx without manip
|
$239.88 |
$239.88 |
$239.88 |
$321.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,319.00
|
|
Ghs community re-entry 15 minutes
|
$40.61 |
$40.61 |
$40.61 |
$75.60
|
|
Ghs conjunctiva foreign body-embed bil
|
$399.04 |
$399.04 |
$399.04 |
$494.40
|
|
Ghs conjunctiva foreign body-superf bil
|
$128.90 |
$128.90 |
$128.90 |
$351.75
|
|
Ghs corneal fb with slit lamp bilat
|
$128.90 |
$128.90 |
$128.90 |
$408.60
|
|
Ghs corneal fb without slit lamp bilat
|
$399.04 |
$399.04 |
$399.04 |
$422.25
|
|
Ghs cricothyroidotomy
|
$232.22 |
$232.22 |
$232.22 |
$777.60
|
|
Ghs cutdown placement age 1 and over
|
$399.04 |
$399.04 |
$399.04 |
$102.60
|
|
Ghs cutdown placement under 1 yr
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Ghs diphtheria toxoid ab igg
|
$15.21 |
$15.21 |
$15.21 |
$165.60
|
|
Ghs dislocation elbow closed treatment
|
$239.88 |
$239.88 |
$239.88 |
$856.20
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$937.56 |
$937.56 |
$937.56 |
$3,175.50
|
|
Ghs ed rmvl or bivalving cast
|
$265.58 |
$265.58 |
$265.58 |
$370.80
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$692.52 |
$692.52 |
$692.52 |
$1,439.40
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$156.46 |
$156.46 |
$156.46 |
$586.80
|
|
Ghs elect torsion swing
|
$156.46 |
$156.46 |
$156.46 |
$282.00
|
|
Ghs electrostagmgraphy
|
$156.46 |
$156.46 |
$156.46 |
$931.50
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$399.53 |
$399.53 |
$399.53 |
$1,341.60
|
|
Ghs excision ingrown nail
|
$399.53 |
$399.53 |
$399.53 |
$484.80
|
|
Ghs eye exam
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Ghs eyelid foreign body-embedded - bil
|
$298.93 |
$298.93 |
$298.93 |
$718.20
|
|
Ghs fat & muscle
|
$4.85 |
$4.85 |
$4.85 |
$33.00
|
|
Ghs fb removal - incisional
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,182.40
|
|
Ghs fb removal - non-incisional
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,551.00
|
|
Ghs fb removal foot - deep - left
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,771.00
|
|
Ghs fb removal from muscle - complicated
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$3,737.40
|
|
Ghs febrile agglutinns(mayo)
|
$6.98 |
$6.98 |
$6.98 |
$76.50
|
|
Ghs fish cytogen
|
$21.42 |
$21.42 |
$21.42 |
$186.00
|
|
Ghs fish hybrid in situ 100-300
|
$51.19 |
$51.19 |
$51.19 |
$354.60
|
|
Ghs flow volume loop
|
$311.40 |
$311.40 |
$311.40 |
$223.20
|
|
Ghs gastric intub aspiration lavage
|
$311.40 |
$311.40 |
$311.40 |
$304.80
|
|
Ghs hcv amplificaiton
|
$35.09 |
$35.09 |
$35.09 |
$223.80
|
|
Ghs heavy metals bld (ars,lead,merc)
|
$22.97 |
$22.97 |
$22.97 |
$22.97
|
|
Ghs hepatitis c virus (hcv riba)
|
$15.49 |
$15.49 |
$15.49 |
$162.00
|
|
Ghs hgb stability-thal
|
$9.47 |
$9.47 |
$9.47 |
$252.75
|
|
Ghs histoplasma antigen
|
$13.25 |
$13.25 |
$13.25 |
$492.00
|
|
Ghs hla-dr/dq, multiple antigens
|
$106.14 |
$106.14 |
$106.14 |
$458.40
|
|
Ghs i and d abscess/hematoma scrotum
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$4,134.00
|
|
Ghs i and d perirectal abscess 46040
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,637.00
|
|
Ghs i and d pilonidal cyst complex
|
$703.59 |
$703.59 |
$703.59 |
$1,572.00
|
|
Ghs i and d pilonidal cyst simple
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Ghs immun0electrophoresis
|
$29.92 |
$29.92 |
$29.92 |
$178.50
|
|
Ghs incision thrombosed ext hemorrhoid
|
$243.21 |
$243.21 |
$243.21 |
$526.50
|
|
Ghs indirect laryngoscopy/w fb removal
|
$194.14 |
$194.14 |
$194.14 |
$194.14
|
|
Ghs inhibitor screen
|
$12.87 |
$12.87 |
$12.87 |
$345.00
|
|
Ghs init tx 1st degree burn
|
$198.70 |
$198.70 |
$198.70 |
$448.50
|
|
Ghs inj neurolytic intercostal nerve
|
$890.29 |
$890.29 |
$890.29 |
$3,021.75
|
|
Ghs inj neurolytic other perph nerve
|
$890.29 |
$890.29 |
$890.29 |
$1,231.20
|
|
Ghs inj tendon origin/insertion
|
$295.19 |
$295.19 |
$295.19 |
$467.40
|
|
Ghs inj transforaminal cerv single bil
|
$890.29 |
$890.29 |
$890.29 |
$1,957.50
|
|
Ghs insertion of needle - bone
|
$399.04 |
$399.04 |
$399.04 |
$550.80
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$399.53 |
$399.53 |
$399.53 |
$1,829.40
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$612.13 |
$612.13 |
$612.13 |
$2,649.00
|
|
Ghs intermed repair over 30 cm - 12037
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,532.20
|
|
Ghs irrigate corpora cavernosa for priapism
|
$243.21 |
$243.21 |
$243.21 |
$2,619.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$399.04 |
$399.04 |
$399.04 |
$569.60
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$399.53 |
$399.53 |
$399.53 |
$477.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Ghs layer closure 2.5cm or less - 12051
|
$399.53 |
$399.53 |
$399.53 |
$520.80
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$399.53 |
$399.53 |
$399.53 |
$998.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$612.13 |
$612.13 |
$612.13 |
$1,212.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$612.13 |
$612.13 |
$612.13 |
$1,134.60
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$399.53 |
$399.53 |
$399.53 |
$993.00
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$399.53 |
$399.53 |
$399.53 |
$471.75
|
|
Ghs layered repair over 3.0 cm -12057
|
$399.53 |
$399.53 |
$399.53 |
$471.75
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Ghs leukocyte alkaline phos (mayo)
|
$8.60 |
$8.60 |
$8.60 |
$154.80
|
|
Ghs mbp
|
$17.20 |
$17.20 |
$17.20 |
$143.25
|
|
Ghs nailbed repair/nail removal
|
$612.13 |
$612.13 |
$612.13 |
$1,236.60
|
|
Ghs nerve blk intercostal, ea addtl level
|
$890.29 |
$890.29 |
$890.29 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$692.52 |
$692.52 |
$692.52 |
$1,541.40
|
|
Ghs nerve block axillary nerve
|
$890.29 |
$890.29 |
$890.29 |
$1,763.25
|
|
Ghs nerve block brachial plexus
|
$890.29 |
$890.29 |
$890.29 |
$1,689.00
|
|
Ghs nerve block celiac plexus
|
$890.29 |
$890.29 |
$890.29 |
$2,512.80
|
|
Ghs nerve block interscaline
|
$890.29 |
$890.29 |
$890.29 |
$1,671.75
|
|
Ghs nerve block lumbar or thoracic symp
|
$890.29 |
$890.29 |
$890.29 |
$1,787.40
|
|
Ghs nerve block sciatic nerve
|
$692.52 |
$692.52 |
$692.52 |
$1,809.60
|
|
Ghs nerve block suprascapular
|
$692.52 |
$692.52 |
$692.52 |
$1,131.00
|
|
Ghs ng placement w fluoro guidance
|
$399.04 |
$399.04 |
$399.04 |
$589.80
|
|
Ghs o2 saturation
|
$9.77 |
$9.77 |
$9.77 |
$106.50
|
|
Ghs o2 uptake rest & exercise
|
$156.46 |
$156.46 |
$156.46 |
$660.60
|
|
Ghs o2 uptake rest & indirect
|
$59.40 |
$59.40 |
$59.40 |
$433.50
|
|
Ghs ob unlisted IV or art inj or infusion
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Ghs opcc repair cvp w subq port
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$4,080.00
|
|
Ghs opcc repair cvp without subq port
|
$618.26 |
$618.26 |
$618.26 |
$2,205.00
|
|
Ghs optokenetic
|
$156.46 |
$156.46 |
$156.46 |
$256.50
|
|
Ghs oscillating trac
|
$311.40 |
$311.40 |
$311.40 |
$260.40
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$25.30 |
$25.30 |
$25.30 |
$47.80
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$25.30 |
$25.30 |
$25.30 |
$25.30
|
|
Ghs ot dds rom
|
$10.05 |
$10.05 |
$10.05 |
$194.25
|
|
Ghs ot group caregiver training
|
$14.15 |
$14.15 |
$14.15 |
$44.40
|
|
Ghs ot prosthetic training/15 min
|
$52.32 |
$52.32 |
$52.32 |
$121.20
|
|
Ghs ot sensory integrative tech/15min
|
$81.32 |
$81.32 |
$81.32 |
$124.20
|
|
Ghs pacing - transcutaneous
|
$654.38 |
$654.38 |
$654.38 |
$940.50
|
|
Ghs peritonsillar abscess i andd
|
$232.22 |
$232.22 |
$232.22 |
$1,080.75
|
|
Ghs phenylketonurid
|
$5.50 |
$5.50 |
$5.50 |
$128.25
|
|
Ghs picc line insert < 5
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$3,226.80
|
|
Ghs plngl fx pm cl
|
$239.88 |
$239.88 |
$239.88 |
$685.80
|
|
Ghs plt ct-manual
|
$4.31 |
$4.31 |
$4.31 |
$43.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Ghs pos nystagmus
|
$128.90 |
$128.90 |
$128.90 |
$251.40
|
|
Ghs ppd (tb intradermal)
|
$24.49 |
$24.49 |
$24.49 |
$52.50
|
|
Ghs pr without cont pulse ox
|
$59.40 |
$59.40 |
$59.40 |
$134.25
|
|
Ghs prostatic acid phosphatase (mayo)
|
$9.66 |
$9.66 |
$9.66 |
$83.40
|
|
Ghs protein, misc fluid
|
$5.61 |
$5.61 |
$5.61 |
$5.61
|
|
Ghs protoporphyrins fract
|
$14.35 |
$14.35 |
$14.35 |
$87.60
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$12.25 |
$12.25 |
$12.25 |
$108.00
|
|
Ghs quinidine
|
$14.60 |
$14.60 |
$14.60 |
$24.00
|
|
Ghs refill of implantable pump
|
$331.69 |
$331.69 |
$331.69 |
$774.00
|
|
Ghs removal intranasal foreign body
|
$128.90 |
$128.90 |
$128.90 |
$341.40
|
|
Ghs removal pharyngeal foreign body
|
$399.04 |
$399.04 |
$399.04 |
$397.50
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,055.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$5,693.40
|
|
Ghs respiratory syncytical virus igg/m
|
$15.89 |
$15.89 |
$15.89 |
$168.60
|
|
Ghs reticulocyte count
|
$4.31 |
$4.31 |
$4.31 |
$35.40
|
|
Ghs rsv eia (respir synctial vrs)
|
$13.91 |
$13.91 |
$13.91 |
$187.80
|
|
Ghs sedimentation rate
|
$4.27 |
$4.27 |
$4.27 |
$59.40
|
|
Ghs semen analysis fert
|
$12.31 |
$12.31 |
$12.31 |
$88.80
|
|
Ghs semen analysis, post-vas
|
$9.84 |
$9.84 |
$9.84 |
$9.84
|
|
Ghs sensitivity (per antimicro)
|
$7.48 |
$7.48 |
$7.48 |
$74.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$399.53 |
$399.53 |
$399.53 |
$819.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$399.53 |
$399.53 |
$399.53 |
$1,230.60
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$399.53 |
$399.53 |
$399.53 |
$965.40
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$399.53 |
$399.53 |
$399.53 |
$2,079.60
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$198.70 |
$198.70 |
$198.70 |
$589.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$198.70 |
$198.70 |
$198.70 |
$589.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$198.70 |
$198.70 |
$198.70 |
$589.80
|
|
Ghs simple repair over 30 cm - 12007
|
$198.70 |
$198.70 |
$198.70 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Ghs sleep study unattended
|
$156.46 |
$156.46 |
$156.46 |
$752.80
|
|
Ghs somatosensory testing lower extremit
|
$311.40 |
$311.40 |
$311.40 |
$978.60
|
|
Ghs somatosensory testing upper & lower limbs
|
$530.60 |
$530.60 |
$530.60 |
$855.60
|
|
Ghs sp train/fitting sp device - kx
|
$128.79 |
$128.79 |
$128.79 |
$324.75
|
|
Ghs speech-gen aug dev eval iii, st
|
$60.57 |
$60.57 |
$60.57 |
$188.80
|
|
Ghs sphenopalatine ganglion block
|
$295.19 |
$295.19 |
$295.19 |
$901.80
|
|
Ghs spont nystagmus
|
$128.90 |
$128.90 |
$128.90 |
$250.80
|
|
Ghs st - eval for alt comm
|
$39.25 |
$39.25 |
$39.25 |
$99.75
|
|
Ghs st - re-eval for alt comm
|
$93.37 |
$93.37 |
$93.37 |
$410.25
|
|
Ghs strapping shoulder - 29240
|
$128.90 |
$128.90 |
$128.90 |
$346.20
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$210.69 |
$210.69 |
$210.69 |
$269.25
|
|
Ghs superficial wnd dehis w packing12021
|
$399.53 |
$399.53 |
$399.53 |
$945.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$612.13 |
$612.13 |
$612.13 |
$2,181.60
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$5,073.00
|
|
Ghs trypsin (fecal)
|
$7.30 |
$7.30 |
$7.30 |
$7.30
|
|
Ghs tx distal phalangeal fx with manipulation
|
$239.88 |
$239.88 |
$239.88 |
$660.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$239.88 |
$239.88 |
$239.88 |
$604.00
|
|
Ghs urine, hydroxproline total
|
$24.30 |
$24.30 |
$24.30 |
$251.40
|
|
Ghs urine, porphyrins quant
|
$14.71 |
$14.71 |
$14.71 |
$288.60
|
|
Ghs vaginal delivery only
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Ghs veeg 12-26 hr intmt mont
|
$530.60 |
$530.60 |
$530.60 |
$2,109.60
|
|
Ghs windowing of cast
|
$157.79 |
$157.79 |
$157.79 |
$157.79
|
|
Gi endoscopic ultrasound
|
$241.72 |
$241.72 |
$241.72 |
$241.72
|
|
Gi inhouse confirmation
|
$9.44 |
$9.44 |
$9.44 |
$84.60
|
|
Gi protein loss
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$937.56 |
$937.56 |
$937.56 |
$1,582.50
|
|
Gi trc img intral colon i&r
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Gi trc img intral esophagus
|
$937.56 |
$937.56 |
$937.56 |
$6,183.60
|
|
Gi wireless capsule measure
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Giardia lamblia antibody
|
$14.72 |
$14.72 |
$14.72 |
$114.00
|
|
Gingivoplasty each quadrant
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Gjb2 gene full sequence
|
$101.12 |
$101.12 |
$101.12 |
$101.12
|
|
Gjb2 gene known fam variants
|
$61.52 |
$61.52 |
$61.52 |
$61.52
|
|
Gjb6 gene com variants
|
$35.00 |
$35.00 |
$35.00 |
$35.00
|
|
Glassia injection
|
$5.71 |
$5.71 |
$5.71 |
$41.40
|
|
Glaucoma scrn hgh risk direc
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Glaucoma scrn hgh risk direc
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Glaucoma surgery
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Glaucoma surgery
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Glaucoma surgery
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Glaucoma surgery
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Glucagon 1 mg solution for injection
|
$195.79 |
$195.79 |
$195.79 |
$1,053.60
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$144.88 |
$144.88 |
$144.88 |
$509.06
|
|
Glucagon plasma - sendout
|
$14.29 |
$14.29 |
$14.29 |
$131.40
|
|
Glucose 1 hr post dose
|
$4.75 |
$4.75 |
$4.75 |
$45.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$3.28 |
$3.28 |
$3.28 |
$30.00
|
|
Glucose blood quantitative
|
$3.93 |
$3.93 |
$3.93 |
$45.00
|
|
Glucose body fluid
|
$3.93 |
$3.93 |
$3.93 |
$59.25
|
|
Glucose monitoring continual min 72hr pt
|
$59.40 |
$59.40 |
$59.40 |
$90.60
|
|
Glucose tolerance test (gtt) 3 specimens
|
$12.87 |
$12.87 |
$12.87 |
$147.00
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$3.92 |
$3.92 |
$3.92 |
$34.80
|
|
Glucose-6-phosphate dhydrogenase screen
|
$6.05 |
$6.05 |
$6.05 |
$55.50
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$0.43 |
$0.43 |
$0.43 |
$11.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$11.03 |
$11.03 |
$11.03 |
$104.80
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$18.58 |
$18.58 |
$18.58 |
$171.75
|
|
Gonadotropin luteinizing hormone (lh)
|
$18.52 |
$18.52 |
$18.52 |
$129.00
|
|
Gonioscopy
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Goniotomy
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Goserelin 10.8 mg subcutaneous implant
|
$734.15 |
$734.15 |
$734.15 |
$1,831.20
|
|
Graft hand or finger tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Great toe with reduction 28495
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Grfg autol fat lipo 25 cc/<
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Grfg autol fat lipo 50 cc/<
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Grfg autol soft tiss dir exc
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Group mnt 2 or more 30 mins
|
$19.31 |
$19.31 |
$19.31 |
$19.31
|
|
Growth hormone antibody
|
$15.74 |
$15.74 |
$15.74 |
$15.74
|
|
Growth stimulation gene 2
|
$75.60 |
$75.60 |
$75.60 |
$237.60
|
|
Gstrst open wo constj tube
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Gu dilat ureter/urethra s&i
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Guided cath fluid drainage 10030
|
$703.59 |
$703.59 |
$703.59 |
$1,600.20
|
|
Gum graft
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Gynecomastia (males) 19300
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
H pylori (c-13) blood
|
$67.36 |
$67.36 |
$67.36 |
$67.36
|
|
H pylori (c-13) breath
|
$67.36 |
$67.36 |
$67.36 |
$346.80
|
|
H pylori ag ia
|
$16.00 |
$16.00 |
$16.00 |
$16.00
|
|
H pylori drug admin
|
$7.86 |
$7.86 |
$7.86 |
$7.86
|
|
HIV 2 pcr qual - sendout
|
$21.92 |
$21.92 |
$21.92 |
$21.92
|
|
HIV prep, ftc/taf 200/25mg
|
$71.27 |
$71.27 |
$71.27 |
$71.27
|
|
HIV prep, ftc/tdf 200/300mg
|
$1.74 |
$1.74 |
$1.74 |
$1.74
|
|
HIV prep, inj, cabotegravir
|
$7.03 |
$7.03 |
$7.03 |
$7.03
|
|
Hair removal by electrolysis 17380
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Hair trnspl 1-15 punch grfts
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Hair trnspl >15 punch grafts
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Hand X-ray
|
$88.05 |
$88.05 |
$88.05 |
$313.04
|
|
Hand tendon reconstruction
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Hand tendon reconstruction
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Hand tendon/muscle transfer
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Haptoglobin quantitative
|
$12.58 |
$12.58 |
$12.58 |
$135.00
|
|
Harvest auto stem cells
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$1,788.00
|
|
Harvest cultured skin graft 15040
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Harvest eye tissue alograft
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Harvest stem cell concentrte
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Hast w/i&r phys/qhp
|
$128.90 |
$128.90 |
$128.90 |
$275.40
|
|
Hast w/oxygen titrate
|
$128.90 |
$128.90 |
$128.90 |
$226.80
|
|
Hba1/hba2 full gene sequence
|
$600.00 |
$600.00 |
$600.00 |
$1,051.50
|
|
Hba1/hba2 gene dup/del vrnts
|
$202.40 |
$202.40 |
$202.40 |
$714.75
|
|
Hba1/hba2 gene fam vrnt
|
$375.25 |
$375.25 |
$375.25 |
$375.25
|
|
Hbb full gene sequence
|
$324.58 |
$324.58 |
$324.58 |
$1,172.40
|
|
Hbb gene com variants
|
$174.81 |
$174.81 |
$174.81 |
$174.81
|
|
Hbb gene dup/del variants
|
$202.40 |
$202.40 |
$202.40 |
$1,672.80
|
|
Hbb gene known fam variant
|
$375.25 |
$375.25 |
$375.25 |
$375.25
|
|
Hbot, full body chamber, 30m
|
$137.90 |
$137.90 |
$137.90 |
$756.60
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$178.02 |
$178.02 |
$178.02 |
$1,272.60
|
|
Hc metata joint dislocation anes
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Hc mohs trunk/arm/leg 1st stage 5 blocks
|
$612.13 |
$612.13 |
$612.13 |
$3,624.00
|
|
Hc nm cardiac blood pool planar 1 stdy wal motn eject fract
|
$538.27 |
$538.27 |
$538.27 |
$538.27
|
|
Hc nm fusion spect CT unlisted
|
$401.83 |
$401.83 |
$401.83 |
$679.20
|
|
Hc nm kidney imaging with flow
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$538.27 |
$538.27 |
$538.27 |
$807.75
|
|
Hc pet myocardial imaging metabolic eval single study
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$4,680.75
|
|
Hcg free betachain test
|
$15.29 |
$15.29 |
$15.29 |
$15.29
|
|
Hcg qualitative
|
$7.52 |
$7.52 |
$7.52 |
$85.20
|
|
Hcg quantitative
|
$15.05 |
$15.05 |
$15.05 |
$145.50
|
|
Hdr rdncl ntrstl/icav brchtx
|
$693.81 |
$693.81 |
$693.81 |
$886.20
|
|
Hdr rdncl ntrstl/icav brchtx
|
$693.81 |
$693.81 |
$693.81 |
$693.81
|
|
Hdr rdncl ntrstl/icav brchtx
|
$693.81 |
$693.81 |
$693.81 |
$2,553.60
|
|
Hdr rdncl skn surf brachytx
|
$262.98 |
$262.98 |
$262.98 |
$598.20
|
|
Hdr rdncl skn surf brachytx
|
$262.98 |
$262.98 |
$262.98 |
$598.20
|
|
Head CT scan (with and without contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,881.36
|
|
Head CT scan (with contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$106.34 |
$106.34 |
$106.34 |
$1,268.90
|
|
Heart first pass multiple
|
$538.27 |
$538.27 |
$538.27 |
$538.27
|
|
Heart image spect
|
$401.83 |
$401.83 |
$401.83 |
$1,651.20
|
|
Heart infarct image
|
$401.83 |
$401.83 |
$401.83 |
$1,094.40
|
|
Heart infarct image (ef)
|
$538.27 |
$538.27 |
$538.27 |
$538.27
|
|
Heinz bodies direct
|
$4.20 |
$4.20 |
$4.20 |
$4.20
|
|
Helicobacter pylori antibody igm
|
$16.85 |
$16.85 |
$16.85 |
$61.20
|
|
Hemagglutination inhibition
|
$8.19 |
$8.19 |
$8.19 |
$8.19
|
|
Hematocrit
|
$2.37 |
$2.37 |
$2.37 |
$37.20
|
|
Hematopoietic nuclear tx
|
$224.13 |
$224.13 |
$224.13 |
$746.40
|
|
Hemiepiphyseal arrest
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Hemin 350 mg intravenous powder for solution
|
$34.17 |
$34.17 |
$34.17 |
$6,247.80
|
|
Hemodialysis one evaluation
|
$699.72 |
$699.72 |
$699.72 |
$1,223.40
|
|
Hemoglobin
|
$2.37 |
$2.37 |
$2.37 |
$36.75
|
|
Hemoglobin copper sulfate
|
$4.01 |
$4.01 |
$4.01 |
$4.01
|
|
Hemoglobin f (fetal) chemical
|
$10.74 |
$10.74 |
$10.74 |
$228.00
|
|
Hemoglobin fetal qualitative
|
$8.00 |
$8.00 |
$8.00 |
$57.00
|
|
Hemoglobin methemoglobin quantitative
|
$8.20 |
$8.20 |
$8.20 |
$132.75
|
|
Hemoglobin plasma
|
$7.31 |
$7.31 |
$7.31 |
$61.20
|
|
Hemoglobin urine
|
$3.95 |
$3.95 |
$3.95 |
$52.20
|
|
Hemoglobin-oxygen affinity
|
$13.34 |
$13.34 |
$13.34 |
$686.40
|
|
Hemolysin acid
|
$8.87 |
$8.87 |
$8.87 |
$8.87
|
|
Hemolysins and agglutinins incubated
|
$12.11 |
$12.11 |
$12.11 |
$91.80
|
|
Hemolysins/agglutinins auto
|
$8.77 |
$8.77 |
$8.77 |
$8.77
|
|
Hemophilus influenza antibdy
|
$15.84 |
$15.84 |
$15.84 |
$168.00
|
|
Hemorrhoidectomy intern transanal deater 2+ 46948
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$911.71 |
$911.71 |
$911.71 |
$2,925.00
|
|
Hemorrhoidopexy stapling 46947
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Hepagam b im injection
|
$71.66 |
$71.66 |
$71.66 |
$586.80
|
|
Hepagam b intravenous, inj
|
$71.66 |
$71.66 |
$71.66 |
$71.66
|
|
Heparin assay
|
$13.09 |
$13.09 |
$13.09 |
$178.20
|
|
Heparin neutralization
|
$11.84 |
$11.84 |
$11.84 |
$187.50
|
|
Hepatitis a antibody igm
|
$11.26 |
$11.26 |
$11.26 |
$107.25
|
|
Hepatitis b core antibody igm
|
$11.77 |
$11.77 |
$11.77 |
$127.50
|
|
Hepatitis b core antibody total
|
$12.05 |
$12.05 |
$12.05 |
$111.75
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$130.66 |
$130.66 |
$130.66 |
$1,109.60
|
|
Hepatitis b surface ag quan
|
$25.32 |
$25.32 |
$25.32 |
$25.32
|
|
Hepatitis b surface antibody
|
$10.74 |
$10.74 |
$10.74 |
$106.20
|
|
Hepatitis c antibody
|
$14.27 |
$14.27 |
$14.27 |
$108.00
|
|
Hepatitis c rna dir probe
|
$31.22 |
$31.22 |
$31.22 |
$31.22
|
|
Hepatitis d quantification
|
$42.84 |
$42.84 |
$42.84 |
$627.00
|
|
Hepatobiliary system imaging
|
$401.83 |
$401.83 |
$401.83 |
$1,494.00
|
|
Hereditary colon ca dsordrs
|
$1,303.95 |
$1,303.95 |
$1,303.95 |
$3,394.80
|
|
Hernia Repair (Inguinal)
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$6,210.72
|
|
Herpes simplex 1 ag if
|
$11.98 |
$11.98 |
$11.98 |
$158.40
|
|
Herpes simplex 2 ag if
|
$11.98 |
$11.98 |
$11.98 |
$143.40
|
|
Herpes simplex type 1 antibody igg
|
$13.19 |
$13.19 |
$13.19 |
$96.00
|
|
Herpes simplex type 2 antibody igg
|
$19.35 |
$19.35 |
$19.35 |
$109.80
|
|
Herpes simplex virus isolation
|
$33.86 |
$33.86 |
$33.86 |
$186.60
|
|
Heterophile antibodies screening
|
$5.18 |
$5.18 |
$5.18 |
$56.40
|
|
Heterophile antibodies titer
|
$6.47 |
$6.47 |
$6.47 |
$6.47
|
|
Heterophile antibody absrbj
|
$7.37 |
$7.37 |
$7.37 |
$7.37
|
|
Hexa gene
|
$51.45 |
$51.45 |
$51.45 |
$1,336.80
|
|
Hhv-6 dna quant
|
$41.76 |
$41.76 |
$41.76 |
$457.80
|
|
Hi enrgy eswt plantar fascia
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Hip X-ray
|
$88.05 |
$88.05 |
$88.05 |
$290.00
|
|
Hip arthr0 w/debridement
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Hip arthr0 w/synovectomy
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Hip arthro acetabuloplasty
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Hip arthro w/fb removal
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Hip arthro w/femoroplasty
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Hip arthro w/labral repair
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Hip arthroscopy dx
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Histamine
|
$29.53 |
$29.53 |
$29.53 |
$254.40
|
|
Histoplasmosis skin test
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Hiv-1 ag ia
|
$24.06 |
$24.06 |
$24.06 |
$171.60
|
|
Hizentra injection
|
$14.12 |
$14.12 |
$14.12 |
$181.20
|
|
Hla class i high defin qual
|
$323.75 |
$323.75 |
$323.75 |
$435.60
|
|
Hla class i phenotype qual
|
$95.52 |
$95.52 |
$95.52 |
$276.00
|
|
Hla class i semiquant panel
|
$357.56 |
$357.56 |
$357.56 |
$645.00
|
|
Hla class i&ii antibody qual
|
$64.19 |
$64.19 |
$64.19 |
$207.60
|
|
Hla class i/ii antibody qual
|
$64.19 |
$64.19 |
$64.19 |
$418.50
|
|
Hla class ii high defin qual
|
$325.80 |
$325.80 |
$325.80 |
$471.00
|
|
Hla class ii phenotype qual
|
$81.88 |
$81.88 |
$81.88 |
$346.80
|
|
Hla class ii semiquant panel
|
$322.96 |
$322.96 |
$322.96 |
$573.00
|
|
Hla i & ii type verify lr
|
$404.52 |
$404.52 |
$404.52 |
$365.25
|
|
Hla i & ii typing hr
|
$345.57 |
$345.57 |
$345.57 |
$2,453.40
|
|
Hla i & ii typing lr
|
$402.12 |
$402.12 |
$402.12 |
$2,362.80
|
|
Hla i low res one antigen equiv ea
|
$74.33 |
$74.33 |
$74.33 |
$791.40
|
|
Hla i typing 1 locus hr
|
$177.25 |
$177.25 |
$177.25 |
$177.25
|
|
Hla i typing complete hr
|
$335.38 |
$335.38 |
$335.38 |
$386.25
|
|
Hla i typing complete lr
|
$403.59 |
$403.59 |
$403.59 |
$1,672.20
|
|
Hla i typing high res 1 allele grp ea
|
$169.90 |
$169.90 |
$169.90 |
$688.80
|
|
Hla i typing low res one locus ea
|
$127.43 |
$127.43 |
$127.43 |
$1,671.60
|
|
Hla ii typing 1 loc hr
|
$123.68 |
$123.68 |
$123.68 |
$1,001.25
|
|
Hla ii typing ag equiv lr
|
$220.74 |
$220.74 |
$220.74 |
$797.40
|
|
Hla typing a b or c
|
$58.00 |
$58.00 |
$58.00 |
$562.20
|
|
Hla typing dr/dq
|
$30.17 |
$30.17 |
$30.17 |
$210.60
|
|
Hla x-match noncytotoxc addl
|
$36.53 |
$36.53 |
$36.53 |
$155.25
|
|
Hla x-math non-cytotoxic
|
$109.49 |
$109.49 |
$109.49 |
$397.50
|
|
Hlth bhv assmt/reassessment
|
$92.50 |
$92.50 |
$92.50 |
$144.75
|
|
Hlth bhv ivntj fam 1st 30
|
$29.79 |
$29.79 |
$29.79 |
$111.60
|
|
Hlth bhv ivntj grp 1st 30
|
$29.79 |
$29.79 |
$29.79 |
$117.00
|
|
Hlth bhv ivntj indiv 1st 30
|
$160.67 |
$160.67 |
$160.67 |
$115.50
|
|
Home sleep test/type 2 porta
|
$156.46 |
$156.46 |
$156.46 |
$1,238.40
|
|
Home sleep test/type 3 porta
|
$156.46 |
$156.46 |
$156.46 |
$1,045.20
|
|
Home sleep test/type 4 porta
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Homocysteine
|
$17.92 |
$17.92 |
$17.92 |
$102.75
|
|
Homogenization tissue
|
$5.88 |
$5.88 |
$5.88 |
$76.80
|
|
Homovanillic acid (hva)
|
$22.41 |
$22.41 |
$22.41 |
$108.00
|
|
Hopd mntl hlt, 15-29 min
|
$29.79 |
$29.79 |
$29.79 |
$29.79
|
|
Hopd mntl hlt, 30-60 min
|
$92.50 |
$92.50 |
$92.50 |
$92.50
|
|
Hopd mntl hlt, grp
|
$29.79 |
$29.79 |
$29.79 |
$29.79
|
|
Hpa-1 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpa-15 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpa-2 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpa-3 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpa-4 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpa-5 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpa-6 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpa-9 genotyping
|
$122.22 |
$122.22 |
$122.22 |
$165.00
|
|
Hpv low-risk types
|
$35.09 |
$35.09 |
$35.09 |
$35.09
|
|
Hpv types 16 & 18 only
|
$40.55 |
$40.55 |
$40.55 |
$228.00
|
|
Hrdtry cardmypy gene panel
|
$584.90 |
$584.90 |
$584.90 |
$9,382.20
|
|
Hrdtry perph neurphy panel
|
$584.90 |
$584.90 |
$584.90 |
$22,852.20
|
|
Hrv skn cll ssp agrft 1st 25
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Htt gene detc abnor alleles
|
$137.00 |
$137.00 |
$137.00 |
$1,271.40
|
|
Human epididymis protein 4 (he4)
|
$20.81 |
$20.81 |
$20.81 |
$180.60
|
|
Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution
|
$1.26 |
$1.26 |
$1.26 |
$1.26
|
|
Hydration IV infusion each additional hour
|
$46.14 |
$46.14 |
$46.14 |
$214.80
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$210.69 |
$210.69 |
$210.69 |
$490.20
|
|
Hydroxocobalamin im 10mcg
|
$0.01 |
$0.01 |
$0.01 |
$83.64
|
|
Hydrxycorticsterds 17- (17-ohcs)
|
$17.90 |
$17.90 |
$17.90 |
$165.60
|
|
Hymenotomy
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Hymovis injection 1 mg
|
$17.44 |
$17.44 |
$17.44 |
$2,459.97
|
|
Hyoid myotomy & suspension
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Hyperthermia ext gen deep
|
$693.81 |
$693.81 |
$693.81 |
$693.81
|
|
Hyperthermia ext gen supfc
|
$262.98 |
$262.98 |
$262.98 |
$262.98
|
|
Hyperthermia gen intrcv prb
|
$578.47 |
$578.47 |
$578.47 |
$578.47
|
|
Hyperthermia ntrstl prb 5/<
|
$578.47 |
$578.47 |
$578.47 |
$578.47
|
|
Hyperthermia ntrstl prb>5
|
$578.47 |
$578.47 |
$578.47 |
$578.47
|
|
Hyqvia 100mg immuneglobulin
|
$18.39 |
$18.39 |
$18.39 |
$18.39
|
|
Hysterosalpingography s&i
|
$241.72 |
$241.72 |
$241.72 |
$1,139.25
|
|
Hysteroscopy ablation
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Hysteroscopy biopsy
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$5,110.50
|
|
Hysteroscopy dx sep proc
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,568.50
|
|
Hysteroscopy lysis
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Hysteroscopy remove fb
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$5,843.25
|
|
Hysteroscopy remove myoma
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,302.75
|
|
Hysteroscopy resect septum
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Hysterotomy abdominal 59100
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$3,761.40
|
|
I & d vag hematoma non-ob 57023
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
I&d abscss rtrphryngl/paraphryngl intraorl apprch
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
I&d frarm&/wrst deep absc/hematoma
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,350.40
|
|
I&d intramural/intramuscular/submuc abscess transanal anes
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
I&d lacrimal gland
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
I&d lacrimal sac
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,729.25
|
|
I&d upper arm/elbow deep abscess/hematoma
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
I&d vag hemtma obst/postpart
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
I&d/bursa/foot 28001
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
I-123 iobenguane diag
|
$2,074.81 |
$2,074.81 |
$2,074.81 |
$10,866.00
|
|
I-123 ioflupane diag
|
$1,388.02 |
$1,388.02 |
$1,388.02 |
$8,455.20
|
|
I131 iodide cap, rx
|
$23.13 |
$23.13 |
$23.13 |
$128.80
|
|
I131 iodide sol, rx
|
$20.88 |
$20.88 |
$20.88 |
$78.60
|
|
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour
|
$71.17 |
$71.17 |
$71.17 |
$285.60
|
|
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour
|
$46.14 |
$46.14 |
$46.14 |
$298.20
|
|
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour
|
$210.69 |
$210.69 |
$210.69 |
$586.50
|
|
IV inj ra drug dx study
|
$401.83 |
$401.83 |
$401.83 |
$564.00
|
|
IV njx tst vasc flo flap/grf
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Ia infect ag ab qual/semiquant sgl step
|
$18.09 |
$18.09 |
$18.09 |
$48.00
|
|
Ia nfct ab sarscov2 covid19
|
$45.28 |
$45.28 |
$45.28 |
$45.28
|
|
Iaadi respiratory synctial virus
|
$13.42 |
$13.42 |
$13.42 |
$13.42
|
|
Iadna legionella pneumophila amplified probe tq
|
$35.09 |
$35.09 |
$35.09 |
$329.25
|
|
Ibmfs seq alys pnl 30 genes
|
$2,448.56 |
$2,448.56 |
$2,448.56 |
$2,448.56
|
|
Ibutilide fumarate 0.1 mg/ml intravenous solution
|
$219.06 |
$219.06 |
$219.06 |
$1,022.55
|
|
Icatibant injection
|
$116.41 |
$116.41 |
$116.41 |
$3,697.02
|
|
Icg angiography i&r uni/bi
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Icut allergy test drug/bug
|
$59.40 |
$59.40 |
$59.40 |
$115.80
|
|
Icut allergy test-delayed
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Icut allergy titrate-airborn
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Idecabtagene vicleucel car
|
$541,260.45 |
$541,260.45 |
$541,260.45 |
$541,260.45
|
|
Identify sperm tissue
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Idh1 common variants
|
$193.25 |
$193.25 |
$193.25 |
$193.25
|
|
Idh2 common variants
|
$295.79 |
$295.79 |
$295.79 |
$295.79
|
|
Idursulfase injection
|
$558.56 |
$558.56 |
$558.56 |
$11,942.56
|
|
Ifnl3 gene
|
$73.37 |
$73.37 |
$73.37 |
$73.37
|
|
Igh gene rearrang dir probe
|
$68.55 |
$68.55 |
$68.55 |
$68.55
|
|
Igh gene rearrange amp meth
|
$197.99 |
$197.99 |
$197.99 |
$464.25
|
|
Igh@ var region somatic mutation analy
|
$294.52 |
$294.52 |
$294.52 |
$1,392.00
|
|
Igh@/bcl2 translocation alys
|
$207.31 |
$207.31 |
$207.31 |
$207.31
|
|
Igk rearrangeabn clonal pop
|
$172.73 |
$172.73 |
$172.73 |
$933.00
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$359.72 |
$359.72 |
$359.72 |
$318.75
|
|
Ihc/icc per specimen initial single antibody stain
|
$171.36 |
$171.36 |
$171.36 |
$310.50
|
|
Ikbkap gene
|
$39.31 |
$39.31 |
$39.31 |
$552.60
|
|
Imetelstat 188 mg intravenous solution
|
$57.02 |
$57.02 |
$57.02 |
$98.40
|
|
Img rta detc/mntr ds phy/qhp
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Img rta detc/mntr ds poc aly
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Img rta detcj/mntr ds staff
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Immt breast prosthesis 19340
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Immune complex assay
|
$24.37 |
$24.37 |
$24.37 |
$89.25
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$47.80 |
$47.80 |
$47.80 |
$623.20
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$48.38 |
$48.38 |
$48.38 |
$1,080.00
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$81.70 |
$81.70 |
$81.70 |
$2,778.42
|
|
Immunoassay tumor antigen quantitative ca 125
|
$20.81 |
$20.81 |
$20.81 |
$141.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$20.81 |
$20.81 |
$20.81 |
$159.00
|
|
Immunoassay tumor qual
|
$25.57 |
$25.57 |
$25.57 |
$167.40
|
|
Immunodiff gel qual ea antigen/ab
|
$11.98 |
$11.98 |
$11.98 |
$123.00
|
|
Immunodiffusion nes
|
$14.05 |
$14.05 |
$14.05 |
$148.80
|
|
Immunofixation electrophoresis serum
|
$22.34 |
$22.34 |
$22.34 |
$219.60
|
|
Immunofluorescence per specimen initial single antibody stain
|
$171.36 |
$171.36 |
$171.36 |
$168.00
|
|
Immunoglobulin assay
|
$12.46 |
$12.46 |
$12.46 |
$108.00
|
|
Imp extar knee shck absrb
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Impact tooth remov part bony
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Impedence cardiogram
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Impl neurostim electr perc
|
$6,562.90 |
$6,562.90 |
$6,562.90 |
$6,471.60
|
|
Impl oi implt sk tc esp<100
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Impl oi implt sk tc esp>=100
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Impl oi implt skull perq esp
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Implant cochlear device
|
$31,807.82 |
$31,807.82 |
$31,807.82 |
$31,807.82
|
|
Implant eye drug system
|
$15,364.83 |
$15,364.83 |
$15,364.83 |
$15,364.83
|
|
Implant hormone pellet(s) 11980
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Implant neuroelectrodes
|
$21,444.39 |
$21,444.39 |
$21,444.39 |
$21,444.39
|
|
Implant neuroelectrodes
|
$6,562.90 |
$6,562.90 |
$6,562.90 |
$4,177.20
|
|
Implant neuroelectrodes
|
$6,562.90 |
$6,562.90 |
$6,562.90 |
$6,447.00
|
|
Implant neuroelectrodes
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$10,672.50
|
|
Implant neurostim arrays
|
$30,473.59 |
$30,473.59 |
$30,473.59 |
$30,473.59
|
|
Implant spinal canal cath
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Implant spine infusion pump
|
$17,674.12 |
$17,674.12 |
$17,674.12 |
$17,674.12
|
|
Implant spine infusion pump
|
$17,674.12 |
$17,674.12 |
$17,674.12 |
$17,674.12
|
|
Implantation iris prosthesis
|
$16,416.44 |
$16,416.44 |
$16,416.44 |
$16,416.44
|
|
Implnt spinl canal catheter 62350
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$7,425.75
|
|
Impltj ntrstrml crnl rng seg
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Imported lipodox inj
|
$528.86 |
$528.86 |
$528.86 |
$2,474.40
|
|
Impres&prep auricular prosth
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Impres&prep def obt prosth
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Impres&prep facial prosth
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Impres&prep intrm obt prosth
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Impres&prep mndbl res prosth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Impres&prep nasal prosth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Impres&prep oral surg splint
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Impres&prep orbital prosth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Impres&prep paltl aug prosth
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Impres&prep paltl lft prosth
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Impres&prep sp aid prosth
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Impres&prep surg obt prosth
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Imuglucerase injection
|
$43.29 |
$43.29 |
$43.29 |
$343.20
|
|
In situ hybridization per specimen initial single probe stain
|
$171.36 |
$171.36 |
$171.36 |
$300.00
|
|
In-111 autol wbc diag per dose
|
$1,031.39 |
$1,031.39 |
$1,031.39 |
$1,031.39
|
|
In-111 ibritumomab tiux dx
|
$798.02 |
$798.02 |
$798.02 |
$12,163.20
|
|
In-111 oxyquinolin per 0.5 mci
|
$772.64 |
$772.64 |
$772.64 |
$2,808.00
|
|
In-111 pentetate dtpa / 0.5 mci
|
$715.29 |
$715.29 |
$715.29 |
$820.20
|
|
In-111 pentetreotide
|
$1,914.61 |
$1,914.61 |
$1,914.61 |
$4,204.80
|
|
Inc dp bone crtx f/arm&/wrst
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Inc dp opn b1 crtx hum/elbw
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incise diaphragm nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incise flexor carpi radialis
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incise hand/finger tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Incise hip/thigh nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incise hip/thigh nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incise inner ear
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Incise inner ear nerve
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Incise inner eye adhesions
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Incise inner eye adhesions
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incise inner eye adhesions
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incise inner eye adhesions
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incise inner eye adhesions
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Incise inner eye strands
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incise nerve back of head
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incise perq finger tendon 26060
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Incise skull for treatment
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Incise skull/brain surgery
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Incise sperm duct pouch
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Incise tear duct opening 68440
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Incise tendon(s) & muscle(s)
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incise thigh tendon & fascia
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incise wrist/forearm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incise/drain eyelid lining
|
$968.54 |
$968.54 |
$968.54 |
$1,020.75
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,080.80
|
|
Incision anal septum infant
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Incision of achilles tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,863.75
|
|
Incision of achilles tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of anal sphincter
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Incision of ankle bone
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incision of breast lesion
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,715.60
|
|
Incision of brow nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incision of burn scab initi
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Incision of cheek nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incision of chin nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incision of eardrum
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Incision of eardrum
|
$232.22 |
$232.22 |
$232.22 |
$2,611.20
|
|
Incision of esophagus
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Incision of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incision of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incision of eyelid
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Incision of facial nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incision of fibula
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of finger tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Incision of foot fascia
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,752.25
|
|
Incision of foot tendon 28234
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Incision of heel bone
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incision of hip tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of hip tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Incision of hip tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incision of hip tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of iris
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incision of iris
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incision of jaw joint
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Incision of jaw nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incision of knee joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of lymph channels
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Incision of metatarsal
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$669.00
|
|
Incision of metatarsal
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incision of metatarsal
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$712.80
|
|
Incision of metatarsals
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incision of midfoot bones
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incision of palm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of prostate
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Incision of rectal abscess
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Incision of sperm duct
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Incision of spinal nerve 64772
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incision of tendon & muscle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$8,293.50
|
|
Incision of tendon sheath
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Incision of thigh tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of thigh tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,752.25
|
|
Incision of thigh tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of thigh tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of thigh tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision of tibia
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Incision of tibia & fibula
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Incision of toe tendons 28011
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Incision of tongue fold
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Incision of tongue nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Incision of urethra
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Incision of urethra
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Incision of urethra
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Incision of urethra
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Incision of windpipe
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Incision of windpipe
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Incision of wrist capsule
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Incision secondary cataract
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Incision tendon sheath
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,771.00
|
|
Incisn of toe tndn
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,608.60
|
|
Incisn windpipe
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,216.00
|
|
Incobotulinumtoxin a
|
$5.31 |
$5.31 |
$5.31 |
$1,317.00
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$9.96 |
$9.96 |
$9.96 |
$24.00
|
|
Induced abortion d&c
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Induced abortion dilat&evac
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$6,344.25
|
|
Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s)
|
$70.20 |
$70.20 |
$70.20 |
$215.25
|
|
Infect ag drug suscept pheno predict
|
$130.35 |
$130.35 |
$130.35 |
$724.80
|
|
Infect ag eia chlamydia trachomatis
|
$15.00 |
$15.00 |
$15.00 |
$15.00
|
|
Infect ag eia influenza a or b ea
|
$14.13 |
$14.13 |
$14.13 |
$62.40
|
|
Infect ag genotype na cytomegalovirus
|
$257.45 |
$257.45 |
$257.45 |
$1,484.40
|
|
Infect ag genotype na dna hepatitis b
|
$257.45 |
$257.45 |
$257.45 |
$445.60
|
|
Infect ag genotype na hiv-1 other region
|
$128.73 |
$128.73 |
$128.73 |
$1,143.60
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$257.45 |
$257.45 |
$257.45 |
$1,404.00
|
|
Infect ag ia direct hiv-1 antgn
