|
Adjmt/revj ext fixj sys anes
|
$3,786.00 |
$6,311.00 |
$8,412.89 |
|
|
Adj tis trans/see area/10.1-30sqcm 14041
|
$1,999.13 |
$3,986.00 |
$6,839.00 |
|
|
Adjustment gastric band
|
$59.34 |
$173.17 |
$198.47 |
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$596.73 |
$596.73 |
$596.73 |
|
|
Administration chemotherapy IV infusion each additional hour
|
$77.78 |
$184.22 |
$267.17 |
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$77.78 |
$187.66 |
$272.16 |
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$325.72 |
$413.84 |
$554.31 |
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$164.86 |
$339.57 |
$390.62 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$77.78 |
$120.12 |
$172.34 |
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$77.78 |
$136.55 |
$222.48 |
|
|
Administration immunization each additional vaccine
|
$12.77 |
$20.32 |
$34.98 |
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$12.77 |
$20.34 |
$83.81 |
|
|
Administration immunization intranasal/oral route each additional vaccine
|
$9.58 |
$12.85 |
$15.71 |
|
|
Administration vaccine hepatitis b
|
$22.44 |
$50.43 |
$59.72 |
|
|
Administration vaccine influenza virus
|
$22.44 |
$50.43 |
$59.72 |
|
|
Administration vaccine pneumococcal
|
$22.44 |
$50.43 |
$59.72 |
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$40.45 |
$41.85 |
$41.85 |
|
|
Adrenal cortex & medulla img
|
$1,426.73 |
$1,444.98 |
$1,537.41 |
|
|
Adv prim care mgmt lvl 1
|
$32.56 |
$32.97 |
$35.08 |
|
|
Adv prim care mgmt lvl 2
|
$32.56 |
$32.97 |
$35.08 |
|
|
Adv prim care mgmt lvl 3
|
$101.09 |
$102.38 |
$108.93 |
|
|
Aep hearing status deter i&r
|
$75.71 |
$340.32 |
$366.72 |
|
|
Aep neurodiagnostic i&r
|
$181.16 |
$340.32 |
$366.72 |
|
|
Aep thrshld est mlt freq i&r
|
$181.16 |
$344.98 |
$449.96 |
|
|
Afamelanotide implant, 1 mg
|
$2,873.33 |
$2,943.42 |
$2,943.42 |
|
|
Afamitresgene autoleucel
|
$770,620.00 |
$770,620.00 |
$770,620.00 |
|
|
_afb id by dna probe rflx ast
|
$20.05 |
$22.06 |
$22.06 |
|
|
#afb mycobacteria suscep. #1
|
$7.31 |
$8.04 |
$8.04 |
|
|
_afb org id by sequencing rflx ast-sendout
|
$115.36 |
$126.90 |
$126.90 |
|
|
Aff2 gen aly detc abnl allel
|
$137.00 |
$150.70 |
$150.70 |
|
|
Aff2 gen alys charac alleles
|
$274.83 |
$302.31 |
$302.31 |
|
|
Aflibercept injection
|
$790.04 |
$790.04 |
$821.98 |
|
|
Afo molded to patient plasti
|
$204.45 |
$239.89 |
$338.07 |
|
|
After cataract laser surgery
|
$599.55 |
$3,986.00 |
$6,839.00 |
|
|
Agalsidase beta 35 mg intravenous solution
|
$223.52 |
$230.26 |
$230.26 |
|
|
Air conduction bilat
|
$28.39 |
$140.87 |
$151.80 |
|
|
Air injection into abdomen 49400
|
$3,786.00 |
$5,339.00 |
$6,311.00 |
|
|
Airway resistance by impulse oscillometry 94728
|
$152.72 |
$173.18 |
$184.26 |
|
|
Albumin body fluid quantitative each specimen
|
$7.78 |
$8.56 |
$36.50 |
|
|
Albumin, human 25 % intravenous solution
|
$21.23 |
$21.23 |
$21.23 |
|
|
Albumin (human), 5%, 250 ml
|
$53.08 |
$53.08 |
$53.08 |
|
|
Albumin ischemia modified
|
$33.94 |
$37.33 |
$37.33 |
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$5.78 |
$6.36 |
$40.00 |
|
|
Albumin serum plasma or whole blood
|
$4.95 |
$5.45 |
$36.50 |
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$17.27 |
$19.00 |
$19.00 |
|
|
Alcohol/sub misuse assess
|
$26.76 |
$27.11 |
$28.84 |
|
|
Alcohol/subs interv 15-30mn
|
$32.56 |
$32.97 |
$35.08 |
|
|
Alcohol/subs interv >30 min
|
$175.59 |
$177.84 |
$189.21 |
|
|
