|
Administration vaccine pneumococcal
|
$54.60 |
$54.60 |
$54.60 |
$49.68
|
|
Ado-trastuzumab emtansine 100 mg intravenous solution
|
$40.45 |
$40.45 |
$40.45 |
$11,350.31
|
|
Adrenal cortex & medulla img
|
$1,544.85 |
$1,544.85 |
$1,544.85 |
$1,987.70
|
|
Adv prim care mgmt lvl 1
|
$38.28 |
$38.28 |
$38.28 |
$51.52
|
|
Adv prim care mgmt lvl 2
|
$38.28 |
$38.28 |
$38.28 |
$51.52
|
|
Adv prim care mgmt lvl 3
|
$109.46 |
$109.46 |
$109.46 |
$139.68
|
|
Aep hearing status deter i&r
|
$368.50 |
$368.50 |
$368.50 |
$303.00
|
|
Aep neurodiagnostic i&r
|
$368.50 |
$368.50 |
$368.50 |
$583.80
|
|
Aep thrshld est mlt freq i&r
|
$368.50 |
$368.50 |
$368.50 |
$635.00
|
|
Afamelanotide implant, 1 mg
|
$2,873.33 |
$2,873.33 |
$2,873.33 |
$78,638.30
|
|
_afb id by dna probe rflx ast
|
$20.05 |
$20.05 |
$20.05 |
$104.50
|
|
#afb mycobacteria suscep. #1
|
$7.31 |
$7.31 |
$7.31 |
$34.72
|
|
_afb org id by sequencing rflx ast-sendout
|
$115.36 |
$115.36 |
$115.36 |
$300.00
|
|
Aff2 gen aly detc abnl allel
|
$137.00 |
$137.00 |
$137.00 |
$189.06
|
|
Aff2 gen alys charac alleles
|
$274.83 |
$274.83 |
$274.83 |
$379.27
|
|
Aflibercept injection
|
$821.98 |
$821.98 |
$821.98 |
$2,738.00
|
|
After cataract laser surgery
|
$649.19 |
$649.19 |
$649.19 |
$1,373.11
|
|
Agalsidase beta 35 mg intravenous solution
|
$223.52 |
$223.52 |
$223.52 |
$14,475.20
|
|
Air conduction bilat
|
$152.54 |
$152.54 |
$152.54 |
$134.00
|
|
Airway resistance by impulse oscillometry 94728
|
$185.15 |
$185.15 |
$185.15 |
$297.00
|
|
Albumin body fluid quantitative each specimen
|
$7.78 |
$7.78 |
$7.78 |
$47.45
|
|
Albumin, human 25 % intravenous solution
|
$21.23 |
$21.23 |
$21.23 |
$234.94
|
|
Albumin (human), 5%, 250 ml
|
$53.08 |
$53.08 |
$53.08 |
$252.77
|
|
Albumin ischemia modified
|
$33.94 |
$33.94 |
$33.94 |
$85.60
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$5.78 |
$5.78 |
$5.78 |
$58.17
|
|
Albumin serum plasma or whole blood
|
$4.95 |
$4.95 |
$4.95 |
$43.00
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$17.27 |
$17.27 |
$17.27 |
$96.00
|
|
Alcohol/sub misuse assess
|
$29.55 |
$29.55 |
$29.55 |
$31.20
|
|
Alcohol/subs interv 15-30mn
|
$38.28 |
$38.28 |
$38.28 |
$56.70
|
|
Alcohol/subs interv >30 min
|
$190.13 |
$190.13 |
$190.13 |
$190.13
|
|
Aldesleukin injection
|
$5,301.26 |
$5,301.26 |
$5,301.26 |
$9,030.11
|
|
Aldosterone suppression eval
|
$125.50 |
$125.50 |
$125.50 |
$315.20
|
|
Alemtuzumab 12 mg/1.2 ml intravenous solution
|
$2,337.69 |
$2,337.69 |
$2,337.69 |
$47,974.31
|
|
Alkaline phosphatase
|
$5.18 |
$5.18 |
$5.18 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$17.93 |
$17.93 |
$17.93 |
$48.57
|
|
Allergen egg white ige
|
$5.22 |
$5.22 |
$5.22 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$7.97 |
$7.97 |
$7.97 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$54.60 |
$54.60 |
$54.60 |
$45.00
|
|
Allergy injection; single 95115
|
$54.60 |
$54.60 |
$54.60 |
$46.80
|
|
Allergy Skin Testing
|
$1,203.94 |
$1,203.94 |
$1,203.94 |
$47.44
|
|
Allg patch or app # of tests 95044
|
$1,203.94 |
$1,203.94 |
$1,203.94 |
$423.37
|
|
Allgrft implnt knee w/scope
|
$15,226.08 |
$15,226.08 |
$15,226.08 |
$6,411.60
|
|
Allograft allowrap 4x4cm dry 16sqcm
|
$127.14 |
$127.14 |
$127.14 |
$5,399.16
|
|
Allograft amnioexcel plus 17mm disk
|
$127.14 |
$127.14 |
$127.14 |
$497.95
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$127.14 |
$127.14 |
$127.14 |
$6,285.56
|
|
Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$20,311.34
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$858.66
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$4,677.40
|
|
Allograft umbil cord+amniotic membrane-q4148-cost per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$5,278.73
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$1,225.35