|
$32.77 |
$32.77 |
$32.77 |
$32.77
|
|
Infect ag ia optc obs chlamydia trach
|
$35.29 |
$35.29 |
$35.29 |
$35.29
|
|
Infect ag ia optc obs influenza
|
$16.55 |
$16.55 |
$16.55 |
$101.25
|
|
Infect ag if ea plyvlnt antsrm
|
$11.98 |
$11.98 |
$11.98 |
$11.98
|
|
Infect ag if hep delta agent
|
$18.36 |
$18.36 |
$18.36 |
$192.60
|
|
Infect ag if influenza a
|
$16.07 |
$16.07 |
$16.07 |
$124.80
|
|
Infect ag if influenza b
|
$12.25 |
$12.25 |
$12.25 |
$124.80
|
|
Infect ag if legionella pneumophila
|
$15.60 |
$15.60 |
$15.60 |
$85.50
|
|
Infect ag if nos ea
|
$16.10 |
$16.10 |
$16.10 |
$90.60
|
|
Infect ag if pneumocystis carinii
|
$11.98 |
$11.98 |
$11.98 |
$122.40
|
|
Infect ag if varicella zoster
|
$13.42 |
$13.42 |
$13.42 |
$115.20
|
|
Infect ag na chlamydia trachomatis qnt
|
$53.47 |
$53.47 |
$53.47 |
$53.47
|
|
Infect ag na hep b amp
|
$35.09 |
$35.09 |
$35.09 |
$126.60
|
|
Infect ag na herpes simplex quant
|
$42.84 |
$42.84 |
$42.84 |
$385.80
|
|
Infect ag na hpv high-risk types
|
$35.09 |
$35.09 |
$35.09 |
$282.00
|
|
Infect ag na influenza r/amp 1st 2 types
|
$95.80 |
$95.80 |
$95.80 |
$520.20
|
|
Infect ag na influenza revr/amp ea type
|
$51.31 |
$51.31 |
$51.31 |
$51.31
|
|
Infect ag na orthopoxvirus amp prb each
|
$51.31 |
$51.31 |
$51.31 |
$180.00
|
|
Infect ag na resp virus 12-25 targets
|
$416.78 |
$416.78 |
$416.78 |
$1,386.00
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$488.66 |
$488.66 |
$488.66 |
$108.00
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$26.07 |
$26.07 |
$26.07 |
$1,288.50
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$41.38 |
$41.38 |
$41.38 |
$40.20
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$11.98 |
$11.98 |
$11.98 |
$108.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$13.42 |
$13.42 |
$13.42 |
$58.50
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$13.82 |
$13.82 |
$13.82 |
$84.75
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$11.98 |
$11.98 |
$11.98 |
$98.25
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$14.38 |
$14.38 |
$14.38 |
$99.00
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$10.33 |
$10.33 |
$10.33 |
$76.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization
|
$10.33 |
$10.33 |
$10.33 |
$67.80
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$24.08 |
$24.08 |
$24.08 |
$168.60
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$11.98 |
$11.98 |
$11.98 |
$303.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$11.98 |
$11.98 |
$11.98 |
$130.50
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$11.98 |
$11.98 |
$11.98 |
$108.00
|
|
Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance
|
$76.77 |
$76.77 |
$76.77 |
$195.60
|
|
Infectious agent nucleic acid amplified probe
|
$35.09 |
$35.09 |
$35.09 |
$349.80
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$35.09 |
$35.09 |
$35.09 |
$203.40
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$37.27 |
$37.27 |
$37.27 |
$286.80
|
|
Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets
|
$416.78 |
$416.78 |
$416.78 |
$933.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$35.09 |
$35.09 |
$35.09 |
$306.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$35.09 |
$35.09 |
$35.09 |
$339.60
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$41.68 |
$41.68 |
$41.68 |
$307.20
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$35.09 |
$35.09 |
$35.09 |
$198.60
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$51.31 |
$51.31 |
$51.31 |
$75.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$142.63 |
$142.63 |
$142.63 |
$194.40
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$142.63 |
$142.63 |
$142.63 |
$210.00
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$35.09 |
$35.09 |
$35.09 |
$97.50
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$35.09 |
$35.09 |
$35.09 |
$195.60
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$416.78 |
$416.78 |
$416.78 |
$481.80
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets
|
$128.29 |
$128.29 |
$128.29 |
$128.29
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets
|
$262.99 |
$262.99 |
$262.99 |
$553.20
|
|
Infectious agent nucleic acid quantification bk virus
|
$42.84 |
$42.84 |
$42.84 |
$483.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$42.84 |
$42.84 |
$42.84 |
$385.80
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$42.84 |
$42.84 |
$42.84 |
$542.40
|
|
Infectious agent nucleic acid quantification hiv-1
|
$85.10 |
$85.10 |
$85.10 |
$739.20
|
|
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets
|
$142.63 |
$142.63 |
$142.63 |
$571.20
|
|
Infliximab 100 mg intravenous solution
|
$31.18 |
$31.18 |
$31.18 |
$700.20
|
|
Infliximab-axxq 100 mg intravenous solution
|
$20.89 |
$20.89 |
$20.89 |
$1,012.80
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$19.68 |
$19.68 |
$19.68 |
$567.60
|
|
Influenza dna amp prob addl
|
$29.22 |
$29.22 |
$29.22 |
$279.00
|
|
Infuse radioactive materials
|
$262.98 |
$262.98 |
$262.98 |
$262.98
|
|
Ingest challenge ini 120 min
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$203.39 |
$203.39 |
$203.39 |
$377.40
|
|
Initial foot exam pt lops
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Initiation & management bipap/cpap initial day
|
$203.39 |
$203.39 |
$203.39 |
$428.40
|
|
Inj acetaminoph 10mg/ibu 3mg
|
$0.22 |
$0.22 |
$0.22 |
$0.22
|
|
Inj adalimumab-ryvk, 1 mg
|
$10.64 |
$10.64 |
$10.64 |
$10.64
|
|
Inj allopurinol sodium 1 mg
|
$4.54 |
$4.54 |
$4.54 |
$5,937.23
|
|
Inj alymsys 10 mg
|
$42.60 |
$42.60 |
$42.60 |
$42.60
|
|
Inj andexxa, 10 mg
|
$131.56 |
$131.56 |
$131.56 |
$13,381.20
|
|
Inj anifrolumab-fnia 1mg
|
$18.10 |
$18.10 |
$18.10 |
$10,166.40
|
|
Inj avacincaptad pegol 0.1mg
|
$105.90 |
$105.90 |
$105.90 |
$105.90
|
|
Inj aval alfa-nqpt 4mg
|
$80.75 |
$80.75 |
$80.75 |
$5,052.80
|
|
Inj bimatoprost itc imp1mcg
|
$212.36 |
$212.36 |
$212.36 |
$7,487.44
|
|
Inj brixadi, more than 7 day
|
$1,691.31 |
$1,691.31 |
$1,691.31 |
$4,344.80
|
|
Inj cefazolin (wg crit care)
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Inj cefazolin sodium, hikma
|
$0.91 |
$0.91 |
$0.91 |
$0.91
|
|
Inj ceftolozane tazobactam
|
$9.13 |
$9.13 |
$9.13 |
$286.20
|
|
Inj crotalidae im f(ab')2 eq
|
$1,044.14 |
$1,044.14 |
$1,044.14 |
$1,044.14
|
|
Inj cuvitru, 100 mg
|
$17.59 |
$17.59 |
$17.59 |
$17.59
|
|
Inj cyclophos dr.reddy's 5mg
|
$9.00 |
$9.00 |
$9.00 |
$9.00
|
|
Inj cyclophosphamd (ingenus)
|
$1.16 |
$1.16 |
$1.16 |
$3.75
|
|
Inj cyclophosphamd auromedic
|
$0.78 |
$0.78 |
$0.78 |
$0.78
|
|
Inj daptomycin (xellia)
|
$0.04 |
$0.04 |
$0.04 |
$0.04
|
|
Inj daxibotulinumtoxina-lanm
|
$3.11 |
$3.11 |
$3.11 |
$3.11
|
|
Inj delandistrogene mox rokl
|
$3,324,571.90 |
$3,324,571.90 |
$3,324,571.90 |
$2,056,320.00
|
|
Inj dupuytren cord w/enzyme
|
$295.19 |
$295.19 |
$295.19 |
$373.50
|
|
Inj efgart-alfa 2mg hya-qvfc
|
$33.74 |
$33.74 |
$33.74 |
$79.80
|
|
Inj eflapegrastim-xnst 0.1mg
|
$21.12 |
$21.12 |
$21.12 |
$21.12
|
|
Inj epidural sgl cerv-thor without img
|
$692.52 |
$692.52 |
$692.52 |
$1,656.60
|
|
Inj epidural sgl lumb-sacral without img
|
$890.29 |
$890.29 |
$890.29 |
$1,524.80
|
|
Inj fensolvi 0.25 mg
|
$140.43 |
$140.43 |
$140.43 |
$140.43
|
|
Inj fluphenazine hcl 1.25 mg
|
$7.43 |
$7.43 |
$7.43 |
$7.43
|
|
Inj fosnetupitant, palonoset
|
$606.35 |
$606.35 |
$606.35 |
$606.35
|
|
Inj givosiran 0.5 mg
|
$117.19 |
$117.19 |
$117.19 |
$119,349.60
|
|
Inj glofitamab gxbm, 2.5 mg
|
$2,770.57 |
$2,770.57 |
$2,770.57 |
$6,717.00
|
|
Inj glycopyrrolate fres kabi
|
$1.85 |
$1.85 |
$1.85 |
$1.85
|
|
Inj herzuma 10 mg
|
$77.49 |
$77.49 |
$77.49 |
$77.49
|
|
Inj human fibrinogen con nos
|
$1.52 |
$1.52 |
$1.52 |
$4,326.08
|
|
Inj hydroxocobalamin IV 25mg
|
$5.18 |
$5.18 |
$5.18 |
$5.18
|
|
Inj imip 4 cilas 4 releb 2mg
|
$2.61 |
$2.61 |
$2.61 |
$7.20
|
|
Inj intralesional <= 7 lsn(s)
|
$198.70 |
$198.70 |
$198.70 |
$281.40
|
|
Inj intralesional > 7 lsns
|
$198.70 |
$198.70 |
$198.70 |
$222.75
|
|
Inj ivig privigen 500 mg
|
$50.43 |
$50.43 |
$50.43 |
$4,345.80
|
|
Inj luxturna 1 billion vec g
|
$3,163.15 |
$3,163.15 |
$3,163.15 |
$3,163.15
|
|
Inj melpha hydroch nos 50 mg
|
$108.03 |
$108.03 |
$108.03 |
$1,713.99
|
|
Inj melphalan (hepzato) 1 mg
|
$787.79 |
$787.79 |
$787.79 |
$787.79
|
|
Inj meropenem (wg crit care)
|
$1.62 |
$1.62 |
$1.62 |
$1.62
|
|
Inj mogamulizumab-kpkc, 1 mg
|
$248.50 |
$248.50 |
$248.50 |
$558.40
|
|
Inj nephrosto/ureterogram w/img exstng access
|
$667.47 |
$667.47 |
$667.47 |
$1,266.00
|
|
Inj non-compmd foam sclrsnt mlt trncl veins same leg
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,976.25
|
|
Inj non-compmd foam sclrsnt sgl trncl vein
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Inj ogivri 10 mg
|
$44.59 |
$44.59 |
$44.59 |
$564.00
|
|
Inj olipudase alfa-rpcp 1mg
|
$393.82 |
$393.82 |
$393.82 |
$393.82
|
|
Inj onase abepar-xioi treat
|
$2,452,115.60 |
$2,452,115.60 |
$2,452,115.60 |
$2,452,115.60
|
|
Inj ontruzant 10 mg
|
$21.99 |
$21.99 |
$21.99 |
$21.99
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$27.99 |
$27.99 |
$27.99 |
$3,925.20
|
|
Inj pemetrexed (accord) 10mg
|
$9.74 |
$9.74 |
$9.74 |
$9.74
|
|
Inj pemetrexed (teva) 10mg
|
$3.79 |
$3.79 |
$3.79 |
$3.79
|
|
Inj pemetrexed ditromethamin
|
$10.34 |
$10.34 |
$10.34 |
$10.34
|
|
Inj pemetrexed, hospira 10mg
|
$4.93 |
$4.93 |
$4.93 |
$4.93
|
|
Inj plasminogen tvmh 1mg
|
$32.31 |
$32.31 |
$32.31 |
$32.31
|
|
Inj recombin esperoct per iu
|
$2.26 |
$2.26 |
$2.26 |
$2.26
|
|
Inj retacrit esrd on dialysi
|
$0.76 |
$0.76 |
$0.76 |
$0.76
|
|
Inj roctavian ml 2x10^13vc g
|
$12,368.21 |
$12,368.21 |
$12,368.21 |
$12,368.21
|
|
Inj romidepsin non-lyo 0.1mg
|
$28.52 |
$28.52 |
$28.52 |
$28.52
|
|
Inj scleros sol mult veins
|
$399.53 |
$399.53 |
$399.53 |
$1,108.20
|
|
Inj scleros sol sgl vein
|
$399.53 |
$399.53 |
$399.53 |
$1,108.20
|
|
Inj sebelipase alfa 1 mg
|
$539.69 |
$539.69 |
$539.69 |
$539.69
|
|
Inj secretin synthetic human
|
$43.79 |
$43.79 |
$43.79 |
$169.20
|
|
Inj secukinumab intrav 1mg
|
$17.84 |
$17.84 |
$17.84 |
$42.80
|
|
Inj teclistamab cqyv 0.5 mg
|
$33.27 |
$33.27 |
$33.27 |
$85.20
|
|
Inj tedizolid phosphate
|
$1.91 |
$1.91 |
$1.91 |
$1,081.80
|
|
Inj teplizumab mzwv 5 mcg
|
$37.65 |
$37.65 |
$37.65 |
$37.65
|
|
Inj thiotepa nos 1 mg
|
$12.24 |
$12.24 |
$12.24 |
$450.00
|
|
Inj tofersen intrathec 1 mg
|
$155.34 |
$155.34 |
$155.34 |
$155.34
|
|
Inj triamcinolone ace X-ray 1mg
|
$18.21 |
$18.21 |
$18.21 |
$18.21
|
|
Inj velmanase alfa-tycv 1 mg
|
$465.05 |
$465.05 |
$465.05 |
$465.05
|
|
Inj w/fluor eval cv device
|
$210.69 |
$210.69 |
$210.69 |
$711.00
|
|
Inj xipere 1 mg
|
$48.00 |
$48.00 |
$48.00 |
$48.00
|
|
Inj zanidatamab-hrii, 2 mg
|
$25.08 |
$25.08 |
$25.08 |
$44.40
|
|
Inj zenocutuzumab-zbco 1 mg
|
$32.62 |
$32.62 |
$32.62 |
$32.62
|
|
Inj(s) sclerosant spider veins limb/trunk
|
$399.53 |
$399.53 |
$399.53 |
$389.25
|
|
Inj, abilify asimtufii, 1 mg
|
$6.03 |
$6.03 |
$6.03 |
$6.03
|
|
Inj, abilify maintena, 1 mg
|
$7.24 |
$7.24 |
$7.24 |
$7,107.60
|
|
Inj, adstiladrin, per tx dos
|
$63,431.05 |
$63,431.05 |
$63,431.05 |
$63,431.05
|
|
Inj, aducanumab-avwa, 2 mg
|
$5.98 |
$5.98 |
$5.98 |
$5.98
|
|
Inj, adzynma, 10 iu
|
$35.59 |
$35.59 |
$35.59 |
$35.59
|
|
Inj, aflibercept hd, 1 mg
|
$319.74 |
$319.74 |
$319.74 |
$319.74
|
|
Inj, afstyla, 1 i.u
|
$1.58 |
$1.58 |
$1.58 |
$1.58
|
|
Inj, alyglo, 500 mg
|
$131.12 |
$131.12 |
$131.12 |
$131.12
|
|
Inj, amisulpride, 1 mg
|
$9.66 |
$9.66 |
$9.66 |
$9.66
|
|
Inj, aponvie, 1 mg
|
$1.92 |
$1.92 |
$1.92 |
$3.00
|
|
Inj, artesunate, 1mg
|
$51.83 |
$51.83 |
$51.83 |
$39,774.01
|
|
Inj, aspara, rylaze, 0.1 mg
|
$55.30 |
$55.30 |
$55.30 |
$96.60
|
|
Inj, bezlotoxumab, 10 mg
|
$39.83 |
$39.83 |
$39.83 |
$11,671.20
|
|
Inj, bortezomib freseniuskab
|
$16.50 |
$16.50 |
$16.50 |
$16.50
|
|
Inj, bortezomib, dr. reddy's
|
$4.91 |
$4.91 |
$4.91 |
$4.91
|
|
Inj, brixadi, 7 days or less
|
$422.83 |
$422.83 |
$422.83 |
$814.80
|
|
Inj, brolucizumab-dbll, 1 mg
|
$346.19 |
$346.19 |
$346.19 |
$346.19
|
|
Inj, bupivacaine (posimir)
|
$0.51 |
$0.51 |
$0.51 |
$0.51
|
|
Inj, bupivacaine liposome
|
$1.49 |
$1.49 |
$1.49 |
$7.20
|
|
Inj, carmustine (accord)
|
$259.70 |
$259.70 |
$259.70 |
$259.70
|
|
Inj, cefiderocol, 10 mg
|
$2.40 |
$2.40 |
$2.40 |
$6.00
|
|
Inj, cimerli, 0.1 mg
|
$86.51 |
$86.51 |
$86.51 |
$519.00
|
|
Inj, cipaglucosidase, 5 mg
|
$89.80 |
$89.80 |
$89.80 |
$229.20
|
|
Inj, clevidipine butyrate
|
$2.88 |
$2.88 |
$2.88 |
$697.20
|
|
Inj, crovalimab-akkz, 10 mg
|
$551.51 |
$551.51 |
$551.51 |
$551.51
|
|
Inj, cyclophosphamd, sandoz
|
$4.21 |
$4.21 |
$4.21 |
$4.21
|
|
Inj, donanemab-azbt, 2 mg
|
$4.14 |
$4.14 |
$4.14 |
$7.20
|
|
Inj, durolane 1 mg
|
$6.68 |
$6.68 |
$6.68 |
$106.40
|
|
Inj, evinacumab-dgnb, 5mg
|
$189.75 |
$189.75 |
$189.75 |
$189.75
|
|
Inj, factor x, (human), 1iu
|
$9.91 |
$9.91 |
$9.91 |
$32.40
|
|
Inj, faricimab-svoa, 0.1mg
|
$34.48 |
$34.48 |
$34.48 |
$100.00
|
|
Inj, focinvez, 1mg
|
$2.87 |
$2.87 |
$2.87 |
$5.40
|
|
Inj, fosaprepitant (teva)
|
$1.13 |
$1.13 |
$1.13 |
$1.13
|
|
Inj, fulvestrant (fresenius)
|
$3.32 |
$3.32 |
$3.32 |
$1,713.99
|
|
Inj, fulvestrant (teva)
|
$46.21 |
$46.21 |
$46.21 |
$46.21
|
|
Inj, granisetron, xr, 0.1 mg
|
$4.96 |
$4.96 |
$4.96 |
$4.96
|
|
Inj, hemgenix, per tx dose
|
$3,685,266.67 |
$3,685,266.67 |
$3,685,266.67 |
$3,685,266.67
|
|
Inj, idacio, 1 mg
|
$8.92 |
$8.92 |
$8.92 |
$8.92
|
|
Inj, immphentiv, 20 mcg
|
$0.13 |
$0.13 |
$0.13 |
$0.13
|
|
Inj, invega hafyera/trinza
|
$12.96 |
$12.96 |
$12.96 |
$12.96
|
|
Inj, ixinity, 1 i.u
|
$1.91 |
$1.91 |
$1.91 |
$1.91
|
|
Inj, kovaltry, 1 i.u
|
$1.58 |
$1.58 |
$1.58 |
$1.58
|
|
Inj, lanreotide, (cipla) 1mg
|
$24.45 |
$24.45 |
$24.45 |
$96.60
|
|
Inj, lecanemab-irmb, 1 mg
|
$1.33 |
$1.33 |
$1.33 |
$1.33
|
|
Inj, lenacapavir, 1 mg
|
$22.02 |
$22.02 |
$22.02 |
$22.02
|
|
Inj, levothyroxine, freskabi
|
$7.10 |
$7.10 |
$7.10 |
$244.63
|
|
Inj, levothyroxine, hikma
|
$5.14 |
$5.14 |
$5.14 |
$5.14
|
|
Inj, mirikizumab-mrkz, 1 mg
|
$48.27 |
$48.27 |
$48.27 |
$48.27
|
|
Inj, motixafortide, 0.25 mg
|
$25.22 |
$25.22 |
$25.22 |
$25.22
|
|
Inj, nithiodote, 3mg / 125mg
|
$2.17 |
$2.17 |
$2.17 |
$3.60
|
|
Inj, nogapendekin pmln, 1mcg
|
$94.12 |
$94.12 |
$94.12 |
$94.12
|
|
Inj, oliceridine 0.1 mg
|
$1.30 |
$1.30 |
$1.30 |
$1.30
|
|
Inj, palonosetron (posfrea)
|
$58.84 |
$58.84 |
$58.84 |
$58.84
|
|
Inj, panzyga, 500 mg
|
$74.46 |
$74.46 |
$74.46 |
$74.46
|
|
Inj, pasireotide long acting
|
$563.79 |
$563.79 |
$563.79 |
$563.79
|
|
Inj, pedmark, 100 mg
|
$95.14 |
$95.14 |
$95.14 |
$95.14
|
|
Inj, pegcetacoplan, 1mg
|
$141.91 |
$141.91 |
$141.91 |
$141.91
|
|
Inj, pegulicianine, 1 mg
|
$36.45 |
$36.45 |
$36.45 |
$36.45
|
|
Inj, pemetrexed (avyxa) 10mg
|
$83.28 |
$83.28 |
$83.28 |
$83.28
|
|
Inj, pemrydi rtu, 10 mg
|
$80.10 |
$80.10 |
$80.10 |
$80.10
|
|
Inj, releuko 1 mcg
|
$0.41 |
$0.41 |
$0.41 |
$0.41
|
|
Inj, rimabotulinumtoxinb
|
$13.34 |
$13.34 |
$13.34 |
$2,348.22
|
|
Inj, rykindo, 0.5 mg
|
$13.03 |
$13.03 |
$13.03 |
$13.03
|
|
Inj, sculptra, 0.5mg
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Inj, sezaby, 1 mg
|
$1.15 |
$1.15 |
$1.15 |
$1.15
|
|
Inj, spesolimab-sbzo, 1 mg
|
$65.73 |
$65.73 |
$65.73 |
$65.73
|
|
Inj, susvimo 0.1 mg
|
$78.43 |
$78.43 |
$78.43 |
$78.43
|
|
Inj, sutimlimab-jome, 10 mg
|
$18.11 |
$18.11 |
$18.11 |
$34.80
|
|
Inj, taliglucerace alfa 10 u
|
$41.06 |
$41.06 |
$41.06 |
$41.06
|
|
Inj, tislelizumab-jsgr
|
$57.42 |
$57.42 |
$57.42 |
$102.00
|
|
Inj, tofidence, 1 mg
|
$5.79 |
$5.79 |
$5.79 |
$5.79
|
|
Inj, trivisc 1 mg
|
$5.45 |
$5.45 |
$5.45 |
$5.45
|
|
Inj, tyenne, 1 mg
|
$4.69 |
$4.69 |
$4.69 |
$12.75
|
|
Inj, uzedy, 1 mg
|
$25.08 |
$25.08 |
$25.08 |
$25.08
|
|
Inj, vasopressin (baxter)
|
$2.94 |
$2.94 |
$2.94 |
$2.94
|
|
Inj, vegzelma, 10 mg
|
$43.62 |
$43.62 |
$43.62 |
$43.62
|
|
Inj. asceniv
|
$496.51 |
$496.51 |
$496.51 |
$496.51
|
|
Inj. byooviz, 0.1 mg
|
$62.15 |
$62.15 |
$62.15 |
$62.15
|
|
Inj. cetirizine hcl 0.5mg
|
$16.40 |
$16.40 |
$16.40 |
$16.40
|
|
Inj. denosumab-bbdz, 1 mg
|
$27.54 |
$27.54 |
$27.54 |
$27.54
|
|
Inj. fe derisomaltose 10 mg
|
$18.95 |
$18.95 |
$18.95 |
$141.60
|
|
Inj. herceptin hylecta, 10mg
|
$62.97 |
$62.97 |
$62.97 |
$413.40
|
|
Inj. inebilizumab-cdon, 1 mg
|
$494.43 |
$494.43 |
$494.43 |
$871.80
|
|
Inj. jivi 1 iu
|
$2.65 |
$2.65 |
$2.65 |
$2.65
|
|
Inj. lumasiran, 0.5 mg
|
$329.10 |
$329.10 |
$329.10 |
$329.10
|
|
Inj. naxitamab-gqgk, 1 mg
|
$685.91 |
$685.91 |
$685.91 |
$96,378.67
|
|
Inj. pemetrexed, 10 mg
|
$52.74 |
$52.74 |
$52.74 |
$152.40
|
|
Inj. tagraxofusp-erzs 10 mcg
|
$348.62 |
$348.62 |
$348.62 |
$544.80
|
|
Inj. teprotumumab-trbw 10 mg
|
$359.09 |
$359.09 |
$359.09 |
$38,425.20
|
|
Inj. xembify, 100 mg
|
$14.91 |
$14.91 |
$14.91 |
$14.91
|
|
Inj., aristada initio, 1 mg
|
$3.26 |
$3.26 |
$3.26 |
$3.26
|
|
Inj., benralizumab, 1 mg
|
$168.13 |
$168.13 |
$168.13 |
$5,853.00
|
|
Inj., emapalumab-lzsg, 1 mg
|
$381.64 |
$381.64 |
$381.64 |
$1,929.00
|
|
Inj., emicizumab-kxwh 0.5 mg
|
$57.43 |
$57.43 |
$57.43 |
$39,043.20
|
|
Inj., evomela, 1 mg
|
$17.37 |
$17.37 |
$17.37 |
$17.37
|
|
Inj., fibryga, 1 mg
|
$1.21 |
$1.21 |
$1.21 |
$1.21
|
|
Inj., guselkumab, 1 mg
|
$74.86 |
$74.86 |
$74.86 |
$675.00
|
|
Inj., ibalizumab-uiyk, 10 mg
|
$79.39 |
$79.39 |
$79.39 |
$79.39
|
|
Inj., lumoxiti, 0.01 mg
|
$23.39 |
$23.39 |
$23.39 |
$31.20
|
|
Inj., meropenem, vaborbactam
|
$2.18 |
$2.18 |
$2.18 |
$991.20
|
|
Inj., omadacycline, 1 mg
|
$4.01 |
$4.01 |
$4.01 |
$4.01
|
|
Inj., patisiran, 0.1 mg
|
$99.82 |
$99.82 |
$99.82 |
$36,180.04
|
|
Inj., perseris, 0.5 mg
|
$12.14 |
$12.14 |
$12.14 |
$12.14
|
|
Inj., plazomicin, 5 mg
|
$3.57 |
$3.57 |
$3.57 |
$85.80
|
|
Inj., tildrakizumab, 1 mg
|
$126.24 |
$126.24 |
$126.24 |
$424.00
|
|
Inj., triluron, 1 mg
|
$10.16 |
$10.16 |
$10.16 |
$10.16
|
|
Inj., triptorelin X-ray 3.75 mg
|
$3,772.85 |
$3,772.85 |
$3,772.85 |
$3,772.85
|
|
Inj., yutiq, 0.01 mg
|
$532.58 |
$532.58 |
$532.58 |
$532.58
|
|
Inj/inf neurolyt sbst spinal canal lesion 62282
|
$890.29 |
$890.29 |
$890.29 |
$2,231.25
|
|
Inject/treat eye socket
|
$298.93 |
$298.93 |
$298.93 |
$571.80
|
|
Inject/treat eye socket
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Inject/treat eye socket
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides)
|
$692.52 |
$692.52 |
$692.52 |
$692.52
|
|
Injection carpal tunnel therapeutic (both sides)
|
$295.19 |
$295.19 |
$295.19 |
$596.40
|
|
Injection epidural blood patch or clot
|
$692.52 |
$692.52 |
$692.52 |
$1,470.60
|
|
Injection eye drug
|
$331.69 |
$331.69 |
$331.69 |
$331.69
|
|
Injection glatiramer acetate
|
$160.39 |
$160.39 |
$160.39 |
$1,207.20
|
|
Injection into brain canal
|
$692.52 |
$692.52 |
$692.52 |
$117.00
|
|
Injection into brain canal
|
$295.19 |
$295.19 |
$295.19 |
$1,094.40
|
|
Injection into hemorrhoid(s)
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Injection into spinal artery
|
$890.29 |
$890.29 |
$890.29 |
$890.29
|
|
Injection into vocal cord
|
$388.31 |
$388.31 |
$388.31 |
$388.31
|
|
Injection of HIV prep drug
|
$71.17 |
$71.17 |
$71.17 |
$71.17
|
|
Injection of sinus tract
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Injection px peyronie ds
|
$243.21 |
$243.21 |
$243.21 |
$239.25
|
|
Injection radioactive tracer sentinel node (both sides)
|
$401.83 |
$401.83 |
$401.83 |
$614.40
|
|
Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides)
|
$692.52 |
$692.52 |
$692.52 |
$1,656.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$210.69 |
$210.69 |
$210.69 |
$238.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$46.14 |
$46.14 |
$46.14 |
$177.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$71.17 |
$71.17 |
$71.17 |
$141.00
|
|
Injection treatment of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Injection treatment of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,851.20
|
|
Injection treatment of nerve
|
$890.29 |
$890.29 |
$890.29 |
$2,706.75
|
|
Injection treatment of nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Injection treatment of nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,866.00
|
|
Injection treatment of nose
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Injection(s) anesthetic agent(s) and/or steroid femoral nerve left
|
$692.52 |
$692.52 |
$692.52 |
$1,021.50
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$692.52 |
$692.52 |
$692.52 |
$911.25
|
|
Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides)
|
$890.29 |
$890.29 |
$890.29 |
$1,671.75
|
|
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level
|
$890.29 |
$890.29 |
$890.29 |
$1,777.50
|
|
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level
|
$890.29 |
$890.29 |
$890.29 |
$1,713.00
|
|
Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance
|
$692.52 |
$692.52 |
$692.52 |
$2,164.80
|
|
Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance
|
$692.52 |
$692.52 |
$692.52 |
$2,047.80
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$295.19 |
$295.19 |
$295.19 |
$616.20
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$295.19 |
$295.19 |
$295.19 |
$595.80
|
|
Injection(s) trigger point(s) single/multiple >= 3 muscle(s)
|
$295.19 |
$295.19 |
$295.19 |
$654.00
|
|
Injection, belinostat, 10mg
|
$52.04 |
$52.04 |
$52.04 |
$9,355.72
|
|
Injection, burosumab-twza 1m
|
$481.57 |
$481.57 |
$481.57 |
$481.57
|
|
Injection, cangrelor
|
$19.81 |
$19.81 |
$19.81 |
$2,314.80
|
|
Injection, daratumumab 10 mg
|
$69.84 |
$69.84 |
$69.84 |
$198.60
|
|
Injection, edaravone, 1 mg
|
$18.84 |
$18.84 |
$18.84 |
$1,484.40
|
|
Injection, fulvestrant
|
$6.98 |
$6.98 |
$6.98 |
$3,584.82
|
|
Injection, inclisiran, 1 mg
|
$12.35 |
$12.35 |
$12.35 |
$39.20
|
|
Injection, isavuconazonium
|
$1.01 |
$1.01 |
$1.01 |
$1,350.22
|
|
Injection, necitumumab, 1 mg
|
$5.73 |
$5.73 |
$5.73 |
$5.73
|
|
Injection, peramivir
|
$1.68 |
$1.68 |
$1.68 |
$6.75
|
|
Injection, renflexis
|
$25.05 |
$25.05 |
$25.05 |
$1,624.80
|
|
Injection, ruconest
|
$36.74 |
$36.74 |
$36.74 |
$36.74
|
|
Injection, siltuximab
|
$161.96 |
$161.96 |
$161.96 |
$3,603.00
|
|
Injection,onabotulinumtoxina
|
$6.50 |
$6.50 |
$6.50 |
$2,876.40
|
|
Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln
|
$2,698.05 |
$2,698.05 |
$2,698.05 |
$8,027.40
|
|
Ins cath ren art 1st bi
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$6,033.75
|
|
Ins cath ren art 1st uni
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,692.00
|
|
Ins cath ren art 2nd+ bi
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$6,376.50
|
|
Ins cath ren art 2nd+ uni
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Ins cerv dilator (sep proc)
|
$304.19 |
$304.19 |
$304.19 |
$678.00
|
|
Ins icd gen exist mlt leads
|
$32,061.58 |
$32,061.58 |
$32,061.58 |
$26,801.25
|
|
Ins icd gen exist sgl lead
|
$22,446.19 |
$22,446.19 |
$22,446.19 |
$33,033.60
|
|
Ins lv lead exist pm/icd
|
$10,465.33 |
$10,465.33 |
$10,465.33 |
$9,178.50
|
|
Ins mark abd/pel for right perq
|
$1,368.26 |
$1,368.26 |
$1,368.26 |
$2,523.00
|
|
Ins mark thor for right perq
|
$1,368.26 |
$1,368.26 |
$1,368.26 |
$1,368.26
|
|
Ins picad w subq port 5yr>
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,510.75
|
|
Ins picc wo subq prt/pmp w image guidnc <5yr
|
$618.26 |
$618.26 |
$618.26 |
$728.25
|
|
Ins pm gen exist dual lead
|
$22,446.19 |
$22,446.19 |
$22,446.19 |
$19,065.75
|
|
Ins pm gen w/exist mlt leads
|
$19,071.16 |
$19,071.16 |
$19,071.16 |
$15,600.75
|
|
Ins pq tunnld ip cath w/img
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$8,416.80
|
|
Ins tun cv cath wo subq prt/pm
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Ins tun cv cath wo subq prt/pm
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,582.00
|
|
Ins tun cvad 2 cath w/subq port(s)
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Ins tun intraperit dia cath
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$4,187.40
|
|
Ins vag brachytx device
|
$304.19 |
$304.19 |
$304.19 |
$561.60
|
|
Ins/rpl ldless pm right vent w img & eval
|
$19,071.16 |
$19,071.16 |
$19,071.16 |
$16,670.40
|
|
Ins/rpl pm gen exist dual lead
|
$10,465.33 |
$10,465.33 |
$10,465.33 |
$10,465.33
|
|
Ins/rpl pm gen exist sgl lead
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$8,275.98
|
|
Ins/rpl pm w/tv ld atrl
|
$10,465.33 |
$10,465.33 |
$10,465.33 |
$15,256.20
|
|
Ins/rpl prph sac/gstr npg/r
|
$21,444.39 |
$21,444.39 |
$21,444.39 |
$21,134.25
|
|
Ins/rpl wireless pulm art sensor incl s&i
|
$28,428.33 |
$28,428.33 |
$28,428.33 |
$22,814.25
|
|
Ins/rplc spi npg/rcvr pocket
|
$30,473.59 |
$30,473.59 |
$30,473.59 |
$29,999.25
|
|
Ins/rplcmt prq eltrd ra pn 1
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Insemination of oocytes
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Insert and remove bone pin
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,639.60
|
|
Insert ant drainage device
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Insert brain-fluid device 61215
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Insert cannula hemo oth 36815
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Insert cannula vein-to-vein hemodialysis
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$6,414.00
|
|
Insert cath pleura with image
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,320.80
|
|
Insert cath pleura without image
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Insert cv cath inf & sup app
|
$8,250.50 |
$8,250.50 |
$8,250.50 |
$8,250.50
|
|
Insert drug del implant, >=4
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Insert drug delivery implant
|
$128.90 |
$128.90 |
$128.90 |
$377.25
|
|
Insert eye socket implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Insert heyman uteri capsule
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Insert lens prosthesis
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Insert multi-comp penis pros
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Insert nasal septal button
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Insert ocular implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Insert ocular implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Insert palate implants
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Insert pessary/other device
|
$201.17 |
$201.17 |
$201.17 |
$332.25
|
|
Insert picvad cath
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,907.75
|
|
Insert pm/icd lead dual
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$8,275.98
|
|
Insert prost urethral stent
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Insert self-contd prosthesis
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Insert semi-rigid prosthesis
|
$12,992.42 |
$12,992.42 |
$12,992.42 |
$12,992.42
|
|
Insert spine infusion device 62360
|
$17,674.12 |
$17,674.12 |
$17,674.12 |
$17,674.12
|
|
Insert sq defib electrode
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$12,994.80
|
|
Insert swan-ganz cath
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,472.00
|
|
Insert tandem cuff
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Insert tissue expander(s)
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Insert tunneled cv 2cath 2sits without port/pmp 36565
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,040.25
|
|
Insert tunneled cv cath
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Insert tunneled cv cath
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,252.75
|
|
Insert uro/ves nck sphincter
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Insert uteri tandem/ovoids
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Insert/repl sq defib w/eltrd
|
$32,061.58 |
$32,061.58 |
$32,061.58 |
$30,741.60
|
|
Insertion catheter artery nfs ther chemotx 36640
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Insertion catheter bladder non indwelling
|
$128.90 |
$128.90 |
$128.90 |
$298.40
|
|
Insertion catheter bladder temporary simple
|
$128.90 |
$128.90 |
$128.90 |
$323.25
|
|
Insertion catheter pleural indwelling tunneled with cuff
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$5,079.00
|
|
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$6,646.50
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,712.75
|
|
Insertion of cannula
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Insertion of heart electrode 33211
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$8,275.98
|
|
Insertion of infusion pump
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular
|
$10,465.33 |
$10,465.33 |
$10,465.33 |
$11,024.25
|
|
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular
|
$10,465.33 |
$10,465.33 |
$10,465.33 |
$10,465.33
|
|
Insertion palate prosthesis
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,472.00
|
|
Insertion picc without port or pump with imaging guidance=>5y
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$1,553.44
|
|
Insertion single tranvenous electrode/ppm/implantable defibrillator
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$7,267.20
|
|
Insertion subcutaneous cardiac rhythm monitor
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$8,275.98
|
|
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides)
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,011.60
|
|
Insertion ureth cath
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber
|
$32,061.58 |
$32,061.58 |
$32,061.58 |
$32,061.58
|
|
Insertion/replacement temporary single chamber electrode/pacemaker catheter
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$6,820.50
|
|
Insitu hybridization (fish)
|
$171.36 |
$171.36 |
$171.36 |
$664.80
|
|
Insitu hybridization auto
|
$359.72 |
$359.72 |
$359.72 |
$717.60
|
|
Insitu hybridization manual
|
$359.72 |
$359.72 |
$359.72 |
$531.75
|
|
Insj phrnc nrv stim sys
|
$45,000.50 |
$45,000.50 |
$45,000.50 |
$45,000.50
|
|
Insj rx elut implt lac canal
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Insj stablj dev w/dcmprn
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Insj stablj dev without dcmprn
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,715.50
|
|
Insrt/redo neurostim 1 array
|
$21,444.39 |
$21,444.39 |
$21,444.39 |
$6,097.20
|
|
Inst fibrinolysis agent ini day
|
$618.26 |
$618.26 |
$618.26 |
$1,097.40
|
|
Inst fibrinolysis agent sbsq d
|
$618.26 |
$618.26 |
$618.26 |
$1,025.25
|
|
Inst tauro 1.35mg/hep 100u
|
$7.68 |
$7.68 |
$7.68 |
$7.68
|
|
Inst via cath agent pleurds
|
$618.26 |
$618.26 |
$618.26 |
$2,146.80
|
|
Install spinal shunt 63741
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Instill pharm renal pelvis
|
$2,250.50 |
$2,250.50 |
$2,250.50 |
$2,250.50
|
|
Instill, bupivac and meloxic
|
$0.81 |
$0.81 |
$0.81 |
$1.80
|
|
Instillation anticarcinogenic agent bladder
|
$667.47 |
$667.47 |
$667.47 |
$897.00
|
|
Instll rx agnt into rnal tub
|
$243.21 |
$243.21 |
$243.21 |
$243.21
|
|
Insulin total
|
$11.43 |
$11.43 |
$11.43 |
$103.50
|
|
Int hrhc lig 1 hroid without img
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,572.50
|
|
Int hrhc lig 2+hroid without img
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,682.00
|
|
Intens cardiac rehab no exer
|
$125.91 |
$125.91 |
$125.91 |
$125.91
|
|
Intens cardiac rehab w/exerc
|
$125.91 |
$125.91 |
$125.91 |
$125.91
|
|
Interdental fixation
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,733.25
|
|
Interdental wirg oth/thn fx
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Interdiscal perq aspir dx
|
$703.59 |
$703.59 |
$703.59 |
$822.75
|
|
Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper)
|
$57.47 |
$57.47 |
$57.47 |
$4,959.00
|
|
Interferon beta-1a inj
|
$2,203.14 |
$2,203.14 |
$2,203.14 |
$2,203.14
|
|
Intermediate visual field xm
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Interrog dev eval icpms ip
|
$37.29 |
$37.29 |
$37.29 |
$112.50
|
|
Interrog dev eval scrms ip
|
$24.49 |
$24.49 |
$24.49 |
$163.80
|
|
Interrog device eval heart
|
$37.29 |
$37.29 |
$37.29 |
$220.20
|
|
Interrog evl pm/ldls pm ip
|
$37.29 |
$37.29 |
$37.29 |
$113.25
|
|
Interrog without prgrmg ipnss
|
$91.79 |
$91.79 |
$91.79 |
$90.00
|
|
Interrog&prgrmg ipnss
|
$91.79 |
$91.79 |
$91.79 |
$90.00
|
|
Interrogate subq defib
|
$37.29 |
$37.29 |
$37.29 |
$117.00
|
|
Interrogation vad in person
|
$91.79 |
$91.79 |
$91.79 |
$91.79
|
|
Interstitial brachy inter
|
$109.50 |
$109.50 |
$109.50 |
$109.50
|
|
Intra-atrial pacing
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$5,625.00
|
|
Intra-atrial recording
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$6,184.50
|
|
Intracranial complete study
|
$241.72 |
$241.72 |
$241.72 |
$1,169.40
|
|
Intracranial limited study
|
$106.34 |
$106.34 |
$106.34 |
$732.75
|
|
Intranasal biopsy 30100
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Intranasal reconstruction
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Intraoral i+d tongue/floor lingual 41000
|
$509.25 |
$509.25 |
$509.25 |
$1,291.20
|
|
Intraoral periapical first
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
Intrapul surf admin endo tube
|
$203.39 |
$203.39 |
$203.39 |
$203.39
|
|
Intrauterine transfusion ftl
|
$437.18 |
$437.18 |
$437.18 |
$645.00
|
|
Intraventricular pacing
|
$7,588.10 |
$7,588.10 |
$7,588.10 |
$5,625.00
|
|
Intrinsic factor antibody
|
$15.08 |
$15.08 |
$15.08 |
$117.00
|
|
Intrm oph exam est patient
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Intro cath dialysis circuit
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$3,121.20
|
|
Intro cath dialysis circuit w/pta
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$7,787.25
|
|
Intro cath dialysis circuit w/stent plcmnt
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$10,578.00
|
|
Intro long gi tube
|
$937.56 |
$937.56 |
$937.56 |
$684.60
|
|
Intro windpipe wire/tube
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Intubation endotracheal emergency procedure
|
$232.22 |
$232.22 |
$232.22 |
$868.80
|
|
Io anal gast n-stim subsq
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Io ga n-stim subsq w/reprog
|
$37.29 |
$37.29 |
$37.29 |
$37.29
|
|
Io rad tx deliver by elctrns
|
$7,644.49 |
$7,644.49 |
$7,644.49 |
$7,644.49
|
|
Io rad tx delivery by x-ray
|
$7,644.49 |
$7,644.49 |
$7,644.49 |
$7,644.49
|
|
Iodine i-125 sodium iodide
|
$208.58 |
$208.58 |
$208.58 |
$208.58
|
|
Ipilimumab 5 mg/ml intravenous solution (wrapper)
|
$183.41 |
$183.41 |
$183.41 |
$440.40
|
|
Irinotecan liposomal 4.3 mg/ml intravenous
|
$65.26 |
$65.26 |
$65.26 |
$115.80
|
|
Iron
|
$6.47 |
$6.47 |
$6.47 |
$60.00
|
|
Iron binding capacity
|
$8.74 |
$8.74 |
$8.74 |
$89.25
|
|
Iron dextran 50 mg/ml injection solution
|
$18.03 |
$18.03 |
$18.03 |
$99.00
|
|
Iron stain peripheral blood
|
$6.88 |
$6.88 |
$6.88 |
$6.88
|
|
Irradiation of blood product each unit reference
|
$39.25 |
$39.25 |
$39.25 |
$135.00
|
|
Irrigation implantable venous access device for drug delivery systems
|
$59.40 |
$59.40 |
$59.40 |
$142.20
|
|
Irrigation sphenoid sinus
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Irrigation vagina and/or appl medicament tx disease
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Isatuximab-irfc 20 mg/ml intravenous solution
|
$82.86 |
$82.86 |
$82.86 |
$149.40
|
|
Island pedicle flap graft
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Ivc venogram s&i
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ivp w/nephrotomography
|
$178.02 |
$178.02 |
$178.02 |
$178.02
|
|
Ivp w/wo kub w/wo tomography
|
$178.02 |
$178.02 |
$178.02 |
$1,283.40
|
|
Ixabepilone 15 mg intravenous solution
|
$138.67 |
$138.67 |
$138.67 |
$399.60
|
|
Jak2 targeted sequence analysis
|
$185.20 |
$185.20 |
$185.20 |
$1,227.60
|
|
Jaw arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Jaw arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Jejunstmy tube plcmt
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,168.00
|
|
John cunningham antibody
|
$16.89 |
$16.89 |
$16.89 |
$62.40
|
|
Keratoprosthesis
|
$14,289.31 |
$14,289.31 |
$14,289.31 |
$14,289.31
|
|
Ketogenic steroids fract
|
$15.47 |
$15.47 |
$15.47 |
$15.47
|
|
Ketone body(s) beta-hydroxybutyrate quantitative
|
$8.17 |
$8.17 |
$8.17 |
$174.60
|
|
Ketorolac 15 mg/ml injection (wrapper)
|
$0.35 |
$0.35 |
$0.35 |
$24.60
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$106.34 |
$106.34 |
$106.34 |
$683.50
|
|
Kidney endoscopy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$3,964.20
|
|
Kidney endoscopy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Kidney endoscopy
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Kidney endoscopy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Kidney endoscopy & biopsy
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Kidney endoscopy & biopsy
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Kidney endoscopy & treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Kidney endoscopy & treatment
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Kidney endoscopy & treatment
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Kidney endoscopy & treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Kidney function study
|
$401.83 |
$401.83 |
$401.83 |
$1,133.25
|
|
Kidney imag w/bld flow multi
|
$538.27 |
$538.27 |
$538.27 |
$1,404.00
|
|
Kidney imaging morphology
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Kidney img w/bldflw sgl without rx
|
$538.27 |
$538.27 |
$538.27 |
$1,552.20
|
|
Kit gene analys d816 variant
|
$124.87 |
$124.87 |
$124.87 |
$1,111.20
|
|
Knee Arthroscopy (Cartilage Repair)
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,545.97
|
|
Knee Arthroscopy (Meniscus Repair)
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,591.33
|
|
Knee MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$790.06 |
$790.06 |
$790.06 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$2,205.00
|
|
Knee X-ray
|
$106.34 |
$106.34 |
$106.34 |
$387.20
|
|
Knee arthroscopy dx
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/drainage
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Knee arthroscopy/surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Knee arthroscopy/surgery
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Knee arthroscopy/surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Knee arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Kras gene addl variants
|
$193.25 |
$193.25 |
$193.25 |
$454.20
|
|
Kras gene variants exon 2
|
$193.25 |
$193.25 |
$193.25 |
$361.80
|
|
L hrt cath chd nm/abn nt cnj
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$3,216.41
|
|
L/s ratio fetal lung
|
$21.99 |
$21.99 |
$21.99 |
$194.40
|
|
Labioplasty 56800
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Lactate dehydrogenase (ldh)
|
$6.04 |
$6.04 |
$6.04 |
$52.00
|
|
Lactic acid
|
$11.57 |
$11.57 |
$11.57 |
$121.80
|
|
Lactoferrin fecal qualitative
|
$19.70 |
$19.70 |
$19.70 |
$119.40
|
|
Lactoferrin fecal quant
|
$19.63 |
$19.63 |
$19.63 |
$194.40
|
|
Lam facetec & foramot crv
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lam facetec & foramot lumbar
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lam facetec & foramot thrc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lamie excise intrspinl lesion thrc 63266
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Laminotomy single cervical
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Laminotomy single lumbar
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lanreotide 120 mg/0.5 ml subcutaneous syringe
|
$36.66 |
$36.66 |
$36.66 |
$33,573.60
|
|
Lap enterolysis
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Lap fimbrioplasty 58672
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Lap impl electrode antrum
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Lap ing hernia repair init
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$1,126.20
|
|
Lap ing hernia repair recur
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Lap insert tunnel ip cath
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$1,267.20
|
|
Lap jejunostomy 44186
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Lap paraesoph her rpr w/mesh
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lap paraesophag hern repair
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lap place gastr adj device
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lap replace gastr adj device
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Lap revise/remv eltrd antrum
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lap revision perm ip cath
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$979.20
|
|
Lap rmvl gastr adj all parts
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,804.53
|
|
Lap rmvl gastr adj device
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,804.53
|
|
Laparo ablate liver tumor rf
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo ablate renal cyst
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo ablate renal mass
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo cholecystectomy/explr
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo cholecystectomy/graph
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparo drng lymphocele 49323
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparo ligate spermatic vein
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparo new ureter/bladder
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo new ureter/bladder
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo partial nephrectomy
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$4,511.40
|
|
Laparo proc abdm/per/oment 49329
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$4,308.00
|
|
Laparo sling operation 51992
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparo urethral suspension
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparo-asst vag hysterectomy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparo-myomectomy complex
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo-vag hyst incl t/o
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparo-vag hyst w/t/o compl
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparoscope proc rectum
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopic myomectomy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopic salpingostomy 58673
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparoscopy aspiration
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy biopsy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$905.40
|
|
Laparoscopy excise lesions
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$1,830.00
|
|
Laparoscopy fundoplasty
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparoscopy gastrostomy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy lymph node biop
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy lymphadenectomy
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparoscopy lymphadenectomy
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparoscopy lysis
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy orchiectomy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy orchiopexy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy pyeloplasty
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparoscopy remove adnexa
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$7,589.40
|
|
Laparoscopy splenectomy
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$2,479.20
|
|
Laparoscopy surg colpopexy
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laparoscopy tubal block 58671
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy ureterolithotomy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy vagus nerve
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopy vagus nerve
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Laparoscopye procstom 43659
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,688.75
|
|
Laparscpy ablat 1>lvr tum cryo
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laps abltj uterine fibroids
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laps esophgl sphnctr agmntj 43284
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laps pelvic lymphadec
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laps surg prst8ect rpbic rad
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Laps surg prst8ect smpl stot
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Largsc w/laser dstrj les
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$6,297.75
|
|
Largsc w/njx augmentation
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$3,180.00
|
|
Largsc w/removal lesion
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Largsc w/rmvl foreign bdy(s)
|
$388.31 |
$388.31 |
$388.31 |
$3,769.20
|
|
Largsc w/ther injection
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Laronidase injection
|
$39.88 |
$39.88 |
$39.88 |
$4,116.73
|
|
Laryngeal function studies
|
$128.90 |
$128.90 |