Aldesleukin injection
|
$5,301.26 |
$5,301.26 |
$5,301.26 |
|
|
Aldosterone suppression eval
|
$125.50 |
$138.05 |
$138.05 |
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$2,337.69 |
$2,440.70 |
$2,440.70 |
|
|
Alkaline phosphatase
|
$5.18 |
$5.70 |
$18.50 |
|
|
Allergen alpha lactalbumin ige
|
$17.93 |
$19.72 |
$19.72 |
|
|
Allergen egg white ige
|
$5.22 |
$5.74 |
$202.00 |
|
|
Allergen specific ige qual multi scrn ea
|
$7.97 |
$8.77 |
$20.00 |
|
|
Allergy injections; 2 or more 95117
|
$15.01 |
$51.07 |
$54.34 |
|
|
Allergy injection; single 95115
|
$11.44 |
$51.07 |
$54.34 |
|
|
Allergy Skin Testing
|
$8.10 |
$1,126.11 |
$1,198.14 |
|
|
Allg patch or app # of tests 95044
|
$333.51 |
$1,126.11 |
$1,198.14 |
|
|
Allgrft implnt knee w/scope
|
$3,786.00 |
$6,311.00 |
$15,152.74 |
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$142.17 |
$166.81 |
$235.08 |
|
|
Allograft amnioexcel plus 17mm disk
|
$60.02 |
$70.42 |
$99.24 |
|
|
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet
|
$2,867.51 |
$2,867.51 |
$2,867.51 |
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$14.20 |
$16.66 |
$23.48 |
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$116.78 |
$137.02 |
$193.10 |
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$191.45 |
$224.63 |
$316.56 |
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$51.22 |
$60.10 |
$84.70 |
|
|
All tstg perq&iq drugs/biol
|
$28.15 |
$43.44 |
$46.22 |
|
|
All tstg perq&iq w/venoms
|
$26.76 |
$27.11 |
$28.84 |
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$4.94 |
$5.19 |
$5.19 |
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$64.41 |
$70.85 |
$70.85 |
|
|
Alpha-fetoprotein amniotic
|
$17.00 |
$18.70 |
$18.70 |
|
|
Alpha-fetoprotein tumor marker
|
$16.77 |
$18.45 |
$99.00 |
|
|
Alteplase 100 mg infusion from pyxis vial
|
$91.47 |
$94.15 |
$94.15 |
|
|
Alt/sgpt
|
$5.30 |
$5.83 |
$5.83 |
|
|
Altuviiio per factor viii iu
|
$4.67 |
$4.67 |
$4.69 |
|
|
Aluminum - quest
|
$25.48 |
$28.03 |
$140.00 |
|
|
Alveoloplasty each quadrant
|
$3,544.29 |
$3,986.00 |
$6,839.00 |
|
|
Alys cplx sp/pn npgt w/prgrm
|
$100.32 |
$101.60 |
$240.37 |
|
|
Amantadine (symmetrel)-sendout
|
$24.89 |
$32.61 |
$72.00 |
|
|
Ambl bp mntr w/sw a/r
|
$63.88 |
$142.67 |
$270.21 |
|
|
Amines vaginal fluid qual
|
$5.99 |
$6.59 |
$6.59 |
|
|
Amino acid screen, urine
|
$13.87 |
$15.26 |
$50.50 |
|
|
Amino acid single qual
|
$14.18 |
$15.60 |
$15.60 |
|
|
Amino acids quant 2-5
|
$19.61 |
$21.57 |
$21.57 |
|
|
Aminolevulinic acid, 10% gel
|
$1.72 |
$1.81 |
$1.81 |
|
|
Aminolevulinic acid delta
|
$16.45 |
$18.10 |
$18.10 |
|
|
Aminolevulinic acid hcl top
|
$393.87 |
$393.87 |
$396.97 |
|
|
Amitriptyline (elavil) -sendout
|
$36.45 |
$57.08 |
$107.50 |
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$20.67 |
$22.21 |
$22.21 |
|
|
Ammonia
|
$14.57 |
$16.03 |
$113.50 |
|
|
Amniocentesisdiagnostic 59000
|
$951.61 |
$3,986.00 |
$6,839.00 |
|
|
Amniocentesis therapeutic
|
$332.44 |
$3,986.00 |
$6,839.00 |
|
|
Amnio-maxx or lite per sq cm
|
$67.81 |
$79.56 |
$112.12 |
|
|
Amniotic fluid scan
|
$9.35 |
$10.29 |
$10.29 |
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,545.97 |
$3,986.00 |
$6,839.00 |
|
|
Amphetamine confirm urine -sendout
|
$43.96 |
$45.21 |
$50.39 |
|
|
Amphetamines 5 or more
|
$37.02 |
$59.52 |
$68.21 |
|
|
Amphotericin b lipid complex
|
$10.30 |
$10.30 |
$11.13 |
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$22.62 |
$22.62 |
$23.33 |
|