|
|
Alloskin
|
$127.14 |
$127.14 |
$127.14 |
$582.40
|
|
Alloskin ac, 1 cm
|
$127.14 |
$127.14 |
$127.14 |
$1.00
|
|
All tstg perq&iq drugs/biol
|
$46.45 |
$46.45 |
$46.45 |
$64.80
|
|
All tstg perq&iq w/venoms
|
$29.55 |
$29.55 |
$29.55 |
$41.34
|
|
Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution
|
$4.94 |
$4.94 |
$4.94 |
$13.14
|
|
Alpha-fetoprotein afp-l3 frac & total
|
$64.41 |
$64.41 |
$64.41 |
$198.60
|
|
Alpha-fetoprotein amniotic
|
$17.00 |
$17.00 |
$17.00 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$16.77 |
$16.77 |
$16.77 |
$106.00
|
|
Alteplase 100 mg infusion from pyxis vial
|
$91.47 |
$91.47 |
$91.47 |
$15,857.45
|
|
Alt/sgpt
|
$5.30 |
$5.30 |
$5.30 |
$47.50
|
|
Altuviiio per factor viii iu
|
$4.69 |
$4.69 |
$4.69 |
$13.32
|
|
Aluminum - quest
|
$25.48 |
$25.48 |
$25.48 |
$83.05
|
|
Alveoloplasty each quadrant
|
$3,837.72 |
$3,837.72 |
$3,837.72 |
$3,892.00
|
|
Alys cplx sp/pn npgt w/prgrm
|
$108.62 |
$108.62 |
$108.62 |
$411.45
|
|
Ambl bp mntr w/sw a/r
|
$152.54 |
$152.54 |
$152.54 |
$320.45
|
|
Amines vaginal fluid qual
|
$5.99 |
$5.99 |
$5.99 |
$12.00
|
|
Amino acid screen, urine
|
$13.87 |
$13.87 |
$13.87 |
$77.00
|
|
Amino acid single qual
|
$14.18 |
$14.18 |
$14.18 |
$36.00
|
|
Amino acids quant 2-5
|
$19.61 |
$19.61 |
$19.61 |
$112.00
|
|
Aminolevulinic acid, 10% gel
|
$1.72 |
$1.72 |
$1.72 |
$1.81
|
|
Aminolevulinic acid delta
|
$16.45 |
$16.45 |
$16.45 |
$87.12
|
|
Aminolevulinic acid hcl top
|
$396.97 |
$396.97 |
$396.97 |
$640.56
|
|
Amivantamab-vmjw 50 mg/ml intravenous solution
|
$20.67 |
$20.67 |
$20.67 |
$9,084.45
|
|
Ammonia
|
$14.57 |
$14.57 |
$14.57 |
$119.70
|
|
Amnioarmor 1 sq cm
|
$127.14 |
$127.14 |
$127.14 |
$1.00
|
|
Amniocentesisdiagnostic 59000
|
$1,030.40 |
$1,030.40 |
$1,030.40 |
$942.60
|
|
Amniocentesis therapeutic
|
$359.97 |
$359.97 |
$359.97 |
$791.05
|
|
Amniocore per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$1.00
|
|
Amnio-maxx or lite per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$1.00
|
|
Amniotic fluid scan
|
$9.35 |
$9.35 |
$9.35 |
$49.01
|
|
Amniowrap2 per sq cm
|
$127.14 |
$127.14 |
$127.14 |
$1.00
|
|
Amp f/th 1/2 jt/phalanx w/neurect local flap
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,786.00
|
|
Amphotericin b lipid complex
|
$11.13 |
$11.13 |
$11.13 |
$226.80
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$23.33 |
$23.33 |
$23.33 |
$519.03
|
|
Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis
|
$262.99 |
$262.99 |
$262.99 |
$262.99
|
|
Amp metatarsal w/toe single 28810
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,986.00
|
|
Amp thigh through femur re-amp 27596
|
$3,342.87 |
$3,342.87 |
$3,342.87 |
$3,494.40
|
|
Amputate hand at wrist
|
$1,893.86 |
$1,893.86 |
$1,893.86 |
$3,086.40
|
|
Amputate hand at wrist
|
$3,342.87 |
$3,342.87 |
$3,342.87 |
$3,342.87
|
|
Amputate leg at thigh
|
$3,342.87 |
$3,342.87 |
$3,342.87 |
$3,342.87
|
|
Amputate leg at thigh
|
$3,342.87 |
$3,342.87 |
$3,342.87 |
$2,854.80
|
|
Amputate lower leg at knee
|
$3,342.87 |
$3,342.87 |
$3,342.87 |
$3,342.87
|
|
Amputate metacarpal bone 26910
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Amputate thigh through femur 27590
|
$3,342.87 |
$3,342.87 |
$3,342.87 |
$3,370.00
|
|
Amputate upper arm & implant
|
$13,116.76 |
$13,116.76 |
$13,116.76 |
$13,116.76
|
|
Amputation follow-up surgery
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Amputation follow-up surgery
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Amputation follow-up surgery
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$7,907.11
|
|
Amputation follow-up surgery
|
$2,164.64 |
$2,164.64 |
$2,164.64 |
$2,934.40
|
|
Amputation follow-up surgery
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,766.40
|