$128.90 |
$333.00
|
|
Laryngoplasty cricoid split
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoplasty fx rdctj fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoplasty laryngeal sten
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoplasty laryngeal sten
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoplasty laryngeal sten
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoplasty laryngeal sten
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoplasty laryngeal web
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoplasty medialization
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Laryngoscop w/arytenoidectom
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Laryngoscop w/vc inj + scope
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laryngoscope w/vc inj
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laryngoscopic sensory vid
|
$84.45 |
$84.45 |
$84.45 |
$84.45
|
|
Laryngoscopy and dilation
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,769.20
|
|
Laryngoscopy and dilation
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laryngoscopy direct w/wo tracheoscopy dx exc newborn
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$2,632.20
|
|
Laryngoscopy for treatment
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laryngoscopy telescopic
|
$388.31 |
$388.31 |
$388.31 |
$907.50
|
|
Laryngoscopy w/biopsy
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laryngoscopy w/bx & op scope
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laryngoscopy w/exc of tumor
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$7,290.00
|
|
Laryngoscopy w/fb & op scope
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laryngoscopy w/fb removal
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Laryngoscopy w/w/o tracheoscopy aspiration
|
$388.31 |
$388.31 |
$388.31 |
$473.25
|
|
Laryngoscopy with biopsy
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$5,543.40
|
|
Laryngoscopy with biopsy 31510
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Larynscop remve cart + scop
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Larynscop w/tumr exc + scope
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Laser surg penis lesion(s)
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Laser surgery eye strands
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Laser surgery of cervix 57513
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Laser surgery of prostate
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Laser surgery of prostate
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Laser treatment of retina
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Laser treatment of retina
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Lat retinacular release open
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Lateral canthopexy
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Lavage cannulation maxillary sinus
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Lavh >250 gms 58553
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lb with mastopexy 15839
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Lead capillary
|
$12.11 |
$12.11 |
$12.11 |
$90.60
|
|
Lefort i-1 piece without graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Lefort i-2 piece without graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Lefort i-3/> piece without graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Lefort ii anterior intrusion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$241.72 |
$241.72 |
$241.72 |
$1,090.23
|
|
Leg vein fusion 34530
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Leishmania antibody
|
$12.25 |
$12.25 |
$12.25 |
$159.00
|
|
Lengthen metacarpal/finger
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lengthen radius & ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lengthen radius or ulna
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Lengthening of hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Lengthening of palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Lengthening of palate+pharyngeal flap 42226
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Lengthening of thigh tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lengthening of thigh tendons
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Lengthening of thigh tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Leukacyte transfusion
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Leukocyte phagocytosis
|
$10.39 |
$10.39 |
$10.39 |
$10.39
|
|
Leuprolide 3.75 mg intramuscular syringe kit
|
$1,737.10 |
$1,737.10 |
$1,737.10 |
$3,559.80
|
|
Leuprolide 30 mg (4 month) intramuscular syringe kit
|
$155.42 |
$155.42 |
$155.42 |
$6,209.40
|
|
Leuprolide depot cipla 7.5mg
|
$220.74 |
$220.74 |
$220.74 |
$220.74
|
|
Leuprolide inj, camcevi, 1mg
|
$51.41 |
$51.41 |
$51.41 |
$51.41
|
|
Levetiracetam therapeutic drug level
|
$13.25 |
$13.25 |
$13.25 |
$155.25
|
|
Lidocaine therapeutic drug level
|
$14.69 |
$14.69 |
$14.69 |
$104.40
|
|
Lig&div&compl strpg saph vn
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Lig/band angioaccess av fistula
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,213.75
|
|
Ligate leg veins open
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligate leg veins radical 37760
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligate/strip long leg vein
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligate/strip short leg vein
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligate/transect fallopian tubes 58600
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Ligation external carotid artery 37600
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation internal jugular vein 37565
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation internal/common carotid artery 37605
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation major artery neck
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,192.60
|
|
Ligation nasal sinus artery
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation of femoral vein
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation of inf vena cava
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Ligation of neck artery
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation of salivary duct
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Ligation upper jaw artery
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation vericose vein cluster(s) 1 leg
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Ligation/biopsy of temporal artery 37609
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Ligation/divis of long saph vein 37700
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Limb exercise test
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Limited visual field xm
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Lip exc/transverse wedge/w closure 40510
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Lip surgery procedure
|
$232.22 |
$232.22 |
$232.22 |
$121.80
|
|
Lipase
|
$6.89 |
$6.89 |
$6.89 |
$139.80
|
|
Lipoprotein blood high res frac & quant
|
$33.86 |
$33.86 |
$33.86 |
$188.40
|
|
Lipoprotein blood quant
|
$34.19 |
$34.19 |
$34.19 |
$280.20
|
|
Lipoprotein direct measurement hdl
|
$8.19 |
$8.19 |
$8.19 |
$63.60
|
|
Lipoprotein direct measurement ldl
|
$10.50 |
$10.50 |
$10.50 |
$75.00
|
|
Lipoprtn dir meas sd ldl chl
|
$34.19 |
$34.19 |
$34.19 |
$34.19
|
|
Lisocabtagene mara car pos t
|
$541,635.66 |
$541,635.66 |
$541,635.66 |
$541,635.66
|
|
Listeria monocytogenes
|
$13.19 |
$13.19 |
$13.19 |
$13.19
|
|
Lithium therapeutic drug level
|
$6.61 |
$6.61 |
$6.61 |
$82.80
|
|
Liver Function Test
|
$8.17 |
$8.17 |
$8.17 |
$92.85
|
|
Liver ds alys 3 bmrk srm alg
|
$176.19 |
$176.19 |
$176.19 |
$917.40
|
|
Liver elastography 91200
|
$156.46 |
$156.46 |
$156.46 |
$552.75
|
|
Liver imag w/vasclr flow
|
$538.27 |
$538.27 |
$538.27 |
$1,510.20
|
|
Liver imaging
|
$538.27 |
$538.27 |
$538.27 |
$901.80
|
|
Liver/spleen imag static only
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Liver/spleen imag w/vasclr flow
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Lmtd oph exam general anes
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Lngth/shrt tendon leg/ankle 1 tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Loncastuximab tesirine-lpyl 10 mg intravenous solution
|
$216.74 |
$216.74 |
$216.74 |
$15,780.00
|
|
Loudness balance test
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Low back disk surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Low cost skin substitute app
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Low cost skin substitute app
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Low cost skin substitute app
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Low cost skin substitute app
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Low frequency non-thermal Ultrasound
|
$198.70 |
$198.70 |
$198.70 |
$45.60
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$106.34 |
$106.34 |
$106.34 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,415.68
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$106.34 |
$106.34 |
$106.34 |
$341.64
|
|
Lower jaw bone graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Lsh uterus 250 g or less
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lsh uterus above 250 g
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lsh w/t/o ut 250 g or less
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lsh w/t/o uterus above 250 g
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Lumbar Spinal Fusion (single level)
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$5,428.66
|
|
Lumbar diskogram s&i
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$2,409.75
|
|
Lumizyme injection
|
$206.62 |
$206.62 |
$206.62 |
$3,672.96
|
|
Lung Function Test (Spirometry)
|
$156.46 |
$156.46 |
$156.46 |
$296.91
|
|
Lung function test (mbc/mvv)
|
$59.40 |
$59.40 |
$59.40 |
$109.60
|
|
Lung perfusion imaging
|
$401.83 |
$401.83 |
$401.83 |
$700.50
|
|
Lurbinectedin 4 mg intravenous solution
|
$206.13 |
$206.13 |
$206.13 |
$380.40
|
|
Luspatercept-aamt 25 mg subcutaneous solution
|
$41.96 |
$41.96 |
$41.96 |
$87.60
|
|
Lutetium lu 177 dotatat ther
|
$312.69 |
$312.69 |
$312.69 |
$607.20
|
|
Lutetium lu 177 vipivotide
|
$253.18 |
$253.18 |
$253.18 |
$600.00
|
|
Lw ntsty Ultrasound stimj bone healg
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Lymph vessel x-ray arm/leg
|
$618.26 |
$618.26 |
$618.26 |
$1,539.60
|
|
Lymph vessel x-ray arms/legs
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$1,553.44
|
|
Lymph vessel x-ray trunk
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,343.60
|
|
Lymph vessel x-ray trunk
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,131.80
|
|
Lymphatics/lymph node imaging
|
$538.27 |
$538.27 |
$538.27 |
$1,417.60
|
|
Lymphocyte culture mixed
|
$36.56 |
$36.56 |
$36.56 |
$667.80
|
|
Lymphocyte transformation mitogen
|
$49.03 |
$49.03 |
$49.03 |
$537.60
|
|
Lymphocytotoxicity assay
|
$189.51 |
$189.51 |
$189.51 |
$325.20
|
|
Lysis intranasal synechia 30560
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Lysis of labial adhesions
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Lysis penil circumic lesion
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
M.avium-intra dna amp prob
|
$35.09 |
$35.09 |
$35.09 |
$471.60
|
|
M.avium-intra dna dir prob
|
$27.29 |
$27.29 |
$27.29 |
$27.29
|
|
M.tuberculo dna dir probe
|
$26.88 |
$26.88 |
$26.88 |
$26.88
|
|
M/phmtrc alys ishquant/semiq
|
$171.36 |
$171.36 |
$171.36 |
$435.00
|
|
M/phmtrc alys skeletal musc
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
MRA chest w IV cont
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
MRA chest wo IV cont
|
$241.72 |
$241.72 |
$241.72 |
$4,193.40
|
|
MRA chest wwo IV cont
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
MRA pelvis w IV cont
|
$357.13 |
$357.13 |
$357.13 |
$1,597.20
|
|
MRA pelvis wo IV cont
|
$241.72 |
$241.72 |
$241.72 |
$1,290.00
|
|
MRA w/cont, abd
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
MRA w/cont, lwr ext
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
MRA without cont, abd
|
$241.72 |
$241.72 |
$241.72 |
$2,731.80
|
|
MRA without cont, lwr ext
|
$241.72 |
$241.72 |
$241.72 |
$1,656.00
|
|
MRA without fol w/cont, abd
|
$357.13 |
$357.13 |
$357.13 |
$2,734.20
|
|
MRA without fol w/cont, lwr ext
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
MRA without fol w/cont, pelvis
|
$357.13 |
$357.13 |
$357.13 |
$2,734.20
|
|
MRI brain w/dye
|
$178.02 |
$178.02 |
$178.02 |
$178.02
|
|
MRI brain without & w/dye
|
$178.02 |
$178.02 |
$178.02 |
$2,185.50
|
|
MRI brain without dye
|
$548.30 |
$548.30 |
$548.30 |
$548.30
|
|
MRI breast c- unilateral
|
$241.72 |
$241.72 |
$241.72 |
$565.80
|
|
MRI breast without cont bi
|
$241.72 |
$241.72 |
$241.72 |
$565.80
|
|
MRI cardiac morph & func wo IV cont
|
$241.72 |
$241.72 |
$241.72 |
$2,562.00
|
|
MRI cardiac morph & func wwo IV cont
|
$357.13 |
$357.13 |
$357.13 |
$3,051.00
|
|
MRI cardiac morph & func wwo IV cont w/stress img
|
$790.06 |
$790.06 |
$790.06 |
$4,758.75
|
|
MRI chest w IV cont
|
$790.06 |
$790.06 |
$790.06 |
$3,051.00
|
|
MRI chest without & w/contrast
|
$357.13 |
$357.13 |
$357.13 |
$3,815.40
|
|
MRI chest without contrast
|
$241.72 |
$241.72 |
$241.72 |
$2,439.75
|
|
MRI fetal sngl/1st gestation
|
$241.72 |
$241.72 |
$241.72 |
$241.72
|
|
MRI loex nonjt w IV cont
|
$357.13 |
$357.13 |
$357.13 |
$3,051.00
|
|
MRI lower extremity other than joint without & w/contrast (both sides)
|
$357.13 |
$357.13 |
$357.13 |
$3,815.40
|
|
MRI lower extremity other than joint without contrast (both sides)
|
$241.72 |
$241.72 |
$241.72 |
$2,439.75
|
|
MRI orbit fac&nck w IV cont
|
$357.13 |
$357.13 |
$357.13 |
$2,910.60
|
|
MRI orbit/face/neck without & w/contrast
|
$357.13 |
$357.13 |
$357.13 |
$3,804.00
|
|
MRI orbit/face/neck without contrast
|
$241.72 |
$241.72 |
$241.72 |
$2,307.75
|
|
MRI tmj
|
$241.72 |
$241.72 |
$241.72 |
$2,332.50
|
|
MRI upper extremity other than joint without & w/contrast (both sides)
|
$357.13 |
$357.13 |
$357.13 |
$3,815.40
|
|
MRI upper extremity other than joint without contrast (both sides)
|
$241.72 |
$241.72 |
$241.72 |
$2,514.00
|
|
MRI upper extremity w/dye
|
$357.13 |
$357.13 |
$357.13 |
$3,126.75
|
|
MRI w/cont, breast, bi
|
$357.13 |
$357.13 |
$357.13 |
$357.13
|
|
MRI w/cont, breast, uni
|
$178.02 |
$178.02 |
$178.02 |
$178.02
|
|
MRI without fol w/cont, breast
|
$357.13 |
$357.13 |
$357.13 |
$2,913.60
|
|
MRI without fol w/cont, brst, un
|
$357.13 |
$357.13 |
$357.13 |
$3,261.00
|
|
Macroscopic exam arthropod
|
$4.27 |
$4.27 |
$4.27 |
$54.00
|
|
Macroscopic exam parasite
|
$4.31 |
$4.31 |
$4.31 |
$51.00
|
|
Magnesium
|
$6.70 |
$6.70 |
$6.70 |
$78.00
|
|
Magnetic image bone marrow
|
$241.72 |
$241.72 |
$241.72 |
$1,656.00
|
|
Malaria antibody
|
$13.19 |
$13.19 |
$13.19 |
$13.19
|
|
Male sling procedure
|
$12,992.42 |
$12,992.42 |
$12,992.42 |
$12,992.42
|
|
Manipulat palm cord post inj
|
$239.88 |
$239.88 |
$239.88 |
$492.75
|
|
Manipulate finger w/anesth
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Manipulate wrist w/anesthes
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Manipulation chest wall demonstration/evaluation subsequent
|
$128.90 |
$128.90 |
$128.90 |
$186.00
|
|
Manipulation chest wall initial demonstration/evaluation
|
$128.90 |
$128.90 |
$128.90 |
$235.20
|
|
Manipulation of hip joint
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Manipulation of spine
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Manual diff wbc count b-coat
|
$5.07 |
$5.07 |
$5.07 |
$41.40
|
|
Margetuximab-cmkb 25 mg/ml intravenous solution
|
$50.45 |
$50.45 |
$50.45 |
$94.80
|
|
Marker lymphatic sentimag magtrace 10 vial
|
$11,379.91 |
$11,379.91 |
$11,379.91 |
$11,379.91
|
|
Mast mod rad
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$3,126.00
|
|
Mast simple complete
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Mastectomy partial
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Mastoid surgery revision
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Mastoidectomy
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Mastoidectomy complete 69502
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Mastoids complete
|
$106.34 |
$106.34 |
$106.34 |
$405.00
|
|
Mastopexy
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Maxillofacial fixation
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Mayo a1app alpha 1 antitrypsin phenotype
|
$14.46 |
$14.46 |
$14.46 |
$108.60
|
|
Mayo aathr protein s free
|
$15.32 |
$15.32 |
$15.32 |
$159.60
|
|
Mayo activated protein c resistance assay
|
$15.32 |
$15.32 |
$15.32 |
$158.40
|
|
Mayo adalimumab (humira) therapeutic drug level
|
$38.57 |
$38.57 |
$38.57 |
$205.80
|
|
Mayo alkaline phosphatase isoenzyme
|
$14.78 |
$14.78 |
$14.78 |
$153.75
|
|
Mayo alpha 1 antitrypsin
|
$13.44 |
$13.44 |
$13.44 |
$197.40
|
|
Mayo amikacin trough therapeutic drug level
|
$15.08 |
$15.08 |
$15.08 |
$153.00
|
|
Mayo analysis gene calr common variants exon 9
|
$121.63 |
$121.63 |
$121.63 |
$1,160.40
|
|
Mayo analysis gene jak2 p.val617phe variant
|
$91.66 |
$91.66 |
$91.66 |
$1,323.00
|
|
Mayo analysis gene smn1 dosage/deletion
|
$137.00 |
$137.00 |
$137.00 |
$1,135.80
|
|
Mayo analysis microarray cytogenomic copy number/snp variants
|
$1,160.00 |
$1,160.00 |
$1,160.00 |
$6,701.40
|
|
Mayo androstenedione
|
$29.28 |
$29.28 |
$29.28 |
$186.40
|
|
Mayo angiotensin 1 converting enzyme (ace) csf
|
$14.60 |
$14.60 |
$14.60 |
$74.40
|
|
Mayo antithrombin iii antigen
|
$10.81 |
$10.81 |
$10.81 |
$108.60
|
|
Mayo aspergillus fumigatus antibody
|
$15.05 |
$15.05 |
$15.05 |
$106.50
|
|
Mayo avwpr vw factor activity
|
$30.86 |
$30.86 |
$30.86 |
$322.80
|
|
Mayo babpb infectious agent nucleic acid amplified probe babesia microti
|
$35.09 |
$35.09 |
$35.09 |
$290.40
|
|
Mayo bart bartonella henselae antibody igg
|
$10.18 |
$10.18 |
$10.18 |
$66.75
|
|
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative
|
$144.84 |
$144.84 |
$144.84 |
$364.20
|
|
Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative
|
$214.62 |
$214.62 |
$214.62 |
$843.00
|
|
Mayo blastomyces antibody immunodiffusion
|
$12.90 |
$12.90 |
$12.90 |
$178.20
|
|
Mayo bordetella pertussis antibody igg
|
$13.19 |
$13.19 |
$13.19 |
$100.80
|
|
Mayo brcmg brucella antibody igm
|
$8.93 |
$8.93 |
$8.93 |
$118.80
|
|
Mayo c1 esterase inhibitor
|
$13.60 |
$13.60 |
$13.60 |
$130.80
|
|
Mayo carnitine total and free quantitative each specimen plasma
|
$16.87 |
$16.87 |
$16.87 |
$166.20
|
|
Mayo cd20b mononuclear cell antigen nos quantitative each
|
$26.78 |
$26.78 |
$26.78 |
$351.00
|
|
Mayo cdcom hla class ii typing low resolution one locus each
|
$122.22 |
$122.22 |
$122.22 |
$465.00
|
|
Mayo ceruloplasmin
|
$10.74 |
$10.74 |
$10.74 |
$97.80
|
|
Mayo chemiluminescent parathyroid related peptide
|
$14.12 |
$14.12 |
$14.12 |
$294.60
|
|
Mayo chikv chikungunya antibodies igg
|
$12.88 |
$12.88 |
$12.88 |
$360.60
|
|
Mayo chlap chlamydia pneumoniae antibody igg
|
$11.82 |
$11.82 |
$11.82 |
$114.75
|
|
Mayo chlap chlamydia pneumoniae antibody igm
|
$12.68 |
$12.68 |
$12.68 |
$82.50
|
|
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte
|
$116.49 |
$116.49 |
$116.49 |
$833.40
|
|
Mayo chromium
|
$20.28 |
$20.28 |
$20.28 |
$129.75
|
|
Mayo coccidioides antibody
|
$11.47 |
$11.47 |
$11.47 |
$128.25
|
|
Mayo cocou cortisone urine
|
$24.09 |
$24.09 |
$24.09 |
$305.40
|
|
Mayo cortisol free
|
$16.71 |
$16.71 |
$16.71 |
$133.20
|
|
Mayo covid-19 antibody nucleocapsid total
|
$42.13 |
$42.13 |
$42.13 |
$123.00
|
|
Mayo coxiella brunetii (q fever) igg antibody
|
$12.12 |
$12.12 |
$12.12 |
$115.80
|
|
Mayo cyanide
|
$19.40 |
$19.40 |
$19.40 |
$170.25
|
|
Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Mayo deoxyribonuclease antibody titer
|
$13.25 |
$13.25 |
$13.25 |
$96.00
|
|
Mayo dhea (dehydroepiandrosterone)
|
$25.27 |
$25.27 |
$25.27 |
$276.75
|
|
Mayo dihydrotestosterone
|
$29.28 |
$29.28 |
$29.28 |
$239.40
|
|
Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid
|
$9.64 |
$9.64 |
$9.64 |
$103.80
|
|
Mayo efpo chloride stool
|
$5.00 |
$5.00 |
$5.00 |
$102.00
|
|
Mayo estriol
|
$24.18 |
$24.18 |
$24.18 |
$138.00
|
|
Mayo estrone
|
$24.95 |
$24.95 |
$24.95 |
$157.50
|
|
Mayo ethosuximide therapeutic drug level
|
$16.34 |
$16.34 |
$16.34 |
$138.75
|
|
Mayo everolimus therapeutic drug level
|
$13.73 |
$13.73 |
$13.73 |
$210.00
|
|
Mayo factor ii
|
$12.98 |
$12.98 |
$12.98 |
$97.20
|
|
Mayo factor v
|
$17.65 |
$17.65 |
$17.65 |
$189.00
|
|
Mayo factor vii
|
$17.90 |
$17.90 |
$17.90 |
$185.40
|
|
Mayo factor viii vw factor antigen
|
$22.94 |
$22.94 |
$22.94 |
$176.40
|
|
Mayo factor viii vw factor multimetric analysis
|
$22.94 |
$22.94 |
$22.94 |
$239.40
|
|
Mayo factor viii vw factor ristocetin cofactor
|
$22.94 |
$22.94 |
$22.94 |
$243.60
|
|
Mayo factor x
|
$17.90 |
$17.90 |
$17.90 |
$191.25
|
|
Mayo factor xi
|
$17.90 |
$17.90 |
$17.90 |
$162.60
|
|
Mayo fat/lipids feces quantitative
|
$16.80 |
$16.80 |
$16.80 |
$126.60
|
|
Mayo fbl culture fungi blood
|
$20.46 |
$20.46 |
$20.46 |
$126.00
|
|
Mayo fdp/fsp paracoagulation
|
$80.46 |
$80.46 |
$80.46 |
$80.46
|
|
Mayo ffspg allergen clam igg
|
$7.82 |
$7.82 |
$7.82 |
$51.75
|
|
Mayo fibrinogen antigen
|
$14.46 |
$14.46 |
$14.46 |
$109.80
|
|
Mayo gabapentin bld/srm/plasma therapeutic drug level
|
$21.67 |
$21.67 |
$21.67 |
$129.60
|
|
Mayo hemosiderin qualitative urine
|
$4.75 |
$4.75 |
$4.75 |
$50.25
|
|
Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative
|
$35.09 |
$35.09 |
$35.09 |
$288.60
|
|
Mayo hip12 infectious agent nucleic acid amplified probe hiv-2
|
$35.09 |
$35.09 |
$35.09 |
$417.00
|
|
Mayo hiser histoplasma antibodies immunodiffusion
|
$13.79 |
$13.79 |
$13.79 |
$161.25
|
|
Mayo hla typing a/b/c single antigen
|
$25.81 |
$25.81 |
$25.81 |
$194.40
|
|
Mayo hvdip HIV 1 antibody
|
$8.89 |
$8.89 |
$8.89 |
$88.20
|
|
Mayo hvdip HIV 2 antibody
|
$13.52 |
$13.52 |
$13.52 |
$97.20
|
|
Mayo hydroxyprogesterone 17-d
|
$27.17 |
$27.17 |
$27.17 |
$140.25
|
|
Mayo immunoassay c1 esterase inhibitor antibody quantitative
|
$17.27 |
$17.27 |
$17.27 |
$259.80
|
|
Mayo immunoassay infectious agent antibody quantitative diptheria igg
|
$14.99 |
$14.99 |
$14.99 |
$109.20
|
|
Mayo immunoassay tumor antigen quantitative ca 27.29
|
$20.81 |
$20.81 |
$20.81 |
$141.00
|
|
Mayo immunoassay tumor antigen quantitative chromogranin a
|
$20.81 |
$20.81 |
$20.81 |
$176.40
|
|
Mayo inf agt nucleic acid amp prb helicobacter pylori clarithromycin resistance
|
$35.09 |
$35.09 |
$35.09 |
$987.60
|
|
Mayo infectious agent antigen immunoassay direct optical observation cryptococcus
|
$16.07 |
$16.07 |
$16.07 |
$141.75
|
|
Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal
|
$11.98 |
$11.98 |
$11.98 |
$218.40
|
|
Mayo infectious agent nucleic acid amplified probe enterovirus
|
$35.09 |
$35.09 |
$35.09 |
$428.40
|
|
Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine
|
$35.09 |
$35.09 |
$35.09 |
$189.00
|
|
Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae
|
$35.09 |
$35.09 |
$35.09 |
$349.80
|
|
Mayo infectious agent nucleic acid amplified probe pneumocystis jirovecii
|
$35.09 |
$35.09 |
$35.09 |
$292.50
|
|
Mayo infectious agent nucleic acid quantification cytomegalovirus
|
$42.84 |
$42.84 |
$42.84 |
$350.40
|
|
Mayo infectious disease hepatitis c chronic six biochemical assays
|
$72.19 |
$72.19 |
$72.19 |
$516.60
|
|
Mayo infliximab therapeutic drug level
|
$38.57 |
$38.57 |
$38.57 |
$523.20
|
|
Mayo inhab inhibin a
|
$15.59 |
$15.59 |
$15.59 |
$267.75
|
|
Mayo insft insulin free
|
$12.95 |
$12.95 |
$12.95 |
$117.00
|
|
Mayo insulin antibodies
|
$21.41 |
$21.41 |
$21.41 |
$119.40
|
|
Mayo iodine
|
$24.11 |
$24.11 |
$24.11 |
$202.20
|
|
Mayo itraconazole therapeutic drug level
|
$27.11 |
$27.11 |
$27.11 |
$140.40
|
|
Mayo lacosamide therapeutic drug level
|
$27.11 |
$27.11 |
$27.11 |
$199.50
|
|
Mayo lamotrigine therapeutic drug level
|
$13.25 |
$13.25 |
$13.25 |
$141.00
|
|
Mayo ld_i lactate dehydrogenase isoenzymes
|
$12.79 |
$12.79 |
$12.79 |
$70.80
|
|
Mayo legionella antibody
|
$15.30 |
$15.30 |
$15.30 |
$104.40
|
|
Mayo leptospira antibody igm
|
$16.20 |
$16.20 |
$16.20 |
$60.75
|
|
Mayo lipoprotein electrophoresis
|
$11.26 |
$11.26 |
$11.26 |
$99.00
|
|
Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory
|
$15.49 |
$15.49 |
$15.49 |
$180.00
|
|
Mayo manganese
|
$26.65 |
$26.65 |
$26.65 |
$100.80
|
|
Mayo metanephrines plasma
|
$16.94 |
$16.94 |
$16.94 |
$384.00
|
|
Mayo mgle voltage-gated calcium channel antibody each
|
$12.05 |
$12.05 |
$12.05 |
$235.20
|
|
Mayo mgrm acetylcholine receptor binding antibody
|
$18.40 |
$18.40 |
$18.40 |
$235.20
|
|
Mayo microsomal antibody liver-kidney
|
$14.55 |
$14.55 |
$14.55 |
$136.20
|
|
Mayo mitotane (lysodren) therapeutic drug level
|
$18.64 |
$18.64 |
$18.64 |
$206.40
|
|
Mayo molecular pathology procedure level 2 apoe genotype
|
$137.00 |
$137.00 |
$137.00 |
$1,204.20
|
|
Mayo mpl sequence analysis exon 10
|
$185.20 |
$185.20 |
$185.20 |
$752.40
|
|
Mayo muramidase
|
$18.75 |
$18.75 |
$18.75 |
$96.75
|
|
Mayo muscle-specific kinase (musk) antibody
|
$18.40 |
$18.40 |
$18.40 |
$235.20
|
|
Mayo mycophenolic acid therapeutic drug level
|
$18.05 |
$18.05 |
$18.05 |
$202.20
|
|
Mayo myoglobin
|
$12.92 |
$12.92 |
$12.92 |
$129.75
|
|
Mayo nickel
|
$24.51 |
$24.51 |
$24.51 |
$178.20
|
|
Mayo organic acid methylmalonic single quantitative
|
$21.21 |
$21.21 |
$21.21 |
$298.20
|
|
Mayo organic acids qualitative each specimen
|
$16.45 |
$16.45 |
$16.45 |
$102.00
|
|
Mayo oxalate 24 hour urine
|
$14.45 |
$14.45 |
$14.45 |
$163.50
|
|
Mayo pancreatic elastase fecal qualitative or semi quantitative
|
$11.53 |
$11.53 |
$11.53 |
$108.60
|
|
Mayo parvs parvovirus b19 antibody igg
|
$15.03 |
$15.03 |
$15.03 |
$123.00
|
|
Mayo paval fluorescent antibody screen agna type 1
|
$12.05 |
$12.05 |
$12.05 |
$132.60
|
|
Mayo pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme)
|
$35.09 |
$35.09 |
$35.09 |
$306.00
|
|
Mayo phospholipid neutralization hexagonal lupus anticoagulant
|
$17.98 |
$17.98 |
$17.98 |
$204.60
|
|
Mayo pntft phenytoin free therapeutic drug level
|
$13.76 |
$13.76 |
$13.76 |
$92.25
|
|
Mayo pqnu porphobilinogen urine quantitative 24 hour urine
|
$8.44 |
$8.44 |
$8.44 |
$131.25
|
|
Mayo pregnenolone
|
$20.67 |
$20.67 |
$20.67 |
$222.00
|
|
Mayo prmb primidone therapeutic drug level
|
$16.59 |
$16.59 |
$16.59 |
$118.80
|
|
Mayo proinsulin
|
$26.69 |
$26.69 |
$26.69 |
$206.25
|
|
Mayo psaft prostate specific antigen free
|
$18.39 |
$18.39 |
$18.39 |
$129.60
|
|
Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative
|
$18.40 |
$18.40 |
$18.40 |
$300.00
|
|
Mayo rbcme osmotic fragility rbc incubated
|
$13.36 |
$13.36 |
$13.36 |
$223.80
|
|
Mayo receptor assay transferrin soluble
|
$36.57 |
$36.57 |
$36.57 |
$193.50
|
|
Mayo renin
|
$21.99 |
$21.99 |
$21.99 |
$165.60
|
|
Mayo repu protein electrophoresis urine
|
$17.83 |
$17.83 |
$17.83 |
$181.20
|
|
Mayo selenium
|
$25.53 |
$25.53 |
$25.53 |
$168.00
|
|
Mayo semb semen analysis volume/count/motility/differential strict morphologic criteria
|
$15.50 |
$15.50 |
$15.50 |
$91.20
|
|
Mayo serotonin
|
$30.98 |
$30.98 |
$30.98 |
$235.20
|
|
Mayo sfgp rickettsia rickettsii antibody igg
|
$19.35 |
$19.35 |
$19.35 |
$109.50
|
|
Mayo sirolimus therapeutic drug level
|
$13.73 |
$13.73 |
$13.73 |
$150.60
|
|
Mayo syphilis test non-treponemal antibody qualitative vdrl
|
$4.27 |
$4.27 |
$4.27 |
$41.40
|
|
Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification
|
$208.92 |
$208.92 |
$208.92 |
$859.80
|
|
Mayo tgrp testosterone free
|
$25.47 |
$25.47 |
$25.47 |
$121.50
|
|
Mayo tgrp testosterone total
|
$25.81 |
$25.81 |
$25.81 |
$184.20
|
|
Mayo thiopurine s-methyltransferase
|
$22.17 |
$22.17 |
$22.17 |
$22.17
|
|
Mayo thyroglobulin
|
$16.06 |
$16.06 |
$16.06 |
$184.20
|
|
Mayo ticks anaplasma phagocytophilum antibody igg
|
$10.18 |
$10.18 |
$10.18 |
$97.80
|
|
Mayo ticks babesia microti antibody igg
|
$12.39 |
$12.39 |
$12.39 |
$126.00
|
|
Mayo ttfb testosterone bioavailable direct
|
$51.28 |
$51.28 |
$51.28 |
$51.28
|
|
Mayo tulab francisella tularensis antibody igg
|
$14.16 |
$14.16 |
$14.16 |
$96.60
|
|
Mayo valpg valproic acid free therapeutic drug level
|
$13.54 |
$13.54 |
$13.54 |
$126.00
|
|
Mayo vasoactive intestinal peptide
|
$35.33 |
$35.33 |
$35.33 |
$326.25
|
|
Mayo vitamin b-2 (riboflavin)
|
$20.24 |
$20.24 |
$20.24 |
$138.60
|
|
Mayo vitamin b3 (niacin)
|
$17.06 |
$17.06 |
$17.06 |
$147.00
|
|
Mayo vitamin k
|
$13.72 |
$13.72 |
$13.72 |
$317.25
|
|
Mayo zonisamide therapeutic drug level
|
$13.25 |
$13.25 |
$13.25 |
$207.75
|
|
Mcoln1 gene
|
$39.31 |
$39.31 |
$39.31 |
$227.40
|
|
Mcp joint arthroscopy dx
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Mcp joint arthroscopy surg
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Mcp joint arthroscopysurg 29902
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Mdfc flap w/prsrv vasc pedcl
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Meas lung vol thru 2 yrs
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Measure kidney pressure
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Measure ureter pressure
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Measurement post void urine by ultrasound
|
$59.40 |
$59.40 |
$59.40 |
$176.40
|
|
Mecp2 gene dup/delet variant
|
$150.00 |
$150.00 |
$150.00 |
$150.00
|
|
Mecp2 gene full seq
|
$527.87 |
$527.87 |
$527.87 |
$527.87
|
|
Mecp2 gene known variant
|
$120.00 |
$120.00 |
$120.00 |
$120.00
|
|
Med physic dos eval rad exps
|
$530.60 |
$530.60 |
$530.60 |
$621.00
|
|
Medial canthopexy
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Mediastinoscpy w/lmph nod bx
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Mediastinoscpy w/medstnl bx 39401
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Meg evoked single
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Meg spontaneous
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Meniscal trnspl knee w/scpe
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Mepolizumab 100 mg/ml subcutaneous auto-injector
|
$31.33 |
$31.33 |
$31.33 |
$8,127.60
|
|
Metabolic Blood Panel (Basic)
|
$8.46 |
$8.46 |
$8.46 |
$97.20
|
|
Metabolic Blood Panel (Comprehensive)
|
$10.56 |
$10.56 |
$10.56 |
$130.97
|
|
Metabolic panel ionized ca
|
$13.73 |
$13.73 |
$13.73 |
$160.50
|
|
Methotrexate therapeutic drug level
|
$38.57 |
$38.57 |
$38.57 |
$124.20
|
|
Methylene blue (antidote) 5 mg/ml intravenous solution
|
$7.86 |
$7.86 |
$7.86 |
$1,620.00
|
|
Methylprednisolone acetate 40 mg/ml suspension for injection
|
$0.12 |
$0.12 |
$0.12 |
$1.20
|
|
Methylprednisolone sodium succinate 1,000 mg intravenous solution
|
$0.26 |
$0.26 |
$0.26 |
$6.80
|
|
Mgmt promoter methylation analysis
|
$124.64 |
$124.64 |
$124.64 |
$227.40
|
|
Microalbumin urine screen
|
$6.23 |
$6.23 |
$6.23 |
$6.23
|
|
Microbe susceptible mlc
|
$40.17 |
$40.17 |
$40.17 |
$40.17
|
|
Microfluid analy tears
|
$22.48 |
$22.48 |
$22.48 |
$22.48
|
|
Microsatellite instability
|
$348.56 |
$348.56 |
$348.56 |
$1,154.40
|
|
Microvolt t-wave assess
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Microwave bronch, 3d, ebus
|
$3,750.50 |
$3,750.50 |
$3,750.50 |
$3,707.40
|
|
Middle cerebral artery echo
|
$106.34 |
$106.34 |
$106.34 |
$285.60
|
|
Minocycline hydrochloride
|
$2.67 |
$2.67 |
$2.67 |
$403.80
|
|
Mirvetuximab soravtansine-gynx 5 mg/ml intravenous solution
|
$69.52 |
$69.52 |
$69.52 |
$129.00
|
|
Mitomycin 40 mg intravenous solution
|
$28.27 |
$28.27 |
$28.27 |
$1,714.80
|
|
Mitomycin instillation
|
$317.42 |
$317.42 |
$317.42 |
$858.00
|
|
Mitoxantrone 2 mg/ml concentrate,intravenous
|
$29.60 |
$29.60 |
$29.60 |
$437.16
|
|
Mlh1 gene
|
$192.32 |
$192.32 |
$192.32 |
$1,123.80
|
|
Mlh1 gene dup/delete variant
|
$202.40 |
$202.40 |
$202.40 |
$1,502.40
|
|
Mlh1 gene full seq
|
$675.40 |
$675.40 |
$675.40 |
$399.00
|
|
Mlh1 gene known variants
|
$331.00 |
$331.00 |
$331.00 |
$331.00
|
|
Mlt osteot rlgnm imed rd hum
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Mnl appl strs jt radiography
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
Mnpj anes sho jt fixj aprats
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Mnpj elbow under anes
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Mnpj of tmj w/anesth
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Mnt subs tx for change dx
|
$34.61 |
$34.61 |
$34.61 |
$34.61
|
|
Modification of contact lens
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Mog-igg1 antb flo cytmtry ea
|
$37.73 |
$37.73 |
$37.73 |
$192.60
|
|
Mometasone sinus sinuva
|
$11.35 |
$11.35 |
$11.35 |
$11.35
|
|
Monovisc inj per dose
|
$528.58 |
$528.58 |
$528.58 |
$2,155.28
|
|
Monthly tx for dmht 20mins
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Mopath procedure level 1
|
$63.96 |
$63.96 |
$63.96 |
$873.75
|
|
Mopath procedure level 3
|
$150.33 |
$150.33 |
$150.33 |
$1,314.60
|
|
Mopath procedure level 5
|
$274.83 |
$274.83 |
$274.83 |
$2,734.80
|
|
Mopath procedure level 6
|
$301.35 |
$301.35 |
$301.35 |
$5,054.40
|
|
Mopath procedure level 7
|
$282.88 |
$282.88 |
$282.88 |
$8,366.40
|
|
Mopath procedure level 8
|
$846.27 |
$846.27 |
$846.27 |
$1,687.80
|
|
Mopath procedure level 9
|
$2,000.00 |
$2,000.00 |
$2,000.00 |
$2,250.00
|
|
Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain
|
$171.36 |
$171.36 |
$171.36 |
$349.20
|
|
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted
|
$359.72 |
$359.72 |
$359.72 |
$599.40
|
|
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual
|
$171.36 |
$171.36 |
$171.36 |
$337.20
|
|
Mosunetuzumab-axgb 1 mg/ml intravenous solution
|
$652.75 |
$652.75 |
$652.75 |
$924.00
|
|
Motion analysis video/3d
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Motion test w/ft press meas
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Motor &/ sens nrve cndj test
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Mouth vestibule bx/w complex rpr 40814
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Mpl gene analysis common variants
|
$150.33 |
$150.33 |
$150.33 |
$1,227.60
|
|
Mr elastography
|
$241.72 |
$241.72 |
$241.72 |
$945.00
|
|
Mr safety determination physician/other qhp
|
$88.05 |
$88.05 |
$88.05 |
$160.20
|
|
Mr safety implant elec prepj
|
$91.79 |
$91.79 |
$91.79 |
$166.80
|
|
Mr safety implt pos&/immoblj
|
$59.40 |
$59.40 |
$59.40 |
$58.50
|
|
Mr sfty implt&/fb asmt stf 1
|
$24.49 |
$24.49 |
$24.49 |
$44.40
|
|
Mr sfty med physics xm cstmz
|
$241.72 |
$241.72 |
$241.72 |
$439.80
|
|
Mr spectroscopy
|
$88.05 |
$88.05 |
$88.05 |
$1,610.25
|
|
Mra, w/dye, spinal canal
|
$357.13 |
$357.13 |
$357.13 |
$1,013.40
|
|
Mra, w/dye, upper extremity
|
$357.13 |
$357.13 |
$357.13 |
$1,987.50
|
|
Mra, w/o&w/dye, spinal canal
|
$357.13 |
$357.13 |
$357.13 |
$417.75
|
|
Mra, w/o&w/dye, upper extr
|
$357.13 |
$357.13 |
$357.13 |
$1,887.00
|
|
Mra, without dye, spinal canal
|
$241.72 |
$241.72 |
$241.72 |
$1,867.50
|
|
Mra, without dye, upper extr
|
$241.72 |
$241.72 |
$241.72 |
$1,833.75
|
|
Mrgfus strtctc ablt trgt icr
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Msh2 gene dup/delete variant
|
$213.30 |
$213.30 |
$213.30 |
$1,522.80
|
|
Msh2 gene full seq
|
$381.70 |
$381.70 |
$381.70 |
$1,502.40
|
|
Msh2 gene known variants
|
$337.73 |
$337.73 |
$337.73 |
$235.80
|
|
Msh6 gene dup/delete variant
|
$238.00 |
$238.00 |
$238.00 |
$1,522.80
|
|
Msh6 gene full seq
|
$641.85 |
$641.85 |
$641.85 |
$1,522.80
|
|
Msh6 gene known variants
|
$308.00 |
$308.00 |
$308.00 |
$235.80
|
|
Mthfr gene analy common variants
|
$65.34 |
$65.34 |
$65.34 |
$357.60
|
|
Mucin synovial fluid
|
$5.86 |
$5.86 |
$5.86 |
$5.86
|
|
Mucopolysaccharides
|
$28.50 |
$28.50 |
$28.50 |
$280.80
|
|
Multi family grp psychotherapy
|
$160.67 |
$160.67 |
$160.67 |
$370.50
|
|
Multifocal erg w/i&r
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Multiple sleep latency test
|
$530.60 |
$530.60 |
$530.60 |
$4,164.75
|
|
Mumps antibody igg
|
$13.05 |
$13.05 |
$13.05 |
$148.50
|
|
Musc myoq/fscq flp h&n pedcl
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Musc/tdn transfer upr a/e 1
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Muscle test cran nerv unilat
|
$311.40 |
$311.40 |
$311.40 |
$441.00
|
|
Muscle test hemidiaphragm
|
$156.46 |
$156.46 |
$156.46 |
$622.20
|
|
Muscle test larynx
|
$128.90 |
$128.90 |
$128.90 |
$327.60
|
|
Muscle test one fiber
|
$156.46 |
$156.46 |
$156.46 |
$520.80
|
|
Muscle transfer shoulder/arm
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Muscle transfers
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Muscle-skin graft arm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Muscle-skin graft leg
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Muscle-skin graft trunk
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Mycobacteria dna amp probe
|
$48.24 |
$48.24 |
$48.24 |
$411.00
|
|
Mycoplasma antibody igm
|
$13.24 |
$13.24 |
$13.24 |
$129.75
|
|
Myd88 gene p.leu265pro vrnt
|
$175.40 |
$175.40 |
$175.40 |
$370.50
|
|
Myelogphy 2/> spine regions
|
$790.06 |
$790.06 |
$790.06 |
$4,064.40
|
|
Myelography l-s spine
|
$790.06 |
$790.06 |
$790.06 |
$3,447.00
|
|
Myelography neck spine
|
$790.06 |
$790.06 |
$790.06 |
$3,476.40
|
|
Myelography thoracic spine
|
$790.06 |
$790.06 |
$790.06 |
$2,874.60
|
|
Myelography via inj w/s&i 2+ regions
|
$790.06 |
$790.06 |
$790.06 |
$2,289.60
|
|
Myelography via inj w/s&i cervical
|
$790.06 |
$790.06 |
$790.06 |
$2,289.60
|
|
Myelography via inj w/s&i lumbosacral
|
$790.06 |
$790.06 |
$790.06 |
$2,289.60
|
|
Myelography via inj w/s&i thoracic
|
$790.06 |
$790.06 |
$790.06 |
$2,289.60
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$11.53 |
$11.53 |
$11.53 |
$108.60
|
|
Myocrd img pet 1 std w/ct
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$1,458.59
|
|
Myocrd img pet 1std rst/strs
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$4,556.25
|
|
Myocrd img pet 2rtracer CT
|
$1,950.50 |
$1,950.50 |
$1,950.50 |
$1,950.50
|
|
Myocrd img pet mlt rst&strs
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$5,301.00
|
|
Myocrd img pet rst/strs w/ct
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$1,458.59
|
|
Myomectomy vag method
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Myringoplasty
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
N block inj common digit
|
$295.19 |
$295.19 |
$295.19 |
$295.19
|
|
N block inj hypogas plxs
|
$890.29 |
$890.29 |
$890.29 |
$1,878.75
|
|
N-invas est c ffr sw aly cta
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Naltrexone, depot form
|
$4.24 |
$4.24 |
$4.24 |
$5,794.40
|
|
Narcosynthesis
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Nasal endoscopy dx uni/bi separate proc
|
$194.14 |
$194.14 |
$194.14 |
$600.00
|
|
Nasal endoscopy with removal of nasal foreign body
|
$232.22 |
$232.22 |
$232.22 |
$135.00
|
|
Nasal function studies
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Nasal sinus therapy
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Nasal/sinus endo spendt remove tiss 31288
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nasal/sinus endo surg w/concha bullosa resct 31240
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Nasal/sinus endo w/ethmoidectomy part 31254
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nasal/sinus endo w/ethmoidectomy tot 31255
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nasal/sinus endo w/front sinus expl 31276
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nasal/sinus endoscopy surg
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nasal/sinus endoscopy surg w/bx 31237
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$4,080.00
|
|
Nasal/sinus maxillary endoscopy dx 31233
|
$388.31 |
$388.31 |
$388.31 |
$388.31
|
|
Nasal/sinus sphenoid endoscopy dx 31235
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Nasopharyngoscopy w/endoscope
|
$194.14 |
$194.14 |
$194.14 |
$365.40
|
|
Natalizumab 300 mg/15 ml intravenous solution
|
$24.13 |
$24.13 |
$24.13 |
$28,621.80
|
|
Natriuretic peptide
|
$39.26 |
$39.26 |
$39.26 |
$273.00
|
|
Natural killer cells total count
|
$37.73 |
$37.73 |
$37.73 |
$243.00
|
|
Nctrnl pen tmscn&/rgdity tst
|
$243.21 |
$243.21 |
$243.21 |
$243.21
|
|
Ndl emg musc 1 xtr/non-limb
|
$128.90 |
$128.90 |
$128.90 |
$241.20
|
|
Ndl insj without njx 1 or 2 musc
|
$24.49 |
$24.49 |
$24.49 |
$22.50
|
|
Ndl insj without njx 3+ musc
|
$24.49 |
$24.49 |
$24.49 |
$31.50
|
|
Ndl oculoelectromyography 1+
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Ndsc dcmprn 1 ntrspc lumbar
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,992.00
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$106.34 |
$106.34 |
$106.34 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,231.16
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$1,914.00
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,733.00
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,030.23
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$1,790.58
|
|
Neck spine disk surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Neck spine disk surgery 63075
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Neisseria meningitidis
|
$13.19 |
$13.19 |
$13.19 |
$223.80
|
|
Nelarabine injection
|
$63.38 |
$63.38 |
$63.38 |
$2,265.28
|
|
Nerobehav stas exam by psy/md f2f 1st hr
|
$311.40 |
$311.40 |
$311.40 |
$323.25
|
|
Nerve conduction 7-8 studies
|
$311.40 |
$311.40 |
$311.40 |
$1,498.80
|
|
Nerve conduction studies 1-2
|
$156.46 |
$156.46 |
$156.46 |
$210.00
|
|
Nerve conduction studies 11-12
|
$530.60 |
$530.60 |
$530.60 |
$2,280.00
|
|
Nerve conduction studies 13+
|
$530.60 |
$530.60 |
$530.60 |
$2,693.40
|
|
Nerve conduction studies 3-4
|
$311.40 |
$311.40 |
$311.40 |
$642.60
|
|
Nerve conduction studies 5-6
|
$311.40 |
$311.40 |
$311.40 |
$1,069.20
|
|
Nerve conduction studies 9-10
|
$530.60 |
$530.60 |
$530.60 |
$1,926.60
|
|
Nerve graft head/neck <4 cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nerve graft head/neck >4 cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nerve palsy fascial graft
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Nerve palsy microsurg graft
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Nerve palsy muscle graft
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Nerve pedicle transfer
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nerve pedicle transfer
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nerve repair w/allograft
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nerve teasing preparations
|
$816.90 |
$816.90 |
$816.90 |
$356.40
|
|
Neurectomy foot
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Neurectomy hamstring
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Neurectomy popliteal
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Neuroeltrd stim post tibial
|
$295.19 |
$295.19 |
$295.19 |
$510.75
|
|
Neurolysis celiac plexus
|
$890.29 |
$890.29 |
$890.29 |
$3,501.75
|
|
Neurolysis trigeminal nerve
|
$890.29 |
$890.29 |
$890.29 |
$890.29
|
|
Neuromuscular junction testing ea nerve any 1 method
|
$156.46 |
$156.46 |
$156.46 |
$357.60
|
|
Neuroplasty digital 1/both same digit
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Neuroplasty nerve of hand or foot 64704
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Neurorraphy w/vein autograft
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Neurovascular pedicle flap
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Neutrlzg antb sarscov2 scr
|
$42.13 |
$42.13 |
$42.13 |
$42.13
|
|
Neutrlzg antb sarscov2 titer
|
$79.61 |
$79.61 |
$79.61 |
$79.61
|
|
Neutron beam tx complex
|
$578.47 |
$578.47 |
$578.47 |
$578.47
|
|
Nfct ds bv&vaginitis dna alg
|
$262.99 |
$262.99 |
$262.99 |
$262.99
|
|
Nipple exploration
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Nipple/areola reconst 19350
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Nitroblue tetrazolium dye
|
$13.61 |
$13.61 |
$13.61 |
$13.61
|
|
Nivolumab 10 mg/ml intravenous solution (wrapper)
|
$33.00 |
$33.00 |
$33.00 |
$104.40
|
|
Nivolumab 240 mg-relatlimab-rmbw 80 mg/20 ml intravenous solution
|
$197.65 |
$197.65 |
$197.65 |
$375.60
|
|
Njx aa&/strd lmbr plex nfs
|
$890.29 |
$890.29 |
$890.29 |
$1,656.60
|
|
Njx aa&/strd nrv nrvtg si jt
|
$692.52 |
$692.52 |
$692.52 |
$685.80
|
|
Njx aa&/strd sc nrv nfs img
|
$890.29 |
$890.29 |
$890.29 |
$1,963.80
|
|
Njx aa&/strd vagus nrv
|
$295.19 |
$295.19 |
$295.19 |
$295.19
|
|
Njx chemonucleolysis lmbr
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Njx interlaminar crv/thrc
|
$890.29 |
$890.29 |
$890.29 |
$2,476.80
|
|
Njx interlaminar crv/thrc
|
$890.29 |
$890.29 |
$890.29 |
$2,067.00
|
|
Njx interlaminar lmbr/sac
|
$890.29 |
$890.29 |
$890.29 |
$1,970.25
|
|
Njx interlaminar lmbr/sac
|
$890.29 |
$890.29 |
$890.29 |
$1,953.00
|
|
Njx px nfrosgrm &/urtrgrm
|
$667.47 |
$667.47 |
$667.47 |
$908.40
|
|
Njx px peyronie ds exps plaq
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Nm imaging bone/joint 3 phase study
|
$401.83 |
$401.83 |
$401.83 |
$1,684.80
|
|
Nm imaging bone/joint whole body
|
$401.83 |
$401.83 |
$401.83 |
$1,474.20
|
|
Nm imaging cardiac blood pooling planar single study at rest or stress
|
$401.83 |
$401.83 |
$401.83 |
$1,651.20
|
|
Nm imaging gastric emptying study
|
$401.83 |
$401.83 |
$401.83 |
$1,431.75
|
|
Nm imaging gastrointestinal acute blood loss
|
$401.83 |
$401.83 |
$401.83 |
$1,626.00
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$538.27 |
$538.27 |
$538.27 |
$1,663.20
|
|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$538.27 |
$538.27 |
$538.27 |
$1,385.40
|
|
Nm imaging pulmonary ventilation/perfusion
|
$538.27 |
$538.27 |
$538.27 |
$1,574.40
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$401.83 |
$401.83 |
$401.83 |
$1,335.00
|
|
Nm radiopharmaceutical therapy oral administration
|
$224.13 |
$224.13 |
$224.13 |
$944.40
|
|
Non-blind interatrial shunt
|
$27,500.50 |
$27,500.50 |
$27,500.50 |
$27,500.50
|
|
Non-card vasc flow imaging
|
$401.83 |
$401.83 |
$401.83 |
$504.80
|
|
Non-cov proc, clinical trial
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Non-cov surg proc,clin trial
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Non-imaging heart function
|
$538.27 |
$538.27 |
$538.27 |
$538.27
|
|
Non-ophthalmic fva
|
$357.13 |
$357.13 |
$357.13 |
$357.13
|
|
Noninv pace analysis
|
$299.91 |
$299.91 |
$299.91 |
$504.00
|
|
Noonan spectrum disorders
|
$2,143.60 |
$2,143.60 |
$2,143.60 |
$2,412.00
|
|
Npm1 gene
|
$246.52 |
$246.52 |
$246.52 |
$1,905.60
|
|
Nps surg dilat eust tube bi
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Nps surg dilat eust tube uni
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Npsy tst eval phsy/qhp 1st hr
|
$530.60 |
$530.60 |
$530.60 |
$316.50
|
|
Nr lnr acclrtr tx max 5 sessions
|
$1,755.91 |
$1,755.91 |
$1,755.91 |
$9,337.20
|
|
Nras gene variants exon 2&3
|
$295.79 |
$295.79 |
$295.79 |
$369.60
|
|
Nrv grf 1strnd arm/leg <4cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv grf 1strnd arm/leg >4 cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv grf 1strnd hnd/foot <4cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv grf 1strnd hnd/foot >4cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv grf mltst arm/leg <4 cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv grf mltst arm/leg >4 cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv grf mltst hnd/foot <4 cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv grf mltst hnd/foot >4 cm
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nrv rpr w/nrv algrft 1st
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Nsl/sins ndsc med&inf dcmprn
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc med/inf dcmprn
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc sphn tiss rmvl
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc surg frnt sins
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc surg frnt&sphn
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc surg max sins
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc surg on dcmprn
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc surg sphn sins
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc tot w/sphendt
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sins ndsc total
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Nsl/sinus endoscopy surg dcr
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Nsl/sinus ndsc cryoabltj pnn
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Nsl/sinus ndsc rf abltj pnn
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Nsl/sns ndsc lig sphnptn art
|
$1,724.47 |
$1,724.47 |
$1,724.47 |
$1,724.47
|
|
Ntrk translocation analysis
|
$518.28 |
$518.28 |
$518.28 |
$518.28
|
|
Ntsty modul rad tx dlvr cplx
|
$578.47 |
$578.47 |
$578.47 |
$2,407.80
|
|
Ntsty modul rad tx dlvr smpl
|
$578.47 |
$578.47 |
$578.47 |
$1,873.80
|
|
Nuclear Stress Test (Heart)
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$3,799.90
|
|
Nuclear exam of tear flow
|
$401.83 |
$401.83 |
$401.83 |
$637.20
|
|
Nuclear matrix protein 22
|
$21.78 |
$21.78 |
$21.78 |
$21.78
|
|
Nuclear rx IV admin
|
$224.13 |
$224.13 |
$224.13 |
$1,315.50
|
|
Nuclear rx intra-arterial
|
$224.13 |
$224.13 |
$224.13 |
$666.00
|
|
Nuclear rx intra-articular
|
$224.13 |
$224.13 |
$224.13 |
$231.00
|
|
Nuclear rx intracav admin
|
$224.13 |
$224.13 |
$224.13 |
$1,622.25
|
|
Nuclr rx interstit colloid
|
$224.13 |
$224.13 |
$224.13 |
$224.13
|
|
Nudt15 gene common variants
|
$291.36 |
$291.36 |
$291.36 |
$472.80
|
|
Nusinersen (pf) 12 mg/5 ml intrathecal solution
|
$1,246.94 |
$1,246.94 |
$1,246.94 |
$492,978.44
|
|
Ob Ultrasound nuchal meas 1 gest
|
$106.34 |
$106.34 |
$106.34 |
$519.60
|
|
Obinutuzumab 1,000 mg/40 ml intravenous solution
|
$78.46 |
$78.46 |
$78.46 |
$213.60
|
|
Observation direct referral from physician office for admission
|
$613.10 |
$613.10 |
$613.10 |
$141.00
|
|
Obstetrics panel
|
$47.81 |
$47.81 |
$47.81 |
$310.80
|
|
Obtaining screen pap smear
|
$24.49 |
$24.49 |
$24.49 |
$24.60
|
|
Occlude fallopian tube(s) device 58615
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Ocrelizumab 30 mg/ml intravenous solution
|
$59.70 |
$59.70 |
$59.70 |
$156.60
|
|
Octreotide,microspheres ER 20 mg intramuscular susp, extended release
|
$212.20 |
$212.20 |
$212.20 |
$8,451.00
|
|
Ocular photodynamic ther
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Ocular reconst transplant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Ocular reconst transplant
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Ocular reconst transplant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Ofatumumab 20 mg/ml intravenous solution (wrapper)
|
$62.23 |
$62.23 |
$62.23 |
$201.60
|
|
Off base opioid tx 70min
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Off base opioid tx, 60 m
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Olanzapine long-acting inj
|
$2.92 |
$2.92 |
$2.92 |
$76.20
|
|
Omalizumab 150 mg/ml subcutaneous syringe (wrapper)
|
$40.56 |
$40.56 |
$40.56 |
$333.60
|
|
Onc brst mrna 11 genes
|
$3,873.00 |
$3,873.00 |
$3,873.00 |
$3,873.00
|
|
Onc brst mrna 70 cnt 31 gene
|
$3,873.00 |
$3,873.00 |
$3,873.00 |
$3,873.00
|
|
Onc thyr mrna 10,196 gen alg
|
$3,600.00 |
$3,600.00 |
$3,600.00 |
$3,600.00
|
|
Onco (ovar) five proteins
|
$897.00 |
$897.00 |
$897.00 |
$897.00
|
|
Onco (ovar) two proteins
|
$260.50 |
$260.50 |
$260.50 |
$150.60
|
|
Oncology colon mrna
|
$3,116.00 |
$3,116.00 |
$3,116.00 |
$3,116.00
|
|
Oncology colorectal scr
|
$508.87 |
$508.87 |
$508.87 |
$508.87
|
|
Oncology gynecologic
|
$579.46 |
$579.46 |
$579.46 |
$579.46
|
|
Oncology gynecologic
|
$177.56 |
$177.56 |
$177.56 |
$177.56
|
|
Oncology prostate prob score
|
$760.00 |
$760.00 |
$760.00 |
$1,501.50
|
|
Oncology tum unknown origin
|
$3,750.00 |
$3,750.00 |
$3,750.00 |
$3,750.00
|
|
Oncoprotein dcp
|
$64.41 |
$64.41 |
$64.41 |
$537.00
|
|
Oncoprotein her-2/neu
|
$64.41 |
$64.41 |
$64.41 |
$141.75
|
|
Oocyte identification
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Open bx/exc inguinofem nodes
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Open nasoethmoid fx with fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Open nasoethmoid fx without fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Open periprosthetic breast capsule 19370
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Open tenotomy tendon flexor foot single or multiple 28230
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Open thrombectomy of av fistula without revision 36831
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Open tx nose & septal fx
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Open tx nose fx w/skele fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Open tx rib 1-3 fx w/fix 21811
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Open tx rib 4-6 fx w/fix 21812
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Open tx rib 7+ fx w/fix 21813
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Oph Ultrasound dx ant sgm Ultrasound uni/bi
|
$106.34 |
$106.34 |
$106.34 |
$106.34
|
|
Oph Ultrasound dx quan a-scan only
|
$106.34 |
$106.34 |
$106.34 |
$105.75
|
|
Ophth Ultrasound b & quant a
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Ophthalmic biometry
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Ophthalmodynamometry
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Opn impltj crnl nrv nea&pg
|
$30,473.59 |
$30,473.59 |
$30,473.59 |
$30,473.59
|
|
Opn impltj nea neuromuscular
|
$21,444.39 |
$21,444.39 |
$21,444.39 |
$21,444.39
|
|
Opn impltj nea perph nerve
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Opn impltj nea sacral nerve
|
$6,562.90 |
$6,562.90 |
$6,562.90 |
$6,562.90
|
|
Opn mpltj hpglsl nstm ary pg
|
$30,473.59 |
$30,473.59 |
$30,473.59 |
$30,473.59
|
|
Opn tx complx malar fx
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx complx malar w/grft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx dprsd zygomatic arch
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx nasomax fx multple
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx nasomax fx w/fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit fx combined
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit fx periorbital
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit fx transantral
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit fx w/bone grft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit fx w/implant
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit fx without impl 21406
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit periorbt w/grft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opn tx orbit periorbtl implt
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Opps service,sched team conf
|
$425.82 |
$425.82 |
$425.82 |
$425.82
|
|
Opscpy extnd on/mac draw
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Opscpy extnd rta draw uni/bi
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Optx acrclv dslc aq/chrn grf
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx acromclv dislc aqt/chrn
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx acute shoulder dislc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx carpl scphd fx int fixj
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx clavicular fx w/int fix
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Optx complicated mndblr fx
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Optx crpl fx oth/thn scph ea
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Optx gr hmrl tbrs fx int fix
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx lunate dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx medial ankle fx
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Optx mndblr cndylr fx
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Optx mndblr fx wo ntrdntl
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Optx mndblr fx xtrnl fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Optx mndblr/max alv ridge fx
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Optx palatal/max fracture
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Optx partclr fx&/dslc elbw w
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Optx post ankle fx
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$6,855.00
|
|
Optx prox humrl fx w/int fix
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Optx prx hmrl fx fix rpr rpl
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Optx rad/uln dislc aqt/chrnc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$4,493.40
|
|
Optx radial shaft fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Optx rdcrpl/ntrcrpl dislc 1+
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx rdl shft fx&cltx rad/ul
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$6,347.40
|
|
Optx rdl shft fx&dstl rad/ul
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx rdl&uln shft fx rds&uln
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$6,405.00
|
|
Optx rdl&uln shft fx rds/uln
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Optx scapular fx w/int fixj
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Optx sho dislc fx
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx sho dislc neck fx fixj
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Optx strclv dslc aq/chrn grf
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx strnclav dislc aqt/chrn
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx tmprmand dislocation
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Optx trns-scphprlnr fx dislc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Optx ulnar shft fx int fixj
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Optx ulnar styloid fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$6,492.00
|
|
Oral busulfan
|
$84.21 |
$84.21 |
$84.21 |
$24.60
|
|
Oral methotrexate (jylamvo)
|
$18.53 |
$18.53 |
$18.53 |
$18.53
|
|
Oral methotrexate (xatmep)
|
$22.66 |
$22.66 |
$22.66 |
$22.66
|
|
Oral netupitant, palonosetro
|
$409.52 |
$409.52 |
$409.52 |
$409.52
|
|
Orchiectomy partial
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Orchiopexy (fowler-stephens)
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Orchiopexy ingun/scrot appr
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Organic acids total quant ea spec
|
$23.60 |
$23.60 |
$23.60 |
$277.20
|
|
Oritavancin 1,200 mg intravenous solution
|
$41.40 |
$41.40 |
$41.40 |
$41.40
|
|
Oritavancin 400 mg intravenous solution
|
$28.52 |
$28.52 |
$28.52 |
$105.60
|
|
Oropharyngeal biopsy 42800
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$836.40
|
|
Orthop traing supvj phys/qhp
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Orthopantogram
|
$88.05 |
$88.05 |
$88.05 |
$270.00
|
|
Orthovisc inj per dose
|
$97.70 |
$97.70 |
$97.70 |
$443.85
|
|
Oscillation chest wall mechanical per session
|
$203.39 |
$203.39 |
$203.39 |
$235.20
|
|
Osmolality blood
|
$6.61 |
$6.61 |
$6.61 |
$63.75
|
|
Osmolality urine
|
$6.82 |
$6.82 |
$6.82 |
$75.75
|
|
Ostectomy complete 1st metatarsal head 28111
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Ostectomy scapula partial
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Osteochondral knee allograft
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Osteochondral knee autograft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Osteochondral talus autogrft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Osteopath manip tx/5-6 body region 98927
|
$25.30 |
$25.30 |
$25.30 |
$25.30
|
|
Osteopath manip tx/7-8 body region 98928
|
$25.30 |
$25.30 |
$25.30 |
$25.30
|
|
Osteopath manip tx/9-10 body region98929
|
$25.30 |
$25.30 |
$25.30 |
$25.30
|
|
Osteoplasty humerus
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Osteot humerus w/wo int fixj
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Osteotomy/graft tarsal/calcaneus/talus 28305
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Ot evaluation high complexity patient/family
|
$128.99 |
$128.99 |
$128.99 |
$272.40
|
|
Ot evaluation low complexity patient/family
|
$128.99 |
$128.99 |
$128.99 |
$265.50
|
|
Ot evaluation moderate complexity patient/family
|
$128.99 |
$128.99 |
$128.99 |
$272.40
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$66.46 |
$66.46 |
$66.46 |
$119.25
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$60.21 |
$60.21 |
$60.21 |
$112.50
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$35.04 |
$35.04 |
$35.04 |
$130.20
|
|
Ot re-evaluation patient/family
|
$88.55 |
$88.55 |
$88.55 |
$138.00
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$44.62 |
$44.62 |
$44.62 |
$126.60
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$28.73 |
$28.73 |
$28.73 |
$106.20
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$29.70 |
$29.70 |
$29.70 |
$106.20
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$37.06 |
$37.06 |
$37.06 |
$117.00
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$41.24 |
$41.24 |
$41.24 |
$110.40
|
|
Ot training self care/home management direct contact each 15 minutes
|
$40.79 |
$40.79 |
$40.79 |
$106.50
|
|
Oth resp proc, group
|
$39.25 |
$39.25 |
$39.25 |
$144.00
|
|
Oth resp proc, indiv
|
$24.49 |
$24.49 |
$24.49 |
$54.60
|
|
Other immunoelectrophoresis
|
$23.13 |
$23.13 |
$23.13 |
$132.60
|
|
Otoplasty 69300
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Ovarian cystectomy 58925
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
P-32 sod phosphate ther per mci
|
$179.12 |
$179.12 |
$179.12 |
$222.60
|
|
PSA (Prostate) Test
|
$18.39 |
$18.39 |
$18.39 |
$103.85
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$12.12 |
$12.12 |
$12.12 |
$61.80
|
|
Palb2 gene full gene seq
|
$676.50 |
$676.50 |
$676.50 |
$676.50
|
|
Palb2 gene known famil vrnt
|
$301.35 |
$301.35 |
$301.35 |
$301.35
|
|
Palifermin injection
|
$35.91 |
$35.91 |
$35.91 |
$11,767.98
|
|
Paliperidone 117 mg/0.75 ml inj
|
$15.08 |
$15.08 |
$15.08 |
$99.20
|
|
Palivizumab 50 mg/0.5 ml inj
|
$719.87 |
$719.87 |
$719.87 |
$6,940.20
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$172.55 |
$172.55 |
$172.55 |
$364.20
|
|
Parathormone (pth) intact
|
$41.28 |
$41.28 |
$41.28 |
$226.20
|
|
Parathyrd planar w/spect&ct
|
$538.27 |
$538.27 |
$538.27 |
$1,989.75
|
|
Parathyroid planar imaging
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Parathyroid planar img w/tomo spect
|
$401.83 |
$401.83 |
$401.83 |
$1,859.40
|
|
Paravaginal defect repair 57284
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Parial mast w/lymph removal 19302
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$198.70 |
$198.70 |
$198.70 |
$251.40
|
|
Parotid duct diversion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Parotid duct diversion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Parotid duct diversion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Part exc/post vert comp/sng/thorac 22101
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Part hymenectomy/revi hymenal ring 56700
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Part removal of metatarsal
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Part removal of metatarsal
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Part removal of metatarsal 28112
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial exc bone humerus
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial excision of lip
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Partial removal finger bone
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$4,321.20
|
|
Partial removal finger bone
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Partial removal foot fascia
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal leg bone(s)
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of eye fluid
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Partial removal of eye fluid
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Partial removal of fibula
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of foot bone
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of hand bone
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of lip
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Partial removal of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Partial removal of penis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Partial removal of pharynx 42890
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Partial removal of radius
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of radius
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of rib
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$1,800.60
|
|
Partial removal of thyroid
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$1,260.00
|
|
Partial removal of thyroid
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$958.20
|
|
Partial removal of tibia
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of toe
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of tongue
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Partial removal of ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Partial removal of vaginal wall 57106
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Partial removal tear gland
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Partial thyroid excision
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Partial thyroid lobect w/contratlat stot lobec 60212
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$2,652.60
|
|
Path clin consltj high 41-60
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Path clin consltj mod 21-40
|
$171.36 |
$171.36 |
$171.36 |
$447.60
|
|
Path clin consltj sf 5-20
|
$53.43 |
$53.43 |
$53.43 |
$198.60
|
|
Patient recorded spirometry
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Patient recorded spirometry
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Pdgfra gene
|
$329.51 |
$329.51 |
$329.51 |
$1,189.80
|
|
Pdt dstr prmlg les phys/qhp
|
$198.70 |
$198.70 |
$198.70 |
$777.00
|
|
Ped home apnea mntr att only
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Ped home apnea mntr dl&alys
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Pedcle fh/ch/ch/m/n/ax/g/h/f
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Pedicle enel/ntroral 15576
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Pegaspargase injection
|
$28,424.06 |
$28,424.06 |
$28,424.06 |
$62,371.80
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$58.40 |
$58.40 |
$58.40 |
$6,417.60
|
|
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe
|
$132.04 |
$132.04 |
$132.04 |
$1,333.80
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$136.04 |
$136.04 |
$136.04 |
$10,699.80
|
|
Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe
|
$229.11 |
$229.11 |
$229.11 |
$645.60
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$103.71 |
$103.71 |
$103.71 |
$2,112.00
|
|
Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe
|
$149.21 |
$149.21 |
$149.21 |
$395.40
|
|
Pegloticase 8 mg/ml intravenous solution
|
$3,638.86 |
$3,638.86 |
$3,638.86 |
$94,586.40
|
|
Pegunigalsidase alfa-iwxj
|
$230.28 |
$230.28 |
$230.28 |
$526.20
|
|
Pelvic CT scan (with and without contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,680.60
|
|
Pelvic CT scan (without contrast)
|
$106.34 |
$106.34 |
$106.34 |
$1,313.40
|
|
Pelvic MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
Pelvic MRI (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$1,966.42
|
|
Pelvic MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$106.34 |
$106.34 |
$106.34 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$106.34 |
$106.34 |
$106.34 |
$476.50
|
|
Pelvic ring fracture uni/bil
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$58.56 |
$58.56 |
$58.56 |
$7,026.00
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$3.73 |
$3.73 |
$3.73 |
$3,134.40
|
|
Pemivibart infusion
|
$450.50 |
$450.50 |
$450.50 |
$450.50
|
|
Peng benzathine/procaine inj
|
$17.37 |
$17.37 |
$17.37 |
$251.40
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$29.30 |
$29.30 |
$29.30 |
$1,422.60
|
|
Penicillin g procaine inj
|
$47.19 |
$47.19 |
$47.19 |
$47.19
|
|
Penile injection
|
$243.21 |
$243.21 |
$243.21 |
$403.80
|
|
Penile vascular study
|
$106.34 |
$106.34 |
$106.34 |
$809.60
|
|
Penile vascular study
|
$106.34 |
$106.34 |
$106.34 |
$435.00
|
|
Penile venous occlusion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Penis plastic surgery
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Penis study
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Pentostatin 10 mg intravenous solution
|
$2,543.89 |
$2,543.89 |
$2,543.89 |
$6,720.00
|
|
Perc cryo ablate renal tum
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Perc d-e cor revasc chro sin
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$17,956.72
|
|
Perc d-e cor revasc t cabg s
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$15,411.00
|
|
Perc d-e cor stent ather s
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$18,556.80
|
|
Perc drug-el cor stent sing
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$15,411.00
|
|
Perc rf ablate renal tumor
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Percut ablate liver rf
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$6,566.25
|
|
Peri-implt capslc brst compl
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Pericardiocentesis wwo imaging
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,461.80
|
|
Perineoplasty rpr per nonob
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Peripheral vascular rehab
|
$59.40 |
$59.40 |
$59.40 |
$148.50
|
|
Perit-vens shunt pat tst
|
$401.83 |
$401.83 |
$401.83 |
$1,127.40
|
|
Peritoneal cath sub q resv per
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Peritoneogram rs&i
|
$548.30 |
$548.30 |
$548.30 |
$338.40
|
|
Perq dev breast 1st mr guide
|
$703.59 |
$703.59 |
$703.59 |
$2,153.40
|
|
Perq dev breast 1st strtctc
|
$703.59 |
$703.59 |
$703.59 |
$1,793.40
|
|
Perq nl/pl lithotrp cplx>2cm
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$0.60
|
|
Perq nl/pl lithotrp smpl<2cm
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$0.60
|
|
Perq p-art revsc 1 abnor bi
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$27,235.50
|
|
Perq p-art revsc 1 abnor uni
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$44,278.50
|
|
Perq p-art revsc 1 nm nt bi
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$27,235.50
|
|
Perq p-art revsc 1 nm nt uni
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$27,235.50
|
|
Perq plmt bile duct stent
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$8,839.80
|
|
Perq plmt bile duct stent
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Perq plmt bile duct stent
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$12,221.25
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$243.21 |
$243.21 |
$243.21 |
$1,159.50
|
|
Perq skel fix rad/uln dislc
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Perq skel fix ulnar styld fx
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Perq transcath closure pda
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$0.60
|
|
Perq transcath cls aortic
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$17,956.72
|
|
Perq transcath cls mitral
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$17,956.72
|
|
Perq tx big toe fracture w/manip 28496
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Perq tx malar fracture
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Perq tx mndblr fx xtrnl fixj
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$3,771.60
|
|
Perq tx nasoethmoid fx
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Pertussis ag if
|
$11.98 |
$11.98 |
$11.98 |
$11.98
|
|
Pertuzu, trastuzu, 10 mg
|
$63.39 |
$63.39 |
$63.39 |
$324.60
|
|
Pertuzumab 30 mg/ml desensitization
|
$16.89 |
$16.89 |
$16.89 |
$22,539.60
|
|
Pet CT skull-mid thgh initial
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$4,854.75
|
|
Pet CT whole body initial
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$4,915.50
|
|
Pet fdg brain metoblic eval sb
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$4,298.25
|
|
Pet image full body
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$14,161.80
|
|
Pet image ltd area
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$4,245.00
|
|
Pet image skull-thigh
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$7,438.80
|
|
Pet image w/ct lmtd
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$4,680.75
|
|
Pet not otherwise specified
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Ph body fluid
|
$3.58 |
$3.58 |
$3.58 |
$39.60
|
|
Phalangectomy ea toe 28150
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Phenobarbital therapeutic drug level
|
$15.30 |
$15.30 |
$15.30 |
$150.00
|
|
Phentolaine mesylate inj
|
$436.51 |
$436.51 |
$436.51 |
$1,028.40
|
|
Phenylep ketorolac opth soln
|
$97.42 |
$97.42 |
$97.42 |
$97.42
|
|
Phenytoin total therapeutic drug level
|
$13.25 |
$13.25 |
$13.25 |
$114.00
|
|
Phleb veins 1 extrm 10-20 stab
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,682.50
|
|
Phleb veins 1 extrm >20 stab
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Phlebotomy therapeutic
|
$128.90 |
$128.90 |
$128.90 |
$284.40
|
|
Phosphorus
|
$4.74 |
$4.74 |
$4.74 |
$56.40
|
|
Phosphorus 24 hour urine
|
$5.78 |
$5.78 |
$5.78 |
$91.20
|
|
Photchmtx tar&uvb/ptrltm&uvb
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Photo patch test
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Photochemotherapy puva
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Photochemotherapy uv-a or b
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Photopheresis
|
$4,685.17 |
$4,685.17 |
$4,685.17 |
$4,685.17
|
|
Photosensitivity tests
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Phys blood bank serv authrj
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Phys blood bank serv reactj
|
$171.36 |
$171.36 |
$171.36 |
$398.40
|
|
Phys blood bank serv xmatch
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Piflu f-18, dia 1 millicurie
|
$332.44 |
$332.44 |
$332.44 |
$1,252.20
|
|
Pik3ca gene trgt seq alys
|
$274.83 |
$274.83 |
$274.83 |
$274.83
|
|
Pild/placebo control clin tr
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Pin finger dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Pin finger fracture each
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Pin hand dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Pin knuckle dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Pinworm exam
|
$4.27 |
$4.27 |
$4.27 |
$49.20
|
|
Place breast rad tube/caths
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Place cecostomy tube perc
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$11,644.80
|
|
Place device/marker, non pro
|
$1,368.26 |
$1,368.26 |
$1,368.26 |
$1,368.26
|
|
Place duod/jej tube perc
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$4,182.60
|
|
Place endorectal app
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Place gastrostomy tube perc
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,587.40
|
|
Place ndl musc/tis for right
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,220.50
|
|
Place needles h&n for right
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Place needles pelvic for right
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Place non-slctv cath thoracic arta
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$6,360.60
|
|
Place po breast cath for rad
|
$9,569.05 |
$9,569.05 |
$9,569.05 |
$720.80
|
|
Place right device/marker pros
|
$1,368.26 |
$1,368.26 |
$1,368.26 |
$1,368.26
|
|
Place slctv cath carotd art uni
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$10,950.75
|
|
Place slctv cath carotid/inom art excrn uni
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$7,552.20
|
|
Place slctv cath carotid/inom art intcrn uni
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$10,549.80
|
|
Place slctv cath subclavian art
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$7,476.75
|
|
Place slctv cath vertebral art uni
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$10,549.80
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,562.25
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$703.59 |
$703.59 |
$703.59 |
$1,564.20
|
|
Placement nephrostomy catheter (both sides)
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,483.40
|
|
Placement of seton
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$12,780.00
|
|
Placental lactogen
|
$20.22 |
$20.22 |
$20.22 |
$20.22
|
|
Plasma cryoprecipitate reduced each unit
|
$147.30 |
$147.30 |
$147.30 |
$147.30
|
|
Plasma protein fract,5%,50ml
|
$8.07 |
$8.07 |
$8.07 |
$8.07
|
|
Plasma volume multiple
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$1,305.48
|
|
Plasma volume single
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$1,305.48
|
|
Plasmaprotein fract,5%,250ml
|
$73.72 |
$73.72 |
$73.72 |
$73.72
|
|
Platelet aggregation each agent teg
|
$24.91 |
$24.91 |
$24.91 |
$202.80
|
|
Platelet automated
|
$4.48 |
$4.48 |
$4.48 |
$38.25
|
|
Platelet deplete of harvest
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Platelet pheresis each unit
|
$397.13 |
$397.13 |
$397.13 |
$1,015.50
|
|
Platelet pheresis irr ea
|
$587.65 |
$587.65 |
$587.65 |
$1,659.00
|
|
Platelet survival
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Platelets each unit
|
$75.96 |
$75.96 |
$75.96 |
$477.00
|
|
Platelets hla matched leukocytes reduced apheresis/pheresis each unit
|
$777.49 |
$777.49 |
$777.49 |
$4,062.00
|
|
Platelets irradiated ea unit
|
$135.78 |
$135.78 |
$135.78 |
$320.40
|
|
Platelets leukocytes reduced each unit
|
$125.77 |
$125.77 |
$125.77 |
$241.20
|
|
Platelets leukocytes reduced irradiated each unit
|
$205.39 |
$205.39 |
$205.39 |
$360.00
|
|
Platelets leukoreduced cmv negative apheresis/phresis each unit
|
$227.25 |
$227.25 |
$227.25 |
$227.25
|
|
Platelets pheresis leukocytes reduced cmv negative irradiated each unit
|
$459.23 |
$459.23 |
$459.23 |
$459.23
|
|
Platelets pheresis leukocytes reduced each unit
|
$487.10 |
$487.10 |
$487.10 |
$2,713.80
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$675.66 |
$675.66 |
$675.66 |
$2,893.20
|
|
Platelets pheresis pathogen-reduced each unit
|
$587.28 |
$587.28 |
$587.28 |
$1,791.00
|
|
Plcmnt biliary drainage cath w/img ext
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$4,144.20
|
|
Plcmnt ureteral stent pq w/img exstng trct
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$4,913.40
|
|
Plcmnt ureteral stent pq w/img new w/cath
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$7,729.80
|
|
Plcmt sft tiss loc pq w/img 1st lsn
|
$703.59 |
$703.59 |
$703.59 |
$1,039.50
|
|
Plerixafor injection
|
$119.47 |
$119.47 |
$119.47 |
$1,570.80
|
|
Plethysmography lung volumes/airway resistance
|
$311.40 |
$311.40 |
$311.40 |
$368.25
|
|
Plmt access bil tree sm bwl
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,239.75
|
|
Plmt biliary drainage cath
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$4,144.20
|
|
Plmt nephroureteral catheter
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$4,763.40
|
|
Plmt ureteral stent prq
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$7,729.80
|
|
Pm device progr eval dual
|
$37.29 |
$37.29 |
$37.29 |
$237.75
|
|
Pm device progr eval multi
|
$37.29 |
$37.29 |
$37.29 |
$245.25
|
|
Pm phone r-strip device eval
|
$37.29 |
$37.29 |
$37.29 |
$181.50
|
|
Pml/raralpha 1 breakpoint
|
$207.31 |
$207.31 |
$207.31 |
$1,114.20
|
|
Pmp22 gene dup/delet
|
$758.36 |
$758.36 |
$758.36 |
$1,054.50
|
|
Pmp22 gene full sequence
|
$769.58 |
$769.58 |
$769.58 |
$2,663.40
|
|
Pmp22 gene known fam variant
|
$46.60 |
$46.60 |
$46.60 |
$46.60
|
|
Pms2 gene dup/delet variants
|
$203.50 |
$203.50 |
$203.50 |
$1,502.40
|
|
Pms2 gene full seq analysis
|
$676.50 |
$676.50 |
$676.50 |
$1,522.80
|
|
Pms2 known familial variants
|
$331.00 |
$331.00 |
$331.00 |
$235.80
|
|
Pneumothrx tx-intraplrl inj ai
|
$618.26 |
$618.26 |
$618.26 |
$618.26
|
|
Poct blood gases ph pco2 po2 arterial calculated o2
|
$26.07 |
$26.07 |
$26.07 |
$228.60
|
|
Polatuzumab vedotin-piiq 140 mg intravenous solution
|
$136.23 |
$136.23 |
$136.23 |
$36,544.20
|
|
Polysom <6 yrs cpap/bilvl
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Polysom any age 1-3> param
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$6,491.40
|
|
Porfimer sodium injection
|
$24,228.42 |
$24,228.42 |
$24,228.42 |
$75,528.84
|
|
Positional change of finger
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Post 1 srfc resinbased cmpst
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Post 2 srfc resinbased cmpst
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Post >=4srfc resinbase cmpst
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Post op service lvrs min 6
|
$530.60 |
$530.60 |
$530.60 |
$598.40
|
|
Potassium 24 hour urine
|
$4.73 |
$4.73 |
$4.73 |
$52.20
|
|
Potassium hydroxide preps
|
$5.83 |
$5.83 |
$5.83 |
$68.40
|
|
Potassium serum/plasma/whole blood
|
$4.76 |
$4.76 |
$4.76 |
$39.60
|
|
Pq kyphplsty 1 bdy lumb w/img
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$8,849.25
|
|
Pq thr inj ext pse
|
$618.26 |
$618.26 |
$618.26 |
$899.40
|
|
Pq vrtbrplst 1 bdy inj crv-thr w/img ini
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Pq vrtbrplst 1 bdy inj lmb-scr w/img ini
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Pr amput fgr/thumb prim/sec any joint/phal sgl incl neurectomies w dir clsr
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,800.40
|
|
Pr application of long arm splint
|
$157.79 |
$157.79 |
$157.79 |
$467.25
|
|
Pr application splint static short arm
|
$128.90 |
$128.90 |
$128.90 |
$288.75
|
|
Pr assessment emotional/behavioral per instrument brief
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Pr biopsy skin punch single lesion
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Pr correction hallux valgus (bunionectomy) with sesamoidectomy when performed with first metatarsal and cuneiform joint arthrodesis any method
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$1,059.00
|
|
Pr correction hammertoe
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$669.00
|
|
Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes
|
$29.79 |
$29.79 |
$29.79 |
$30.00
|
|
Pr cystourethroscopy with insertion indwelling ureteral stent
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,768.60
|
|
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/<
|
$198.70 |
$198.70 |
$198.70 |
$378.60
|
|
Pr egd flexible transoral w/placement percutaneous gastrostomy tube
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,795.25
|
|
Pr evaluation psychiatric diagnostic w/medical services
|
$160.67 |
$160.67 |
$160.67 |
$394.50
|
|
Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment
|
$128.87 |
$128.87 |
$128.87 |
$130.50
|
|
Pr excision benign lesion scalp/neck/hands/feet/genitalia <= 0.5 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,896.00
|
|
Pr excision benign lesion trunk/arms/legs 3.1 - 4.0 cm
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$2,709.00
|
|
Pr excision nail/nail matrix partial/complete permanent removal
|
$399.53 |
$399.53 |
$399.53 |
$1,233.00
|
|
Pr incision & drainage abscess complicated/multiple
|
$399.53 |
$399.53 |
$399.53 |
$712.80
|
|
Pr incision & drainage abscess simple/single
|
$198.70 |
$198.70 |
$198.70 |
$484.20
|
|
Pr incision & drainage abscess vulva/perineal
|
$304.19 |
$304.19 |
$304.19 |
$831.60
|
|
Pr incision & removal foreign body subcutaneous tissues simple
|
$399.53 |
$399.53 |
$399.53 |
$589.80
|
|
Pr management transitional care high w/in 7 days of discharge
|
$128.87 |
$128.87 |
$128.87 |
$278.40
|
|
Pr management transitional care moderate w/in 14 days of discharge
|
$128.87 |
$128.87 |
$128.87 |
$229.50
|
|
Pr neuroplasty and/or transposition ulnar nerve at elbow
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Pr planning advance care 1st 30 minutes
|
$92.50 |
$92.50 |
$92.50 |
$143.25
|
|
Pr removal drug delivery implant
|
$399.04 |
$399.04 |
$399.04 |
$1,440.00
|
|
Pr removal foreign body external auditory canal without anesthesia
|
$128.90 |
$128.90 |
$128.90 |
$298.40
|
|
Pr removal intrauterine device
|
$304.19 |
$304.19 |
$304.19 |
$589.80
|
|
Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm
|
$399.53 |
$399.53 |
$399.53 |
$825.60
|
|
Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm
|
$198.70 |
$198.70 |
$198.70 |
$477.00
|
|
Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm
|
$198.70 |
$198.70 |
$198.70 |
$477.00
|
|
Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm
|
$198.70 |
$198.70 |
$198.70 |
$477.00
|
|
Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm
|
$198.70 |
$198.70 |
$198.70 |
$520.80
|
|
Pr split-thickness autograft trunk/arm/leg 1st 100 sq cm/<tbsa infant/child
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Pr tube thoracostomy w/connection to drainage open
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,412.60
|
|
Pralatrexate injection
|
$388.83 |
$388.83 |
$388.83 |
$4,072.20
|
|
Pre-op service lvrs 1-9 dos
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Pre-op service lvrs 10-15dos
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Pre-op service lvrs complete
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Pre-plan 3d model w/ccta
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Prealbumin
|
$14.59 |
$14.59 |
$14.59 |
$114.00
|
|
Prefab stnlss steel crown pe
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Prefab stnlss steel crwn pri
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$106.34 |
$106.34 |
$106.34 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$106.34 |
$106.34 |
$106.34 |
$580.03
|
|
Pregnancy associated plasma protein-a
|
$15.05 |
$15.05 |
$15.05 |
$136.20
|
|
Prep skin to 100cm2 other
|
$612.13 |
$612.13 |
$612.13 |
$1,401.75
|
|
Prep skin to 100cm2 trk/ext
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,410.00
|
|
Preparation palate mold
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Prepare embryo for transfer
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Pressure max expiratory/inspiratory
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Pretreat rbc absorption reference
|
$59.40 |
$59.40 |
$59.40 |
$128.25
|
|
Pretreat rbc density gradient separation reference
|
$171.36 |
$171.36 |
$171.36 |
$70.80
|
|
Pretreat rbc w chem/drugs reference
|
$59.40 |
$59.40 |
$59.40 |
$183.60
|
|
Pretreat rbc w enzyme reference
|
$171.36 |
$171.36 |
$171.36 |
$219.00
|
|
Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref
|
$171.36 |
$171.36 |
$171.36 |
$139.80
|
|
Prgrmg dev eval impltbl sys
|
$37.29 |
$37.29 |
$37.29 |
$226.20
|
|
Prgrmg dev eval pm/ldls pm
|
$37.29 |
$37.29 |
$37.29 |
$176.40
|
|
Prgrmg dev eval scrms ip
|
$37.29 |
$37.29 |
$37.29 |
$225.00
|
|
Prgrmg eval implantable dfb
|
$37.29 |
$37.29 |
$37.29 |
$176.40
|
|
Prgrmg eval implantable dfb
|
$37.29 |
$37.29 |
$37.29 |
$265.20
|
|
Prgrmg eval implantable dfb
|
$37.29 |
$37.29 |
$37.29 |
$316.80
|
|
Prim art mech thrmbc non-intracranial
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$17,956.72
|
|
Probe nasolacrimal duct
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Probe nasolacrimal duct
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Probe nasolacrimal duct
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Probe nl duct w/balloon
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Procainamide 100 mg/ml injection (wrapper)
|
$194.32 |
$194.32 |
$194.32 |
$225.00
|
|
Procalcitonin
|
$27.22 |
$27.22 |
$27.22 |
$138.00
|
|
Proctosigmoidoscopy ablate
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Proctosigmoidoscopy control bleed 45317
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,989.75
|
|
Proctosigmoidoscopy dilate 45303
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Proctosigmoidoscopy dx 45300
|
$911.71 |
$911.71 |
$911.71 |
$1,663.20
|
|
Proctosigmoidoscopy removal
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,967.75
|
|
Proctosigmoidoscopy removal
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Proctosigmoidoscopy tumor removal 45315
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Proctosigmoidoscopy volvul
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Proctosigmoidoscopy w/bx 45305
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$3,114.00
|
|
Proctosigmoidoscopy w/fb remove 45307
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$3,015.00
|
|
Proctosigmoidoscopy w/stent
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$5,952.81
|
|
Progesterone
|
$20.86 |
$20.86 |
$20.86 |
$105.00
|
|
Prolactin
|
$19.38 |
$19.38 |
$19.38 |
$162.00
|
|
Prolonged IV inf, req pump
|
$331.69 |
$331.69 |
$331.69 |
$331.69
|
|
Proph rta dtchmnt crtx dthrm
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Proph rta dtchmnt pc
|
$548.60 |
$548.60 |
$548.60 |
$534.75
|
|
Proph tx w/wo mthylmthcrylt
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Prophylactic tx radius
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Prophylactic tx radius&ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Prophylactic tx ulna
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Prostate biopsy, any mthd
|
$359.72 |
$359.72 |
$359.72 |
$309.00
|
|
Prostate laser enucleation
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Prostatectomy (turp)
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$4,998.00
|
|
Prostatic microwave thermotx
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Prostatic rf thermotx
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Protein c activity
|
$13.84 |
$13.84 |
$13.84 |
$121.20
|
|
Protein c concentrate
|
$1.50 |
$1.50 |
$1.50 |
$123.00
|
|
Protein electrophoretic fractionation & quantitation serum
|
$10.74 |
$10.74 |
$10.74 |
$139.50
|
|
Protein s total
|
$11.61 |
$11.61 |
$11.61 |
$156.00
|
|
Protein total 24 hour urine
|
$3.67 |
$3.67 |
$3.67 |
$39.60
|
|
Protein total body fluid
|
$4.00 |
$4.00 |
$4.00 |
$67.80
|
|
Protein total serum plasma whole blood
|
$3.67 |
$3.67 |
$3.67 |
$37.50
|
|
Prothrombin complex kcentra
|
$2.14 |
$2.14 |
$2.14 |
$8.25
|
|
Prothrombin time substitution plasma fractions each
|
$3.94 |
$3.94 |
$3.94 |
$66.00
|
|
Proton treatment complex
|
$1,275.51 |
$1,275.51 |
$1,275.51 |
$1,275.51
|
|
Proton trmt intermediate
|
$1,275.51 |
$1,275.51 |
$1,275.51 |
$1,275.51
|
|
Proton trmt simple w/comp
|
$1,275.51 |
$1,275.51 |
$1,275.51 |
$1,275.51
|
|
Proton trmt simple without comp
|
$578.47 |
$578.47 |
$578.47 |
$578.47
|
|
Protoporphyrin rbc screen
|
$9.74 |
$9.74 |
$9.74 |
$9.74
|
|
Provide inr test mater/equip
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Prp i/hern init block >5 yr
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$8,917.80
|
|
Prq av fstl crt uxtr sep acs
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$33,250.80
|
|
Prq av fstl crtj uxtr 1 acs
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$33,250.80
|
|
Prq revasc byp graft 1 art and/or branches
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$15,411.00
|
|
Prq skel fix clcnl fx w/mnpj
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Prq skel fix epcndylr hum fx
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Prq skel fix sprcndlr hum fx
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Prq skel fix talus fx w/mnpj
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$4,493.40
|
|
Prq skel fix tarsl fx w/mnpj
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Prq tcat plmt ntrac st 1 les
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$12,034.50
|
|
Prq trlml c athrc st angiop1
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$23,616.60
|
|
Prq trluml c angiop 1art&/br
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$9,413.25
|
|
Prq trluml c athrc 1 art&/br
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$12,754.50
|
|
Prq trluml revsc ch occ ant
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$20,522.25
|
|
Prtl exc bone olecrn process
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Prtl exc bone radial h/n
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Prtl exchange transfuse nb
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Prtl excision bone clavicle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Prtl excision bone scapula
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Psy/npsy phys/qhp 2> tst 1st 30 min
|
$128.90 |
$128.90 |
$128.90 |
$225.60
|
|
Psych test eval svc phys/qhp 1st hr
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Psych/neuropsych test admin automated result 96146
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Psychoanalysis
|
$160.67 |
$160.67 |
$160.67 |
$160.67
|
|
Psychotherapy group therapy
|
$92.50 |
$92.50 |
$92.50 |
$58.20
|
|
Psychotherapy patient individual therapy 30 minutes
|
$160.67 |
$160.67 |
$160.67 |
$168.00
|
|
Psychotherapy patient individual therapy 45 minutes
|
$160.67 |
$160.67 |
$160.67 |
$175.80
|
|
Psychotherapy patient individual therapy 60 minutes
|
$160.67 |
$160.67 |
$160.67 |
$254.40
|
|
Psycl/nrpsyc tech 1st
|
$399.04 |
$399.04 |
$399.04 |
$210.75
|
|
Pt application of modality >=1 area electrical stimulation each 15 minutes
|
$18.62 |
$18.62 |
$18.62 |
$103.20
|
|
Pt application of modality >=1 area iontophoresis each 15 minutes
|
$23.82 |
$23.82 |
$23.82 |
$103.20
|
|
Pt application of modality >=1 area ultrasound each 15 minutes
|
$17.72 |
$17.72 |
$17.72 |
$99.00
|
|
Pt application of modality traction mechanical
|
$18.62 |
$18.62 |
$18.62 |
$119.25
|
|
Pt evaluation high complexity patient/family
|
$126.19 |
$126.19 |
$126.19 |
$274.20
|
|
Pt evaluation low complexity patient/family
|
$126.19 |
$126.19 |
$126.19 |
$238.40
|
|
Pt evaluation moderate complexity patient/family
|
$126.19 |
$126.19 |
$126.19 |
$264.00
|
|
Pt init/spiromet rec/review/interp 94016
|
$31.91 |
$31.91 |
$31.91 |
$31.91
|
|
Pt re-evaluation patient/family
|
$86.04 |
$86.04 |
$86.04 |
$117.60
|
|
Pt repositioning canalith procedure(s) per day
|
$46.75 |
$46.75 |
$46.75 |
$223.20
|
|
Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan
|
$15.57 |
$15.57 |
$15.57 |
$110.40
|
|
Pt therapeutic procedure >=1 area gait training each 15 minutes
|
$37.06 |
$37.06 |
$37.06 |
$110.25
|
|
Pt therapeutic procedure >=1 area massage each 15 minutes
|
$38.63 |
$38.63 |
$38.63 |
$105.00
|
|
Pt wheelchair management each 15 minutes
|
$39.57 |
$39.57 |
$39.57 |
$76.20
|
|
Pten gene dup/delet variant
|
$300.00 |
$300.00 |
$300.00 |
$336.60
|
|
Pten gene full sequence
|
$600.00 |
$600.00 |
$600.00 |
$564.60
|
|
Pten gene known fam variant
|
$46.60 |
$46.60 |
$46.60 |
$43.80
|
|
Pterygomaxillary fossa surg any appr 31040
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Pul art balloon repr percut
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$10,756.50
|
|
Pulmonary vent imaging
|
$401.83 |
$401.83 |
$401.83 |
$672.00
|
|
Pulse ox continuous overnight monitoring
|
$156.46 |
$156.46 |
$156.46 |
$302.40
|
|
Punc of shunt for asp or inj
|
$692.52 |
$692.52 |
$692.52 |
$801.75
|
|
Puncture arterial withdrawal blood for diagnosis
|
$128.90 |
$128.90 |
$128.90 |
$87.60
|
|
Puncture aspiration abscess/hematoma/bulla/cyst
|
$399.53 |
$399.53 |
$399.53 |
$496.20
|
|
Puncture spinal lumbar diagnostic
|
$692.52 |
$692.52 |
$692.52 |
$1,212.00
|
|
Puncture/clear windpipe 31612
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Pvb thoracic cont infusion
|
$692.52 |
$692.52 |
$692.52 |
$2,406.00
|
|
Pvb thoracic single inj site
|
$692.52 |
$692.52 |
$692.52 |
$692.52
|
|
Pyruvate
|
$14.48 |
$14.48 |
$14.48 |
$108.75
|
|
Pyruvate kinase
|
$9.44 |
$9.44 |
$9.44 |
$130.80
|
|
Quan puplmtry phy/qhp uni/bi
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Quant diff pulm perf and vent w/imaging
|
$538.27 |
$538.27 |
$538.27 |
$2,655.60
|
|
Quant diff pulm perf w/imaging
|
$401.83 |
$401.83 |
$401.83 |
$1,362.40
|
|
Quest t3 uptake
|
$6.47 |
$6.47 |
$6.47 |
$81.75
|
|
Quinupristin/dalfopristin
|
$4.26 |
$4.26 |
$4.26 |
$4.26
|
|
R hrt cath chd abnl nt cnj
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$3,216.41
|
|
R hrt cath chd nml nt cnj
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$3,216.41
|
|
R&l hrt cath chd abnl nt cnj
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$3,216.41
|
|
R&l hrt cath chd nml nt cnj
|
$3,216.41 |
$3,216.41 |
$3,216.41 |
$3,216.41
|
|
Rabies ig heat-treated human im/subq 90376
|
$347.32 |
$347.32 |
$347.32 |
$3,103.43
|
|
Rabies ig ht&sol human im/sc
|
$237.10 |
$237.10 |
$237.10 |
$8,111.40
|
|
Rabies immune globulin (pf) 300 unit/ml intramuscular solution
|
$266.44 |
$266.44 |
$266.44 |
$880.00
|
|
Rabies vaccine id
|
$264.47 |
$264.47 |
$264.47 |
$264.47
|
|
Rad rescj tum dstl/shft hum
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Rad rescj tum shoulder<5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad rescj tum tiss a/e 5 cm+
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad rescj tum tiss a/e <5cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad resec soft tis tum/ft/toe/<3cm 28046
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad resect abd tumor 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad resect hand tumor 3 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad resect hand tumor < 3 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad resect tumor/neck/ant thor/<5cm21557
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rad resection tum radial h/n
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Radiation physics consult
|
$132.77 |
$132.77 |
$132.77 |
$568.80
|
|
Radiation therapy dose plan
|
$132.77 |
$132.77 |
$132.77 |
$571.20
|
|
Radiation treatment aid(s)
|
$132.77 |
$132.77 |
$132.77 |
$132.77
|
|
Radiation treatment aid(s)
|
$366.07 |
$366.07 |
$366.07 |
$1,244.40
|
|
Radiation treatment aid(s)
|
$132.77 |
$132.77 |
$132.77 |
$489.00
|
|
Radiation treatment delivery
|
$109.50 |
$109.50 |
$109.50 |
$698.40
|
|
Radiation treatment delivery
|
$109.50 |
$109.50 |
$109.50 |
$109.50
|
|
Radiation treatment delivery
|
$262.98 |
$262.98 |
$262.98 |
$952.80
|
|
Radic resect abd tumor<5cm 22904
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Radic resect shoulder tumor 5cm/> 23078
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Radical resection of elbow
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Radiesse injection
|
$333.42 |
$333.42 |
$333.42 |
$333.42
|
|
Radiotherapy dose plan imrt
|
$1,368.26 |
$1,368.26 |
$1,368.26 |
$3,873.00
|
|
Radium ra223 dichl ther/uci
|
$171.78 |
$171.78 |
$171.78 |
$389.40
|
|
Radphm lcl tmr plnr bdy sgl day img
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$1,936.80
|
|
Radphm lcl tmr plnr bdy two day img
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$2,386.20
|
|
Radphm lcl tmr spect/ct 2+ areas/2+ days
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$2,767.80
|
|
Radphm lcl tomogr sgl area sgl day
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$2,767.80
|
|
Radphm lcl tumor plr sgl day
|
$401.83 |
$401.83 |
$401.83 |
$1,070.40
|
|
Ramucirumab 10 mg/ml intravenous solution
|
$74.45 |
$74.45 |
$74.45 |
$147.60
|
|
Ranibizumab injection
|
$91.11 |
$91.11 |
$91.11 |
$844.80
|
|
Rapid Strep Test
|
$16.53 |
$16.53 |
$16.53 |
$72.00
|
|
Rapid desensitization
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Rasburicase 1.5 mg intravenous solution
|
$376.48 |
$376.48 |
$376.48 |
$9,544.20
|
|
Ravulizumab-cwvz 100 mg/ml intravenous solution
|
$225.19 |
$225.19 |
$225.19 |
$71,857.80
|
|
Rbc count only automated
|
$3.02 |
$3.02 |
$3.02 |
$21.40
|
|
Rbc deglycerolized each unit
|
$653.74 |
$653.74 |
$653.74 |
$1,263.00
|
|
Rbc depletion of harvest
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Rbc irradiated each unit
|
$149.22 |
$149.22 |
$149.22 |
$510.60
|
|
Rbc serum pretx incubj drugs
|
$399.04 |
$399.04 |
$399.04 |
$229.60
|
|
Rcnst bfrnt sp orb rm&lw fhd
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rdctj forehead cntrg only
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Rdctj forehead cntrg&prostc
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rdctj forehead cntrg&setback
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Re-explore parathyroids
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$1,744.80
|
|
Realignment of tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Rebuild eardrum structures
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rebuild eardrum structures
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rebuild eardrum structures
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rebuild outer ear canal
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rebuild outer ear canal
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconst lwr jaw w/fixation
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconst lwr jaw w/graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconst lwr jaw without fixation
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconst lwr jaw without graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstr lwr jaw segment
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstr lwr jaw w/advance
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct ankle joint
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Reconstruct cleft foot
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Reconstruct cleft palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct cleft palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct cleft palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct cleft palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct cleft palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct cleft palate
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Reconstruct elbow joint
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Reconstruct elbow joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Reconstruct elbow joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reconstruct elbow lat ligmnt
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Reconstruct elbow med ligmnt
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reconstruct extra finger
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Reconstruct finger joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Reconstruct finger joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Reconstruct head of radius
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reconstruct head of radius
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reconstruct lip w/local flap 40525
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Reconstruct lip with flap
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct lower jaw bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct orbit/forehead
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct shoulder joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reconstruct shoulder joint
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Reconstruct ulna/radioulnar
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Reconstruct upper jaw bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruct urethra stage 1
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Reconstruct urethra stage 2
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Reconstruct urethra/bladder
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Reconstruction knee
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reconstruction knee
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Reconstruction knee
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reconstruction of anus
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Reconstruction of eyelid
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Reconstruction of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Reconstruction of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Reconstruction of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Reconstruction of jaw
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of jaw
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of jaw
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of jaw
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of jaw joint
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of jaw joint
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Reconstruction of jaw joint
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of lower jaw
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of mouth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of mouth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of mouth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of mouth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of mouth
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of nail bed
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Reconstruction of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of orbit
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of throat
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reconstruction of urethra
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Reconstruction of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Reconstruction of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Reconstruction of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Reconstruction of urethra
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Reconstruction of urethra
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Reconstruction of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Reconstruction of urethra
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Reconstruction of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Reconstruction tongue fold
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Rectal sensation test
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Red blood cells each unit
|
$144.32 |
$144.32 |
$144.32 |
$759.60
|
|
Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit
|
$485.37 |
$485.37 |
$485.37 |
$485.37
|
|
Red blood cells leukocytes reduced cmv negative irradiated each unit
|
$222.86 |
$222.86 |
$222.86 |
$397.80
|
|
Red blood cells leukocytes reduced each unit
|
$182.00 |
$182.00 |
$182.00 |
$818.40
|
|
Red blood cells leukocytes reduced irradiated each unit
|
$255.80 |
$255.80 |
$255.80 |
$797.40
|
|
Red blood cells washed each unit
|
$396.87 |
$396.87 |
$396.87 |
$665.40
|
|
Red cell mass multiple
|
$538.27 |
$538.27 |
$538.27 |
$538.27
|
|
Red cell mass single
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Red cell sequestration
|
$401.83 |
$401.83 |
$401.83 |
$2,616.00
|
|
Red cell survival study
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Redo endovas vena cava filtr
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Reduce testis torsion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Reduction of facial bones
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reduction of procidentia 45900
|
$911.71 |
$911.71 |
$911.71 |
$1,067.25
|
|
Refill maint impl spine pump
|
$295.19 |
$295.19 |
$295.19 |
$352.50
|
|
Refill/maint pump/resvr syst
|
$210.69 |
$210.69 |
$210.69 |
$423.60
|
|
Reinforce clavicle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Reinforce eye wall
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Reinforce shoulder bones
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Reinforce tibia
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Reinforce/graft eye wall
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Reinnervate larynx
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Reinsert ocular implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Release encircling material
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Release eye tissue
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Release facial nerve
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Release facial nerve
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Release facial nerve
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Release finger contracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Release forearm/hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release inner ear canal
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Release knuckle contracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release middle ear bone
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Release muscles of hand
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release of eye fluid
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Release of foot tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Release of foot tendon 28225
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release of foot tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release of foot tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release of lower leg tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release of lower leg tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release of midfoot joint
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Release of midfoot joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release of shoulder ligament
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Release palm & finger tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release palm contracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Release palm contracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release palm contracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release palm contracture 26045
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release palm/finger tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Release thumb contracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Release wrist/forearm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Relieve bladder contracture
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Relocation of testis(es)
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Relocation skin pocket aicd
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,513.00
|
|
Relocation skin pocket pm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$2,504.40
|
|
Rem endovas vena cava filter
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$5,661.75
|
|
Rem interrog dev eval icpms
|
$37.29 |
$37.29 |
$37.29 |
$109.50
|
|
Rem interrog dev eval scrms
|
$37.29 |
$37.29 |
$37.29 |
$109.50
|
|
Rem interrog evl pm/ids
|
$37.29 |
$37.29 |
$37.29 |
$189.00
|
|
Rem mntr physiol 1st dev supply ea 30 days
|
$37.29 |
$37.29 |
$37.29 |
$84.00
|
|
Rem mntr physiol 1st set up pt educaj eqp
|
$128.87 |
$128.87 |
$128.87 |
$115.80
|
|
Rem mntr wrls p-art prs snr
|
$37.29 |
$37.29 |
$37.29 |
$37.29
|
|
Rem/biv cast full arm/leg
|
$265.58 |
$265.58 |
$265.58 |
$441.00
|
|
Rem/biv cast shldr/hip spica
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Remdesivir 100 mg intravenous powder for solution
|
$6.73 |
$6.73 |
$6.73 |
$16.80
|
|
Remote 30 day ecg tech supp
|
$311.40 |
$311.40 |
$311.40 |
$1,414.20
|
|
Remov/replc penis pros comp
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Removal anal seton other marker 46030
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,179.08
|
|
Removal biliary drg cath
|
$937.56 |
$937.56 |
$937.56 |
$1,398.75
|
|
Removal central venous catheter tunneled without port/pump
|
$618.26 |
$618.26 |
$618.26 |
$2,172.00
|
|
Removal central venous device tunneled w/port/pump central/peripheral insertion
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,838.00
|
|
Removal cerclage w/anes
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Removal cerclage without anes
|
$201.17 |
$201.17 |
$201.17 |
$722.40
|
|
Removal cerumen impacted (both sides)
|
$59.40 |
$59.40 |
$59.40 |
$168.00
|
|
Removal clot in graft oth/thn 35875
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Removal clot in graft xcp 35876
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,270.25
|
|
Removal devitalized tissue non-selective debridement without anesthesia per session
|
$198.70 |
$198.70 |
$198.70 |
$276.00
|
|
Removal embedded foreign body vestibule mouth smpl
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Removal foreign body extrn auditory canal with anes
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Removal foreign body foot cmplx
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,957.50
|
|
Removal foreign body foot subcutaneous right
|
$703.59 |
$703.59 |
$703.59 |
$873.00
|
|
Removal foreign body gum 41805
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,692.75
|
|
Removal foreign body jawbone
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Removal foreign body mouth
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Removal implant from finger/hand 26320
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,620.24
|
|
Removal implant superficial separate procedure
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$3,355.20
|
|
Removal mamma implant mat 19330
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,262.20
|
|
Removal neck/armpit lesion
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Removal neck/armpit lesion 38555
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Removal of adenoids
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of adenoids
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of adenoids
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of adenoids <12yrs 42835
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of anal fissure
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Removal of anal tags
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$3,128.40
|
|
Removal of ankle bone
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of ankle implant
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of ankle/heel lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of arm artery clot 34111
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Removal of artery clot 34101
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Removal of bladder lesion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of bladder stone
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Removal of bone for graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of bone for graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of bone lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of bone lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of bone lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of breast lesion
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,704.25
|
|
Removal of brow wrinkles
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Removal of calcium deposits
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Removal of epididymis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of epididymis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of ethmoid sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of ethmoid sinus
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Removal of external ear
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,288.40
|
|
Removal of eye
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Removal of eye
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Removal of eye lesion
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Removal of eye lesion
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Removal of eye lesion
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Removal of face wrinkles
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Removal of fascia for graft
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Removal of fascia for graft
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Removal of finger lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Removal of finger tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Removal of foot fascia
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of foot joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of foot joint lining
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of foot lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of foot lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Removal of foot lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$644.40
|
|
Removal of forearm lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of forehead wrinkles
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Removal of foreign body
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Removal of frontal sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of frontal sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of frontal sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of frontal sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of frontal sinus
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of frontal sinus 31085
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of gum tissue
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of head of humerus
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of heel bone
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of heel spur
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of hip foreign body 27087
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$4,678.80
|
|
Removal of humerus lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of humerus lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of humerus lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of hydrocele
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of hydrocele
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Removal of hydroceles
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Removal of implant deep
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Removal of infusion pump
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$3,639.30
|
|
Removal of inner eye fluid
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Removal of inner eye lesion
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Removal of intranasal lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of intranasal lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of iris
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Removal of iris
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Removal of iris
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Removal of iris
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Removal of ischial bursa
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of jaw bone lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of jaw joint
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of knee cartilage
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of knee cartilage
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of knee cyst
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of kneecap
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of kneecap bursa
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of larynx lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of larynx lesion 31512
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Removal of lens lesion
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Removal of lens material
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Removal of lens material
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Removal of lens material
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Removal of lymph nodes neck
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Removal of metatarsal
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of metatarsal heads
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of neck wrinkles
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Removal of nerve lesion
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Removal of nerve lesion
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Removal of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of nose lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of nose lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Removal of nose polyp(s) 30115
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of ocular implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Removal of palm tendon each
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Removal of salivary stone
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of salivary stone 42335
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Removal of scrotum
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of scrotum lesion
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Removal of sesamoid bone
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of shunt
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Removal of skin wrinkles
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Removal of sperm cord lesion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of spinal shunt
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Removal of suture from anus 46754
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Removal of tail bone
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of tear gland
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Removal of tear sac
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Removal of tendon for graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Removal of tendon lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$639.60
|
|
Removal of testis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of testis
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Removal of thyroid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$3,475.80
|
|
Removal of thyroid
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$1,246.20
|
|
Removal of thyroid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Removal of toe lesions
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$476.40
|
|
Removal of toe lesions
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Removal of ureter stone
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Removal of urethra
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Removal of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of urethra gland
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of urethra gland
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Removal of urethra lesion
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Removal of urethra lesion
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Removal of vein clot
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Removal of vein clot
|
$618.26 |
$618.26 |
$618.26 |
$618.26
|
|
Removal of vein clot 34490
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Removal of wrist bone
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of wrist bones
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of wrist lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of wrist prosthesis
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal of wrist prosthesis
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Removal prosth radial head
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Removal skin tags fibrocutaneous any area <= 15 lesions
|
$198.70 |
$198.70 |
$198.70 |
$471.00
|
|
Removal sutr/staple req anes
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,784.80
|
|
Removal tunnled intprtnl cath
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,209.40
|
|
Removal w/reinsrt nonbiogrdble
|
$399.04 |
$399.04 |
$399.04 |
$2,805.00
|
|
Removal/replacement ppm generator dual lead system
|
$10,465.33 |
$10,465.33 |
$10,465.33 |
$10,465.33
|
|
Remove & graft wrist lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove & graft wrist lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove anal fist complex
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove anal fist inter
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove anal fist subq
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove ankle joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove ankle joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove armpit lymph nodes
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Remove bladder stone
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Remove bladder stone
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,368.25
|
|
Remove blood clot from eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Remove brain canal fluid
|
$295.19 |
$295.19 |
$295.19 |
$295.19
|
|
Remove cartilage for graft
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Remove cartilage for graft
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Remove collar bone lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove coronoid process
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove cranial cavity fluid
|
$692.52 |
$692.52 |
$692.52 |
$692.52
|
|
Remove digit nerve lesion 64776
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove drug implant
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Remove ear canal lesion(s)
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Remove ear canal lesion(s) 69140
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove epididymis lesion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Remove epididymis lesion
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Remove exostosis maxilla
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Remove ext hem groups 2+
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$3,552.60
|
|
Remove eye implant material
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Remove eye implant material
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Remove eye lesion
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Remove eye lesion
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Remove eye/attach implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Remove eye/insert implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Remove eye/revise socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Remove eye/revise socket
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Remove eyelid lesion
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Remove eyelid lesion
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Remove eyelid lesion(s)
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Remove eyelid lesions
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Remove eyelid lesions
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Remove femur lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove femur lesion/bursa
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove femur lesion/graft
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Remove femur lesion/graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove finger bone
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Remove forearm bone lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove foreign body from eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Remove foreign body from eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$3,769.20
|
|
Remove foreign body from eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Remove gastric port open 43887
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Remove groin lymph nodes
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Remove hand bone lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Remove hip bone les deep
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove hip bone les super
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove hip foreign body 27086
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$417.75
|
|
Remove hip/pelvis lesion 27047
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,790.00
|
|
Remove humerus lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove humerus lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove implant of eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Remove in/ex hem groups 2+
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove in/ex hem grp & fiss 46257
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove in/ex hem grp w/fistu
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove in/ex hem grps & fiss
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove in/ex hem grps w/fist
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Remove inner ear
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove inner ear & mastoid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove inner ear lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove int/ext hem 1 group
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$922.20
|
|
Remove intact mammary implant
|
$3,829.28 |
$3,829.28 |
$3,829.28 |
$3,829.28
|
|
Remove iris and lesion
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Remove jaw joint cartilage
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove knee cyst
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove knee joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove knee joint lining
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove lamina/facets lumbar
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove limb nerve lesion
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove lower leg bone lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove mandible cyst complex
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove mastoid air cells
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove mastoid structures
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove maxilla cyst complex
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove middle ear nerve
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Remove muti-comp penis pros
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Remove nasal foreign body
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Remove nasal foreign body
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Remove nerve lesion
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove part lumbar vertebra
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove part of neck vertebra
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove pilonidal cyst compl
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$1,492.20
|
|
Remove pilonidal cyst exten
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Remove prostate regrowth
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Remove renal tube w/fluoro
|
$667.47 |
$667.47 |
$667.47 |
$1,830.00
|
|
Remove sacrum pressure sore close 15936
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Remove sacrum pressure sore ostc 15937
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Remove sciatic nerve lesion
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Remove self-contd penis pros
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Remove shoulder blade lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove shoulder fb deep
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Remove shoulder foreign body subq 23330
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,566.00
|
|
Remove skin nerve lesion
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove skin nerve lesion 64788
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove sperm pouch lesion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Remove spinal canal catheter 62355
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove spinal cord lesion
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove spine eltrd perq aray
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove spine eltrd plate
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,439.01
|
|
Remove spine infusion device
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Remove spine lamieieiotina >2 crvcl 63015
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove spine lamina 1/2 crvl
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove spine lamina 1/2 lmbr
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove spine lamina 1/2 scrl
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove spine lamina 1/2 thrc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove spine lamina >2 lmbr
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove spine lamina >2 thrc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove stent via transureth
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Remove sympathetic nerves
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove sympathetic nerves
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Remove sympathetic nerves
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove tear gland lesion
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Remove tear gland lesion
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Remove thyroid duct lesion
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Remove thyroid duct lesion
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Remove thyroid lesion 60200
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Remove tonsils and adenoids
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove tonsils and adenoids
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Remove ureter calculus
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Remove ureter stent percut
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$6,318.00
|
|
Remove uro sphincter
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Remove vagina tissue part
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Remove vaginal foreign body 57415
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,308.25
|
|
Remove vagus n eltrd
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Remove vc lesion scope/graft
|
$6,922.47 |
$6,922.47 |
$6,922.47 |
$6,922.47
|
|
Remove vc lesion w/scope 31545
|
$3,686.95 |
$3,686.95 |
$3,686.95 |
$3,686.95
|
|
Remove ventilating tube
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Remove w insert drug implant
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Remove windpipe lesion
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Remove wrist joint cartilage
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove wrist joint implant
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove wrist joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove wrist joint lining
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove wrist tendon lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Remove wrist tendon lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$817.80
|
|
Remove wrist/forearm lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Remove wrist/forearm lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove/graft bone lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove/graft finger lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove/graft foot lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove/graft foot lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove/graft foot lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove/graft forearm lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Remove/graft forearm lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Remove/graft hip bone lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove/graft leg bone lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove/graft leg bone lesion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remove/repair hearing aid
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Remove/replace penis prosth
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Remove/replace ur sphincter
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Remove/revise male sling
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Remove/transplant tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Remv/repl penis contain pros
|
$20,128.56 |
$20,128.56 |
$20,128.56 |
$20,128.56
|
|
Remv/replc penis pros compl
|
$12,992.42 |
$12,992.42 |
$12,992.42 |
$12,992.42
|
|
Remvl peritoneal fb frm cavity
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Renal abscess open drng 50020
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Renal cyst study s&i
|
$548.30 |
$548.30 |
$548.30 |
$0.60
|
|
Renal endoscopy 50572
|
$667.47 |
$667.47 |
$667.47 |
$667.47
|
|
Renal function panel
|
$8.68 |
$8.68 |
$8.68 |
$156.00
|
|
Renal scope w/tumor resect
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Renal venogram bil s&i
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,859.75
|
|
Reopen fallopian tube
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Repair achilles tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair anal fistula
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair anorectal fist w/plug
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair arm/leg nerve
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair av fistula ext 35190
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$8,080.20
|
|
Repair biceps tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair bladder & vagina
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Repair bladder defect
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Repair bladder neck
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Repair bladder-vagina lesion
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Repair bladder-vagina lesion
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Repair blood ves direct neck 35201
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Repair blood vessel dir lower extr
|
$703.59 |
$703.59 |
$703.59 |
$1,582.20
|
|
Repair blood vessel dir upper extr
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Repair blood vessel direct hand finger
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$7,133.40
|
|
Repair blood vessel lesion
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$1,553.44
|
|
Repair blood vessel lesion
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Repair blood vessel lesion
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Repair blood vessel lesion
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Repair blood vessel lesion
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Repair blood vessel w/graft lower extremity 35286
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Repair blood vessel w/vein graft lower extremity 35256
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Repair brow defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair carpal bone shorten
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair cleft hand
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair cleft lip/nasal
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair cleft lip/nasal
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair cleft lip/nasal
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Repair cleft lip/nasal
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair cleft lip/nasal
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair complex wound scalp/arms/legs 2.6 - 7.5 cm
|
$612.13 |
$612.13 |
$612.13 |
$2,172.00
|
|
Repair corporeal tear
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Repair defect arm art 35045
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Repair defect of artery 35011
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$2,715.60
|
|
Repair deformity of toe
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$624.60
|
|
Repair degenerated kneecap
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair dental ellis ii fx
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Repair detached retina
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Repair detached retina
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Repair detached retina
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Repair detached retina crtx
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Repair detached retina pc
|
$548.60 |
$548.60 |
$548.60 |
$666.75
|
|
Repair eardrum structures
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair elbow deb/attch open
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair elbow perc
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,752.25
|
|
Repair elbow w/deb open
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair esophagus opening
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Repair extns tendon finger without grft ea
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$5,324.40
|
|
Repair extra toe(s)
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair eyelid wound
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,473.50
|
|
Repair eyelid wound
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,675.25
|
|
Repair facial nerve
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair facial nerve
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair fibula nonunion
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair finger deformity
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Repair finger tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,126.75
|
|
Repair finger/hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair finger/hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,430.80
|
|
Repair finger/hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair finger/hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair finger/hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair finger/hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair foot dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Repair foot dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair foot dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Repair forearm tendon sheath
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair forearm tendon/muscle
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair forearm tendon/muscle
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair forearm tendon/muscle
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair forearm tendon/muscle sec 25263
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair hand joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair hand joint with graft
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair hand joint with graft
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair humerus with graft
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Repair ing hernia sliding
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$1,504.20
|
|
Repair iris & ciliary body
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Repair iris & ciliary body
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Repair lac palate<2 cm
|
$509.25 |
$509.25 |
$509.25 |
$509.25
|
|
Repair leg fascia defect
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair lip full thkns =<one-half vert height
|
$509.25 |
$509.25 |
$509.25 |
$1,080.75
|
|
Repair lip full thkns >one-half vert height/cmplx
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$2,046.00
|
|
Repair lower leg epiphyses
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair lower leg tendons
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair lower leg tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair lumbar hernia
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Repair middle ear structures
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Repair middle ear structures
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Repair multi-comp penis pros
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Repair muscles of hand
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair nasal septum defect
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Repair nasal stenosis
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair nonunion carpal bone
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair nonunion hand
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair nose to lip fistula
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair of achilles tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of anal sphincter
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair of anal sphincter
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair of anal stricture
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair of ankle ligament
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$4,493.40
|
|
Repair of ankle ligament
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of ankle ligaments
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of arm nerves
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Repair of bladder opening
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$619.20
|
|
Repair of body cast
|
$157.79 |
$157.79 |
$157.79 |
$157.79
|
|
Repair of circumcision
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Repair of digit nerve hand/foot 1 nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Repair of enterocele vaginal approach 57268
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Repair of eye socket wound
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Repair of eye wound
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair of eye wound
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$5,442.60
|
|
Repair of eye wound
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$6,308.40
|
|
Repair of eye wound
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Repair of eye wound
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$4,080.00
|
|
Repair of eye wound
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,322.00
|
|
Repair of facial nerve
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair of facial nerve
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair of fibula epiphysis
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of foot bones
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Repair of foot tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of hand or foot nerve
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair of hand or foot nerve
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair of humerus
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$5,152.80
|
|
Repair of hydrocele 55060
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Repair of knee cartilage
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of knee ligament
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of knee ligament
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of knee ligaments
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of kneecap tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of leg epiphyses
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of leg epiphyses
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of leg nerve
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair of leg tendon each
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of leg tendon each
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of leg tendon each
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of low back nerves
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair of metatarsals
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of nasal septum
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Repair of penis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Repair of rectocele 45560
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair of rectum
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair of rectum
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Repair of ruptured tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of shoulder
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of sperm duct
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Repair of thigh muscle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of tibia
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair of tibia epiphysis
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of toe dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,126.75
|
|
Repair of ulnar motor nerve 64836
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repair of urethra defect
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Repair of urethra defect
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Repair of urethra injury
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Repair of urethra injury
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Repair of urethra injury
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Repair of urethra injury 53502
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Repair of urethral lesion
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Repair of web finger
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of web finger
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Repair of web finger
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair of windpipe
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair of windpipe
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair of windpipe defect
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Repair oronasal fistula 30600
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair palate
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$4,334.40
|
|
Repair palate pharynx/uvula
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair paravag defect lap
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Repair paravag defect vag 57285
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Repair penis
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Repair penis
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Repair pm/icd lead dual
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$3,691.50
|
|
Repair pm/icd lead sgl
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$3,639.30
|
|
Repair radius & ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair radius or ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,667.60
|
|
Repair rectum & vagina
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Repair rectum-vagina fistula
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Repair recur fem hernia reduce 49555
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Repair retinal detach cplx
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Repair rotator cuff acute
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair rotator cuff chronic
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair rpr lac tongue floor mouth > 2.6 cm/cmplx
|
$232.22 |
$232.22 |
$232.22 |
$2,260.20
|
|
Repair rpr lip full thickness vermilion only
|
$509.25 |
$509.25 |
$509.25 |
$2,097.00
|
|
Repair salivary duct
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair salivary duct
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair sciatic nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Repair shoulder capsule
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair shoulder capsule
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair shoulder capsule
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair shoulder capsule
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair shoulder capsule
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair shoulder capsule
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair stern/nuss without scope
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair sternum/nuss w/scope
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair stomach opening
|
$3,804.53 |
$3,804.53 |
$3,804.53 |
$3,709.50
|
|
Repair tear ducts
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Repair tendon extensor foot 1/2 each tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$4,561.20
|
|
Repair tendon/muscle forearm/wrist prime sngl ea
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$5,322.00
|
|
Repair testis injury
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Repair throat wound
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Repair toe dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair tongue lac <2.5cm past 1/3 tongue 41251
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Repair umbilical lesion
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Repair upper arm/elbow tendon/muscle ea
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$6,880.20
|
|
Repair upper jaw fistula
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair urethrovaginal lesion 57310
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Repair uro sphincter
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Repair vagina
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Repair vagina/perineum
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Repair valve femoral vein
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Repair webbed toe(s)
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Repair windpipe opening
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Repair/graft achilles tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft eye lesion
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Repair/graft finger tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair/graft finger tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair/graft finger tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair/graft hand tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft hand tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair/graft hand tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft hand tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft kneecap tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft of foot tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft of foot tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft of thigh muscle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft of tibia
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft radius & ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repair/graft radius & ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft radius or ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft radius or ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/graft wrist bone
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/revise wrist joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repair/transpose mp nerve 64856
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Repeat thyroid surgery
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$2,567.40
|
|
Replace duod/jej tube perc
|
$937.56 |
$937.56 |
$937.56 |
$2,618.40
|
|
Replace elbow joint
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Replace eye fluid
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Replace g-j tube perc
|
$937.56 |
$937.56 |
$937.56 |
$3,105.00
|
|
Replace g/c tube perc
|
$937.56 |
$937.56 |
$937.56 |
$2,695.80
|
|
Replace picvad cath
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,903.00
|
|
Replace tissue expander w/perm prost 11970
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Replace tunneled cv cath
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,001.25
|
|
Replace/irrigate catheter
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Replace/irrigate catheter
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Replace/revise brain shunt
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$5,543.40
|
|
Replacement of contact lens
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Replacment pt electronic sys
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$1,017.39
|
|
Replantation digit complete
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Repos lv lead pm/icd
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,322.50
|
|
Repos sq defib eltrd
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$4,831.80
|
|
Reposg phrnc nrv stim trnsvn
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,353.25
|
|
Reposition intraocular lens
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Reposition pm/icd lead
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,780.00
|
|
Repr elbow lat ligmnt w/tiss
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Repr elbw med ligmnt w/tissu
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Repr of anal fistula w/glue
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Reprogram cochlear implt 7/>
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Reprogram cochlear implt <7
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Reptilase test
|
$9.85 |
$9.85 |
$9.85 |
$87.60
|
|
Reremove wrist tendon lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Rerepair fem hernia blocked
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Rerepair ing hernia blocked
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$5,185.20
|
|
Rerepair ing hernia reduce
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$7,126.80
|
|
Resect back tum 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect back tum < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect condyle distal phalanx ea toe 28153
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect distal finger tumor
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Resect enlarged toe
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect enlarged toe tissue
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect face/scalp tum 2 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect face/scalp tum < 2 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect foot/toe tumor 3 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect forarm/wrist tum 3cm>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect forearm/wrist tum<3cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect hip/pelv tum 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect hip/pelv tum < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect inferior turbinate
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Resect leg/ankle tum 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect leg/ankle tum < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect metatarsal tumor
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect neck tumor 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect part/compl phalangeal base ea 28126
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect phalanx of toe tumor
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Resect prox finger tumor
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect radius/ulnar tumor
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Resect talus/calcaneus tum
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect tarsal tumor
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resect thigh/knee tum 5 cm/>
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resect thigh/knee tum < 5 cm
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Resection of elbow joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Resection palate/lesion 42120
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Resin three surfaces-anterio
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Reslizumab 10 mg/ml intravenous solution
|
$10.58 |
$10.58 |
$10.58 |
$34.40
|
|
Resp virus 6-11 targets
|
$218.06 |
$218.06 |
$218.06 |
$1,146.60
|
|
Resuscitation cardiopulmonary
|
$311.40 |
$311.40 |
$311.40 |
$741.75
|
|
Resuscitation delivery/birthing room
|
$654.38 |
$654.38 |
$654.38 |
$721.50
|
|
Reteplase injection
|
$2,904.58 |
$2,904.58 |
$2,904.58 |
$2,904.58
|
|
Reticulated platelet assay
|
$35.74 |
$35.74 |
$35.74 |
$85.50
|
|
Reticulocyte automated
|
$3.99 |
$3.99 |
$3.99 |
$54.75
|
|
Reticulocyte direct measurement automated
|
$5.57 |
$5.57 |
$5.57 |
$5.57
|
|
Retifanlimab-dlwr 500 mg/20 ml intravenous solution
|
$29.98 |
$29.98 |
$29.98 |
$29.98
|
|
Retrieval of oocyte
|
$870.74 |
$870.74 |
$870.74 |
$870.74
|
|
Retrograde ejaculation anal
|
$19.59 |
$19.59 |
$19.59 |
$19.59
|
|
Rev mastoidectomy rsltg modf rad mstdc 69602
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rev-rem impl neurostim gen-rec
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,288.00
|
|
Rev/rmv perph nstim eltrd ra
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,439.01
|
|
Rev/rmv prph sac/gstr npg/r
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,439.01
|
|
Rev/rplcmt sk-mnt crnl nstm
|
$21,444.39 |
$21,444.39 |
$21,444.39 |
$21,444.39
|
|
Rev/rplct hpglsl nstm ary pg
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Revasc intra lithotrip-ather
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$20,533.20
|
|
Revasc intra lithotrip-stent
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$20,533.20
|
|
Revasc intravasc lithotripsy
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$11,449.20
|
|
Revasc lith-sten-ath tib/per
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$20,329.50
|
|
Revasc lithotr-ather tib/per
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$20,329.50
|
|
Revasc lithotr-stent tib/per
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$20,329.50
|
|
Revasc lithotrip tibi/perone
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$12,754.50
|
|
Revasc lithotrip-stent-ather
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$30,547.80
|
|
Revis reconst shoulder joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revise abdomen-venous shunt
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Revise aqueous shunt eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Revise arm/leg nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Revise breast reconst 19380
|
$6,521.46 |
$6,521.46 |
$6,521.46 |
$6,521.46
|
|
Revise eye
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise eye muscle
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise eye muscle
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise eye muscle(s)
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise eye socket implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise eye sockets
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise eye sockets
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise eye sockets
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise eye sockets
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise eye with implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise eyelashes
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Revise eyelashes
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise eyelid defect
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise eyelid lining
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise eyelid lining
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise eyelid lining
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Revise finger joint each
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Revise finger joint each
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise gastric port open 43886
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Revise graft w/vein
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Revise graft w/vein 35881
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Revise hand/finger tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise head/neck of femur
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise hernia & sperm veins
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Revise kneecap
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise kneecap with implant
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revise knuckle joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise knuckle with implant
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise low back nerve(s)
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Revise lower leg tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise lower leg tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise lower leg tendons
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise middle ear & mastoid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear & mastoid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear & mastoid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear & mastoid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear & mastoid
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear & mastoid 69645
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise middle ear bone
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revise ocular implant
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise ocular implant
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise palsy hand tendon(s)
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise palsy hand tendon(s)
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise penis/urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revise penis/urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revise penis/urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revise prosth vag graft lap
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Revise radius & ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise radius & ulna
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revise radius or ulna
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise reconst elbow joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revise reconst elbow joint
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Revise spermatic cord veins
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,239.75
|
|
Revise spermatic cord veins
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revise spine eltrd perq aray
|
$6,562.90 |
$6,562.90 |
$6,562.90 |
$6,562.90
|
|
Revise spine eltrd plate
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Revise thigh muscles/tendons
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise thumb tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise thumb tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise two eye muscles
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise two eye muscles
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise ulnar nerve at wrist
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Revise ureter
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revise urethra stage 1
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Revise urethra stage 2
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Revise vag graft via vagina
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Revise windpipe scar
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Revise wrist joint
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise wrist/forearm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revise/graft eyelid lining
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise/graft eyelid lining
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise/graft eyelid lining
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise/graft eyelid lining
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Revise/graft eyelid lining
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revise/implant finger joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revise/remove neuroelectrode
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,439.01
|
|
Revise/remove neuroreceiver
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Revise/remove sling repair
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Revise/repl vagus n eltrd
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$12,470.31
|
|
Revision of amputation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of ankle joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of aqueous shunt
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Revision of arm nerve(s)
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Revision of big toe
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of bladder neck
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revision of calf tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revision of cervix
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Revision of cervix
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Revision of collar bone
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revision of collar bone
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of colostomy
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Revision of cornea
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revision of cranial nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Revision of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revision of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$3,819.60
|
|
Revision of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revision of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revision of eyelid
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Revision of foot
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revision of foot and ankle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of foot bones
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revision of foot fascia 28250
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revision of foot tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of foot tendon
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Revision of hip tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revision of ileostomy; simple 44312
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Revision of infusion pump
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$3,639.30
|
|
Revision of iris
|
$548.60 |
$548.60 |
$548.60 |
$2,392.50
|
|
Revision of iris
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Revision of jaw muscle/bone
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Revision of jaw muscle/bone
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Revision of knee joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revision of knee joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revision of knee joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revision of knee joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revision of knee joint
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Revision of larynx
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision of leg vein 37780
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Revision of neck muscle
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Revision of neck muscle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of neck muscle
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revision of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision of nose
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision of nose
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Revision of penis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$4,524.60
|
|
Revision of penis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revision of penis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revision of penis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,367.50
|
|
Revision of pharyngeal walls
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision of radius
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revision of radius
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of sciatic nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Revision of scrotum
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revision of scrotum
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Revision of spinal shunt
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Revision of testis
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Revision of thigh muscles
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of toe
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Revision of ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of unstable kneecap
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of unstable kneecap
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revision of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revision of urethra
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Revision of urethra
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Revision open av fistula without thromb
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Revision orbitofacial bones
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revision tips
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$7,508.40
|
|
Revision/removal of kneecap
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Revj fem anast autog vn grf
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Revj fem anast nonautog grf
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Revj mstdc rsltg compl mstdc
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revj mstdc rsltg tympanplsty
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Revj prior hypspad repair
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Revj/rmvl nea pn w/int nstim
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,439.01
|
|
Rezafungin 200 mg intravenous solution
|
$10.62 |
$10.62 |
$10.62 |
$26.25
|
|
Rf abltj nrv nrvtg si jt
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$3,768.60
|
|
Rheumatoid factor qualitative
|
$6.14 |
$6.14 |
$6.14 |
$75.00
|
|
Rheumatoid factor quantitative
|
$5.67 |
$5.67 |
$5.67 |
$74.40
|
|
Rhinp prim lat&alr crtlge&/elvtn nsl tip
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rho(d) immune globulin h, sd
|
$30.77 |
$30.77 |
$30.77 |
$1,551.00
|
|
Rib cartilage graft
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Right ventric recording
|
$1,213.99 |
$1,213.99 |
$1,213.99 |
$2,545.80
|
|
Risankizumab-rzaa 60 mg/ml intravenous solution
|
$14.84 |
$14.84 |
$14.84 |
$26.40
|
|
Risk ascvd tst once pr 12 mo
|
$29.79 |
$29.79 |
$29.79 |
$29.79
|
|
Risperidone microspheres 12.5 mg/2 ml inj
|
$10.94 |
$10.94 |
$10.94 |
$4,199.40
|
|
Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln
|
$36.96 |
$36.96 |
$36.96 |
$218.40
|
|
Rituximab 10 mg/ml concentrate,intravenous
|
$75.93 |
$75.93 |
$75.93 |
$432.00
|
|
Rituximab-abbs 10 mg/ml intravenous solution
|
$31.18 |
$31.18 |
$31.18 |
$372.60
|
|
Rituximab-arrx 10 mg/ml intravenous solution
|
$29.92 |
$29.92 |
$29.92 |
$196.20
|
|
Rituximab-pvvr 10 mg/ml intravenous solution
|
$26.50 |
$26.50 |
$26.50 |
$7,826.40
|
|
Rmv implant contraceptive capsule 11976
|
$703.59 |
$703.59 |
$703.59 |
$1,314.00
|
|
Rmv ntr oi imp sk tc esp<100
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Rmv ntr oi imp sk tc>=100
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Rmv ntr oi implt skl prq esp
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Rmv sk-mnt crnl nstm pg/rcvr
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Rmv&rplcmt phrnc nrv stim ld
|
$12,470.31 |
$12,470.31 |
$12,470.31 |
$13,161.00
|
|
Rmv&rplcmt phrnc nrv stim pg
|
$30,473.59 |
$30,473.59 |
$30,473.59 |
$30,000.00
|
|
Rmvl esophgl sphnctr dev
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Rmvl ext fixj sys under anes
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,046.80
|
|
Rmvl fb upr arm/elbow deep
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rmvl fecal impaction/fb spx under anes
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,949.60
|
|
Rmvl foreign body upper arm/elbow subcutaneous
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,470.60
|
|
Rmvl hpglsl nstim ary pg
|
$6,404.07 |
$6,404.07 |
$6,404.07 |
$6,404.07
|
|
Rmvl icd by tv extr
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$4,482.75
|
|
Rmvl icd gen w/rplc icd gen dual lead sys
|
$22,446.19 |
$22,446.19 |
$22,446.19 |
$22,446.19
|
|
Rmvl icd gen w/rplc icd gen mlt lead sys
|
$32,061.58 |
$32,061.58 |
$32,061.58 |
$32,061.58
|
|
Rmvl icd gen w/rplc icd gen sgl lead sys
|
$22,446.19 |
$22,446.19 |
$22,446.19 |
$22,446.19
|
|
Rmvl icd pulse gen only
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$3,655.80
|
|
Rmvl ndwellg tun pleural cath
|
$618.26 |
$618.26 |
$618.26 |
$1,826.40
|
|
Rmvl perm pm pulse gen
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$4,150.50
|
|
Rmvl phrnc nrv stim pg only
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,353.25
|
|
Rmvl phrnc nrv stim sys
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,353.25
|
|
Rmvl phrnc nrv stim transvns
|
$3,439.01 |
$3,439.01 |
$3,439.01 |
$3,287.25
|
|
Rmvl pm gen w/rplc pm gen mlt lead sys
|
$19,071.16 |
$19,071.16 |
$19,071.16 |
$19,071.16
|
|
Rmvl pm gen w/rplc pm gen sgl lead sys
|
$8,275.98 |
$8,275.98 |
$8,275.98 |
$8,797.50
|
|
Rmvl prosthhumrl&ulnar cmpnt
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Rmvl sq defib electrode
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$4,551.75
|
|
Rmvl subq card rhythm mntr
|
$703.59 |
$703.59 |
$703.59 |
$1,912.80
|
|
Rmvl tiss expndr without implant insrtn
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Rmvl tongs/halo anthr indiv
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Rmvl tv pm lead dual
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$3,687.00
|
|
Rmvl tv pm lead sgl
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$3,303.75
|
|
Rolapitant, oral, 1mg
|
$1.56 |
$1.56 |
$1.56 |
$1.56
|
|
Romidepsin 10 mg/2 ml intravenous powder for solution
|
$31.08 |
$31.08 |
$31.08 |
$127.20
|
|
Romiplostim 125 mcg subcutaneous solution
|
$11.00 |
$11.00 |
$11.00 |
$34.60
|
|
Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper)
|
$12.00 |
$12.00 |
$12.00 |
$8,372.44
|
|
Rotavirus antibody
|
$18.23 |
$18.23 |
$18.23 |
$18.23
|
|
Routine footcare pt w lops
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Rozanolixizumab-noli 140 mg/ml subcutaneous solution
|
$23.16 |
$23.16 |
$23.16 |
$23.16
|
|
Rp loclzj tum 2+area 1+d img
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Rp loclzj tum spect w/ct 1
|
$1,305.48 |
$1,305.48 |
$1,305.48 |
$2,767.80
|
|
Rp loclzj tum spect w/ct 2
|
$1,458.59 |
$1,458.59 |
$1,458.59 |
$3,322.20
|
|
Rp therapy unlisted px
|
$224.13 |
$224.13 |
$224.13 |
$224.13
|
|
Rpl non-tun cvc wo sbq prt/pmp
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,587.20
|
|
Rpl picc wo subq port/pump incl image guidnc w/s&i
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,534.25
|
|
Rpl tun cvc wo subq port
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Rpl tun-cvad w subq port
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,880.50
|
|
Rpl tun-cvad w subq pump
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Rplc oi implt sk tc esp>=100
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Rplcm oi implt sk tc esp<100
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Rplcmt oi implt skl prq esp
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Rpr aa hrn 1st 3-10 ncr/strn
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Rpr aa hrn 1st 3-10 rdc
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,239.75
|
|
Rpr aa hrn 1st < 3 cm rdc
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$6,856.20
|
|
Rpr aa hrn 1st < 3 ncr/strn
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$10,089.00
|
|
Rpr aa hrn 1st > 10 rdc
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,239.75
|
|
Rpr aa hrn rcr 3-10 rdc
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,239.75
|
|
Rpr aa hrn rcr < 3 ncr/strn
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Rpr aa hrn rcr < 3 rdc
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Rpr blood ves w/vein graft/up ext 35236
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Rpr blood vsl grf oth vein lo ex
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Rpr choanal atresia ntranasl
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rpr choanal atresia trsnpltn
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rpr fem hernia init blocked
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Rpr hern preemie reduc
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Rpr hypspad comp dsj & urtp
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Rpr hypspad comp simple
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Rpr ing hern premie blocked
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Rpr ing hernia baby blocked
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Rpr ing hernia baby reduc
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Rpr ing hernia init blocked
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$3,529.06
|
|
Rpr ing hernia init reduce
|
$6,239.75 |
$6,239.75 |
$6,239.75 |
$6,239.75
|
|
Rpr intst excl anrect fist
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Rpr nsl vlv collapse w/implt
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rpr nsl vlv collapse w/rmdlg
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Rpr rem hernia init reduce
|
$3,529.06 |
$3,529.06 |
$3,529.06 |
$1,509.60
|
|
Rpr xtnsr tndn leg prim without grft ea tndn
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Rpr&refit spct prsth aphakia
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Rrp hypspad comp moblj&urtp
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Rsv assay w/optic
|
$13.10 |
$13.10 |
$13.10 |
$13.60
|
|
Rtm 1st set-up&pt educaj eqp
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Rtm dev sply mscskl 16-30 d
|
$37.29 |
$37.29 |
$37.29 |
$37.29
|
|
Rtm dev sply resp sys 16-30d
|
$37.29 |
$37.29 |
$37.29 |
$37.29
|
|
Rubella antibody igg
|
$14.39 |
$14.39 |
$14.39 |
$84.00
|
|
Rubeola antibody igg
|
$12.88 |
$12.88 |
$12.88 |
$165.00
|
|
Russell viper venom diluted
|
$9.58 |
$9.58 |
$9.58 |
$119.40
|
|
Rx metab gen seq alys pnl 6
|
$917.08 |
$917.08 |
$917.08 |
$917.08
|
|
S bowel endoscope w/stent
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$4,379.25
|
|
Sacituzumab govitecan-hziy 180 mg intravenous solution
|
$36.26 |
$36.26 |
$36.26 |
$5,043.00
|
|
Salivary gland function exam
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Salivary gland imaging
|
$401.83 |
$401.83 |
$401.83 |
$541.50
|
|
Salivary glnd img serial img
|
$401.83 |
$401.83 |
$401.83 |
$1,228.80
|
|
Salmonella antibody
|
$13.19 |
$13.19 |
$13.19 |
$29.25
|
|
Salpingostomy 58770
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Same day nb discharge 99463
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Sargramostim injection
|
$56.09 |
$56.09 |
$56.09 |
$1,092.15
|
|
Sars-cov-2 antb quantitative
|
$51.43 |
$51.43 |
$51.43 |
$51.43
|
|
Sarscov & inf vir a&b ag ia
|
$70.29 |
$70.29 |
$70.29 |
$70.29
|
|
Sarscov coronavirus ag ia
|
$35.33 |
$35.33 |
$35.33 |
$34.80
|
|
Sc ther infusion reset pump
|
$71.17 |
$71.17 |
$71.17 |
$71.17
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$241.72 |
$241.72 |
$241.72 |
$1,126.20
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$106.34 |
$106.34 |
$106.34 |
$873.00
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$241.72 |
$241.72 |
$241.72 |
$819.60
|
|
Scan duplex aorta/ivc/iliac unilateral/limited
|
$106.34 |
$106.34 |
$106.34 |
$715.80
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$106.34 |
$106.34 |
$106.34 |
$518.40
|
|
Scan duplex extremity veins unilateral/limited study
|
$106.34 |
$106.34 |
$106.34 |
$810.75
|
|
Scan duplex lower extremity arteries complete bilateral
|
$241.72 |
$241.72 |
$241.72 |
$1,108.20
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$106.34 |
$106.34 |
$106.34 |
$830.25
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$106.34 |
$106.34 |
$106.34 |
$779.25
|
|
Sclerotherapy fluid collection pq w/img
|
$1,620.24 |
$1,620.24 |
$1,620.24 |
$1,810.50
|
|
Scope plantar fasciotomy
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Scr c/v cyto,thinlayer,rescr
|
$26.49 |
$26.49 |
$26.49 |
$78.00
|
|
Scr c/v cyto,thinlayer,rescr
|
$43.97 |
$43.97 |
$43.97 |
$43.97
|
|
Screen cerv/vag thin layer
|
$20.26 |
$20.26 |
$20.26 |
$61.20
|
|
Screen pap by tech w md supv
|
$18.19 |
$18.19 |
$18.19 |
$18.19
|
|
Screening Colonoscopy (average risk)
|
$911.71 |
$911.71 |
$911.71 |
$1,440.00
|
|
Screening Colonoscopy (high risk)
|
$911.71 |
$911.71 |
$911.71 |
$1,864.80
|
|
Screening HIV antigen/antibody combination assay
|
$24.08 |
$24.08 |
$24.08 |
$24.08
|
|
Screening Mammogram
|
$169.06 |
$169.06 |
$169.06 |
$331.50
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$18.05 |
$18.05 |
$18.05 |
$100.20
|
|
Screening hepatitis b non-obstetric high risk
|
$28.27 |
$28.27 |
$28.27 |
$60.00
|
|
Screening hepatitis c antibody high risk
|
$46.35 |
$46.35 |
$46.35 |
$46.80
|
|
Screening prostate cancer PSA
|
$19.31 |
$19.31 |
$19.31 |
$96.00
|
|
Sedimentation rate erythrocyte automated
|
$2.70 |
$2.70 |
$2.70 |
$51.00
|
|
Select picture audiometry
|
$59.40 |
$59.40 |
$59.40 |
$56.25
|
|
Self-meas bp pt educaj/train
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Semen analysis presence/motility
|
$12.05 |
$12.05 |
$12.05 |
$86.40
|
|
Semen analysis w/count
|
$8.61 |
$8.61 |
$8.61 |
$64.20
|
|
Sensorimotor examination
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Sensorineural acuity lvl tst
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Separate eyelid adhesions
|
$2,332.96 |
$2,332.96 |
$2,332.96 |
$2,332.96
|
|
Sept9 promoter methylation analysis
|
$192.00 |
$192.00 |
$192.00 |
$602.40
|
|
Sequestrectomy olecrn proces
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Sequestrectomy radial h/n
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Sequestrectomy shft/dstl hum
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Serpina1 gene
|
$43.65 |
$43.65 |
$43.65 |
$345.60
|
|
Set radiation therapy field
|
$366.07 |
$366.07 |
$366.07 |
$1,485.60
|
|
Set radiation therapy field
|
$366.07 |
$366.07 |
$366.07 |
$1,029.00
|
|
Set radiation therapy field
|
$132.77 |
$132.77 |
$132.77 |
$655.20
|
|
Set-up cardiovert-defibrill
|
$299.91 |
$299.91 |
$299.91 |
$625.80
|
|
Sever cranial nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Sex transformation f to m
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Sex transformation m to f
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Sgmdsc w/band ligation
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,564.40
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.5cm/<
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm
|
$198.70 |
$198.70 |
$198.70 |
$615.00
|
|
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm
|
$399.53 |
$399.53 |
$399.53 |
$819.00
|
|
Shave sgl skin lsn f/e/e/n/l/m >2cm
|
$399.53 |
$399.53 |
$399.53 |
$582.75
|
|
Shave sgl skin lsn s/n/h/f/g 0.5cm/<
|
$198.70 |
$198.70 |
$198.70 |
$494.40
|
|
Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm
|
$198.70 |
$198.70 |
$198.70 |
$520.80
|
|
Shave sgl skin lsn s/n/h/f/g 1.1-2cm
|
$198.70 |
$198.70 |
$198.70 |
$252.00
|
|
Shave sgl skin lsn s/n/h/f/g >2cm
|
$399.53 |
$399.53 |
$399.53 |
$399.53
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$399.53 |
$399.53 |
$399.53 |
$520.80
|
|
Shave sgl skin lsn t/a/l 0.6-1.0cm
|
$198.70 |
$198.70 |
$198.70 |
$206.25
|
|
Shave sgl skin lsn t/a/l 1.1-2.0cm
|
$198.70 |
$198.70 |
$198.70 |
$660.00
|
|
Shigella antibody
|
$24.48 |
$24.48 |
$24.48 |
$24.48
|
|
Sho arthrs dx +- synovial bx
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Sho arthrs srg bicp tenodsis
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Sho arthrs srg capsulorraphy
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Sho arthrs srg compl synvct
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Sho arthrs srg lmtd dbrdmt
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Sho arthrs srg lss&rescj ads
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Sho arthrs srg prtl synvct
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Sho arthrs srg rmvl loose/fb
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Sho arthrs srg rpr slap les
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Sho arthrs srg xtnsv dbrdmt
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Shorten radius & ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Shorten radius or ulna
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Shortening of hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,272.00
|
|
Shoulder MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,650.10
|
|
Shoulder MRI (with contrast)
|
$790.06 |
$790.06 |
$790.06 |
$2,769.75
|
|
Shoulder MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$1,938.28
|
|
Shoulder X-ray
|
$88.05 |
$88.05 |
$88.05 |
$306.88
|
|
Shoulder prosthesis removal
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Shuntogram nonvascular supervision & interpretation
|
$106.34 |
$106.34 |
$106.34 |
$262.80
|
|
Sialidase enzyme assay
|
$12.22 |
$12.22 |
$12.22 |
$143.40
|
|
Sialography s&i
|
$241.72 |
$241.72 |
$241.72 |
$547.80
|
|
Sialolithotomy 42330
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,732.75
|
|
Sickling rbc
|
$5.51 |
$5.51 |
$5.51 |
$81.00
|
|
Sig w/tndsc balloon dilation
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,738.25
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$911.71 |
$911.71 |
$911.71 |
$1,976.25
|
|
Sigmoidoscopy and biopsy
|
$911.71 |
$911.71 |
$911.71 |
$1,831.50
|
|
Sigmoidoscopy flex decompression 45337
|
$911.71 |
$911.71 |
$911.71 |
$2,571.60
|
|
Sigmoidoscopy for bleeding
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,885.20
|
|
Sigmoidoscopy w/ablation
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,604.00
|
|
Sigmoidoscopy w/fb removal 45332
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,885.20
|
|
Sigmoidoscopy w/plcmt stent
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$4,379.25
|
|
Sigmoidoscopy w/resection
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,712.75
|
|
Sigmoidoscopy w/tumr remove
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$1,885.20
|
|
Sigmoidoscopy w/ultrasound
|
$911.71 |
$911.71 |
$911.71 |
$1,380.60
|
|
Sigmoidoscopy w/us guide bx
|
$1,179.08 |
$1,179.08 |
$1,179.08 |
$2,106.60
|
|
Sigmoidoscopy/submucosal injection 45335
|
$911.71 |
$911.71 |
$911.71 |
$1,650.75
|
|
Signal avg ecg w or without ecg 93278
|
$59.40 |
$59.40 |
$59.40 |
$393.00
|
|
Sim ang w/prs cath rad emb
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$11,340.57
|
|
Simple cystometrogram 51725
|
$243.21 |
$243.21 |
$243.21 |
$759.00
|
|
Single energy x-ray study
|
$106.34 |
$106.34 |
$106.34 |
$106.34
|
|
Sinus CT scan (with and without contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$178.02 |
$178.02 |
$178.02 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$106.34 |
$106.34 |
$106.34 |
$1,275.30
|
|
Sinus/juglr venogram s&i
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,226.60
|
|
Sinusotomy maxillary sinus 31020
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Sinusotomy sinus remove polyps 31032
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Sinusotomy sphenoid w/wo bx 31050
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Sipuleucel-t - su
|
$55,945.97 |
$55,945.97 |
$55,945.97 |
$95,750.46
|
|
Sirolimus-protein bound 100 mg intravenous suspension
|
$84.53 |
$84.53 |
$84.53 |
$84.53
|
|
Skin Biopsy
|
$198.70 |
$198.70 |
$198.70 |
$378.65
|
|
Skin and muscle repair face
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Skin full graft 20sq cm less 15200
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Skin pedicle flap arms/legs
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Skin pedicle flap trunk
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Skin test unlisted antigen ea
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Sleep Study (Polysomnography)
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$4,141.16
|
|
Sleep study attended
|
$530.60 |
$530.60 |
$530.60 |
$404.25
|
|
Sleep study unattended
|
$156.46 |
$156.46 |
$156.46 |
$632.25
|
|
Slitting of prepuce
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$4,029.00
|
|
Slitting of prepuce
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Slp stdy unatnd w/anal
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Sm-153 lexidron ther
|
$4,314.91 |
$4,314.91 |
$4,314.91 |
$5,947.80
|
|
Small bowel endoscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,414.00
|
|
Small bowel endoscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,175.50
|
|
Small bowel endoscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,350.50
|
|
Small bowel endoscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Small bowel endoscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,466.00
|
|
Small bowel endoscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Small bowel endoscopy
|
$937.56 |
$937.56 |
$937.56 |
$2,467.50
|
|
Small bowel endoscopy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,597.25
|
|
Small bowel endoscopy 44365
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$2,040.75
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,096.75
|
|
Small bowel endoscopy br/wa
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Small bowel endoscopy br/wa
|
$937.56 |
$937.56 |
$937.56 |
$1,895.40
|
|
Small bowel endoscopy/biopsy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$3,414.00
|
|
Small bowel endoscopy/biopsy
|
$1,896.99 |
$1,896.99 |
$1,896.99 |
$1,896.99
|
|
Small bowel endoscopy/stent 44370
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$7,896.80
|
|
Smallpox&monkeypox vac 0.5ml
|
$0.01 |
$0.01 |
$0.01 |
$2.43
|
|
Smear fluorescent and/or acid fast stain
|
$5.39 |
$5.39 |
$5.39 |
$81.00
|
|
Smear gram stain
|
$4.27 |
$4.27 |
$4.27 |
$55.80
|
|
Smear nasal eosinophil
|
$5.79 |
$5.79 |
$5.79 |
$47.25
|
|
Smear special stain inclusion bodies/parasites
|
$5.99 |
$5.99 |
$5.99 |
$43.20
|
|
Smear wet mount
|
$5.82 |
$5.82 |
$5.82 |
$77.25
|
|
Smn1 gene full gene sequence
|
$301.35 |
$301.35 |
$301.35 |
$301.35
|
|
Smpd1 gene common variants
|
$47.00 |
$47.00 |
$47.00 |
$1,189.20
|
|
Snrpn/ube3a gene
|
$51.07 |
$51.07 |
$51.07 |
$376.50
|
|
So gsap cl fr cpy nmbr&mcrst
|
$1,345.31 |
$1,345.31 |
$1,345.31 |
$1,345.31
|
|
So gsap cll fr dna/dna&rna
|
$1,195.83 |
$1,195.83 |
$1,195.83 |
$2,242.50
|
|
So gsap cll fr mcrstl ins
|
$3,288.51 |
$3,288.51 |
$3,288.51 |
$3,288.51
|
|
So gsap dna cpy nmbr&mcrstl
|
$1,046.35 |
$1,046.35 |
$1,046.35 |
$1,137.00
|
|
So neo gsap dna mcrstl ins
|
$896.87 |
$896.87 |
$896.87 |
$896.87
|
|
So neo gsap dna/dna&rna
|
$2,989.55 |
$2,989.55 |
$2,989.55 |
$2,989.55
|
|
Sodium 24 hour urine
|
$5.06 |
$5.06 |
$5.06 |
$52.20
|
|
Sodium serum/plasma/whole blood
|
$4.81 |
$4.81 |
$4.81 |
$40.20
|
|
Software meas of cardiac vol
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
Somatosensory testing
|
$311.40 |
$311.40 |
$311.40 |
$760.80
|
|
Somatropin injection
|
$48.92 |
$48.92 |
$48.92 |
$2,111.40
|
|
Sotalol hydrochloride IV
|
$25.05 |
$25.05 |
$25.05 |
$13,396.05
|
|
Special physics consult
|
$132.77 |
$132.77 |
$132.77 |
$732.00
|
|
Special radiation dosimetry
|
$132.77 |
$132.77 |
$132.77 |
$471.00
|
|
Special radiation treatment
|
$578.47 |
$578.47 |
$578.47 |
$1,986.00
|
|
Special teletx port plan
|
$366.07 |
$366.07 |
$366.07 |
$975.60
|
|
Specific gravity body fluid
|
$3.28 |
$3.28 |
$3.28 |
$25.80
|
|
Specimen fat stain
|
$5.88 |
$5.88 |
$5.88 |
$60.75
|
|
Speech audiometry complete
|
$59.40 |
$59.40 |
$59.40 |
$104.25
|
|
Speech evaluation complex
|
$241.72 |
$241.72 |
$241.72 |
$927.00
|
|
Speech recep thresh
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Sperm antibody test
|
$10.67 |
$10.67 |
$10.67 |
$73.80
|
|
Sperm identification
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Sperm isolation complex
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Sperm isolation simple
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Sperm washing 58323
|
$201.17 |
$201.17 |
$201.17 |
$201.17
|
|
Sphenoid sinus surgery
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$692.52 |
$692.52 |
$692.52 |
$1,439.40
|
|
Spine device implant surgery
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Spirmtry w/brnchdil inf-2 yr
|
$311.40 |
$311.40 |
$311.40 |
$311.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$311.40 |
$311.40 |
$311.40 |
$526.80
|
|
Spirometry up to 2 yrs old
|
$156.46 |
$156.46 |
$156.46 |
$929.25
|
|
Spleen imaging
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Split blood or products
|
$171.36 |
$171.36 |
$171.36 |
$303.00
|
|
Sprchoroidal spc njx rx agt
|
$331.69 |
$331.69 |
$331.69 |
$331.69
|
|
Sputum specimen collection
|
$171.36 |
$171.36 |
$171.36 |
$337.50
|
|
Sr-89 stront chlor ther / mci
|
$4,146.34 |
$4,146.34 |
$4,146.34 |
$2,773.60
|
|
Srs linear based
|
$7,644.49 |
$7,644.49 |
$7,644.49 |
$8,479.20
|
|
Srs multisource
|
$7,644.49 |
$7,644.49 |
$7,644.49 |
$7,644.49
|
|
St analysis behavior qualitative voice/resonance
|
$140.62 |
$140.62 |
$140.62 |
$318.75
|
|
St cognitve performance testing healthcare professional each hour
|
$129.95 |
$129.95 |
$129.95 |
$330.75
|
|
St evaluate speech sound production
|
$142.56 |
$142.56 |
$142.56 |
$310.20
|
|
St evaluate speech sound production comprehensive/expressive
|
$292.08 |
$292.08 |
$292.08 |
$334.80
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$113.53 |
$113.53 |
$113.53 |
$354.75
|
|
St evaluation swallow function
|
$91.47 |
$91.47 |
$91.47 |
$383.25
|
|
St treatment speech individual
|
$98.27 |
$98.27 |
$98.27 |
$203.40
|
|
St treatment swallow dysfunction/oral
|
$107.20 |
$107.20 |
$107.20 |
$216.80
|
|
Staggered spondaic word test
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Staph a dna amp probe
|
$35.09 |
$35.09 |
$35.09 |
$129.00
|
|
Stem cells total count
|
$77.78 |
$77.78 |
$77.78 |
$102.75
|
|
Stenger test pure tone
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Stenger test speech
|
$530.60 |
$530.60 |
$530.60 |
$404.25
|
|
Stent iliac/open or perc/uni/init 37221
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$17,448.00
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$54,766.80
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$24,161.40
|
|
Stimulation of spinal cord
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Storage/year embryo(s)
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Storage/year oocyte(s)
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Storage/year reprod tissue
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Storage/year sperm/semen
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Str markers spec anal addl
|
$304.81 |
$304.81 |
$304.81 |
$1,683.00
|
|
Str markers specimen anal
|
$233.07 |
$233.07 |
$233.07 |
$1,270.50
|
|
Strapping of ankle and/or ft 29540
|
$157.79 |
$157.79 |
$157.79 |
$315.60
|
|
Strapping of chest
|
$157.79 |
$157.79 |
$157.79 |
$157.79
|
|
Strapping of elbow or wrist 29260
|
$59.40 |
$59.40 |
$59.40 |
$230.25
|
|
Strapping of hand or finger
|
$59.40 |
$59.40 |
$59.40 |
$272.25
|
|
Strapping of hip
|
$128.90 |
$128.90 |
$128.90 |
$147.00
|
|
Strapping of knee
|
$128.90 |
$128.90 |
$128.90 |
$243.60
|
|
Strapping of toes 29550
|
$59.40 |
$59.40 |
$59.40 |
$151.50
|
|
Strep a ag ia
|
$16.81 |
$16.81 |
$16.81 |
$76.80
|
|
Strep a dna dir probe
|
$20.05 |
$20.05 |
$20.05 |
$20.05
|
|
Strep b assay w/optic
|
$12.73 |
$12.73 |
$12.73 |
$12.73
|
|
Strep b dna amp probe
|
$35.09 |
$35.09 |
$35.09 |
$194.40
|
|
Streptokinase antibody
|
$12.66 |
$12.66 |
$12.66 |
$12.66
|
|
Stress test pulmonary
|
$128.90 |
$128.90 |
$128.90 |
$309.00
|
|
Stress tte complete
|
$548.30 |
$548.30 |
$548.30 |
$1,989.60
|
|
Subdural tap fontanelle/sutur infant init 61000
|
$692.52 |
$692.52 |
$692.52 |
$692.52
|
|
Subq njx fil matrl 5.1-10cc
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Subq njx filling matrl 1cc/<
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Subtalar arthro w/deb
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Subtalar arthro w/exc
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Subtalar arthro w/fb rmvl
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Subtalar arthro w/fusion
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Suction lipectomy head&neck
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Suction lipectomy lwr extrem
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Suction lipectomy trunk
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$3,660.97
|
|
Suction lipectomy upr extrem
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Sugars multiple quant
|
$11.53 |
$11.53 |
$11.53 |
$11.53
|
|
Sugars single quant
|
$11.53 |
$11.53 |
$11.53 |
$104.40
|
|
Sup of prep of antigen # of vials 95144
|
$46.14 |
$46.14 |
$46.14 |
$46.14
|
|
Supply of digital device
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Supprelin la implant
|
$45,560.39 |
$45,560.39 |
$45,560.39 |
$185,546.55
|
|
Surg dx exam anorectal
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Surg tx anal fistula 2nd stage 46285
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Surgery for urethra pouch
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Surgery to stop leg growth
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Surgery to stop leg growth
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Surgery to stop leg growth
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Surgery to stop leg growth
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Surgical exposure prostate 55860
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Surgical opening of stomach
|
$937.56 |
$937.56 |
$937.56 |
$937.56
|
|
Surgical opening of throat
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Surgical pathology level 1 gross examination only
|
$24.49 |
$24.49 |
$24.49 |
$58.20
|
|
Surgical pathology level 2 gross & microscopic examination
|
$39.25 |
$39.25 |
$39.25 |
$168.75
|
|
Surgical pathology level 3 gross & microscopic examination
|
$53.43 |
$53.43 |
$53.43 |
$212.40
|
|
Surgical pathology level 4 gross & microscopic examination
|
$53.43 |
$53.43 |
$53.43 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$359.72 |
$359.72 |
$359.72 |
$472.50
|
|
Surgical pathology level 6 gross & microscopic examination
|
$816.90 |
$816.90 |
$816.90 |
$691.20
|
|
Suscept studies macrobroth dilution ea
|
$6.64 |
$6.64 |
$6.64 |
$87.00
|
|
Susceptibility agar dilution per agent
|
$4.75 |
$4.75 |
$4.75 |
$69.75
|
|
Susceptibility enzyme detection per enzyme
|
$4.75 |
$4.75 |
$4.75 |
$24.75
|
|
Susceptibility mic per plate
|
$8.65 |
$8.65 |
$8.65 |
$88.20
|
|
Suspension of testis
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Svc venogram s&i
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,241.75
|
|
Sweat collection by iontophoresis
|
$53.43 |
$53.43 |
$53.43 |
$73.80
|
|
Sympathectomy cervical
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Sympathectomy digital artery
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Sympathectomy supfc palmar
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Synthetic sentence id test
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Synvisc or synvisc-one
|
$9.09 |
$9.09 |
$9.09 |
$73.20
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$4.40 |
$4.40 |
$4.40 |
$67.50
|
|
T cells absolute cd 4 count
|
$26.78 |
$26.78 |
$26.78 |
$148.80
|
|
T cells absolute cd4/cd8 including ratio
|
$46.98 |
$46.98 |
$46.98 |
$261.60
|
|
T cells total count
|
$37.73 |
$37.73 |
$37.73 |
$112.80
|
|
T-cell depletion of harvest
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
T3 (triiodothyronine) free
|
$16.94 |
$16.94 |
$16.94 |
$86.40
|
|
T3 (triiodothyronine) total
|
$14.18 |
$14.18 |
$14.18 |
$72.00
|
|
T4 (thyroxine) free
|
$9.02 |
$9.02 |
$9.02 |
$78.00
|
|
T4 (thyroxine) total
|
$6.87 |
$6.87 |
$6.87 |
$82.80
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$262.23 |
$262.23 |
$262.23 |
$1,588.00
|
|
Tacrolimus therapeutic drug level
|
$13.73 |
$13.73 |
$13.73 |
$171.00
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$14.08 |
$14.08 |
$14.08 |
$28.80
|
|
Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection
|
$73.55 |
$73.55 |
$73.55 |
$133.80
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$72.40 |
$72.40 |
$72.40 |
$175.20
|
|
Target gsa panel hmtlmph neop
|
$759.53 |
$759.53 |
$759.53 |
$1,708.50
|
|
Target gsa panel organ neop
|
$597.91 |
$597.91 |
$597.91 |
$1,643.25
|
|
Target gsa panel organ/hmtlmph neop
|
$2,919.60 |
$2,919.60 |
$2,919.60 |
$5,739.00
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$1,567.49 |
$1,567.49 |
$1,567.49 |
$2,828.40
|
|
Tattooing/intraderm 6.1-20.0 sq cm 11921
|
$612.13 |
$612.13 |
$612.13 |
$931.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$100.00 |
$100.00 |
$100.00 |
$615.60
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$61.98 |
$61.98 |
$61.98 |
$345.00
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$0.30 |
$0.30 |
$0.30 |
$357.60
|
|
Tbs techl calculation only
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
Tbs techl prep&transmis data
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
Tc-99m arcitumomab
|
$809.51 |
$809.51 |
$809.51 |
$2,781.60
|
|
Tc-99m bicisate
|
$683.80 |
$683.80 |
$683.80 |
$697.80
|
|
Tc-99m exame autol wbc diag per dose
|
$1,040.32 |
$1,040.32 |
$1,040.32 |
$1,040.32
|
|
Tc-99m exametazime diag
|
$802.34 |
$802.34 |
$802.34 |
$1,461.00
|
|
Tc-99m non-heu per study dose
|
$10.00 |
$10.00 |
$10.00 |
$15.00
|
|
Tca peel dermal 15789
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Tcd emboli detect w/inj
|
$106.34 |
$106.34 |
$106.34 |
$585.00
|
|
Tcd emboli detect without inj
|
$106.34 |
$106.34 |
$106.34 |
$240.60
|
|
Tcran magn stim redetemine
|
$311.40 |
$311.40 |
$311.40 |
$354.00
|
|
Tcranial magn stim tx deli
|
$311.40 |
$311.40 |
$311.40 |
$354.00
|
|
Tcranial magn stim tx plan
|
$311.40 |
$311.40 |
$311.40 |
$354.00
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$217.09 |
$217.09 |
$217.09 |
$418.80
|
|
Tee w or without fol w/cont, mon
|
$790.06 |
$790.06 |
$790.06 |
$865.50
|
|
Tee w or without fol w/cont,cong
|
$790.06 |
$790.06 |
$790.06 |
$1,626.00
|
|
Telavancin injection
|
$7.47 |
$7.47 |
$7.47 |
$987.60
|
|
Telethx isodose plan cplx
|
$366.07 |
$366.07 |
$366.07 |
$2,237.40
|
|
Telethx isodose plan simple
|
$366.07 |
$366.07 |
$366.07 |
$1,855.20
|
|
Temozolomide 100 mg intravenous solution
|
$10.39 |
$10.39 |
$10.39 |
$1,714.80
|
|
Temperature gradient studies
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$32.29 |
$32.29 |
$32.29 |
$539.40
|
|
Tendon lengthening
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tendon lngth upr a/e ea tdn
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tendon shortening
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tendon transfer with graft
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$171.94 |
$171.94 |
$171.94 |
$14,427.60
|
|
Tenodesis biceps tdn at elbw
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Tenolysis extensor tendon hand/finger each
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tenolysis triceps
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tenoplasty elbow to sho 1
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Tenosynovectomy radic 26145
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Tenotomy length/rls abductor hallucis musc 28240
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Tert gene targeted seq alys
|
$185.20 |
$185.20 |
$185.20 |
$347.25
|
|
Test for chlorohydrocarbons
|
$6.01 |
$6.01 |
$6.01 |
$94.80
|
|
Test for porphobilinogen
|
$5.82 |
$5.82 |
$5.82 |
$5.82
|
|
Test for urine cystines
|
$9.55 |
$9.55 |
$9.55 |
$9.55
|
|
Test pathogen(s) for platelets reference
|
$59.40 |
$59.40 |
$59.40 |
$51.00
|
|
Test stress cardiovascular tracing only
|
$311.40 |
$311.40 |
$311.40 |
$1,012.50
|
|
Test urine for lactose
|
$11.25 |
$11.25 |
$11.25 |
$11.25
|
|
Test urine for porphyrins
|
$13.36 |
$13.36 |
$13.36 |
$25.80
|
|
Test urine urobilinogen
|
$4.47 |
$4.47 |
$4.47 |
$4.47
|
|
Testicular imaging w/vasc flow
|
$401.83 |
$401.83 |
$401.83 |
$1,193.40
|
|
Testosterone undecanoate 1mg
|
$1.99 |
$1.99 |
$1.99 |
$1.99
|
|
Tetanus immune globulin inj
|
$577.05 |
$577.05 |
$577.05 |
$1,524.00
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$18.30 |
$18.30 |
$18.30 |
$48.80
|
|
Tgsap hl neo 5-50 rna alys
|
$759.53 |
$759.53 |
$759.53 |
$759.53
|
|
Tgsap so neo 5-50 rna alys
|
$597.91 |
$597.91 |
$597.91 |
$597.91
|
|
Tgsap so/hl 51/< rna alys
|
$2,919.60 |
$2,919.60 |
$2,919.60 |
$2,157.60
|
|
Thaw cryoprsvrd reprod tiss
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Thaw preserved stem cells
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Thawing cryopresrved embryo
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Thawing cryopresrved oocyte
|
$171.36 |
$171.36 |
$171.36 |
$171.36
|
|
Thawing cryopresrved sperm
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Theophylline therapeutic drug level
|
$14.14 |
$14.14 |
$14.14 |
$111.00
|
|
Ther fx nasal inf turbinate
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Ther nma rdctj intus/obstrcj
|
$178.02 |
$178.02 |
$178.02 |
$208.50
|
|
Ther/proph/diag inj ia
|
$210.69 |
$210.69 |
$210.69 |
$369.00
|
|
Therapeutic procd strg endur
|
$24.49 |
$24.49 |
$24.49 |
$49.20
|
|
Therapeutic pulpotomy
|
$1,662.63 |
$1,662.63 |
$1,662.63 |
$1,662.63
|
|
Therapy activation ipnss
|
$91.79 |
$91.79 |
$91.79 |
$90.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$40.94 |
$40.94 |
$40.94 |
$40.94
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$34.61 |
$34.61 |
$34.61 |
$25.80
|
|
Therapy photodnmc lght dstr lsn skn by staff rx per day
|
$198.70 |
$198.70 |
$198.70 |
$765.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$618.26 |
$618.26 |
$618.26 |
$1,542.40
|
|
Thoracoscopy diagnostic 32601
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Thoracoscopy w/bx med space
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Thoracoscopy wbx sac
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Thorcscpy w/biop pleura
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Thrcspy w/diag bp lng inf uni
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Thrcspy w/diag bp lng nod uni
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Throat x-ray & fluoroscopy
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
Thrombectomy/inf pq dialysis circuit
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$5,701.52
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$8,133.75
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$12,329.25
|
|
Thrombin time
|
$5.77 |
$5.77 |
$5.77 |
$86.40
|
|
Thrombin time titer
|
$6.85 |
$6.85 |
$6.85 |
$6.85
|
|
Thromboendarterectomy including patch graft if preformed;
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$6.47 |
$6.47 |
$6.47 |
$96.60
|
|
Thromboxane urine
|
$35.11 |
$35.11 |
$35.11 |
$130.80
|
|
Thumb fusion with graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Thumb fusion with graft
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Thumb tendon transfer
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Thymectomy prtl/tot transcervical appr 60520
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Thyroglobulin antibody
|
$15.91 |
$15.91 |
$15.91 |
$154.80
|
|
Thyroid (TSH) Test
|
$16.80 |
$16.80 |
$16.80 |
$110.00
|
|
Thyroid Ultrasound
|
$106.34 |
$106.34 |
$106.34 |
$603.90
|
|
Thyroid imaging
|
$401.83 |
$401.83 |
$401.83 |
$999.00
|
|
Thyroid met imaging
|
$401.83 |
$401.83 |
$401.83 |
$869.40
|
|
Thyroid met imaging/studies
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Thyroid mets imag whole body
|
$538.27 |
$538.27 |
$538.27 |
$2,013.75
|
|
Thyroid uptake measurement
|
$401.83 |
$401.83 |
$401.83 |
$856.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$2,113.24 |
$2,113.24 |
$2,113.24 |
$7,476.81
|
|
Thyrotropin releasing hormone
|
$50.41 |
$50.41 |
$50.41 |
$50.41
|
|
Thyroxine binding globulin (tbg)
|
$14.78 |
$14.78 |
$14.78 |
$96.60
|
|
Tib/per revasc stent & ather 37231
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$17,956.72
|
|
Tibial arthroscopy/surgery
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Tibial arthroscopy/surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Tilt table study
|
$530.60 |
$530.60 |
$530.60 |
$1,428.00
|
|
Tisagenlecleucel car-pos t
|
$578,324.58 |
$578,324.58 |
$578,324.58 |
$2,194,589.53
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$188.65 |
$188.65 |
$188.65 |
$334.80
|
|
Tissue culture placenta
|
$150.30 |
$150.30 |
$150.30 |
$1,024.20
|
|
Tissue culture skin/biopsy
|
$140.73 |
$140.73 |
$140.73 |
$1,299.00
|
|
Tissue culture tumor
|
$147.52 |
$147.52 |
$147.52 |
$873.75
|
|
Tissue exam koh skin/hair/nails
|
$4.27 |
$4.27 |
$4.27 |
$70.80
|
|
Tissue transglutaminase iga
|
$11.53 |
$11.53 |
$11.53 |
$100.20
|
|
Tlh uterus 250 g or less
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Tlh uterus over 250 g
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Tlh w/t/o 250 g or less
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Tlh w/t/o uterus over 250 g
|
$10,411.22 |
$10,411.22 |
$10,411.22 |
$10,411.22
|
|
Tnot opn elbw to sho ea tdn
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tobramycin peak therapeutic drug level
|
$16.13 |
$16.13 |
$16.13 |
$115.80
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5.79 |
$5.79 |
$5.79 |
$5,861.40
|
|
Tomosynthesis breast diagnostic left
|
$53.92 |
$53.92 |
$53.92 |
$108.00
|
|
Tomosynthesis breast screen bilateral
|
$65.52 |
$65.52 |
$65.52 |
$65.52
|
|
Tone decay hearing test
|
$39.25 |
$39.25 |
$39.25 |
$39.25
|
|
Tongue base vol reduction
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Tongue biopsy; posterior one-third 41105
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$2,845.50
|
|
Tongue suspension
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Tongue to lip surgery
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Tonsillectomy (age 12+)
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$2,735.53
|
|
Tonsillectomy (child under 12)
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$1,240.00
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$39.50 |
$39.50 |
$39.50 |
$70.20
|
|
Tot disc arthrp 1ntrspc crv
|
$18,390.05 |
$18,390.05 |
$18,390.05 |
$18,390.05
|
|
Total Hip Replacement
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$9,613.60
|
|
Total Knee Replacement
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,668.80
|
|
Toxoplasma antibody igg
|
$14.39 |
$14.39 |
$14.39 |
$108.60
|
|
Toxoplasma antibody igm
|
$14.41 |
$14.41 |
$14.41 |
$106.50
|
|
Tp53 gene full gene sequence
|
$641.85 |
$641.85 |
$641.85 |
$3,902.40
|
|
Tp53 gene trgt sequence alys
|
$329.51 |
$329.51 |
$329.51 |
$2,041.20
|
|
Tpmt gene com vrnts
|
$174.81 |
$174.81 |
$174.81 |
$477.00
|
|
Tprnl balo cntnc dev adjmt
|
$243.21 |
$243.21 |
$243.21 |
$243.21
|
|
Tprnl balo cntnc dev bi
|
$12,992.42 |
$12,992.42 |
$12,992.42 |
$12,992.42
|
|
Tprnl balo cntnc dev rmvl ea
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Tprnl balo cntnc dev uni
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Tprnl plmt biodegrdabl matrl
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Tr retinal les preterm inf
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Trabectedin 1 mg intravenous solution
|
$383.07 |
$383.07 |
$383.07 |
$2,068.20
|
|
Trabeculoplasty laser surg
|
$548.60 |
$548.60 |
$548.60 |
$671.25
|
|
Trachelectomy (cervicectomy) 57530
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Tracheobrnchsc thru est trachs incisn
|
$509.25 |
$509.25 |
$509.25 |
$1,812.00
|
|
Tracheostoma revision; simple, without flap rotation
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$68.91 |
$68.91 |
$68.91 |
$121.20
|
|
Transabdom amnioinfus w/us
|
$304.19 |
$304.19 |
$304.19 |
$338.25
|
|
Transcath biopsy
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$3,482.25
|
|
Transcath closure of asd
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$15,283.20
|
|
Transcath closure of vsd
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$15,782.25
|
|
Transcath occlusion non-cns
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$11,340.57
|
|
Transcath rmvl perm ldss pmkr rv
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,724.00
|
|
Transcrv abltj utrn fibrd rf
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Transcutaneous hgb 88738
|
$5.02 |
$5.02 |
$5.02 |
$5.02
|
|
Transfer of abdominal muscle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Transfer of embryo
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Transfer of iliopsoas muscle
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Transfer of iliopsoas muscle
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transfer of spinal muscle
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transfer skin pedicle flap
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Transfer tendon to pelvis
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transferrin
|
$12.76 |
$12.76 |
$12.76 |
$108.00
|
|
Transfusion blood/blood component(s)
|
$437.18 |
$437.18 |
$437.18 |
$1,008.60
|
|
Transorl lwr esophgl myotomy
|
$5,952.81 |
$5,952.81 |
$5,952.81 |
$5,814.75
|
|
Transperi needle place pros
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Transplant forearm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transplant forearm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transplant hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transplant of thigh tendon
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Transplant palm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transplant/graft hand tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transplant/graft palm tendon
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Transplants of thigh tendons
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Transplj hematopoietic boost
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$1,437.00
|
|
Transplt allo hct/donor
|
$59,142.33 |
$59,142.33 |
$59,142.33 |
$3,943.20
|
|
Transplt allo lymphocytes
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$1,639.28
|
|
Transplt autol hct/donor
|
$1,639.28 |
$1,639.28 |
$1,639.28 |
$3,260.40
|
|
Transposition of vein valve
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$5,405.70
|
|
Transurethral rf treatment
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Trastuzumab 150 mg intravenous solution
|
$76.18 |
$76.18 |
$76.18 |
$5,762.28
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$43.28 |
$43.28 |
$43.28 |
$1,410.00
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$28.62 |
$28.62 |
$28.62 |
$198.00
|
|
Trauma partial team response w/critical care services level 4
|
$1,323.17 |
$1,323.17 |
$1,323.17 |
$6,448.80
|
|
Trb@ gene rearrange dirprobe
|
$49.59 |
$49.59 |
$49.59 |
$49.59
|
|
Treat ankle dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,980.00
|
|
Treat ankle dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treat ankle dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat ankle fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treat big toe fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat cheek bone fracturemalar 21360
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Treat clavicle dislocation 23545
|
$239.88 |
$239.88 |
$239.88 |
$998.40
|
|
Treat ectopic pregnancy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Treat ectopic pregnancy
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Treat elbow dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat elbow dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,074.80
|
|
Treat elbow fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treat elbow fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Treat elbow fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,135.00
|
|
Treat eyelid by injection
|
$399.04 |
$399.04 |
$399.04 |
$399.04
|
|
Treat eyelid lesion 67850
|
$968.54 |
$968.54 |
$968.54 |
$968.54
|
|
Treat finger fracture each
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,055.00
|
|
Treat finger fracture each
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat foot bone lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat foot dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat foot dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat foot dislocation
|
$239.88 |
$239.88 |
$239.88 |
$261.75
|
|
Treat foot dislocation
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Treat foot dislocation
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Treat foot dislocation
|
$239.88 |
$239.88 |
$239.88 |
$568.20
|
|
Treat foot dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat foot dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Treat fracture of radius
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Treat fracture of radius
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,815.75
|
|
Treat fracture of ulna
|
$239.88 |
$239.88 |
$239.88 |
$1,728.60
|
|
Treat hand bone lesion
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Treat hand dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
Treat hand dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat hand dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat heel fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treat hip dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,050.40
|
|
Treat hip dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$4,051.20
|
|
Treat humerus fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,055.00
|
|
Treat humerus fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$7,589.40
|
|
Treat humerus fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Treat humerus fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat humerus fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Treat humerus fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,552.40
|
|
Treat humerus fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Treat humerus fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Treat humerus fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Treat knee dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,630.40
|
|
Treat knee fracture 27530
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Treat knee fracture(s)
|
$239.88 |
$239.88 |
$239.88 |
$642.00
|
|
Treat kneecap dislocation
|
$239.88 |
$239.88 |
$239.88 |
$2,336.00
|
|
Treat kneecap dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$4,493.40
|
|
Treat kneecap fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treat knuckle dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat knuckle dislocation
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,448.20
|
|
Treat lower jaw fracture 21462
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Treat lower leg bone lesion
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat lower leg dislocation
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat lower leg dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat lower leg dislocation
|
$239.88 |
$239.88 |
$239.88 |
$2,812.80
|
|
Treat lower leg fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$5,152.80
|
|
Treat lower leg fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treat lower leg fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Treat lower leg joint
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$4,493.40
|
|
Treat metacarpal fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat metacarpal fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat metatarsal fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$6,347.40
|
|
Treat metatarsal fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat midfoot fracture each
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$5,502.00
|
|
Treat midfoot fracture each
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat penis lesion graft
|
$9,247.15 |
$9,247.15 |
$9,247.15 |
$9,247.15
|
|
Treat penis lesion graft
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Treat radius fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Treat radius fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$6,347.40
|
|
Treat sesamoid bone fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat skull fracture
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Treat spinal cord lesion
|
$890.29 |
$890.29 |
$890.29 |
$890.29
|
|
Treat spinal cord lesion
|
$890.29 |
$890.29 |
$890.29 |
$890.29
|
|
Treat sternum fracture
|
$239.88 |
$239.88 |
$239.88 |
$390.75
|
|
Treat tail bone fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat thigh fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$3,355.20
|
|
Treat thigh fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treat thigh fracture
|
$239.88 |
$239.88 |
$239.88 |
$261.75
|
|
Treat thigh fracture
|
$239.88 |
$239.88 |
$239.88 |
$647.20
|
|
Treat thigh fx growth plate
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,678.50
|
|
Treat thigh fx growth plate
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Treat thumb fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat thumb fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat toe dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat toe dislocation
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat toe dislocation
|
$265.58 |
$265.58 |
$265.58 |
$3,197.40
|
|
Treat toe fracture
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treat trigeminal nerve
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Treat trigeminal tract
|
$1,952.77 |
$1,952.77 |
$1,952.77 |
$1,952.77
|
|
Treat ulnar fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,874.60
|
|
Treat ulnar fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treat vaginal bleeding
|
$201.17 |
$201.17 |
$201.17 |
$235.50
|
|
Treat wrist bone fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,815.75
|
|
Treat wrist dislocation
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Treat/graft heel fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,747.20
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,747.20
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,747.20
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$5,405.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$128.90 |
$128.90 |
$128.90 |
$246.60
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$203.39 |
$203.39 |
$203.39 |
$286.80
|
|
Treatment missed abortion completed surgically 1st trimester
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$5,405.40
|
|
Treatment mouth roof lesion
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Treatment of anal fissure
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Treatment of anal fissure w/dilat 46940
|
$2,742.39 |
$2,742.39 |
$2,742.39 |
$2,742.39
|
|
Treatment of ankle fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treatment of ankle fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treatment of ankle fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treatment of ankle fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treatment of ankle fracture 27786
|
$239.88 |
$239.88 |
$239.88 |
$825.60
|
|
Treatment of choroid lesion
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Treatment of corneal lesion
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Treatment of eyelid lesions
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Treatment of fibula fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$5,152.80
|
|
Treatment of fibula fracture 27780
|
$239.88 |
$239.88 |
$239.88 |
$769.80
|
|
Treatment of foot infection
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,560.75
|
|
Treatment of foot infection
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Treatment of gum lesion
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Treatment of heel fracture 28400
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Treatment of miscarriage
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Treatment of mouth lesion physical 40820
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Treatment of penis lesion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Treatment of penis lesion
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$2,862.05
|
|
Treatment of rectal prolapse
|
$911.71 |
$911.71 |
$911.71 |
$911.71
|
|
Treatment of retinal lesion
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Treatment of retinal lesion
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Treatment of retinal lesion
|
$3,771.00 |
$3,771.00 |
$3,771.00 |
$3,771.00
|
|
Treatment of thigh fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,093.25
|
|
Treatment of thigh fracture
|
$239.88 |
$239.88 |
$239.88 |
$677.25
|
|
Treatment of thigh fracture
|
$239.88 |
$239.88 |
$239.88 |
$759.00
|
|
Treatment of thigh fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treatment of thigh fracture
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$2,068.50
|
|
Treatment of tibia fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Treatment of tibia fracture
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Treatment of tibia fracture
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$6,347.40
|
|
Treatment of toe fracture 28510
|
$239.88 |
$239.88 |
$239.88 |
$371.40
|
|
Treatment of urethra lesion
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,048.51
|
|
Treatment of urethra lesion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Treatment of urethra lesion
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Treatment radiation delivery level 2
|
$262.98 |
$262.98 |
$262.98 |
$787.80
|
|
Treatment x10sv retinopathy
|
$548.60 |
$548.60 |
$548.60 |
$548.60
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$141.17 |
$141.17 |
$141.17 |
$258.60
|
|
Treponema pallidum antibody
|
$13.24 |
$13.24 |
$13.24 |
$146.40
|
|
Treprostinil injection
|
$55.48 |
$55.48 |
$55.48 |
$1,570.80
|
|
Trg gene rearrangement anal
|
$201.50 |
$201.50 |
$201.50 |
$732.00
|
|
Triamcinolone a inj prs-free
|
$24.51 |
$24.51 |
$24.51 |
$696.00
|
|
Trichinella antibody
|
$12.56 |
$12.56 |
$12.56 |
$140.25
|
|
Trichomonas assay w/optic
|
$15.29 |
$15.29 |
$15.29 |
$123.60
|
|
Triglycerides
|
$5.74 |
$5.74 |
$5.74 |
$80.40
|
|
Trilaciclib 300 mg intravenous solution
|
$5.39 |
$5.39 |
$5.39 |
$5.39
|
|
Trim nail(s)
|
$59.40 |
$59.40 |
$59.40 |
$105.60
|
|
Trim nondyst nails
|
$59.40 |
$59.40 |
$59.40 |
$138.60
|
|
Triptorelin pamoate
|
$491.90 |
$491.90 |
$491.90 |
$3,103.20
|
|
Trluml dil aq o/f can w/st
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Trluml dil aq o/f can without st
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,715.50
|
|
Trmt of fracture (femoral shaft) 27500
|
$239.88 |
$239.88 |
$239.88 |
$729.60
|
|
Trnscath plc vas stent w/s&i ini vein
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$13,370.25
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$6,120.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$4,949.25
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$6,966.60
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$5,324.40
|
|
Trnscath tx thromblytc vein ini day
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$5,236.20
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$3,660.97 |
$3,660.97 |
$3,660.97 |
$8,968.80
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,955.80
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$1,829.23
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,955.80
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,955.80
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$4,080.00
|
|
Troponin quantitative
|
$12.47 |
$12.47 |
$12.47 |
$114.60
|
|
Trurl dstrj prst8 tiss rf wv
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Tte w or without contr, cont ecg
|
$790.06 |
$790.06 |
$790.06 |
$2,577.00
|
|
Tte w or without fol w/con,stres
|
$790.06 |
$790.06 |
$790.06 |
$1,171.20
|
|
Tte w or without fol w/cont, com
|
$790.06 |
$790.06 |
$790.06 |
$1,098.00
|
|
Tte w or without fol w/cont, f/u
|
$790.06 |
$790.06 |
$790.06 |
$693.75
|
|
Tubal Ligation (Laparoscopic)
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$1,536.60
|
|
Tumor cell deplete of harvst
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Tvh >250 gms 58290
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Tx atrial fib pulm vein isol
|
$24,532.30 |
$24,532.30 |
$24,532.30 |
$29,199.75
|
|
Tx closed distal humerus fx
|
$239.88 |
$239.88 |
$239.88 |
$134.40
|
|
Tx closed hip disl traumatic without anes
|
$239.88 |
$239.88 |
$239.88 |
$998.40
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,483.00
|
|
Tx closed tib shaft fx without manip
|
$239.88 |
$239.88 |
$239.88 |
$718.20
|
|
Tx contour defects 1.1-5.0cc 11951
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Tx contour defects >10.0 cc
|
$612.13 |
$612.13 |
$612.13 |
$612.13
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$5,134.20
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$5,728.20
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$5,368.20
|
|
Tx open nsl sptl fx
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$5,854.20
|
|
Tx tarsal bone fx without manip 28450
|
$239.88 |
$239.88 |
$239.88 |
$509.40
|
|
Tympanic membrane repair
|
$1,481.28 |
$1,481.28 |
$1,481.28 |
$1,481.28
|
|
Tympanolysis transcanal 69450
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Tympanometry & reflex thresh
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$509.25 |
$509.25 |
$509.25 |
$2,048.25
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$5,915.66 |
$5,915.66 |
$5,915.66 |
$5,915.66
|
|
U/s trtmt, not leiomyomata
|
$12,866.82 |
$12,866.82 |
$12,866.82 |
$12,866.82
|
|
Ua w/micro/comp poc
|
$4.02 |
$4.02 |
$4.02 |
$25.80
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$71.90 |
$71.90 |
$71.90 |
$133.20
|
|
Ugt1a1 gene analy common variants
|
$234.00 |
$234.00 |
$234.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$106.34 |
$106.34 |
$106.34 |
$288.00
|
|
Ultrasound bone density measure
|
$106.34 |
$106.34 |
$106.34 |
$106.34
|
|
Ultrasound breast complete
|
$106.34 |
$106.34 |
$106.34 |
$546.60
|
|
Ultrasound breast unilateral limited (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$423.00
|
|
Ultrasound chest
|
$106.34 |
$106.34 |
$106.34 |
$461.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$106.34 |
$106.34 |
$106.34 |
$257.40
|
|
Ultrasound dx ophth b-scan
|
$106.34 |
$106.34 |
$106.34 |
$438.00
|
|
Ultrasound elastography parenchyma
|
$106.34 |
$106.34 |
$106.34 |
$202.20
|
|
Ultrasound encephalogram
|
$106.34 |
$106.34 |
$106.34 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$106.34 |
$106.34 |
$106.34 |
$718.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$106.34 |
$106.34 |
$106.34 |
$540.00
|
|
Ultrasound hips infant dynamic
|
$88.05 |
$88.05 |
$88.05 |
$382.50
|
|
Ultrasound infant hips ltd without stress
|
$88.05 |
$88.05 |
$88.05 |
$295.50
|
|
Ultrasound joint complete left
|
$106.34 |
$106.34 |
$106.34 |
$785.40
|
|
Ultrasound joint/nonvascular extremity limited left
|
$106.34 |
$106.34 |
$106.34 |
$571.80
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$106.34 |
$106.34 |
$106.34 |
$106.34
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$241.72 |
$241.72 |
$241.72 |
$915.75
|
|
Ultrasound pregnant uterus follow up per fetus
|
$106.34 |
$106.34 |
$106.34 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$106.34 |
$106.34 |
$106.34 |
$548.25
|
|
Ultrasound pregnant uterus transvaginal
|
$106.34 |
$106.34 |
$106.34 |
$678.60
|
|
Ultrasound prostate/transrectal
|
$106.34 |
$106.34 |
$106.34 |
$695.40
|
|
Ultrasound retroperitoneal limited
|
$106.34 |
$106.34 |
$106.34 |
$543.00
|
|
Ultrasound scrotum and contents
|
$106.34 |
$106.34 |
$106.34 |
$693.75
|
|
Ultrasound spinal canal and contents
|
$106.34 |
$106.34 |
$106.34 |
$411.00
|
|
Ultrasound transvaginal non obstetric
|
$106.34 |
$106.34 |
$106.34 |
$704.25
|
|
Ultrasound trgt dyn mbubb 1st les
|
$178.02 |
$178.02 |
$178.02 |
$303.00
|
|
Ultraviolet therapy
|
$10.45 |
$10.45 |
$10.45 |
$10.45
|
|
Umbilical cord occlud w/us
|
$304.19 |
$304.19 |
$304.19 |
$304.19
|
|
Unlistd noninvas vasc dx std
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Unlisted CT procedure
|
$88.05 |
$88.05 |
$88.05 |
$758.40
|
|
Unlisted all/immlg svc/px
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Unlisted chemotherapy px
|
$46.14 |
$46.14 |
$46.14 |
$44.25
|
|
Unlisted cranfcl&maxlfcl px
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted cv px dx nuc med
|
$401.83 |
$401.83 |
$401.83 |
$1,864.20
|
|
Unlisted cytogenetic study
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Unlisted cytopathology px
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Unlisted dx gi procedure
|
$156.46 |
$156.46 |
$156.46 |
$247.20
|
|
Unlisted endocrine px dx nuc
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Unlisted fetal invas px w/us
|
$201.17 |
$201.17 |
$201.17 |
$201.17
|
|
Unlisted fluoroscopic px
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
Unlisted gi px dx nuc med
|
$401.83 |
$401.83 |
$401.83 |
$780.60
|
|
Unlisted gu px dx nuc med
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Unlisted hystsc px uterus
|
$201.17 |
$201.17 |
$201.17 |
$201.17
|
|
Unlisted laparoscopic liver biopy 47379
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$3,289.80
|
|
Unlisted laparoscopic procedure 49659
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laparoscopic reduction intestine 44238
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$3,467.40
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px appendix
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px bladder
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px endoc sys
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px esoph
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px lymphtc sys
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px ovidct ovry
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px renal
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px spleen
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px testis
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px ureter
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted laps px uterus
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlisted maxlfcl prosth px
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted misc path test
|
$53.43 |
$53.43 |
$53.43 |
$299.40
|
|
Unlisted mr procedure
|
$88.05 |
$88.05 |
$88.05 |
$1,037.40
|
|
Unlisted muscskel px dx nuc
|
$401.83 |
$401.83 |
$401.83 |
$545.40
|
|
Unlisted muscskel px head
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted neurological dx px
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Unlisted nrvs sys px dx nuc
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Unlisted oph svc/procedure
|
$24.49 |
$24.49 |
$24.49 |
$24.49
|
|
Unlisted orl service/px
|
$24.49 |
$24.49 |
$24.49 |
$117.00
|
|
Unlisted procedure colon
|
$911.71 |
$911.71 |
$911.71 |
$2,595.60
|
|
Unlisted procedure esophagus
|
$937.56 |
$937.56 |
$937.56 |
$152.40
|
|
Unlisted procedure eyelids
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Unlisted procedure larynx
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted procedure liver
|
$703.59 |
$703.59 |
$703.59 |
$2,694.00
|
|
Unlisted procedure orbit
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Unlisted procedure pancreas
|
$703.59 |
$703.59 |
$703.59 |
$152.40
|
|
Unlisted procedure rectum
|
$911.71 |
$911.71 |
$911.71 |
$882.75
|
|
Unlisted procedure spine
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Unlisted psychiatric service/proc 90899
|
$29.79 |
$29.79 |
$29.79 |
$29.79
|
|
Unlisted px abdomen muscskel
|
$239.88 |
$239.88 |
$239.88 |
$1,461.75
|
|
Unlisted px accessory sinus
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted px ant segment eye
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$761.40
|
|
Unlisted px arthroscopy
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Unlisted px biliary tract
|
$937.56 |
$937.56 |
$937.56 |
$1,788.00
|
|
Unlisted px casting/strpg
|
$157.79 |
$157.79 |
$157.79 |
$152.00
|
|
Unlisted px conjunctiva
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Unlisted px exc pressure ulc
|
$703.59 |
$703.59 |
$703.59 |
$703.59
|
|
Unlisted px external ear
|
$232.22 |
$232.22 |
$232.22 |
$126.00
|
|
Unlisted px extraocular musc
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Unlisted px foot/toes
|
$239.88 |
$239.88 |
$239.88 |
$3,556.50
|
|
Unlisted px forearm/wrist
|
$239.88 |
$239.88 |
$239.88 |
$109.20
|
|
Unlisted px hands/fingers
|
$239.88 |
$239.88 |
$239.88 |
$4,387.20
|
|
Unlisted px inner ear
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted px lacrimal system
|
$298.93 |
$298.93 |
$298.93 |
$298.93
|
|
Unlisted px leg/ankle
|
$239.88 |
$239.88 |
$239.88 |
$118.20
|
|
Unlisted px male genital sys
|
$243.21 |
$243.21 |
$243.21 |
$90.60
|
|
Unlisted px med radj physics
|
$132.77 |
$132.77 |
$132.77 |
$132.77
|
|
Unlisted px middle ear
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted px neck/thorax
|
$232.22 |
$232.22 |
$232.22 |
$1,989.00
|
|
Unlisted px palate uvula
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted px pelvis/hip joint
|
$239.88 |
$239.88 |
$239.88 |
$239.88
|
|
Unlisted px posterior segmnt
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$4,036.20
|
|
Unlisted px salivry glnd/dux
|
$232.22 |
$232.22 |
$232.22 |
$93.60
|
|
Unlisted px small intestine
|
$937.56 |
$937.56 |
$937.56 |
$2,744.40
|
|
Unlisted px temporal bone
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted px ther rad tx plng
|
$132.77 |
$132.77 |
$132.77 |
$132.77
|
|
Unlisted px tongue flr mouth
|
$232.22 |
$232.22 |
$232.22 |
$286.80
|
|
Unlisted px vestibule mouth
|
$232.22 |
$232.22 |
$232.22 |
$232.22
|
|
Unlisted reprod med lab proc
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Unlisted resp px dx nuc med
|
$401.83 |
$401.83 |
$401.83 |
$401.83
|
|
Unlisted spec derm svc/px
|
$198.70 |
$198.70 |
$198.70 |
$198.70
|
|
Unlisted surgical path px
|
$53.43 |
$53.43 |
$53.43 |
$53.43
|
|
Unlisted transfusion med px
|
$24.49 |
$24.49 |
$24.49 |
$306.00
|
|
Unlisted ultrasound procedure
|
$88.05 |
$88.05 |
$88.05 |
$306.00
|
|
Unlisted vasc endoscopy px
|
$618.26 |
$618.26 |
$618.26 |
$618.26
|
|
Unlstd hematop ret/endo lymp
|
$401.83 |
$401.83 |
$401.83 |
$607.20
|
|
Unlstd laps px mat care&dlvr
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unlstd laps px sprmatic cord
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Unsched dialysis esrd pt hos
|
$699.72 |
$699.72 |
$699.72 |
$1,560.60
|
|
Upgrade pm system
|
$10,465.33 |
$10,465.33 |
$10,465.33 |
$7,818.75
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$357.13 |
$357.13 |
$357.13 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$241.72 |
$241.72 |
$241.72 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$937.56 |
$937.56 |
$937.56 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$937.56 |
$937.56 |
$937.56 |
$1,675.80
|
|
Uppr gi scope w/submuc inj
|
$937.56 |
$937.56 |
$937.56 |
$2,262.00
|
|
Urachal cyst/sinus excision 51500
|
$5,834.36 |
$5,834.36 |
$5,834.36 |
$5,834.36
|
|
Urea nitrogen
|
$3.95 |
$3.95 |
$3.95 |
$39.60
|
|
Urea nitrogen 24 hour urine
|
$5.56 |
$5.56 |
$5.56 |
$49.50
|
|
Urea nitrogen clearance
|
$7.20 |
$7.20 |
$7.20 |
$57.00
|
|
Ureter endoscopy
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Ureter endoscopy & biopsy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Ureter endoscopy & biopsy
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Ureter endoscopy & catheter
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Ureter endoscopy & treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Ureter endoscopy & treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Ureter endoscopy & treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Ureter endoscopy & treatment
|
$5,083.62 |
$5,083.62 |
$5,083.62 |
$5,083.62
|
|
Ureteral reflux study
|
$401.83 |
$401.83 |
$401.83 |
$1,251.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$241.72 |
$241.72 |
$241.72 |
$642.60
|
|
Urethrlys transvag with scope
|
$3,448.97 |
$3,448.97 |
$3,448.97 |
$3,448.97
|
|
Urethrocystography void s&i
|
$241.72 |
$241.72 |
$241.72 |
$707.25
|
|
Uric acid blood
|
$4.52 |
$4.52 |
$4.52 |
$48.60
|
|
Uric acid urine
|
$5.08 |
$5.08 |
$5.08 |
$52.20
|
|
Urinalysis (with microscopy)
|
$3.17 |
$3.17 |
$3.17 |
$36.52
|
|
Urinalysis (without microscopy)
|
$2.25 |
$2.25 |
$2.25 |
$32.50
|
|
Urinalysis microscopic only
|
$3.05 |
$3.05 |
$3.05 |
$13.80
|
|
Urinalysis qual/semiquant excpt ia
|
$2.17 |
$2.17 |
$2.17 |
$14.40
|
|
Urinary reflex study
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Urine Culture Test
|
$8.07 |
$8.07 |
$8.07 |
$65.15
|
|
Urine flow measurement 51736
|
$128.90 |
$128.90 |
$128.90 |
$128.90
|
|
Urine pregnancy test
|
$8.61 |
$8.61 |
$8.61 |
$63.00
|
|
Urography inf drip &/or bolus
|
$178.02 |
$178.02 |
$178.02 |
$178.02
|
|
Urography, antegrade
|
$357.13 |
$357.13 |
$357.13 |
$1,132.80
|
|
Use 1st target lesion
|
$106.34 |
$106.34 |
$106.34 |
$189.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$13.29 |
$13.29 |
$13.29 |
$55.80
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$157.68 |
$157.68 |
$157.68 |
$746.40
|
|
V-exc/lip/w/pri linear closure 40520
|
$3,243.07 |
$3,243.07 |
$3,243.07 |
$3,243.07
|
|
Vaccine rabies im
|
$312.03 |
$312.03 |
$312.03 |
$800.00
|
|
Vaccinia vrs vac 0.3 ml perq
|
$0.01 |
$0.01 |
$0.01 |
$0.01
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Vag hyst incl t/o complex
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Vag hyst including t/o
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Vag hyst t/o & repair compl
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Vag hyst w/enterocele compl 58294
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Vag hyst w/enterocele repair
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Vaginal bx
|
$201.17 |
$201.17 |
$201.17 |
$184.50
|
|
Vaginal delivery after cesarean delivery 59612
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Vaginal hysterectomy
|
$4,936.45 |
$4,936.45 |
$4,936.45 |
$4,936.45
|
|
Vaginectomy partial w/nodes
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Valproic acid total therapeutic drug level
|
$13.54 |
$13.54 |
$13.54 |
$153.75
|
|
Valrubicin injection
|
$1,376.79 |
$1,376.79 |
$1,376.79 |
$6,841.31
|
|
Valvuloplasty aortic
|
$5,701.52 |
$5,701.52 |
$5,701.52 |
$6,420.60
|
|
Valvuloplasty mitral
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$11,340.57
|
|
Valvuloplasty pulmonary
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$12,754.50
|
|
Vancomycin peak therapeutic drug level
|
$13.54 |
$13.54 |
$13.54 |
$147.00
|
|
Vanomycin dna amp probe
|
$35.09 |
$35.09 |
$35.09 |
$35.09
|
|
Varicella zoster antibody igg
|
$12.88 |
$12.88 |
$12.88 |
$117.00
|
|
Varicella-zoster immue globin im
|
$2,359.90 |
$2,359.90 |
$2,359.90 |
$2,359.90
|
|
Vasc emb/occ w/prs cath
|
$17,956.72 |
$17,956.72 |
$17,956.72 |
$17,508.00
|
|
Vasc graft into carpal bone
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Vasectomy
|
$2,048.51 |
$2,048.51 |
$2,048.51 |
$2,361.00
|
|
Vedolizumab 300 mg intravenous solution
|
$22.06 |
$22.06 |
$22.06 |
$27,154.80
|
|
Veeg cont 2-12 hrs
|
$530.60 |
$530.60 |
$530.60 |
$1,194.00
|
|
Veeg ea 12-26hr cont mntr
|
$1,017.39 |
$1,017.39 |
$1,017.39 |
$2,109.60
|
|
Veeg intrmnt 2-12 hrs
|
$311.40 |
$311.40 |
$311.40 |
$783.60
|
|
Veeg unmon 12-26 hrs
|
$530.60 |
$530.60 |
$530.60 |
$530.60
|
|
Veeg unmon 2-12 hrs
|
$311.40 |
$311.40 |
$311.40 |
$586.80
|
|
Vein x-ray adrenal gland
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Vein x-ray adrenal glands
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$2,962.20
|
|
Vein x-ray eye socket
|
$618.26 |
$618.26 |
$618.26 |
$1,141.50
|
|
Vein x-ray kidney
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,750.25
|
|
Vein x-ray liver
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Vein x-ray liver w/hemodynam
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,147.50
|
|
Vein x-ray liver without hemodyn
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,476.40
|
|
Vein x-ray skull
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$2,489.25
|
|
Vein x-ray skull epidural
|
$618.26 |
$618.26 |
$618.26 |
$797.25
|
|
Vein x-ray spleen/liver
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$3,324.60
|
|
Velaglucerase alfa 400 unit intravenous solution
|
$380.18 |
$380.18 |
$380.18 |
$5,564.78
|
|
Vemp test i&r cervical
|
$156.46 |
$156.46 |
$156.46 |
$336.60
|
|
Vemp test i&r ocular
|
$156.46 |
$156.46 |
$156.46 |
$336.60
|
|
Vemp tst i&r cervical&ocular
|
$311.40 |
$311.40 |
$311.40 |
$636.60
|
|
Ven thrombosis images bilat
|
$401.83 |
$401.83 |
$401.83 |
$1,103.25
|
|
Venogram ext bil s&i
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$2,472.00
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,553.44 |
$1,553.44 |
$1,553.44 |
$1,553.44
|
|
Venous m-thrombectomy add-on
|
$3,147.50 |
$3,147.50 |
$3,147.50 |
$6,159.75
|
|
Venous mech thrombectomy
|
$11,340.57 |
$11,340.57 |
$11,340.57 |
$12,268.80
|
|
Venous sampling s&i
|
$5,405.70 |
$5,405.70 |
$5,405.70 |
$4,294.50
|
|
Venous thrombosis imaging
|
$538.27 |
$538.27 |
$538.27 |
$1,172.40
|
|
Ventilator each subsequent day
|
$661.10 |
$661.10 |
$661.10 |
$1,138.50
|
|
Ventilator initial day
|
$661.10 |
$661.10 |
$661.10 |
$1,387.50
|
|
Ventricular puncture prev burr hole without inj 61020
|
$890.29 |
$890.29 |
$890.29 |
$693.75
|
|
Version cephalic external
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$1,444.80
|
|
Verteporfin injection
|
$11.55 |
$11.55 |
$11.55 |
$11.55
|
|
Very long chain fatty acids
|
$19.75 |
$19.75 |
$19.75 |
$342.75
|
|
Viper venom prothrombin time
|
$17.49 |
$17.49 |
$17.49 |
$17.49
|
|
Virus isolation addl studies ea
|
$20.20 |
$20.20 |
$20.20 |
$186.60
|
|
Visit established high 40-54 minutes/level 5
|
$128.87 |
$128.87 |
$128.87 |
$128.87
|
|
Visual audiometry (vra)
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Vit for macular hole
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Vit for macular pucker
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Vit for membrane dissect
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Vital capacity test
|
$156.46 |
$156.46 |
$156.46 |
$156.46
|
|
Vitamin D Test
|
$29.60 |
$29.60 |
$29.60 |
$142.35
|
|
Vitamin b-12
|
$15.08 |
$15.08 |
$15.08 |
$111.00
|
|
Vkorc1 gene
|
$88.20 |
$88.20 |
$88.20 |
$88.20
|
|
Vol reduction of blood/prod
|
$171.36 |
$171.36 |
$171.36 |
$131.25
|
|
Volume deplete of harvest
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Volume measurement urine timed
|
$3.64 |
$3.64 |
$3.64 |
$25.80
|
|
Vonvendi inj 1 iu vwf:rco
|
$1.85 |
$1.85 |
$1.85 |
$10.80
|
|
Vulvectomy simple partial
|
$3,179.53 |
$3,179.53 |
$3,179.53 |
$3,179.53
|
|
Vutrisiran 25 mg/0.5 ml subcutaneous syringe
|
$4,983.86 |
$4,983.86 |
$4,983.86 |
$13,248.60
|
|
Vyjuvek 5x10^9pfu/ml, 0.1 ml
|
$1,037.12 |
$1,037.12 |
$1,037.12 |
$1,037.12
|
|
Warde 1003990 aldosterone
|
$40.75 |
$40.75 |
$40.75 |
$244.50
|
|
Warde 1005020 citrate 24 hour urine
|
$27.80 |
$27.80 |
$27.80 |
$182.25
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$12.90 |
$12.90 |
$12.90 |
$138.00
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$25.25 |
$25.25 |
$25.25 |
$225.60
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$15.50 |
$15.50 |
$15.50 |
$133.50
|
|
Warde 1015200 kappa light chain free
|
$17.27 |
$17.27 |
$17.27 |
$130.80
|
|
Warde 3004000 immunoglobulin subclass 1
|
$8.02 |
$8.02 |
$8.02 |
$128.40
|
|
Warde 3008005 oligoclonal bands
|
$27.39 |
$27.39 |
$27.39 |
$138.60
|
|
Warde 3016000 west nile virus antibody
|
$16.85 |
$16.85 |
$16.85 |
$111.20
|
|
Warde 3016000 west nile virus antibody igg
|
$14.39 |
$14.39 |
$14.39 |
$111.20
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$12.25 |
$12.25 |
$12.25 |
$100.80
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$8.90 |
$8.90 |
$8.90 |
$49.20
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$17.98 |
$17.98 |
$17.98 |
$100.20
|
|
Warde 3400683 amplification rna markers infectious disease bacterial vaginosis
|
$142.63 |
$142.63 |
$142.63 |
$447.60
|
|
Warde 3400852 arsenic
|
$18.97 |
$18.97 |
$18.97 |
$142.20
|
|
Warde 3708165 mercury urine
|
$16.26 |
$16.26 |
$16.26 |
$109.20
|
|
Warde acetylcholine receptor blocking antibody
|
$18.40 |
$18.40 |
$18.40 |
$355.80
|
|
Warde actin (smooth muscle) antibody each
|
$12.05 |
$12.05 |
$12.05 |
$132.60
|
|
Warde adenosine deaminase pleural fluid
|
$8.10 |
$8.10 |
$8.10 |
$87.60
|
|
Warde adrenocorticotropic hormone (acth)
|
$38.62 |
$38.62 |
$38.62 |
$195.00
|
|
Warde aldolase
|
$9.71 |
$9.71 |
$9.71 |
$79.50
|
|
Warde amino acids 6 or more quantitative each specimen
|
$16.87 |
$16.87 |
$16.87 |
$552.75
|
|
Warde amiodarone therapeutic drug level
|
$18.64 |
$18.64 |
$18.64 |
$141.00
|
|
Warde analysis gene hfe common variants
|
$65.36 |
$65.36 |
$65.36 |
$1,048.20
|
|
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative
|
$163.96 |
$163.96 |
$163.96 |
$718.20
|
|
Warde anti-mullerian hormone
|
$38.62 |
$38.62 |
$38.62 |
$198.75
|
|
Warde apolipoprotein b
|
$21.09 |
$21.09 |
$21.09 |
$117.00
|
|
Warde bile acids
|
$17.12 |
$17.12 |
$17.12 |
$143.25
|
|
Warde cadmium blood
|
$23.64 |
$23.64 |
$23.64 |
$111.60
|
|
Warde calcitonin
|
$26.79 |
$26.79 |
$26.79 |
$136.20
|
|
Warde calculus (stone) infrared
|
$12.90 |
$12.90 |
$12.90 |
$97.20
|
|
Warde clozapine therapeutic drug level
|
$20.15 |
$20.15 |
$20.15 |
$94.50
|
|
Warde cobalt heavy metal quantitative each nes
|
$21.96 |
$21.96 |
$21.96 |
$248.25
|
|
Warde collagen cross links c-telopeptide
|
$18.68 |
$18.68 |
$18.68 |
$148.50
|
|
Warde complement total hemolytic
|
$20.32 |
$20.32 |
$20.32 |
$171.75
|
|
Warde copper
|
$12.41 |
$12.41 |
$12.41 |
$159.00
|
|
Warde cryoglobulin
|
$6.47 |
$6.47 |
$6.47 |
$75.60
|
|
Warde erythropoietin
|
$18.79 |
$18.79 |
$18.79 |
$127.50
|
|
Warde estrogen fractionated
|
$32.30 |
$32.30 |
$32.30 |
$298.80
|
|
Warde fluorescent antibody screen endomysial iga
|
$12.09 |
$12.09 |
$12.09 |
$102.00
|
|
Warde folic acid rbc
|
$17.65 |
$17.65 |
$17.65 |
$90.60
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$9.70 |
$9.70 |
$9.70 |
$252.75
|
|
Warde gastrin
|
$17.63 |
$17.63 |
$17.63 |
$146.40
|
|
Warde growth hormone (hgh)
|
$16.67 |
$16.67 |
$16.67 |
$114.00
|
|
Warde haloperidol therapeutic drug level
|
$15.78 |
$15.78 |
$15.78 |
$72.75
|
|
Warde helminth antibody strongyloides igg
|
$13.01 |
$13.01 |
$13.01 |
$139.80
|
|
Warde hemoglobin fractionation/quantitation electrophoresis
|
$12.87 |
$12.87 |
$12.87 |
$102.60
|
|
Warde hepatitis a antibody
|
$12.39 |
$12.39 |
$12.39 |
$111.75
|
|
Warde hepatitis be antibody
|
$11.57 |
$11.57 |
$11.57 |
$94.50
|
|
Warde hepatitis delta agent antibody
|
$17.16 |
$17.16 |
$17.16 |
$142.20
|
|
Warde immunofixation electrophoresis urine
|
$29.35 |
$29.35 |
$29.35 |
$241.20
|
|
Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn
|
$11.53 |
$11.53 |
$11.53 |
$93.75
|
|
Warde infectious agent nucleic acid genotype hepatitis c
|
$257.45 |
$257.45 |
$257.45 |
$1,579.80
|
|
Warde islet cell antibody zinc transporter 8
|
$23.57 |
$23.57 |
$23.57 |
$202.80
|
|
Warde lipoprotein (a)
|
$14.32 |
$14.32 |
$14.32 |
$93.00
|
|
Warde lipoprotein-associated phospholipase a2
|
$46.31 |
$46.31 |
$46.31 |
$234.60
|
|
Warde mitochondrial antibody each
|
$25.45 |
$25.45 |
$25.45 |
$114.00
|
|
Warde neutralization rabies
|
$16.91 |
$16.91 |
$16.91 |
$105.00
|
|
Warde oxcarbazepine therapeutic drug level
|
$13.25 |
$13.25 |
$13.25 |
$129.60
|
|
Warde pancreatic elastase fecal quantitative
|
$22.97 |
$22.97 |
$22.97 |
$129.00
|
|
Warde protein c antigen
|
$12.01 |
$12.01 |
$12.01 |
$110.40
|
|
Warde sex hormone binding globulin
|
$21.73 |
$21.73 |
$21.73 |
$141.00
|
|
Warde somatomedin
|
$21.26 |
$21.26 |
$21.26 |
$119.25
|
|
Warde sugars single qualitative each specimen stool
|
$5.50 |
$5.50 |
$5.50 |
$28.80
|
|
Warde t3 (triiodothyronine) reverse
|
$15.76 |
$15.76 |
$15.76 |
$133.20
|
|
Warde thyroid stimulating immunoglobulins
|
$50.86 |
$50.86 |
$50.86 |
$407.25
|
|
Warde topiramate therapeutic drug level
|
$11.92 |
$11.92 |
$11.92 |
$130.20
|
|
Warde virus isolation tissue culture innoculation presumptive id herpes simplex
|
$26.07 |
$26.07 |
$26.07 |
$162.00
|
|
Warde viscosity
|
$11.67 |
$11.67 |
$11.67 |
$119.40
|
|
Warde vitamin a
|
$11.61 |
$11.61 |
$11.61 |
$97.20
|
|
Warde vitamin b-1 (thiamine)
|
$21.23 |
$21.23 |
$21.23 |
$147.60
|
|
Warde vitamin b6 (pyridoxine)
|
$28.10 |
$28.10 |
$28.10 |
$198.00
|
|
Warde vitamin c (ascorbic acid)
|
$9.89 |
$9.89 |
$9.89 |
$72.00
|
|
Warde vitamin d (1 25 dihydroxy)
|
$38.50 |
$38.50 |
$38.50 |
$205.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$14.18 |
$14.18 |
$14.18 |
$102.00
|
|
Warde zinc
|
$11.39 |
$11.39 |
$11.39 |
$95.25
|
|
Wash harvest stem cells
|
$437.18 |
$437.18 |
$437.18 |
$437.18
|
|
Wbc automated
|
$2.54 |
$2.54 |
$2.54 |
$36.60
|
|
Wedge rescj/bisctj ovary uni/bi 58920
|
$7,394.81 |
$7,394.81 |
$7,394.81 |
$7,394.81
|
|
Wedging of cast
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Wedging of clubfoot cast
|
$265.58 |
$265.58 |
$265.58 |
$265.58
|
|
Western blot test
|
$17.03 |
$17.03 |
$17.03 |
$181.20
|
|
Wet mounts/ w preparations
|
$18.19 |
$18.19 |
$18.19 |
$40.80
|
|
Whole blood for transfusion
|
$225.12 |
$225.12 |
$225.12 |
$603.00
|
|
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit
|
$242.44 |
$242.44 |
$242.44 |
$242.44
|
|
Whole blood/red blood cells leukocytes reduced cmv negative each unit
|
$172.20 |
$172.20 |
$172.20 |
$267.60
|
|
Whole mitochondrial genome
|
$1,287.00 |
$1,287.00 |
$1,287.00 |
$1,287.00
|
|
Wilate injection
|
$1.27 |
$1.27 |
$1.27 |
$1.27
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$399.53 |
$399.53 |
$399.53 |
$230.40
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$198.70 |
$198.70 |
$198.70 |
$204.00
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$399.53 |
$399.53 |
$399.53 |
$230.40
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$399.53 |
$399.53 |
$399.53 |
$348.60
|
|
Wrist X-ray
|
$88.05 |
$88.05 |
$88.05 |
$311.17
|
|
Wrist arthroscopy
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Wrist arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Wrist arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Wrist arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Wrist arthroscopy/surgery
|
$3,244.61 |
$3,244.61 |
$3,244.61 |
$3,244.61
|
|
Wrist arthroscopy/surgery
|
$7,143.73 |
$7,143.73 |
$7,143.73 |
$7,143.73
|
|
Wrist endoscopy/surgery
|
$1,600.41 |
$1,600.41 |
$1,600.41 |
$1,600.41
|
|
X-ray abdomen 1 view
|
$88.05 |
$88.05 |
$88.05 |
$284.25
|
|
X-ray abdomen 2 views
|
$106.34 |
$106.34 |
$106.34 |
$327.00
|
|
X-ray abdomen >=3 views
|
$106.34 |
$106.34 |
$106.34 |
$336.00
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$106.34 |
$106.34 |
$106.34 |
$504.00
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$88.05 |
$88.05 |
$88.05 |
$397.80
|
|
X-ray ankle 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$398.25
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$357.13 |
$357.13 |
$357.13 |
$814.20
|
|
X-ray bone age studies
|
$106.34 |
$106.34 |
$106.34 |
$289.80
|
|
X-ray bone length studies
|
$106.34 |
$106.34 |
$106.34 |
$366.00
|
|
X-ray bone survey complete
|
$106.34 |
$106.34 |
$106.34 |
$682.20
|
|
X-ray bone survey infant
|
$106.34 |
$106.34 |
$106.34 |
$292.80
|
|
X-ray cervical spine 2-3 views
|
$88.05 |
$88.05 |
$88.05 |
$405.00
|
|
X-ray cervical spine 4-5 views
|
$106.34 |
$106.34 |
$106.34 |
$526.20
|
|
X-ray cervical spine >= 6 views
|
$106.34 |
$106.34 |
$106.34 |
$666.60
|
|
X-ray clavicle complete (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$267.75
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$178.02 |
$178.02 |
$178.02 |
$690.75
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$178.02 |
$178.02 |
$178.02 |
$1,107.00
|
|
X-ray elbow 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$379.50
|
|
X-ray elbow >= 3 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$373.80
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$178.02 |
$178.02 |
$178.02 |
$713.40
|
|
X-ray exam entire spi 4/5 vw
|
$106.34 |
$106.34 |
$106.34 |
$381.75
|
|
X-ray exam entire spi 6/> vw
|
$106.34 |
$106.34 |
$106.34 |
$341.25
|
|
X-ray exam of arm infant
|
$106.34 |
$106.34 |
$106.34 |
$299.25
|
|
X-ray exam of eye sockets
|
$106.34 |
$106.34 |
$106.34 |
$399.00
|
|
X-ray exam of femur 1
|
$88.05 |
$88.05 |
$88.05 |
$237.60
|
|
X-ray exam of jaw joint
|
$241.72 |
$241.72 |
$241.72 |
$542.40
|
|
X-ray exam of jaw joint
|
$88.05 |
$88.05 |
$88.05 |
$331.50
|
|
X-ray exam of mastoids
|
$106.34 |
$106.34 |
$106.34 |
$310.80
|
|
X-ray exam of middle ear
|
$548.30 |
$548.30 |
$548.30 |
$475.20
|
|
X-ray exam of penis
|
$106.34 |
$106.34 |
$106.34 |
$106.34
|
|
X-ray exam of perineum
|
$241.72 |
$241.72 |
$241.72 |
$284.25
|
|
X-ray exam of salivary gland
|
$88.05 |
$88.05 |
$88.05 |
$501.60
|
|
X-ray exam of sinuses
|
$88.05 |
$88.05 |
$88.05 |
$318.60
|
|
X-ray exam of tear duct
|
$241.72 |
$241.72 |
$241.72 |
$241.72
|
|
X-ray exam of teeth
|
$241.72 |
$241.72 |
$241.72 |
$241.72
|
|
X-ray exam of teeth
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
X-ray exam si joints
|
$106.34 |
$106.34 |
$106.34 |
$218.40
|
|
X-ray exam thorac spine4/>vw
|
$106.34 |
$106.34 |
$106.34 |
$405.00
|
|
X-ray eye detection foreign body (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$419.40
|
|
X-ray facial bones complete > 3 views
|
$106.34 |
$106.34 |
$106.34 |
$444.00
|
|
X-ray femur >=2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$405.00
|
|
X-ray finger(s) >= 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$294.60
|
|
X-ray foot 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$398.25
|
|
X-ray forearm 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$394.50
|
|
X-ray hand 2 views (both sides)
|
$106.34 |
$106.34 |
$106.34 |
$405.00
|
|
X-ray head for orthodontia
|
$88.05 |
$88.05 |
$88.05 |
$88.05
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$292.80
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$106.34 |
$106.34 |
$106.34 |
$414.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$106.34 |
$106.34 |
$106.34 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$106.34 |
$106.34 |
$106.34 |
$414.00
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$106.34 |
$106.34 |
$106.34 |
$456.60
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$88.05 |
$88.05 |
$88.05 |
$270.75
|
|
X-ray humerus >= 2 views left
|
$88.05 |
$88.05 |
$88.05 |
$363.75
|
|
X-ray joint survey 1 view
|
$106.34 |
$106.34 |
$106.34 |
$343.50
|
|
X-ray knee 1-2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$399.00
|
|
X-ray knee ap standing bilateral
|
$88.05 |
$88.05 |
$88.05 |
$237.60
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$106.34 |
$106.34 |
$106.34 |
$405.00
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$375.75
|
|
X-ray lumbosacral spine >= 4 views
|
$106.34 |
$106.34 |
$106.34 |
$577.50
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$106.34 |
$106.34 |
$106.34 |
$666.60
|
|
X-ray male genital tract
|
$241.72 |
$241.72 |
$241.72 |
$241.72
|
|
X-ray mandible complete > 4 views
|
$106.34 |
$106.34 |
$106.34 |
$412.80
|
|
X-ray mandible ltd <4 views
|
$88.05 |
$88.05 |
$88.05 |
$326.25
|
|
X-ray nasal bones complete > 3 views
|
$88.05 |
$88.05 |
$88.05 |
$283.50
|
|
X-ray neck soft tissue
|
$88.05 |
$88.05 |
$88.05 |
$285.60
|
|
X-ray nose to rectum for foreign body child
|
$88.05 |
$88.05 |
$88.05 |
$246.00
|
|
X-ray of mammary ducts
|
$241.72 |
$241.72 |
$241.72 |
$438.00
|
|
X-ray optic foramina
|
$88.05 |
$88.05 |
$88.05 |
$292.80
|
|
X-ray pelvis 1-2 views
|
$106.34 |
$106.34 |
$106.34 |
$300.00
|
|
X-ray pelvis complete > 3 views
|
$106.34 |
$106.34 |
$106.34 |
$405.00
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$357.13 |
$357.13 |
$357.13 |
$839.25
|
|
X-ray ribs 2 views left
|
$88.05 |
$88.05 |
$88.05 |
$304.80
|
|
X-ray ribs 3 views bilateral
|
$106.34 |
$106.34 |
$106.34 |
$419.40
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$106.34 |
$106.34 |
$106.34 |
$399.00
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$106.34 |
$106.34 |
$106.34 |
$600.75
|
|
X-ray sacroiliac joints >= 3 views
|
$106.34 |
$106.34 |
$106.34 |
$397.80
|
|
X-ray sacrum/coccyx >= 2 views
|
$88.05 |
$88.05 |
$88.05 |
$297.00
|
|
X-ray scapula complete (both sides)
|
$106.34 |
$106.34 |
$106.34 |
$304.20
|
|
X-ray sella turcica
|
$88.05 |
$88.05 |
$88.05 |
$405.00
|
|
X-ray shoulder 1 view (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$263.25
|
|
X-ray sinus tract/fistula/abscess
|
$548.30 |
$548.30 |
$548.30 |
$1,129.80
|
|
X-ray sinuses paranasal complete > 3 views
|
$88.05 |
$88.05 |
$88.05 |
$405.00
|
|
X-ray skull < 4 views
|
$106.34 |
$106.34 |
$106.34 |
$364.20
|
|
X-ray skull > 4 views complete
|
$106.34 |
$106.34 |
$106.34 |
$440.40
|
|
X-ray slg plne bdy sect without urogr
|
$106.34 |
$106.34 |
$106.34 |
$945.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$178.02 |
$178.02 |
$178.02 |
$669.60
|
|
X-ray spine single view
|
$88.05 |
$88.05 |
$88.05 |
$309.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$88.05 |
$88.05 |
$88.05 |
$385.80
|
|
X-ray sternum > 2 views
|
$88.05 |
$88.05 |
$88.05 |
$331.80
|
|
X-ray surgical specimen
|
$548.30 |
$548.30 |
$548.30 |
$400.50
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$178.02 |
$178.02 |
$178.02 |
$719.25
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$88.05 |
$88.05 |
$88.05 |
$419.40
|
|
X-ray thoracic spine 2 views
|
$106.34 |
$106.34 |
$106.34 |
$388.50
|
|
X-ray thoracic spine 3 views
|
$106.34 |
$106.34 |
$106.34 |
$419.40
|
|
X-ray thoracolumbar spine >=2 views
|
$88.05 |
$88.05 |
$88.05 |
$348.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$88.05 |
$88.05 |
$88.05 |
$396.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$106.34 |
$106.34 |
$106.34 |
$378.00
|
|
X-ray tibia/fibula 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$405.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$364.80
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$178.02 |
$178.02 |
$178.02 |
$589.50
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$178.02 |
$178.02 |
$178.02 |
$580.20
|
|
X-ray wrist 2 views (both sides)
|
$88.05 |
$88.05 |
$88.05 |
$355.50
|
|
X-ray xm phrnx&/crv esoph c+
|
$178.02 |
$178.02 |
$178.02 |
$178.02
|
|
Xcapsl ctrc rmvl cplx w/ecp
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$2,280.73 |
$2,280.73 |
$2,280.73 |
$2,280.73
|
|
Xcapsl ctrc rmvl insj 1+
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Xcapsl ctrc rmvl w/ecp
|
$4,022.86 |
$4,022.86 |
$4,022.86 |
$4,022.86
|
|
Xcpsl ctrc rmvl cplx insj 1+
|
$5,159.71 |
$5,159.71 |
$5,159.71 |
$5,159.71
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,321.00
|
|
Xfer tis s/a/l 10 sq cm/<
|
$1,829.23 |
$1,829.23 |
$1,829.23 |
$3,955.80
|
|
Xm archive tissue molec anal
|
$24.49 |
$24.49 |
$24.49 |
$40.50
|
|
Xylose absorption test blood &/or urine
|
$12.91 |
$12.91 |
$12.91 |
$46.80
|
|
Xyntha inj
|
$1.54 |
$1.54 |
$1.54 |
$1.54
|
|
Yersinia antibody
|
$13.19 |
$13.19 |
$13.19 |
$13.19
|
|
Yttrium y-90 ibritumomab ther
|
$56,824.55 |
$56,824.55 |
$56,824.55 |
$94,667.40
|
|
Ziconotide injection
|
$10.13 |
$10.13 |
$10.13 |
$4,530.00
|
|
Zika virus dna/rna amp probe
|
$51.31 |
$51.31 |
$51.31 |
$197.25
|
|
Zika virus igm antibody
|
$16.85 |
$16.85 |
$16.85 |
$114.75
|
|
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper)
|
$7.98 |
$7.98 |
$7.98 |
$74.40
|
|
Zolbetuximab-clzb 100 mg intravenous solution
|
$33.56 |
$33.56 |
$33.56 |
$46.20
|
|
_afb id by dna probe rflx ast
|
$20.05 |
$20.05 |
$20.05 |
$141.00
|
|
_afb org id by sequencing rflx ast-sendout
|
$115.36 |
$115.36 |
$115.36 |
$1,266.00
|
|
_fragile x methylation-sendout
|
$44.89 |
$44.89 |
$44.89 |
$162.00
|